In conventional LASIK, a microkeratome that contains a disposable surgical blade is used to cut and form the hinged corneal flap. Since sometimes LASIK complications are associated with the abnormal cutting of corneal flap with a microkeratome, IntraLase Corp. (Irvine, CA) has introduced a variation of LASIK called bladeless LASIK.

Bladeless LASIK uses a type of high energy laser called femtosecond (FS) laser or IntraLase instead of microkeratome blade to create the hinged flap in LASIK surgery, while other steps are the same as conventional LASIK procedure.

Bladeless LASIK or IntraLase is claimed to significantly decrease the overall LASIK complication rates. However, LASIK surgery costs more - about $250 to $500 per eye - if you choose the IntraLase method. Usually, you will be given the choice whether you prefer a microkeratome blade or IntraLase in creating corneal flap but sometimes some surgeons only use IntraLase method and may bundle it into the overall LASIK fee.

It is important to know that the IntraLase FS laser is different from the laser used to reshape your corneal tissue. In IntraLase LASIK, the surgeon uses two types of laser in LASIK procedure - the IntraLase FS laser to cut the corneal flap and another laser to remove your corneal tissue. This is why IntraLase is sometimes promoted as bladeless or all-laser LASIK.

There have been many tremendous technology advancement made to correct vision problems in recent years and many patients have had successful results and reported that the refractive eye surgery they had have improved their quality of lives by not having to see and read with glasses or contact lenses.

LASIK is not the only surgical method to correct vision problems, although it is considered as the most popular one. Below are several surgical methods to correct the refractive errors on eyes:

1. LASIK
LASIK is a shot form of laser assisted in-situ keratomileusis. It is a surgical procedure to correct mild to moderate eye problems by using laser. Before reshaping the cornea using LASIK method, the ophthalmologist uses a special blade (microkeratome) or special cutting laser to cut a small hinged flap in the outer layer of cornea and then the laser is used to reshape the cornea - either to flatten the curve of cornea or make it steeper. After that, the flap is replaced over the reshaped cornea. LASIK as an option of refractive eye surgery is for patients with nearsightedness (myopia) and farsightedness (hyperopia), with or without astigmatism.

2. PRK (Photo Refractive Keratectomy)
Same with LASIK, the PRK method is also an option for patients who are nearsighted, farsighted, with or without astigmatism in low-to-moderate degree. During the PRK, the ophthalmologist uses an excimer laser to reshape the cornea. Not like LASIK that create a hinged flap in the cornea before reshaping it, PRK is performed with an excimer laser, which uses a cool ultraviolet light beam to precisely remove (ablate) very tiny bits of tissue from the surface of the cornea, not underneath the cornea in order to reshape it.

3. LASEK
LASEK stands for Laser Epithelial Keratomileusis. It’s also called E-LASIK or epithelial LASIK because basically LASEK procedure is similar to LASIK. It is used for patients who have too thin or too flat corneas for LASIK. During LASEK eye surgery, the outer part of cornea (epithelium) is cut with finer blade called trephine (20% alcohol solution to loosen the edge of epithelium) to allow the laser to reshape the underneath tissue of cornea. Then the epithelial flap is replaced.

4. ALK
ALK is a short form of Automated Lamellar Keratoplasty, a surgical procedure to correct vision in people with severe nearsightedness and mild degrees of farsightedness. It has the similar procedure as LASIK that created a flap with a cutting device across the cornea but not reshaping the cornea with laser. Instead, ALK uses a special cutter to remove a thin slice of cornea. Then, the corneal flap is replaced. However, ALK is no longer routinely performed due to more predictable results from other vision correction procedures.

5. LTK
LTK or Laser Thermokeratoplasty eye surgery is a slightly new surgical procedure for patients with farsightedness and astigmatism. During LTK laser eye surgery, a laser beam uses heat to shrink and reshape the cornea. It’s a very fast eye surgery and the FDA has labeled LTK as a ‘non-permanent’ eye surgery because a patient who have had the LTK laser eye surgery will commonly lose some or even all the corrective effects within three months to ten years after surgery.

6. AK
AK or Astigmatic Keratotomy is a refractive eye surgery to treat astigmatism. Patients with astigmatism have cornea shaped like football and the AK eye surgery makes one or two incisions at the steepest part of the cornea to allow cornea relax and take a more rounded shape. Astigmatic Keratotomy is one of the safe and effective ways to correct astigmatism, but it has been largely replaced by LASIK in recent years.

7. RK
RK stands for Radial Keratotomy. It was once of the most popular eye surgery to correct nearsightedness. However, the development of other refractive eye surgery, such as LASIK, LASEK and PRK has largely replace RK method.

8. Epi-LASIK
Epi-LASIK is a kind of surgical procedure similar to LASEK, that was developed to solve some problems with LASIK and LASEK. It’s suitable for patients with too thin cornea (who have low degrees of myopia or nearsightedness). During the Epi-LASIK eye surgery, instead of cutting the epithelium with a finer blade like in LASEK, the ophthalmologist uses a blunt, plastic oscillating blade and epithelial separator to fold the flap out of the way. Then excimer laser is used to sculpt the underneath corneal tissue and the epithelial flap is replaced with a kind of spatula.

As the technology of refractive eye surgery continues to improve, a new method of laser eye surgery has been found. The new procedure is known as Custom LASIK or Wavefront LASIK. Some people may also call it Wavefront-guided LASIK. It is a variation of LASIK surgery that uses wavefront technology to precisely measure the irregularities in the way your eye processes images. Unlike the conventional LASIK that only uses the eyeglasses or contact lenses prescription to guide the laser in reshaping the coreal tissue, Custom LASIK or Wavefront LASIK customize all your visual irregularities in a 3-D map (wavefront map) and transfer it electronically to program the laser used in reshaping your cornea. This is because every eye’s focusing ability is unique, just like the fingerprint.

Because Custom LASIK uses a customized map in programming the laser treatment for your eyes, needless to say that Custom LASIK may bring better results compared to conventional LASIK such as sharper and higher quality vision. While traditional LASIK can only correct ordinary vision defects such as myopia, hyperopia and astigmatism, Custom LASIK is capable of correcting those ordinary refractive errors (myopia, hyperopia and astigmatism) plus other vision distortions due to higher order aberrations, that can not be corrected with glasses or contacts or even conventional LASIK surgery, such as glare, halos, starbursts, ghosting of images and poor night vision, which are the also the risks of post-LASIK complications.

But actually, not all ophthalmologists agree that Custom LASIK can treat above vision distortions. Some refractive surgeons argue that both Custom LASIK and conventional LASIK may cause these aberrations in some cases. However, research has shown that Wavefront LASIK may less likely to cause such aberrations than conventional LASIK.

The advent of Custom LASIK has increased the public interest in undergoing the customized LASIK surgery. But just like any other laser surgery, Custom LASIK or Wavefront LASIK may not be suitable for everyone. It is also not a surgical procedure to treat all kind of vision related problems so it is highly recommended to visit your ophthalmologist for a consultation and he or she will determine if you are a good candidate for Custom LASIK or not. Also the cost of Custom LASIK is a worth considerable thing because it is definitely costs more than conventional LASIK because it uses a wavefront scanner, called aberrometer, which is an expensive device.

Different providers may charge different fees for LASIK eye surgery. For example, the average fees per procedure as reported by TLC Laser Eye Centers in 2002 was $1,800, $1,957 in fourth quarter of 2004 and $2,000 in 2005; while another LASIK provider, LASIK Plus reported its average price per LASIK procedure was $1,344 in the second quarter of 2005, $1,351 in fourth quarter of 2004 and $1,173 in the first quarter of 2003.

The average cost of LASIK surgery in the U.S. have been rising over the past several years due to additional technology used in LASIK procedure, such as Custom LASIK and IntraLase. In 2002, the cost was between $1,550 to $1,600 per eye and had risen to about $1,700 by October 2003 and continued to rise to $1,800 at the end of 2004 and $1,950 in 2005. For 2006, the cost of the surgery was about $2,000 per eye as reported by LASIK industry sources.

As you can now find many advertisements online and offline offering such eye surgery to reduce or eliminate your dependence on glasses or contacts, be aware of advertisements that offer too low price such as $299 or $500 per eye. There might be any hidden costs behind it - cost of the consultations, pre-operative examination fee, follow-up fee, enhancement fee if something goes wrong, post-operative prescriptions, and more. Although there have been rules and guidelines on LASIK eye surgery advertising in certain states, it is suggested to discuss with your doctor what the LASIK price will include. [See the questions to ask your doctor about cost of LASIK surgery]

9. Central Lamellar Keratitis (CLK)
CLK is a different form of lamellar keratitis that appears within the first 24 to 48 hours. Its treatment is similar to DLK, but additional enhancements are needed after recovery.

10. Loss of Best Corrected Vision
Only a small number of patients may experience a slight loss of visual sharpness following LASIK. It means that even with glasses, you are no longer to be able to read the 20/20 line on the eye chart, but can still read the 20/30 or 20/40 line without glasses or contact lenses. Losing more than two lines of vision is a very rare condition - less than 1% in statistical result.

11. Central Islands
Central Islands is a result of a small raised area in the treatment zone that receives less laser beams or does not obtain full ablation compared to surrounding tissue. Central islands may decrease and disappear after several months following LASIK surgery, but in some cases, enhancement surgery is needed as a treatment to this problem, by lifting LASIK flap and targeting a small amount of laser beams onto the small raised area. However, as technology has developed rapidly, this kind of complication has been eliminated by proper screening and tracking and also smoother laser application.

12. Irregular Corneal Flap
This is a condition when the corneal flap shifts slightly and folds or wrinkles (striae) and may distort visions. Enhancement surgery is also needed to treat striae by lifting the corneal flap and ironing the flap using a special device.

13. Keratectasia or Ectasia
An excessive removal of corneal tissue during LASIK eye surgery may lead to eye bulging. This condition is called Keratectasia or Ectasia. However, current LASIK practice using more precise LASIK blades (microceratomes) or Custom LASIK have significantly decrease this complication.

14. Infection and Severe Inflammation
Infection and severe inflammation are very rare LASIK complications. To help avoiding these complications, follow the instructions of doctor to not applying creams, eye makeup and not using hot tub, whirlpool or swimming for a certain period of time (several weeks). Antibiotic eye drops prescribed by your doctor as post-operative medication may also help to prevent infection, pain and redness on eye.

15. Unattached corneal flaps or free caps and buttonholes or partial flaps
Both vision-threatening complications are caused by abnormal cutting of corneal flap using microkeratome blade.

LASIK Complications and Risks page: << 1 2 3

3. Dry Eye
It is normal if you feel dry, itchy or scratchy on eye after LASIK surgery. This temporary problem lasts for about 4 weeks and decreases as your cornea has healed properly. That is why your doctor will give you lubricating eye drops or maybe artificial tears to treat dry eye.

4. Corneal Abrasion
Corneal abrasion is a small breakdown in the epithelial surface caused when microkeratome makes the corneal flap. This happens in a small percentage of LASIK procedures because in some eyes, the surface cells may not adhere well. But don’t worry, as the epithelium grows back quickly within one to three days. To improves comfort and promotes healing, doctor will give you a very thin bandage contact lenses if this problem occurs.

5. Night Glare, Halos, Sensitivity to Light and Hazy or blurred vision
Most of LASIK patients experience these temporary complications for one week up to one month after LASIK surgery. However, some patients may experience these kinds of refractive errors due to the presence of higher order aberrations, which can be treated with Custom LASIK or Wavefront-guided LASIK. Oversize pupil also could cause the night vision problems due to LASIK treatment zone is smaller than pupil’s larger size.

6. Regression
Patients with severe myopia, hyperopia and astigmatism are more likely to experience regression. Regression is gradual decrease in visual acuity over time after LASIK. If significant regression occurs, enhancement surgery may be needed to achieve permanent results.

7. Epithelial Ingrowth
Epithelial Ingrowth happens when the epithelium (corneal surface cells) grows beneath the corneal flap created during the LASIK surgery and causes blurry vision, irritation or swelling. This problem is treated easily by gently lifting the flap and removing the ephitelial cells.

LASIK Complications and Risks page: << 1 2 3 >>

It is preferred to choose a LASIK surgeon who is associated with reputable or the very best eye care clinincs and research centers, such as American College of Surgeons or academic medical center, such as a teaching hospital or one that is well-known for advanced technology. An association with certain academic medical center will help the LASIk surgeon keeping up with current information and newest technologies and procedures.

You may also need to ask some basic questions to the LASIK surgeon concerning his level of expertise and experience, including how long he has been performing refractive surgery procedures, especially LASIK, how many total procedures he has performed, how many LASIK surgery he has performed with the same equipment and the same refractive error as you have, what is the percentage of 20/20 or better outcomes he has achieved, the costs and more questions (see the list here: 50 Tough Questions for Your LASIK Doctor).

During the consultation with your LASIK surgeon, pay attention to the way he listens to you and give you answers. If the doctor seems hurried and distracted, you can probably expect the same response if the surgery goes wrong and you are in need of reassurance. If he seems like dishonest in answering and explaining something and not fully examine you to make sure you are a good candidate for LASIK surgery, he is not the right surgeon for you. Also it is recommended to find a surgeon with a personal touch, means that he will take the responsibility and not let you feel abandoned if the something goes wrong after the surgery and he even will do his best to refine or improve the unsuccessful result.

Usually, people tend to choose LASIK surgeon who charges the cheapest cost. This is one of the biggest mistake. Yes, the most expensive one is not always the best, but you must also consider the quality of services and the reputation of a surgeon. Remember that a good surgeon will minimize the risk of getting a bad operation outcome, that will last for a lifetime.

Choosing the Right Surgeon page 1

6. You do not suffer from any disease such as autoim-muno disorders or are on medications such as steroids or immunosuppressants that may slower wound healing.

7. You have sufficient corneal thickness - thick enougth for the ophthalmologist to successfully cut a hinged flap of appropriate depth before sculpting the cornea. Performing LASIK on a cornea that is too thin may result in blinding complications.

8. You have an appropriate pupil size. The doctor will take the measurement in a dark room, as it plays an important role in your night vision after LASIK surgery and also to help surgeon to plan the laser vision correction strategy.

9. You are not currently pregnant or nursing.

10. You do not have scarring of the cornea.

11. You do not have a history of ocular herpes within a year prior to having LASIK surgery. However, LASIK will be considered when a year has passed from initial diagnosis of the disease.

12. You do not have a history of dry eyes, as LASIK surgery tends to worsen this condition.

13. Usually it is not recommended to have additional LASIK surgery if you have undergone any refractive surgery such as RK, PRK or LASIK in the past. Careful consideration may be needed to decide whether you will need an additional refractive surgery, depends on your unique situation.

14. You do not suffer from certain diseases such as advanced glaucoma, corneal diseases, other eye diseases (inflammations of the eye), eye injuries or previous eye surgeries, corneal thinning disorders (keratoconus) and cataracts.

15. You have been informed about the risks and benefits of LASIK surgery and fully understand what to expect before, during and after LASIK surgery. You also must fully aware that the result of LASIK eye surgery and the healing rate may vary from one to another and even from eye to eye in each individual.

How is your result? From above description, do you think you are a good candidate of LASIK surgery? Because you are unique, whether you think you are eligible or not, make sure to visit an ophthalmologist and have an exam for the final decision.

Are You a Good Candidate for LASIK page 1

However, the risks and complications may increase if you undergo LASIK eye surgery with a less experienced eye surgeon. That is why choosing the right LASIK surgeon is important in determining the success of surgery.

Many of the complications are just temporary problems and decrease as time goes by, while some patients may experience permanent complications, but most of the permanent problems can be resolved through enhancement surgery (second LASIK procedure or touch-up). If you have heard that LASIK can cause a permanent vision loss, actually it is a very rare problem as a result of this procedure.

The following are list of complications that may occur after the LASIK procedure:

1. Undercorrection and Overcorrection
Undercorrection is a result of not enough corneal tissue is removed during the surgery, while contrary to undercorrection, too much tissue removed during the LASIK procedure may caused an overcorrection result. Undercorrection is more common than overcorrection in any refractive surgery. Both problems are often temporary and decreases as the cornea stabilizes, but sometimes can be permanent. However, enchancement surgery may likely resolve permanent undercorrection or overcorrection, while temporary conditions of undercorrection and overcorrection can be treated with glasses or temporary contact lenses until they resolve.

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