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An investigation was recently carried out by the UK consumer magazine Health Which? that revealed any doctor can carry out laser eye surgery after only a few days training and without any specialist qualifications. Health Which? looked at clinics offering the the most widely used laser eye surgery procedure Lasik and found that the complication rates varied between surgeons and clinics. Some of the clinics highlighted a low risk of complications whilst others stated the risks were non-existent. According to the Royal College of Ophthalmologists complications occur in less than 5% of cases in laser eye surgery procedures carried out in the UK.
The Health Which? report also states that both the Medical Defence Union (MDU) and the Medical Protection Society (medical insurance companies), are increasing the fees they charge doctors that work in this field due to the increasing number of compensation claims. Matthew Robson, clinical risk manager for the Medical Defence Union (MDU) said that the number of laser surgery claims reported by its members account for one in three of all ophthalmology claims, rising 166% in six years. While this may also be affected by the increasing number of people deciding to undergo laser eye surgery Matthew Robson also said: "While some of the claims are as a result of faulty surgical technique, an underlying feature in many more cases is patients' unrealistic expectations about what can or cannot be achieved by surgery. Therefore before undergoing laser eye surgery make sure you are fully briefed on what to expect. An indepth discussion of the risks of laser eye surgery including corneal ectasia, dry eyes and loss of night vision can be viewed by clicking the link side effects of laser eye surgery.
Am I a good candidate for laser eye surgery?
The Ideal LASIK Candidate
Ideal candidates include those who:
• Are over 18 years of age and have had a stable glasses or contact lens prescription for at least two years.
• Have sufficient corneal thickness. A LASIK patient should have a cornea that is thick enough to allow the surgeon to be able to create a clean corneal flap of appropriate depth.
• Are affected by one of the common types of vision problems such as myopia (nearsightedness), astigmatism (blurred vision caused by an irregular shaped cornea), hyperopia or hypermyopia (farsightedness), or a combination of these.
• Do not suffer from any disease that may reduce the effectiveness of the surgery or the patient’s ability to heal properly and quickly.
• Are adequately informed about the benefits and risks of the procedure. Candidates should thoroughly discuss the procedure with their physicians and understand the limits of laser eye surgery.
The ‘Less Than Ideal’ candidate
Some factors exist that preclude a candidate from being ideal for LASIK surgery such as those who:
• Have a history of dry eyes, as this condition can worsen following laser eye surgery.
• Are being treated with medications such as steroids or immunosuppressants or suffer from autoim-mune disorders that can prevent or slow healing.
• Have scarred cornea(s).
• If you are pregnant or nursing, you are not an ideal candidate, because the hormonal changes can temporarily affect the shape of your eyes.
The Non-LASIK Candidate
Non-candidates include individuals who have:
• Diseases such as cataracts, advanced glaucoma, corneal diseases, corneal thinning disorders (keratoconus or pellucid marginal degeneration), or certain other eye diseases that affect vision.
• Extremely poor vision. There are limits to how much vision can be improved by laser eye surgery. FDA limits exclude those with more than -14.00 diopters of myopia, more than 6.00 diopters of astigmatism or more than +6.00 diopters of hyperopia.
• Unstable prescription. As we grow older our eyes change shape and size. Most prescriptions stabilise by age 18, but eyes can change throughout our 20s. Therefore LASIK surgeons prefer to operate on patients who are over 18 and whose prescriptions have not changed significantly in two years.
• Irregular cornea. If the cornea is too irregular in shape, it can't be operated on. For example, a condition known as keratoconus, in which the cornea gradually steepens until it becomes cone-shaped, will disqualify a patient for LASIK. A certain amount of irregularity is okay, such as in people with mild to moderate astigmatism.
• Large pupils. The area to be treated by the LASIK laser is only a small, circular part of the cornea. If your pupils are too large their circumference might exceed the area to be treated. Large pupils can lead to such visual problems as ghosting, starbursts and halos.
What should I do before laser eye surgery?
If you do decide to go ahead with laser eye surgery, you will have an initial or baseline evaluation carried out by your eye doctor to determine if you are a good candidate for laser eye surgery.
Prior to the eye examination you should stop wearing contact lenses or glasses. Depending on the type of contact lens the shape of your cornea can change for up to several weeks after you have taken them out. Soft contact lenses should be taken out 2 weeks before, soft lenses or RGP lenses 3 weeks before and hard lenses 4 weeks before. If your cornea is not it's stabilised natural shape during the evaluation inaccurate measurements can be made. Therefore these measurements may need to be repeated a few times to ensure that your cornea shape has stabilised.
On the day of the surgery, you must not apply any creams or colognes to your face as these will hamper the procedure, perhaps leading to problems later. Many other rules to follow are specific to you and your habits, so visiting a specialist before the procedure takes place is mandatory.
What happens during the pre-operative examination?
Just as in a normal eye exam the doctor will use instruments such as: a refractor (to determine your prescription); a slit lamp (to look into the back of the eye for retinal problems); and a tonometer (to determine intraocular pressure, if this value it can be an early sign of glaucoma). Your doctor will also look for signs of dry eye disease.
A corneal topographer is also usually used that photographs your eye and creates a corneal "map". This map will display any irregularities in the cornea and steepness or flatness in the cornea that ust be corrected. New "wavefront" devices may also be used that send waves through the eye to provide an even more precise map of the cornea.
Finally, the doctor will question you about any health problems you have or medications you take. Always tell your doctor about past and present medical conditions and medications you are curently taken and medications that you are allergic to.
During your evaluation the doctor should discuss the potential risks and alternatives to surgery, expectations and what you should do before, during and after surgery. You should also have the opportunity to ask your doctor questions. Always give yourself plenty of time to think about the potential risks and benefits, to read any literature given to you by your doctor before deciding to sign the informed consent form.
Will it help with age-related vision loss?
Laser surgery will not be able to cure age-related presbyopia and the need for reading glasses that people often develop in their mid-40's. This is because presbyopia is not a problem with the shape of the cornea it occurs when the lens becoming less flexible with age.
Can both eyes be done on the same day?
Yes, but your consultant should outline the risks. In order to reduce the risk of cross contamination should complications arise, each eye should be treated as separate procedure.
How long will it take me to recover?
Never drive after laser eye surgery and your first follow-up visit as you may be given medication and your vision will be blurry. Most patients have a reasonably comfortable period after surgery and are back at work within a few days to two weeks.
Is it painful?
The eyes are aneasthetised by drops so you will not feel any discomfort during surgery. However some patients experience can experience a "scratchy feeling." Please do not rub your eyes as this can affect healing and further treatment may be required. After the aneasthetic wears off further irritation is minor and usually disappears within a few hours. You may be sensitive to light for a few days.
How long does the treatment take?
The laser treatment itself takes only about 15 to 40 seconds and the patient should be able to leave after about 30 to 60 minutes.
Is the treatment permanent?
According to the results of the U.S. clinical trials and results reported internationally, the treatment appears to be permanent. As people age, however, their eyes change and re-treatment may be necessary.
Are there any activity restrictions following surgery?
As mentioned previously following laser eye surgery do not rub your eyes. Other than that, patients can do whatever they feel up to as long as they follow their doctors' instructions.
What if I move my head during surgery?
The surgeon should be skilled in switching the laser off if the patient moves his or her head. This allows him to realign the beam with the corneal "target" and proceed with the surgery.
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