LASIK: For Which of Your Patients With Refractive Error?

December 31, 2006

Laser in situ keratomileusis, orLASIK, was first described in 1990 1;since then, it has surpassed cataractsurgery as the most common eye operationperformed in the world. 2 Asmany as 1.5 million corneal refractivelaser surgeries are done annually inthe United States. 3,4

Laser in situ keratomileusis, orLASIK, was first described in 19901;since then, it has surpassed cataractsurgery as the most common eye operationperformed in the world.2 Asmany as 1.5 million corneal refractivelaser surgeries are done annually inthe United States.3,4

LASIK involves lifting a cornealflap with a microkeratome and ablatingthe corneal stromal tissue with anexcimer laser to achieve refractivechange.5 This procedure can correctmyopia, astigmatism, and hyperopiawith minimal discomfort. After surgery,visual recovery is rapid andrefractive stability is good.3 Residualrefractive error may be treated withrepeated LASIK surgery.

According to recent guidelines from the American Society of Cataract and Refractive Surgery, LASIK is appropriate for patients withthe following characteristics

6

:

  • Age older than 18 years.
  • Stable prescription for at least 2 years.
  • Cornea sufficiently thick to allowfor corneal flap of appropriate depth.
  • Myopia, up to --12 diopters; astigmatism,up to 6 diopters; or hyperopia,up to +6 diopters.
  • No other eye diseases.
  • No disorders or medications that could impair healing.
  • Awareness of risks and benefits of surgery and realisticexpectations.

The Table lists contraindications to LASIK surgery.6

 Table - Contraindications to LASIK
Relative contraindications 
 
Age younger than 18 y 

Contraindications 

LASIK, laser in situ keratomileusis. *FDA-approved dioptric range for correction with current LASIK technology: myopia, up to − 12 diopters; astigmatism, up to 6 diopters; hyperopia, up to + 6 diopters.

Fewer than 1% of patients who undergo the procedurehave serious, vision-threatening complications.6 Less seriouscomplications occur more frequently and delay full recovery.2,7 These complications can result in glare and halosthat occur in dim lighting and may be severe enough to interferewith normal activities, such as night driving. Mostof these problems resolve several months after surgery.6

References:

REFERENCES:1. Pallikaris IG, Papatzanaki ME, Stathi EZ, et al. Laser in situ keratomileusis.Lasers Surg Med. 1990;10:463-468.
2. Karpecki PM, Linn SH. LASIK complications and management. In: Hom MM,ed. LASIK: Clinical Co-Management. Boston: Butterworth Heinemann; 2001:87-94.
3. Price FW. Lasik. In: Focal Points: Clinical Modules for Ophthalmologists. SanFrancisco: American Academy of Ophthalmology; 2000;18:1-14.
4. The Eye Surgery Education Council Web site. Available at: www.eyesurgeryeducation.com. Accessed October 22, 2002.
5. Perez-Santonja JJ, Bellot J, Claramonte P, et al. Laser in situ keratomileusis tocorrect high myopia. J Cataract Refract Surg. 1997;23:372-385.
6. The Eye Surgery Education Council. LASIK Surgery Screening Guidelines for Patients.Fairfax, Va: American Society of Cataract and Refractive Surgery; 2002:1-4.
7. Melki SA, Azar DT. LASIK complications: etiology, management, and prevention.Surv Ophthalmol. 2001;46:95-116.