During Laser Eye Surgery

   Preparing for Surgery

Preparing for laser surgery can be a bit frightening and intimidating - after all, it could transform the way in which you live your life and mean you may not have to use glasses or contacts ever again.

When the day for surgery arrives you should allow for a three to four hour visit to the clinic. This will give you enough time to discuss the procedure with your optometrist as well as any last minute measurement that might be needed prior to surgery commencing.

You will be allowed to eat and drink as per normal prior to the operation as any anaesthetic is administered locally.

You should wear loose, comfortable clothing and avoid wearing make-up, creams, mascara, eye shadow, eyeliner, deodorant and perfume on the day of your laser eye procedure.

In addition, if you wear soft contact lenses they should be removed two weeks prior to your procedure. Wearers of rigid gas permeable (RGP) lenses or those with Toric soft lenses, you should stop wearing them at least 3 weeks before surgery and those people who wear hard lenses should remove them at least 4 weeks before the day of surgery.

    During Laser Eye Surgery

The surgery itself normally takes no longer than half an hour. You will be sat in a reclining chair like at the dentists, in an examination room that contains the laser eye surgery equipment.

This equipment normally includes the laser itself, microscope and computer screen.

The surgery is performed whilst you are fully awake although you may be given a relaxant such as valium and anaesthetic eye drops.

Once the anaesthetic drops have been placed in the eye the area surrounding the eye will be thoroughly cleaned and the eyelid held open with a special instrument called a speculum.

Laser eye surgery including LASIK, tends to be done in three stages:

First a flap is created in the outer layer of the cornea;

Then a laser is used to shape and remodel the cornea;

And this is followed by the flap being replaced.

    Creating a Flap in the Cornea

Creating the flap can be done in one of two ways. Either a sharp blade called a microkeratome is used or a laser is used.

With the microkeratome blade method a ring is placed over the cornea and a high pressure vacuum is created. Once the vacuum is in place the blade is attached and the flap is carefully created. After the flap is created the ring and attached blade are removed and the blade disposed of.

With the laser method, the cornea is flattened with a clear plastic plate. Laser energy is then focused inside on the corneal tissue, creating thousands of small bubbles of gas and water that separate the tissue underneath the cornea surface, creating a flap. Once the flap has been created the plate is removed.

Whichever method is used the result is the same. A flap is created in the cornea with a hinge at one end. The flap is carefully folded back, revealing the stroma, the middle section of the cornea.

Whilst the surgeon lifts and folds back the flap you may experience discomfort and during the rest of the procedure you vision may be blurred.

    Laser Remodelling of Corneal Stroma

The next step of the procedure is to remodel the corneal stroma. This is carried out with an Excimer laser which is position over your eye. Once the laser is in position you will be asked to stare at a light in order to fix you eye on one spot.

With you eye in the correct position, the surgeon will initiate the laser remodelling. The laser will remove corneal tissue to an extent and depth as programmed by the computer based on the measurement taken at your initial examination. The laser vaporises tissue in a very controlled manner only removing what it needs to and leaving the rest intact. No burning with heat or actual cutting is needed to remove the unwanted tissue.

Whilst you eye is being remodelled your vision will be very unclear as the flap will be lifted. You will probably only see white light surrounding the orange light of the laser.

    Repositioning of the Corneal Flap

Once the laser has completed the reshaping of the stromal layer the surgeon will reposition the flap over the area that has been treated. The surgeon will then carefully check that the flap is correctly positioned and that no air bubbles or debris remain beneath it. The flap should remain in position by natural adhesion until healing is completed.

A shield or bandage contact lens is sometimes placed over your eye at the end of the procedure as protection, since no stitches are used to hold the flap in place.

It is important for you to wear this shield to prevent you from rubbing your eye and putting pressure on your eye while you sleep, and to protect your eye from accidentally being hit or poked until the flap has healed.

After your laser eye procedure, you will be unable to drive home, so be sure to make transport arrangements for the day.