Laser surgery my help you see the light
Dr. John Martinelli conducts a mock eye exam in his office at Martinelli Eye Center in South Union Township on Thursday.
Courtney Swenglish (left) and her mother, Darla Swenglish, are shown in their Smithfield-area home on Friday. Darla says the LASIK procedure she underwent 13 years ago exceeded her expectations, and she’s happy with the clear vision that the surgery has provided her and her daughter.
Dr. John Martinelli shows the patient's-eye-view of a magnifying lens in his office at Martinelli Eye Center in South Union Township on Thursday.
Dr. Deepinder Dhaliwal, director of Cornea and Refractive Surgery Services at the University of Pittsburgh Medical Center Eye Center
Courtney Swenglish comes from a LASIK family: Her mother, Darla Swenglish, had the laser vision surgery done 13 years ago; a year earlier, her aunt had undergone the procedure.
So in 2010, when LASIK became an option for Courtney at age 21, it wasn’t difficult for her to discard the eyeglasses and contact lenses she had worn since she was in second grade in favor of laser vision correction.
“I was having problems with contacts. My eyes were extremely irritated, and I would get eye infections,” recalls the Smithfield-area woman. “Everywhere I went I had to carry my glasses, my contacts and contact solution. I met with the eye doctor and said, ‘I can’t take it anymore.'”
As she marks the five-year anniversary of her LASIK surgery this month, Courtney says she sees in “high definition,” her vision clearer than it ever was with her glasses or contacts. And in the five years since her operation, LASIK surgeons have been afforded even more advanced technology that has further improved the safety and efficacy of the surgery.
Still, the positive results seen with LASIK occur only in properly selected patients. To get the most out of LASIK, you must educate yourself about them so that you have the right expectations going in. You also need a thorough evaluation, a skilled, experienced surgeon, the right procedure, and the right follow-up care to maximize your results and optimize your vision, experts say.
“We make sure that every single patient is a perfect candidate for it,” says Dr. John Martinelli, of Martinelli Eye and Laser Center, in Uniontown, who performed Courtney’s surgery. “When the right person has it done, good things happen.”
What to expect
LASIK, or laser in situ keratomileusis, is the most widely used refractive surgery to treat nearsightedness, farsightedness and astigmatism, an abnormal curvature of the cornea.
During the procedure, the surgeon creates a thin flap on the surface of the cornea to access the tissue underneath. Then, using a highly focused excimer laser, the surgeon removes tiny amounts of tissue to reshape the cornea and more precisely focus light on the retina to improve vision. The flap is then restored to its original position and heals naturally.
Your eye surgeon probably will give you a mild sedative to help you relax during the surgery. The procedure is painless, although your vision will be blurry and you might experience some eye discomfort in the hours afterward. Martinelli says most patients go home and take a nap after surgery, and by the time they wake up, their vision has begun to clear.
“It takes a few hours for the procedure to settle in. The next day, the vast majority of people are 20/20. In fact, if I have someone who comes back the next day and isn’t reading 20/20, I get angry,” he says.
You must return to the LASIK center the day after surgery so that your surgeon can carefully examine your corneas and other areas of the eye to check for signs of inflammation or infection and to ensure that the corneal flap is healing properly. You’ll also schedule subsequent follow-up visits, at an interval your physician recommends.
You’ll wear a protective shield or goggles in the hours after your surgery, and you’ll also be given antibiotic and anti-inflammatory eye drops and, if necessary, artificial tears or prescription drops to manage any temporary eye dryness that may develop. Refrain from rubbing your eyes, and follow your doctor’s recommendations regarding activities you should avoid in the days and weeks after surgery. Otherwise, you should be able to resume normal activities the day after LASIK surgery.
Cutting-edge LASIK
Many refractive surgeons now take advantage of high-tech wavefront customized LASIK. In this procedure, a scanner generates a detailed map of the eye that is used to program the laser and allow the surgeon to precisely customize the reshaping of the cornea. With this technology, the surgeon can correct not only nearsightedness, farsightedness and astigmatism, but also visual aberrations that eyeglasses and contacts cannot fix. Also, the customized surgery typically eliminates common complications–such as glare and “halos” when viewing lights at night–that often accompanied traditional LASIK surgery.
“I do custom correction on every LASIK patient because I really believe in it, and it really optimizes the quality of vision,” says Dr. Deepinder Dhaliwal, director of Cornea and Refractive Surgery Services at the University of Pittsburgh Medical Center Eye Center. “I have patients who tell me that after surgery, they feel like they see better than they ever did in their glasses or contacts. They say they feel like they’re seeing in high definition.
Most modern lasers also feature specialized eye-tracking technology that compensates for any eye movements and keeps the laser on target during surgery, resulting in better outcomes, Martinelli says. In years past, LASIK surgeons used a surgical instrument known as a microkeratome to open the flap in the cornea. But today’s LASIK specialists also have the option of using a laser to create the corneal flap as well as perform the surgery.
“We’re not using the keratome anymore, but rather lasers, where nothing touches the eye,” Martinelli says. “There’s less opportunity for mechanical error.”
Is LASIK right for you?
No matter how advanced the technology, the most significant factor determining the success of LASIK surgery is proper patient selection, Dhaliwal says. She estimates that she and her colleagues probably turn away about half the patients who seek LASIK treatment, because they’re not good candidates.
“The key with laser vision correction is that you have to do the surgery in the correct way on the correct patient,” she says. “We really believe in doing the right procedure for the patient. Sometimes the right thing is to do nothing. I see people who’ve had surgery and they really were not good candidates, and then they come to me and they’re crying because they can’t see well.”
Your eye-care specialist will perform a thorough review of your medical history, medication use and allergies. You’ll also undergo a careful ocular examination to rule out medical conditions that might preclude you from LASIK.
Your overall health and the health of your eye are among the factors affecting your candidacy for LASIK. You should not have the surgery if you have uncontrolled glaucoma, severe dry eye or signs of cataracts. If you have cataracts, Dhaliwal says, wait until they become significant enough for cataract surgery, because the implantable lens used to replace the lens with cataracts can be customized to correct your vision problem.
LASIK may not be an option if you have poorly controlled diabetes, an autoimmune disease (such as lupus or rheumatoid arthritis) or other conditions that inhibit proper healing after surgery. Plus, to be a LASIK candidate, you must have stable vision, meaning your contact-lens or eyeglass prescription did not change within the past year. For this reason, refractive surgery typically is not recommend for patients younger than age 21, whose visual acuity often remains in flux.
Since corneal tissue is removed during LASIK, you’re not a candidate for the surgery if your corneas are too thin. Instead, your surgeon may recommend a procedure known as photorefractive keratectomy (PRK), a precursor to LASIK in which the surgeon uses an excimer laser to reshape the surface of the cornea without creating a flap. Compared to their LASIK counterparts, PRK patients may experience more eye discomfort and hazy vision, and generally take longer to recover and gain clear vision. However, Martinelli says, the end results of both refractive surgeries are similar over the long term.
Another, newer option for people younger than age 45 with corneas too thin for LASIK are implantable collamer lenses. These clear lenses function like contact lenses but instead work within your eye rather on the surface.
“Now we can take highly nearsighted people who should never have LASIK and we can implant these collamer lenses in their eyes, and within a few hours, they sit up and they can see,” Dhaliwal says. “It’s unbelievable. The more of these I do, the more I want to do.”
Are you right for LASIK?
Aside from the medical criteria, perhaps the most significant determinant of your LASIK candidacy is what you expect to gain from the surgery, Martinelli says.
Fact is, although LASIK and other refractive surgeries have a high success rate, you may require follow-up laser enhancement treatments to fine tune your initial surgery. And while vision in the vast majority of patients stabilizes within a week after LASIK, others may experience vision fluctuations even up to a year afterward, Martinelli says.
“The number one reason we consider whether a person is a good candidate for LASIK is their personality,” he adds. “You have to have an open mind and the proper expectations.”
Additionally, you might still need a mild eyeglass prescription to help you see better at night, or you might require reading glasses after a certain age.
“Some people say, ‘If I have to wear any kind of glasses ever after surgery, I’m not going to be happy,'” Dhaliwal says. “Well, you probably shouldn’t have the surgery.
“We have long discussions with our patients about expectations,” she adds. “I see a lot of patients who are not thrilled with the results they got somewhere else, and oftentimes it’s because wherever they had it done, the people didn’t take the time to explain what to expect.”
Living with LASIK
For Courtney Swenglish, the results of LASIK surgery surpassed her expectations. Within hours of her surgery, she could read the letters on a bottle of hair spray that her father held across the room from her. And now that her vision is better than 20/20–20/10, to be exact–she can see from a distance the scores of sporting events on the televisions throughout the restaurants where she and her fiancé dine on Friday nights, and tell him how his favorite teams are faring.
“I didn’t see things as sharply as I do now whenever I had glasses. Every time I see somebody fooling with their contact lenses or complaining about their glasses, I always tell them to look into LASIK,” she says. “It was the best decision I ever made.”
Now age 53, Darla Swenglish says she still enjoys the clear vision that LASIK afforded her when she had it done at age 40, although she now needs reading glasses. She’s happy with the vision that LASIK has provider her and her daughter, so much so that she plans to add another of her children to her “LASIK family”–her son Tyler, who turns 21 in March, is planning to have the surgery sometime in the spring, she says.
“It was above my expectations,” Darla says. “I thought that if I could come out of it and maybe just need glasses to wear every once in a while, not all the time, that any improvement was better than nothing. Well, it’s been 13 years for me, and I’m happy with it. It’s so nice now that you can see everything.”
Learn about your provider (for sidebar)
The price of LASIK surgery can vary considerably, depending on the level of technology used. Unfortunately, LASIK and other refractive surgeries, for the most part, are considered elective procedures and aren’t covered by medical insurance.
LASIK surgeons Dr. John Martinelli and Dr. Deepinder Dhaliwal recommend researching the LASIK provider you choose, especially those offering discounted rates. In some cases, they say, the price quoted may cover only the cost of the surgery, and not the expense of the pre-operative evaluation, wavefront custom LASIK, follow-up enhancements or other important services.
One way or another, LASIK using custom wavefront technology costs an average of about $2,000 per eye, Martinelli says. “Be careful of the lowball pricing,” he advises. “It rarely ever ends up being that amount, because there are other things that need to be added to it in order to achieve a good outcome.”
“LASIK is not a commodity,” Dhaliwal adds. “Everyone wants to get a good deal, but when it comes to your eyes, you shouldn’t be looking for the biggest discount. Why would you try to save money on your eyes?”
Seek out patient testimonials about your LASIK surgeon, and find out about your provider’s level of experience and the technology he or she employs. Also find out how many doctors and staff members at the laser-vision center have had refractive surgery themselves, suggests Martinelli, who underwent LASIK 18 years ago
“If they’ve had it done, then you know that you should be able to trust them,” he says. “Most of our staff has had it done.”
He also emphasizes the importance of the preoperative evaluation and performing LASIK only in the right candidates: “Frankly, I’m looking for reasons not to do it. If you’re at a center where they tell you too quickly that you’re a good candidate and too quick to schedule you for surgery, be careful. If you want, get a second opinion. Do your homework.”
Dhaliwal recommends choosing LASIK centers where the surgeon is personally involved in the preoperative evaluation and screening process. “The key,” she says, “is you have to go to a place where you feel comfortable with the experience, the expertise and the equipment upgrades, and you need a surgeon you feel comfortable with.”