Despite the widespread acceptance of LASIK and the vast amount of public information that is readily available, there are still certain areas of particular interest, as well as sources of potential confusion, to patients who are considering the procedure. In this report, the first of a series, we will examine and clarify some of the most common issues and choices patients face when considering Laser Vision Correction.
Bladeless All-Laser LASIK vs. Microkeratome Blade LASIK
In LASIK, a microscopic corneal flap is created under which an excimer laser applies the patient’s prescription. Healing of the corneal flap is quite rapid, allowing highly functional vision within 12 hours. The corneal flap can be made with a femtosecond laser (bladeless) or with an automated instrument called a microkeratome (using a microscopic blade). Currently, about two-thirds of the procedures in the United States are done with a microkeratome. Both are excellent methods of performing LASIK, but most importantly, there are no statistical differences in visual outcomes between the two procedures. The prescription that is applied to the eye is the same with both methods and the success rate in achieving 20/20 vision is the same. There are, however, important differences between the two methods. Microkeratome technology requires more training and experience, yet it is significantly less expensive, takes less time in surgery, and nearly always causes less discomfort than bladeless. Bladeless technology may be a better choice in patients with certain corneal parameters and is generally easier to learn and to use by surgeons who are less experienced in corneal surgery. It is important to choose a surgeon who offers both technologies, allowing the selection of the best procedure for you.
I Have Good Distance Vision but I Hate My Reading Glasses! Is Laser Vision Correction for Me?
Over the past decade, several procedures such as LTK, CK, and multifocal IOLs have been promoted as being able to eliminate reading glasses in patients over 40 while not reducing their distance vision. Despite the desirability of such a procedure, there is no technology that will create normal vision both at near and at distance simultaneously in an eye of a patient over the age of 40. As all patients who wear only reading glasses can attest to, the distance vision is blurred when looking through a reading prescription. Unfortunately, research testing of bifocal laser prescriptions has been uniformly unsuccessful… and, not surprisingly, the laser “time machine” which reverses the normal aging process has yet to be invented!
Nonetheless, LASIK may eliminate distance and reading glasses simultaneously in patients over 40 given the correct scenario. If a patient can function well with one eye corrected for distance and one corrected eye for near, which is called monovision, and which many patients already achieve by wearing a distance contact in one eye and a reading contact in the other eye, then LASIK monovision is a highly successful option. LASIK monovision corrects one eye for distance and one eye for near, allowing a patient over age 40 to see both without glasses or contacts.
In patients who wear reading glasses only who are not regular contact lens wearers, a short trial of a reading contact lens in the non-dominant eye with their current Eye Doctor can usually determine if they can have LASIK monovision.