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LASIK is the abbreviation for laser in-situ keratomileusis. It is a commonly performed surgery to correct refractory errors and restore a near to glasses free vision in people who are nearsighted, farsighted, or have astigmatism (1).

Though the excimer laser had been used for many years before, the development of LASIK is generally credited to Ioannis Pallikaris from Greece around 1991(2).

Procedure – Anesthetic drops are used that numb the surface of the eye. The patient is in awake state throughout the entire procedure. LASIK may be done on one or both eyes during the same session (3)

In this procedure, a highly specialized laser (excimer laser) alters the shape of the cornea, which is the transparent front covering of the eye thus a flap of corneal tissue is created. This flap is then peeled back so that the excimer laser can reshape the corneal tissue underneath. A hinge on the flap prevents it from being completely separated from the cornea.

A common and safer method utilizes different type of laser (femtosecond) to create the corneal flap. The amount of tissue the laser will remove is calculated ahead of time. Once the reshaping is done, the surgeon replaces and secures the flap. No stitches are involved. The cornea will naturally hold the flap in place (3).

With 20 years of laser eye surgery development behind us, many questions about patient risks and outcomes remain. A review of how far the procedure has come and what considerations are needed before opting into refractive surgery are outlined here.

Millions of people in North America, Europe, and Asia have had successful laser eye surgery, making it the most practiced procedure to correct vision problems caused by refractive errors. Laser surgery corrects nearsightedness, farsightedness, and astigmatism.

How it works
In Canada, commonly performed procedures are photo-refractive keratectomy (PRK), first introduced in the early 90s, and LASIK, introduced in the mid-90s. In PRK, just enough tissue is removed to reshape the cornea in a way that corrects vision. The initial healing process takes a week. In LASIK, a flap in the cornea is cut away to remove tissue from the inside layers of the cornea to correct vision. The recent advancement of Wavefront technology creates a detailed map of the eye, allowing for even more precise vision correction.

Advancements
Progress has been made in each type of surgery. A move from broad beam lasers (6 to 8 mm diameter) to flying spot lasers (0.95 mm diameter) have improved accuracy. Femtosecond lasers have replaced manual ones used for flap cutting, reducing intra-ocular complications related to flap cutting.

The range of prescriptions suitable for refractive surgery has increased. Nearsightedness up to -12.50D,farsightedness up to +6.75D, astigmatism up to -6.00, and presbyopia (the inability to focus on nearby objects caused by normal ageing) can now be corrected.



Correction breakthroughs

A procedure called refractive lenticule extraction-small incision lenticule extraction (ReLEx-SMILE), a flapless laser eye or keyhole surgery, is accurate enough to avoid flap-related complications. It also has less biomechanical impact on the cornea because it preserves the strongest part of the cornea.

Laser blended vision is a corneal laser eye surgery that takes about 10 minutes to perform in both eyes, heals in a few hours, and can correct 97 per cent of all people with bifocals or reading glasses by increasing the depth of field of each eye. Laser blended vision enables surgeons to avoid the outdated technique of replacing a clear permanent lens inside the eye.


Limitations

Patients not suited for surgery are those at the very extremes of prescriptions—outside of the +6.75D farsightedness and -12.50D nearsightedness range. These people still require lenses to be inserted into the eye to correct their high prescriptions.

Dr. Yaldo was Michigan’s first to perform CATz Lasik, the most precise LASIK treatment available in the world, surpassing even the most advanced wavefront-guided Lasik eye surgery treatment. Read Story.

In over 95% of cases, CATz topography-guided Lasik eye surgery produces “Super-Normal Vision”, which is defined as better than 20-20 vision! The new topography-guided Lasik technology — known as Customized Aspheric Treatment Zone (or “CATz”) — maps the patient’s cornea by measuring nearly 7,000 points of light, versus the approximately 200 points of light measured with traditional wavefront technology.

While just a small number of surgeons in the U.S. are currently trained and certified to offer topography-guided LASIK, the procedure and related technology have been used widely for more than a decade throughout Europe, Asia, and South America. “CATz is by far the most precise LASIK technology available, and it represents a huge leap forward,” notes Dr. Yaldo. “I am proud to have played a role in its development over the past several years. I’m also delighted to be one of the first surgeons in the nation to offer what is now the new gold standard for LASIK.”

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