Lasik Surgery in India

"Invention" of spectacles was a great achievement at a time when patients with refractive error were severely handicapped or practically blind. Spectacles enjoyed high degree of popularity for a long time, but now their disadvantages viz., cosmetic blemish, restricted field of clear vision, aberrations, obstruction in sports and physical discomfort, are apparent. However, this should not mean that spectacles are to be condemned. There are still many situations where spectacles are not just the only alternative available for restoration of vision but a respectable visual device.

A question that always haunts the mind of the ophthalmologists and patients: why depend on prosthesis when it is possible to restore natural vision with all its inherent advantages (not just cosmetic) finds no answer.

Extensive research and technical advancements have produced following alternatives:

1.       LASIK (Laser Assisted In-situ Keratomileusis)

2.       Customised Ablation LASIK or Wavefront Guided Lasik , ETC

LASIK (Laser Assisted In-situ Keratomileusis)

Lasik is currently the best method of correction of refractive errors. It is accurate, effective and safe.

In LASIK an ultra-thin (130 to 180 micron) flap of cornea is raised and then using a computer controlled Excimer Laser (mostly Argon Fluoride 193nm) is delivered to reshape the corneal stroma into predetermined curvature. The flap is repositioned back. This leads to correction of both myopia and hypermetropia, and also moderate amount of astigmatism. The procedure is short and simple and being computer controlled is highly accurate.

The steps are detailed below.

Patient Selection

Case selection is an extremely important determinant of the result of Lasik surgery:

Preoperative Preparation

Procedure

LASIK is performed under topical anesthesia (lignocaine 4% or Proparacaine) and the only cooperation required of the patient is to fixate at a blinking (red) light. Newer LASIK machines have an eye tracker device which realigns the Laser to any changes in the position of the eye thereby ensuring proper centration of ablation. The steps are:

1.       After the anesthesia the face of the patient is covered with a drape just exposing the eye and an eyelid speculum is applied to retract the eyelids (patient feels a stretch on the lids). The patient fixates his gaze at a blinking light.

2.       A suction ring is placed around the cornea and serves to stabilize the eyeball and act as a platform for the microkeratome. When suction is activated vision becomes hazy and a pressure on the eye is felt.

3.       The automated microkeratome dissects through the superficial layers of the cornea and the corneal flap is folded back. During this step the patient hears the sound of a motor in front of the eye.

4.       Excimer Laser ablates the stromal bed to resurface it into desired curvature. What makes the Excimer laser so well suited for corneal ablation is its ability to remove tissue with accuracy up to 0.25 micron with each pulse. Often, only 50 microns of tissue are removed to achieve the proper amount of correction. The Excimer produces a non-thermal light beam that eliminates the possibility of thermal damage to surrounding tissues. In current Lasers employing flying spot technology a 2 mm spot ablates the tissue to correct the refractive error and then a 1 mm spot blends this area with surrounding cornea by creating smooth transition zones.
During this step a clicking sound is heard and an odor of ablating tissue (similar to charring hair) is smelt and a light flashing close to the eye is seen. All this while patient needs to concentrate on the center of the blinking red spot of light.

5.       The corneal flap is then repositioned and allowed to dry for a few minutes. The flap self-seals without the need of sutures.

6.       The eye may be patched after instilling antibiotic drops for 1-2 hours and the patient is advised to report back the next day. Eye drops are prescribed to be started on the same day. Analgesics are prescribed for 2-3 days.

Precautions

Complications

No surgical procedure is without any complications. However, LASIK is a relatively safe technique of correction of refractive errors. The possible complications can be:

Results

Results are generally very satisfactory and it has been reported that in carefully selected cases more than 90 % achieve unaided visual acuity of 6/12 or better (i.e., 6/12 6/9 6/6 6/5).

There is a subjective difference in degree of satisfaction among the patients. Some patients with a vision of 6/12 may feel very happy while other may be dissatisfied even with a vision of 6/5.

Conclusion

LASIK is major advance in the field of refractive surgery, which combines efficacy, safety, precision and accuracy. This technique is taking us on the path that, in the past, ophthalmologists feared to tread, towards the goal of unaided natural clear vision. The future is here today ... Wave-front Guided Lasik promises to correct all optical aberrations of the eye resulting in much better quality vision ...

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