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A:
There are very few inherent risks
and complications involved in LVC surgery.
In spite of our very best efforts and
the best technology, there will be some
results that are less than ideal. You
must make a decision based upon the best
information available whether or not the
potential benefits of your contemplated
surgery outweigh the risks. Although it
is not possible to list every potential
risk or complication that may result from
the procedure, many of them are described
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Halos
/ Starbursts: Some patients will notice
glare, halos or starbursts around objects at night
or in dim-light conditions. Patients who notice
these effects may need to wear glasses to drive
at night. For the vast majority, these symptoms
are temporary. However, others will continue to
experience them for several months or longer.
During your pre-operative evaluation, we will
determine whether or not you are at high risk
for seeing long-term halos. These side effects
tend to be less noticeable the closer you get
to the ideal correction of your refractive error.
Note that CustomLASIK
reduces the frequency of glare, halos or starbursts
problems following treatment and results in clearer,
crisper vision compared to treatments performed
by conventional LASIK.
Dry
eyes: Increased dryness
of the eyes is a common, but generally
temporary, complication arising from LASIK, CustomLASIK,
IntraLase, or PRK. It typically lasts for several
months, though some patients may experience dryness
for a longer period of time. It is important to
use lubricating drops frequently. If the eyes
remain dry for prolonged period, there are other
drops or techniques that can help. Patients who
have dry eyes prior to the procedure are likely
to experience dry eyes after the procedure.
Infection: All eye
surgeries carry with them the possibility of infection.
This is an extremely rare occurrence, with a 1 in
10,000 treated eyes. Fortunately, as the laser vision
correction techniques have developed over the years,
firmly established protocols now exist which dramatically
minimize the risk of infection. Most infections
respond well to antibiotic treatment.
Diffuse
Lamellar Keratitis (DLK) or “Sands of the
Sahara”: Some patients develop an
inflammatory reaction between the flap and the
corneal bed, called Diffuse Lamellar Keratitis
(DLK) or “Sands of the Sahara.” Patients
with DLK may not show any symptoms at all or may
experience blurred vision and tearing. DLK can
generally be treated with eye drops and rarely
results in any permanent impairment of vision.
Retinal
detachment: Although retinal
detachment is not usually considered
a specific complication of laser vision correction
surgery, it is at least a possibility. Even without
any surgical intervention, myopic patients are
always at risk for retinal detachment and LASIK
may not alter this risk.
Anesthesia
or drug reactions: As with all types
of surgery, there is a possibility of complications
due to anesthesia, drug reactions, or other factors
which may involve other parts of your body. The
patient must inform the doctor if they have ever
had a reaction to any kind of anesthesia.
Corneal
scarring: There are corneal irregularities
which can rarely occur. The worst case scenario
could be corneal scarring. The risk of corneal
haze or scarring is more in PRK than in LASIK.
Equipment
malfunction: The microkeratome,
IntraLase
and Excimer
lasers have proven to be very elegant,
very dependable devices for creating the corneal
flap and reshaping the cornea. Nevertheless, we
are working on the cornea which is about 0.6mm
thick, and as with any device, the microkeratome,
IntraLase, and Excimer laser are not perfect.
In spite of out best efforts, there are times
when they produce a less than ideal result. We
will not begin your procedure unless our equipments
are functioning properly. Additionally, we might
have to stop at the safest possible point if a
malfunction should develop.
Surgical
team: The less the experience of the surgeon
and team, the greater is the risk. But even with
the best available equipment and the most experienced
surgeons, complications can and do occur. The
only way to avoid all risks of surgery is not
to have the surgery done at all. As a generality,
the more serious the risk, the less likely it
is to occur. LASIK
Gimmicks.
Vascular
occlusion: When
the suction ring is applied to the eye to create
a corneal flap, the pressure inside the eye increases
significantly and most patients notice either
a dimming or a complete loss of light in the eye.
As the suction ring is removed, the vision is
restored within a few seconds. There is a less
than 1 in 1,000,000 probability that when the
suction ring interrupts the blood supply to the
eye, permanent damage to the retina and loss of
vision can result. Note that unlike microkeratome,
IntraLase
employs a suction ring that uses low vacuum.
Increased
pressure in the eye: The drugs used
during the first week after surgery, on rare occasions,
may cause increased pressure in the eye. This
raised pressure needs to be closely monitored
and may require additional topical and/or oral
medications. It is important for you to return
to NeoVision Eye Center for scheduled follow-up
visits to monitor your eye pressure in order to
modify the medication schedule as needed.
Eyelid
droop: The eyelids have a natural tendency
to droop with age. The eyelid speculum that is
used in the procedure may hasten this process.
Corneal
ectasia: A certain minimum amount of corneal
tissue must remain under the flap after the laser
has achieved tissue removal. The amount of remaining
tissue relates directly to the long-term stability
of the cornea. Less than optimum remaining cornea
may result in bulging, called ectasia. This problem
can be avoided by precise pre-operative measurements
and creating an optimum corneal
flap during surgery. LASIK
Gimmicks.
Improper
corneal flap: The corneal flap may
be of improper or irregular thickness or incompletely
cut. Such problems may require that the procedure
be stopped until the surgeon can safely cut a
new flap. There is also a small risk that the
hinge of the flap may be cut from the cornea (also
known as a “free flap”). In most instances
of “free flap” the surgeon can still
perform the laser treatment. This detached flap
is repositioned and covered with a bandage contact
lens to promote healing. Note that the IntraLase
laser may avoid partial and "buttonholed"
flaps, corneal wrinkles, and flaps that are too
thick.
Increased
light sensitivity and vision fluctuations:
Patients’ eye may become extremely sensitive
to light and glare after the procedure. Visual
acuity may also fluctuate. These
conditions are generally temporary and usually
go away within 1-3 months after the surgery.
Epithelial
defects: The epithelium in some eyes is
only loosely attached to the corneal surface.
Such eyes are at increased risk for epithelial
erosions or defects, especially as the microkeratome
passes over the corneal surface. In some cases,
this risk is identified before surgery and the
patients are advised accordingly. There are, however,
occasional patients where there are no pre-operative
clues. In addition, older patients are more likely
to have occult areas of this weakened skin. Note
that the IntraLase laser may better avoid some
of the epithelial irregularities and sloughing.
Epithelial
ingrowth: Epithelial cells can appear
as either “isolated pockets or nests”
under the LASIK flap. This may result due to improper
healing at the edge of the flap. Most of these
are fairly easy to successfully eliminate. Note
that the IntraLase
flap follows the curvature of the cornea and produces
a flap with vertical edges, unlike the edges left
by a microkeratome.
This difference in flap architecture may reduce
the chance of corneal epithelial ingrowth.
Under-correction
or over-correction: The healing response
of the eye occasionally counteracts the precisely
calibrated removal of tissue by laser. While the
treatment of your refractive
error is designed to completely neutralize
your refractive error (unless otherwise agreed
upon with your surgeon) this treatment is based
on an average eye’s healing response. If
your eye heals differently from the “average”,
this may result in an over- or under-correction.
A patient’s tolerance for under-correction
or over-correction varies. In majority of instances,
the over- or under-correction can be corrected
with glasses, contact lenses, or additional surgery.
It is important that you understand
this possible outcome and accept it as one of
the risks of surgery. If this should occur, you
will probably be disappointed with your result.
Under- or over-corrections are actually the most
common undesirable result or complication of surgery.
Significant over-corrections occur about 1% of
the time.
Re-treatment
or enhancements: The vast majority of patients
require only one refractive treatment. Due to
each individual’s prescription level and
unique physiology, however, an additional treatment
or enhancement may be required. The additional
procedure can involve all of the risks and side
effects as discussed before for the primary procedure.
As always, this risk should be weighed against
the expected or desired benefit. The patient must
generally wait at least three to six months after
the first treatment and must have adequate corneal
tissue and stable vision. Results cannot be predetermined
or guaranteed. LASIK
Gimmicks.
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