Talamo Laser Eye Consultants

LASIK Eye Surgery - Your Choice For LASIK in Boston

To Learn about Intralase Blade-FREE LASIK, click HERE

This section provides valuable information for all patients considering laser vision correction.  It discusses general background about LASIK surgery, including the mechanical approach to LASIK using instruments with blades (microkeratomes), a technique that we have supplanted with All-Laser LASIK using the Intralase femtosecond laser, which we believe offers improved safety and efficacy.  In addition, this section provides important information about your candidacy for LASIK and tips for selecting an experienced surgeon.  Please take a moment  to familiarize yourself with this important information.

Until recently, if you were one of the millions of people with a refractive error, eyeglasses and contact lenses were the only options for correcting vision. With the arrival of refractive surgery, some people with myopia (nearsightedness), hyperopia (farsightedness), or astigmatism (a cornea with unequal curves), may now have their vision improved through surgery.

LASIK is performed as an outpatient procedure using topical anesthesia with drops. The procedure itself generally takes about fifteen minutes per eye. The surgeon creates a flap in the cornea with a microkeratome or an infrared laser (discussed in detail in our section on Intralase All-laser LASIK). The flap is lifted and the cool beam of the excimer laser is used to remove a layer of corneal tissue. The flap is folded back to its normal position and sealed without sutures. The removal of corneal tissue permanently reshapes the cornea.

The ideal candidate for LASIK has a stable refractive error within the correctable range, is free of eye disease, is at least eighteen years old and is willing to accept the potential risks, complications and side effects of LASIK. You can find out if you are a candidate for LASIK by having a free consultation with Dr. Talamo and by taking our "Am I A Candidate?" online test. For more information, look over the information here and elsewhere in our web site.

Basic Lasik: Tips on Lasik Eye Surgery  adapted from "Facts for Consumers" by the American Academy of Ophthalmology (AAO)

If you're tired of wearing glasses or contact lenses, you may be considering Lasik eye surgery.  Before you decide, get a clear picture of what you can expect.

The Facts:

• Millions of people have had Lasik, most very successfully. 
• Lasik is surgery to a very delicate part of the eye.
• As with any surgery, there are risks and possible complications.
• Lasik may not give you perfect vision. 
• If you have Lasik to correct your distance vision, you'll still need reading glasses at age 45 and beyond.
• Lasik surgery is too new to know if there are any long-term ill effects beyond five  to ten years after surgery.
• Lasik surgery cannot be reversed.
• Most insurance does not cover the surgery.
• You may need additional surgery - called "enhancements" - to get the best possible vision after Lasik.

To see clearly, the cornea and the lens must bend - or refract - light rays so they focus on the retina - a layer of light-sensing cells that line the back of the eye. The retina converts the light rays into impulses that are sent to the brain, where they are recognized as images. If the light rays don't focus on the retina, the image you see is blurry. This is called a refractive error. Glasses, contacts and refractive surgery attempt to reduce these errors by making light rays focus on the retina.

Refractive errors are caused by an imperfectly shaped eyeball, cornea or lens, and are of three basic types:

• myopia - nearsightedness; only nearby objects are clear.
• hyperopia - farsightedness; only objects far away are clear.
• astigmatism - images are blurred at a distance and near.

There's also presbyopia - "aging eye." The condition usually occurs between ages 40 and 50, and can be corrected with bifocals or reading glasses.

Are You A Good Candidate for Lasik?
Lasik is not for everyone.

• You should be at least 18 years old since the vision of people younger than 18 changes.
• You should not be pregnant or nursing as these conditions might change the measured refraction of the eye.
• You should not be taking certain prescription drugs, such as Accutane or oral prednisone.
• Your eyes must be healthy and your prescription stable. If you're myopic, in many cases you should postpone Lasik until your refraction has stabilized, as myopia may continue to increase in some patients until their mid- to late 20s.
• You should be in good general health. Lasik may not be recommended for patients with diabetes, rheumatoid arthritis, lupus, glaucoma, herpes infections of the eye, or cataracts. You should discuss this with your surgeon.
• Weigh the risks and rewards. If you're happy wearing contacts or glasses, you may want to forego the surgery.
• Understand your expectations from the surgery. Are they realistic?
• Ask your surgeon if you're a candidate for monovision - correcting one eye for distance vision and the other eye for near vision. For most patients, Lasik cannot correct presbyopia so that one eye can see at both distance and near. However, Lasik is often used to correct one eye for distance and the other for near. If you can adjust to this correction, it may eliminate or reduce your need for reading glasses. In some instances, surgery on only one eye is required. If your surgeon thinks you're a candidate, ask about the pros and cons.

Finding a Surgeon/Boston LASIK Specialist

Only ophthalmologists (eye surgeons) are permitted to perform Lasik.

Ask your surgeon the following questions:

1. How long have you been doing Lasik surgery?
2. How much experience do you have with the Lasik procedure?
3. How do you define success?
   What's your success rate?
   What is the chance for me (with my correction) to achieve 20/20?
   How many of your patients have achieved 20/20 or 20/40 vision?
4. How many patients return for enhancements?
   In general 5-15% return.
5. What laser will you be using for my surgery? Do you use a blade (microkeratome) or a laser to create the flap?
   Make sure your surgeon is using a laser approved by the U.S. Food and Drug Administration (FDA).
6. What's involved in after-surgery care?
7. Who will handle after-surgery care? Who will be responsible?
8. What about risks and possible complications?

Risks and Possible Complications

Before the surgery, your surgeon should explain to you the risks, possible complications and potential side effects, including the pros and cons of having one or both eyes done on the same day. This is the "informed consent" process. Some risks and possible complications include:

• Over- or under-correction. These problems can often be improved with glasses, contact lenses and enhancements.
• Corneal scarring, irregular astigmatism (permanent warping of the cornea), and an inability to wear contact lenses.
• Corneal infection.
• "Loss of best corrected visual acuity" - that is, you would not be able to see as well after surgery, even with glasses or contacts, as you did with glasses or contacts before surgery.
• A decrease in contrast sensitivity, "crispness," or sharpness. That means that even though you may have 20/20 vision, objects may appear fuzzy or grayish.
• Problems with night driving that may require glasses.
• Flap problems, including: irregular flaps, incomplete flaps, flaps cut off entirely, and ingrowth of cells under the flap.

The following side effects are possible, but usually disappear over time. In rare situations, they may be permanent.

• Discomfort or pain
• Hazy or blurry vision
• Scratchiness
• Dryness
• Glare
• Haloes or starbursts around lights
• Light sensitivity
• Small pink or red patches on the white of the eye

LASIK Surgery: What to Expect Before, During and After

Before LASIK
You'll need a complete eye examination by your refractive surgeon. A preliminary eye exam may be performed by a referring doctor. Take your eye prescription records with you to the exams. Your surgeon should:

• Dilate your pupils to fine-tune your prescription.
• Examine your eyes to make sure they're healthy. This includes a glaucoma test and a retina exam.
• Ask you to sign an informed consent form after a thorough discussion of the risks, benefits, alternative options and possible complications. Review the form carefully. Don't sign until you understand everything in the form.

Take the following measurements:

• The curvature of your cornea and the size of your pupils.
• The topography of your eyes to make sure you don't have an irregular astigmatism or Keratoconus.
• The pachymetry - or thickness - of your cornea. You need to have enough tissue left after your corneas have been cut and reshaped.

If you qualify for surgery, your surgeon may tell you to stop wearing your contact lenses for a while before measurements are taken because contacts can temporarily change the shape of the cornea.  Your surgeon also may tell you to stop wearing makeup, lotions or perfume for a few days before surgery. These products can interfere with the laser treatment or increase the risk of infection after surgery.

During LASIK
Lasik is an outpatient surgical procedure. The only anesthetic is an eye drop that numbs the surface of the eye. The surgery takes 10 to15 minutes for each eye. Sometimes, both eyes are done during the same procedure; but sometimes, surgeons wait to see the result of the first eye before doing the second eye.

The Surgical Procedure: A special device (either a microkeratome with a blade or, at Talamo Laser Eye Consultants, the Intralase femtosecond laser) creates a hinged flap of thin corneal tissue off the outer layer of the eyeball (cornea) and the flap is lifted out of the way. The laser reshapes the underlying corneal tissue (for a more detailed description of the advanced technology used at Talamo Laser Eye Consultants, see our section on Custom LASIK), and the surgeon replaces the flap, which quickly adheres to the eyeball. There are no stitches. A shield - either clear plastic or perforated metal - is placed over the eye to protect the flap.

After LASIK
Healing is relatively fast, but you may want to take a few days off after the surgery. Be aware that:

Pain after LASIK surgery is almost always minimal.  You may experience a mild burning or sensation for a few hours after surgery. Do not rub your eye(s).

Your vision probably will be blurry the day of surgery, but it will improve considerably by the next day when you return for a follow-up exam.

If you experience aggravating or unusual side effects, report them to your surgeon immediately.

Do not drive until your vision has improved enough to safely do so.

Avoid swimming, hot tubs and whirlpools for two weeks after surgery.

Alternatives to Lasik Laser Vision Correction

You may want to discuss some surgical alternatives to Lasik with your eye surgeon:

• Photorefractive keratectomy (PRK) is a laser procedure used to reduce myopia, hyperopia and astigmatism without creating a corneal flap.
• Astigmatic keratotomy (AK) is an incisional procedure to reduce astigmatism.
• Intacs (Intrastromal corneal rings) are clear, thin, polymer inlays placed on the eye to correct low myopia only.
• Phakic Intraocular Lenses such as the Staar Visian ICL (Intraocular Contact Lens)