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Long-Term Effects of LASIK Surgery

Dr. Marian S. Macsai July 11, 2008 12:00 PM This chat has ended. Thank you for participating.
Kristin (Moderator) - 11:51 AM:
Welcome to our Long-Term Effects of LASIK Surgery chat with Dr. Marian S. Macsai. Our chat will begin in 10 minutes, please feel free to begin submitting questions. Thank you.

Dr. Marian S. Macsai (NorthShore) - 12:01 PM:
Hello everyone. I look forward to answering all your questions. Let's get started.

Rich (Chicago, IL) - 12:01 PM:
I’m 20 and am thinking about LASIK surgery. I read that it’s best to wait until my prescription on my glasses is stable, but I’m not sure how long that would take. How long do you think I should wait?

Dr. Marian S. Macsai (NorthShore):
Rich, this is a great question. We consider your prescription stable when it hasn't changed significantly in one year. In most patients, this occurs within 18 and 21 years of age. It might be worth getting a LASIK consult now so the surgeon can document if your vision is changing or stable before having LASIK.

Lisa (Mt. Prospect, IL) - 12:03 PM:
I’m diabetic but don’t need to take any insulin (only oral medication), can I still have the surgery successfully? Should I even take that risk?

Dr. Marian S. Macsai (NorthShore):
Lisa, diabetes alone is not a contraindication to LASIK alone. However, some diabetics have dry eyes or other disease. Your LASIK surgeon can determine if these exist. If you are wearing contact lenses and plan to do so for the rest of your life, there may come a time when you can no longer wear your contacts due to your diabetes. At that point, you may wish you had LASIK years ago. So go ahead and find out if you're a candidate.

Mary (Niles, IL) - 12:04 PM:
I have very dry eyes and it seems to be getting worse. What is the most effective treatment for this?

Dr. Marian S. Macsai (NorthShore):
Mary, there are many different kinds of dry eyes, and many different treatments available. Some people have dry eyes from systemic diseases or medicines. Others have dry eyes related to their age. And many times, we do not know the cause. Treatments include artificial tears, prescription drops such as Restasis, or placing small plugs to close the tear drains. I would recommend you have a complete exam with your ophthalmologist to determine what treatment plan is best for you.

Odette Yee (Morton Grove,IL) - 12:07 PM:
Hi I am thinking of having the laser surgery and heard that there are two methods available. The "wave" method and another method where 4 incisions are done. I hear the wave is the method to go with. Is that the same as the Lasik? Which version would you recommend?

Dr. Marian S. Macsai (NorthShore):
Odette, the wave method you are refering to is wavefront technology and that is the state-of-the-art way to perform LASIK surgery. It is a customized measurement of the glasses prescription for your eye. It is very precise and reliable. The four incision technique is called Radial Keratotomy and is no longer considered the best treatment for near-sightedness. I would strongly recommend you have LASIK surgery with wavefront technology.

Dave (Evanston, IL) - 12:09 PM:
What time frame does "long-term" refer to?

Dr. Marian S. Macsai (NorthShore):
Dave, LASIK was first performed in 1994 when the excimer laser was FDA approved. Therefore, our long-term data on this procedure is limited to 14 years.

Dave (Evanston, IL) - 12:10 PM:
If glaucoma is in my family history, are there any long-term Lasik problems?

Dr. Marian S. Macsai (NorthShore):
Dave, a family history of glaucoma does not necessarily eliminate LASIK surgery as an option. In current glaucoma management, we measure the pressure in your eye and the thickness of your cornea to determine the overall pressure of the eye. After LASIK surgery your cornea is thinner, and as a result this may affect the pressure reading obtained with today's instruments. There are newer instruments under development that will eliminate this effect in the future.

Joanne (Algonquin, IL) - 12:12 PM:
Hi doctor. How long should I go without driving after LASIK surgery?

Dr. Marian S. Macsai (NorthShore):
Joanne, it is not recommended that you drive after your LASIK surgery for the first day. At your first post-operative visit your vision will be measured. It will probably be 20/40 or better. In the United States, you are legal to drive with 20/40 vision. However, some patients may wish to wait longer if they are not comfortable. Once you are 20/40 you are legal to drive.

Jennifer Brook (Glenview, Il) - 12:14 PM:
I had mono vision LASIK 2 years ago but need readers to look at computer and small print, should I have an enhancement?

Dr. Marian S. Macsai (NorthShore):
Jennifer, this is a good question. If you are in your late 40s or older, mono vision should allow you to see clear at the distance and either near or computer. There are really 3 fields of vision in a person your age, these are reading, computer or intermediate, and distance. With mono-vision, one eye is set for distance, and the other is set for either near or intermediate. You should be able to either see for reading or the computer with your near eye. If not, I would suggest you discuss further treatment with your surgeon if it is safe.

Dave (Evanston, IL) - 12:17 PM:
My prescription has numbers in all three parts (sphere, axis, cylinder). Will Lasik correct all of it?

Dr. Marian S. Macsai (NorthShore):
Dave, depending on how thick your cornea is and if your eye is healthy, modern LASIK surgery will correct all 3 of these numbers. The sphere measures how near-sighted or far-sighted you are, and the cylinder is a measurement of your astigmatism. Astigmatism is correctable with LASIK.

Mike (Tinley Park, IL) - 12:19 PM:
Even after I have completely healed from the surgery, am I still at higher risk for eye infections?

Dr. Marian S. Macsai (NorthShore):
No. Lasik puts you at no greater risk for eye infections after it has healed.

Liza Kurian-Castillo (Glencoe, Il) - 12:19 PM:
Do I have to worry about moving my eyes during the lasik procedure?

Dr. Marian S. Macsai (NorthShore):
Liza, state-of-the-art lasers for LASIK surgery have tracking systems that track your eye very closely during the procedure. If you move your eye the laser will follow you or stop until your eye has moved back into the correct position.

Lauryn (Chicago, IL) - 12:20 PM:
What kinds of illnesses would prevent someone from qualifying for LASIK?

Dr. Marian S. Macsai (NorthShore):
Lauryn, patients with active autoimmune diseases, such as Rheumatoid Arthritis, are not good candidates for LASIK surgery. Your doctor will review your medical history before determining if you are a candidate for LASIK.

Scott (Lincolnshire, IL) - 12:21 PM:
I'm 43 and becoming slightly farsighted (nearsighted with astigmatism since I was 8). My mom had one eye corrected near and the other far. Your thoughts on that approach?

Dr. Marian S. Macsai (NorthShore):
Scott, your mother had monovision LASIK surgery. This is an excellent option for patients over 40. However, before having this procedure it is best to have a contact lens trial to demonstrate the monovision as not all patients will tolerate this. Approximately 1/3 of the population, regardless of their prescription, cannot tolerate monovision. It is best to identify these patients prior to performing LASIK surgery.

Liza Kurian-Castillo (Glencoe, Il) - 12:23 PM:
Is all laser surgery LASIK?

Dr. Marian S. Macsai (NorthShore):
Liza, I believe you are asking about all-laser LASIK. Currently in LASIK surgery, a flap of the cornea is separated and the shape of the cornea is changed under the flap. This flap can be made with a blade or a laser. All-laser LASIK is when the flap is created with a laser. This is a safer way to create the flap and many patients heal much more rapidly with this technique.

Sarah (Aurora, IL) - 12:25 PM:
Will LASIK get rid of cataracts?

Dr. Marian S. Macsai (NorthShore):
Sarah, no, LASIK will not get rid of cataracts. In fact, if you have cataracts, you should not have LASIK surgery. However, there are now implants available for cataracts patients that allow patients to see well in the distance and up close without their glasses.

Dave (Evanston, IL) - 12:27 PM:
I've read that night-time "halo" effect has been a problem for some Lasik patients. Is this still a problem and what percentage of people have it? If it occurs can an enhancement be done to reduce or eliminate it?

Dr. Marian S. Macsai (NorthShore):
Dave, newer technologies for Lasik, such as Wavefront and customvue, have decreased the incidence of this unpleasant side-effect considerably. If a patient has halos only at night, there are options you may want to consider including using certain prescription drops before going out at night. A patient may benefit from a touch-up of their Lasik procedure. With current technology, halos at night after LASIK surgery has healed are reported in approximately 1% of patients.

Frank (Canton, OH) - 12:29 PM:
What are some of the complications associated with LASIK?

Dr. Marian S. Macsai (NorthShore):
Frank, complications of LASIK include infection or inflamation under the flap which occurs rarely. If a patient is involved in trauma shortly after their LASIK procedure the flap can be moved, which requires surgical repositioning. Other complications may include a dryness, mild discomfort, glare or halos at night, or a need for a fine-tuning of the procedure. All of these should be discussed with you by your surgeon before you have LASIK surgery.

Robert Steel (Chicago, IL) - 12:31 PM:
Hello doctor. Is it true that LASIK removes the need for reading glasses?

Dr. Marian S. Macsai (NorthShore):
Robert, LASIK can eliminate the need for reading glasses when patients have monovision LASIK performed.

Mary (Niles, IL) - 12:32 PM:
What if you had lasik and didn't know at the time that you had an autoimmune disease? What are the issues with lasik and those types of conditions?

Dr. Marian S. Macsai (NorthShore):
Mary, if a patient has had successful LASIK surgery and then develops an autoimmune disease, there are really no issues to worry about. Before FDA approval, one patient with an autoimmune disease had LASIK and developed problems immediately after the procedure. As a result, LASIK is no longer indicated for patients with active autoimmune disease.

April (Palatine,IL) - 12:34 PM:
I have pseudotumor cerebri that has been under control for some time. Can people with this condition still have LASIK?

Dr. Marian S. Macsai (NorthShore):
April, people with pseudotumor cerebri that is under control can have LASIK as long as their eyes are healthy, their corneas are thick enough, and their eyeglasses prescription is stable. LASIK will not improve or worsen the pseudotumor cerebri.

Janice (Chicago, IL) - 12:35 PM:
How is someone at greater risk to developing complications after the surgery?

Dr. Marian S. Macsai (NorthShore):
Janice, this is a complicated question. In some patients if they had a preexisting condition that was not identified, they may develop post-operative complications. In other patients who have worn their contact lenses for many years, they may be at a greater risk for needing a fine tuning. Patients with pre-existing dry eyes are at greater risk for post-operative dry eyes.

Meghan (Winnetka, IL) - 12:37 PM:
Hello Dr. Macsai. Is it possible I would need to wear glasses again 10+ years down the road after having LASIK? If there is a need for correction, would I not be able to wear contacts again?

Dr. Marian S. Macsai (NorthShore):
Meghan, yes, this is possible. Patients may require glasses 10 years after LASIK for many different reasons, such as aging, cataract formation, or development of other eye diseases.

Odette (Morton Grove,IL) - 12:39 PM:
When Lasik is performed can it be done for far and near sightedness? I have been wearing contacts for a long time and now I am having trouble seeing near. Recently my eye doctor started me on mono vesion. Can this be done with Lasik?

Dr. Marian S. Macsai (NorthShore):
Odette, in patients who successfully wear monovision contact lenses, monovision LASIK is an excellent option as long as your eyes are healthy enough to undergo the procedure.

Erick (Naperville, IL) - 12:39 PM:
Are there any other surgeries that have the same functions of LASIK?

Dr. Marian S. Macsai (NorthShore):
Erick, there are other surgeries. One option is PRK, which reshapes the front surface of the cornea after the skin cells are removed. In this procedure, the skin cells grow back and as a result, patients may heal more slowly than LASIK surgery patients. Another option is the implantation of a collamer lens inside your eye. This lens is implanted with minor surgery and performs the same function as contact lenses.

Susan Lim (Gurnee, Il) - 12:42 PM:
Good afternoon Dr Macsai, It's so nice to know that I can ask you questions directly about LASIK and dryness. 1st question: How bad is the dryness after LASIK?

Dr. Marian S. Macsai (NorthShore):
Susan, dry eyes after LASIK surgery are commonly a problem for the first 2-3 months while the eye is healing. When we create the flap for LASIK surgery, corneal nerves are cut and until these nerves regenerated, some patients experience a dryness. One way to improve the situation is to place small plugs in the tear drains at the time of LASIK surgery. Another is to use artificial tears. It is important to screen patients for dry eyes before LASIK surgery.

Rocio (Matteson, IL) - 12:43 PM:
Are there instances where LASIK is absolutely necessary?

Dr. Marian S. Macsai (NorthShore):
Rocio, as long as a patient's vision can be corrected with glasses or contact lenses, LASIK is not considered medically necessary.

Rachel (Chicago, IL) - 12:44 PM:
I'm told I'm nearsighted by -1 in each eye so the only time I wear glases is for driving when it's dark outside. Should I wait for my vision to worsen to get LASIK?

Dr. Marian S. Macsai (NorthShore):
Rachel, if you only need glasses for driving at night, I would not have LASIK surgery. If this changes in the future, you may want to reconsider.

Erick (Naperville, IL) - 12:45 PM:
Follow up from my previous question. Would you say that LASIK is the most efficient one out of the alternatives you listed?

Dr. Marian S. Macsai (NorthShore):
Erick, I would agree that LASIK surgery has been shown to have a lower risk of complications than the other surgeries I mentioned.

Odette (Morton Grove,IL) - 12:46 PM:
How long is it recommended to wait to have lasik surgery now that I have switch to mono vision and adjusted well to this?

Dr. Marian S. Macsai (NorthShore):
Odette, once you have adjusted well to your monovision, you can consider LASIK surgery. Be certain that you have a complete exam and you are a good candidate before proceeding.

Joseph (Lincolnwood, IL) - 12:47 PM:
What kind of discomforts can I expect post-surgery? How long do these discomforts usually last?

Dr. Marian S. Macsai (NorthShore):
Joseph, most patients have some foreign-body sensation or discomfort for the first 3-5 hours after LASIK surgery. It is normal for patients to experience these symptoms for a few days. Patients may experience tearing or dryness after the procedure. However, each individual heals differently.

Liza Kurian-Castillo (Glencoe, Il) - 12:50 PM:
Can anything be done to help lessen the "halo" and "glare" seen at night? I heard wearing shooters glasses (yellow tint) will take care of this problem.

Dr. Marian S. Macsai (NorthShore):
Liza, newer technologies, such as Wavefront and Customvue, have decreased the incidence of this unpleasant side-effect. If the halos are only at night, there are options you may want to consider including certain prescription drops. A patient may benefit from a touch-up of their Lasik procedure. With current technology, halos at night after LASIK surgery has healed are reported in approximately 1% of patients. I am not familiar with shooter glasses.

Kristin (Moderator) - 12:51 PM:
Ladies and Gentlemen, we only have 10 minutes left in our chat. Please submit any final questions you have and Dr. Macsai will do her best to get to them. Thank you.

George (Niles, IL) - 12:51 PM:
I have been thinking about having LASIK for the past year and I still can't decide whether or not I should. What kind of factors would you suggest I look into to make my decision?

Dr. Marian S. Macsai (NorthShore):
George, once you have determined that you are a good candidate for LASIK, be sure that you have it performed using all-laser LASIK technology with Wavefront. I would suggest you go somewhere that you are comfortable with the surgeon and know that if you develop post-operative complications the surgeon will be available to manage them.

Bob (Park Ridge, IL) - 12:53 PM:
I like to swim on a regular basis. How long should I wait after my surgery to go back to swimming?

Dr. Marian S. Macsai (NorthShore):
Bob, I recommend patients not swim for 2 weeks after LASIK surgery.

Marc (Chicago, IL) - 12:54 PM:
I have decided to start the process of LASIK surgery, what can I expect from my first visit to the doctor?

Dr. Marian S. Macsai (NorthShore):
Marc, during your first consultation, numerous measurements will be made of your eyes, including the prescription of your glasses, thickness of your cornea, and 3-dimensional imaging. The surgeon will determine if you are a good candidate for LASIK and discuss with you the risks and what outcomes you can expect.

Gina (Chicago, IL) - 12:55 PM:
I’ve heard LASIK can cure astigmatism, how does that process work?

Dr. Marian S. Macsai (NorthShore):
Gina, LASIK does correct astigmatism. This is done by reshaping your cornea with the laser during the procedure.

Tom (Chicago, IL) - 12:56 PM:
How long do I need to wait before exercising (lifting weights and running) after having lasik?

Dr. Marian S. Macsai (NorthShore):
Tom, I allow patients to exercise the day after their procedure. If you are running outside, it would be advisable to wear sunglasses for the first week after the surgery.

Odette (Morton Grove,IL) - 12:57 PM:
Thank you for the information Dr. Macsai. Are you accepting new patients for these procedure?

Dr. Marian S. Macsai (NorthShore):
Yes, you can find out more by contacting us through our toll-free number 877-396-3937 or visiting our LASIK website.

Mert (Chicago, IL) - 12:58 PM:
Are you conscience during the surgery?

Dr. Marian S. Macsai (NorthShore):
Mert, good question. You are conscience during LASIK surgery. You will be asked to look at a fixation light. It is not possible to perform this procedure under general anesthesia at this time. We often give patients a mild sedative before the procedure to help reduce their anxiety. Strong anesthetic drops are placed on your eye so the procedure is not painful. You may experience some pressure during creation of the corneal flap. However, patients find LASIK to be easier than they expect.

Kristin (Moderator) - 12:58 PM:
Thank you everyone for participating, the doctor has time for one last question.

Betsy (Highland Park) - 1:01 PM:
While shopping around I've encounterd a wide variety of prices, what should I be sure and check for before deciding on a doctor to perform the lasik?

Dr. Marian S. Macsai (NorthShore):
Betsy, this is a great question. There are numerous centers where patients are screened and cared for by technicians and other professionals who are not their surgeon. It is best that you are comfortable where you have your surgery and are able to see your surgeon for your pre-operative and post-operative care.

Kristin (Moderator) - 1:03 PM:
Thanks again for participating. If you would like additional information about LASIK, please visit our website.

Dr. Marian S. Macsai (NorthShore) - 1:04 PM:
Thanks everybody, great questions! I hope that you have all learned something and will consider a consultation to see if this procedure is right for you. You can find out more by contacting us through our toll-free number 877-396-3937 or www.enh.org/LASIK.
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