Frequently Asked Questions
1. How should someone choose a LASIK surgeon?
First find a doctor by getting a referral from another doctor or a patient who has had laser vision correction. Remember, you should choose a doctor, not a laser center or particular equipment (most, but not all, laser systems are equally good today). Focus your attention on just who will be performing your surgery. In evaluating a surgeon, some important things to look for are:
- Education and training. Look for specialty fellowship training in corneal surgery. This is additional formal education after a doctor’s ophthalmology residency program.
- Experience. Choose a surgeon who has done at least 1000 LASIK surgeries in his/her career, does more than 500 procedures each year, and has been doing LASIK for more than 5 years.
- Specialization. Choose a surgeon who specializes exclusively in this type of surgery.
- Technology. Choose a surgeon who offers the complete range of technologies including Intralase and Custom Wavefront procedures.
- Comfort. Make sure that you are comfortable with the surgeon and staff no matter where you go for your surgery.
2. What will my vision be after the LASIK procedure?
This varies among patients depending on the degree of nearsightedness, farsightedness, and astigmatism. Expect to see well after LASIK, but don’t necessarily expect to see perfectly. As with any surgery, each patient may get a slightly different result depending on individual factors. No surgeon can guarantee 20/20 vision. Studies in which we have participated show that, after one procedure, 95 percent of patients in general achieve 20/40 or better vision (that needed to pass the driver’s test) and about 70% achieve 20/20 or better. At CLEI, for patients with 5 diopters or less of nearsightedness, well over 90% ultimately achieve 20/20 visual acuity. In the case where vision is not as clear as you want, an enhancement procedure will be suggested. We will discuss the anticipated outcome for your specific situation as well as your possible need for a second treatment during your LASIK measurement session.
3. Will I need glasses or contact lenses after the procedure?
Usually not. However, LASIK is designed to decrease your dependency on glasses and contact lenses, not necessarily eliminate them for all tasks. For instance, some patients may need glasses for reading, night driving, or other specific tasks. Most patients find that they can do most things without glasses or contacts after the procedure.
4. What are the possible side effects?
Possible side effects and complications will be discussed in detail with you by the doctor. As in any kind of eye surgery, there is no guarantee of success. In general, there are four possible side effects important to consider (although, of course, others are possible). They include:
- Undercorrections and overcorrections. Because patients respond and heal differently, it is possible that the entire refractive error may not be corrected. If you are undercorrected, your vision will be clearer without glasses, but less powerful glasses may still be necessary to fine tune to your best vision. Some patients are overcorrected. For them, up-close vision also might be difficult without glasses.
- Reading glasses. Some patients, especially those more than 40 years old, may need reading glasses after the procedure.
- Glare/halo/double vision. In some instances, especially at night, a patient may notice glare from lights or “ghost” images. In some cases, the risk of this has been minimized with the Custom Cornea Wavefront technique, but still may occur.
- Haze and surface irregularity. In LASIK, cells may grow beneath the flap or there may be problems with the flap such as wrinkling. Some patients may need to undergo treatment again.
5. There seem to be a number of different procedures. What is the difference?
There are 2 portions of the procedure to think about. First, how is the eye prepared for the laser? Here there are 2 general techniques: LASIK with a corneal flap and LASEK/PRK without a flap (see FAQ #6 below). For LASIK procedures, the flap can either be prepared with the Intralase laser or with a microkeratome. Second, how is the laser computer programmed for the treatment? Here, again, there are 2 techniques: Programming using numbers similar to an eyeglass prescription or programming using the custom wavefront measurement. Whether the nearsighted/astigmatism input or the custom wavefront input is used, either the LASIK or LASEK/PRK procedure can be done.
The exact technique of eye preparation and laser treatment will be determined by the surgeon based on the results of your examination. Some techniques are safer with better results for some patients, whereas other techniques will be better for other patients. No procedure is the “best” for everybody.
6. What is the difference between LASIK and LASEK/PRK?
First, remember that the 2 procedures are essentially the same. There is no difference in laser used, the principles of the vision correction, or in outcomes in general. The difference is the first step in preparing the eye for laser treatment. In LASIK, a thin flap or pancake of corneal tissue is first prepared. The laser treatment is applied beneath this flap and the flap is reapplied. In LASEK/PRK, the surface epithelial cells are first slid to the side and the laser treatment is applied to the cornea surface directly under the cells. Sometimes the cells are preserved as a sheet and sometimes they are removed depending on your individual case. The cells regrow and smooth in about 5 days. LASEK/PRK generally is suggested in patients with thinner corneas or other problems where we think that it will be a safer technique.
|Item||LASEK / PRK Eye Surgery||Traditional LASIK|
|Procedural difference||Surface epithelium removed||Corneal flap prepared|
|Excimer laser procedure||Similar||Similar|
|Postoperative discomfort||Variable||Usually minimal|
|Visual recovery||Fluctuates over 1-2 weeks||Starts improving at 1 day|
|Possible side effects||Glare/halo/ghosting Corneal haze||Glare/halo/ghosting Corneal flap problems|
7. Is the procedure painful?
The procedure itself is done using topical numbing drops and is not painful. There may be some scratchiness and discomfort after the procedure when the anesthesia wears off. Medications are given to minimize this discomfort.
8. How much time must I take off from work following the procedure?
This depends on your job. In general, LASIK patients can return to work either the day after the procedure or they take one day off. For those jobs in which good visual acuity in both eyes is critical, it may take several days for vision to return to a level in which you can perform your job properly.
9. How often do I return for follow-up examinations after the procedure?
In general, there are short checkups one day and around 10 days after the procedure. We then examine you at three months, and six months and one year if necessary. The examination schedule is tailored to your specific situation.
10. How long does the procedure take?
Expect to be at the center for about three hours the day of the procedure. You will be in the actual laser room about 30 minutes.
11. How soon will I notice improvement in my vision after the treatment?
After LASIK, visual improvement is usually noted the day after the procedure and continues for a few weeks. After LASEK/PRK, most patients start to notice visual improvement in one day with variable vision over the first week.
12. Are the results achieved from LASIK permanent?
Based on results of a clinical trial we published in 1998, approximately 93% of patients achieve stable improved vision 6 months after LASIK. For most patients, the visual results of LASIK appear to be permanent. A few patients may have long term changes, but such changes are generally small compared with the original visual problem.
13. After LASIK, how will my vision be at night or in low light?
Depending on your night vision with glasses or contact lenses before LASIK, some patients will note improved night vision, others little change, and others worse night vision. Testing before LASIK can help to identify patients who may have night vision problems. If so, the treatment plan may be modified to minimize any night vision effects, or we may decide that you are not a good candidate. If you do have night vision problems after LASIK, many resolve over time. Night driving glasses, contact lenses, or laser retreatment may help the problem in others. Custom Cornea wavefront LASIK may help to improve night vision in some cases.
14. If I’m corrected for distance will I lost my ability to see well close up?
The need for reading glasses is age dependent. As you get older, the natural lens in the eye becomes less flexible and less able to focus up close. LASIK is used to improve distance vision without glasses or contact lenses. Since it is like wearing permanent contact lenses, your reading vision after LASIK will be similar to that with your contact lenses.
15. If I wear bifocals now will I still need to wear reading glasses even after LASIK?
If both eyes are corrected the best possible for distance vision, then you will still need reading glasses. In some cases, monovision, or blended vision, is used for older patients to retain some reading vision without reading glasses. In this approach, one eye is made as good as we can for distance vision, and the other eye is tuned for reading vision. There is one drawback to this approach. Although reading vision is retained, since the reading vision eye is not as clear for distance, overall distance clarity may not be quite as good. In such cases, glasses for driving may be necessary.
16. Will my eyes be dry after LASIK?
There may be some dryness in the first few weeks after LASIK. This is usually well controlled with artificial teardrops. In rare cases, dryness may persist. During the examination before the laser, we will check to see if you are at particular risk for a dry eye.
17. Will my insurance cover the procedure?
Although most insurance companies consider laser vision correction procedures to be elective surgery (which isn’t covered), all plans and individual policies are a little different. If your plan does cover the procedure, we will give you the necessary codes for reimbursement.
18. How can I find out if I am a candidate and which procedure is best for me?
You can see us for a complimentary evaluation. During this visit, the Institute’s staff will perform testing to determine if you are a good candidate and which procedure is best for you. They will also discuss the risks and benefits at length. The findings will be reviewed with the doctor. Call (201) 883-0505 to arrange an appointment.
19. What if I live far from the Cornea and Laser Eye Institute?
We are located adjacent to a Marriott hotel. We can also arrange for transportation. In addition, we work closely with doctors throughout New Jersey, the United States, and overseas who would be able to perform some of your checkups closer to home.
If you have further questions, you can ask us directly at Ask Dr. Hersh
Some useful websites to further answer your questions are: