Successful LASIK Eye Surgery: What a Good LASIK Eye Surgery Provider Does Before and During LASIKMarch 14, 2014
Andrew E. Holzman, M.D., F.A.C.S.
“Would you recommend your LASIK eye surgery provider to me?” The answer to this question is one of the most common ways to measure the success rate of LASIK eye surgery providers. This percentage can approach nearly 100 percent in surveys at experienced providers, such as at the TLC Laser Eye Centers® where I perform surgeries.
LASIK eye surgeries such as LASIK and PRK are performed by skilled ophthalmologists, who have help from trained staff and technicians. However, how your pre-op care and actual surgery go depend largely on the particular protocols of your ophthalmologist. There’s no single, standardized way laser eye surgery doctors perform their procedures across the industry, although all ophthalmologists abide by a high standard of care. But one truth is clear: The key to LASIK eye surgery success lies in your ophthalmologist routinely putting in extra effort before the procedure and in following a strict set of protocols in the operating room.
Pre-Operative Care Point 1:
A good LASIK eye surgery provider screens non-candidates during consultations.
“What would make me a LASIK eye surgery non-candidate?” This is a common question, and staff can determine if you’re a good candidate during your consultation, which is an eye exam where many specialized tests are performed.
One of these tests is called corneal tomography. It shows a 3-D view of the cornea and provides information about its structure and shape. If there are abnormalities possibly related to weakness in the cornea, these will show up on your corneal tomography. Abnormal tomography is one of the more common reasons a patient could be disqualified for certain types of LASIK eye surgery. Sometimes PRK, for instance, may be a safer option than LASIK for these patients.
Other ocular reasons that can disqualify patients include dry eyes, surface or lid inflammatory conditions, abnormally thin corneas or corneal scarring. Glaucoma, cataracts, retinal abnormalities and other conditions that affect the eyes are also reasons a surgeon might not proceed with LASIK eye surgery.
Pre-Operative Care Point 2:
A good LASIK eye surgery provider reviews your complete medical history.
Occasionally the LASIK eye surgery exam comes back normal, but a patient’s medical history can give us a reason to pause. Medical-history yellow flags might include autoimmune disorders, such as rheumatoid arthritis, lupus and other conditions that might yield ocular complications. People with diabetes sometimes have fluctuations in their vision and thus can have difficulty healing after laser eye surgery, making them poor candidates.
Even people with a healthy medical history and promising eye-exam results could be ruled out as candidates for LASIK eye surgery. Reasons this would be the case include a patient having an unstable eye prescription, such as in a young adult (e.g., someone in her 20s) whose eyes are still changing. It is best for these patients to wait to have LASIK eye surgery until their prescription has stabilized. A person might also have unrealistic expectations about the results of the procedure. It is very important for surgeons and their teams to feel comfortable with each person who seeks the procedure, and those with unrealistic expectations are often non-candidates.
A good doctor will not recommend LASIK eye surgery if these “red flags” are found along the way. LASIK eye surgery, while miraculous and extraordinarily successful, remains a delicate elective procedure that should be performed only when a patient is deemed to be a good candidate.
Pre-Operative Care Point 3:
A good LASIK eye surgery provider prescribes appropriate pre-surgery eye drops.
Pre-operative care will often involve the use of prescribed eye drops. LASIK eye surgeons routinely prescribe an antibiotic eye drop, a non-steroidal anti-inflammatory eye drop and artificial tears before surgery. I personally will recommend the use of an additional over-the-counter ointment for people over age 35, as I’ve found this to reduce surgical surface problems.
Pre-Operative Care Point 4:
A good LASIK eye surgery provider treats existing conditions before providing LASIK.
Sometimes a patient would be a candidate for LASIK eye surgery if not for a treatable, pre-existing condition. The most common of these issues I encounter is dry eye syndrome. The treatment can be as easy as a patient using artificial tears before surgery. I might also suggest using a humidifier in the bedroom and paying attention to how much air or heat blows in the patient’s face during the day. If additional treatment is needed, I might prescribe Restasis®, an eye drop. In every case, whatever the treatment becomes, I see the patient prior to surgery to make sure dry eye is resolved before proceeding with LASIK eye surgery.
Another common issue is an inflammation of the eyelid, known as blepharitis. This inflammation can lead to corneal infections and ulcerations if untreated. Because laser eye surgery relies on a normal corneal surface, blepharitis can thus pose a problem to a patient. To treat blepharitis before LASIK eye surgery, I often prescribe a regimen of antibiotics, warm compresses and eyelid scrubbing. This usually treats the inflammation, and we can move forward with laser vision correction.
A third, fairly common condition is Epithelial Basement Membrane Disease (EBMD). EMBD weakens the front layer on the eye, which can lead to occasional irritations or erosions that are challenging to heal. My team looks closely for signs of EBMD during each laser eye surgery consultation. We use an “adhesion test” on the outer layer of the eye to test for this disease. If EBMD is found, I will usually recommend PRK instead of LASIK, since PRK eye surgery can be performed in someone with a weaker front layer, whereas LASIK eye surgery can create a high-risk procedure.
Many additional, common conditions could factor in to my determination of someone’s candidacy for LASIK eye surgery. For instance, something as common as psoriasis could signal that someone’s eyes might not heal as well as expected after LASIK. There are often treatments for psoriasis and other conditions. A good laser eye surgeon will conduct a thorough pre-operative LASIK consultation before moving to the next step with you: LASIK eye surgery.
LASIK Eye Surgery Care Points:
A good LASIK eye surgeon takes all possible precautions.
During LASIK eye surgery your surgeon has many opportunities to go above and beyond in his or her care. For me, each technique I employ starts with the small things, which I believe are key to a smooth recovery and the best possible results. For instance, I use surgical drapes over the eyelids to ensure the cleanest possible environment. My team and I mark the cornea to make sure our astigmatism corrections align perfectly. We keep the corneal surface well maintained during surgery. We use chilled and filtered fluids, which help us keep the cornea less inflamed during surgery. I use a femtosecond laser to create the LASIK flap, which I have found to create numerous advantages for my patients, including greater flap security, a smaller surgical footprint, improved accuracy of vision correction, and less dry eye during recovery. (Some providers still use a microkeratome blade instead of a femtosecond laser.)
I hope this article helps you find the right provider for you in your local area. When a surgeon meets these points, you’ll know you’re in the hands of someone who will take care to get you your best possible outcomes.
Dr. Andrew Holzman is one of the Washington, D.C., area’s most experienced laser eye surgeons, having performed more than 50,000 procedures. Find Dr. Holzman at TLC Laser Eye Centers®.