A U.S. patent was granted to Gholam A. Peyman, MD, in June 1989 for a method of modifying the corneal curvature of the eye.
The surgical procedure involved cutting a flap in the cornea, pulling the flap back to expose the corneal bed, ablating the exposed surface and then replacing the flap. The current procedure of laser assisted in-situ keratomileusis (LASIK) was not FDA approved until 1999.
LASIK is now part of the vernacular and is recognized worldwide with millions of procedures performed and still tens of thousands performed annually in the U.S.. The satisfaction of LASIK has been reported to be as high as 94 to 98 percent,1 a rating on Rotten Tomatoes that would warrant a blockbuster!
However, this is still surgery, and with every success there is the potential of a complication. Thus, in order to stay focused on this awesomesauce—yes another word added to the dictionary—procedure, a reminder of how to handle the infrequent complication is warranted.
LASIK patient evaluation
The evaluation of a LASIK patient is the first step in the process of avoiding and managing complications. The evaluation is designed to root out these outliers who would not benefit from this procedure.
In fact, I look at that examination to prove why the patient should not have LASIK surgery as opposed to finding reasons why he should. We know that a cornea can be thinned only so much before it succumbs to ectasia.
Thus, the corneal thickness needs to be commensurate with the amount of tissue ablated to obtain the desired correction. Thus the refractive error is a slightly moving target comparable to the corneal thickness.
Topography needs to be symmetrical and void of any signs of ecstatic disorder. This vetting process must also include a cerebral component, justifying that the patient has a clear understanding of what the procedure will accomplish. Yes, I am specifically referring to those low myopic presbyopes.
1.McGhee CN, Craig JP, Sachdev N, Weed KH, Brown AD. Functional, psychological, and satisfaction outcomes of laser in situ keratomileusis for high myopia. J Cataract Refract Surg. 2000 Apr;26(4):497–509.
2.Hoffman RS, Fine IH, Packer M. Incidence and outcomes of LASIK with diffuse lamellar keratitis treated with topical and oral corticosteroids. J Cataract Refract Surg. 2003 Mar;29(3):451-6.
3. Ursea R, Purcell TL, Tan BU, Nalgirkar A, Lovaton ME, Ehrenhaus MR, Schanzlin DJ. The effect of cyclosporine A (Restasis) on recovery of visual acuity following LASIK. J Refract Surg. 2008 May;24(5):473-6.