Questions & Answers

 

Common LASIK Questions & Answers

Q: Am I a candidate for LASIK?
A: There are several considerations with this question. First, you must ask yourself "Why do I want LASIK?" LASIK decreases or eliminates your dependence on glasses and/or contact lenses. An ideal candidate is someone who requires good uncorrected vision for their job (law enforcement or fire fighting) or their other daily activities or hobbies. If your glasses or contact lenses interfere with your sports and recreation, for example, swimming, scuba diving, snow skiing or rock climbing, you may also be a good candidate. Patients also have LASIK because of decreased tolerance for wearing contact lenses. Many patients decide to have LASIK because they are tired of the hassle or the ongoing expense of contact lenses. This is a very common and legitimate reason for having LASIK, but be sure of your motivations and discuss this with your surgeon prior to surgery.

 

The question "Am I a candidate...?" involves your refractive correction (the strength of your glasses or contact lenses) and the thickness, shape and health of your cornea. LASIK corrects nearsightedness up to 14.00 diopters, farsightedness up to 6 diopters, and astigmatism up to 6 diopters. For those with higher degrees of refractive error there may be newer surgical options available which Dr. Mills would be happy to explain at the time of your consultation. The best way to tell if you are a candidate is to make a free screening appointment with Eye Care Professionals (775-322-1000), and bring your old glasses or contact lens prescription for our inspection. You can also complete ask the doctors section on our website with your request.

 

 

Q: What does LASIK cost?

A: $1,800 per eye, or finance for less than $60 per month, per eye. Those charges include your initial consultation, your surgery, the laser facility fee and one year follow-up with your surgeon. Individual insurance plans and their coverage change quickly, so please contact us for insurance authorization.

 

Q: What is included in the surgery fee?

A: Eye Care Professionals surgical fee includes the laser facility charges, the surgeon fee, a complete eye examination and pre-op exam, all postoperative examinations for one year, and the initial eye drops that are required after surgery. In a small percentage of cases enhancement surgeries may be required. If required during the first year post-operatively, the patient pays $200 (the VISX laser fee) for each enhancement. After one year there are some additional costs for enhancement surgery, though this is a rarely necessary.

Q: Can I have LASIK if I wear bifocals?
A: The answer is a qualified "yes". For more information, read about monovision below.

Q: Is there an upper age limit that LASIK cannot be done?
A: No. Dr. Schonder and Dr. Mills have done LASIK on several patients in their 60s. However, healing and recovery of your best vision may be a little slower than in a 20-year-old patient.

Q: How old must I be before I have LASIK?
A: You must be 18 and have a stable glasses prescription.

Q: Are there medical contraindications to LASIK surgery?
A: Yes, LASIK should not be done in patients with keratoconus. In some patients, the cornea is too thin to perform LASIK. LASIK cannot be performed on a patient who has an active eye disease. LASIK can be performed on a patient with diabetes, but not a patient with active diabetic retinopathy. Active autoimmune disease such as lupus or rheumatoid arthritis, because it affects healing is a contraindication to LASIK surgery. LASIK cannot be done while on Cordarone or Accutane.

Q: Can I have LASIK while I am pregnant?
A: No. During pregnancy, the increased hormones soften the collagen of the cornea resulting in variable vision and unpredictable surgical results. Also, performing LASIK on a patient who is nursing is not recommended.

Q: What is monovision?
A: Monovision is a correction in presbyopic patients (over 40 years of age) of the dominant eye for distance and the non-dominant eye for near. This is a common method of correcting vision in patients requiring bifocals after reaching their 40's. This method of vision correction can be done with refractive surgery or with contact lenses. In fact, President Reagan and Vice President Al Gore used a contact lens for monovision. If both eyes in a presbyopic patient are corrected fully for distance, reading glasses are then required. This may be the desired result. Not everyone can adjust to monovision. If not, then the non-dominant under corrected eye can be enhanced for distance correction. For patients over 40, a detailed discussion with the doctor to determine the patient's visual needs and goals is required. A trial of monovision with contact lenses can help predict which patients will do well with this type of laser correction.

Q: Is there a charge for enhancement (repeat surgery)?
A: There is no charge by Eye Care Professionals for enhancement for one year, as long as the doctors at Eye Care Professionals performed the original surgeries. VISX Laser Company now charges $200 per eye for enhancements. After one year there are some additional costs for enhancement surgery. The vast majority of patients does extremely well following their initial surgery and will not need any enhancements.

Q: Will insurance or health plans pay for LASIK?
A: Usually not, but some plans are beginning to pay a portion of LASIK surgery. Our insurance department keeps current on these coverage changes. Please contact us to arrange authorization.

Q: How often will I be examined?
A: You will have one or two examinations prior to your surgery. You will be examined by your surgeon one day post-op. Also, you will have exams one week, one month and three months after your surgery day. Of course, if you or the surgeon has any concerns, you will have examinations as needed.

Q: Should I have LASIK on one eye at a time or both?
A: Most patients have LASIK done on both eyes at the same surgical setting. There is convenience for the patient in having both eyes done simultaneously. LASIK has a very low complication rate; however, it is a surgical procedure. For example, there have been cases reported of vision loss from infection or retinal hemorrhage. Dr. Schonder and Dr. Mills may, on occasion, encourage you to consider having LASIK done on one eye at a time.

Q: How long will I be off work after LASIK?
A: We usually perform our LASIK surgeries on Wednesday. Most patients return to work the following Monday.

Q: How long must I be out of contact lenses before having LASIK?
A: You must have discontinued your hard contact lenses for three weeks, and soft contact lenses for two weeks, prior to your pre-surgical consultation. Contact lenses, especially hard contact lenses, alter the shape of your cornea. A stable refraction is needed to ensure a good result. Going this long without contact lenses may be impossible for some patients. Hard contact lenses may be temporarily switched to soft contact lenses to shorten this time table. Sometimes, we can work with one eye at a time by discontinuing the contact in first one eye and later in the other eye.

Q: Will my LASIK surgery complicate future surgeries?
A: Dr. Schonder and Dr. Mills have done cataract surgery on patients who have had RK, PRK and LASIK surgeries in the past without complications. It is more difficult to determine the power of the intraocular lens (IOL) used during cataract surgery after refractive surgery.

Q: How many LASIK surgeries has Eye Care performed?
A: Dr. Schonder and Dr. Mills have been performing refractive surgery since 1985 and LASIK surgery since 1998. Our surgeons have performed over 3,000 refractive surgeries, including LASIK, PRK (Photorefractive Keratectomy), AK (Astigmatic Keratotomy) surgeries for Astigmatism, and RK (Radial Keratotomy) and more recently ICL (implantable collamer lens) surgery.

Q: Does LASIK surgery hurt?
A: Though the eye is made numb with eye drops there is some pressure on the eye and the eyelids while the microkeratome is used. To decrease a patient's stress and discomfort during that part of the procedure, patients are given Valium pre-operatively. There is no discomfort during the laser's use. You will be given one pain pill after completion of the surgery. The eye will usually feel scratchy for about three hours after LASIK. Usually, no other pain medicines will be required.

Q: If enhancement is required, when is it done?
A: Most often, we wait to ensure that the vision has stabilized at three months. Occasionally, intervention earlier is required.

Q: How are enhancements done?
A: Most often, the original flap is lifted, the laser correction performed and the flap allowed to re-adhere. The microkeratome is usually not required. Rarely, other surgical procedures such as AK, RK or PRK will be recommended for further treatment. On occasion, the flap will have to be re-cut and the laser repeated.

Q: Have any of the staff at Eye Care had refractive surgery?
A: Yes. Twenty staff and family members have had refractive surgery by Dr. Schonder and Dr. Mills. The office staff has seen the excellent results and the happy, satisfied patients and decided also to have the procedure.

Q: I have had RK surgery in the past. Can I have LASIK?
A: Yes. LASIK can be performed one year after RK surgery. The results are generally very good, but there may be a slight increase in surgical risk. Also, not all blurred vision after RK surgery can be corrected by more refractive surgery.

Q: How long will it take for me to see clearly after LASIK?
A: Virtually all patients have much better uncorrected vision the morning after surgery. However, very near- sighted or very far-sighted patients may take a week or longer before achieving their best vision.

Q: What is the complication rate with LASIK?
A: Minor complications, which can result in less than optimal outcomes and blurry vision, occur in about 1% of patients. Severe complications such as infection or retinal hemorrhage have occurred in about 1 in 15,000 cases.

Q: What is the enhancement rate at Eye Care Professionals?
A: Our enhancement rate is less than 5%, which is less than half of the national average. Some of these enhancements are patients who were unsuccessful trying monovision.

Q: What are the side effects of LASIK?
A: Potential undesirable side-effects include dry eyes, problems with night vision and halos or ghosting of vision. Most of these symptoms will clear in weeks or months and some patients say that the night vision or halos are no worse than they experience with their contact lenses. For reasons that are not completely understood, the eyes are drier than normal for up to six months after LASIK. This is, of course, more of a problem at our high and dry climate, requiring frequent use of lubricating drops and sometimes temporary plugs to keep the eyes better lubricated. Other less common side-effects are explained during our pre- operative patient education.

Q: Are there newer surgical methods or lasers on the horizon?
A: There have been rapid improvements in both the laser and microkeratome to make the flap. Improvements are expected for patients with unusual problems such as thin cornea, extreme farsightedness and extreme nearsightedness. LASIK does not work as well for patients with these problems. If you have these difficulties, the doctors at Eye Care Professionals will discuss with you your best options. Some currently available alternatives include PRK, ICL and refractive lens exchange.

Q: Can LASIK be done if I have diabetes?
A: Yes, LASIK can be done for patients with diabetes, as long as the diabetes is under good control. LASIK should not be performed if the patient has complications related to diabetes such as diabetic retinopathy and hemorrhages or macular edema.

Q: Are the doctors at Eye Care Professionals board-certified?
A: Yes. Both Dr. Mills and Dr. Schonder are board-certified by the American Board of Ophthalmology.

Q: Are the equipment and surgical instruments sterile?
A: Yes, all surgical equipment is sterilized before use on each patient. All disposables including the microkeratome blades are replaced after single use on the patient, and new sterile blades and disposables are obtained for the next patient.

Q: What laser do you use?
A: We use the most up-to-date VISX S-4 laser with CustomVue Wavefront Treatment capabilities. The S-4 features a 3D active eye tracker that follows your eye during treatment. Unlike other tracking systems, no uncomfortable dilation is required. The VISX laser is the gold standard for other laser manufacturers in the industry.

Q: What is Wavefront Custom LASIK?
A: Wavefront measurement refers to a very advanced means of measuring a patient's refractive error. Using technology adopted from deep space telescopes, we can now detect and treat refractive aberrations in a more sophisticated manner. Basically, a beam of light is projected into the eye and the reflected light returning through the pupil is then captured and measured and analyzed to create a very unique completely customized map of the imperfections in a patient's visual pathway. Dr. Mills was the first LASIK surgeon to provide Wavefront guided LASIK in Northern Nevada. Both Dr. Schonder and Dr. Mills have experience with Wavefront Guided LASIK and either would be happy to discuss this technologically advanced surgery with you at the time of your evaluation.