Q: I was told my corneas are too thin for LASIK. What are the minimum thicknesses required for LASEK or other forms of laser eye surgery that may benefit me?

A: Thin corneas

LASIK and PRK work by reshaping the cornea to change the way light is focused in your eye. This is achieved through removal of corneal tissue with a specialized laser. As you can imagine, having inherently thin corneas, like you have, leaves little corneal tissue to reshape before the cornea becomes dangerously thin. If the cornea becomes too thin, it is at increased risk to warp and thin further, which may result in poor vision, scarring and may ultimately require a corneal transplant.

However, there are plenty of other options for correcting vision that can work for patients who are not good candidates for laser vision surgery. These options vary, and candidacy usually depends on your eye and visual goals and demands. I would discuss with your eye surgeon to see if any of those options work for you.

Q: I had LASIK less than a month ago. My doctor is telling me I need an enhancement. How early can you have an enhancement?

A: Prompt Enhancement

Typically, I will wait at least 6 months before deciding whether an enhancement is necessary. At that point, I will also confirm that there is at least 6 months of stability in my patient's prescription. So ultimately, it is at least 6-12 months before I will recommend or proceed with an enhancement.

It can be frustrating to need glasses, especially after you have anticipated freedom from glasses and contacts. However, the best way to ensure stability, and therefore accuracy of your treatment/enhancement, is to allow the eye time to heal completely and confirm a stable refraction. In any case, a candid discussion with your surgeon is important to achieve the best outcome.

Q: Can I get an eye exam without dilation, the 'air puff' test, or numbing drops?

A: Annoying things ophthalmologists do

The short answer is "Yes." I always tell my patients that they are in full control of their eye care and their visit. That being said, I also advise my patient that we perform the tests you mention for good reason. We are looking for problems in your eye that could result in vision loss. If caught early, many of these issues can be prevented or at least slowed. The "air puff" test is checking your eye pressure (an important measurment for the detection of glaucoma). This information is critical to assessing your general eye health, and should be performed at every visit. However, there are other ways of performing eye pressure checks, so if you absolutely hate this test, ask your tech or physician to perform pressure checks another way. However, understand that numbing drops are needed to measure pressure with those other instruments. 

Numbing drops also help if a small procedure needs to be performed. The nerves of the cornea are very sensitive, and so numbing is a way to keep you comfortable. The numbing should only last 20-30 minutes, so you should actually be feeling normal around the time you check out. 

Dilation is a critical part of assessing your eye health. It allows us to see all areas of the retina and optic nerve. With dilation we are able to see if your eye has diabetes, glaucoma, macular degeneration, freckles and many other eye disorders. Without dilation, the view to the back of the eye is limited and important issues can be missed. Fortunately, in most healthy adults the dilation only needs to be performed every 1-2 years. 

Also, don't hesitate to call the office beforehand and inquire about the need for dilation and pressure checks at your visit. They will often be able to provide you with an answer, or if they cannot answer themselves, they can ask one of the medical staff if dilation would be needed. That way, you can plan accordingly or reschedule if needed.

Q: When can I get into a spa after Lasik?

A: Spa after LASIK

The biggest risk that spas, pools and hot-tubs pose is infection. Bacteria grow very easily in collections of warm water. If you are not fully healed from surgery, there is a risk these bacteria can gain easy access and cause infection in your eye.

I typically advise my patients that they should stay out of pools, hot-tubs and spas for at least one to two weeks. However, if a patient is healing slowly, I advise them to stay out of these types of environments until they are fully healed. Only your physician will know when you are healed, and can direct you more specifically.

Q: My near vision seems to be worse after LASIK surgery. Will this improve with time?

A: Near vision issues following LASIK

Most commonly, difficulty with near vision is secondary to a phenomenon called presbyopia. As we age, our lens loses the ability to change shape and position in the eye, and as such, small print becomes hard to read.

When we have LASIK, this process can sometimes be accelerated, and we have difficulty with presbyopia earlier than we otherwise would.

It is also important to understand that this is not a disease, but rather a normal aging process. Often times, this can be addressed with over-the-counter readers.

However, I would recommend you visit with your eye doctor to ensure this is indeed presbyopia, and that no other issues are causing your difficulty.

Q: Is SMILE Eye Correction Surgery a Type of LASIK?

A: SMILE vs LASIK

There are many surgical approaches to correcting refractive errors (i.e. your glasses prescription) - these include LASIK, PRK and SMILE. Each of these techniques reshape the cornea to alter the optics of the eye and make you less dependent on glasses and contacts.

The two most commonly performed techniques are LASIK and PRK. With these types of laser corrective surgeries, the surgeon uses an excimer laser to reshape the cornea. In LASIK, a flap is made with either a microkeratome, or more frequently in recent years, a femtosecond laser. In PRK, there is no flap. Instead, the outermost layer of the cornea (the epithelium) is removed to expose the layer of the cornea to be reshaped, and is then allowed to grow back after surgery.

SMILE - SMall Incision Lenticule Extraction - is a newer way of performing laser vision correction, and uses a femtosecond laser (the same laser used in LASIK to make the flap) to remove a thin disc of tissue from within the cornea.

The end result of these three techniques is ultimately the same - we are reshaping your cornea to make you less dependent on glasses and contact lenses. They simply represent slightly different surgical methods to achieve this goal. Which procedure is best for you is based on the individual characteristics of your eyes, and you should discuss each option with your surgeon.

Q: 10 years after LASIK, I've developed light glare. What should I do?

A: Difficulty with glare following LASIK surgery

There are several reasons to have issues with glare and night vision problems following LASIK. These include issues with the flap, regression of refractive error, significant dry eye and development of unrelated ocular issues (such as cataracts or inflammation in the eye).

Night glare and light sensitivity can occur in many different eye conditions, and so it is important to visit with your eye doctor to determine exactly what the problem might be. Often times these can be treated/reduced with appropriate diagnosis and therapy.

Q: When can I go back to weight lifting after LASIK?

A: Exercise after LASIK

One of the most critical aspects in the success of LASIK is the health of the flap. If you were to damage the flap, for example with exercise, it could significantly limit the long-term success of the surgery and permanently diminish your vision. Because it has not had a chance to scar into place, even mild trauma early on after surgery can cause significant injury to the flap.

I tell my patients that at 2 weeks, they can engage in light exercise (running, walking) that does not involve weights or projectiles (i.e. racket balls, soccer balls, tennis balls). After about 1 month, I lift the restrictions on exercise, but recommend eye protection with any of these types of activities. Ultimately, your physician has implemented these restrictions for your benefit and to ensure you the best chance of success.

Q: My eyes are overcorrected after LASIK. What should I do?

A: Overcorrection

There is a higher rate of regression (a shift back in the direction of your original prescription) in farsighted (eg +1.50) patients compared to nearsighted (eg -1.50) patients. As such, surgeons will over-treat hyperopia (farsightedness) with a goal of slight myopia (nearsightedness) in the early stages, anticipating the eye will regress to your final target (no glasses prescription).

As such, you are less than one month out, and I would anticipate things will shift back towards your goal of having no refractive error, and thus no need for glasses in the distance. However, if this shift does not occur, a discussion with your surgeon is warranted to confirm no further treatment is needed.