Laser in situ keratomileusis (LASIK) is the most popular method of laser eye surgery.  LASIK uses an excimer laser to correct nearsightedness, farsightedness, or astigmatism by removing a thin lenslet of tissue from the surface of the cornea (the clear, front "watch crystal" of the eye).  This is analogous to removal of a "tissue contact lens".  Lasik surgery
 

In LASIK, a pancake-like thin flap of the cornea is first prepared, either with a laser called Intralase or with an instrument called a microkeratome. Here at the Cornea and Laser Eye Institute - Hersh Vision Group, we use the all-laser technique exclusively. The flap acts to preserve the surface epithelial cells (which are like tiles on a floor) to promote quick healing and recovery of vision (most patients can drive the day after LASIK). Next, the Wavelight excimer laser is used to remove a small amount of tissue from the corneal surface beneath the flap. The excimer laser uses a mixture of gases to produce a beam of invisible ultraviolet light energy, which when applied via an eye tracking mechanism, results in meticulous removal of this "tissue contact lens".

After corneal reshaping, the LASIK procedure is finished when the corneal flap is repositioned. When the flap is replaced, it lies in the bed of excimer laser removed tissue, causing the surface to change shape with the effect of decreasing nearsightedness, farsightedness, or astigmatism.

LASIK procedures are performed under eyedrop anesthesia and are not painful. A lid retainer supports your lids to avoid blinking during the procedure and a video eye tracking mechanism compensates for any eye movements. At the end of LASIK, clear protective eye goggles are placed. Eyedrops to avoid infection and control inflammation are used for one week, in addition to artificial tear drops.

You are generally comfortable after the LASIK procedure. There may be some stinging for a few hours afterwards. Vision usually begins to improve by the next morning. Most people can work the next day; however, you will be seen in the office for an examination on that day.

There are two basic types of possible side effects with LASIK. Because patients may respond and heal differently, it is possible that the entire refractive error may not be corrected or that there might be some overcorrection. If undercorrected, your vision will be clearer without glasses, but less powerful glasses may still be necessary to fine tune to your best vision. For some patients who are overcorrected, especially those patients who are somewhat older, reading vision might be difficult without glasses. Furthermore, older patients, 40 years and older, may require reading glasses after the procedure. Patients who are undercorrected or overcorrected usually can undergo a retreatment procedure to further improve their vision.

The following animations demonstrate the 2 parts of the all-laser LASIK procedure:  Laser flap creation and Wavelight correction of nearsightedness, farsightedness, or astigmatism.   (Click on icon to right to choose video). 
 

We will discuss the possibilities of under and overcorrection in your particular case and what you may reasonably expect to achieve with your vision. In general, around 5% of patients will undergo a retreatment enhancement procedure to further improve vision if it is not clear after 3 months. In addition, other optical side effects include haloes around lights and glare, especially at night. These side effects have been much improved with the new Wavelight LASIK procedure. The other group of relatively rare complications may be secondary to problems with the LASIK surgery itself and subsequent corneal healing. We will discuss these possibilities in detail.

Although most excimer laser treatments today are done with the LASIK technique, some people may be better off with the surface LASEK/PRK procedure. Our preoperative examination and measurements determine our recommendation of the procedure which would be best in your particular situation.

In general, possible benefits of LASIK as compared with LASEK/PRK:

• Tissue removal beneath a flap rather than at the surface preserves the surface corneal cells (epithelium) with the advantage of faster visual recovery
• Postoperative discomfort is reduced
• Tissue removal beneath a flap may decrease the risk of haze or scarring

Some risks of LASIK as compared with LASEK/PRK include:

• Surgical risks (these are rarer with surgeons experienced in LASIK)
• Damage to the corneal flap
• Difficulties with the flap postoperatively

The Cornea and Laser Eye Institute is located in beautiful Teaneck, New Jersey, an easy commute from Paramus, Morristown, and Princeton, and is the preferred destination for LASIK patients across the bridge in Manhattan, New York City. Our NJ LASIK patients are encouraged to visit our office and have their questions answered personally.

In depth articles and studies:

PRK Versus LASIK
LASIK Retreatment

In the news:

Should bilateral LASIK be performed sequentially or simultaneously? - January 1, 2000
Re-treatment requires forceps to maintain clear interface, avoid flap damage - February 1, 2000
Tracking trends in LASIK enhancement - March 1, 2000
When two refractive surgeries are better than one - May 1, 2000
At Issue: LASIK enhancement preferences - February 15, 2002
At Issue: Refractive procedures in 2010 - December 15, 2002
At Issue: Lens exchange vs. corneal refractive surgery - June 15, 2004
What are practical applications to civilian refractive surgery from extensive military refractive results, and how could civilian surgeons incorporate those applications into practice? - March 25, 2010