The Lasik Blog

The mass media is heating up over the small percentage of LASIK patients who experience complications afterwards, such as dry eyes, glare or halos around light sources, and difficulty with driving at night.

After more than a decade of increasing numbers of people having LASIK and being delighted with their new clear vision, suddenly the LASIK downside is being emphasized. All surgeries have risks and complications. A small percentage of people always has some trouble after a surgery, which is why no surgery is ever guaranteed to give a perfect outcome 100% percent of the time.

LASIK Candidacy

In the early LASIK days, it's true that some eye surgeons rushed to offer it to as many people as possible, and failed to screen their patients adequately. It has been said a million times that LASIK is not for everybody. To qualify as a good LASIK candidate, you must:

• Have a stable prescription
• Be over 18 years old
• Have no autoimmune disease such as Lupus, or any condition that might interfere with healing
• Have appropriate corneal thickness and pupil size
• Be within a certain range in the severity of your myopia or hyperopia
• Preferably not be a diabetic
• Have realistic expectations

There are more requirements, and each individual must be carefully tested, examined, and questioned. No two human eyes are exactly the same, and each individual responds to surgery in their own way, healing quickly or not so quickly, following the doctor's directions or perhaps not, etc. There are many variables that go into a successful LASIK outcome.

Choosing a Good LASIK Surgeon

If you would like to have a LASIK surgery, you need to do some homework first. Read up about LASIK, and look around for a highly qualified and highly experienced eye surgeon. Do not choose the one who charges the least. A low fee will usually indicate that some corners are being cut at that doctor's office. Perhaps staff is not fully trained, or instruments are not sterilized often enough, or patients are not well screened. LASIK equipment is expensive and the medical skill required to do it well does not come cheap either.

So do yourself a great favor and take time over choosing your LASIK surgeon. Ask to speak to some previous patients. Check the doctor's standing with the American Board of Ophthalmology. Ask each doctor you consult with how many LASIK procedures he or she has performed, and expect the answer to be in the thousands.

The mass media thrives on negative news, and usually magnifies it to dramatic proportions, as this sells newspapers and increases TV audiences. However, despite the current flap, LASIK has overwhelming success when it is performed on good candidates by a qualified ophthalmologist.

Have you ever been gazing up at the sky and noticed strange little shapes floating around in your vision? When you try to examine one of them, it darts away and continues to drift lazily around, maybe shimmering or vibrating a little. They may gradually change their shape and may disappear, or not. This drifting behavior occurs because they exist in fluid.

Floaters Related to Aging and Usually Not a Danger

Our eyes are filled with fluid -- aqueous fluid in the anterior chamber (in front of the lens) and vitreous fluid in the much larger posterior chamber, behind the lens. As we age the vitreous fluid (often referred to as just "the vitreous"), starts to shrink, with cells clumping together here and there and casting little shadows on the retina, the light-sensitive cells at the back of the eye. These shadows are floaters.

You are more likely to develop floaters if you:

• Have diabetes
• Have had a cataract surgery
• Are very myopic (nearsighted)

Floaters can arise because of an infection, eye injury, inflammation, bleeding in the eye, or tears in the retina. These causes will have consequences more damaging than just floaters.

Vitreous Detachment May Require Immediate Care

In some older people (over about 50), the vitreous can abruptly pull away from the retina. You may notice this by a sudden increase in the numbers of floaters, or by light flashes at the side of your vision. It usually does not need any treatment, as it does not threaten vision. If it happens in one eye, it will likely happen in the other eye too, although perhaps not for a few years.

However, in some cases, vitreous detachment pulls hard enough on the retina that it can pull the retina itself out of position -- known as retinal detachment, and definitely sight-threatening. Or it can cause damage to the macula, which is the central area of the retina where the fovea centralis is. The fovea is the small area that gives us our clearest visual focus.

If you experience any sudden increase in light flashes at the sides of your vision, or in floaters, do contact your eye doctor immediately. Your vision could be in danger. Retinal detachment can cause blindness, and any tears or breaks in the retina can lead to retinal detachment. So it's better not to delay in seeking advice and care.

There are several types of glaucoma and the most common one is open-angle glaucoma. Glaucoma is detectable damage to the optic nerve caused by high intraocular pressure and its causes are not well understood. The fluid inside the eye always exerts a certain amount of pressure outwards, and in a normal eye, the cornea (front clear part) holds its curvature steady, the lens, iris, and sclera are not damaged by the pressure, and the optic nerve and retina remain healthy.

However, in a glaucomatous eye, the pressure is too high and causes eye tissue damage. When the optic nerve is damaged, our sight is compromised. Glaucoma is a progressive disease, and if not treated will cause blindness.

The retina is made up largely of light-sensitive cells which receive the image information in light rays entering the eyes. They convert it to electrical energy. The optic nerve is connected to the retina and carries this electrical (neural) energy to the brain, which interprets it. When the optic nerve is damaged, it is less able to carry that vision information to the brain, which gradually reduces our visual field until it becomes zero.

Diagnostic Tests

Traditionally, glaucoma is diagnosed through several tests. Two are tests of intraocular pressure:

• The 'puff test' -- where a puff of air is sent to the eye and gives a measurement of how much intraoculat pressure that eye has
• The visual field test -- where tiny lights flashing for a moment are the stimulus for you to press a button at each light. The testing system converts this into a map of each eye, with black areas where lights flashed but you didn't press the button because you didn't see them.

A third is an examination of the optic nerve:

• Stereoscopic photographs are taken of the optic nerve

Newer tests attempt to measure the thickness of nerve fibers in the retina. Glaucoma reduces their thickness until they are lost. By measuring any changes in the thickness of these fibers, these tests detect the glaucoma progression.

A Recent Mayo Clinic Study

Using Mayo Clinic records, a team of ophthalmologists (all members of the American Academy of Ophthalmology) and others recently compared intraocular fluid pressures to cerebrospinal fluid (CSF) pressures. CSF surrounds the spinal cord and brain, extending to the area of the optic nerve.

They chose 28 glaucoma patients and 49 control group patients without glaucoma. Both groups had received eye examinations, and had had CSF samples taken through a lumbar puncture between 1996 and 2007.

The researchers found that CSF pressures were significantly lower in all glaucoma patients than they were in any of the control group patients. This was independent of any patient's age, or the reason he or she had had the lumbar puncture done.

In other words, they found that in the glaucoma patients, lower CSF pressures were combined with higher intraocular pressures. Further studies are now planned, to learn more about the role of CSF pressure in the development of glaucoma.

If you are approaching age 40 or so, and have not had any glaucoma testing, it is strongly urged that you do so. Glaucoma can creep up silently on a person, and you may not notice anything is amiss until you have permanently lost a significant amount of vision. If you are in the Bloomington or Peoria areas in Illinois, please visit the Gailey Eye clinic, where any of six highly-trained ophthalmologists can help you keep your eyesight intact.