LASIK - Laser In Situ Keratomielusis

By Jaime Santamaria II, M.D., F.A.C.S., F.I.C.S.

LASIK is now the most popularly done refractive surgery procedure in the world. It is an operation performed for people who want to reduce or eliminate their dependence upon glasses.

LASIK is a procedure where a flap formed in the cornea, using one of the various keratomes ("corneal cutter"). The cornea is then treated with an Excimer laser to change its curvature before the flap is placed back into position. The procedure normally takes five minutes per eye and is not felt by the patient due to the use of anesthetic drops. The Excimer laser is controlled by a computer, which appropriately reshapes the cornea depending on the person's prescription.

LASIK is quite accurate for patients who have myopia (nearsightedness), and also is reasonably accurate for patients who have myopia and astigmatism. It is also effective in treating hyperopic patients (farsighted).

A patient over the age of 40 does not have just one eye prescription to correct his or her vision. The prescription needed for distance is not the same as that need for reading. This condition, which is normal in all patients, is called presbyopia, taken from the Greek meaning "elder's vision." Many patients, therefore, who are treated with LASIK and who are over 40 frequently need reading glasses also. In some patients the reading glasses can be avoided by doing a treatment creating "mono vision."

In this treatment one of the eyes, usually the dominant eye, is chosen for the distance correction. The other eye, or non-dominant eye, is chosen for the reading correction. This works well for many patients. However, some patients cannot tolerate using one eye for distance and the other for reading. Of course, before a doctor would recommend such mono vision treatment, it is important to very carefully allow the patient to use trail frames in the office to make absolutely certain that the prescription is exactly what they would like to have. Therefore, LASIK procedures in patients who are over 40 definitely involve a compromise: treating both eyes for distance and using reading glasses, or correcting one eye for distance vision and the other one for reading.

For some patients, neither one of these options is acceptable. However, there is now a relatively new treatment which is being performed in patients over 40 who would like to not only have their distance vision corrected, but also their reading vision. This treatment is called a "clear lens extraction." It involves performing a surgical procedure exactly the same as is performed for patients who have cataracts, but instead of placing a normal intraocular lens, a lens is placed that corrects both the distance and reading vision. The lens commonly used for this is made by the Allergan corporation and is known as the "Arrayâ„¢" lens. If patients are selected carefully and correctly, clear lens extractions is not only very advantageous, but also obviates the need for any future cataract surgery. Some have called the operation an operation for all time.

Not everyone is a candidate for clear leans extraction or LASIK. Patients who have other diseases, such as macular degeneration, glaucoma, or corneal dystrophies, are not good candidates for either procedure.

Dr. Santamaria, who performs both LASIK and clear lens extractions, is the Director of Santamaria Eye Center, with offices in Perth Amboy and Edison, NJ. He is the author of numerous peer review and scientific publications, including some on the safety of refractive surgery. He also serves as Assistant Clinical Professor of Ophthalmology at Columbia Presbyterian Medical Center in New York, and is a member of the Wills Eye Hospital surgical network.

More information or an appointment with Dr. Santamaria for these procedures can be obtained at 732.826.5159.