Singapore Lasik


	Additionally, some may decide to undergo LASIK because of vocational benefits and other lifestyle benefits, while a few others may be forced to opt for this procedure as their profession demands it, for instance sports professionals and airline cabin crew. Besides the need to improve their working life, many active individuals who rely on corrective eyewear also realize that their dependence on glasses and contacts restrict them from realizing their full potential in sports or other daily activities they enjoy.




		Advantages & Disadvantages of LASIK Surgery PROS: Advantages of LASIK i. Outpatient Procedure It is a very short procedure which takes about 10 minutes per eye. It is performed with only topical anaesthesia. ii. Rapid healing with little postoperative pain Most LASIK patients will experience discomfort and tearing for the first 8-10 hours after surgery. However, once the surface layer has healed, there is no more pain and the patient can resume normal activities. iii. Good accuracy and stable postoperative refractive results LASIK surgery gives very good accuracy for low-moderate myopia (up to -500 degrees or -5.0D). Studies have shown that the results for low-moderate myopia are excellent and up to 98% will achieve 6/12 or better vision. 6/12 vision is equivalent to the minimum legal vision requirement for driving. CONS: Disadvantages of LASIK i. It is very technology and equipment intensive Maintenance of the laser machine has to be constant and frequent to achieve the best possible results. Complications may occur if the equipments are faulty. The results for very high myopia (-10.0D and above) are not very good Only about 82% of very high myopes will achieve 6/12 or better vision with WaveFront LASIK surgery. Even with the latest machines such as Ladarvision, the surgeon is still limited by the thickness of the cornea for very high myopia patients. Right now, a lot of research is going into phakic intraocular lenses and clear lens extraction for patients with very high myopia. ii. Dependence on patient’s corneal thickness If the cornea is not thick enough to safely leave behind a minimum thickness of the corneal bed after laser, the structural integrity of the cornea may be lost and a dangerous complication (called keratoectasia) may occur where the cornea becomes 'distorted'. If keratoectasia occurs, it is quite difficult to treat and sometimes, a corneal graft may become necessary. Complications of LASIK Surgery Like any other surgeries, LASIK surgery comes with some possible complications. These include loss of corneal flap, folds of the corneal flap, shifting or wrinkling of the corneal flap, interface inflammation, epithelial in-growth underneath the flap, and instability of the flap requiring corneal sutures and infection - all of which can result in permanent loss of best corrected vision. i. Dry eyes This is probably the commonest complication encountered in LASIK surgery. Most patients will experience a slight dryness of their eyes after LASIK surgery. This is easily treated with lubricating eyedrops. In more severe cases, punctal plugs can be inserted into the tear drainage channels (called canaliculi) of both eyes. This will stop the tears from draining out of the eye and relieve the severe dryness. ii. Glare, haloes and starbursts It is dependent on spherical power & astigmatism which Dr. Chuah will discuss with you. Some patients experience light sensitivity and glare, or they may complain that they see haloes, starbursts and 'ghost images' next to the real image. This is most noticeable at night, especially when looking at point sources of light, such as the headlights of oncoming cars or streetlamps. Patients with naturally large pupils or those who had correction done for high myopia are at greatest risk. These after effects can limit one's ability to drive and work. Most times, these symptoms will lessen significantly or go away in six months. If they persist indefinitely, the eye surgeon may prescribe certain eyedrops in the evening such as Alphagan eyedrops or Pilocarpine eyedrops to constrict the patient's pupils and reduce the glare. iii. Difficulty reading in the immediate postoperative period This is especially disturbing for middle aged patients who are starting to get long-sighted/far-sighted due to ageing (presbyopia). During LASIK surgery, the eye surgeon usually aims to deliberately overcorrect the refractive error by a small margin to allow for postoperative healing with regression. The patient will usually end up far-sighted for up to six weeks. During this period, wearing a cheap temporary pair of reading glasses will help the patient to read emails and newspapers. iv. Under or over correction Under and over correction of refractive power can occur despite the surgeon's best effort. This is due to the individual variation in the healing process and in tissue density. Over correction is less well accepted than under correction. A significantly over corrected eye will need glasses to see well for both far and near distances. For this reason, most doctors will deliberately aim for a slight under correction especially in middle aged patients and patients with high myopia. If significant under or over correction has occurred, a second 'enhancement' operation can be considered. Usually, this 'enhancement' operation is performed three months after the initial operation to allow the refractive power to stabilize. v. Corneal flap complications Risk in 1 300 to 1 in 500. The LASIK procedure may be aborted because of problems encountered when creating the corneal flap. These include an incompletely cut flap, a completely sheared off flap or a flap with a 'button hole' defect. Post-operatively, wrinkles may develop within the flap or the flap may become dislodged. All these flap complications may cause optical aberrations which are difficult to correct with glasses. There is also a category of post-operative flap problems. These include Diffuse Lamellar Keratitis which is caused by trapped foreign body debris or toxins and an epithelial in-growth syndrome caused by migration of surface epithelial cells into the undersurface of the flap. In the severe cases, the flap may need to be re-lifted, cleaned and repositioned. While severe corneal flap complications are rather uncommon, they can lead to a loss of the best corrected visual acuity. vi. Loss of best corrected visual acuity Loss of best corrected visual acuity refers to seeing worse after the operation despite the best spectacle or contact lens correction. A common cause would be irregular astigmatism arising from de-centered or uneven ablation. The uneven bumps on the surface of the cornea that result from uneven ablation is also known as 'central islands'. Loss of best corrected visual acuity can also occur from excessive corneal scarring, corneal haze and flap related complications. Usually, vision improves with time as further healing occurs. Severely affected patients may suffer a permanent drop in their best corrected visual acuity. Fortunately, in most cases, vision loss is limited to only one or two lines where there is difficulty in reading the smallest letters of the visual acuity testing chart. vii. Contact lens wear intolerance If there is still residual refractive error after the LASIK surgery, the patient may not be able to wear contact lenses to correct this. This is due to the change in the central corneal shape after the LASIK surgery which prevents the contact lens from sitting well on the cornea. viii. Equipment malfunction Both the microkeratome and the excimer laser are manufactured and maintained according to the manufacturer's exacting specifications. However, it is still possible that the machines may rarely malfunction, resulting in a possible abandonment of the procedure before completion. In some instances, this may cause a loss of best corrected vision. ix. Eye Infection As with all types of surgery, there is possibility of infection. However, infection when picked up early can be treated and vision can be saved. Should adverse reaction occur, for example pain, swelling or irritation, you should contact your eye doctor immediately. You should also stop taking medication or applying eyedrops and/or ointment if an allergic reaction occurs. Severe eye infection after LASIK surgery is the most feared complication. The incidence is rare and occurs in about one in 5,000 surgeries. When it occurs, it may cause severe corneal scarring, loss of best corrected visual acuity and if uncontrolled by antibiotics, even a loss of the entire eye. Therefore, it is important to apply the prescribed antibiotic eyedrops diligently after the surgery according to the eye surgeon's instructions. x. Glaucoma In some eyes, the long term use of the anti-inflammatory steroid eye drops used after surgery may cause glaucoma. However, these may prevented through regular visits and close observations by your eye doctor to monitor the eye pressures. xi. Retinal detachment Highly myopic patients are at increased risk of retinal tears and retinal detachments. Retinal detachment may occur if predisposing retinal lesions, such as retinal tears and retinal thinning, are not detected and treated prior to LASIK surgery. It is important for the eye surgeon to perform a thorough eye examination before performing LASIK surgery. Nevertheless, it is impossible to state every possible complication that may occur as a result of LASIK surgery, or any surgery for that matter, therefore the complications mentioned here are not complete. You can, however, be assured that most complications that arise from LASIK surgery can be treated if detected early and will improve with time.

	\| MEDICAL BENEFITS \| \| ADVANTAGES & DISADVANTAGES \| \| COMPLICATIONS \| Medical Benefits of LASIK Surgery If you’re nearsighted, you would understand the inconvenience of having to pick up a pair of glasses before venturing off to the movies. And if you wear contact lenses, you have the daily hassle of putting them in every morning and taking them out every night. LASIK surgery may then seem as the most appealing option to rid you of your bothersome glasses and contacts. No doubt, LASIK is one of the most common and perhaps the most preferred and effective type of treatment due to a large number of benefits. Among the numerous benefits of LASIK, cosmesis is probably the main reason many opt for this procedure. For the most part, those dependant on corrective eyewear may feel self-conscious and unattractive, or may eventually even get tired of the daily hassle. Self-esteem, convenience, as well as the ability to save on money required to replace or repair contacts and spectacles is perhaps the most motivating factor for many that opt for LASIK surgery. Additionally, some may decide to undergo LASIK because of vocational benefits and other lifestyle benefits, while a few others may be forced to opt for this procedure as their profession demands it, for instance sports professionals and airline cabin crew. Besides the need to improve their working life, many active individuals who rely on corrective eyewear also realize that their dependence on glasses and contacts restrict them from realizing their full potential in sports or other daily activities they enjoy.

	Aesthetics aside, LASIK also provides a variety of medical benefits. Wearing contact lenses can cause a number of eye complications such as allergic conjunctivitis (see Fig 1-1), corneal abrasions(see Fig 1-2) and corneal ulcers (see Fig 1-3) that may result from poor lens hygiene or sensitivity to lens materials and solutions. Fig 1-1 Conjunctivitis

	Fig 1-2 Corneal Abrasions

	Fig 1-3 Corneal Ulcer

	Additionally, if not attended to properly and compliantly with daily cleaning and disinfecting, frequent and prolonged wearing of contact lenses can lead to corneal erosions, torn and lost lenses within the eye and abnormal ingrowths of blood vessels into the cornea. Those with high myopia and/or high astigmatism, as well as anisometropia, may also suffer symptoms of spectacles intolerance such as giddiness and distorted vision from wearing high-powered or uneven powered spectacles. And where glasses and contact lens may not be suitable solutions for those with unusual refractive errors, LASIK surgery can then be an option to be considered.

	LASIK surgery can also be well-suited for sports and fitness enthusiasts who engage in vigorous outdoor activities and contact sports to prevent the risk of having their eyes injured when their contact lens get hit or when their glasses get broken or damaged. Moreover, certain occupations, primarily airline cabin crew, are prone to disorders related to contact lens wear - such as allergic conjunctivitis and corneal ulcers - due to the dry temperatures in long haul flights and the tendency to nap with contact lenses on.