LASIK: ocular refractive surgery
What is it?
LASIK is a suitable procedure for the correction of myopia, astigmatism and hypermetropia.
What is it?
Understanding how LASIK surgery works.
Synonyms: Refractive Surgery, Ceratorrefractive Surgery, Laser Excimer Surgery . The term LASIK comes from English, which means Laser-Assisted in situ Keratomileusis. The surgery decreases the dependence of glasses or contact lenses, and can even dispense the use. Unlike LASEK and PRK surgeries, LASIK surgery does not perform advanced surface ablation, in which the corneal epithelium is removed. However, in all three surgeries the same laser is used, which works to re-sculpt the curvature of the cornea according to the degree to be treated.
Which doctor performs surgery
LASIK surgery can be either normal or personalized. The normal LASIK, or therapeutic, is made based on a unique model, which caters to most people. Custom LASIK requires a specific examination of the patient's eye, and LASIK surgery will be in a specific way for that patient, that is, the professional will work the laser in a different way, especially for that case. The steps of both surgeries, however, are the same.
LASIK surgery can be done by people who have ametropia (myopia, astigmatism and farsightedness), individual or combined. However, the surgical option depends on the evaluation made by the ophthalmologist, as some candidates may respond better to PRK or LASEK surgery. People with a combination of ametropia can correct all of them in one procedure. It is important that the patient has the cornea of sufficient thickness so that the surgeon can make, with the use of laser, the appropriate modification to his case;
There are different limits for each ametropia. The minimum limits are dictated by the dependence of the glasses, ie any person who depends on the use of glasses would have ametropia large enough to be able to be evaluated for LASIK surgery. The ceilings, however, are more restrictive. The ideal indications are for myopia less than 8.00 degrees, astigmatism less than 4.00, and hyperopia less than 4.00.
Prior to LASIK surgery, the ophthalmologist should have a complete ophthalmologist . All vision surgeries should include topography and central pachymetry examinations along with retinal evaluation, which includes corneal thickness, refraction, corneal mapping, pressure, and pupil dilation as the measurement of corneal thickness. These are the minimum examinations that must be performed, according to the Brazilian Council of Ophthalmology, the Ophthalmic Specialized Ophthalmic Center and the Brazilian Society of Refractive Surgery. However, are there other exams that can be ordered by the doctor, such as corneal tomography, which evaluates the cornea and ocular aberrometry three-dimensional? study of full-spectrum optic aberrations and study of higher order aberrations. This battery of tests will also assess whether the patient needs a personalized LASIK
On the day of your LASIK surgery, it is best to take a light meal and take any medications that may be prescribed, as antibiotics. Do not wear eye makeup or have any bulky hair accessory, so as not to interfere with the positioning of your head. In addition, the treatment of inflammations and infections of the ocular surface, such as blepharitis, are fundamental to the success of the surgery.
How it is performed
During the LASIK procedure, a device called a microkeratome or femtosecond laser is used. cut a thin layer on the cornea, about 0.1mm thick. This first procedure, called a flap, is what differentiates LASIK from other refractive surgeries. This lamella is then lifted and the newly exposed tissue of the cornea is treated with the same laser used in LASEK and PRK (excimer laser) eye surgeries for corneal remodeling and grade correction. Fixing the patient in the laser light during surgery is critical for more perfect correction. After this step, the corneal removed flap is placed back and the surgery is complete.
Types of Anesthesia
Local anesthesia through eye drops. Some surgeons may apply mild sedation, but everything will depend on the patient.
LASIK surgery takes about 10 minutes to be performed in both eyes.
Length of stay
LASIK surgeries usually done in an outpatient setting (laser centers). The time spent depends on local logistical procedures, but usually the patient stays in the hospital for about 1 hour.
Who can not do
The contraindications for visual correction with LASIK are related to the patient having some disease in the cornea, such as keratoconus , in which refractive surgery may worsen the disease. Other eye diseases, such as glaucoma and cataracts, are contraindications to LASIK, as well as people who have degrees higher than the surgical indication. Patients who may be contraindicated for having surgery or having the procedure postponed are:
- Patients with a history of dry eye syndrome
- Persons on treatment with medicines that make healing difficult, such as steroids;
- Presence of a scar on the cornea;
- Prescription of glasses or contact lenses unstable in the last two years;
- Pregnancy or lactation;
- History of ocular herpes in the last year; is patient recovery
LASIK surgery has a faster recovery compared to LASEK and PRK surgeries, but you have to be very careful not to scratch your eyes. The patient may experience pain, sore eyes, discomfort, tearing and photophobia within five days of LASIK. There will be recovery of 90% of vision in 24 hours and 100% in two months. The dependence of the glasses will be diminished, being able to reach the total independence. Vision can range from light to blurry for the first 24 hours after LASIK surgery. There may be some degree in 1 to 5% of the cases depending on the initial ametropia.
Care after surgery
It is not necessary to use a buffer, but a therapeutic contact lens for a week, regardless of grade. The contact lens is applied immediately after surgery, and allows the surface of the eye to heal completely. Once the surface of the eye is healed, the contact lens is removed. Use of specific eye drops for one or two weeks is also indicated to prevent infections and keep your eyes moist. Visits to the ophthalmologist should be made during the first six months after surgery, normally following the following schedule: the day after surgery; one week after surgery; 30 days after surgery; three months after surgery;
Some recommendations of the Brazilian Society of Refractive Surgery after LASIK surgery are:
- Avoiding eye trauma (strokes, falls, etc.)
- Avoid group sports for 30 days
- Avoid scratching or rubbing the eyes
- Avoid swimming pool, sea, sauna and makeup for 30 days
- Avoid physical exertion for a week - Start using medication on arrival
- Rest and keep your eyes closed for three hours after surgery;
- Maintain your hygiene habits, such as bathing and washing your face, without dropping water, shampoo or soap into your eyes. If this occurs, drip two to three drops of lubricating eye drops;
- Wear sunglasses during the day and in outdoor activities, especially when exposed to the sun; - Avoid use of cosmetics, hair dye for 15 days,
- Protect the eyes in environments with dust, plants and volatile substances, for 15 days;
- When washing the face, avoid rubbing the eyelids;
- Always wash your hands thoroughly with soap and water before eye care;
- Do not remove contact lenses. If it falls out of your eyes, do not refill and contact your doctor immediately.
There is a risk of inadequate correction of the degree and need to re-operate in 1 to 5% of cases. There is also the risk of infection and creation of corneal irregularities. It may be that the patient experiences a marked loss of vision over time, but it is very rare. In the event of the need to redo the operation the LASIK, PRK or LASEK technique may be used again. In LASIK, complications related to infection are rare, in the order of one case for five to ten thousand patients operated. However, LASIK surgery may have complications related to flap. If the patient scratches his eyes the first week, he may move the flap, resulting in a medical emergency. But LASIK surgery is approved by the National Agency of Sanitary Surveillance (ANVISA), by the Brazilian Council of Ophthalmology, by the Brazilian Council of Ophthalmology, by the Brazilian Council of Ophthalmology. Ophthalmic Center Specialized in Ocular Surface and by the Brazilian Society of Refractive Surgery
Cost of surgery
So far, the Unified Health System (SUS) does not perform LASIK surgery. The health plans cover refractive surgery for hyperopia up to 6 degrees and myopia from 5 degrees, associated or not with astigmatism, according to Resolution 167 of the National Agency of Supplementary Health (ANS).
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