Dr. King:
We’ve been here a really long time. Today, we might actually film something
Dr. King:
Hi. Welcome to Days of Our Eyes. I’m Dr. King.
Dr. Cha:
I’m Dr. Cha.
Dr. King:
And today we’re gonna continue our refractive surgery series and we’re to
Dr. Cha:
Take it from the top.
Speaker:
Whenever you’re ready.
Dr. Cha:
Hello. Welcome to Days of our eyes. I’m Dr. Cha.
Dr. King:
I’m Dr. King. I’m half asleep.
Dr. Cha:
Me too. And today we’re gonna talk about one of the first refractive procedures that we listed off in the series of refractive surgeries. We’re talking about LASIK with a K, not a Lasix, with an X.
Dr. King:
Yes. LASIK with a K. No Lasix.
Dr. Cha:
No LASIK.
Dr. King:
What is it?
Dr. Cha:
I don’t know
Dr. King:
Who’s good for it.
Dr. Cha:
You tell me.
Dr. King:
Stick around, you’ll find out. So there’s two lasers involved in LASIK. So the first one, we use a laser to make the flap. Once it’s made, we’ll lay that flap back. Using us a special tool. Then the LASIK laser, the excimer laser does its little sculpting thing. When that’s finished, we just lay the flap back down. Surgeon smooths it with a special tool and it’s done.
Dr. Cha:
Yeah. So what prescriptions do these correct ducting
Dr. King:
They can correct a farsightedness up to around a +6 and nearsightedness into the moderate, moderately high range up to around a -9. give or take depends on the device you’re using. Depends on a lot of other variables, but those are kind of the generalized limits to the procedure. And when you get into those extremes, there are cases in times where there are other procedures that might actually be better. So there’s overlap in a lot of these different procedures, but that’s the general ranges for LASIK. So it’s pretty it’s got a pretty broad range.
Dr. Cha:
Yeah. What about astigmatism? Dr. King?
Dr. King:
Yes. Nowadays we can correct astigmatism as well. There are certain limits to how much, once again, that depends on the system that’s being used. There are different systems out there. And the good news about the astigmatism front is that’s always getting better. That’s one of the things that, that they’re constantly working on. So our abilities to correct astigmatism are constantly improving.
Dr. Cha:
Yeah. I remember a patient, we, she or she, he, she, they had about four units. HIPAA HIPAA Yeah. . But they had like four units of astigmatism. I think we were able to correct all of it.
Dr. King:
Nice. A good candidate for LASIK is anybody who is, falls within those prescription ranges. And once again, you start at your regular eye doctor. ’cause they’re gonna know your eyes the best of anybody. In addition, because we’re, we’re reshaping the, the cornea. We have to have a certain corneal thickness to work with. We’re gonna end up with a little thinner cornea than what we started. Think of it as a sculpting process. You start out with a big piece of stone to create a sculpture that’s smaller than the original. So one of the keys here to LASIK is making sure that we have a corneal thickness that is adequate, that after surgery we have so much undisturbed corneal bed. One of the things we do when we measure this is we make sure that the person has not had anything in contact with their eyes for at least a week. That includes contact lenses, hence we talked about contacts. Mm-hmm. , we don’t want anything that can influence the corneal cur curvature. It has to be a pristine cornea. So if it’s a soft lens wearer it’s about a week, right?
Dr. Cha:
Yeah.
Dr. King:
Rigid gas permeable wears those suckers. They’re literally rigid. They can actually mold the cornea. Those folks need to stay outta their lenses a lot longer. The last thing we wanna do is create a cornea that won’t stay healthy the rest of your life. Mm-hmm. . So corneal thickness is a very important aspect of who’s a good candidate. Another thing that makes a person a good candidate is you have to have a decent tear film. Tears cover the surface of the cornea. That the cornea is literally bathed by the tears. So if you run particularly dry, if you have a poor tear film that needs to be addressed before you have surgery, a lot of folks wanna just like bypass that. It’s like, no, that’s not a good move to make. You want a decent, healthy tear film that’s gonna nourish that cornea. Tears aren’t just water, they’re nutrients that feed the surface. So if you have a toxic tear film, how’s that cornea gonna heal after surgery. So we have to create a good environment. Once again, that starts at your regular eye doctor’s office before you ever go talk to a surgeon. Once you get that stuff straightened around, then we can decide who’s a good candidate.
Dr. Cha:
And you know, it’s not just as simple as getting a measurement of how thick it is making sure, you know, maybe getting a volume of how much tears you have. If you have a scarring from something that had, might have happened dramatically in the past or things like, you know, we talked about eye rubbing and how that can actually thin the cornea. Right. We’re gonna thin the cornea purposefully for LASIK. And if we don’t want to, you know, poke any bears that might be, you know, hiding so to speak. , see your eye doctor, you know, inquire about it, right? Mm-hmm. , even at a routine exam, it’s like, Hey, you know, glasses and contacts work for me, but I am actually very curious and interested in refractory surgery such as LASIK. What, you know, would I be a good candidate? And if so, and if it’s a question mark, who do I go to to, you know, answer those questions. Right?
Dr. King:
The local eye doctor in your area is gonna know who’s doing a good job at this. You know, and who does a lot of these and who’s got the newest technology? They may have a doctor they work with. If, if your doctor isn’t a surgeon they may have somebody they work with. So it’s always good to start with your regular eye doctor, the person that knows your eye the best. ’cause everybody’s an individual when it comes to deciding candidacy. There’s a lot of variables and that’s why you have to be really honest with your doctor. It does. It always is a good idea to ask. ’cause what happens a lot of times is folks won’t talk to their regular doctor. They just go out on their own and kind of just walk into, you know, ABC LASIK center and you know, say, “Hey, can I have something done?” And they’re there to sell LASIK and so they’ll be like,
“sure.” You know, talk to your doctor first. Make sure that you’re in a good spot to start.
Speaker:
What is it like, what do you see during the procedure?
Dr. Cha:
Oh, during the procedure.
Dr. King:
It’s horrifically scary. , we have to drug people. I just dread LASIK days. Our lasik suite, you know, it has soundproof walls. .
Dr. Cha:
Yes. We have scrubbers coming in. It
Speaker:
Is glass so we can observe
Dr. King:
Actually our LASIK suite is all glass. We just have shades we can drop down so that family can watch. What do you see with LASIK? Well,
Dr. Cha:
Hmm.
Dr. King:
You just see
Dr. Cha:
Light . Yeah.
Dr. King:
You’re not watching, you’re not, you’re not seeing the doctor, you know, coming at you or anything like that. ’cause you’re laying on a table. Once the flap is made and laid back, everything just kind of goes out of focus and you have a little fixation light. And the great thing about LASIK these days, there are a lot of safety measures built in. Everything has to be lined up for the laser to do the pattern. ’cause it’s not a constant beam. Everybody thinks that It’s like, like something off Star Trek where you’re like, no, it’s a sculpting process. So it’s a series of little blasts and because part of the pre-op we actually map the cornea. So we make a topographical map. We also map corneal irregularities called high order aberrations. These are things that can cause distortion and vision besides the regular stuff. So you end up improving the overall quality of the image, not just the focus, but how vivid and true it is.
Speaker:
Are you awake during the procedure?
Dr. King:
Yes.
Dr. Cha:
Yes. Yes you are. You are, you are relaxed usually.
Dr. King:
Yeah. You, you have the option of, of taking something to relax you so that you’re not, you know, twitchy or anything like that. But you’re a hundred percent awake when we become unconscious, you know? Have you ever watched, you know, your eyes kind of roll up in your head. It’s kind of hard to laser something that’s rolled up in your head. So we need you to be awake. You need to be able to fixate the, the blinking lights.
Speaker:
So what’s the healing process like for lasik?
Dr. King:
Well, once the Valium wears off, we send you home and we don’t wanna hear it from you . I’m kidding. The healing process is fairly straightforward. You, you can see that day, but it’s gonna be a little hazy ’cause that flaps kind of settling down. So the vision’s gonna get sharper over the first week. But you can see right away we ask that you don’t rub or touch the eyes, you know, because that flap that that flap is settling in and, and reattaching the cornea has a unique healing power. I’ve mentioned this in other episodes. When you first lay that flap down, it, it seats itself like Velcro. So it’s gonna hold in place. You can blink and it’s not gonna move that flap. But then over the first week that tightens up and we have a nice sealed flap.
So to begin with, we ask, you know, rubbing you, you wear shields when you sleep at night so that you don’t accidentally roll over and rub the eye or put pressure on it. We do the same thing after cataract surgery. Anytime we mess with the eyes, we don’t want you rubbing them and you just lubricate, lubricate with artificial tears to keep the eyes moist. You do use an antibiotic steroid drop for about a week. But there’s no big pain or anything. It, it’s, it’s watery and, and scratchy. The day of surgery for sure, that we do recommend go home and sleep. The human body does most of its healing while you’re sleeping. So the best thing you can do is go home and take a nap. Like I want to right now. Yes. But I’m here talking to you. Yeah.
Speaker:
What’s the age range for LASIK? So I know on our website we say it’s 18 to 44?
Dr. King:
You can do as young as 18 as long as things are stable. If there’s been a prescription change in the last year, I don’t recommend doing it ’cause we’re gonna correct you to what you are today. But what if you continue to change? I don’t like to put numbers on it. I have a personal philosophy. I know also that corneal tensile strength, the cornea tends to be more resilient around age 21. So to me that’s prime. It’s almost philosophical. Yeah. When you talk about the, the, the youngest, you can do LASIK. I will say the younger, you know, teenagers that have it, I believe have a higher risk of needing an enhancement and enhancement’s where you go back and do a touch up a couple years later because there’s been a little drift. Yeah. And if I can avoid enhancements, that’s a great thing because the less you mess with the eye, the better.
Do it once, do it right and be done. So lowest age would be when you’re stable. Highest age, boy, that’s another one. You can go into the forties, but what starts happening is, even though we can fix distance in our forties, our eyes start to lose the flexibility to change or accommodate from far away to close up. So now we focus you out to distance, let’s say, and you start losing the ability to see up close so you could end up needing reading glasses. So once again, we try to assess somebody’s ability to focus before we talk about LASIK with them. There may be other options that will work better.
Dr. Cha:
When I talk to like, especially friends in and around my age, I kind of tell them, you’re, you’re the prime candidate. You’ve kind of finished your schooling, you’re kind of more stable in your professional career. You can actually kinda reap the benefits of this investment you’re making for yourself by that point. You know, you’re not, you know, you’re not fighting for rent. You have some, you know, fun money in the pocket and you want to, you know, do something nice for yourself. Yeah. That’s gonna be a long-term investment.
Dr. King:
That’s, I mean, that’s a real sweet spot. So yeah. Twenties and thirties, fantastic. Teens and forties. Let’s talk let’s, let’s be a little more let’s assess the entire situation. So I would never rule it out. But let’s compare it to other things that we can offer.
Gonna bust a myth. .
Speaker:
Okay. Do so the cornea never fully heals. Myth or not a myth.
Dr. King:
Myth. Cornea never fully heal. What? Are you just waiting for your cornea to fall off. . Millions of people walking around every day going, is this the day? Of course the cornea, heals is there a little scar visible? Yes. Where the seam, where the LASIK laid, where the flap laid down. I keep saying the LASIK laid down, the flap laid down. Yeah. There’s a little scar visible. But with these new laser flaps, those things even disappear. There are some folks, unless I put a special stain in and look at a certain angle, you can’t even tell they had lasik.
Dr. Cha:
Yeah. Sometimes you miss it
Dr. King:
So yeah. Cornea’s not gonna fall off. Don’t worry about it. That’s a myth.
Speaker:
Got it. LASIK is painful during the procedure.
Dr. King:
No. I was kidding about the soundproof LASIK Suite patients are very calm. It’s more, it’s worse to think about it than actually when it’s being done. It’s natural to be afraid because it’s your eyes. but no, there’s no pain involved. It can feel scratchy and stingy afterwards. You know, for the first day and then that goes away. But even that, it’s not like, ahhh, it’s just, you know, I know that something was done to my eyes.
Dr. Cha:
Like I said, I would do it just for fun.
Dr. King:
So we hope you learned a little bit of something about LASIK today. And if you like what you saw, be sure and subscribe down below. If you have any questions, drop ’em in the Dropbox. We’ll try to answer for you. In the meantime, I’m Dr. King. And I’m Dr. Cha. We’ll see you next time on Days of Our Eyes.