Refractive surgery can be performed on most people who wear glasses or contact lenses for distance vision. It cannot be done to do away with reading glasses which become necessary after the age of 40-45 years of age.

You may be suitable for surgery if:

• You are at least 18 years of age (but less than 60 years)
• Have a stable prescription for more than a year
• Have reasonable expectations
• Are in good health and not using certain medications
• Have healthy eyes
• You are not pregnant, and are not breast feeding
• Your prescription must be within certain limits

If you think you are a good candidate, book an appointment with the ophthalmologist for a full exam and he can discuss all your options with you.

LASIK is an acronym for laser in-situ keratomileusis. In short this means a laser beam reshapes your cornea from within (under a corneal flap). PRK stands for Photo-Refractive Keratectomy.

The first LASIK operation was performed in 1990 by the Greek ophthalmic surgeon Ioannis Pallikaris. PRK was first approved by the U.S. FDA in October 1995 after more than 10 years of clinical trials, and LASIK was approved in 1999. These procedures have been widely available since the mid-1990s.

Like every procedure, refractive surgery changes all the time.

At Umhlanga Eye and Laser we have upgraded our equipment at regular intervals, and now have the first 500Hz Wavelight laser in Africa. The Occulizer 2 and Topolizer Vario complements this state-of-the-art Excimer laser to ensure a perfect outcome. We have regularly updated our keratomes, and currently use the Moria SBK and M2 systems

Older lasers created irregular corneal surfaces and was the cause of night vision problems and halos.

There are two main types of wavefront technology used in LASIK. Customised wavefront laser is treatment individualised to your eye after measurements are done on an instrument called a wavefront analyser. This can correct tiny imperfections in the eye and may be required for eyes that have a large amount of higher order aberrations. Wavefront Optimised laser is a treatment which has been designed to minimise aberrations induced and it is the technique we use on most patients. Both these techniques have improved the quality of vision as compared to conventional LASIK and help to minimise night glare and halos.

The Excimer laser is a sophisticated piece of equipment. It is manufactured overseas. In the USA a device has to undergo rigorous testing and clinical trials to establish the safety and effectiveness before it can be FDA approved. The laser we use is FDA approved. We have a maintenance contract to ensure that the laser is compliant with all regulations and is safe and accurate at all times.

Most patients do not find the procedure painful at all. Some do find it a little uncomfortable or have a feeling of “pressure”. It is over very quickly. For most patients the fear of the unknown is worse than the actual procedure. Anaesthetic drops are used to numb the eye just before surgery begins and you may wish to use a mild sedative.

Numerous checks are done before you are escorted into the laser theatre. Once you are in, the procedures will be completed in 10-20 minutes.

We use a small instrument called a speculum to prevent blinking. We have an active eye tracker which detects even microscopic eye movement and can redirect the laser beam as required.

Most LASIK patients see well the day following surgery and usually will be able to resume most of their normal daily activities. Patients with high prescriptions may recover more slowly. PRK patients also heal more slowly. The speed of recovery can vary between patients.

Most patients prefer to have both eyes treated at the same time. However you do have the option of treating them on separate days should you so wish.

LASIK and PRK are considered to be very safe. Over 17 million cases have been performed worldwide in the past 20 years. In the hands of an experienced surgeon utilising state-of-the-art equipment, the procedure has an extremely low incidence of serious complications.

Almost everything you do in life has risks. All types of surgery have some degree of risk and refractive surgery is not excluded. However, the chance of having a serious vision reducing complication has been documented in a number of clinical studies to be very low. LASIK and PRK have been around for many years and countless studies have been done to improve the results and safety. Millions of people have had excellent results. Thus it is one of the most common operations done the world over. Some potential complications include conditions such as dryness, complications in making the surgical flap, night glare, under or over-correction, ectasia and loss of best-corrected vision.

The risks of the surgery are discussed fully prior to surgery. Preoperative screening ensures that we proceed with the procedure only when it is medically advisable. We prefer a conservative approach. Laser treatment should not be done if the patient cannot accept the remote possibility of a complication that could occur.

Perhaps the best way to help prevent complications is to choose a surgeon who is experienced and has been performing refractive surgery for a number of years. It is important to ensure that the equipment used is current and properly maintained.

Corneal flap surgery was first performed over 50 years ago by Jose Barraquer in Columbia and the excimer laser has been in use for almost 20 years. Patients have now been monitored for many years. The National Institute of Health and Clinical Excellence (NICE) published a guidance document on LASIK and determined that the procedure was safe and effective, and that there were no serious concerns about the long-term safety if performed with the latest technology and techniques.

Realistically there is no real chance of this (some say there is perhaps a chance of about 1 in 5 million – the same risk as dying in a plane crash).

While laser vision correction has proven overwhelmingly successful in reducing dependence on glasses and contact lenses, the degree of improvement may vary among individuals. How well and how quickly your vision improves depends on how well you heal and the severity of your prescription.

While we can never promise patients “perfect” (20/20 or 6/6) vision, most patients with mild to moderate prescriptions do achieve 20/20 vision or are within 1 to 2 lines of this on an eye chart. This means they no longer need glasses or contacts to drive, play sports, watch movies and TV, or participate in careers requiring excellent vision such as police and fire departments.

Monovision is an option where one eye is corrected for distance and the other for near vision. This arrangement suits some although most people prefer to have both eyes corrected for distance. Monovision is subject to individual adaptation. Should you be in the presbyopic age group (i.e. over 40 years) and wish to consider this, you would need to try it out with a contact lens trial to see if it suits you. Your optometrist can arrange this for you.

Most people have vision that is legal for driving without glasses the day after surgery. PRK patients take longer. Your vision is tested the day after surgery and we can inform you if you are indeed legal.

Usually you can return to work the day or two after your procedure. PRK patients may need to take a week off work.

We look at the stability of your prescription prior to planning surgery. If your eyes are stable there is an excellent chance that you will have permanent correction of your refractive error. However some patients’ eyes do change with time. Some patients may need to wear glasses for some demanding tasks (e.g. for night driving) and others may need a late enhancement.

Most patients do not require any correction after their procedure. However you certainly can should this need ever arise. Contact lenses can be worn 6 weeks after the procedure.