Post LASIK Procedure Questions

Ans. It is not only after a laser procedure, but a general principle not to wash your eyes. Yes, some may think that this is contradictory to what they have grown up hearing about. Even if the water is pure and not tap water, it does not have the same salt concentration as the tears that bathe your eyes. As a result, water is irritating to the eye. This is why we recommend lubricating eye drops rather than water be used to lubricate your eyes. These artificial tears have a good salt balance and are soothing rather than irritating and potentially damaging like water. In the healing phases after LASIK (around 3-6 months), the corneal nerves are regenerating in the flap. The new nerves that grow in are hypersensitive to irritation so it would be common to notice irritants like pure water, wind, or smoke in the eye more than usual. Once the nerves fully heal, the increased sensitivity goes away and the irritation sensitivity returns to normal for most patients. If this is happening while swimming, you could consider using goggles.

Ans. The corneal flap heals overnight. Then it takes vigorous amount of rubbing to displace it, which most are careful about. We have never seen a case of displaced flap. We also give protective eye wear for the immediate post procedure period. Rest, you can wash your face, gently clean the eyes from the next day itself. In some, microscopic healing goes on for a couple of weeks.

Ans. This need to be avoided for about a week to 10 days since the eye drops are also being used and the eyes are still healing

Ans. Next day itself. However for a week like mentioned earlier, it may be in short spans and moderate work.

Ans. You may start all these after about 10 -15 days with makeup you were using earlier to be sure that it is not allergic to your eyes.

Ans. After about 10 to 15 days, keeping in mind to tell them not to rub over the eyes.

Ans. No. So long as you watch TV in a well lit room and a distance of about 10- 12 feet is what is ideal.

Ans. No touching the eyes for the first day, we give you a protective eye wear to help you through with that. No vigorous rubbing for a month, but you can gently clean and touch your eyes, rub the corners gently from the next day.

Ans. When I meant 0.4% do not get 20/20, I meant in the first attempt, with re treatment they achieve this as well. None of our patients have had any permanent damage to their eyes. We choose the patients very carefully. If you are not seeing 20/20 before LASIK, then it may not improve.

Ans. Yes, many do this. As long as you are careful and wear protective sunglasses in dusty areas and use the eye drops as told. Bumps are not good for the retina although it does nothing to the LASIK process done. Those having high myopia or negative numbers, have a longer shaped eye ball and hence have thinner retinal lining. This can detach from the wall if bad bumps. This can happen in absence of having undergone LASIK as this is inside the eye and due to the long shape which we do not change in LASIK.

Ans. Yes, as I said above you can travel anywhere after 3 days of the procedure, go on a nice vacation WITHOUT glasses! Usually, most people prefer to do the LASIK procedure before their vacation, so that they may enjoy the same. Also, since most come back to Mumbai before flying out, they get a chance to come for a follow-up check up again. However we leave it up to you to plan your procedure during your trip and would help you schedule the dates for the same. The precautions to be followed whether in Mumbai or any other city in the world that you will be in are the same, and simple. The eye drops will need to be used at least 4 times a day in the first few days. Do not rub or touch your eyes with unclean hands. If planning to swim, use good protective swimwear and avoid underwater swimming as far as possible, just wading in the pool or sea leisurely is fine.

Ans. The precautions are fairly simple and would be similar to all irrespective of LASIK done. The fear is of catching an eye infection. The first week after LASIK you will be on eye drops which are antibiotics so that aspect is anyways taken care of. However, some general and basic rules of hygiene such as not rubbing your eyes with unclean hands, carrying a hand sanitizer to keep the hands clean etc helps. We ask you to wear a pair of good UV protecting sunglasses when outdoors to protect your eyes from dust, strong sunlight and allergens. Only swimming underwater is to be avoided for a few days. Those looking forward to enjoy our beaches can swim in the sea or pool, but with swimming goggles for protection.

Ans If you have seen our advantages of using the ‘Concerto’ you will find that we have listed ‘no night vision problems’ which is haloes, glares etc, described on the internet as permanent problems. In the healing phase you may experience some of these effects as they are ‘subjective descriptions’, however, they resolve, usually latest by 3 months. In fact the Wavelight is the only platform the US FDA states to ‘improving night vision’. The only symptoms we expect patients to face, although not in all, and differing in intensity, is temporary dry eyes and not very crisp and clear vision. The vision also fluctuates slightly in the first 3 months as the healing continues on a microscopic level, but we see these symptoms settle down in almost all cases. In rare cases (less than 0.5% of them), it is due to a small refractive error still needing to be fine tuned. This is usually seen in those with high powers.

Ans. The vision usually clears to be functional within a few days after LASIK. Both eyes also do not heal at the same time. Maximum healing time is seen to be anywhere up to 3 months (usually) and in very few cases even 6 months. This is because the corneal nerves also have their own speed in which they regenerate. During this time, you may experience temporary blurring, which may clear for a short while with lubricating eye drops. The usual considerations for blurry vision early after LASIK include: dryness A residual refractive error flap smoothness. If there are any flap related issues, they are corrected as early as possible. Fortunately, these types of problems are quite rare and usually obvious to a LASIK surgeon. The vision after LASIK can differ, especially if there are dry spots on the cornea. Dry eye causes vision to fluctuate throughout the day. Artificial tears increase the quality of the tear film and help stabilize the vision. Residual refractive error would cause continuous blurring. If it does not resolve with healing after 3 months, a possible enhancement at three months post op is enough to treat it.

Ans. Dark glasses are not meant only for discomfort with light. It is given as a protective eye wear for first 6 hours so that you do not rub your eyes. After this, you will need to use regular sunglasses in the open areas for a week to prevent dust and any foreign bodies from going into the eye and causing you to rub them. Otherwise it is not required. Washing eyes is not a good habit and not advised by the doctors, but you may wash your face with eyes closed the next day after LASIK using your usual face wash or soap.

Ans. The doctor will guide you after the procedure. However, on average, 3 months is fine using a good quality coloured lens.

Ans. Our overseas patients visit their optometrist at the end of 3 to 6 months and definitely as their annual visit, nothing special.

Ans. All you need to do is inform the cataract doctor who will need to calculate the power of the lens to be implanted accordingly. The cataract surgery itself does not differ.

Ans. Again differs from centre to centre. In our centre we have the longest experience with wavefront-guided LASIK in India. We have one of the most advanced technologies in the first and only eye hospital in India to be given JCI accreditation. We prepare you for just one thing. Less than 1% of the time to max 2% of the time, the treatment may need fine tuning. This is called enhancement. We use all your eye maps to predict all your number to have been removed. However, we cannot predict corneal healing a 100% and sometimes there is a small refractive error of say 0.50 D upto 1.00 D that needs a touch up.

(I have gone through your website which says there would be no side effects, still I keep meeting people who complain of some form of side effect at the least) a) Halo effect/ blurred lights (bulbs / direct sunlight / car headlights / faded bright colors) starburst around lights in the night which increases if source of light decreases in room(my pupil might be expanding beyond corrected zone) b) Poor night vision c) Night glare (especially while driving – from the headlights of the oncoming vehicles) d) Prolonged irritation in the eye e) Prolonged dryness f) Blurred morning vision g) Blood clot in the eye (in the visible white area around the eyeball h) Negligible vision in dim light, people/objects seem like black outline. 3. Strong glare from oncoming traffic (light) at night due to which I can no more drive a 4 wheeler or ride a 2 wheeler. 4. If there is any source of light behind a person or objects then I do not see that object at all, all I see is a black outline of the object or person. 5. Strong reflection from shiny objects in sunlight Or Light sensitivity & Contrast loss. 6. Glare around objects in day time. Ans. The above exist with the kind of technology used. In the night the pupil expands to let in more light, so if your treatment zone is smaller than the pupil dilation, this issue will exist. Some lasers do not have the capability to treat a large optical zone (which in the WaveLight Laser that we use is the largest possible), hence we do not face this issue. You may feel some temporary glare when the layers of the eyes are healing and this will not extend to over 3 months. But the kind you read about on the net is permanent night vision issues which we do not face. For this we also check your pupil diameter in dim light condition. The above again happens if you have dry eyes or are prone to dryness. The dry eye is checked by Dr Shroff using tests and if having dry eyes it is then graded as mild, moderate or severe. Severe needs to be treated before LASIK, so, you will be declared unfit, if this comes about. For mild to moderate we have Epi-LASIK as an option. As a precaution, we also prescribe lubricating eye drops for three months after LASIK to cover all patients from the temporary dryness and irritation that one would feel on the surface of the eyes as a result of healing. This may or may not happen; again it is outside the treated area and will fade away in 15 days time. Q a) All the side effects mentioned in question 1 are short term in nature. Are there any chances of developing any long term symptoms? Let’s say, after a period of 1-2 years would I need to take any precaution in any activity because of the LASIK surgery b) OR, I will be at par with any other person with healthy eyes? c) Similarly, are there any specific disadvantages to a person who has undergone a LASIK surgery vis a vis one who hasn’t in case of any future eye injury? d) Since you are doing LASIK treatment from more than last 10 years, are their instances of patients coming back after 2-3 years or more with complaints of any sorts? Ans. We have not seen any long term side effects of LASIK, which is a superficial treatment and if done on the right candidate in the correct manner, it is very safe and also its results are permanent. However, vision is not just deteriorated due to spectacle errors or powers. A lot goes into terming ‘healthy eyes’. The laser does not enter inside the eyes, hence if any changes due to age, diabetes, high blood pressure etc were to creep into the eyes, it would have happened irrespective of LASIK and its line of treatment also does not change. However, when one undergoes a cataract surgery, in today’s cataract one can also get rid of their spectacle errors, but for this an accurate formula needs to be applied if you have undergone LASIK. Our surgeon, Dr Anand Shroff also performs cataract besides LASIK and hence is able to with his expertise achieve this in those patients who have had LASIK in the past. All it requires is for you to inform your doctor that a procedure was performed. The only thing that we have seen with patients coming back is a small number creeping in due to their lifestyle on the PC and if they do not follow our instructions. This with our instructions is reduced to being less than 0.4% of the time. The choices are to either re treat or fine tune the initial procedure or use glasses for very fine visual work (the choice usually depends on their lifestyle and age). Besides this, other eye events have been independent of the LASIK procedure.

Ans. Hormones not only in pregnancy but sometimes even higher doses due to hormonal imbalance like in hirsuitism etc can lead to slightly fluctuating numbers. However, this does not happen to everyone, and neither is there any predictor in whom it may happen. Studies indicate that those on hormones, even oral contraceptive pills and pregnancy can have slight variation in numbers. In our practice we have not seen this happen. The possibility of needing an enhancement or re treatment has to be then explored.

Ans. If you just touch and it does not scratch the cornea, its fine, but if your eyes are open and it scratches the cornea, it can disturb the healing process. We advise you to wear the protective wear in the first 6 hours during which time the flap heals. After that it takes a vigorous amount of rubbing to displace what we have done.

Ans. The logic is the same, as shampoo entering the eyes can lead to an urge to rub the eyes hard, hence avoided for 2-3 days. The face may be washed the next day itself.

Ans. The water may sting your eyes as it would even otherwise. It is however, not a good idea to purposefully wash your eyes or splash water in your eyes. It is questionable that tap water is free from bacteria. It also washes away your natural tears which protect your eyes.

Ans. Gym may be started after 2-3 days where you can use treadmills, exercise equipment, but no sauna or steam till about 15-20 days or so. The eyes may be sensitive to some aerosols or aroma oils.

Ans. Yes, on an average most people recover after a week to 10 days. Some take longer, even up to about 6 weeks.

Ans. Anytime before 3 months from the procedure is good.

Ans. The most important being taking care when on the computers and using the computer glasses prescribed. If not taken this prescription from us on the next visit and until then make sure that you are taking frequent breaks when using the PC.

Ans. This is definitely for 3 months as this is the healing period. After that any artificial tears or lubricating eye drop is to be used as an on and off need as per your symptoms.

Ans. Gently, yes. However do refrain from rubbing eyes in general as even in absence of having done LASIK it is known to be a contributing factor to changing the shape of the cornea.

Ans. Please do so. However, most physical sports need you to use protective eye wear irrespective of having undergone LASIK, so do use that.

Ans. If thoroughly evaluated and performed in the right candidate with the latest technology, patients who have LASIK do not generally require glasses for most activities. However, patients who are over the age of forty must wear reading glasses after LASIK (if both eyes were corrected for clear distance vision). Some patients will choose “monovision”, in which one eye is corrected for distance and the other eye is corrected for near. Whether you are a candidate for monovision will be determined during your consultation with Dr. Anand Shroff.

Ans. LASIK has been performed since 1991 and its safety is established. Twenty year follow-up data are not available. Still, the likelihood of delayed problems is extremely low. LASIK is a variant of lamellar surgery, which has been performed for 50 years, and these patients have not been noted to develop late problems.

Ans. This is only for the first day and probably very bright sunlight for a week (which happens to all people). Hence you must use good UV-protective sun wear for a few days after LASIK which is any case a good habit for the eyes to prevent UV damage.

Ans. No, you will need a designated driver! For the first couple of hours your eyes will be sensitive to light and the vision blurred, so you should wear the special dark glasses that we provide.

Ans. Less than 0.3% currently (2012-13)

Ans. This depends from person to person, usually heals in 7 to 10 days, upper limit 3 months.

Ans. We have treated many cases with history of Glaucoma for their powers by doing LASIK. The important thing here is for you to know your visual expectation. Today, you face visual issues due to 2 reasons, one is glaucoma, which affects inside the eye, the second are your powers per se. The increased eye pressure affects the optic nerves and one poses a risk of having decreased vision due to glaucoma. Now, if this were to happen, it would happen irrespective of you wearing glasses, using lenses or having done laser eye surgery. LASIK is only going to replace the specs or lenses, so the vision to expect from LASIK is the same what you enjoy today with glasses. LASIK itself will not increase the pressure in the eye as one would believe that it would increase or further affect the glaucoma condition, unless not in check or not under control. However, it is only your check up with Dr. Anand Shroff who is our LASIK as well as Glaucoma expert to know if this is a suitable step for you.

Ans. In some cases, crying has not resulted in any harm, in some it has as below. Any rubbing of the eyes immediately after LASIK can pose a risk to the ‘flap’ which has been taken. The risk is basically either in the form of creating folds, wrinkles or displacement of the same. What will you feel? Symptoms of “something in my eye’ or pain if flap is shifted or displaced, unclear hazy vision or blurred vision if flap fold or flap wrinkles. The treating doctor would know if there is any issue when he/she examines the eyes under the slit lamp check. If any issues like wrinkles etc, he has to treat the same.

Ans. We treat patients from over 96 countries and most from these places cannot revisit us. This is the reason we have a high performance laser like to WaveLight 500 Hz Laser to get us accuracy in results. If planned well, you need no more than 4-5 days in Mumbai.

Ans. Most of our patients are computer users for many hours. Yes, you will be able to work well. For the first few days you may feel a bit of strain, which will settle. However, to avoid getting a shift in getting any number you will be taught how to sit correctly in front of the PC. There is more about this on our website www.shroffeye.org about Computer Vision Syndrome.

Ans. As regards your profession, we treat most of our patients from the IT sector as computers create more problems for vision like dry eyes etc. Dr Anand Shroff, our expert will be guiding you with the correct way of sitting on the PC and also give you a special instructions and computer prescription glasses (plus number) for the long hours on the PC. This is to avoid a shift in numbers after LASIK and also to avoid eye strain while on the computers. One does not need to wear this for any other purpose and also only when sitting for very long hrs on the PC not for short working. Most of our patients return to computers on Day 3 as a full days 8 hr work schedule. This is fine. In the first week you need to use lubricating eye drops along with antibiotics (so, you will carry these with you). Further, when you visit us, Dr Shroff will guide you in the correct way to use your eyes when on the PC and also prescribe a pair of computer glasses to you to negate any effects that the computers may have on long term vision

Ans. The reason why most of our fixed days are Saturdays is to help patients get back to work on Monday. Yes, you can use the computers on Monday itself for your routine regular amount of time. For the first week, you may need to go a bit easy by taking frequent breaks, will need to use the eye drops we prescribe at least 4 times a day. But you should be able to do your routine work on the computers.

Ans. Yes, but wait for the first week when you will need to use eye drops frequently. Regular makeup is allowed from next day, but avoid eye make up until your second eye check (about 7 days after LASIK) till you meet the doctor.

Ans. Great. You can look forward to joining as early as Monday, (with one days rest on Sunday).

Ans. This does not affect the LASIK outcome, but for better recovery initially in the first 3-4 months we do advise using lubricating eye drops or artificial tears.

Ans. The reason for sensitivity needs to be determined. Some eyes are sensitive ‘subjectively’ with nothing wrong. Some have an underlying allergy. This will be dealt with during your examination with Dr Anand.However, to ease your mind, during the LASIK process, eye drops which anaesthetize your eyes are used, hence you will be comfortable during the process. We have had patients put across similar queries and they have done well. The laser technology we use is important not to give you any disadvantages such as night vision problems, haloes and glares which exist with other systems. In addition using complete disposables, we never have encountered infection. In fact we have a strict infection control group within the hospital itself.

Ans. Higher order aberrations, decreased contrast, haloes, glares.

Ans. Yes, the cylindrical errors up to 6 are treatable. In our experience with the laser technology we use, the Wavelight 500 Hz system, we have near zero night vision problems from even US FDA data. In our practice we till date have seen no glares, haloes etc. This also depends on one test which checks your pupil size dynamically in light and dark, which is part of your evaluation process with us. Your friend may have been treated with an older technology and hence facing these issues. In fact our laser is one of the best for re correcting such issues of older lasers with Topolink treatments.

Ans. You are given a kit containing antibiotic and anti inflammatory eye drops to be used for a week only. Lubricating eye drops are used for a month or two, after which it is need-based.

Ans. We check every patient for dryness before the surgery (during your LASIK evaluation). If you have severely dry eyes, LASIK is discouraged until the dryness is treated. If the dryness is mild, EpiLASIK is the choice. However, temporarily for some days to some weeks (upto 6 weeks) one can feel ‘dry’. Using lubricating eye drops decreases dryness for those sitting on the computers for very long hours [computer vision syndrome].

Ans. Your eyes may water or burn. You may feel a poking and pricking sensation for only a few hours after LASIK, between 2 hours to 6 hours. Keep your eyes closed for most of those hours or ‘sleep it out’.

Ans. This happens for most only in the first week or two. Hence our advice is to get back to work, but work with frequent short few second breaks between computer uses. This feeling of eye strain is sometimes described by patients to be the kind that people get when they have change of spectacle number and they have to get used to a new pair of glasses.

Ans. LASIK is performed on the cornea which is a superficial part of the eye. The floaters exist in the vitreous (inner part of the eye) and hence no laser surgery on the eye can help the floaters. LASIK can be performed if you have no other indication which deems you unfit. However, one must keep in mind that the floaters may not improve after LASIK and if they worsen, it again has no link to this procedure.

Ans. You are advised to avoid hair bath for two days post LASIK, but a body bath can be taken the next day itself. This is a precaution to avoid the chance of having shampoo enter your eye and make you rub or itch hard. The sunglasses are also eye protection form dust and wind (foreign particles) in the first week when your eyes are still healing. After that we hope it becomes a habit to wear good sun wear for UV protection.