Are you approaching the point, or possibly even at the point, where you think it’s time to get rid of your glasses or your contact lenses?
If you’re tired of having to move between your long-distance pair of glasses and your reading glasses, laser correction may be the answer for you!
Laser eye surgery can be an overwhelming topic. Learn everything you need to know from a leading expert in the field, Dr Dylan Joseph.
What Is Laser Eye Surgery?
When you dig deeper into the fascinating world of vision correction, one quickly realises that there are many options to help you get the best out of your vision. Not your brother’s, not your neighbour’s, but yours’!
In short, laser eye surgery or vision correction is a type of refractive surgery for the correction of myopia, hyperopia, and astigmatism.
To help you better understand, we will now dive into the history of laser eye surgery, its benefits and the different types of procedures. You will also find out if you are a candidate for laser eye surgery, as well as what the risks, recovery time and costs are.
The History of Laser Surgery
We have come a long way since the first laser eye surgery was performed in 1988 by Dr McDonald.
Interestingly, the patient was going to have her eye removed for malignant melanoma and asked doctors if they would like to perform the experimental laser procedure on the eye first.
What a door for science this patient opened for us, and potentially for you!
This procedure was called photo-refractive keratectomy or PRK. This was the first way in which laser vision correction was approached, and it is still a very well accepted way of performing vision correction today.
This flap was then lifted, the underlying bed of tissue was lasered, and the flap replaced, like a natural bandage. This procedure allowed for less discomfort and faster visual recovery.
In 2002, the technology ramped up even more, and the first 100% bladeless laser surgery was performed with a femtosecond laser.
With bladeless LASIK, a femtosecond pulse laser, which is essentially gas bubbles, is used to create the thin flap instead of the manual keratome. This allowed for a more precise measurement of the depth of the flap, making the procedure super accurate, and with often fewer side effects than the keratome.
At our clinic, we are privileged to have one of two full WaveLight laser vision correction suites in the country making the LASIK experience completely bladeless.
What are the Benefits?
It is imperative to know what your eyes are telling you. So, let’s start with the basic anatomy and understand why people need to wear spectacles or contact lenses and learn how laser eye surgery can change your life.
Myopia, the fancy word for short-sightedness, is a condition that causes light rays to focus in front of the retina, causing distant objects to look blurry.
Hyperopia, the fancy word for far-sightedness, is a condition that causes light rays to focus behind the retina, causing near objects to look blurry.
Astigmatism is the clinical term for irregularity in the shape of your cornea, which is the clear front portion of the eye.
A good way to understand astigmatism is to imagine your eye is shaped like a rugby ball and not a soccer ball. This causes the light rays to focus at multiple points in front or behind the retina rather than at a single point; causing distorted vision.
Usually, people with high astigmatism complain that their night vision isn’t great. Many people also believe that if you have astigmatism, it cannot be treated with laser vision correction. This is most certainly not true if you have a healthy form of astigmatism which will be determined from your initial examination. After that, we can offer you a solution to eradicate or decrease those night vision halos and glare.
The amount of myopia, hyperopia or astigmatism is measured in “dioptres,” a term used to describe the power of a lens. With the advances in technology today and specifically the WaveLight refractive suite that Dr Joseph uses, we are now able to treat a wide range of visual problems and ranges from -12 up to +6! If you have astigmatism, we can correct up to 6 dioptres of this with our treatment.
Can I get Laser Eye Surgery?
We mentioned earlier that you could essentially eliminate spectacles, contact lenses or reading glasses with laser eye surgery.
If we look at this in finer detail, this implies that people will wear different types of vision correcting aids at various stages of their lives. To put it simply, if you are younger than 40 years of age and would like vision correction, then it makes sense to correct both your eyes for great distance vision.
Why? Because your eyes are still able to help you focus on your near work at that stage.
Remember though, that when you hit your mid-40’s, you are going to start struggling with what is known as the short arm syndrome. This is when everything close-up is going to start looking blurred. You will then need reading spectacles to sort this issue out.
But have no fear. If you have previously had LASIK surgery and have started to notice that you have a reading problem, most of the time we’re able to do another touch-up procedure to help you with your reading.
If you’re older than 45 years old, you have already entered that age where you are going to have to start mourning the loss of your near vision.
This is normal, contrary to what your body and mind are telling you.
The type of glasses you need will have a profound impact on your approach to treatment, as the ideal will be to try and preserve both your near vision as well as your distance.
Imagine you had surgery to correct your distance vision over 45 years of age and not your near vision, because your focus muscles don’t respond as they used to, you will find you are not able to read after the laser. Not ideal if that’s what you are targeting.
For this exact reason, it’s imperative to have this thoroughly evaluated prior to any treatment and to discuss these in’s and out’s before committing to a laser correction procedure.
You don’t need to fear this situation as we’ll walk you through it step-by-step and even show you what the effect of the laser eye surgery will be like before you have the procedure done.
If you wear varifocals, multifocal spectacles or contact lenses, we will once again show you a great laser suggestion to help reduce, if not eliminate, your need for these spectacles. Some people who wear varifocals cannot have laser vision correction for several reasons, but they can have what is called a refractive lens exchange. In this case, we remove the human lens from inside the eye and replace it with a lens which is going to give you the multifocality you’ve been used to.
We will be able to determine all of this from your consultation with Dr Joseph. Contact us to make an appointment.
The bottom line is that the best visual solution will be tailored specifically for you. What is good for the goose, in this case, is not necessarily good for the gander. People are different, with different eyes and visual needs
How do the Different Types of Laser Surgery Work?
There are three ways in which we can do laser treatment:
Remember reading earlier about the creation of an ultra-thin flap? This is what LASIK is.
The beauty of this procedure is that the visual recovery is very quick, usually within one to six days, and secondly, there is minimal discomfort. Perhaps a sandy sensation in your eyes for a day or so.
During a LASIK procedure, an ultra-thin flap is made in the cornea by our femtosecond laser or FS200 using tiny air bubbles – 2000 000 to be exact. Yes, you heard correctly, it is all just air.
No blades, no cutting.
The older method of creating flaps is with what we called a microkeratome which is a small blade which accurately creates a flap. These blades, although very accurate, are thought to carry a slightly higher risk of dry eye after surgery than with the femtosecond laser.
The beauty of using air these days is that it doesn’t cause much harm to the tiny nerves which are in the top layers of the cornea. You have heard of dry eye, haven’t you?
This used to be a relatively common occurrence after LASIK surgery but has dramatically decreased since the advent of femtosecond laser surgery. Remember that the majority of dry eye is temporary and treatable.
LASIK surgery itself is also completely painless.
When we evaluate you for the first time in the clinic, we will be able to tell you whether your eye health and anatomy will be good for the LASIK procedure.
Several other reasons may exclude you from having LASIK, but that doesn’t mean you can’t have other types of laser vision correction, such as advanced surface ablation procedures. These procedures are generally used on patients whose corneas are too thin for LASIK or who have some strange warning signs on their corneas that they may be a little unstable to create a flap in.
The LASEK surgery procedure is where the very thin layer on top of the cornea is gently moved to the side. The treatment is then done, and this tiny layer is then replaced to allow healing. These cells are replaced over the next six days.
The positives of LASEK surgery is that studies show a slightly faster healing rate as opposed to the standard approach and that there is marginally less discomfort
Photorefractive keratectomy (PRK) is when the thin layer of epithelial cells is completely removed as opposed to being replaced.
This is the most common way of performing a surface ablation procedure. The recovery is the same as with LASEK, and there is no difference with visual outcomes.
Trans-epithelial PRK is when the latest development in technology on our WaveLight platform known as Streamlight is used.
Instead of manually removing the cell layer on top of the cornea, the excimer laser removes it and then does the laser vision correction directly afterwards. It is a superb no-touch technique that is getting fantastic results.
Dr Dylan Joseph worked in a clinic in Dublin, Ireland, where they were the first in the world to have used such smart technology and have recently published 6-month results.
Laser Eye Surgery Risks
The rates of complications and severe side effects are exceptionally low in a laser vision correction centre.
But as with any surgical procedure, nothing is entirely void of risk and potential complications. And as infrequent as they are, it is in the management of these complications and side effects that, in most instances, result in a great visual outcome.
So, let’s look in the potential complications and side effects a little more in-depth:
When we create a LASIK flap, the underlying bed is potentially exposed to bugs that live on the surface of your eye and the surface of your skin. Although we clean both thoroughly pre-operatively, there does exist a chance that one of these bugs decides to set up home underneath the flap.
It is extremely rare but could result in cases of mild or severe infection. Mild infection can usually be treated with antibiotics and usually, doesn’t lead to permanent visual loss. Severe infection, on the other hand, even if treated with antibiotics, could lead to permanent vision changes and would require further management at the clinic.
This is in the magnitude of around 1:10 000.
Your immune response, otherwise known as your body’s way of responding to an insult is unique to it, and inflammation can occur as a result.
This is often successfully treated with anti-inflammatory drops. Severe cases would require further management at the clinic.
• Dry Eyes
Fortunately, this incidence is exceptionally low because of strict pre-operative screening.
It is very important to pick up and treat dry eyes before having laser vision correction. Using our state-of-the-art diagnostic equipment makes this process a lot easier.
Having said this, LASIK itself can induce dry eyes, although in our clinic we use a femtosecond laser to create the laser flap-this is just gas bubbles which separate the layers of the cornea, as opposed to cutting them as with a manual keratome or blade.
In most cases after LASIK, it is as a result of suddenly not having the protective effect of glasses or contact lenses anymore, and the subsequent reduced corneal sensitivity for some weeks to months after the procedure. It usually resolves with the use of artificial tears. We will be able to tell you soon after the procedure whether this will be necessary or not. By 6-weeks postoperatively, most patients no longer need to use artificial tears.
Dry eyes tend to affect certain groups, for example, women around the menopause age, those with dry eyes, contact lens wearers and long-sighted patients.
Dry eyes may, infrequently, be permanent.
• Aborting the procedure
There is a minimal chance (±0.1%) that the procedure may be aborted due to a complication with the making of the flap.
We will then have to stop the procedure, which can be continued 6-weeks later once the flap has healed.
If the procedure is aborted before the flap is lifted, there will be no impact on vision. Remember that the femtosecond laser is only gas bubbles-within 24-hours, all of them will have dissolved and your vision returned to what it was before the surgery.
• Displacement of the flap
If you rub your eye straight after the procedure, the flap may be displaced.
It is simply repositioned if this occurs. This would usually be on the next day. Many small flap folds can be ‘ironed’ out in the office on day one post-op, but larger folds and folds impacting vision would need to be taken back to theatre, have the flap lifted and repositioned.
The flap may also displace at any time after the procedure if the eye is subjected to rubbing or trauma and would require further care at the clinic.
• Corneal Ectasia
This is even rarer nowadays due to the seriously stringent criteria when it comes to making sure you are a good LASIK candidate.
Having said that, even with a completely normal eye, it may occur.
Ectasia is a bulging of the cornea that can lead to distortion of vision and may require further surgery in the form of corneal cross-linking (CXL). The risk of developing corneal ectasia is assessed by the doctor at your evaluation.
This is minimal though not completely eradicated.
• Glare and Halos
There may be some glare at night and in dimly illuminated situations for a while after the procedure.
It tends to take longer for the night vision to recover and a guideline is “One month per dioptre” for the glare to diminish to normal. Some residual glare with monovision is normal.
Monovision is a solution for people over 2 who may need to correct their distance and near vision. We treat the one eye for distance and the other for near.
Don’t worry, we show you this with a contact lens trial prior to any surgery. The glare at night can easily be sorted out with a pair of night-time driving specs
The final result is determined by your healing to a large extent.
There is a multitude of factors behind needing an enhancement. Because of this, there is a possibility that an additional procedure may be required at a later stage to enhance or adjust the outcome.
This is usually less than 1% for short-sighted people and around 5% for far-sighted people. Rarely, a 3rd procedure may be necessary to achieve the required result, especially with far-sightedness.
There is a common misconception that LASIK ‘wears’ off. The laser itself results in a permanent change to the cornea, which cannot ‘wear’ off. However, if you are in front of a computer many hours per day, you induce growth in the length of your eye, which could result in you becoming more short-sighted again!
There are massive advances too, in the very thin layer on the front surface of your eye, which also holds a key to part of what causes regression.
We are privileged to have access to such wonderful diagnostic devices at our clinic, making our lives and yours a lot more straightforward.
• Epithelial Ingrowth
Epithelial ingrowth occurs when epithelial, or better known as surface cells, migrate under the flap edge during the healing process.
These cells are meant to, and in most cases, stay on top of the surface of your eye after LASIK. If they do enter the interface, or area under the flap, they often die naturally. This would be monitored at more frequent postoperative visits to the clinic.
If the cells don’t die out naturally or if they have an impact on your vision, the flap may need to be lifted to remove the cells or may require YAG laser treatment directly to the ingrowing cells.
The incidence of epithelial cell ingrowth with this procedure is less than 1%.
All in all, the rates of complications are exceptionally small in a dedicated laser vision correction centre. But more importantly, it is how they are managed.
Laser Eye Surgery Recovery
Your recovery process depends very much on what type of procedure you have had. Remember, there are two ways in which we can correct your vision.
LASIK surgery is an outpatient procedure, meaning you are in the morning and at home the same day. The advent of LASIK has helped reduce downtime after the procedure because there is minimal discomfort and secondly because your visual recovery is so quick.
Usually, the first 24-hours will seem a little hazy, but this clears up within the first four to six days and, usually, by the end of the first week after surgery, your vision is on par with, if not better!
How much does Laser Eye Surgery Cost?
If you’re on this page, you are probably three-quarters of the way to committing to having laser eye surgery.
Should cost be a factor that triggers the final decision?
We live in a cost-sensitive environment, and across the board, you will come across a wide range of pricing in your searches. One fact about cost is that if it sounds too good to be true, it probably is.
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Dr Joseph pioneers advanced laser eye surgery in South Africa
Posted on September 02,2019
By Dr. Dylan Joseph