An Eye Surgeon Describes Lasik Eye Surgery Treatment Step-by-Step

An Eye Surgeon Describes Lasik Eye Surgery Treatment Step-by-Step

During the treatment phase of the Lasik, the surgeon uses the excimer laser to actually reshape your cornea. A small eyelid holder is put in place so that you cannot squeeze your eyes shut for this part. It's okay to close the other eye and, in fact, I usually put a shield over it to block everything out so that you don't visually have any distractions to the other side. Additional, numbing anesthetic drops are put onto the eye and additional marks are made on the cornea for orientation purposes. Again, you feel very little at this point except for some pressure. If you feel anything at all, it is typically from pressure on the lids or eyebrow bone. You will be asked to looked directly at the blinking red fixation light as much as possible. The surgeon will initially be getting the computer to lock onto your eye so that the treatment will be properly oriented.

After the computer has done its lock-on, the surgeon will carefully free up the Lasik flap and lift it out of the way. During this phase, the blinking red fixation light may seem to dance and move around so it may be somewhat difficult to hold steady. But after the flap is lifted, visually things return to a stable position. With the flap out of the way, the laser will be activated and the reshaping of the cornea starts. From the patient perspective, you may visually notice some change in the lights and they may even seem to come into focus a bit better. You also will hear a very loud banging or clicking sound which the excimer laser makes while it works. In some cases, there will be an odor of burning or fumes as the laser vaporizes the tissue. The laser doesn't actually "burn" tissue because there is no significant temperature rise. The eye never gets hot, but remains a normal temperature as the excimer laser very precisely vaporizes and reshapes tissue. This part of the surgery usually requires less than a minute depending on the amount of your prescription. I usually let my patients know verbally how they are doing and how far along they are. Because you tend to be nervous as the patient, time seems to flow at a very different rate so it's nice to have somebody letting you know when you only have 10 seconds or so to go.

After the laser is finished, the surgeon will need to rinse the cornea and replace the flap. During the rinsing phase, you'll feel a lot of water flowing over the surface of your eye and some may flow down onto the side of your face a bit. After the flap is put back into position and aligned, the surgeon will wait about a minute or two to let it settle. At that point, we do a blink test. The eyelid holders are removed and you are asked to blink rapidly to make sure that the flap has taken hold. Actually, for several days to weeks, the surgeon will ask you not to rub your eyes in order to let the flap fully heal into position.

After the procedure is complete in both eyes, we have the patient sit up. Typically, we expect to have the patient see significantly better almost right away so we have them look at a clock on the wall and tell us what they can see. Most patients can tell the time by that point, although it may seem a bit fogged up. I tell patients that it may seem like they have Vaseline in their vision or as though they were wearing glasses and came in from the cold so their lenses are fogged. That's very normal because there is in fact still some water in and under the flap which takes some time to absorb. By the next day, that vision will usually improve to the point that the patient could drive.

And that marks the completion of the Lasik procedure itself. After you go home, the anesthetic drops will begin to wear off and you will begin to feel some minor irritation. For me, it felt like I had an eyelash in my eye but some people have more tearing and light sensitivity. In most cases, this discomfort only lasts in the first 6 to 8 hours after surgery. For that reason, we provide sleeping pills and pain pills for the patients. We try to get our patients to go home and take a nap because if they can sleep through those first few hours, when they wake up, they will feel almost nothing and their vision will be improving even further.

Hopefully, this insiders' view of Lasik surgery from the patient perspective of a surgeon is helpful. Armed with an understanding of the process, you can go forward with much less anxiety. As I said, it is normal for anybody (even a surgeon) to feel nervous when they undergo a procedure. But knowledge takes away the unexpected and when there are few or no surprises, you will find yourself focusing more on the exciting outcome of great vision that you will achieve.

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