Refractive Surgery Options – Eric D. Donnenfeld, MD, FAAO
1. Anesthetic drops are applied to the eye.
2. A hinged flap is created by the surgeon and folded back.
3. The inner corneal layer is reshaped with the laser.
4. The surgeon closes the flap.
5. The flap adheres naturally and securely.
LASIK is a laser-assisted surgery that is used to reshape the patient's cornea, thereby altering the angle at which light enters the eye resulting in improved vision. When performed by an experienced Long Island LASIK surgeon such as Eric D. Donnenfeld, MD, FAAO, LASIK can lead to remarkable vision correction results, greatly reducing or completely eliminating patients' dependence on glasses and contact lenses.
LASIK eye surgery is a painless procedure that is performed under topical anesthesia in less than 20 minutes. Dr. Donnenfeld offers LASIK, CustomLASIK and iLASIK to patients throughout New York, New Jersey and Connecticut.
LASIK on Long Island: The Procedure
Laser eye surgery begins with a thorough preoperative evaluation employing advanced technology to determine if the patient is a candidate. The next step is analysis of the eye's unique visual imperfections. This is accomplished through the use of advanced diagnostic technology known as wavefront or CustomLASIK. This information is then used to calibrate the surgical laser (excimer laser) for corneal reshaping. The first step of LASIK surgery involves the creation of the corneal flap, a thin piece of tissue that is lifted and folded back from the surface of the eye to expose the stroma (middle part of the cornea). During the creation of the corneal flap, Dr. Donnenfeld uses a femtosecond laser for a blade-free LASIK surgery, also known as iLASIK or all-laser LASIK.
Next, the cool laser beam from the excimer laser is administered to remove microscopic layers of the cornea, thereby eliminating refractive errors such as nearsightedness, farsightedness and/or astigmatism. This step usually takes less than one to two minutes per eye.
Following corneal reshaping, the corneal flap is returned to its original position, where it naturally seals to the surface of the eye without the need for stitches.
The combination of custom excimer laser with a tracking system and flap formation with the most advanced femtosecond laser is known as iLASIK. This is the same technology employed by the military for its fighter pilots and NASA for our astronauts. Dr. Donnenfeld uses the same technology as these government agencies.
LASIK Surgery Recovery and Results
Because the outermost layer of the cornea (corneal flap) is preserved and protects the eye during the healing process, postoperative discomfort is minimal. Nonetheless, LASIK patients are provided with detailed aftercare instructions and antibiotic eye drops for a smooth and safe recovery. Patients who undergo LASIK under the excellent care of Dr. Donnenfeld typically experience improved vision within 24 hours following surgery.
LASIK Eye Surgery Candidates
The best candidates for LASIK eye surgery are individuals over the age of 18 whose eyeglass prescription has changed minimally for one to two years. Those whose corneas are too thin may not be good candidates for LASIK but will most likely qualify for alternative vision correction treatments such as PRK or implantable contact lenses, also performed by Dr. Donnenfeld. Your candidacy can only be determined during an eye exam with a LASIK surgeon.
LASIK vs. Contact Lenses
Both contact lenses and LASIK can produce clear vision quality in the right candidates. However, there are some obvious differences.
Contacts require regular maintenance — they must be purchased, cleaned, disinfected and sometimes adjusted pending any changes in vision prescription. There is always the risk of eye infection or simply discomfort when wearing contact lenses. The costs of buying and cleaning contact lenses can also add up over time.
On the other hand, LASIK is convenient and virtually maintenance-free. LASIK significantly reduces or, in some cases eliminates, the need to wear contact lenses. After achieving clearer vision with LASIK, patients no longer need to worry about buying boxes of contact lenses or bottles of cleansing solution. LASIK is a one-time investment in clearer vision.
PRK vs. LASIK
Photorefractive keratectomy (PRK) and LASIK are refractive surgeries to correct nearsightedness, farsightedness and astigmatism caused by abnormalities in the cornea’s shape. During both procedures, the surgeon uses an excimer laser to reshape the cornea, which then allows light entering the eye to properly focus on the retina for clear vision.
The primary difference between the procedures is that LASIK surgery involves creating a thin, hinged flap in the outermost layer of corneal tissue before reshaping the stromal (middle) layer, and PRK does not. During PRK, the surgeon removes the cornea’s entire outer (epithelial) layer, and then sculpts the stromal layer of tissue.
After the LASIK procedure, the flap is restored over the surface of the eye, where it seals and heals itself. After PRK, the epithelial cells must regenerate to cover the surface of the eye. Because of this difference, PRK recovery is often slower and may cause some minor discomfort.
Despite the chance of a longer recovery, PRK is often an excellent alternative for candidates that do not qualify for LASIK because their corneas are too thin and cannot sustain the creation of a corneal flap. Both procedures produce excellent and comparable outcomes.
Life after LASIK
Life after LASIK is more exciting. Relieved from the burden of wearing glasses or contact lenses, people that have had LASIK find it easier to participate in more physical and sports activities.
A great example is running, which is more convenient without wearing contacts or glasses. Runners that wear glasses and contacts know that glasses can slip around on the nose and become fogged up, and contact lenses can dry up after a while. Thankfully, these are no longer concerns after having LASIK.
Team sports like basketball, soccer and baseball are also more accessible and enjoyable for people that have had LASIK. Prior to LASIK, the risk of accidental contact could have kept players on the bench; after LASIK, clear vision and freedom from glasses or contacts makes it easier to join the game.
Additionally, people that have LASIK can enjoy water sports like swimming and SCUBA diving without worrying about contact lenses falling out or becoming suctioned to the eye (which can happen due to increasing atmospheric pressure while diving).
Top 10 LASIK FAQs
1. Is LASIK Safe?
LASIK has an excellent safety record and is recognized by the FDA as an effective treatment for vision correction. However, as with any surgical procedure, there are risks associated with LASIK. In extremely rare cases, patients may experience vision difficulties such as blurred vision, glare, halos and dry eye immediately after surgery. Side effects such as corneal flap complications and infection are also possible but highly rare. These complications generally occur right after the procedure, in which case Dr. Donnenfeld and his trusted medical team can address them immediately.
2. Is LASIK Surgery Painful?
LASIK surgery itself is generally painless as numbing eye drops are used to keep the eyes comfortable. You may feel some pressure briefly during the creation of the corneal flap. Recovering from LASIK surgery is quick and also relatively painless. Immediately after the procedure you may feel some temporary discomfort, such as mild irritation or a gritty sensation in the eye. Dr. Donnenfeld may prescribe aspirin or special eye drops to relieve these mild symptoms.
3. Can I Have Both Eyes Done at the Same Time?
Thanks to the use of advanced laser technology, Dr. Donnenfeld is typically able to perform LASIK surgery on both eyes at the same time. The laser treatment itself usually takes less than a minute, while the entire procedure takes approximately 15 minutes per eye. If you prefer to have LASIK performed on each eye on separate days, Dr. Donnenfeld can accommodate. He can perform the surgeries a week or two apart. It is important to note, however, that it may be uncomfortable having one eye corrected and the other eye uncorrected between surgery days.
4. How Do I Prepare for LASIK Surgery?
Prior to your surgery, Dr. Donnenfeld will provide detailed instructions on how to prepare for your procedure. It is important for you to follow these instructions carefully. You may be asked to stop wearing contact lenses for about two weeks prior to surgery to allow your corneas to stabilize. Immediately after surgery, you will be groggy, so it is important to make arrangements for someone to drive you home. Fill your prescriptions ahead of time and request a few days off work to allow yourself plenty of time to recover.
5. When Can I Resume Normal Activities?
Recovering from LASIK surgery is generally quick. After your procedure, it is recommended you sleep for the remainder of the day to allow your eyes to rest. Most patients notice an improvement in their vision within a day or two after surgery and return to work within a few days of surgery. Recovery varies from patient to patient, so your follow-up appointment is key. You will meet with a member of our team a day or two after surgery to determine when you can return to work. Should a complication arise during your recovery, our team can address it promptly.
6. Will I Need Glasses or Contacts After LASIK?
LASIK surgery has proven to be overwhelmingly effective in providing clearer vision, with more than 95 percent of LASIK patients achieving 20/20 vision. Most patients no longer need to rely on glasses or contacts, and the ones that do see their dependence on corrective eyewear drastically reduced.
While the results from LASIK surgery are considered to be permanent, you will still be susceptible to age-related eye conditions such as presbyopia and cataracts. Should you develop one of these conditions, you may need to use reading glasses or additional treatment.
7. How is LASIK Different from Previous Types of Refractive Eye Surgery?
LASIK and other similar laser vision correction surgeries (such as PRK) have a higher success record than previous forms of refractive eye surgery. Older techniques typically involve manually performed incisions rather than automated lasers for correction. The use of laser energy to reshape the cornea allows for safer and more precise results than ever before. Because of this, laser eye surgery has a substantially lower incidence of complications than other refractive eye surgeries.
8. Can LASIK Make You Go Blind?
It is extremely rare for anyone to go blind from LASIK surgery. Most LASIK risks and complications are mild and can be addressed right away and successfully. While complications are rare, follow-up care is crucial to the success of your results. It is important for you to follow your surgeon's pre-op and post-op instructions and attend all follow-up visits as directed. Your results also depend on the laser eye surgeon you choose. Dr. Donnenfeld has performed more than 55,000 successful laser eye surgeries.
9. How Much Does LASIK Cost?
The cost of LASIK varies, depending on the specific approach, technology and other factors. The only way to find out how much your LASIK surgery will cost is by scheduling a personal consultation with Dr. Donnenfeld. Once Dr. Donnenfeld evaluates your eyes, our team can provide a customized price quote for your surgery.
Some patients may be hesitant to undergo LASIK surgery because of the large upfront cost. However, it is important to remember that LASIK can help you save thousands of dollars in vision-related costs as you will no longer need to invest in glasses, contact lenses and cleaning supplies. Because of this, many of our patients believe LASIK is well worth the investment.
Dr. Donnenfeld believes everyone deserves clearer vision and offers several financing options to help you pay for your procedure.
10. How Do I Choose a LASIK Surgeon?
The success of your LASIK surgery depends on the skill and experience of your eye surgeon. Your LASIK surgeon should have completed medical school, ophthalmology residency training and specialized education in refractive surgery. The surgeon should have years of experience under their belt, having performed thousands of LASIK surgeries (Dr. Donnenfeld has performed tens of thousands, including on other eye surgeons and their families). Your LASIK surgeon should also use only the latest laser technology, such as wavefront (CustomLASIK) technology and the femtosecond laser for precision.
Last but definitely not least, your LASIK surgeon should have glowing patient reviews and be considered the "go-to" surgeon for LASIK in their community. Visit the surgeon's office to get a firsthand look at the staff. Everyone, from the surgeon to the receptionist, should be warm, professional and friendly. This will ensure your LASIK surgery experience is a positive one.