A Surgeon Gives his Perspective as a LASIK Patient

Surgery of any kind can be a source of anxiety for the patient and LASIK eye surgery is no different.

Having a good idea of what to expect is an important step in overcoming your fear and remaining relaxed during the procedure. As a surgeon, I am constantly telling my patients the particulars of the procedure so that they will have no surprises during their LASIK. And it has been profoundly useful to me that I myself have undergone LASIK so that I can relate to them exactly what they will experience from the patients perspective rather than just from the view of the surgeon.


So, what can you expect from LASIK?

First of all, it is normal to feel a bit excited and even nervous as the time approaches to have the surgery. Even as an experienced LASIK surgeon, I found myself becoming nervous as I waited in the prep area before surgery.

In our LASIK center, we ask patients to arrive 30 to 45 minutes early in order to receive a number of medications before the procedure. One is an antibiotic eye drop and the other is a topical anesthetic drop.

I recall the anesthetic drop stinging a bit initially and causing my eyes to water up. I received a couple of sets of these drops while I waited and I was happy to see that the additional sets of eye drops did not sting at all.

That’s usually what our staff tells patients to expect. The initial drop stings but since it also numbs the eye, the second drop will not sting at all. That just means that the drops are doing their job properly.

Also, while in the prep area, we give patients a pill (valium) to help them relax further. As I said earlier, it is normal to feel nervous prior to any kind of surgical procedure and I was certainly no exception. The pill helps to take the edge off your nervousness and makes you less fidgety.

I’ve had a number of people try to shrug it off and avoid taking the valium, but I insist that they do. Some people see it as an option and that taking it is a sign of weakness or that they aren’t tough enough. Actually, the pills make the procedure go much more smoothly for the surgeon as well as the patient.

They actually decrease the hypersensitive reactions and subconscious, automatic eye movements that a person has. So with the valium, a patient’s hyper tendency to blink or squeeze their eyes shut in reaction to the eye lid holders or to the microscope lights is significantly reduced which makes access to the cornea easier for the surgeon and makes for a smoother procedure.

Also the valium helps to suppress the normal involuntary movements of your eye and can make for an easier treatment by helping you stay locked on target.


In the LASIK room

From the prep area, I was taken to the laser room itself. Here the surgeon usually makes a number of marks on your cornea with a sterile felt tip pen. Again, because of the eye drops, you can’t really feel any of it.

Then you lie down on the surgical table and are looking up into the microscope lights. In our system, you’d be looking up into a circular ring shaped white light and in the middle of the circle of light there is a blinking red lighted dot. The blinking red light is the fixation light that you will need to look at during the treatment.

One of the staff will usually take this time to use a sterilizing solution to clean the area around your eyes. That’s done to reduce the amount of bacteria and lower the incidence of infections.

At this point, the surgeon is ready to create the LASIK flap on your cornea. So you will feel him hold your eyelids open and place a suction ring over the front of your eye. There is a little pressure associated with the suction ring but usually no pain.

The one exception is that if you have a small, tight eye socket or a prominent eye brow bone, you may feel some pain if the ring is pressing up against the bone. Obviously, the surgeon will work hard to avoid any unnecessary pain but depending on your bone anatomy, it may be impossible to avoid any contact in that area.

Once the suction ring is in place, everything goes dark in that eye. I actually remember seeing just sparkles and not complete blackness. But you should not be able to see the lights or anything else clearly at all.

That is actually a good sign and means that the suction ring is properly attached to your eye. I use the blade-free Intralase technology, so the next step is to attach the Laser mechanism to the suction ring and activate it.

At that point, it requires about 20 seconds to create a complete LASIK flap. Afterward, the suction ring is removed and your vision returns although it usually seems somewhat fuzzy. That’s normal so you shouldn’t worry about it.

The Intralase creates bubbles when it does its work so your vision should seem fogged. I usually proceed to create the second LASIK flap on your other eye at that point so you will experience the exact same things on the other side. Now we usually take about a 2 minute break. That waiting time allows most of the bubbles to absorb so that the view will be clearer during the treatment phase of the LASIK.

During the treatment phase of the LASIK, the surgeon uses the excimer laser to actually reshape your cornea.

A small eyelid holder is put in place so that you cannot squeeze your eyes shut for this part. It’s okay to close the other eye and, in fact, I usually put a shield over it to block everything out so that you don’t visually have any distractions to the other side.

Additional, numbing anesthetic drops are put onto the eye and additional marks are made on the cornea for orientation purposes. Again, you feel very little at this point except for some pressure. If you feel anything at all, it is typically from pressure on the lids or eyebrow bone. You will be asked to looked directly at the blinking red fixation light as much as possible. The surgeon will initially be getting the computer to lock onto your eye so that the treatment will be properly oriented.

After the computer has done its lock-on, the surgeon will carefully free up the LASIK flap and lift it out of the way. During this phase, the blinking red fixation light may seem to dance and move around so it may be somewhat difficult to hold steady. But after the flap is lifted, visually things return to a stable position.

With the flap out of the way, the laser will be activated and the reshaping of the cornea starts. From the patient perspective, you may visually notice some change in the lights and they may even seem to come into focus a bit better. You also will hear a very loud banging or clicking sound which the excimer laser makes while it works. In some cases, there will be an odor of burning or fumes as the laser vaporizes the tissue.

The laser doesn’t actually “burn” tissue because there is no significant temperature rise. The eye never gets hot, but remains a normal temperature as the excimer laser very precisely vaporizes and reshapes tissue. This part of the surgery usually requires less than a minute depending on the amount of your prescription.

I usually let my patients know verbally how they are doing and how far along they are. Because you tend to be nervous as the patient, time seems to flow at a very different rate so it’s nice to have somebody letting you know when you only have 10 seconds or so to go.

After the laser is finished, the surgeon will need to rinse the cornea and replace the flap. During the rinsing phase, you’ll feel a lot of water flowing over the surface of your eye and some may flow down onto the side of your face a bit.

After the flap is put back into position and aligned, the surgeon will wait about a minute or two to let it settle. At that point, we do a blink test. The eyelid holders are removed and you are asked to blink rapidly to make sure that the flap has taken hold. Actually, for several days to weeks, the surgeon will ask you not to rub your eyes in order to let the flap fully heal into position.


Post LASIK procedure

After the procedure is complete in both eyes, we have the patient sit up. Typically, we expect to have the patient see significantly better almost right away so we have them look at a clock on the wall and tell us what they can see.

Most patients can tell the time by that point although it may seem a bit fogged up. I tell patients that it may seem like they have Vaseline on their vision or as though they were wearing glasses and came in from the cold so their lenses are fogged. That’s very normal because there is in fact still some water in and under the flap which takes some time to absorb. By the next day, that vision will usually improve to the point that the patient could drive.

And that marks the completion of the LASIK procedure itself.

After you go home, the anesthetic drops will begin to wear off and you will begin to feel some minor irritation. For me, it felt like I had an eyelash in my eye but some people have more tearing and light sensitivity. In most cases, this discomfort only lasts in the first 6 to 8 hours after surgery. For that reason, we provide sleeping pills and pain pills for the patients.

We try to get our patients to go home and take a nap because if they can sleep through those first few hours, when they wake up, they will feel almost nothing and their vision will be improving even further.

Hopefully, this insiders’ view of LASIK surgery from the patient perspective of a surgeon is helpful. Armed with an understanding of the process, you can go forward with much less anxiety. As I said, it is normal for anybody (even a surgeon) to feel nervous when they undergo a procedure.

But knowledge takes away the unexpected and when there are few or no surprises, you will find yourself focusing more on the exciting outcome of great vision that you will achieve.


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