Qualifications for Custom LASIK
There are several conditions which make it impossible for a patient to receive the benefits of custom LASIK.
Because the custom surgery can involve removing more tissue than standard LASIK, patients with thin corneas may not be eligible for wavefront-guided LASIK surgery. In addition, those with strong nearsightedness, farsightedness, or astigmatism, as well as those with especially large pupils, may be discouraged from having this surgery.
If you are seeking monovision treatment for presbyopia, you will be better off with standard LASIK treatment, since current lasers cannot perform the undercorrection required for proper monovision.
If you have few higher-order aberrations and meet the other guidelines for refractive surgery candidates, the benefit of custom LASIK may not be worth the cost for you. You may wish to get more than one eye surgeon's opinion before making this choice.
Who Should Have Custom LASIK
Wavefront-guided, or custom, laser eye surgery may be required if you have significant "higher-order" aberrations in your eye. These go beyond simple nearsightedness, farsightedness, and astigmatism, and can affect your vision even once these lower-order conditions have been treated.
Another group of people who require custom LASIK are patients who have had refractive surgery in the past, but are suffering from side effects or complications that keep them from achieving their best possible visual acuity.
If you are too nearsighted or farsighted, have too much astigmatism, or have thin corneas, you may not be a candidate for custom LASIK.
Benefits of Custom LASIK
Custom LASIK can provide very precise correction of visual acuity, with fewer side effects than standard LASIK. This means that custom LASIK can in some cases achieve a much greater improvement in your vision than other forms of surgery.
The wavefront technology is especially effective for people with unusual or hard-to-fix vision problems, or in enhancement surgery for those who have had an unsuccessful experience with standard LASIK.
Custom LASIK also reduces the incidence of post-surgical vision problems such as ghosts, halos, and difficulty driving at night. Research is continuing into possible applications for this technology that could expand the range of conditions it can treat.
What is Custom LASIK?
Custom LASIK uses a technology called "wavefront" to diagnose the unique shape of the patient's cornea, then to create a map that the surgeon can use to perform very precise LASIK adjustments.
The wavefront technology has been around for decades, used by astronomers to adjust the large mirrors in their telescopes to correct for distortions caused by the earth's atmosphere. Only recently has it been applied to the improvement of human vision.
Many surgeons will perform a wavefront diagnostic for all patients requesting vision correction surgery. Not all will use this diagnostic to create the surgical map, either because they do not find it necessary or because the diagnostic shows the patient is not a good candidate for laser surgery.
What to Expect After Custom LASIK
Most LASIK patients experience dramatic improvement in their pre-surgery eyesight within 24 hours of the surgery. After that, the improvements continue at a more modest pace. It may be six to eight weeks before you experience the full "custom" effect of the surgery. You may even find that after the custom surgery, you are able to see better than you could with your old glasses or contact lenses.
Otherwise, the recovery from custom LASIK is the same as for standard LASIK surgery. Patients will need someone to drive them home, and will need to wear a protective shield for 1 to 3 days, but should experience little discomfort after the first few hours.
Costs of Custom LASIK
Custom LASIK typically costs more than traditional LASIK, in part because the manufacturers of wavefront devices take a royalty from the surgeon on each procedure performed. This extra cost -- perhaps $400 or $500 per eye -- is one reason patients are warned not to shop for laser eye surgery on price alone. If your eyes require a custom procedure for maximum visual benefit, you may not be happy with the results from a cheaper procedure.
Even with custom LASIK, there is a chance that you will require enhancement surgery afterward to fully correct your vision. As part of your research before the surgery, you should ask your surgeon what the cost of such enhancements will be if they are needed. Many practices offer them free or for a reduced cost.
What to Expect Before Custom LASIK
You should have a thorough consultation with your eye surgery professional, including the wavefront scan. For this part of the process, you will be asked to look at a target light while the laser sends a beam into your eye and measures its refraction to get a precise diagnosis of the aberrations in your eye.
You should then have the opportunity to ask questions of the surgeon about your diagnosis, why custom LASIK is appropriate in your case, and what the process looks like. You should also find out what laser will be used on your eyes, and whether the process is truly "custom" (designed specifically for your eye defects) or merely "optimized."
How Custom LASIK Works
The wavefront technology used in custom wavefront LASIK surgery is highly precise -- more precise, in fact, than the surgery it is supporting, which means it may find optical defects that cannot be corrected.
As with other laser procedures, the patient is asked to look at a target light. A laser beam sends a specific pattern of light waves into the eye, and the wavefront sensor measures the changes in that pattern as it is reflected back. To use a simple example, if a straight line is reflected back as wavy, it indicates there is an error in the eye's lens and shows the magnitude and nature of that error.
The human eye is imperfect, so no one's eyes will reflect back the exact pattern that is beamed in. Wavefront diagnostics are a vital tool for today's laser eye surgeons.