Ask the Specialists-Ask the specialist-All About Lasik

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All About Lasik

May 31st - Jun 30th 2012

Fed up of wearing spectacles and contact lenses? If you are 21 years of age and above, and suffer from myopia (short-sightedness), hyperopia (long-sightedness), and astigmatism, you are a good candidate for LASIK, a surgical procedure that uses lasers to correct your vision. LASIK, performed as a day surgery, is quick and painless, and frees you from wearing spectacles and contact lenses.

If you have questions related to LASIK, take this opportunity to ask our expert today.

How does it work?

Each month, we offer 2 topics for discussion. Members can post their questions online. At the end of each month, we will publish the answers from our panel of specialists here.

Remember to sign up or log in before you post a question.

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		Dr. Mohamad Rosman (profile) Consultant Dept of Refractive Surgery Service Singapore National Eye Centre

	Posted by chu
For eyes with different degrees of myopia and astig, is it advisable to do Lasik on just one eye, to correct the eyesight of just the eye with poorer eyesight?

Answered by Dr. Mohamad Rosman
Consultant
Dept of Refractive Surgery Service
Singapore National Eye Centre

Unless the myopia and astigmatism of one eye is very low and the vision of that eye is relatively good, ie able to see quite well without glasses, it is advisable to perform LASIK in both eyes. This will enable good vision in both eyes after LASIK and also help with stereoscopic(3D) vision.

In general, I will advise my patients to consider performing LASIK in one eye only if their unaided vision in the better eye is 6/9 or better and that eye is not their dominant (also known as master) eye. Patients are generally unhappy if the vision in their dominant eye is poorer than their other eye. We also still have the option of performing LASIK on the unoperated eye later.

Posted by tontonrokushi

Seeking enlightenment on Lasik

I am a myopic girl and have astigmatism detected in recent years. As at March 2012, my optician has confirmed that I am still not needing reading glasses. For a good part of my youth, I was wearing spectacles. I surmise this is partly because the eye specialist, whom my dad brought me to visit, was a staunch advocate of spectacles.

During my work life, I explored the optical world anew and discovered the freedom of switching between spectacles and contact lens. Alas contact lens proved practical during dance rhythmic and aerobic exercises, fun soccer etc. Besides, I like my eyes to look bigger. But in the recent 4-5 years, while back for my post-grad studies, it's funny now I have grown accustomed to wearing spectacles. I have unknowingly also completely forgotten about contact lens.

I think to myself, I may consider Lasik plan but 'after you' as I chat with my varsity buddy. She was SNEC Lasik 'guinea pig' (last year). May be it's just me, I was terrified to see her back to campus (after some rest) with blood shot eyes (like a cackling demon!) Afterwards, I shelved my Lasik plan. May be now it's my chance to seek authentic advice.

I am still thinking about the inevitable presbyopia (old age eyes) befalling on me, even though i may still not be needing reading glasses just yet. My diabetes is under control. But I have dry eyes only in the recent 4 years. Doctor, it would be almost magical if the Lasik mage can give me perfect vision.

I am curious if it can really correct for everything at one go, that is, correct the myopia, astigmatism and future presbyopia. Will the surgical outcome be better if I wait for the old age eyes to definitely set in first. Or is Lasik performed now, actually able to preempt presbyopia later on in life?

Must you check on the quantity and quality of the cornea tissue (which may thin with age?) before surgery is exercised. I also hear that patient is locally anaestheticised, I must not blink, but what if anxiety causes me to blink unconsciously, then does that cause accident during surgery.

What must I expect post-surgery recovery. I mean Pain- be truthful and tell me how bad is it? (I have a low pain threshold) Oh yes, is the post-surgery scary blood shot eyes a norm, doctor? Thanks in anticipaton of your reply.

Answered by Dr. Mohamad Rosman
Consultant
Dept of Refractive Surgery Service
Singapore National Eye Centre

It actually depends on age. Base on your story, I assume that you are nearing presbyopia. The decision on when and how much to correct depends a lot on each individual needs. I would prefer to discuss with you in detail on this. However, in general, I would correct patients who does not have existing presbyopia fully, ie eliminate their myopia and astigmatism. These patients tend to prefer good vision in both eyes as they have not experienced the inconvenience of presbyopia yet. However, this means that they will require reading glasses when their presbyopia sets in, just like a normal person.

LASIK cannot treat presbyopia fully. I would consider performing monovision LASIK for my patients who are both myopic and presbyopic. Basically, this means that we leave one eye slightly myopic. As everyone uses both eyes to see, they will be able to see distance objects well with the fully corrected eye and near objects with the slightly myopic eye. However, not everybody likes monovision, as such I will examine these patients in detail and even test to see if they like monovision.

In your case, if you are indeed nearing 40 years old (ie presbyopic age) we can consider a trial of monovision to see if you are suitable. In which case, if we can perform monovision LASIK on you, we may be able to treat your myopia, astigmatism and at the same time, delay the onset of presbyopia. But it would really help if I can examine and discuss the pros and cons of monovision LASIK with you. Performing LASIK now or later does not affect the surgical outcome.

As for your friend with bloodshot eyes, I suspect she underwent bladeless LASIK using the Intralase femtosecond laser platform. This is an older platform which needs to apply pressure on the sclera of the eye (ie the white part of the eye) during the LASIK procedure. As such, sometimes, this results in the rupture of fine blood vessels there, leading to subconjunctival haemorrhage (ie bleeding at the white part of the eye). Currently, there are newer lasers which do not apply pressure on the sclera and thus, do not cause such unsightly side effects. I usually use the newer Visumax femtosecond platform which does not cause this problem.

Yes, we will need to assess each potential LASIK patient thoroughly. We have to ensure that the patient has sufficient corneal thickness and that their corneas are normal before performing LASIK.

During LASIK, we will use a small instrument to help the patient keep their eyes open. So, even if the patient has a tendency to blink, his/her eyes will still be open during surgery. I have not had any patients who were able to close eyes during LASIK. Furthermore, the actual laser procedure is usually less than 30 seconds and most patients are able to control their blinking tendency for this short period of time.

You are most welcome. Most patients will experience some degree of discomfort after LASIK, usually lasting 4 hours. Most patients tend to have difficulty keeping their eyes open during this period and may tear excessively. Some patients will feel some irritation in their eye, something like feeling that there is an eyelash in their eyes. Very few complain of pain which affects them greatly. In general, after 4 hours, most patients are very comfortable and are able to do most normal activities.

Post-surgery blood shot eyes used to be the norm with the older femtosecond laser machines. However, this is no longer the case. Femtosecond lasers are needed to perform bladeless LASIK. Blood shot eyes are the result of the use of older femtosecond laser platforms which needs to apply pressure on the sclera of the eye (ie the white part of the eye) during LASIK procedure. As such, sometimes, this results in the rupture of fine blood vessels there, leading to subconjunctival haemorrhage (ie bleeding at the white part of the eye). Currently, there are newer lasers which do not apply pressure on the sclera and thus, do not cause such unsightly side effects. I usually use the newer Visumax femtosecond platform which does not cause this problem. Thus, the occurrence of bloodshot eye may depend on where a person undergoes LASIK and the femtosecond laser platform used.

	Posted by mosmos
I am now wearing spectacles with astigmatism and short-sightedness of more than 500 degrees on each eye. I also have dry eyes which I need to use the eye drop quite often during the day. I heard that people with dry eyes are not suitable for lasik. Is that true?

Answered by Dr. Mohamad Rosman
Consultant
Dept of Refractive Surgery Service
Singapore National Eye Centre

Not all patients with dry eyes are unsuitable for LASIK. While it is true that LASIK may make the dry eyes worse, bladeless LASIK nowadays with femtosecond laser platforms creates thinner cornea flaps which reduce the occurrence of persistent post-LASIK dry eyes.

Many of my patients have dry eyes as a result of prolonged contact lens usage. However, most of them recover after and period of treatment and had LASIK done after recovering from dry eyes. They usually do not have problems with dry eyes after LASIK. As such, it is important to treat the dry eye condition before performing LASIK.

However, if you still have significant dry eyes after treatment, we can consider other forms of refractive surgery options which have lower risks of inducing dry eyes. These include, surface ablation procedures, phakic intraocular lenses and maybe even the newer SMILE (small incision lenticular extraction) procedure.

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