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Jasmine’s pre-LASIK evaluation was scheduled at 9.45am
and she arrived punctually. After being greeted by the friendly
staff of the clinic, she was told that the pre-LASIK evaluation
will be performed by one of the experienced LASIK optometrists.
Upon completion of all the necessary tests, the test results
will be presented to the eye surgeon, Dr Gerard Chuah, who
will further counsel and discuss with her about her suitability
and the LASIK surgery.
The pre-LASIK evaluation began with random questions about
her general eye health and notation of her family medical
history. Following that, basic eye examinations such as
the automated refraction
- to check her eye power - and the tonometry - to check
her eye pressures - were performed.
After these basic tests, her visual
acuity was examined using the visual acuity chart.
A subjective refraction
was also performed to fine tune the automated refraction
performed earlier. A detailed refraction has to be performed
in order to better document and compare the improvement
in her visual acuity after the LASIK surgery.
Anesthetic eyedrops were
then instilled into Jasmine’s eyes to numb the eyes
for the next test – the corneal thickness test or pachymetry.
This test is one of the critical tests of the pre-LASIK
evaluation, as it helps to determine the suitability of
a candidate for LASIK surgery, and more importantly, the
exact type of LASIK surgery appropriate.
The corneal thickness test, or pachymetry,
takes approximately five minutes and involves the contact
measurement of the cornea using the prop of the pachymetry
machine. After the pachymetry test, a more detailed and
accurate test, which is the Orbscan, was also performed.
The Orbscan is the non-contact measurement of the corneal
thickness. Together, the results of the pachymetry and Orbscan
help to accurately determine the type of LASIK surgery suitable
for a patient.
Once these tests were completed, Jasmine’s eyes were
then dilated to enlarge
the pupils and prepare her for consultation with Dr Gerard
Chuah. While waiting for her pupils
to be fully dilated, Jasmine was counseled
by her LASIK optometrist, whereby the success rate
of LASIK surgery, expected post-LASIK vision, the complications
of LASIK surgery, what to expect during and after surgery,
etc. were all explained clearly to her.
Once her pupils were fully dilated, Jasmine was brought
into Dr Gerard Chuah’s consultation room, where she
was further examined with a Slit-lamp biomicroscope. This
is to ensure that the anterior of the eye is clear with
no ocular surface diseases. Following this, a detailed dilated Fundus examination
was also performed, with special attention to the clarity
of the crystalline lens, to exclude any retinal problems
(such as retinal tears or retinal detachments).
During her consultation with
Dr Gerard Chuah, Jasmine also had the opportunity
to discuss the risks and benefits of LASIK surgery, as well
as to address the concerns she had about the surgery. Jasmine
was then told that she was a suitable candidate for Conventional LASIK and that her surgery can be performed on the
same day.
With that, her pre-LASIK evaluation was
over in less than 90 minutes, and her LASIK surgery was
scheduled at 3.00pm. It was explained to her that the reason
the surgery was scheduled later in the afternoon, and not
immediately following the evaluation, was because the number
of hours in between was necessary to constrict her pupils
and ensure that they are suitable for surgery.
With so much time in her hands, Jasmine decided to head
home for some rest and use the time to mentally psyche herself
up for the surgery. As she left the clinic, she was thankful
to have her sunglasses on hand, as the dilation of her pupils
had left them enlarged and sensitive to light, and her vision
slightly blurred.
The
LASIK Surgery
Jasmine returned to the clinic at 2.30pm as instructed.
She was told to return earlier than her scheduled surgery
time as she needs to be informed of the post-operative LASIK
medication, and also be dressed for the surgery. Her LASIK
optometrist then sat down with Jasmine to go through the
“Dos” and “Don’ts” after LASIK
surgery, the correct application of the post-operative medications
and the importance of lid hygiene so as to avoid complications
during recovery.
Once these were done, Jasmine was brought to the surgery
theatre, where she was asked to change into a clean dressing
gown. She was then brought into a room containing the laser
system, and she was asked to lie on her back on a flat bed.
Jasmine observed that the laser system includes a large
machine with a microscope attached to it and a computer
screen. While lying down on the flat bed, an anesthetic
eyedrop was instilled into her eye.
A soft protective plastic sheet was then placed over her
eye lids, and an instrument called a lid speculum was used
to hold her eyelids open. A ring was then placed on her
eye and very high pressures were applied to create suction
to her cornea. During this period, Jasmine felt her vision
starting to dim while the suction ring was on, and she also
felt pressure and some discomfort.
Dr Chuah entered the laser room shortly after and once she
was ready, he then signaled the start of the surgery. As
he began, he explained to Jasmine that the surgery will
be done by creating a thin flap through the top layer of
her cornea with a specialized corneal cutting instrument
called a microkeratome.
The microkeratome is attached to the suction ring. As further
explained by Dr Gerard Chuah, there are two types of microkeratomes:
the mechanical blade microkeratome and the laser microkeratome.
There are advantages and disadvantages
with either of the two types of microkeratomes.
Once the corneal flap was done, the microkeratome and the
suction ring were then removed. The flap was then lifted
and folded back on its hinge to dry the exposed tissue.
Next, the laser was then positioned over her eye and she
was asked to stare at a red light. She was told that this
red light was not the laser used to remove tissue from the
cornea, but instead will help her keep her eye fixed on
one spot once the laser comes on.
Although Jasmine was able to see, she experienced
fluctuating degrees of blurred vision during the rest of
the procedure.
Dr Chuah further explained that a computer is what controlled
the amount of laser energy delivered to her eye and the
computer was already programmed before the start of surgery,
to vaporize a particular amount of tissue based on the measurements
taken during her pre-LASIK evaluation.
Once Jasmine’s eye was in the correct position, Dr
Chuah began the laser on the corneal bed underneath the
flap, making microscopic changes to reshape the cornea.
As the laser began, Jasmine could hear batches of buzzing
sounds and she was also aware of a smell similar to burning
hair.
The lasering process was completed in only a short while,
and upon completion of the lasering process, the corneal
flap was replaced into its natural position. Dr Chuah added
that the obvious advantage of LASIK surgery is that the
flap acts like a bandage, protecting the lasered area. The
area of healing is limited to a small thin area around the
circumference of the flap where the surface layer is cut.
This heals rapidly within 8-10 hours and a patient normally
does not feel any pain once the surface layer is healed.
At the end of the procedure, a shield was
placed over Jasmine’s eye as protection, since no stitches
were used to hold the flap in place. Jasmine was reminded
that it is important to wear this shield to prevent her
from rubbing the eye and putting pressure on the eye during
sleeping, and to protect the eye from accidentally being
hit or poked until the flap heals.
Jasmine was then brought out of the laser room and into
the waiting area of the surgery theater.
Immediately
After the LASIK Surgery
After changing out of her surgery clothes and before heading
home, Jasmine was brought into a consultation room for a
final time, where Dr Chuah examined the corneal flap. After
the examination, while in the waiting area, Jasmine was
pleased to note that she can see immediately after the surgery.
However, she was told by her LASIK optometrist that her
vision may be blurry for the first 12 hours after surgery.
She was assured that the blurriness will resolve and that
noticeable improvement in vision will be noticed after resting
the eye overnight. A gradual improvement in vision, as she
was told, is expected as further healing occurs over the
next few weeks. She was also informed that vision is usually
stable in a month’s time.
As advised to her during her pre-LASIK evaluation, she made
arrangements for a family member to pick her up after the
surgery. Jasmine was accompanied by the optometrist until
the arrival of her family member.
Before leaving the surgery theatre, she was once again advised
by her optometrist to head straight home and to have ample
rest for the remaining part of the day. She was also reminded
to return to the clinic the next morning for a post-operative
review. As was already explained during her evaluation process,
she will be required for a review within the first 24 to
48 hours after surgery and at regular intervals after for
at least the first six months.
Shortly after reaching home, Jasmine noted a slight burning
sensation and itch in her eyes. Both her eyes were tearing,
and her vision was slightly blurry. In addition, she also
experienced sensitivity to light, and was seeing glare and
haloes around lights. The whites of her eyes also looked
red and bloodshot. Jasmine recalled being told that these
were normal after LASIK surgery and that these symptoms
should improve considerably within the first few days after
surgery.
Feeling reassured, she was able to relax, although she found
it hard resisting rubbing her eyes. However, she managed
to refrain from rubbing them as she was told it could dislodge
the corneal flap, requiring further treatment.
While resting that night, Jasmine was touched to receive
a phone call from her optometrist, checking on her well-being
and condition after the surgery. She was able to rest well
and looked forward to her review the next day.
The
Day After LASIK Surgery
At the first post-operative visit the day after her LASIK
surgery, Jasmine’s vision was tested and the corneal
flap was examined thoroughly. She was advised by Dr Gerard
Chuah that it is important to wait one to three days following
surgery before beginning any non-contact sports, depending
on the amount of activity required.
To help prevent infection, she was advised to wait at least
two weeks before using lotions, creams, or make-up around
the eye. She was also advised to avoid swimming for the
next two weeks. Strenuous contact sports such as boxing,
football, karate, etc. should not be attempted for at least
four weeks after surgery or as advised later by Dr Gerard
Chuah.
Jasmine was also told that during the first
few months after surgery, her vision may fluctuate, and
it may take up to three to six months before her vision
stabilizes. Glare, haloes, difficulty driving at night,
and other visual symptoms may also persist during this stabilization
period.
In addition, she was reminded of the several precautions
that are important after LASIK surgery:
  To
adhere to the antibiotic and steroid eyedrops regime as
prescribed after the
LASIK surgery – to prevent bacteria infection and to
control the healing response
To
avoid crowded and dusty places for the first three days
after surgery
To
wear the protective eye shield when sleeping for the first
week after the
surgery
to prevent accidental rubbing and trauma to the corneal
flap
Do
not squeeze her eyes too hard for the first day after the
surgery
Do
not rub her eyes for the first three weeks after the LASIK
surgery
Through constant and regular reviews, and her strict adherence
to the eyedrop regime, Jasmine was able to recover well
and without any complications. She is happy to be able to perform
her daily activities without going through the hassle of
spectacles or contact lenses.
She is also pleased to be able to engage
in contact sports and vigorous outdoor activities without
being restricted by her dependence on corrective eyewear
and the worry of damaging them. To Jasmine, the freedom
from corrective eyewear is worth the whole LASIK experience!
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