The first step, ideally, is research. If you’re considering eye surgery, you should do what you can to be informed. You can also phone or e-mail us to ask questions or to order a free brochure. And don’t forget to ask your doctor for another opinion on refractive eye surgery.
Consultation & Booking
Before going any further, you need to find out whether you qualify for the surgery. If you live in or near Vancouver, you can call us to schedule a free consultation. When you come for this appointment, it is helpful to bring us your prescription (or have your doctor fax it to us in advance). We will examine your eyes to ensure that you are a good candidate for the treatment. You will be shown an educational video, discuss the risks and benefits of refractive surgery with a patient counsellor, and then meet with our surgeon. Our goal is to help you develop a full understanding of your condition so that you can make an informed decision about whether to proceed with the surgery.
If you are unable to visit us for a consultation, then you should at least discuss refractive surgery with your eye doctor (optometrist or ophthalmologist) before booking your surgery with us. If you do not have a regular eye doctor, we may be able to recommend one near your home. Have your doctor fax us your prescription and other relevant information.
If you qualify and opt for the surgery, the next step is to schedule the surgery appointment. We recommend that patients take at least four days away from work or studying and avoid strenuous activities during this period of time. Also, keep in mind that you will probably be unable to see well enough to drive for a few days after the surgery.
The cost for surgery depends on your prescription. Cost includes your pre-operative tests on the day of surgery, one-day post-operative check up and patient care kit. You must also arrange for follow up care with an eye doctor. If your regular eye doctor is unavailable for this purpose, we may be able to help you find another. Note that followup care is a separate cost; please enquire with your regular eye doctor to determine their fees.
Since contact lenses tend to warp the cornea slightly, time is needed for the cornea to relax into its natural shape to ensure maximum accuracy during refractive surgery. Hard or gas-permeable contact lenses must be removed at least one month before surgery. Soft contact lenses must be removed at least one week before surgery.
The Surgery Appointment
On the day of surgery, another eye examination is performed to help us re-confirm the exact details of the modifications to be made to your eye(s). This information is then programmed into the system which controls the laser. All consent forms and full payment for the procedure is due on the day of surgery.
After the initial examination, you are brought into the preoperative room where you will be prepped for surgery. Instructions and expectations will be reviewed by a surgical technician. Anesthetic eye drops will be applied to the surface of the eye(s). You are then brought into the laser room and positioned comfortably under the laser. During the procedure, there is a blinking fixation light which you are instructed to look at. There are several key steps in the procedure, such as when the laser is firing, when it is especially important to look steadily at the fixation light. The non-operated eye is patched to help you concentrate.
The exact sequence of events is different for PRK and for LASIK.
In a PRK operation, an eyelid holder is put in place to help keep your eye open. Then the surgeon places a few marks on your cornea and removes the epithelium (outer skin) with a laser. During this time, the fixation light appears to distort and to move around.
The underlying surface is polished, then the laser is ready to fire. The laser makes a clicking or buzzing sound as it fires. The amount of time the laser is fired varies from a few seconds to about three minutes, depending on the degree of correction and the type of laser used. If your eye wanders during this time, the surgeon stops the laser and reminds you to look at the fixation light before resuming the treatment. When the laser is finished, the surgeon places a contact lens on your eye as a bandage, then removes the eyelid holder.
(In some cases, the surgeon may decide to remove the epithelium with a small but blunt metal instrument (a miniature spatula) instead of the laser. The difference in procedure from the patient’s point of view is minor.)
In a LASIK operation, an eyelid holder is used, as with PRK. Then a ring-shaped suction device is placed around your cornea, making it easier to keep your eye still. When the suction is turned on, everything seems to go dark. The surgeon then puts the keratome in place and runs it across the eye and back, during which time it makes a buzzing noise. The suction is turned off, and the flap is pulled away from the central cornea. Then the laser is fired, as in PRK. When the laser is finished, the surgeon puts the flap back in place and then takes two to three minutes to make sure it is positioned properly before removing the eyelid holder. A bandage contact lens is usually not required.
If you are scheduled to have both eyes done on the same day, the second eye is done immediately after the first. When the surgeon finishes the operation(s), you are taken into a nearby examination room to make sure that flaps and/or contact lenses are properly in place.
A patient counsellor will review post-operative instructions and you are given a kit with postoperative medications.
The First Day
Following surgery, you are encouraged to go home and rest. The next day you return for a postoperative check by your surgeon. If you do not live in the Vancouver area, we ask only that you stay overnight in Vancouver so we can monitor you the next day. (We can supply information on accommodations.)
You may experience some temporary discomfort within the first 24 hours after surgery. (This is more likely with PRK than with LASIK.) Your kit contains pain-relieving medications to help you with this as well as ophthalmic drops to promote the healing process. The drops should be taken as instructed; typically about four times per day for each of two kinds of drops, but varying with each patient.
Vision is usually a little blurry immediately after LASIK, and more so after PRK. In the case of PRK, the blurriness often gets worse over the course of the first day or two. Do not expect to see well enough to drive during this time. You may also experience extra light-sensitivity. You should wear good sunglasses outside during the daytime.
Avoid poking or rubbing your eye(s). Also avoid getting any water in them. When taking a shower, keep your operated eye(s) tightly shut. Swimming pools and hot tubs should be avoided for two weeks.
The First Week
After the first day there is usually no more discomfort. Four days after PRK you must visit your doctor to have your bandage contact lens removed. We do not recommend removing the contact lens yourself because the newly-healed surface is still susceptible to possible infections. At this time PRK patients will begin a four-month regimen of steroid drops to control the healing of your eye.
Vision after PRK is not good enough to drive for the first few days. Noticeable daily improvement usually begins around the third or fourth day, and continues for several weeks. Eye drops are also used for the first week after LASIK, but are then discontinued. Many LASIK patients find that their vision is good enough for nearly everything within two days after surgery. You should see your doctor one week after your surgery.
The First Year
After PRK or LASIK, it can take as much as three months for your vision to stabilize. Recovery is generally faster after LASIK, and stability of vision can be achieved in as little as two weeks. LASIK patients are advised not to rub their eyes for two months post-operatively. After PRK, steroid drops must be taken strictly according to the prescribed regimen for three to four months. Deviations from this regimen may contribute to haze and/or regression.
You should see your regular eye doctor one month, two months, three months and six months after surgery. This is especially important after PRK, to see whether the steroid drops are causing an increase in eye pressure, and to deal with this if necessary.
For most patients, this is the end of the story; complete freedom from, or less dependence on, glasses or contact lenses.