Last month I discussed a few exciting aspects of the newly-approved
excimer laser treatment for nearsightedness and astigmatism. In
this article I will detail some of the risks involved with the
procedure, and the role that your primary care optometrist plays
in the "team-approach" to refractive surgery.
Let's just start with the BIGGIE. You will probably sign a consent
form that states something like this: "you understand that
you may be the first one in the world to go blind from this procedure."
What a pleasant thought. In reality, after several hundred thousand
cases performed around the world in the last eight years and in
47 different countries, NO ONE has become blind. So, in a way,
that consent form is somewhat reasurring, in its own morbid way.
Infection is probably the primary concern of doctors. If it occurs,
it is usually during the first 48-72 hours after surgery. The
odds are 1 in 500 that you will have a problem with infection.
By observing a few simple post-op rules and using your eyedrops
as instructed, this risk is very low.
Pain is another "risk" that patients are concerned about.
Roughly 1 in 10 people describe their post-op experience as painful.
Most will describe it as a scratchy nuisance. You will be given
medicine for pain but instructed not to use it unless needed.
With the application of a soft contact bandage-lens, and eyedrops,
the discomfort is kept very minimal. If you do experience some
discomfort it will dissipate within three days. There is absolutely
NO pain during the actual laser treatment, and the eye is anesthetized
with only eyedrops, no needles.
Night glare is something we can all relate to at one time or another.
Following the PRK procedure this glare could be worse. It will
dissipate during the 3-6 month post-op period. Corneal "haze"
is a phenomenon that many PRK patients will have to some degree.
It has been more of a concern for doctors, as patients are rarely
affected visually. It is part of the healing process of the cornea
and typically disappears after 6-12 months. In cases of severe
haze, which is rare, post-op medications offer some control and
even another excimer procedure can be used to eliminate stubborn
cases.
Over and under correction of your myopia is another possible risk.
Although statistics show that 90-95% of PRK patients will attain
acuities of 20/40 or better without glasses, that still leaves
1 in 10 that will be worse than 20/40. Again, sometimes it is
possible to effect the outcome by adjusting the post-op medications.
In cases where this is not effective, an enhancement laser procedure
can be performed anywhere from 3 months up to a year or later.
The close association between your primary care optometrist and
your refractive surgeon is crucial. As mentioned previously, there
are many aspects of post-surgical care that can help to determine
the final outcome of your laser treatment. The OD-MD team stay
in close contact for several months after the surgery, even transmitting
data over the internet, in order to co-ordinate the best possible
treatment for the finest surgical outcome. Your optometrist will
then ensure that the healing process is on schedule, that no infection
occurs, and that your vision steadily improves. He will also suggest
interim measures of correction while one eye is healing and the
other awaits a laser procedure. This can be a bit tricky when
one eye is near "normal" and the other is still quite
myopic.
Photorefractive keratectomy (PRK) and laser assisted intrastromal
keratomileusis (LASIK) are remarkably safe and effective surgical
procedures for those people desiring less dependence on glasses
or contact lenses. These procedures are not perfect and candidates
must have the proper expectations.