Seven things to consider before you choose LASIK surgery

Seven things to consider before you choose LASIK surgery

LASIK surgery is easily one of the most popular and performed types of refractive surgery in Singapore. This article helps to provide some pointers to consider before choosing LASIK surgery.

Realistic expectations

The surgical outcome is dependent on a few factors. For instance, those with lower myopia and/or astigmatism will generally have better outcomes than those with a higher degree of myopia and/or astigmatism.

It is important to have the right objectives and realistic expectations for LASIK surgery. Most people are keen for LASIK surgery due to the inconvenience of spectacles (i.e. during sports) or discomfort of prolonged contact lens wear. The aim of LASIK surgery is to eliminate or reduce the need for them for most activities. 

For those who are 38 years old and above with presbyopia, the option of monovision is available – where one eye is used to see far and one eye is used to see near. This technique is usually sufficient to help with near work majority of the time. However, a pair of reading spectacles may still be required if a person needs to read very small print for a prolonged period of time. 

In general, LASIK surgery has a good track record in terms of safety, predictability and reliability. Complication rate is low and the visual recovery is quick. Common side effects such as dry eye, seeing haloes, starbursts and glares at night or under dim lighting are possible. However, these side effects usually clear up after a few weeks or months for most people. 

Lang Eye Centre - Dr. Ang, an Eye Surgeon in Singapore operates the machine used to conduct LASIK Surgery.

Eye health and stability

You will need to undergo a LASIK evaluation to ensure the eyes are suitable for LASIK surgery. The LASIK surgeon will ask detailed questions about your medical history and also carefully examine the eyes to rule out any ocular conditions that may result in complications or poor and unpredictable surgical results. Some common ocular conditions include:

  • Active eye infection/inflammation
  • Cataract 
  • Glaucoma 
  • Severe dry eye 
  • Extreme refractive error 
  • Dystrophies and/or progressive conditions resulting in deterioration of vision or thinning of cornea such as keratoconus

LASIK surgery is also not recommended for those who are currently pregnant as the hormonal level in the body changes during pregnancy. These changes can affect the eye prescription which reduces the reliability of test results during the LASIK evaluation and in turn decreases the predictability of surgery outcome. It is advisable to wait after delivery before considering LASIK surgery.

Lifestyle factor

Those with occupations or hobbies that require very distinct sharp vision should also weigh the potential risks versus the benefits of LASIK surgery carefully. While the side effects such as dry eye and seeing haloes, starbursts and glares at night or under dim lighting usually improve after the initial recovery period, it may persist for 3 to 12 months or longer. In some people, side effects may become permanent but uncommon.

Age consideration

To ensure stability and predictability in the results achieved by LASIK surgery, those with drastic changes in eye prescriptions every year are not ideal candidates for LASIK surgery. This usually happens to those younger than 18 years old. In this case, it will be more beneficial for the eye prescription to be monitored. LASIK surgery should only be considered when the eye prescription has stabilised for at least 1 year.

Long-term eye care

Most people are able to resume daily activities after recovery from LASIK surgery. While side effects such as dry eye and seeing halos, starbursts and glares at night will usually subside by 3 to 12 months, it is advisable to have a routine general eye check to monitor the vision and ocular health.

It is a common misconception that the refractive errors corrected by LASIK surgery may ‘rebound’ years after the surgery. This is not possible as the corneal tissue that is removed during surgery does not regrow. LASIK surgery though is unable to control the changes to eyeball’s shape or length months or years after the surgery. Should these changes take place, refractive errors can occur. These changes are independent of LASIK surgery and would have still occurred whether or not LASIK surgery has taken place. 

In such cases, spectacles may be used to sharpen the vision if required. Some may consider a LASIK enhancement or retreatment but the LASIK surgeon will first need to determine if the eye has sufficient residual corneal thickness after the first surgery and if it is beneficial to have an enhancement surgery. 

Possible risks and complications

LASIK surgery is a low-risk not a no-risk surgery. In the rare case of an infection, vision loss may occur if the infection is left untreated. There is also the possible risk of inflammation due to the body’s immune reaction and occasionally can be more severe and may require more intensive medication. Flap complication is uncommon with the IntraLase technology but may still occur. If it does occur, LASIK can still be carried out at a later time after the flap heals. 

It is also of great importance for the LASIK surgeon to have the experience and expertise to assess a person’s suitability for LASIK surgery based on corneal thickness and shape. This is critical in minimising ectasia, a condition whereby there is weakening of the cornea post-LASIK surgery that can lead to corneal bulging and progressive vision loss.

Other vision correction options

In instances where the eye is deemed unsuitable for LASIK surgery, alternatives like Epi-LASIK or implantable contact lens surgery can be considered. 

Epi-LASIK is suitable for those with thinner corneas whose myopia is less than 600 degrees. It is a type of surface ablation that does not require the creation of a cornea flap. Alcohol is used to remove the most superficial layer (epithelium) instead. The excimer laser is thereafter applied to the underlying layer (stroma). Epi-LASIK saves more corneal tissue and is safer for those with thinner corneas. In additional, there is no risk of flap complications.

Unlike LASIK/Epi-LASIK which removes corneal tissue, the implantable contact lens (ICL) surgery is able to correct high levels of eye prescription without thinning the cornea. A small incision of 2mm is made on the cornea and the ICL is inserted into the eye through the incision – between the iris and the natural lens. The wound seals up on its own without the need of stitches. The procedure is reversible if need be by simply removing the ICL unlike LASIK surgery – the corneal tissue that is removed during surgery does not regrow.

If you would like to understand more about LASIK surgery at Lang Eye Centre please contact us at +65 6684 1000 or manager@langeye.sg to find out more.

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