Refractive Laser Eye Surgery is based on reshaping the front window of the eye, the cornea, to correct myopia, hypermetropia, and astigmatism. The excimer laser removes tissue with extreme precision and has been used to reshape the cornea in refractive surgery for the last 20 years. Technical progress during this period has been rapid, and night vision problems (glare/halo/starburst) associated with earlier procedures have largely been eliminated by modern laser delivery systems.
In LASIK, 2 lasers are used to perform the procedure. Initially a femtosecond laser is used to create a flap in the cornea. Femtosecond lasers work by focusing extremely short pulses of laser in the cornea. This leads to the formation of tiny gas bubbles that separate the surrounding corneal layers. By placing many thousands of pulses in the cornea it is possible to create a flap quickly, painlessly and accurately. After the flap is created it is lifted and a second type of laser, an excimer, is then used to reshape the cornea. The amount of the laser treatment is set by the surgeon, and tailored to suit the desired correction. Following laser treatment, the flap is replaced. In essence, the cornea is reshaped without surface damage and subsequent scarring responses. This provides a rapid, virtually painless recovery and fast stabilization of the visual result.
LASEK and trans-PRK are similar treatments that involve reshaping the front surface of the cornea using an excimer layer. With LASEK the thin epithelial surface layer of the eye is first gently removed using alcohol before the laser is applied. In trans-PRK the laser is first used to remove the thin layer of epithelial cells quickly and painlessly from the central corneal surface prior to using the same laser to reshape the cornea. Trans-PRK is the technique that is normally used by Mark Wilkins when a surface treatment is required. Unlike in LASEK, where alcohol is used to remove epithelial cells, with trans-PRK the final size of the epithelial defect is smaller and recovery quicker. After the cornea has been reshaped an anti-scarring drug, mitomycin C, is often applied to the corneal surface to reduce haze (loss of corneal clarity) and regression (corneal shape changes during healing which can reduce the effect of treatment). A bandage contact lens is then applied to protect the operated area for a few days whilst the epithelial layer heals. Eye drops are used to minimise discomfort, but approximately 5-7 days in which the eyes are relatively sore, light sensitive and watery is normal. Vision returns over the next two weeks whilst the new skin layer remodels. Although the recovery is slower after trans-PRK than after LASIK, final visual results are normally equally good.
Treatments are normally performed on a Wednesday afternoon, with initial postoperative review 24 hours after for LASIK surgery and 5-7 days after LASEK/Trans-PRK surgery. Office-based work is usually no problem from the day after Wavefront LASIK. For outdoor occupations, professional drivers and patients having LASEK /Trans-PRK laser, work can normally be resumed by the MONDAY following treatment. Patients are normally reviewed a minimum of 3 times after surgery (at 1 day, 1 month and 3 months after LASIK and at 5 days, 1 month and 3 months after LASEK/Trans-PRK), with additional review appointments as required. Liaison with a referring ophthalmologist is usually possible for overseas patients. The minimum time in the UK for patients coming for treatment from overseas is 1 week.
WHEN CAN I RETURN TO NORMAL DAILY ACTIVITIES?
For the first week, face and hair washing must be done without getting water or shampoo in the eyes. Wash hair backwards and use either a flannel or cotton wool and cleanser for the face. Try not to get water or shampoo in the eyes in the shower. The post-op goggles are not designed to be worn in the shower.
Do not use eye make-up around the eyes for the first week, as removing it can be difficult. Eye lash curling and tinting should be avoided for one month.
Avoid smoky and dusty environments for the first week. If you do get dust, dirt or an eyelash in your eye, wash out gently with any of your eye drops. Do not drive until your vision meets driving standard (usually 36-48 hours). This will be confirmed at your first follow-up appointment. We strongly advise you not to travel by air within the first week of surgery, particularly on long-haul flights. Please let us know if you have any travel plans within this time.
For the first week, avoid running, aerobics golf, tennis, badminton or going to the gym (in case of injury or sweat running into the eyes).You may resume such activity after one week.
Do not swim in the sea for two weeks or in chlorinated water for four weeks after treatment. You may resume scuba diving after four weeks.
Do not play rugby or any other contact sport, or practise any martial arts, for at least one month.
Saunas and steam rooms can be used after two months.