Co-management for lasik and cataract surgery


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LASIK (laser-assisted in situ keratomileusis), is the most popular refractive surgical procedure. In this procedure, a laser is used to permanently change the shape of the cornea (the clear covering on the front of the eye) to correct common vision problems such as nearsightedness, farsightedness, astigmatism, and presbyopia. This improves vision and reduces a person's need for glasses or contact lenses.

LASIK uses an excimer laser (an ultraviolet laser) to remove a thin layer of corneal tissue, giving the cornea a new shape, so that light rays are focused clearly on the retina.

In the case of a nearsighted person, the goal of LASIK is to flatten the too-steep cornea; with farsighted people, a steeper cornea is desired. LASIK can also correct astigmatism by smoothing an irregular cornea into a more normal shape.

LASIK is an outpatient surgical procedure with no need to stay at the surgery center overnight as it will take 10 to 15 minutes to perform for each eye.

The procedure is done while the patient is awake, but the patient may request mild sedation. The only anesthetic used is eye drops that numb the surface of the eye. LASIK can be done on one or both eyes during the same session.

How To Prepare For LASIK Eye Surgery?

Before LASIK eye surgery, the eye surgeon will evaluate the patient’s medical history and perform a full eye examination, including measuring corneal thickness, refraction, corneal mapping, eye pressure, and pupil dilation. Afterward, the surgeon will discuss what to expect during and after the procedure.

On the day of the surgery, eat a light meal before going to the doctor and take all prescribed medications, if any. Do not wear eye makeup, creams, perfumes or lotions on the day before and the day of surgery, or have any bulky hair accessories that will interfere with positioning head under the laser.

Contact lenses shouldn't be worn for at least three days prior to the evaluation. In the case of, rigid gas permeable contact lenses, they should not be worn for at least three weeks before. Patients should arrange for a ride home from the place of surgery, as their vision might be blurry.

What Happens During LASIK Eye Surgery?

The LASIK surgeon uses a computer to adjust the laser for each patient’s particular prescription. An instrument to hold the eyelids open may be used and the patient will be asked to look at a target light for a short time while the laser sends pulses of light to painlessly reshape the cornea. During LASIK eye surgery, a suction ring is placed on the eye just before cutting the corneal flap that may cause a feeling of pressure and may cause vision to dim slightly. Then, an instrument called a femtosecond laser is used to create a thin flap in the cornea. The corneal flap is then painlessly peeled back and the underlying corneal tissue is reshaped using another laser. After the cornea is reshaped so that it can properly focus light onto the retina, the cornea flap is put back in place and the surgery is complete. A distinct odor might be detected as the laser removes the corneal tissue which some people describe as similar to that of burning hair, but is nothing to worry about.

What To Expect After LASIK Eye Surgery?

The eyes might temporarily be dry even though they do not feel that way. One eye drop will be prescribed to prevent infection and inflammation and another eye drop to keep eyes moist. These drops may cause a momentary slight burn or blurring of your vision upon using them. Do not use any eye drops not approved by the LASIK surgeon.

Healing after LASIK eye surgery usually occurs very rapidly. Vision may be blurry and hazy for the first day, but most patients notice improved vision within a few days of surgery. There will be a follow-up evaluation 24 to 48 hours after LASIK eye surgery, as well as at regular intervals within the first six months.

What Are The Advantages Of LASIK Eye Surgery?

LASIK has many benefits, including:
➢ Vision is corrected nearly by the day after LASIK.
➢ LASIK causes a dramatic reduction in eyeglass or contact lens dependence and many patients no longer need them at all.
➢ Adjustments can be made years after LASIK to further correct vision if vision changes with age.
➢ LASIK is associated with very little pain due to the numbing eye drops that are used.
➢ No bandages or stitches are required after LASIK.

Cataract Surgery

woman with LASIK

Although you’re probably not looking forward to cataract surgery, keep in mind that modern cataract surgery is one of the safest and most effective surgeries performed today. There are over three million cataract surgeries in the United States every year and the vast majority have excellent outcomes which greatly improve quality of life.

Being prepared for your upcoming surgery by knowing what to ask your eye doctor and understanding your options will ease your mind and be sure you’re ready for recovery.

Find An Ophthalmologist

First, you’ll need an ophthalmologist to perform cataract surgery. Ophthalmologists treat eye diseases, prescribe medications, and perform surgeries to improve eye and vision-related conditions. In addition to four years of medical school and one year of internship, all ophthalmologists have three years of residency. Here are some ways to identify the best provider for your needs:

  • Your Regular Eye Doctor – Even if your eye doctor is an optometrist, he/she will be knowledgeable about ophthalmologists in the region and can advise on their specialties.

  • Family and Friends – If they had a positive experience, you can hear personal stories to really know if the doctor is right for you.

  • Go Online – Find eye surgeons in your area by using the American Academy of Ophthalmology’s Find an Ophthalmologist tool.

Consult With The Ophthalmologist

Once you find the right doctor, you’ll have a consultation before proceeding. You'll undergo a comprehensive eye exam and a preoperative exam to determine the level of correction needed and confirm you're healthy enough for surgery.

Your doctor will also need to take measurements of your eyes before the procedure. This will determine the curvature of your cornea and the length of your eye. They need this information to choose the right size and power of the intraocular lens (IOL). This artificial lens will replace the cloudy lens inside your eye.

There are a variety of IOLs with different features available. Before surgery, you and your eye surgeon will discuss which type might work best for you and your lifestyle but bear in mind that insurance companies may not pay for all types of lenses. Some of the types of lenses available include:

  • Fixed-focus monofocal – This has a single focus strength for distance vision. You’ll likely still need reading glasses.

  • Accommodating-focus monofocal – These are designed to provide a greater range of paragraph vision after cataract surgery than conventional monofocal IOLs.

  • Multifocal – Like glasses with bifocal or progressive lenses, they allow near, medium and far vision.

  • Astigmatism correction (toric) – If you have significant astigmatism, this type of lens can help correct your vision.

Get Ready For Surgery

Just before surgery, your eye doctor will have some instructions, including:

  • Stopping any medications that could increase your risk of bleeding during the procedure or interfere with cataract surgery

  • Using antibiotic eye drops one or two days before the surgery

  • Fasting 12 hours before the procedure

Be Ready For Recovery

As you prepare for your upcoming procedure, keep the following in mind for your recovery period.

  • Get a driver – Make sure you have a reliable companion who can drive you to and from your appointment. Uncomplicated cataract surgery usually lasts 15-20 minutes.

  • However, you’ll probably be at the hospital for about 90 minutes. They need to prepare you for surgery and provide instructions about your cataract surgery recovery before you leave.

  • Have a Day-of-Surgery Caregiver – Some surgery centers require that someone be with you for at least one day if you received anesthesia, so be sure to ask and arrange coverage.

  • Ongoing Helper – You should also arrange for a friend or family member to help around the house or drive you for at least the first week. You won’t be able to do any strenuous activity and heavy lifting (nothing over 25 pounds) and you shouldn’t bend, exercise or perform any other similar activity that might stress your eye.

  • Medical Assistance – If you anticipate any difficulty giving yourself medicated eye drops, find someone who can administer them for you several times each day for a few weeks after surgery.

  • Stay Inside – Plan to stay indoors as much as possible, but you’ll receive a special pair of sunglasses for when you go outside.

With a better understanding of what to expect before cataract surgery, you can reduce any anxiety and form a plan for a successful procedure. Soon, you’ll be seeing your world more clearly – and be happy you decided to do it!

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