Tag: surgery lasik

On rare occasions, one will encounter a patient with extreme anxiety, if not an outright phobia, with his eye examination. Not only will he refuse all drops, citing agitation and fear, but also there is absolute defiance toward any tonometry or touching of the eyelids. Contact lenses? Not a chance. LASIK surgery? No way. Well, maybe. 

We have performed LASIK eye surgery on these types of patients utilizing general anaesthesia or, in the more recent past, with a Diprivan (propofol, AstraZeneca) drip. With the advent of Diprivan, surgery lasik can quickly and easily be performed even in the most highly anxious patients. 

Our pediatric colleagues perform exams under anaesthesia routinely and without hesitation. One wouldn’t hesitate to use Diprivan to achieve a lower eyelid blepharoplasty. There is an entire subspecialty within dentistry that utilizes conscious sedation. Furthermore, literature on LASIK surgery in the pediatric population utilizing general anaesthesia is abundant. However, I have yet to read anything in the literature on using Diprivan in adults for performing LASIK. 

Ironically, we all have had patients who became agitated or completely uncooperative after we had already started their LASIK. During these complex cases, the surgeon, whose pulse is racing as fast as the excimer fires, often thinks, “I wish I had an anesthesiologist right now to sedate this patient!” These markedly uncooperative patients can have suboptimal results secondary to movement during flap creation and poor fixation during the ablation. I recommend a much safer way of treating such patients if the surgeon can identify them before surgery. 

Related: How to Choose An Expert Surgeon for Your LASIK Eye Surgery

Once carefully consented, these patients can be the most ecstatic and gratifying people in one’s practice. It’s almost as if they had given up hope of discarding their glasses. In the past 14 years of having a practice specializing in LASIK and cataract surgery, I have performed LASIK using Diprivan anaesthesia on two patients. Both were in their early 30s. Neither tried contact lenses because of the “fear of something getting near their eyes.” Just getting close to their eyelids would lead to panic. They infrequently scheduled examinations because of anxiety. Both were moderate-to-high myopes who had never even considered the surgery until I offered them the option of performing it with an anesthesiologist. 

Preoperative preparation

Your surgeon will conduct routine testing. After that, he will use Pentacam and Orbscan to quickly obtain the thickness of your cornea without applanation pachymetry. Schirmer’s testing may not be possible, so the customary tear film, meibomian gland and external exam are even more critical. Your surgeon should also document the size of your pupil even with a penlight if the patient is intolerant of formal pupillometry. 

Consent

These patients certainly do not want to hear any details of the procedure. However, they need to have the risks of infection, complications and even blindness explained carefully, as with any LASIK patient. Furthermore, they need to explain the risks of anaesthetic-related complications. 

Anaesthesia

These cases should be done in a laser centre adjacent to a surgery centre so that the patient can receive appropriate care if there is an anaesthetic-related complication. The patient fasts for 6 hours before the procedure, before a board-certified anesthesiologist uses some medication on the eyes. Your optometrist should explain the case details to the anesthesiologist ahead of time. Ideally, the anesthesiologist can watch an earlier case to become familiar with what he will do. All appropriate equipment, medication and monitoring devices should be available. 

The surgeon will start an intravenous line and administer verse to relax your nerves. He will then administer oxygen through a nasal cannula, obtain pulse oximetry and place EKG leads. The eye care provider will also help with Vitals, blood pressure, respiration and record pulse, as with any similar intraocular or extraocular surgical procedure. Gas anaesthesia is a poor choice because of reports of nitrous oxide interfering with the argon fluorine excimer laser. A Diprivan drip is a perfect sedative because of its rapid induction time and effortless ability to titrate the dose. Once he turns off the “drip”, the patient rapidly returns to normal. 

Intraoperative procedure

He continues to do the usual prep. Draping the lashes and placing the lid speculum are best done after the patient is unresponsive. Using an IntraLase femtosecond laser (Abbott Medical Optics) must be in the same room as the excimer laser because the patient will be immobile for the entire procedure. 

The trickiest part of the procedure is tracking. It is impossible to place limbal marks for astigmatism alignment preoperatively. Thus, preoperatively noting iris or limbal landmarks can be helpful. I used the Visx laser (AMO) on both patients with outstanding results, but there may be some advantages to using a laser with an activity tracker. 

Using toothed forceps or globe fixation devices can be critical for fixation. One of my two patients became a bit “lighter” as I began the excimer portion of the surgery on the second eye. She was very cooperative with fixating on the fixation light. 

Checking the flap for alignment, fibres, and debris is critical before completion because it will be challenging to do anything postoperatively without subjecting the patient to another round of anaesthesia. Your surgeon will place the goggles before stopping the Diprivan drip and exiting the laser suite. 

Postop

As with any ophthalmic procedure, the anesthesiologist or recovery room nurse monitors the vital signs, gives the patient something to drink, removes the IV and discharges the patient when ready. Carefully explaining instructions to family or friends is essential. These patients will struggle with their postoperative drops. I have explained preoperatively to the patient, family, and friends the best way to administer eye drops. I like to have the patients lie down supine with their eyes closed. 

The drops are placed in the medial canthal area while their eyes are closed. Your ophthalmologist will instruct you to open your eyes after he might have put the drops in the medial canthal “trough.” After opening their eyes, if you don’t feel any drop getting into the eye, the surgeon needs to repeat that procedure until you feel something. 

Conclusion 

I hope this article will encourage my colleagues to try this procedure. Countless people are terrified of having their eyes examined, let alone having LASIK. Offering an anesthesiologist to such patients can make LASIK as life-changing an event as it has been for the rest of us. 

LASIK eye surgery is a sure way to improve your overall vision, but protecting your eyes doesn’t stop after the procedure. Instead, to ensure the best post-operative results and to safeguard your vision well into the future, there are essential steps you need to take to promote and protect your overall eye health.

Following the procedure, your surgeon will give various post-operative instructions to encourage a quick recovery. But even once you are fully recovered, there are certain things you should do regularly to protect your eyes. Learn more about quick recovery after LASIK surgery.

This article reviews the best things you need to do to protect your eyes after having LASIK surgery. Not only will those practices ensure you achieve your desired, but they can also protect your eyes from future damage and injuries.

Plan Your Outdoor Activities Carefully

One of the benefits of LASIK surgery is it offers a quick recovery time – most people are back to their daily routines within the first 24 hours. But, you won’t be able to do all activities right away. You won’t be able to engage in some strenuous activities for a few days, or in some cases, a week. We have devised a recommended activity schedule for you to follow.

For example, on the day of your LASIK eye surgery, you must avoid any activities in which your eyes may be rubbed, poked, or touched. You must prevent showering so that water and soap don’t get in your eyes. You won’t drive your lovely cars and will be instructed to avoid alcohol. However, you will complete outdoor activities or light exercise three days after your LASIK eye surgery. You can only swim with tight goggles. But, you will have to go out without applying your precious eye makeup. A week after the procedure, you can resume vigorous activities, like sailing or swimming.

Remember, even when you are fully recovered and become active in participating in various activities, it is important to utilize proper protective gear, such as safety goggles. That is especially important if you have a job in which eye injuries are common in the workplace.

Attend Post-Operative Exams & Appointments

Following your procedure, we’ll schedule you for various mandatory post-operative exams to monitor your recovery progress. These take place:

• 24 hours post-procedure
• Two weeks post-procedure
• 1-year post-procedure

It is also essential to keep up with regular eye exams. That isn’t only to evaluate the results of your LASIK eye surgery but to monitor your overall eye health. That is important even if you don’t have any apparent trouble with your vision since many eye problems, such as glaucoma, diabetic retinopathy, cataracts, and macular degeneration, can go unnoticed.

For adults younger than 40 years with no diagnosed eye problems or symptoms, it is usually recommended to have a constant eye check-up every two years. Conversely, since eye health tends to deteriorate with age, those 40 and older should get their eyes checked every 1-2 years. People with a history of eye problems can consider seeing their eye care provider at least once every year.

Treat Dry Eyes

Some patients experience dry eyes after their LASIK eye surgery, although in many cases, LASIK side effects are temporary while the eyes heal. The following symptoms characterize dry eyes:

• Burning, red, or itchy eyes
• Excessive tearing

There are various ways to correct dry eyes. For example, standard methods to treat dry eye include over-the-counter or prescription medications; speak to your doctor for more information. You may also use warm water to relieve yourself from the symptoms. You can place a wet cloth over the treated eyes for ten minutes, massaging the eyelids with mild soap.

You can also try a relief plug, a microscopic plug inserted into a patient’s tear duct. It increases the tear film’s level, thereby helping to regulate moisture levels and minimize the discomfort of experiencing dry eye symptoms.

Wear UV-protective Sunglasses Outdoors

Even if you have not had LASIK surgery, wearing sunglasses is essential for ensuring your overall eye health. Specifically, sunglasses protect the eyes from UV rays, which can cause macular degeneration, cataracts, and many other things.

Beware that not every sunglass is made of the same quality of materials. Wearing sunglasses without an appropriate level of protection will do little to protect your eyes. The American Academy of Ophthalmology recommends looking for sunglasses with a tag or sticker indicating they block 98% to 100% of UV rays.

Furthermore, you’ll be instructed to wear a particular pair of sunglasses immediately following your LASIK eye surgery, which will be provided to you. We ask that you wear these sunglasses instead of a personal pair, which may not provide sufficient protection. Afterwards, continue to wear high-quality sunglasses that block 98% to 100% of UV rays when outdoors.

Protect Your Eyes From Digital Eye Strain

Digital eye strain refers to vision-related problems caused by prolonged exposure to digital devices. It’s characterized by symptoms such as:

• Eyestrain
• Headaches
• Blurred vision
• Dry eyes
• Neck and shoulder pain

Digital eye strain has been linked to various short- and long-term health problems. Whether you work at a computer or scroll through a phone or tablet in your time, taking steps to protect the eyes from the blue light emitted by digital screens is crucial to ensuring overall eye health.

For example, blue light-blocking glasses have recently emerged as a promising way to protect eyes from strain caused by devices. Some perceived benefits include reducing eye strain, promoting better sleep, and increasing productivity. Research on the attractive benefits of blue light glasses is still inconclusive. However, there are other helpful steps you can take to minimize digital eye strain, including:

• Sit 25 inches away from the screen.
• Utilize a matte screen to reduce glare.
• Avoid using devices before bed.
• “20-20-20” Rule: look at something every 20 minutes for at least 20 feet away for 20 seconds.

Final Thoughts 

LASIK eye surgery can restore your vision by reducing or removing the need for eyeglasses and contacts. But the key to achieving the best post-operative visual results is incorporating habits and deliberate practices that promote best eye health. From keeping up with follow-up appointments and eye examinations to wearing the proper eye protection, it is up to you to protect your vision.

LASIK eye surgery is arguably the most remarkable medical innovation of the present day technology, eliminating the need for glasses or contacts and restoring near-perfect vision for tens of millions of patients. It is still a surgical procedure, and your future vision depends on selecting the most qualified, skilled, and experienced LASIK surgeon in your neighbourhood. 

Finding a good LASIK surgeon is among the most critical steps you will take if you have been diagnosed with sight problems and are considering a vision correction procedure like lasik eye surgery. Since everybody is different, knowing the exact thing that works best for you regarding personality and approach is essential. Getting that grit feeling: “Yes, you must be able to say: this is the expert  I trust, who can give me the confidence to proceed and help me achieve my vision goals” is extremely valuable.

5 Things To Ask When Choosing your LASIK Surgeon 

Several recently posted reports on the Internet explain what makes the best LASIK eye surgery candidate, but the qualities that define the best LASIK surgeons are even more critical. The surgeon’s profile, credentials and current licensure are the foundational places to start. And, you must have verified every detail online to be double sure.  

Your preferred LASIK surgeon must be a board-certified ophthalmologist. Once you have verified that, look a little deeper to ensure your eyes get the safest LASIK surgery, diagnosis, and long-term follow-up care they deserve. 

How many LASIK procedures has he performed, and how many does he perform surgery each week?

While we acknedlege the fact that every one of us would start our career journey somewhere, it is also true that the doctors’ experience, reviews and track records should speak volumes for themselves. Preferably, your LASIK surgeon must have completed at least 10,000 procedures in his entire career. Also, he should perform them regularly, which indicates their skills are top-notch and recommendable. 

One of the most critical questions you can ask your soon-to-be surgeon is, “Have you ever rejected a patient’s request for LASIK eye surgery?” if the answer is ‘Yes’, you are on the right track. It shows the surgeon knows the rules and regulations of the procedure. The reality is that not everybody is a good LASIK eye surgery candidate. Exclusions include diabetes, immune system disorders, or rheumatoid arthritis.   

If the surgeon says he has never rejected a patient, it might mean that he loves money more than the patient’s overall well-being and long-term success, and that is not the right surgeon for you. The right ophthalmologist will always prioritize your health and safety above all else. 

He must have successfully treated numerous patients with your vision diagnosis.

LASIK surgeries can correct many vision problems, including far-sightedness, near-sightedness, astigmatism, and more. Your surgeon should have experience using LASIK surgery to treat patients with the same type and vision impairment successfully. Knowing that your soon-to-be surgeon has performed thousands of successful LASIK surgeries on patients with similar vision problems will give you peace of mind. 

When choosing the right LASIK surgeon, do not base your decision on the cost

Beware of prices that looks too cheap. When selecting the right LASIK surgeon, some may offer you bottom-dollar pricing, but you don’t have to sacrifice the excellence of the procedure and post-surgery care for a discount. Equally, some surgeons may provide you with what seems to be an attractive discount but instead offer terrible service.  

What feelings were you left with after your consultations?

You should schedule LASIK eye surgery consultations with your region’s two or three competent surgeons. In addition to providing more opportunities to understand the procedure and what you should expect, you also can get a feel for their office space, staff, and the surgeon.  

While you are there, take the time to evaluate and ask yourself the following questions:

• Are the staff members friendly? 
• Was the consultation with the surgeon educational and informative? Or did he appear more like a salesperson? 
• Did you feel calm asking your questions? Were the answers understandable? 
• Did you feel seen, listened to, safe, and cared for?

Always honour your grit feeling. If the office space offers “all of the greatest and latest” in LASIK technology, but you do not feel comfortable, or the surgeon seems untruthful, your search is not over. Only trust your vision to an ophthalmologist who has gained your 100% trust without remorse.

Do they offer the most suitable laser procedure for you?

There is nothing like size fits all procedure in vision correction. The options include LASIK,  implantable contact lenses, refractive lens exchange and PRK. Your surgeon should be transparent about which procedure is best to accomplish your desired vision correction and whether or not s/he can perform the surgery.

The Best Three Tips for Finding the Right LASIK Surgeon for you 

Here are three tips for finding a perfect LASIK surgeon:

• Do thorough research. The Internet, your local chamber of commerce, and medical organizations like the American Academy of Ophthalmology and the American Society for Cataracts and Refractive Surgery are all excellent resources.
• Get referrals from family and friends who have had the procedure. Talk to them about their experiences. It is also a perfect idea to speak with your physician and optometrist to get their input and perhaps even a referral.
• Once you meet a qualified surgeon, get additional references and recommendations from current and past clients who can discuss their capability with the particular surgeon and practice.

You want the most competent surgeon to help you achieve your ultimate vision correction goals and expectations, so put in the effort to find the right surgeon that meets your needs.

In conclusion 

Beware of a surgeon who over-promises. LASIK eye surgery is a terrific option, but there are boundaries to what it can achieve. For instance, it may not give you perfect vision, just better vision. And since your eyes will continue to change, you might still need reading glasses when you’re older. Your surgeon should be upfront about these limitations, including what you should expect for how long LASIK lasts, LASIK risks, what to expect with LASIK recovery, and more.