That’s the first question Sandhya Acharya, 26, an economics graduate, gets asked these days. It’s been a year since she underwent the surgery and people still want to know how her eyes are after Lasik. Do her eyes hurt when exposed to sunlight? Are her eyes still dry? Is she still wearing glasses? And most importantly, is her vision still blurred?
Her answer to each of the questions is a frustrated yes before complaining that her eyes burn and sting. She has problems looking at bright pictures and reading books with comparatively smaller fonts. She has single-handedly depleted the stock of Refresh Tears, a lubricant eye drop that moisturizes and relieves dry and irritated eyes, at her local pharmacy.[break]
Photos: Bijay Gajmer
“I’ve been wearing glasses ever since I was in grade seven. Since the past few years, I had been using contact lenses. I wanted to end the vision hassle for once and for all, so I opted for Lasik surgery,” says Sandhya who sits wearing sunglasses as she speaks. As ironic as that might be, sunglasses have now replaced her power glasses.
Lasik (Laser-Assisted in Situ Keratomileusis), commonly referred to as laser eye surgery, is a type of refractive surgery for the correction of myopia (inability to see distant objects clearly), hyperopia (difficulty to see nearby objects) and astigmatism (abnormally curved cornea). Myopia (also called short-sightedness) occurs due to the formation of image in front of the retina, and hyperopia (also known as hypermetropia or farsightedness) occur due to the formation of image behind the retina.
While contact lenses are a good alternative for those who don’t want to wear thick glasses, a lot of people in their 20s and 30s feel burdened by the task of even putting on and removing them on a daily basis. Dr Kamal Khadka, Medical Director at Bharatpur Eye Hospital in Chitwan, says that a lot of young people these days opt for Lasik surgery purely for cosmetic reasons.
“Personally, I don’t recommend Lasik surgery to my patients because if complications arise after the operation, then there’s no way to correct it,” says Dr Khadka, adding that when and if his patients express a strong desire to undergo the procedure, then he makes sure they are aware of both the pros and cons before referring them to Tilganga Institute of Ophthalmology (TIO) for the surgery.
TIO has been conducting laser eye surgery for correction of refractive error since last year after a gap of four years. Everyone above 18 years without medical conditions like thyroid problems, diabetes, autoimmune diseases and rheumatic diseases can get Lasik. Pregnant women, however, aren’t allowed to undergo this procedure due to fluctuating eyesight because of hormonal imbalance.
The major issue with laser surgery lies in determining who should undergo the surgery. TIO’s state-of-the-art equipment and technology scans patients and takes numerous factors into consideration to ensure safety and unparalleled accuracy during surgery.
Here’s how Lasik works. A laser cuts a flap in the front of the eye. The flap is folded back, and a second laser reshapes the cornea to make a lens that’s of the right shape and focus. Then the flap is put back.
Many examinations of corneal refraction, corneal thickness, eye pressure and others checkups by ultrasound and scans are done before giving patients the go-ahead for the operation. Even then, there’s no guarantee that the surgery will have no side effects.
Puran Shrestha, 31, art director and graphics designer for an advertising agency, has been living with a permanent glare. While he’s happy that he got rid of those bulky glasses he had been wearing for over 15 years and that he doesn’t even have to wear contact lenses occasionally, the constant glare hampers his work.
“I have to constantly work on the computer and I can’t focus for too long. My vision gets blurred and I have to close my eyes and rest for a while,” says Puran, adding that he has consulted many ophthalmologists all of whom have told him the same thing: He has to live with it. There’s no way to correct it now.
After the surgery, forget the dryness and the glare that are now a part of his life, Puran also at times feels as if he has put on his contact lenses inside out. The doctors have told him that it’s most probably a side effect of dry eyes because the flaps they cut out have healed perfectly.
“Imagine having a side effect of a side effect,” he says with a frustrated heave of his shoulders.
Lasik surgery, though is a simple procedure lasting anywhere between 15 to 30 minutes, comes with a fair share of side effects. From irreversible eye damage and severe night vision problems to decreased contrast sensitivity, the side effects can be harrowing. In case of people with high astigmatism, the results of Lasik can be unpredictable. Also, sometimes people might still need glasses after surgery because of errors in calculation leading to over- or under-correction.
Explaining how Lasik surgeries are carried out, Dr Rita Gurung, Deputy Director at Tilganga, says the cornea is thinned, using laser to ensure that the image is formed on the retina.
“We ablate the middle part of the cornea to reduce the distance between the cornea and the retina to correct myopia and we ablate the sides of the same to elongate it in case of hyperopia,” she explains, adding that patients with refractive error of up to -14 and +6 can be corrected by the surgery.
Though high power alone does not make one eligible for surgery, those with less power are generally not advised to opt for Lasik. Also a person should have stable eyesight with no change in power for at least two to three years to be eligible for the surgery.
“Refractive power bec-omes more or less stable by the mid-20s. So if you’re considering Lasik, it’s wise to wait till you are at least 24 years old,” says Dr Khadka, adding that there is no guarantee that even then you’ll never need glasses again for myopia later on in life.
According to Dr Gurung, 96% of people will have perfect vision while the rest can have a defect of up to -1 or +1 after the surgery. Also, one of the major surgical side effects of Lasik is that it causes dry eye. Sandhya and Puran will vouch for that. Their eyes have never been the same.
“If the doctors had warned me of the possible side effects, then I wouldn’t have undergone the treatment,” says Puran, mentioning that everyone just harps on the pros and cons and no one provides accurate information. Sandhya adds that it could also be because of people’s willingness to undergo the surgery at any cost that the doctors don’t stress on the side effects and focus on the fact that it is a simple operation.
“It’s more or less a business because a lot of people are doing it for purely aesthetic purposes without considering the health aspect of it,” says Sandhya who now firmly believes that Lasik should only be done if wearing glasses seriously hampers your work. “If you’re doing fine with glasses or contacts, then it’s better to stick to them.”
It is likely that Lasik surgery will gain more popularity as the years pass, especially among the young crowd. Plenty of people have had tremendously wonderful experiences even as many are living with the side effects of an ill informed decision. The public deserves an honest study, free from the bias and influence of the Lasik industry. There are bright doctors and trustworthy public health officials who have no financial interest in Lasik and who are certainly qualified to perform a credible study. Without that, the public will not be able to assess the true risks, benefits of and alternatives to Lasik surgery. And under such circumstances, how is a patient ever supposed to make a truly informed decision?
Before you sign up for Lasik surgery, here are a few things to think about
• Lasik is an irreversible surgery at a very delicate part of your eye.
• As with any surgery, there are risks and possible complications.
• Millions of people have had Lasik, many very successfully, but it’s not for everyone.
• Lasik may not give you perfect vision. Detailed, precise vision may be slightly diminished.
• Even with Lasik to correct your distance vision, you are likely to need reading glasses in your mid-40s. Lasik surgery cannot correct or prevent presbyopia, the age-related loss of focusing power for seeing near objects.
• The benefits of the Lasik procedure may diminish over time, and one may require a second surgery, called “retreatment,” to restore the desired vision correction. This is more likely for people who were more nearsighted or farsighted, or had higher astigmatism before Lasik.
Aside from the actual surgery, post-operative care is one of the things that LASIK surgery patients worry about the most. Laser eye surgery, though it’s one of the most minimally disruptive procedures you can undergo in terms of recovery time, does need precautions and safety measures even in post-operation period.
Though there might not be many complications from this simple procedure, adhering to doctors’ instructions will ensure the best possible results. If you’re considering laser eye surgery, here’s a list of dos and don’ts that you should follow after your procedure.
Do’s after LASIK surgery
Do use a protective eye covering. It’s required to be worn for some weeks even while sleeping so as to prevent the rubbing of the eyes. It’s best that eyes aren’t touched at all during the recovery period to avoid damage to the corneal flap.
Do use the prescribed eye drops, as directed. Painkillers can help manage whatever pain there may be after the operation. Antibiotics and anti-inflammatory medications might be prescribed for prevention of complications and to reduce swelling. You might also be advised to use moistening eye drops to help lubricate the eyes, as some drying is expected to occur.
Do wear safety glasses during sports or high-risk activities. It isn’t necessary to live in a bubble after undergoing Lasik surgery. But if you’ll be engaging in activities that increase your risk of eye injury, then use safety glasses.
There’s no need to seclude yourself for weeks after Lasik surgery. Normal activities can be resumed the very next day but do exercise some caution. Do avoid swimming, hot tubs and water sports for two weeks after the surgery.
Don’ts after LASIK surgery
Don’t rub your eyes at least for two weeks after surgery. Some eye discomfort is to be expected after undergoing any medical procedure, but no matter how strong the urge is, don’t rub your eyes. There may be a feeling of having something inside your eye but always resist the temptation to touch it.
Don’t get soap or water directly in your eyes. Avoid this for two weeks after your procedure. Even tap water that has been treated has the capability of carrying organisms that can do serious harm to a healing cornea. If soap or water does get into your eyes, put your head down and blink, so that your tears will wash them out.
Don’t wear eye makeup. Mascara and eyeliner shouldn’t be applied for three days after Lasik surgery. Extreme caution should be observed when removing makeup.
Don’t forget post-op appointments. Follow-up care is extremely important after Lasik surgery, so be sure to make it to all your post-operative appointments.
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