LASIK: More Than a Fix for Nearsightedness

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LASIK is the most popular corneal refractive procedure worldwide, with more than 700,000 procedures performed each year in the U.S. alone. LASIK produces excellent results when performed by a skilled eye doctor, and although it’s not an ophthalmologic cure-all, the technology is adaptable to a wide variety of vision problems.

How LASIK Works
The concept behind LASIK — or laser assisted in situ keratomileusis — is fairly straightforward. Your cornea accounts for much of your eye’s focusing ability, and irregular or abnormally shaped corneas cause blurry vision. Reshaping the corneas with LASIK can often compensate for blurred vision due to these abnormalities, which doctors call refractive errors. During a LASIK procedure, your doctor uses a blade or laser to create a flap on the front of your cornea. The flap is carefully folded back, and the underlying cornea is reshaped with a laser. The flap is then returned to its original position. No stitches are required, and postoperative discomfort is usually minimal. Most people’s vision is markedly improved within two to three days, although full vision stabilization may take longer.

Myopia
People with myopia, or nearsightedness, have trouble focusing on far-away objects. More LASIK procedures are performed to correct myopia than any other vision problem. According to a 2011 review in BMC Ophthalmology, over 80 percent of laser refractive procedures performed at Johns Hopkins Wilmer Eye Institute during one quarter of 2009 were done on myopic patients, 65 percent of whom opted for LASIK. While most LASIK patients are primarily interested in correcting nearsightedness, the procedure is also commonly used to deal with other refractive problems.

Hyperopia
People with  hyperopia, or farsightedness, have trouble focusing on nearby objects. Until recently, LASIK was less satisfactory for treating hyperopia than myopia, and farsighted people were more likely to experience glare and halos following the procedure. However, a study published in the May 2010 issue of Clinical Ophthalmology demonstrated a reduction in these minor complications when a broader area of the hyperopic patient’s cornea is treated with laser. These findings are representative of the ongoing research that continues to improve LASIK’s utility for correcting a variety of refractive problems.

Astigmatism
Astigmatism occurs when your cornea is not perfectly dome shaped. If the surface of your cornea is shaped more like a football than a baseball, the light entering your eye bends unequally. This produces sharp images in some areas of your field of vision and fuzzy images in others. The type of astigmatism you have is determined by the direction and extent corneal warping. Many people with astigmatism also have myopia or hyperopia.

According to W. Neil Wills, M.D., a LASIK doctor, most forms of astigmatism — including those associated with myopia or hyperopia — can be effectively treated with LASIK. A condition called irregular astigmatism is an exception.

Presbyopia
Some amount of presbyopia, or “aging eyes,” is universal in older adults. As you age, the lenses inside your eyes gradually lose flexibility. This becomes noticeable at about age 45 to 50 with loss of the ability to focus on nearby objects. Unlike other refractive errors that are due to structural problems with your focusing mechanism, presbyopia is caused by a loss of your eyes’ ability to change focus. When presbyopia becomes significant, most people require reading glasses or bifocals to read or work at a computer.

Dr. Wills explains that LASIK can treat your eyes, but it cannot affect your age. If you have presbyopia and want to reduce your dependence on corrective lenses, your eye surgeon might suggest a technique called “monovision LASIK,” which corrects one eye for reading and the other for distant vision. Monovision LASIK generally allows you to see well at all distances, but it may impair your depth perception. Although the thought of having your eyes focused at different distances might seem disconcerting, Dr. Wills reports that 90 percent of patients adjust to monovision LASIK within a few months.

High Satisfaction Rate
More than 95 percent of patients undergoing LASIK are satisfied with the results of their surgery, regardless of their original vision problem. Millions of people have undergone LASIK, and even the NASA and U.S. military have adopted the procedure for their aviators. Before you proceed with laser vision correction, schedule a consultation with a LASIK doctor who will perform a thorough evaluation to determine if LASIK is a good option for you.

 

References
American Academy of Ophthalmology Clinical Updates: Demographics of Refractive Surgery Patients and Market Trends

http://www.aao.org/vp/edu/refract/v1m5/refractive_management_v1m5.pdf

Eye Surgery Education Council: More than 95 Percent of LASIK Patients Report Satisfaction Rate Worldwide

http://eyesurgeryeducation.org/resources-news.php?id=30&type=news

Email Interview with W. Neil Wills, MD, FACS

American Family Physician: LASIK:  A Primer for Family Physicians

http://www.aafp.org/afp/2010/0101/p42.html

BMC Ophthalmology: Trends in Refractive Surgery at an Academic Center: 2007 – 2009

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3115925/

Clinical Ophthalmology: Predictability and Stability of Refraction with Increasing Optical Zone Diameter in Hyperopic LASIK

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874273/

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