Laser-Assisted In Situ Keratomileusis (LASIK) is the most popular from of laser eye surgery with 8,000 LASIK treatments performed every week in the UK.
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This is a rather long account of my experience of laser eye surgery. Get a cuppa, and settle down.....
Why I chose to have this done
I still remember that day, 22 years ago, in school assembly when I realised I could no longer see the words during 'hymn practice'. Resigned to the humiliation of NHS specs, I never imagined the day would come when I would have my eyesight restored - technology is a wonderful thing.
10 years ago, I looked at Laser Eye Surgery and the method at the time was known as PRK. This involved removing tissue from the surface of the eye and was associated with a long (up to 6 months) and painful recovery process. It did not take me long to decide that this was not an avenue I wanted to pursue.
However, a few months ago, I was advised that I could no longer wear contact lenses due to blood vessel damage in my eyes. For the most part, I was quite happy wearing spectacles although they are incredibly inconvenient at times – sports, in the rain etc, but it was one day at the beach when I realised that I could not identify my 2 year old son if he was more than 30 feet away and that got me thinking about having laser eye surgery again.
The Research
During my initial research, I was pleased to discover that the advances in laser eye surgery have been significant. PRK is still available – primarily in an enhanced form known as LASEK which reduces the recovery time to days or a couple of weeks. Far more interesting was a technique known as LASIK. The major benefits for me seemed to be an instant recovery and NO PAIN.
I spent three or four weeks researching a number of sites on the web. There is a tremendous amount of information out there and you really need to have an open mind. You will find that the horror stories considerably outweigh those recounting their success. You need to bear in mind that in any walk of life – the voice of the disgruntled minority is typically heard loudest. With an estimated 4.5 million LASIK procedures to be carried out this year, even if 95% are entirely satisfied with the outcome, that still leaves 225,000 unhappy and vociferous opponents of the surgery.
My research revealed that less than 2% of patients experienced a loss of Best Corrected Visual Acuity (BCVA) after surgery. (BCVA is the best vision you have whilst wearing spectacles). As my prescription was approximately –2.00 in each eye with –1.00 astigmatism, I had fairly mild short-sightedness so this reduced the risks for me even further.
For most people, the aim of the surgery is to remove the need to wear glasses. To this end, a successful outcome could be to achieve 20/40 unaided vision. (20/40 is the minimum standard required to drive in the UK without corrective aids). Equally, for most people, the desire is to achieve 20/20 vision. I was quite surprised to learn that with my glasses I actually had 20/10 vision – ‘SuperVision’ if you like. I later learned that I had a 99.9% chance of getting to 20/40, with every probability that I would achieve 20/20 or better, depending on the success of the surgery and the individual healing characteristics of the eye.
NOTE: These were my own conclusions. Each individual is different, the higher the prescription, the greater the chance of an unsatisfactory outcome. If anybody 100% guarantees you a successful outcome, then at the current time, they are lying.
It is important that you carry out your own research. You could spend days, weeks or months doing this because there is so much information out there. Some of the sites I found most useful were:
In particular, you will notice the last of these sites is designed to highlight the dangers and failures of LASIK. Carefully consider both sides of the argument in your research.
The Procedure
I won’t go into detail because it would take far too much space and you can easily get details using the above links, but basically a thin flap is cut in you cornea, this is folded back and the laser applied below the eye surface. The laser dissolves the irregular areas of your eye to correct your vision distortion. The flap is then replaced. This is performed under local anaesthetic.
Possible Complications
Again, you will get extensive details using the links provided, but amongst the most common are:-
Night Vision – many people report that after surgery the experience ‘halos’, ‘ghosting’ or ‘starbursts’ around lights. This can be particularly bad when driving, as it magnifies the effect of the oncoming headlights causing night blindness. Research indicates that people with large dilated pupils (>8mm) are most at risk from these problems.
Dry Eyes – Because a flap is cut in the surface of the eye, this apparently severs the communication between nerve endings and the brain in some areas of the eye. Normally, when the eye is dry, a signal is sent to release moisture from the tear ducts. Post surgery, this signal may not be as effective as it should be requiring the use of eye drops (wetting agents).
Flap complications – There are a number of problems that can result from the flap. It can become dislodged, wrinkled or in severe cases completely displaced. Usually this can be treated, but could lead to the need for further surgery in the worst cases. Any flap complication is likely to compromise the outcome of your surgery.
THE NEXT STEP
Having satisfied myself that the surgery was worth investigating further, I decided to book some consultations for a personalised assessment. There are now many clinics in the country performing LASIK and I attended three consultations to provide a comparison.
I chose Accuvision, Harley Street Laser Eye Clinic and Ultralase for my consultations. The consultation involves a number of tests to assess your suitability for surgery. Many of the tests you would receive in a standard eye exam, but additionally they measure corneal thickness, pupil size, eye pressure and produce a corneal ‘map’ showing the irregularities in the eye’s surface. The consultant should talk to you in detail about the likely outcome in your individual case and the complications involved. These consultations are free of charge, although there are still a few clinics charging £30 - £70.
I ranked my consultations as follows:
1. Accuvision – Very thorough. Pulled no punches in detailing the possible complications. Provided plenty of time for me to ask questions. Equipment seemed hi-tech and new. One consultant Optometrist completed the entire consultation. Consultation time: 1 hour 40 mins.
2. Ultralase – Very thorough. Less detailed on some aspects than Accuvision, and equipment slightly older. Also provided lots of opportunities to ask questions. Saw 3 different people. Kept me waiting between consultants at one point for over 25 mins which did not impress me. Consultation time: 1 hour 5 mins (excluding waiting time)
3. Harley Street Laser Eye Clinic (HSLEC)– Very Poor. Less tests performed than others. Consultant surgeon seemed keen to get it over with as quickly as possible, and effectively pushed me out of the door after just 25 mins.
No sales pressure was applied at any of these clinics, but after the consultations I was no longer interested in HSLEC. At this point, I discovered a fantastic UK website for reading experiences of patients and their dealings with the various UK clinics. It really is a must in helping you with your decision.
http://www.lasik-eyes.co.uk
THE TECHNOLOGY AND THE SURGEON.
Just to complicate matters further, there is consideration of the type of laser used, type of micro-keratome (the device used to cut the flap), eye tracking devices and wavefront. Again, please use the links provided to find out more, but as a summary:-
Laser – There are differing types available. This can impact the quality of outcome as different lasers will erode (ablate) your cornea with varying degrees of precision and potentially removing more of the cornea.
Eye-tracking device – These track the movements of the eye during surgery. Obviously, the laser needs to be precisely applied to the correct area and as hard as you try, you ain’t gonna keep your eye totally still. Typically, they will track your eye 250 times per second, although some trackers claim speeds up to 4000 times per second. In an active tracker, the laser will adjust to these movements accordingly. With a passive tracker, the laser will shut down if the eye moves more than a predetermined amount.
Wavefront – A relatively new innovation, wavefront creates a more specific map of the eye determining exactly how light entering the eye is dissipated. The theory is that by more specifically identifying areas of distortion, and treating those areas in greater detail, then the quality of vision post surgery should be enhanced, particularly where night vision is concerned. As it is a fairly new procedure, there is relatively little information available as to its advantages over the standard lasik procedure.
You will also want to know that you are in good hands. You should enquire as to the surgeon's record i.e. number of surgeries performed, the number that have required further surgery, the number that achieved 20/20 vision or better. You will get good ideas of the right questions to ask from the websites I mentioned.
MY DECISION
I decided to go with Accuvision. Ultralase were a viable (and considerably cheaper) alternative, but I was convinced that the Accuvision technology would maximise my chances of a best case outcome. The laser used would remove 10-15% less of my cornea than the one used by Ultralase, and Accuvision had given the best overall impression at consultation and also had wavefront. Despite the lack of data available, I decided that wavefront was worth pursuing as it appeared my vision could only be enhanced by using it i.e. there was no downside versus the standard procedure (other than cost).
On that note, I had decided to get this done where I felt I had the best chance of a great outcome. I only have one pair of eyes, I was not going to jeopardise those for the sake of a few hundred pounds. You can pay anywhere from £700 to £2,000 per eye for this surgery, you make your own decision – cost was not my deciding factor. If I wanted to get this done and it was out of my price range – I would save up a little longer rather than take second choice.
SURGERY DAY
I was taken into the preparation room where my eyes were cleaned with Iodine and anaesthetic drops applied. 10 mins later I was lying under the laser. I had read extensively about the procedure so knew what to expect and felt pretty calm. My eyelids were taped back to keep them out of the way then my left eye was covered, a suction ring was applied to my right eye, vision blacked out for 10 secs and was then very blurry. I could hear the faint sound of the micro-keratome cutting the flap, but could not feel it at all. With the flap safely folded out of the way, I was told to focus on the green light in the laser housing. This was proving difficult as I kept losing sight of it – the laser was applied three or four times in short bursts. There was an odd smell, which I am told is the laser gases. The flap was replaced, a protective contact lens applied and the eye covered. After a short delay, the procedure was repeated for the left eye, although this time I had no problem focussing on the green light. No pain was experienced, just slight discomfort when the suction ring was being fitted.
I was taken into the consultation room, and advised that surgery had gone well.(Thankfully!!) A couple of inspections revealed no initial problems. I was given some eye-drops and instructed on their use and then sent home with orders to rest the eyes as much as possible and under no circumstances must I rub the eye. By this stage, my eyes were irritable. It was akin to having a piece of grit in your eye – more annoying than painful. I was driven home by my wife. I wanted to keep my eyes shut as that was the most comfortable, but I could not resist the urge to open them occasionally to read a numberplate or road sign – the first time I had been able to do that without glasses or contacts for over 20 years. Once home, I kept my eyes closed for most of the evening, taped on my protective eye shields to prevent rubbing the eyes whilst sleeping and hit the sack.
THE NEXT DAY
Eyes still irritable when I woke, but vision much clearer. Went to Accuvision for check up. Protective contact lenses were removed and the irritation immediately subsided. Advised everything looks good. Vision tested at almost 20/20 and told it will continue to improve. Already my vision was better that it used to be with contact lenses. Very pleased at 24 hours.
THE NEXT WEEK
Over the next week, vision and focus progressively improved. There were fluctuations, particularly if working on the PC or reading a newspaper, but they were minor inconveniences. They say you could go back to work the day after surgery, but I would not recommend this. I would definitely opt for a Thursday or Friday surgery and take the weekend to fully get used to your ‘new’ eyes.
I was experiencing some night vision issues – starbursts from bright lights, ghosting from streetlamps, but these were not severe. Irritation was virtually non-existent after 3 days and was largely due to some minor dry-eye symptoms. Easily solved with eye drops.
At my one week checkup, vision 20/20 everything looking good.
TWO MONTHS ON
Well almost two months as I write…..my last checkup at 5 weeks had vision at slightly better than 20/20 in both eyes with the flap healing well. I have experienced no discomfort for weeks now, the fluctuations are decreasing and the night vision issues are all but gone - not quite as sharp as before, but I can safely drive at night with no problems. I am pleasantly surprised that Dry-Eye has not been a problem – particularly as I spend 12 hours looking at a PC monitor. Overall, I am extremely pleased with the outcome. After 22 years of wearing spectacles, I still get that strange sensation behind the ear that can be caused by poorly adjusted specs, or occasionally I will attempt to take my specs off even though I am not wearing any – slowly but surely I am getting used to the fact that I no longer need them. YIPPEE!!!
WOULD I RECOMMEND LASIK?
Maybe!!! There are so many factors to consider that it will not be right for everybody. I am, however, happy to recommend the team at Accuvision who have been superbly professional throughout.
Remember, this is a surgical procedure and there are real risks involved. You are playing with your eyes, and whilst there are no documented cases of anybody going blind as a result of lasik, you need to satisfy yourself that the risks are worth taking. Do some thorough research, contact some former patients and make up your own mind. For me, I am very pleased to have taken the plunge. Simple things like going out in the rain, or exercising at the gym or going swimming, even riding rollercoasters are so much easier now - I can’t wait to go on holiday!!!!
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