Common Questions About Refractive Surgery

Refractive surgery includes procedures to correct nearsightedness (myopia), farsightedness (hyperopia), and/or astigmatism. Refractive surgery is designed to reduce or eliminate your dependence on glasses and contact lenses. LASIK (Laser Assisted In-Situ Keratomileusis*) and PRK (Photorefractive Keratectomy*) are the procedures most commonly performed. A cool excimer light beam gently reshapes the front surface of your eye (cornea). Other methods include: (CK) Conductive Keratoplasty,* Astigmatic Keratotomy (AK), Radial Keratotomy (RK), Clear Lensectomy (CL),and Implantable Contact Lens (ICL).*

*U.S. Food and Drug Administration (FDA) approved

Custom wavefront ablation is a modification of conventional Laser Vision Correction. All of the eye’s unique visual errors are first measured and then downloaded into the laser for subsequent treatment with LASIK or PRK. Laser vision correction has traditionally provided the same type of correction as spectacles or contact lenses by permanently treating myopia, hyperopia, and astigmatism. Recent studies have revealed that additional subtle visual errors (called “higher order aberrations”) limit eyesight and may contribute to night glare and halos. Correcting these aberrations may improve visual outcomes after laser vision correction. The Erdey Searcy Eye Group welcomes the opportunity to discuss how individuals may benefit from this technological step forward in refractive surgery.

Your eyeglass or contact lens prescription, occupation, leisure activities, age and personal expectations all help to determine whether or not you are a good candidate for vision correction surgery. General requirements include the following: 18 years of age or older, with no significant change in your glasses or contact lens prescription for at least one year, in good general health, and have good eye health with no ocular diseases. You must have REALISTIC EXPECTATIONS and understand that vision correction procedures are not always perfect. To find out if you are a suitable candidate, please schedule a complementary consultation with the Erdey Searcy Eye Group.

Laser Vision Correction (LVC) is eye surgery! Some people have the misconception that since the laser is computer controlled, the skill and experience of the surgeon and staff is of negligible importance. This could NOT be further from the truth. The following factors significantly determine how well you will see after your LVC procedure:

• The quality of the pre-operative evaluation process, conservative patient selection, and meticulous monitoring during post-operative eye healing. These must be individualized for each patient.
• The training and expertise of your surgeon in creating and replacing your cornea flap and in applying the laser during your LVC procedure.

Ask if the surgeon has cornea/refractive fellowship training (additional formal training, usually a year or more, beyond a general ophthalmology residency.not just a weekend laser course!) Ask how much clinical research experience the surgeon has in Laser Eye Surgery and what contributions have they made in the field.

There are risks with any surgical procedure. The odds of encountering risks are small (less than 1%). Most adverse events are reversible with good visual results. Serious irreversible sight-threatening complications while possible are very rare. In contrast, the odds of a sight-threatening corneal infection eventually occurring in a contact lens wearer (particularly if the contact lenses are not removed at bedtime) are significantly greater.

Although the majority of our patients achieve 20/25 or 20/20 (considered perfect vision), there are no guarantees. We continuously monitor our refractive surgery outcomes. This allows us to regularly refine our techniques, thereby improving your chances of a successful result. The last 100 eyes of our LASIK patients analyzed showed the following:

1. Nearly 100% achieve 20/40 vision (legal driving in Ohio). Some patients may only need glasses with a very subtle prescription, for use in low illumination (night driving) to see distance objects crisply.
2. Approximately 87% are within one line of 20/20 on an eye chart. This visual quality can be compared to that of contact lenses and glasses. Patients who achieve this level of vision after surgery are independent of corrective lenses for distance and near (assuming they are not over age 40 and require reading glasses).

The degree of improvement may vary from individual to individual depending upon the severity of their original eyeglass prescription. This quality of vision generally allows patients to participate in sports, drive, swim, watch TV, movies, and see the alarm clock without glasses or contacts following refractive surgery.

The practice of performing LASIK on both eyes at the same time is popular because of patient convenience (fewer office visits) and more rapid restoration of optical balance between the two eyes. In fact, the vast majority of our patients choose this option. However, there are a few patients who simply prefer to have one eye done at a time, and there are also some clinical circumstances in which we may advise you to have one eye done at a time.

The decision to perform LASIK on one or both eyes at the same time is made on an individual basis during your consultation.

The reasons to have LASIK on ONE eye at a time may include:

1. ACCURACY: The healing process and visual recovery in the first eye is monitored and this information may be used to make subtle modifications to the treatment plan for the second eye.
2. SAFETY: Both eyes would not simultaneously be subjected to certain surgical risks such as infection, retina damage, or other adverse reactions which, although very rare, could lead to significant loss of vision in both eyes.
3. VISUAL RECOVERY: Although the vast majority of LASIK patients experience a rapid recovery in their vision, the recovery can at times be delayed. Please realize that even a temporary loss of vision quality in both eyes is extremely disruptive. If the eyes are operated on separately, you can function with the fellow eye while the first eye fully recovers. This is especially true if you are able to wear a contact lens in the untreated eye.
4. SATISFACTION: You will be given the opportunity (before proceeding to the second eye) to determine whether the LASIK procedure has produced satisfactory visual results without loss of vision quality or other uncommon undesirable side effects such as glare, ghost images, or increased light sensitivity. If you are over age 40, you will have an opportunity to experience the change in your close vision. This could influence your decision on whether or not to fully correct your other eye to maintain some degree of close vision without the need for glasses (monovision).

After you and your surgeon are satisfied with the results of the first eye, we will proceed with LASIK on the second- eye usually one to two weeks later. To maintain balanced vision, a contact lens is often used in the untreated eye until the second eye is treated.

Yes. The benefits of your procedure are permanent. The few patients that require an enhancement procedure will typically do so within the first several months following the procedure, not years later.

Occasionally, fine-tuning the original surgical procedure to obtain best visual outcome is necessary. If necessary, an enhancement is usually performed 3 months following the original procedure after the eye has stabilized.* If we determine an enhancement is necessary during the first year following a procedure performed at the Erdey Searcy Eye Group, you will receive it at no additional charge from the Erdey Searcy Eye Group (occasionally there is a minimal fee from the laser facility). That is our “Best Vision Commitment”.

*Our LASIK enhancement rate is approximately 4%. This compares to published rates of as high as 43%.

Patients who have good control of their blood sugar with no systemic or ocular diabetic complications are generally suitable candidates.

It can in some instances. The decision to operate when this condition exists can only be made after a comprehensive eye exam. It is not uncommon for us to treat your dry eyes before the refractive procedure.

Yes, contact lenses can cause “molding” of the cornea. Before surgery we need to take precise measurements of the corneal shape without the influence of contact lenses. The cornea needs to return to its natural shape prior to the examination and surgery to achieve the most accurate results.

• Hard/Gas Permeable Lenses: Remove lenses at least 3 weeks before your visit
• Soft Lenses: Remove at least 3 days before your visit.

A complete eye examination is first performed. Additional tests may include corneal topography (a computer generated mapping of your corneal curvature), corneal pachymetry (an ultrasonic measurement of your corneal thickness), and an A-Scan (an ultrasonic measurement of the length of your eye). Sometimes this is done in our office, but it can also be done by many of our referring optometrists or ophthalmologists. Once all necessary information is gathered, you and your surgeon will determine the best procedure for you. Our surgery coordinator will schedule your surgery time for you.

Refractive surgery is a brief, outpatient procedure. Although you are awake and alert, anesthetic eye drops are applied so there is typically no discomfort. A lid speculum is used to gently hold open your eyelids so you cannot blink during the procedure. During LASIK, a thin flap of corneal tissue is made with a very precise instrument. It takes less than a minute for the actual application of the laser light. The surgeon will demonstrate the laser beam to you before it is actually applied to your eye. Once you are finished, you will be given your eye drops and final instructions before going home. LASIK patients generally experience no significant discomfort after surgery! Although most patients resume normal activity immediately without restrictions, some prefer to relax for the remainder of the surgery day. You will usually be seen in the office the next day.

No. You will need a responsible adult to accompany you on the day of your surgery.

After your surgery, you will be asked to adhere to a series of examinations to ensure that your eye is healing as expected and to measure your visual progress. You may have your follow-up care with the Erdey Searcy Eye Group or with your comanaging optometrist. A typical schedule includes the following visits: one (1) day, one (1) week, three (3) months, 12 months, then annually thereafter.

Optometrists and ophthalmologists residing within and outside of our region refer many patients to us. Patients benefit by having their care shared by two specialists, one of whom is likely to be both familiar with the patient’s history and conveniently located. These doctors have been trained in the pre- and post- surgical care of refractive surgery patients and work closely with us to provide you with the highest quality eye care available. Usually a pre-operative evaluation will be performed in their office. Patients are then referred to the Erdey Searcy Eye Group for surgical consultation and the procedure. Shortly afterwards, you may return to their care for the remainder of the postoperative period.

Some patients experience fluctuation in their vision for the first few days following refractive surgery. Other common side effects that usually dissipate with time are: slightly scratchy sensation or dryness, increased tearing and light sensitivity, tender eyelids or mild eyelid swelling, sensitivity to smoke, and halos, ghosting, or starburst effects around objects or lights. Using your prescribed eye medications and artificial tear drops will soothe your eyes during the immediate postoperative period.

Presbyopia (the need for bifocals) occurs as a natural aging process of the crystalline lens inside the eye (located behind the pupil). After age 40, the ability of the crystalline lens to instantly change shape in order to focus light rays on the retina for near vision tasks starts to decline. This decline is gradual through age 50 at which time there is generally a total dependence on bifocals or reading glasses. Refractive surgery changes the cornea curvature, and thus does not affect the natural aging process of the eye’s crystalline lens. Therefore, you will more than likely still need to use reading glasses as you get older. If you are approaching or are in the presbyopic age range (above age 40), you and your doctor may decide to “tailor” the surgery (leave some residual near-sighted ability in your non-dominant eye) to allow some independence from reading glasses. This is called monovision. You may be familiar with this arrangement if you are over age 40 and have worn contact lenses set up for monovision.

The use of one eye for distance vision and one eye for near vision is referred to as monovision and is one of the options to consider as part of your refractive surgery decision if you are over age 40. Monovision has been used successfully for over 20 years with contact lens correction and with various types of refractive surgery. By correcting one eye to focus for distance and one eye to focus for near, the vision part of our brain tends to suppress or filter out the image from the eye that is not in clear focus. The eye that is not in focus usually does not bother the patient.

One of the best ways to define monovision in the context of refractive surgery is that you can aim to have each eye corrected to focus at any distance you choose. How well it will see at other distances depends upon how old you are. For example, if you are 30 and we correct each eye to excellent distance vision, then you will have good vision at almost any distance because, due to your young age, your eyes will be able to accommodate (adjust focus) for near vision tasks. If, on the other hand, you are over 40 and we correct each eye to excellent distance vision, you will not see well at a typical reading distance and will need reading or near vision glasses. This change in accommodation (focusing ability) will generally begin to be noticed around age 40 and will usually become significantly worse over the next few years (presbyopia). This loss of ability to change your focusing distance from far to near (presbyopia) will occur whether or not you have refractive surgery. At any age, if you have the vision in one eye corrected to focus for near tasks such as reading, you will not see clearly with this eye for distance.

As a general rule, however, we suggest against monovision if you are under age 35 for two reasons:

1. It will be a number of years before you will notice any benefit
2. It is very possible that there could be a better (or at least as good) surgical way to help presbyopia by the time it becomes a problem for you.

We also generally recommend against monovision at any age for people who may need to see above average for tasks at a particular distance, such as pilots, race car drivers, anyone who drives for a living (especially at night), and avid tennis players (especially for night playing).

We create monovision using the laser such that the dominant eye focuses at distance and the non-dominant eye focuses at near. The brain typically adjusts to each eye being focused at a different distance within 6-8 weeks. You do not need to consciously make any adjustments.

There is no right or wrong answer to the question of whether to have monovision. We hope that this information is helpful in making this decision.

In most cases, if you could wear contact lenses before surgery you should be able to wear them after surgery. Because the shape of your cornea has been altered, you will need to have an optometrist fit you with new lenses. Fortunately, the need to wear contact lenses after refractive surgery is rare.

Refractive surgery has created a whole new world for water sports enthusiasts who previously had to wear goggles or masks with corrective lenses or were afraid of losing their contact lenses in the water. However, you should avoid water sports or pressure exerted from diving at excessive depths for several weeks following the surgery to allow your cornea to fully heal.

No. The FAA has approved these procedures for all classes of pilots and air traffic controllers. However, rules are constantly changing. If this applies to you, please check with the appropriate agency to verify their requirements before having this procedure. NOTE: Military aviation has their own guidelines!

Our fee includes the surgery, post-operative kit containing medications and sunglasses, follow up care for 1 year, and any enhancement treatments if necessary during the first 12 months. There are easy payment plans available. An Erdey Searcy Eye Group financial counselor can review all of your options with you. Please contact us and our patient counselor will be happy to talk with you.

• Insurance companies generally consider refractive surgery “cosmetic” and do NOT cover the cost. However, we advise all patients to check with their insurance provider to be sure.
• A surgical procedure may be tax deductible depending on your filing status. Check with your accountant.
• If your company has a flexible benefits program, refractive surgery can often be included.
• Payment plans provided at about $70.00 /month for both eyes.

Over a 15-year period, the one-time fee for laser vision correction is less than the cost of corrective lenses.

*Price may vary **based on treatment of two eyes

Although we will provide information and guidance, only you can answer that question. You need to ask yourself why you want the surgery and if your visual expectations realistic.