Myopia, or short–sightedness is a common occurrence. And, in Lasik Surgery about 95 per cent of the people the refractive number stabilizes at about 18 or 19 years of age. Refractive error is genetically predetermined or can be caused due to strain to eyes particularly as a result of spending long hours before the computer terminal. Among corrective options like spectacles and contact lens, now novel forms of treatment such as laser surgery have ushered in a new era in eye care.

The Laser Assisted In Situ Keratomileusis or Lasik as it is popularly known ensures a cure for even high degree of short–sightedness permanently.

“Lasik does not only improve appearance, but increases one’s market value in terms finding jobs as well. Nowadays multinationals do not accept people with eyesight less than the –4D mark. If a young boy or girl aspires to join the merchant navy or take up the demanding job of a airline pilot, eyesight requirements are very stringent.That’s when he / she could opt for permanent corrective treatment like Lasik”, states Dr. Shrikant Kelkar, Consultant Eye Surgeon and Director, National Institute of Ophthalmology (NIO), Pune. These are not the only reasons why one could consider corrective laser surgery. People with high refractive errors in both eyes who pursue a job that requires lot of traveling could be at an acute disadvantage if their spectacles broke and there was no way to replace them. For such people, Lasik surgery would eliminate the high degree of dependence on corrective lenses. The laser technique can also correct moderate far–sightedness (hypermetopia) and astigmatism.

Preparing for Lasik surgery It is essential that the patient should be made aware of the whole procedure and his consent taken before the surgery commences, asserts Dr. Kelkar. Patients wearing corrective lens are advised to discontinue using their lenses a fortnight prior to the Lasik treatment.

Lasik laser treatment is a wholly computer controlled operation. Prior to surgery, a few mandatory tests are conducted. The right refractive error in both eyes of the patient as well as his blood pressure is checked and noted. For patients with a negative number a colored mapping of corneal curvature is taken to find out if there are any retinal holes or patches. The retinal surface is then welded to ensure against retinal detachment. If that is not done, it may lead to the patient losing his/her eyesight.

All data is then fed into the computer. After which a routine safeguard is carried out. A bio–engineer checks whether the machine performs as per specific requirements and the right calibration is achieved. “At NIO, we carry the check–test after every fourth surgical procedure”, informs Dr. Kelkar.

What is it?
During Lasik treatment, a microkeratome is allowed to glide across the cornea. A thin layer of the corneal flap measuring 1/15th mm or about 160 microns is lifted with the help of this instrument. Then, ultraviolet light and energy pulses from the Excimer Laser reshape the stoma before the flap is put back in its original position.

While the surgery is in process an eye tracker in the machine is programmed to take care of limited movements of the patient and the operation will automatically stop in case of excessive movements. The operation commences again after a few minutes right from where it was switched off.

The surgery itself takes just 15 minutes for each eye. The whole operation is performed under local anesthesia.

Normally, it takes about two months for the cornea’s natural bonding qualities to heal the eye fully. During operation, it is possible that the fragile conjunctival vessels may be touched and may cause redness in the eye. Initially, a watery feeling may also persist after the operation. But, this lasts for only a week. Most patients can return to their normal activities within a week, states Dr. Kelkar.

Is it safe?
The Lasik treatment shows best results in case of patients aged between 18 to 35 years. “In 99.9 per cent of cases, the surgery shows productive results. There are instances of around five per cent when the patient’s number has regressed after the treatment”, states Dr. Kelkar.

“No surgery is 100 per cent safe. The eye is a sensitive and vital organ. If by chance infection sets in: antiseptic medication if initiated will not reach the area as the cornea receives no blood supply. So the patient must take adequate post–operative care. After surgery, regular checkups are carried at 48 hours, one week, one month and finally at three months to check if the patient’s eyesight is corrected and that no side–effects persist”, he adds.

In the long run Lasik laser therapy has shown some limitations. People who avail of this treatment have to use reading glasses after 40 years. The Lasik technique cannot be used to treat people suffering from a condition known as presbyopia or aging of the eye. Although this condition can be treated by leaving one eye slightly short sighted.

Lasik surgery vs. ‘Eagle’s Vision’
The Lasik procedure is less painful, causes less regression and less corneal haze and guarantees faster recovery than its predecessor Photo Refractive Keratotomy (PRK). Lasik is a modification of PRK.

“Nowadays, an upgraded technique Eagle’s Vision or Wavefront–assisted laser treatment is much talked about as a new generation process”, reveals Dr. Kelkar. The process follows on the same steps as the Lasik technique. However, instead of topography analysis, a bolometer is used to measure the spherical and chromatic abrasions in the internal cornea. “In case of PRK the abrasions would be pulverized at 60 to 70 microns. In Eagle’s Vision, they are taken care off at 4 to 6 microns’, states Dr. Kelkar. To bring this curative treatment to the layman, plans are afoot to install the state–of–the–art Wavefront facility at the NIO. The new facility is expected to be operational by the first week of April 2001, he informs.

What about costs?
Skeptics may argue that the highly sophisticated and state–of–the–art laser therapy is bound to be expensive. Justifiably, Lasik surgery is available at a cost of Rs 28,000 while Eagle’s Vision is expected to cost the patient a whopping Rs 32,000. However, Dr. Kelkar is optimistic. “If an engine driver or an umpire’s vision (in the playground) is corrected, he will definitely be very happy. Ultimately, the aim of such surgery is better sight without glasses”, he affirms.

“As our living standards improve, people who can afford to buy contact lens which cost a minimum Rs 2,000 per year, will be able to afford the Lasik or the Wavefront treatment which is a once in a lifetime surgery”, he argues.