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What is LASIK?

LASIK stands for laser in-situ keratomileusis. This is a new form of refractive surgery that is a combination procedure. This means that it has two steps. The first step is to create a flap on the cornea (the clear "window" at the front of the eye) with an instrument called a microkeratome, then the Excimer Laser is used to reshape the cornea under the flap. After the laser treatment, the flap is replaced and it protects the treatment area. This allows a wider range of prescriptions to be treated. Since the treatment area is under the flap, the vision recovers more rapidly and there is less discomfort.

What is the difference between LASIK, PRK and RK?

Both LASIK and PRK (Photo Refractive Keratectomy) use the Excimer Laser to reshape the cornea to reduce nearsightedness. With the PRK, the laser is used on the surface of the cornea and in LASIK, the laser is used under a protective flap of corneal tissue. Having the treatment area on the surface of the cornea creates a longer healing time and it can take several weeks to achieve good vision. With the treatment area under the protective flap in LASIK, the eye heals faster and visual recovery is quicker. With the PRK, steroid drops are sometimes needed for several months. With the LASIK procedure, enhancements are easier since the flap can be re-lifted for a period of time without requiring use of the microkeratome. RK (Radial Keratotomy) is an incisional form of refractive surgery. A delicate diamond blade is used to create thin incisions on the front surface of the cornea. The incisions are made in a radial pattern, like the spokes of a wheel. The central part of the cornea is not treated. The length and amount of incisions are determined by the patient's age and glasses prescriptions. A variation of RK is AK (Astigmatic Keratotomy). Making incisions only in the steepest parts of the cornea can treat astigmatism.

How long has LASIK been performed?

LASIK uses both the Excimer Laser and a microkeratome together. The Excimer Laser has been used since the mid 1980's and in 1995 received the FDA approval for PRK, a procedure where the cornea or front surface of the eye is reshaped. Physicians have been creating a protective flap of tissue for over thirty years. In 1991 these two techniques were combined to create the LASIK procedure for use in refractive surgery. The LASIK procedure has been used most widely outside the United States, where government regulatory oversight is not as stringent. It has been under investigation by the FDA since 1995 and is now approved.

Can LASIK treat nearsightedness, farsightedness, and astigmatism?

Yes, it can treat all three. The LASIK procedure treats nearsightedness by flattening the cornea, farsightedness by steepening the cornea; and astigmatism by rounding out the cornea to be more spherical rather than "football" shaped.

How do I know if I am a candidate for LASIK?

The following criteria are used in determining if you are a candidate for the surgery:

• Prescriptions of up to -12.00 to -13.00 diopters of myopia (nearsightedness)
• Prescriptions of +1.00 to +6.00 diopters of hyperopia (farsightedness)
• -4.00 diopters or less of astigmatism
• Minimum age of 21
• No systemic disease that would affect the outcome
• No eye disease that would affect the outcome
• Have realistic expectations and understanding of the procedure

In order to determine if you are a candidate for LASIK, a comprehensive eye examination is required.

What is your success rate for achieved visual acuity (that is, 20/40 or better) and what is the best correction I can expect?

The national average of 20/40 or better is about 98%. Dr. Kiley's success rate is around 99%. Of those, about 3/4's have achieved in the 20/20 or 20/25 range. There are many variables that can affect the visual outcome. Some of these may include humidity in the laser room, corneal moisture during the procedure, machine variations and patient healing. Larger amounts of nearsightedness or astigmatism can be affected more by these variables. Most patients, however, continue to have vision much improved over their preoperative non-corrected vision and in most cases can be corrected to 20/20.

How many surgeries have you personally performed?

Dr. Kiley has been doing microsurgery for over 20 years. He took his first RK courses in 1983 and has performed RK for a number of years. Our office was involved in the investigational studies for PRK starting in 1991. Dr. Kiley started doing PRK in 1995 when the FDA approved this procedure. He obtained LASIK certification in 1998. Dr. Kiley has performed thousands of refractive procedures.

Are there any patients we may speak with on whom you've done this procedure?

Yes. We have several employees in our office that have had the procedure as well as a list of patients whom you may call with questions. This list can be obtained from one of our refractive technicians.

How much does the operation cost?

We charge a competitive, reasonable fee for LASIK because of greater efficiency and the lowest possible operating expenses. We also provide a low monthly payment plan to help make the procedure affordable. Our normal fee for in-house LASIK procedures for the treatment of nearsightedness, farsightedness and astigmatism is $1895 per eye. The fees may vary from time to time, depending on coverage by insurance plans such as Optic Blue, VSP, etc., corporate discounts, and limited time promotional price reductions. Ask us what fee you may qualify for. Below is an explanation of everything that is included in the fee.

1. LASIK surgery, astigmatic keratotomy, and enhancements for up to two years.
2. One-year follow-up care on the operated eye. Any office visits after the initial one-year period will incur a minor office charge. If an enhancement is done after the initial one-year period, an additional 90 days follow-up care will be included. Any office visits that are not related to the surgery will be charged at regular prices.
3. All pre-operative and post-operative medications will be provided for the initial surgery and any enhancements. If a bandage contact lens is required, this will be provided.
4. The facility fee or operating room charge.
5. The royalty fee, if any, for use of the Excimer laser.

The pre-operative exam is extensive and includes an undilated and dilated refraction, corneal measurements, as well as evaluation of the general eye health, and a comprehensive explanation of the procedure, risks and benefits. There is a charge for this service. Glasses/contact lens fees are available through our Optical Dispensary.

1. The first spectacle lens will be charged to the patient.
2. Any additional lens change will be at no charge to the patient within 60 days of the surgery.
3. After your post-op period is over, if you paid for a temporary glasses lens and you do not require spectacles, we will give you credit for the amount you paid on your lenses (contact lenses are provided at the patient's expense). This can be used by you or any immediate family member in The Optical Dispensary for glasses, contact lenses or sunglasses.

What are the possible complications, risk and side effects? What are the chances that I may not see as well after the operation?

As with any surgical procedure, there are some risks and side effects. Serious complications are far less than 1%. Most problems are treatable or temporary. Some of the possible complications include flap scars or slippage, epithelial ingrowth, under or over correction, corneal haze, infection, ghosting or halos. It is possible to have decreased contrast sensitivity. The refractive technicians and Dr. Kiley will discuss these in more detail on the consult visit.

Do you operate on both eyes the same day?

Yes, but we also offer patients the option of waiting a day (or longer) if they wish, to make sure the first eye is doing well. Our patients' safety and well being is our primary concern and determines the sequence of surgery.

What anesthesia will I receive during the operation and how long does the procedure take?

We use eye drops to numb the eye a few minutes prior to the surgery. We also give a low dose of Valium prior to the surgery if the patient desires. The procedure takes approximately 5 to 10 minutes per eye. The actual time to make the flap is only a matter of few seconds, and the laser treatment is usually less than a minute depending on the amount of correction to be treated. However, the eye has to be prepared for the procedure and there are steps after the procedure that must be taken in order to assure that the flap is properly seated and will stay in position.

What is the recovery period and when will I be able to return to work?

Most people can return to work the next day if the vision permits. You may have some mild fluctuations in your vision that usually stabilizes within a few weeks or longer in some cases of high astigmatism or nearsightedness. For the first three nights after the surgery, you will need to wear a protective eye shield. You will not be able to swim for one week. You may resume exercise the next day after the surgery in most cases. However, contact sports such as basketball or racquetball are restricted for the first two weeks and after that you should wear protective eyewear.

Will I still need to wear glasses after the procedure and can I still wear contact lenses if needed?

This depends on several factors, including your visual needs, your refractive error and even your personality. Although many of our patients achieve 20/20, it is important to understand that the goal of refractive surgery is to reduce your dependence on glasses and contacts. You may achieve good vision without glasses but may still require them for certain tasks such as night driving. LASIK does not always eliminate the need for reading glasses. This is a separate problem called presbyopia that effects people as they get older. Since the LASIK procedure reshapes the cornea, there is a small chance that you will not be able to wear contact lenses, although most people can, if they wish. Many people decide to have refractive surgery to begin with because they have problems wearing contacts such as with dry eyes or allergies. You may have these same problems after surgery, although some people find contact lens wear easier since the lenses are thinner.

What if, years from now, I develop cataracts? Will this operation interfere or prohibit me from having cataract surgery?

No. You will still get all the normal aging changes in the eyes. Having the surgery will not make it happen sooner or put it off longer. You can still have surgery for cataracts but it is important to let your surgeon know if you have had refractive surgery in the past so that they may calculate the measurements for the implant properly.

Is LASIK permanent? What are the long-term risks of this surgery?

Vision tends to stabilize after the first few months. We don't expect to see significant late changes since the cornea is left stronger than with RK (Radial Keratotomy). Longterm studies are not available, as LASIK has only been performed since 1991. But, after several years, long term results are good and appear to be stable.

What other forms of refractive surgery are there?

There are a number of new techniques and procedures that are being investigated at the present time. There are plastic ring segment implants that can be placed in the cornea. These are currently approved for low ranges of nearsightedness. Their main benefit is that they can be removed at a later date if the patient is experiencing symptoms or side effects. They have a number of their own risks and side effects. There are also "contact lenses"that can be placed inside the eye behind the iris and over the natural lens. These can correct higher ranges of nearsightedness than LASIK but the long-term effects are not yet known. It is possible that they can result in glaucoma, cataracts, or an inflammatory condition called iritis. Lenses can also be attached to the iris itself. These appear to be effective in high ranges as well and we are awaiting longer-term studies. In some cases, the natural lens in the eye itself can be removed and replaced with an artificial lens implant as is done in standard cataract surgery. This type of surgery would be limited primarily to very high degrees of nearsightedness. Low ranges of farsightedness can be treated with a "hot" type of laser. With this type of surgery, carefully controlled small burns are placed around the cornea to cause reshaping. The range of treatment is currently somewhat limited. Other forms of refractive surgery will no doubt appear in the future as technology continues to improve.

How can I contact Dr. Kiley and the Raleigh Eye Center?

For more information, contact us at 919-876-2427 or 800-596-0384. Tell the operator that you are interested in learning more about refractive surgery. She will transfer you to one of our refractive technicians. You may also contact us at the following address:

The Raleigh Eye Center
3320 Executive Drive Suite 111
Raleigh, NC 27609
Fax: 919-850-9234