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Potential Risks of the Excimer Laser Procedure

It is essential that you understand as much as possible about the risks associated with the excimer laser procedure. The risk of having a serious vision-threatening complication is much less than 1%, however, the excimer laser procedure, like all surgical procedures, has limitations and risks.

Everyone fears losing their vision. NO cases of blindness have ever been reported from either the PRK or LASIK procedures.

There are some specific side effects and risks you may encounter after PRK:

1. PAIN -- There is no pain or discomfort during the procedure itself. With new techniques, as few as 10% of patients have pain post-surgically, which is treated with medications for 1-2 days. Most patients experience only some irritation, light sensitivity, and watering of their eyes for a few days.

2. INFECTION -- This is probably the greatest risk during the first 48-72 hours post-surgically (~0.2%). You will receive antibiotic eye drops before and after the procedure. The risk of infection is lower than 2/1000, and most infections are treated and eliminated. A severe enough infection can produce scarring which reduce sharpness of vision. If this occurs, an 'enhancement procedure' may be required to eliminate or reduce the scar tissue.

3. NIGHT GLARE -- Like most forms of eye surgery, the excimer laser can cause glare after the procedure. You will typically experience day and night glare for the initial three to four days after the procedure. After a few days, you will continue to have a small amount of night glare which generally starts to clear at the time the second eye is treated. Typically, after six months, you will be back to your 'pre-procedure' level of night glare. Some patients, however, still require a thin pair of glasses or contacts in the evening to further reduce night glare and improve their vision. TLC doctors use only state-of-the-art laser equipment and techniques, enabling them to significantly decrease the risk of glare.

4. HEALING HAZE -- As your eye heals, you will have blurred vision for approximately the first week after the procedure. This is not the healing haze, but is due to the corneal surface cells smoothing out and the clearing of microscopic superficial swelling. "Healing Haze", is the term for collagen protein that develops on the surface of your eye as it remodels. When your vision begins to improve and you are experiencing your procedure's benefits, this is when microscopic collagen protein actually begins to develop. Almost everyone develops 'trace' degrees of haze, and most are not even aware of it. The probability of severe haze that can affect your vision is as follows:

Mild myopia <1%
Moderate myopia 1%
Severe myopia 2-3%
Extreme myopia 4-5%

Severe haze is more common in patients with severe or extreme myopia, and one of the main factors in predicting your risk is whether you are a good healer. Among all types of procedures, 1% of patients are abnormal healers. Fortunately, the eye usually clears with time. If haze persists, additional 'laser enhancement' may be required.
5. UNDER CORRECTION/OVER CORRECTION - Under-correction is more common than over-correction. Small amounts of under-correction do not seriously affect the resulting vision, however, large amounts may require a second enhancement procedure. Initial over-correction is usually planned as the cornea tends to regress (i.e. 'bounce back') somewhat toward its original shape as it heals. The eye generally stabilizes to near predicted results within three months, however, on rare occasions, the patient may remain over/under-corrected. In such a situation, the patient may have to wear a thin pair of glasses or contact lenses. After six months, TLC doctors can usually enhance over corrected patients as well, with newer lasers and techniques.
6. REGRESSION -- Regression is the shift back toward myopia or astigmatism, following the excimer laser procedure. In most cases the regression experienced is minimal. Rarely, in severe cases of myopia, it can be significant. It is always safer to perform a second procedure to correct regression than to significantly overcorrect your prescription. Most patients only require a single procedure that we fully expect will last their lifetime. About one in ten patients will require a second 'enhancement' procedure within the first year, which is covered in the initial procedural fee.
7. LOSS OF SHARPNESS -- About 1% of patients experience a small loss of visual sharpness following the excimer laser procedure. This loss of sharpness is usually minimal (this means that you might lose the ability to read the bottom line or two of the eye chart). Overwhelmingly, patients actually maintain the sharpness in their vision after the procedure. In a few instances, patients actually gain sharpness of vision in comparison to their pre-procedure vision.
8. FALSE EXPECTATIONS -- One of the more important difficulties an excimer laser candidate can experience is false expectation. Many RK or excimer advertisements you hear on radio or see in the newspaper and television promise that you can "throw away your glasses!". These ads can be, and are in fact misleading. While it is true that most patients having the excimer laser procedure will not require glasses or contacts after the procedure, some patients will require reading glasses or will require a thin pair of glasses for activities such as night driving. It is best not to think of the procedure as eliminating your glasses, but as reducing your functional dependence upon them and improving your vision.
Finally, it is important to note that nearsighted individuals, regardless of whether or not they choose to have the excimer laser procedure, need to have annual dilated retinal examinations by their doctor.

Risks Associated With LASIK:
The post-operative risks of the LASIK procedure are similar in type to those involved with the PRK procedure, as listed above, however, the statistical probability of many of them occurring are significantly reduced with LASIK.
There are basically five main advantages to LASIK versus PRK. These are:

  • 1. The ability to correct severe and extreme cases of myopia (up to -35.00D), and astigmatism (up to -8.00D), with greater predictability of results and decreased probability of regression.
    2. Reduced risk of healing haze, or scar tissue (0.1% vs. 2-5% for PRK)
    3. Reduced risk of post-operative infection (0.03% vs. 0.2% for PRK)
    4. Reduced risk of post-operative pain (2% vs. 10% for PRK)
    5. Faster visual recovery-- this allows both eyes to be safely treated within days of each other.
  • Due to the fact that LASIK involves the inner layers of corneal tissue, there is a higher degree of risk during the procedure itself than with PRK. The procedural risk that raises the greatest level of concern among people is perforation of the eye. There are no known cases, where an eye has actually been perforated during the LASIK procedure.

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