Frequently Asked Questions Naturally, you have questions about the Flaum Eye Institute Refractive Surgery Center and laser vision correction. This is a list of frequently asked questions that may help you understand more about the procedure. How does LASIK work? Am I a candidate for LASIK? Am I too old to have LASIK? How safe is LASIK? Does LASIK hurt? How long does it take to do LASIK? How accurate is LASIK? What if I blink or move during the procedure? How soon after the surgery will I be able to see? When will I be able to drive? What are the possible complications? I’ve heard that LASIK causes night vision problems…is this true? How long will the effect of LASIK last? How often will I have to see the doctor following my surgery? Can I wear my contacts before my surgery? Can you work with my regular eye doctor? Do you offer financing? How does LASIK work? LASIK (laser in situ keratomileusis) is a laser vision correction technique that uses an excimer laser to reshape the cornea and correct a wide range of nearsightedness, farsightedness and astigmatism. First, Dr. MacRae uses a precision femtosecond laser or an instrument called a microkeratome to create a thin surface flap of your cornea; this takes a few seconds. Then the excimer laser, which has been pre-programmed with your exact correction, applies a rapid, cool ultraviolet light that precisely removes a very small amount of tissue from the inner portion of the cornea. These short laser pulses correct the curvature of the cornea, allowing images to be focused clearly on the retina. The flap is then smoothed back into its original position where it quickly bonds back in place, usually in three to five minutes, restoring a smooth, intact surface. LASIK has been performed for nearly 20 years. Back to Top Am I a candidate for LASIK? The decision to have laser vision correction depends on the results of a thorough preoperative evaluation. Just as you are a unique individual, each eye requires unique and careful examination with the best technology. At Flaum Eye Institute Refractive Surgery Center, we complete a 2 1/2 hour, 27 point evaluation to determine whether or not you are a safe candidate for laser vision correction. It is important to understand that not everyone is a suitable candidate for LASIK. Some basic requirements include: A stable eyeglass prescription for at least two years. Best corrected vision of at least 20/40. Healthy cornea. No active eye disease. Over 18 years old. Back to Top Am I too old to have LASIK? Although there’s no real “maximum age” for laser vision correction, we would first need to determine that the overall health of your eyes is good, and that your vision difficulties are not being caused by cataracts or some other eye disease. Before the decision is made to proceed with laser vision correction, your vision needs to be stable. Depending on your age, you may need reading glasses after treatment. Nearly everyone needs reading glasses by their mid-40s. This is known as presbyopia. Presbyopia is a natural change in the lens inside of the eye and is not influenced by refractive surgery. If you are wearing bifocals or readings glasses now, you will still need reading glasses after LASIK. A treatment option with refractive surgery is known as monovision. In a monovision treatment, the patient’s dominant eye is corrected for distance vision with their non-dominant eye being left slightly nearsighted. Although not a replacement for reading glasses, this preserves a degree of near vision clarity. Back to Top How safe is LASIK? The FDA has approved LASIK as a safe and effective procedure. It is important, however, to remember that LASIK is not the right choice for everybody. Some people are not appropriate candidates, and if treated could have less than optimal results. It is important that you receive a thorough pre-operative evaluation to determine if LASIK is right for you. Back to Top Does LASIK hurt? No. The actual treatment itself is painless. You will be given plenty of anesthetic drops to completely numb the eye. You may feel a light pressure sensation around your eye, and after the procedure is finished you will feel a sensation our patients describe as gritty or like a lash in your eye for a few hours…but most people experience very little pain. We’ll give you a prescription for a pain reliever should you need it, but most people need nothing more than Tylenol or Advil and a little rest time. Back to Top How long does it take to do LASIK? The actual procedure usually takes less than 10 minutes per eye. Depending on your prescription, and the amount of correction needed, the laser itself only takes 20-50 seconds to correct your vision. However, you should plan on being in the office for approximately an hour-and-a-half on your day of surgery. Back to Top How accurate is LASIK? Based on clinical data from the FDA and our personal experience from Dr. MacRae's Results, LASIK is very accurate. Careful consideration of your needs and a complete preoperative evaluation help Flaum Eye Institute Refractive Surgery Center achieve excellent results with the vast majority of our patients. Even with our advanced technology and experience, approximately 1 in 10 patients may need to have a retreatment in one eye to achieve their best uncorrected vision. This is because we are treating human tissue and there is always some variability in how each individual’s eye will heal. Back to Top What if I blink or move during the procedure? Although everyone shares these concerns, we take measures to ensure that moving or blinking is not a problem. Your eye will be held open with a holder supporting your lid so that you can’t blink. The holder is placed immediately before the treatment and removed immediately afterward. Lying still during the treatment is another common concern. The bed of the laser has a contoured headrest with an indent, which allows the back of your head to rest securely, but comfortably in place. During the treatment itself, Dr. MacRae will gently hold your head in position to help keep you steady. He also uses a focusing mechanism to assure that the treatment is precisely centered. Your job is simply to watch a blinking target light. While you are doing this, the laser’s computer will also be using its tracking system to monitor the position of your eye. The eye tracker adjusts the laser treatment to follow the small movements everyone’s eyes make during the procedure. Back to Top How soon after the surgery will I be able to see? Visual recovery varies from one day to one week. The majority of patients resume normal activities one to two days following surgery but it may take 1 to 2 months for your vision to fully stabilize. Although everyone is a little different, the vast majority of our LASIK patients achieve legal driving vision or better, the very next day. That is one of the most exciting advantages of the LASIK procedure; clear vision comes in quickly. Initially, your vision might not be crisp and may fluctuate slightly. This is perfectly normal and should improve gradually day by day. Back to Top When will I be able to drive? On the day of your surgery it is important to have a driver take you home. You will also need a driver to bring you to your post-operative appointment the day after surgery. In most cases, patients are able to drive by the end of that day. Back to Top What are the possible complications? It’s perfectly normal to be concerned about the “worst case scenario”. In nearly 17,000 cases, Dr. MacRae has never had a patient experience severe vision loss as a result of refractive surgery. With an experienced surgeon, the procedure itself is relatively safe. The excimer laser is computer controlled, pre-programmed with your treatment data and activated by Dr. MacRae. Statistically, there is a remote possibility of the loss of vision due to corneal infection or inflammation which we address by maintaining sterile conditions in the laser suite and by instructing you to use medicated drops for the first week after the procedure. Fortunately, we have never had a patient lose vision from these problems. That being said, refractive surgery has its risks and we will explain them to you at the end of your evaluation. Potential complications include: Under or over correction, corneal flap healing problems, pain or discomfort, dry eye, hazy vision, sensitivity to light, glare at night, loss of best corrected visual acuity, or infection. The majority of patients who are safe candidates for treatment have a trouble-free experience. Before considering surgery, we carefully evaluate each patient to understand whether or not you are a good candidate. The doctors will be happy to discuss any concerns that you may have. Our goal is for you to understand as much about this treatment as possible before surgery so that you can be comfortable with your treatment options. Since so many other surgeons turn to Dr. MacRae to treat complications when they do occur, know that your eyes will receive the best of care with Flaum Eye Institute Refractive Surgery Center. Back to Top I’ve heard that the laser causes night vision problems…is this true? Starbursts, glare and halos at night can be caused by several things. The first is when an inadequate diameter area of the cornea is treated. The treated area must approximate your pupil size under dim light. We analyze pupil size four different ways to make certain that your treatment area is large enough. The second cause of night vision problems is the use of older generation lasers and poor treatment designs. Dr. MacRae custom designs each patient’s treatment so that the optimal optics can be obtained. The new “flying spot” lasers, such as our Bausch and Lomb Technolas 217z, apply a much smoother treatment and blend the region between treated and untreated cornea better. The third potential cause of night vision problems after LASIK is the presence of subtle optical imperfections known as Higher Order Aberrations in the visual system. All patients seen at Flaum Eye Institute Refractive Surgery Center are tested with the Zywave Wavefront Sensor to detect any pre-existing higher order aberrations. When present, a form of LASIK known as Zyoptix Customized Vision Correction might be recommended for you. Dr. MacRae worked extensively with the Bausch and Lomb engineers to design this treatment. This treatment pattern reduces the incidence of starbursting. Very few of our patients report any night vision problems after their first month post-op. Back to Top How long will the effect of LASIK last? In most cases, the treatment effect of laser vision correction is permanent, especially if your eyeglass prescription was stable before treatment. If there is something in your genetics that says your prescription will change in the future, having surgery now will not prevent that from occurring. In our experience, a change like this is very uncommon If necessary though, you may be able to be re-treated many years later should that occur. Back to Top How often will I see the doctor following my surgery? Your postoperative appointments will be scheduled: One day One week One month Three months And six months (optional) More frequent appointments may be scheduled as needed. The doctors at Flaum Eye Institute Refractive Surgery Center will be available to see you whenever they or you feel that it is necessary. Back to Top Can I wear my contacts before my surgery? Because contact lenses can alter the shape of your cornea, you will need to remove your contacts prior to your pre-operative exam. If you wear soft lenses, they should be removed a minimum of one week before your exam. If you wear rigid/gas permeable lenses, remove them at least 6-8 weeks prior to your exam. By removing the lenses, the cornea will be restored to a more natural shape before measurements are taken. Following your pre-operative exam, if you are a soft lens wearer, you will be able to wear your lenses up to 24 hours before your surgery. If you wear rigid/gas permeable lenses, you may be asked to leave your lenses off until your day of surgery. Back to Top Can you work with my regular eye doctor? In order to make the process of care as comfortable as possible for you, we offer to co-manage with your current ophthalmologist or optometrist. You may choose to have your pre-operative evaluation, treatment and one day post-op visit at Flaum Eye Institute Refractive Surgery Center with the balance of your post-op care provided by your personal eye doctor. If you would like to do this, we will reduce our surgical fee by a set amount per eye treated and your personal eye doctor will charge you a separate fee for their care. Please discuss this option with your eye doctor prior to the time of your evaluation. We believe that it is very important for you to continue seeing your personal eye doctor starting one year after your surgery. We will keep your doctor fully updated about the care you receive while with Flaum Eye Institute Refractive Surgery Center. Back to Top Do you offer financing? At Flaum Eye Institute Refractive Surgery Center, we understand that laser vision correction is an investment. We offer various financing options—ranging from short-term, no interest to long-term plans. Feel free to contact our patient education staff to learn more. Back to Top Do you have more questions? If you have additional questions, please contact our patient education staff, or, come to our next free LASIK seminar.