According to the American Academy of Ophthalmology, LASIK is the most popular vision correction procedure in the United States. It’s a surgical procedure that reshapes the cornea to improve vision. The surgery is done under local anesthesia, which means the patient is awake, but their eyes are numb. All told, the procedure takes about five to ten minutes per eye.
The cornea is the clear lens covering over your iris and pupil. In LASIK surgery, a thin flap is cut in the cornea and lifted up to expose its inner surface. A laser then reshapes the cornea, and the flap is put back in place in order to promote quick healing.
The procedure can improve your vision to a level that allows you to see well without glasses or contact lenses. The surgery can be used to correct nearsightedness and astigmatism. It is not as effective or appropriate when used in hyperopic (far-sighted) eyes.
LASIK is considered safe and effective, but it does have some risks.
There are definitely some variations in the cost of LASIK. The doctors at Cannon EyeCare only refer to the top-rated local Seattle-Metro area surgeons. The cost is typically about $4500 total (not including preoperative care). Sometimes the surgeon and optometrist work out a co-management agreement that allows you to pay for the surgery and all follow-ups at once. In other practices, you’ll pay the optometry clinic directly for post-operative care.
It is important to know your insurance will not contribute a dime to cover the cost of LASIK in the vast majority of cases. Insurance companies see LASIK as an ‘elective procedure.’ Since it’s not ‘medically necessary,’ they typically won’t cover it. Check with your Human Resources department or call your insurer for details.
The ideal LASIK candidate:
To find out if you are a LASIK candidate, schedule a consultation with Dr. Cannon. The medical practice Cannon EyeCare is located at Market Optical in Seattle’s University Village shopping center.
If you have any questions, please call our office at (206) 522-9323.
Visit Cannon EyeCare in Seattle’s University Village for a preoperative examination and evaluation. Ideally, you would come to this visit with your last few pair of glasses. Bringing in the prescriptions would also allow the eye doctor you work with to assess how stable your prescription is. See this article in our medical eye blog about preparing for your eye exam
The initial visit is much like a routine eye exam. There will be at least one additional preoperative visit to double-check initial findings. Typically, you would be dilated at the second preoperative visit. You will also get a “cycloplegic refraction” at the second visit. This test involves the use of drops that blur your vision for 24 hours. The blur is a result of the main effect of this drop: stopping the eye muscles from focusing. The side effect of a cycloplegic refraction is blur that is much like when you had your eyes dilated in the past, but it lasts for approximately 24 hours.
Some patients will need to work on improving eye health issues such as blepharitis (crusting and irritation on the lids from bacterial overgrowth). Others may need to work on dry eye or other ocular surface issues to become a better surgical candidate. These preoperative visits can often be billed to insurance.
Read More — How to prepare for your eye exam
It is important to understand that wearing contacts can cause swelling (edema) in your corneas. Contact lenses themselves (especially RGPs or poorly-fit soft contacts) can also cause some irritation on your cornea or the nearby tissues. Then there’s the contact lens solution, which is typically a cocktail of chemicals that kill bacteria, fungus, and viruses. Contact lens solutions themselves can cause ocular surface diseases such as dry eye and keratitis.
Here is the take-home message: if at all possible, avoid wearing contacts for a full week before your each preoperative (pre-op) visit and your surgical date. The importance of this in your outcome could not be overstated.
LASIK is considered safe and effective, but it does have some risks. These include dry eyes, glare and halos around lights, and a condition called post-LASIK ectasia — a gradual warping of the cornea that can lead to serious vision problems. Severe complications like this are exceedingly rare at the time of this writing in the summer of 2021. Modern technology paired with a skilled surgeon makes the risk of this type of issue extremely low these days.
Some people who get LASIK have trouble seeing at night, especially when driving at night or in bad weather. This glare is a known side-effect and is more common in younger individuals because they have larger pupils. This happens because larger pupils allow light through the peripheral cornea outside of the LASIK treatment zone.
LASIK does not fix presbyopia — the normal loss of near vision as we age. This is a big part of our recommended age range. Everybody expects that after LASIK, they won’t need glasses. We want our patients who get LASIK in their 40s (or beyond) to understand that they are likely to need reading glasses for near work.
The LASIK procedure is done in an ophthalmologist’s office. It is not an overnight stay. The entire procedure takes about 15 to 20 minutes. Yet, there are many steps before and after the surgery. You should expect to spend 3-5 hours at the surgery center. Please bring a driver to take you home.
The surgical support staff and technicians will be able to help you if you need anything before or after surgery.
When the surgeon is ready for you, you will go into the operating room where you will lay down and have very specific instructions to follow.
You will hear some noises during the procedure but should not feel significant discomfort. Some patients report smelling something similar to burnt hair, which is normal.
After the LASIK procedure, you may have some mild discomfort for a few hours, but this should resolve with the use of medicated drops and NON-PRESERVED artificial tears. Taking a nap after surgery is often helpful as well. There are no bandages or stitches, so you can go home right after the surgery. It is important to avoid rubbing your eyes after LASIK surgery, as doing so can dislocate the flap.
Read More – A Clear Look at the Cornea Flap
You will need someone to drive you home because your vision will be blurry for several hours after surgery. Most patients can return to normal activities 24-36 hours after surgery. Many patients take just 2 days off work for LASIK – the day of surgery and the day following surgery.
Make sure you understand how the surgeon wants you to use your medicated drops and the non-preserved artificial tear drops before you leave the surgery center. If you have questions, please ask them before you leave.
Don’t rub your eyes at all in the first 2-3 days after surgery. Be gentle if you do rub them at all in the first month after surgery. Rubbing the eyes before the flap has fully adhered to the rest of your eye can result in a dislocation of the flap. This can be a serious complication.
Do not smoke or use nicotine products during your recovery period. Smoking can cause complications with healing and increase the risk of infection after surgery.
Typically there will be a 1-day post-operative exam at the surgery center. Most patients will need a 1-week post-op exam with their optometrist. Some will also need a 1-month follow-up depending on the surgeon’s preferences and how fast the eyes are healing.
If there is any indication of complications, you may be asked to return sooner for additional examinations to monitor your progress.
It is quite rare, but there have been reports of retinal tears in myopic patients after having LASIK. It is important that LASIK patients understand the importance of reporting changes in flashes, floaters, or loss of vision in the month after surgery as soon as possible.
Patients often have a good deal of anxiety when thinking about getting eye surgery. While every surgery has risks, LASIK has been refined to the point that the outcomes are reliably good and the risk of serious complications is quite low.
Still, it’s important to become well-educated about the treatment’s risks and benefits and the pros and cons of different surgeons and surgeries. While the eye doctors at Cannon EyeCare do not perform LASIK procedures, we do coordinate surgical care with a few carefully selected surgeons.
We would typically see the patient for an initial preoperative eye exam and evaluation. This initial evaluation will seem similar to a routine eye exam. Then, if the patient is a good LASIK candidate, we would see them for 1-3 additional preoperative visits. Most patients just need one or two follow-up visits prior to surgery, and these visits can sometimes be billed to insurance.
It is important to understand that no surgery is without risk. Letters back and forth between your optometrist and the ophthalmologist / surgeon keep everybody in the loop so that they can coordinate care and handle any complications in a timely manner.
LASIK is designed to significantly reduce your need for glasses and contacts. There is a risk of dry eye in the first six months following surgery. You may also have some long-term glare in dim lighting. Patients occasionally notice that focusing on near tasks takes more effort, but this typically resolves within a month unless the patient is over age 40.
The reason that myopia makes you a good candidate is that myopes (nearsighted patients) tend to get the most precise, predictable, and stable correction from LASIK.
If a hyperopic (far-sighted) patient chooses to get LASIK, they are more likely to need glasses within a few years. Mild to moderately nearsighted patients (-0.25 to about -2.50 diopters) are not such great candidates for LASIK because their vision is not so bad in the first place. While it can be frustrating to need glasses to drive, nearsighted people with a moderate Rx can read and /or use computers with ease, which is kind of nice in today’s society.
Patients who are a -3.00 and up cannot even read their alarm clock without finding their glasses first. This severe distance blur makes them good candidates for LASIK or similar forms of refractive surgery.
Clearly, patients with terrible distance vision receive a larger benefit from refractive surgery than those with a mild Rx. Patients beyond -7.00 of nearsightedness may not be a candidate for LASIK, but read our blog about PRK for other options.
LASIK also helps people with astigmatism, but it is not ideal for those with more than two or three diopters of astigmatism.
Having a stable glasses prescription for 2+ years prior to surgery is crucial; your surgeon does not want to try to hit a moving target. People with a variable prescription prior to surgery are much less likely to be satisfied with their result from LASIK.
Both your ophthalmologist (surgeon) and your optometrist (primary care eye doctor) want you to be happy with your result 5 years or even 10 years down the line. Waiting until your prescription is stable (typically age 25-28) benefits everybody involved – you most of all.
The reason that age is a factor is two-fold:
A good LASIK surgeon will not want to operate if your eyes are unhealthy to begin with. Corneal degenerations and ocular surface diseases like dry eye are contraindications.
Some things, like mild to moderate blepharitis or dry eye, can be brought under control by your optometrist with a few medical eye exams and related home treatments before you see the surgeon.
Other problems, like moderate to severe dry eye or a corneal dystrophy, may make you a non-candidate. See your local optometrist for an eye exam to see if you might be a good candidate for refractive surgery. If you want to be glasses and contact lens-free, LASIK could be the way to go.
Yes. You will be fully awake during the surgery. The surgeon actually needs you to be awake, aware, and participating in the treatment by looking at a fixed spot. If a patient feels anxious prior to surgery, they should inform the surgical staff. The surgeon is an MD and can sometimes authorize the use of in-office pharmaceuticals to help curb surgical anxiety.
The risk of blindness is extremely small. The most common reason for vision loss after LASIK is a condition called keratoconus, which occurs in about 1 out of every 2,000 people who undergo LASIK.
Keratoconus causes an increase in the steepness of the cornea, which can lead to severe nearsightedness and astigmatism. It can also cause significant light sensitivity and glare.
Other rare complications include flap dislocation (when the flap folds over on itself due to injury or eye rubbing during healing), infection, inflammation, and scarring. These complications generally occur in less than 1 percent of cases.
Your optometrist will do their best to get any dry eye disease under control prior to your surgery. Controlling this problem helps with the accuracy of the surgeon’s laser treatments as well as the ease of healing. This is because one of the most common side effects of refractive surgery is symptoms of dry eye. See your optometrist for help with managing dry eye. Please understand that any medical visits beyond the 30 days after surgery will likely be billed to insurance or paid out of pocket.
The short answer is yes. LASIK surgery is a permanent procedure, but it does not mean that you will never need to wear glasses or contacts again. Even if you achieve optimal results and need no correction for distance, you will still need to wear glasses or contacts for reading and close-up vision after age 44.
The best predictor of your prescription stability after surgery is your prescription stability before surgery. If your prescription has not changed significantly since your surgery, the results of your LASIK procedure should last for 10 years or more. That being said, the precision of LASIK results varies widely. This is why we don’t recommend using a GROUPON to get LASIK.
The National Eye Institute says that “Your eye care professional may recommend an eye exam every year or two after LASIK to check for changes in your refractive error (how well your eyes focus).” It’s also noteworthy that many surgery centers require annual eye exams in order to maintain their surgical warranty for touch-ups.
Sincerely, Dr. Mark J. Cannon, optometrist @ Cannon EyeCare (at Market Optical) in Seattle, Washington