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Pre-Procedure FAQ’s
Ans. No. LASIK only treats distant (far) powers. I know that you have must have read some information on LASIK, however, specific to the age of over 40 years, there are some age related issues such as presbyopia. LASIK will be advised to you not just from the examination findings, but also after understanding your lifestyle. As it is an elective procedure, its benefits should outweigh the down-side for you. Many do choose LASIK in spite of being over 40 + years of age, but most of them are the kind who are willing to accept reading glasses and have considerable benefit in getting rid of their distant numbers.
About Presbyopia and LASIK
At the age of 40 to 50 years, everyone starts having change in his or her optics due to an age related phenomenon. After 40 years, we all need to use reading glasses. In older people who have not had LASIK done and still need to use numbers for distant work, these are then used as ‘Bi focals’ or ‘verifocals’. Reading glasses are an age related issue and no one is exempt from it.
It is called ‘Presbyopia’. There is no permanent treatment by laser for this, although some doctors advertise ‘presbyopic LASIK’, which is a laser treatment needing to be repeated every 1 or 1.5 years and is unsuccessful, hence not advocated by Dr Anand Shroff, our LASIK expert and Corneal surgeon.
There are few who opt for Monovision. However, these are people who have been used to ‘monovision’ with contact lenses. Those who want to try this out are encouraged to use contact lenses for a short period to see if the monovision helps or suits them.
With LASIK, we could help you for distant numbers (your Myopia and Astigmatism) by correcting them off completely which would then leave you with reading numbers alone. Hence, you have to let us know if you are willing to accept these reading powers?
Also, there is a possibility that you may require a cataract procedure in the near future, and then LASIK would have benefitted you only till that time. Due to the above, many in their 50′s choose lens exchange as an option which addresses not only the presbyopia, and distant powers, but also addresses a possible cataract in future. This is called clear lens exchange, however advised for those close to 50’s.
Ans. A good candidate comes from our LASIK tests or the LASIK evaluation. We use the Pentacam Occulyzer which checks 25,000 points on the cornea.
Thin corneas usually do not pose a problem for us as we have a two-fold advantage of a laser which saves 40% cornea compared to most others and using a special kit which saves 90 microns more or performing bladeless EpiLASIK. However, if you can send us the exact pachymetry (corneal thickness) or the topography maps and reports that you may have, it will enable us to know which procedure is more suitable for your eyes.
Ans. We can answer the part of suitability for your eyes only when our doctor has examined you. However, in all the patients we have done, whether EpiLASIK or LASIK, we achieve what we aim for.
If for some reason LASIK cannot remove your entire power, then alternative procedures like ICL (Implantable Contact Lenses) are recommended for you.
In some rare cases where powers are very high, we prepare you that to achieve 20/20 or 6/6 vision, LASIK may need to be done in two steps. This probability is less than 0.4% of the time. Then we ine -tune our treatment by not repeating all steps of LASIK, but just last few steps. This retreatment we include in your fees for the first year post LASIK. If a patient chooses not to enhance or fine tune the procedure then contact lenses or glasses can be used. However, since all patients are aiming 20/20 vision, very few would opt out of it.
Ans. We decline patients for LASIK if they are found unsuitable for the procedure due to:
1. High refraction beyond limits of laser- alternatives like ICL are explored
2. Severe dry eye which would need treatment first
3. Keratoconus or any abnormality found during the eye check which deems them unfit. You will appreciate that there cannot be a fixed percentage for this.
However, important is that if LASIK is not found suitable, we do explore other procedures which may benefit more.
Ans. Dry eyes need to be examined before LASIK. If one does LASIK on a pre existing condition like dry eyes, yes, the dryness can get aggravated. However, many centres do not do a detailed analysis of this prior to LASIK. If we find you having dry eye from our quantitative tests and qualitative Tests like Schirmers and TBUT (Tear Break Up Time), then you are graded and marked as mild, moderate or severe dry eyes with a scoring and a certain TBUT time is specified. Then the treatment is planned accordingly. If moderate or severe dry eye, then LASIK can definitely not be done first. This needs to be first treated and then monitored to see if the score is improving after the treatment.
If there is mild dry eye, or you have an occupational situation wherein we find that you are in a high probability of getting dry eye in future, then EpiLASIK (a modification) in initial steps of LASIK is then advised.
Dr Shroff will be conducting this examination himself and will be in the position to tell what is best only after this initial checkup. In LASIK, the reason for aggravating dryness is because there is necessity to create a ‘flap’ on the cornea. This disturbs the corneal nerve supply and may cause dry eyes post treatment, usually temporary.
However, in cases where we would not like to aggravate an already existing dry eye situation which is in control, then we prefer doing LASIK with no flap being made (No cut, no flap LASIK- Bladeless),.
The only downside being a longer time period in recovery, about 4 days more than LASIK and need to use specific eye drops for 3 months.
Ans. You will appreciate that the queries you have asked relate to statistics (eg. How many/ what percent, etc) and one cannot have a single statistic unless they have stopped working! These will keep changing. Hence we do not have a copy of any general answers other than on our FAQ’s which we keep updating, but answer specific queries related to you. Our results are excellent with a re treatment rate of less than 0.4%. Our aim is to achieve 20/20 if not better. We manage this in a single step in over 99.6% patients; in others we do it in two steps. This is called re treatment. The decision to undergo re treatment depends on the doctor and patient. If the cornea is still not fully healed we wait, if healed we treat again, not doing all steps of the first treatment but just re lifting the flap and fine tuning the LASIK. We do not charge for this in the first year of the treatment.
We can treat numbers as high as -12.00 D but even say ‘no’ to smaller numbers as the suitability for LASIK is not just dependent on numbers alone.
Ans. Loss of sight has never been faced in our Center. We are very strict about not only our protocols, using complete disposable kits and tight infection control; we also use very sensitive tools which help us screen the candidates thoroughly.
Ans . Most overseas patients are in Mumbai for about 5 days from the time they undergo their check up. We plan better so that they arrive a day earlier to the procedure date for the check up and hence are in Mumbai for at least 3 days after LASIK. Up to 7 days is ideal.
We usually perform LASIK on Wednesdays and Saturdays and therefore better to see us a day earlier. Do write to us before you finalize the tickets to ensure availability of Dr Shroff.
Ans. Up to 2 hrs or more depending on the time taken by your eyes to dilate. You cannot self drive the day of the check up as your eyes are dilated.
Ans. Immediately after the check up Dr Anand Shroff will inform you if you are fit for this procedure.
Ans. That is our aim too. The only thing that we prepare our patients for is the event of needing a touch up or retreatment as they call it. This is sometimes because, in spite of having done our best and taken all predictable objectives, we still cannot predict wound healing. It sometimes can heal leaving behind a small number. In our experience we have seen up to 0.75 D usually. However, this is treatable and we offer to re treat this number free of cost. Hence, it only means that in rare cases LASIK may be in two steps. The rate of this re treatment or fine tuning in our center is less than 0.5% which in most centers is above 20%. The success rates of each center differ and that is because like I mentioned earlier success depends on a combination of doctors experience, technology the doctor is using and the general practices of sterilization, disposables etc.
The Wavelight Concerto 500 Hz Laser that we are using now is the 500 Hz system and superior in performance to the 200 Hz and the 400 Hz which is available in USA. A site http://www.allaboutvision.com/wavelight/ may give you a better idea of what this technology is about from experts in USA. However they are referring to the 200 Hz which treats up to -7.00D safely, and we with the 500 Hz go up to -12 D.
But a good laser alone is not the only criteria, the experience of the surgeon is equally or more important. Dr Anand Shroff is a very skilled doctor and even trains new users of the Wavelight laser from many different countries in our HQ in Germany.
Ans. This is what we recommend. It has been demonstrated in several large, clinical studies that LASIK results and safety are identical whether the procedure is performed on both eyes simultaneously versus one eye at a time. Most patients elect to have both eyes operated upon the same day out of convenience, less time out of work, and avoiding imbalance between the two eyes.
Ans. Yes, if you wear soft contact lenses, we prefer you to take them out 3 (three) days prior to your initial evaluation in order to obtain an accurate reading for the topography test. For soft or soft toric contact lenses, you need to take them out 3 days prior to the laser procedure as well. If you wear rigid gas permeable studies show that 3 or more weeks are necessary for the eye to stabilize. In these cases, we try to put our patients on soft disposable lenses for 3 to 4 weeks and then reevaluate after 3 days with no contact lenses
Ans. We definitely need to see you on the next day of the LASIK procedure. Many from out of town also fly the same evening or the next day. However, if in Mumbai we see you again after 7 to 10 days. If not, the follow up check is planned according to your convenience. You will require an annual eye checkup which can be done in your own city / country.
Ans. 1. You are still growing anatomically and hence must wait for your physical growth to stabilize, only then will your numbers stabilize. This is typical for those who are just 18 years. Hence our checkup determines your fitness.
2. If you do LASIK on older technology which is not equipped to treating high numbers
3. Your lifestyle habits like sitting on the computers continuously for very long hours. For this our Doctor trains you for the correct method of sitting as well as prescribes a specific computer number for the long hours so that you do not induce a small number along the way. Most of our LASIK patients are from this industry and cannot avoid the long hrs on the PC but with our advice have managed to keep numbers at bay. If however a small number does creep in, this can be re treated again as a short fine tuning treatment or if the patient desires can use glasses or contact lenses for that work.
In our center our rate of enhancement or needing to “fine tune” a treatment is less than 0.4% with our current technology which is as high as 5- 7 % in most centres worldwide.
Ans. Your checkup also involves a quantitative check for “dry eyes” and we grade it as mild, moderate or severe. If having a score fitting in severe dry eyes, no laser is recommended since it will aggravate dryness. Then you need to first get the dry eye condition treated. If mild to moderate, many centers would either do LASIK and you may end up having dry eyes for a long time, but in our center we even have the option of EpiLASIK which does not aggravate dryness and is just a modification in the initial process of LASIK, the laser used to treat the numbers being the same.
Ans. Yes, and that is one of the reasons that we have excellent results.
Ans. You are asked to come for a check the very next day, wherein you will be examined for healing and 20/20 vision. In very few patients healing takes longer, sometimes weeks. A simple check determines if there is any number that needs fine tuning or enhancement.
Ans. Greater than 99% of patients haven’t required an enhancement. Less than 1% we do free of charge in the first year of treatment. None have lost any lines of vision, which means that if they were seeing 20/20 with glasses or lenses, then they are seeing 20/20 if not better today after LASIK.
Ans. Corneas will become regular after LASIK, so soft contact lenses can be worn if required. Coloured lenses usually after 1 month of the procedure.
Ans. We have treated up to -6D cylinders with great result!
Ans. Yes, it is safe, but depends on how comfortable you are doing this immediately after the procedure. If this travel involves out of town travel, then please take time and read our patients experiences especially those travelling from abroad, as most of them travel from Day 2 or 3 of procedure. Means of transport do not matter. Your instructions remain the same whichever city you go to regarding eye drops and not rubbing your eyes.
Ans. Which category of LASIK you fit in can only be answered after your check up. What you get is included in the current fee card which is sent as an email with the relevant attachments. The surgery includes immediate eye drops and medications required for your first week, a pair of protective eye wear and your post LASIK checkups up till three months are included free of charge to you. For the first year any ‘touch up’ or ‘fine tuning’ required is also free of charges.
Ans. LASIK is usually recommended when the powers are stable. We expect the powers to change when the height of the person is increasing. Knowing that until 18 years of age, this anatomic growth can take place, we avoid LASIK. However, there are certain special situations wherein the powers have been stable and monitored closely, those needing to join a career where powers have to be treated and vision needs to be 20/20 or 6/6, in such cases LASIK can be considered below age 18 years.
For children, we recommend examined regularly by a good Ophthalmologist which will help in having the eye records over the years, so it will help to know if the numbers have been stable at 18 years.
If you were to visit us directly after turning 18 years, then we would not know what their powers were earlier. So, important is that they understand the role of regular checkups, at least once every 2 years for us to be able to plan a successful laser treatment.
Ans. Yes, dry eyes if severe need to be treated before considering any laser procedure. Hence the need to be seen by an expert who will not just diagnose the dry eye issue but classify or grade it, as mild dry eye, moderate or severe with a scoring.
Then, if it is mild and you are not from any ground like computer IT or any systemic body condition which causes dry eye, LASIK can still be considered. We also have EpiLASIK which is done to not aggravate dry eyes as this is just a modification of LASIK.
However, if moderate or severe dry eye, then treatment is necessary before considering any laser treatment, so that the quality of vision post LASIK is not compromised. Your check up with our doctor, Dr Anand Shroff will determine if you have dry eyes and if you do what grade?
Ans. When you visit Dr Anand Shroff, our LASIK surgeon, he will examine you and guide you better regarding your suitable treatment.
Ans. The total time for the procedure is less than 5 minutes per eye considering that the Concerto Laser we use is the world’s fastest laser; actual laser time is in seconds. The actual laser time is 0.4 seconds multiplied by your spectacle number.
Ans. Yes, as it heals better and because this is a superficial treatment which does not ‘enter’ the eye like in a cataract surgery where one eye at a time is done.
Ans. Yes. You need to visit us the next day, once again at your convenience. Other follow ups only if in the country are required.
Ans. Dr Anand Shroff not only performs the procedures himself, but also the pre LASIK checks where we collect your data for the wavefront treatments.
Ans. This is usually not an option, that patients decide, unless they were to join Army / Navy etc where LASIK is disallowed. Then EpiLASIK is opted for voluntarily. But the usual course is when Dr Shroff examines you and the data collected during the checkup indicates if LASIK is unsuitable. Some reasons like dry eyes, thin corneas etc, where LASIK is unsuitable, can still be treated with EpiLASIK. So, this usually comes out of the check up with Dr Anand Shroff. The vision post procedure remains the same, whether LASIK or EpiLASIK. The only difference is in an initial disposable kit, even the laser applied (Concerto 500 Hz) is the same. Please read more about EpiLASIK on the homepage of our website.
Ans. Yes, this should not be an issue. LASIK has no long term effects that affect pregnancy. It is sometimes that pregnancy hormones can affect immediate healing, so we usually advise to try conception after this immediate period of about 6-8 weeks is over.
Ans. Usually, if planned well, LASIK done on Saturday, you may leave India on Monday/ Tuesday.
Ans. We have treated many cases of cataract who have done LASIK in their past.
This does not affect the steps of the procedure. The only thing is to inform your eye surgeon of the history of LASIK done as today cataract treatment is not just about treating the cataracts alone but also about treating the powers of the eyes to be least dependent or completely free from glasses after cataract surgery, hence there is an adjustment needed in the calculation of the IOL power.
Ans. Change in prescription is in the range which is acceptable. The change in powers within 0.75D is fine, so long as we do not find any abnormality (this again is checked up by Dr Shroff). Also, the usual cause of this increase is due to long hours on the PC. After LASIK you will have to take specific instructions from Dr Shroff and even wear a computer prescription glass to avoid getting any shift in powers later. Cylindrical errors up to -6.00D are corrected by our laser-The Concerto. Usually we accept a change of 0.75D, but any other change should be checked up and powers stable for a year before considering LASIK.
Ans. Not on eye drops etc. but no contact lenses (soft) for at least 3 days prior to check up.
Ans. Sometimes, taking hormonal medication for acne for long term (not Isoretinoin) can cause a change in cornea, causing shift in powers.
Ans. No, this will not. Do not be surprised if your numbers too may be found different when we examine ourselves as well! Upto 0.75 D is acceptable as a change due to human factor as no person checks their powers with the same center, same doctor etc. In fact on the same day if you were go to two different opticians, quite possible that you are prescribed slightly different power.
What’s important for us is that Dr Anand Shroff checks the powers himself, three times – with dilation, with the aberrometer and then the data that is taken is not manual, but from the wavefront analyzer. So, do not worry regarding this.
Ans. Probably Zurich, Cologne, Kuwait, Mexico City, Helsinki.
Ans. Our worst case scenario is to mentally prepare yourself that LASIK can happen in two steps. Our aim is to achieve 20/20 if not better. We manage this in a single step in over 99.6% patients, others we do it in two steps. This is called retreatment. The decision to undergo re treatment depends on the doctor and patient. If the cornea is still not fully healed we wait, if healed we treat again, not doing all steps of the first treatment but just re lifting the flap and fine tuning the LASIK. We do not charge for this in the first year of the treatment. If due to your lifestyle, age, medical reason you have a number in the future, then has to be checked by the doctor to see suitable treatment.
Ans. Yes, even today the IOL surgery has changed, not so much for the surgery part, but for the implants used. Today we can offer multifocal lens implants for patients of cataract and even the same for people with glasses over the age of 50 years even if they do not have a cataract. This is called PRELEX or Presbyopic Lens Exchange. The suitability of what is best is usually done by our cornea and refractive surgeon who performs both the procedures.
If we have details of your age, numbers you are using the kind of lifestyle you need, we could even discuss this by e mail. To answer your query of the possibility of undergoing IOL surgery after LASIK….nothing changes, the surgery would be the same. The only point to remember would be to inform your doctor doing the IOL surgery that you had undergone LASIK. This is because the IOL also has a certain power, measured specific to your eye.
Today’s implants are aiming to not just treat a cataract alone, but also correct the numbers, so the calculation of what implant goes in depends on the measurements taken by the doctor who will need to adjust the same considering you have undergone LASIK. Besides this, the recovery etc remains the same as for anybody else.
Ans. Over 40 years of age everyone gets reading glasses, no one is exempt of it. Some people get this ‘plus’ or ‘reading glasses’ after 50 years, hence this depends from person to person, different race, hereditary factors etc. But all get it at some point, if this happens after 40 years it is an acceptable natural change in the optics of your eyes, called ‘Presbyopia’.
If one has myopia (minus numbers for distance), it helps you push the need for reading glasses behind by a year or so. Hence, if a Myopic who is not using glasses for reading were to do LASIK today, yes he/she would need reading glasses, depending on when they would have naturally got them.
Now, the reading glasses is something that one can never avoid completely, so eventually it Myopics will need to use bi- focals.
Monovision is an option wherein we correct myopia completely for one eye and leave behind a minor number in the other. It sounds odd, but over time one learns to read the distance with the eye good for far vision and reads near for comfortable print by the eye left behind with a small number. This is accepted by most who wear contact lenses where their optician has given them this monovision trial in their lenses, i.e. one lens has the actual number so you read clearly with this and the other lens is slightly under corrected so you read near with this. Now, when one wants to do extensive near reading it may be a strain.
So, we recommend them to use near glasses as per what is required for their age when they are doing near work for a long time. When we have performed monovision for people who have never undergone the monovision trial, we have found that they are neither happy for far, nor happy for near. My suggestion to you is to see your optician and get contact lenses which will give you a trial and see how you feel with this for about 2-3 weeks if you plan on monovision. This will give you an idea of what your vision will be like after LASIK with monovision correction. Hence, if you are over 40 years of age, most times it helps to learn a bit about your lifestyle and suggest what would be best, after the examination, but it certainly helps you plan better keeping all options of treatment in mind.
Ans. Our refractive consultant will be doing specific tests for LASIK to check the effect of the thyroid problem and its medications on the eyes such as dryness, Glaucoma, Proptosis, changing numbers etc. In the absence of which you may undergo the procedure, if found suitable for the same.
We can also perform EpiLASIK in certain situations like Dry eyes. Also, you would know if your numbers have changed drastically over the years that you were diagnosed with this condition, hence please bring along your records. The eligibility depends on the tests that are done, just a history of hypo or hyper thyroidism does not make you unfit.
Ans. If after our detailed checkup we find that you are a good candidate for the procedure, you will do very well. However, with just numbers being sent to us to decide via e mail is difficult as you will appreciate that it will be general responses until the time that we have examined you ourselves. We do not take any chances and do not recommend the procedure to anyone whom we are doubtful of results.
Ans. This can be best answered after your eye examination with Dr Shroff. But yes, those in the older age group, usually in their 50′s are advised a lens implant procedure as it is more likely that they are closer to getting a cataract at their age and also because the newer advanced lens implants also help in reading without needing glasses for most tasks which LASIK will not help with.
Ans. Usually the LASIK specific tests are Pachymetry (corneal thickness), Topography, Aberrometry, Dry Eye evaluation, Pupil size check for dim light conditions, besides the regular checks for the health of your eyes.
Your suitability and the best type of laser surgery can only be determined via an eye examination and that too from a centre offering all kinds- LASIK, Bladeless LASIK and Relex smile and in the hands of a good eye surgeon who does a thorough pre laser evaluation.
Advantage of smile and surface ablation over LASIK is from the presence of flap (corneal cut) in LASIK versus none in surface ablation and smile.
Advantage of smile over surface ablation is long term need for steroid eye drops (12 weeks) in surface laser treatments versus that for 2 weeks in smile. If you default in this use, corneal healing slows down and can also lead to corneal scars. Also, significantly uncomfortable for first 2-3 days, hence, reserved for those who really have the indication for it as determined by the surgeon.
Advantage of LASIK over surface treatment and smile is faster visual rehabilitation in comparison.
All three procedures end up in 20/20 or 6/6, and visual results are comparable. No procedure has better visual acuity over others.
We can only say, that from our experience…
Dr Shroff advices surface treatments when there is a necessity- thin cornea, previous laser treatment, scars or erosions on cornea, wants to join Army etc
Smile more helpful for those who may have a risk of flap displacement like those in careers of martial arts, outdoor activities etc or those who fear the “flap” or corneal cut or those who have allergies and in the habit of knuckling or rubbing their eyes.
People have heard of LASIK and do not yet know much about Relex smile; also few centres offer Relex smile hence many more cases of LASIK in India.
If you are found fit for all three types of procedures, then the final decision can also depend on what you are most comfortable to undergo.
Ans. Lazy eye encompasses a wide range of visual problems and levels of visual acuity. The only way to know for sure if you are a candidate for LASIK is to come to the office for a consultation with Dr. Shroff for a thorough evaluation to determine if LASIK will help you. Many patients with lazy eye have enjoyed their results following LASIK because they no longer need glasses or contact lenses to achieve their best acuity.
Ans. We send you the Appointment schedule of Dr Anand Shroff, our LASIK surgeon when we send you a detailed e-mail reply. We work with a team which includes having a laser engineer trained from Germany for running the laser; hence our days of working are fixed days of the week unless there are changes in the doctor’s schedule.
Hence, we always request you to please write to us with your specific dates before finalizing your tickets as we then can help you better and plan a convenient schedule for you.
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