FAQ's ABOUT LASIK
Because every individual is unique (age, sex, occupation, health, eye characteristics, etc.), these questions are only a guideline. Special considerations may always exist. That's why it is best to schedule a FREE LASIK consultation, so that we may go over any questions in detail.
Can I go blind from LASIK?
To the best of our knowledge, in over 7 million cases performed in the U.S., no one has ever gone blind from LASIK. Early LASIK procedures subjected people to more complications than today's LASIK procedures, mainly due to lack of surgeon experience and inferior equipment. Some individuals who had LASIK in the 90's and even early 2000's have had LASIK induced visual distortions and in some cases, had to undergo corrective surgical procedures like corneal transplants to correct these LASIK complications. But today's LASIK is much different from early LASIK. The biggest risk in today's LASIK procedure, as with any surgery, is the possiblity of infection (many infections after LASIK are self-induced through patient neglegence). Propper LASIK procedure today is to prophalacticly apply antibiotic drops for a week following the procedure, which virtually eliminates onset of infection (wearing contact lenses has shown to be as much as 5 times more likely to result in infection than having LASIK). Choosing a qualified surgeon, using the newest technology and carefully following your post-operative instructions, almost eliminates any chance of going blind from LASIK. You actually have a much higher chance of dieing in a car accident on the way to the doctors.
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What is my down time after LASIK?
LASIK is an outpatient procedure that requires only an anesthetic eye drops to successfully perform the procedure. The visual results are usually very rapid and within hours of the surgery, most patients have functional vision. By the next day, most individuals are seeing well enough to drive and go back to work; however, individual results depend on a number of factors including age, amount of correction, and individual healing characteristics. It is not uncommon for vision to fluctuate for several weeks to several months as the eyes heal. If you have a specific question regarding your personal situation, please call us toll free @ 866-942-4001.
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What is a LASIK enhancement?
An enhancement is an additional laser procedure used for fine tuning after the initial LASIK procedure. Mostly due to individualistic healing factors combined with the size of the treatrment, it is sometimes necessary for additional treatments (to enhance your vision). This can be done no sooner than three months following the initial procedure and sometimes may take up to six months even if the correction is a little off at the end of the healing period which is generally around three months. Most LASIK enhancements occur in the first year (typically around 10-12% of patients in the U.S. need enhancements). An enhancement is usually done on individuals with 20/40 vision or worse and must have at least 3/4 of a diopter of refractive error. Regression can occur at anytime and an enhancement can be performed as long as it is recommended by your surgeon–even five or ten years down the road. Fortunately, Envision Laser Centers strong comitment to patient satisfaction, our enhancement rates are much lower than the national average.
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Is LASIK covered by insurance?
Almost all insurance companies consider any laser vision correction procedure to be an elective procedure, even though LASIK is correcting a vision disability. Insurance companies feel glasses and contact lenses are a fair alternative to having LASIK surgery. These days, with people changing health care providers because people tend to job hop, insurance companies do not want to spend a few grand for LASIK (especially when that person may have another insurance plan a year or two down the road). They prefer to spend a much smaller amount on annual or biannual glasses prescriptions and exams, because in the long run it is more profitable for the insurance companies. If an insurance company would decide to cover the cost o f LASIK, so many people would opt for LASIK, that it would cause a great financial burden for that insurance provider.
There are some insurance companies that offer partial LASIK coverage, but in most cases this is just a way to refer patients to certain providers in exchange for a discount of surgery cost. LASIK provides convenience, safety, and long term savings over the daily use of contact lenses and glasses. Every individual has to look at each of these benefits and how they play a role in their lives before making a decision to have laser vision correction.
Envision Laser Centers give insurance discounts for many eyecare insurances such as VSP, Davis Vison and Eyemed. For a complete list or to see if your provider offers a discount, please call us at 866-942-4001.
What are Punctal Plugs?
The most common side effect after LASIK is temporary dry eyes which can affect comfort and vision shortly after LASIK. Punctal plugs are the easiest way to avoid dryness issues.
 Most studies suggest that between 75-80% of LASIK patients have some form of dryness after surgery that can last from weeks to months. Dry eyes may affect your vision after surgery and may increase your risk of regression after surgery. Your eyes need lubrication from tears to help them heal after surgery. There are two ways to combat this dryness.
One way is to use preservative free artificial tears hourly for two weeks following surgery and to use them as needed in most cases until three months post-operatively. In some cases it may be as long as a year, especially in older individuals or individuals with pre-existing dry eye conditions (patients with an existing severe dry eye condition should not undergo LASIK until the condition is remedied).
The second way is by inserting very small dissolvable punctal plugs into your tear ducts. The tears that individuals produce escape by evaporating or draining through your tear ducts (which is why when you cry your nose runs). By preventing your tears from draining, they remain on your eye with their natural antibiotics to aid in healing. You cannot see or feel these plugs and in about three months they dissolve and your tear ducts are back to normal.
There is nothing wrong with using artificial tears, but you must be regimented enough to use them hourly. Artificial tears must be preservative free (preservatives can be toxic in high doses) for the first 30 days. The use of these tears can be almost as costly as having punctal plugs inserted.
LASIK evolves with technology and punctal plugs have been shown to decrease regression after surgery, reduce vision fluctuation, increase comfort and minimize the possibility of flap slippage after surgery. Our doctors will be more than happy to discuss each individual’s case independently, because some people may be more susceptible to dryness after surgery than others.
Envision Laser Centers recommend punctal plug insertion on the day of your surgery rather than insertion after dryness is present. It is much easier to keep the cornea moist than to rehydrate a dry cornea (much like it is easier to keep a swimming pool full of water than it is to fill the pool when it is empty). By inserting punctal plugs, you are helping to ensure adequate tear film to promote proper healing.
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Can I see up close after LASIK (MONOVISION)?
Yes, people under the age of 40 can generally see up close after LASIK. People over the aga of 40 may need reading glasses for near tasks. There are several ways to get around the use of reading glasses after a person becomes presbyopic (loses their near vision). The most popular way at this time is a process called monovision.
The use of one eye for distance and one eye for near vision is referred to as monovision and is one of the options to consider as part of your refractive surgery decision if you are over the age of 40.
Monovision has been used successfully for over 25 years with contact lens correction and with various types of refractive surgery. By correcting one eye to focus in the distance and one eye to focus for near, the vision part of our brain tends to suppress or filter out the image from the eye that is not in clear focus. The patient is not bothered by the eye that is not in focus. Monovision is not the best of both worlds, but for many people such as lawyers and reporters who continually focus back and forth between close and distance objects, monovision provides the best alternative for accomplishing their goals.
The change in accommodation (focusing ability) to see objects at near will generally begin to decline around the age of 40 and will usually get worse quite rapidly over the next 10-15 years (presbyopia). Presbyopia, loss of ability to change your focusing distance from far to near, will occur whether or not you have refractive surgery. This is the reason people over the age of 40 generally need magnifying glasses (readers) to see up close. There is no right or wrong answer to the question of whether to have monovision. This information is to help you make this decision.
As a rule, we suggest against monovision if you are under the age of 35 for two reasons:
- It will be a number of years before you will notice any benefit from it; and...
- It is very possible that there will be a better (or at least as good) surgical way to help presbyopia by the time it is a problem for you.
We also generally recommend against monovision at any age for people who may need to see better than average for distant tasks. Some examples might be pilots, race car drivers, someone who drives for a living (especially at night), and avid tennis players (especially for playing at night), etc.
In our experience, most people over the age of 40 to 45 who try monovision and take a few months to become accustomed to it, like it and find it very useful. Those who have monovision will be able to generally see well enough both at distance and near to do most things at any age without corrective lenses. Depending on the exact result obtained (as is true for everyone having refractive surgery) there might still be some situations when the very best vision or the maximum visual comfort might require wearing glasses (or possibly contacts). Night driving and prolonged reading are two examples that are mentioned frequently, but it could be anything for which you feel the need or desire to see the very best possible. It is probably helpful to realize that without a specific cure for presbyopia, once you are past the 40 year age range, all refractive corrections involve compromise. If you have both eyes corrected for good distance vision, you will need glasses for close vision. If you have both eyes corrected for close vision (not a common choice) you will need glasses to clearly see everything far away. If you choose monovision, although your vision may work well for almost all purposes, you might feel it is less than perfect.
We know of no perfect way to help you make this choice. We would suggest that if significant doubt remains in your mind, that you aim to have your vision corrected for good general distance vision and plan to use reading glasses when necessary.
It is important to note that if you choose monovision and are unable to get used to it, it can be reversed by performing an "enhancement" procedure on the eye made to see near. Once the enhancement is performed the near eye then sees more clearly in the distance and reading glasses are then required for all near tasks. Below you will find the answers to frequently asked questions about monovision. If you have any further questions regarding your care, please contact us.
MONOVISION FREQUENTLY ASKED QUESTIONS
If I choose to have monovision, does that mean I will never need reading glasses?
No. Presbyopia continues to worsen as you get older, whether or not you have monovision. At some point, the presbyopia may be so bad that reading glasses will be necessary. Still, there is a benefit to having the monovision because there won't be a complete dependence on glasses for things up close. Larger print will still be readable without glasses, and things slightly farther away (like computers and dashboards of cars) will still be readable. Without monovision, even these things would be blurry without reading glasses. For this reason, patients usually don't "give up" their monovision as they get older. They still read better with the monovision than they would if both eyes are corrected for distance, even though for certain things, reading glasses become necessary.
What will the vision be in my reading eye with monovision?
The distance vision in the eye set for reading will be less than 20/20 for distance. The reading eye is left slightly near sighted to allow for better close vision. The amount of residual nearsightedness may be different for different patients, depending on age at the time of surgery, how "good" the patient wants the reading to be, how much distance vision they are willing to give up, and how long they want to be able to read before they eventually need reading glasses. Typically, the amount of nearsightedness left will be between -1.00 and -2.00 diopters. On average it is -1.50 diopters. Regardless of how many residual diopters of nearsightedness are left to allow for the monovision, the vision on the eyechart cannot be predicted just by looking at this number. There is no conversion between diopters and visual acuity on the eyechart (20/20, 20/30, etc.). In other words, if you are left with -1.50 diopters of residual nearsightedness you may see 20/40 with that eye in the distance, or you may see 20/100, 20/80 or 20/50. It can be and is different for different people. In any case, it is not really important how each eye sees separately, it is a two eye world and what is important is how you see with both eyes open you and are you able to comfortably see both near and far for most of your needs.
I tried monovision with contacts and didn't like it. Will it work better with surgery?
It may, and it may not. Part of it depends on how it was tried with the contact lenses. Was it tried for a day, or for a month or more? Sometimes it takes awhile for the brain to "adjust" to this way of seeing. Were the contact lenses properly fit? Was the proper eye set for distance? Was there any astigmatism that needed to be corrected that wasn't with the contacts? Even if everything was done "right" there is certainly a chance that monovision didn't work well. Some of these people have gone on to have surgery, and have tried monovision with surgery and have liked it. Some still did not like it, even with surgery. There may be some contact lens problems that people attribute to monovision problems, and that is why some people may do well with it, even if the contacts didn't work well.
How do you decide which eye to do for distance and which for near?
There are several factors involved. One is, which is the dominant eye? Usually, but not always, the dominant eye is set for distance. Sometimes a patient will come in who has been wearing contacts for monovision and the dominant eye is set for near. If this has been done for awhile, and the patient is doing well with the monovision, we will keep it this way and correct the non-dominant eye for distance. Some patients have a large difference between the measurements in the two eyes. One eye may be -4.00 diopters and the other may be -8.00. Even if the -8.00 diopter eye is the dominant eye, we might make that the reading eye in order to minimize the amount of treatment each eye gets. Part of the purpose of the comprehensive eye exam is to look at all of these issues and decide what will work out best
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