Step One: Pre-LASIK Eye Exam
As part of preparation for LASIK surgery, you will receive a dilated pre-operative eye exam. At Cutarelli Vision, we believe this can be one of the most important steps of your procedure.
Pre-Op LASIK Exam Overview
If you are having your LASIK candidacy screening performed through your own eye care professional, you are still required to complete a pre-operative LASIK exam at our office before your LASIK procedure. We will be unable to confirm your candidacy for LASIK or LASIK alternatives until these tests are completed.
Someone To Drive You Home
For your eye exam, we will need to dilate you to look inside your eyes. We recommend that you bring a dark pair of sunglasses or we’ll be happy to supply you with disposable during your appointment. Although rare, some patients may not like being dilated, or might have extreme light sensitivity. In this case, we recommend you bring someone with you to drive.
Assessment Of Your Eye Health History
Current Prescription
Your current prescription needs to be stable during the last 2 years in order for LASIK to be appropriate at this time.
Contact Lens Wear
Contact lenses warp the corneal surface and cause measurements that are not representative of your true refraction. You will have to stop wearing contact lenses prior to LASIK eye surgery. The time interval required depends upon the type of lens and how long you have been wearing them, and may be longer than the minimum times listed below depending on your initial topography results.
Soft Lenses:
- At least 1 week prior to your dilated LASIK exam
- At least 1 week prior to LASIK surgery
Gas Permeable And True Hard (PMMA) Lenses:
- At least 3 weeks prior to your dilated LASIK exam – if you have worn them for more than 10 years an additional week for each decade of wear will be required. Remember, the accuracy of your measures depend on patient diligence. Please follow this advice in order to avoid unnecessary risk of complications or poor visual outcomes.
Ocular Or Systemic Diseases And Medications
Some ocular or systemic diseases and medications can affect your suitability as a candidate for LASIK.
Previous ocular problems: This refers to such conditions as lazy eyes , strabismus , or double vision and will need to be addressed in order to validate your candidacy for LASIK.
Previous Eye Injuries
Be sure to inform Dr. Cutarelli about any eye related injury, regardless of how long ago it occurred.
Your Pre-Operative Eye Exam
Refraction
This test determines the visual acuity of your eyes, both uncorrected and as corrected by glasses or contacts, both with and without dilation.
Motility
This exam will assess the ability of the muscles to align your eyes properly.
Eyelids
This test exams your eyelids to see if they turn inward (possibly scratching the cornea ) or outward (possibly directing tear flow away from the eye), plus other related conditions that might effect your vision.
Conjunctiva
The conjunctiva is the transparent membrane that covers the outer surface of the eye and lines the inner surface of the eyelids. This test will check for irritations, redness, irregular blood vessels or other abnormalities.
Cornea
The cornea will be examined for overall health, scarring, any previous trauma, and pathology, using slit lamp device that acts as a microscope for doctor.
Crystalline Lens
This natural lens inside your eyes will be examined to determine if clouding of the lens (a cataract ) or other abnormalities are currently present.
Intraocular Pressure
The intraocular pressure inside your eye will be measured to detect glaucoma or pre- glaucomatous conditions. Glaucoma is a visual loss caused by damage to the optic nerve from excessively high pressures in the eye. It is one of the most common causes of preventable vision loss.
Posterior Segment
The dilated (fully open) pupil exam is used to assess the health of the posterior segment (inside back surface of your eye). This test allows Dr. Cutarelli to screen the retina, optic nerve, and blood vessels for a number of eye and systemic disorders.
Tear Film
It is very normal for patients to experience temporary dryness after LASIK. However, patients who have inadequate tears before surgery are at higher risk of prolonged dry-eye symptoms after surgery. Keep in mind that feeling of dryness while wearing contact lenses is not the same thing. Experiencing dry eyes while wearing contact lenses does not mean that the eyes are dry when contact lenses are not being worn.
Different Methods To Evaluate Tear Function Include:
- Placement of colored agents in the tears
- Physically measuring the tears themselves
- Inspection of the tear film with a microscope
Pupil Size
Most glare, halos, and diminished night-vision following LASIK surgery is due to a combination of larger pupil size and a high amount of nearsightedness or farsightedness. Because large pupils allow light rays to enter from the periphery of the cornea, custom programming the laser for a larger optical and ablation zone can minimize glare and halos. However, this can only be accomplished with lasers that have an adjustable zone from 6.0 mm to 8.0 mm, such as the ones we use here at Cutarelli Vision.
Pupils should be measured when they are the largest potential size, which occurs under the darkest conditions.
There Are Four Methods For Pupil Size Evaluation:
- Light amplification – utilizing night vision technology derived from the military, an examiner looks through one end of the device at the pupil. Pupil diameter is measured against a tiny ruler in the viewfinder to give accurate measurements in room light that would otherwise be too dark to take a measurement.
- Ruler card – a technician uses a hand-held card with different sized circles on it to match the diameter o the pupil to that of a circle on the card. This has the disadvantage of requiring that the room lights be bright enough for the examiner to read the card; therefore, the pupils may be smaller with this level of illumination than they would really be with nighttime illumination.
- Visual estimation – a technician guesses the pupil size by simply looking at it. This is the least accurate method and has the same disadvantage of the ruler card of requiring bright enough lighting for the examiner to see the pupils.
- Epithelium: The cornea is covered on the surface with a thin clear layer of skin cells, called the epithelium. In some people, this layer of cells is not attached firmly. Loose epithelium may lead to a higher risk of complications. By microscopic examination of the cornea, this test will determine if a loose epithelium condition exists.
Corneal Thickness
The medical term for measuring corneal thickness is pachymetry. This test will be used to calculate precisely how deep the laser will be allowed to penetrate. Since LASIK involves creating a flap on the surface of the cornea and using a laser to reshape the cornea by removing tissue, it is possible for the laser to remove too much, leading to corneal bulging and distorted vision. In order to be sure the laser does not penetrate beyond the safest level, pachymetry is imperative.
Topography
Using a topographer, your eyes will be tested by corneal topography. As no one has a perfectly rounded cornea, the topographer machine will display the degree of astigmatism you have – the irregularities and actual steep or flat shape of your cornea, which cause your vision to be less than perfect. Occasionally patients have abnormal astigmatism called keratoconus, which is a cone-shaped cornea. These corneas often are weaker than normal corneas and thus should not be treated by LASIK.
Wavefront Mapping
The VISX CustomVue Wavefront Analyzer will provide a detailed analysis of your entire visual system. Dr. Cutarelli will use this information to further validate that you are an appropriate laser eye surgery candidate and formulate a highly customized vision correction plan specifically for your eyes. Read our section on Wavefront LASIK for more information on this incredible technology.
Vocational And Lifestyle
Your work or recreational requirements can influence vision correction choices. For example, some choices can affect depth perception or the ability to see well at a particular distance.
Reviewing The Results
You and Dr. Cutarelli will go over the results of your exam together and further plan your LASIK eye surgery.
Next Step
Schedule and prepare for your LASIK procedure. This appointment will be scheduled at the time of your comprehensive eye exam.
Step Two: LASIK Preparation
LASIK Eye Surgery At Cutarelli Vision Is An Out-Patient Procedure, Which Means That You Walk Into Our Surgical Suite, Have Your Procedure, And Then Walk Out Again. Dr. Cutarelli Typically Performs LASIK Surgeries On Wednesday And Friday Afternoons At Our On-Site Surgery Center In Denver And Fort Collins, Colorado.
Your LASIK eye surgery procedure will be scheduled at the time of your comprehensive LASIK eye exam.
Pre-Op Instructions And Considerations Before Your LASIK Procedure
Forms To Sign
- Please carefully review the informed consent forms as these are to be signed prior to the day of surgery.
Travel Arrangements
- If you are coming in from out of town, travel and accommodations are your responsibility – although, our office is happy to provide you with some referrals. We do partner with many area hotels that offer discounts to our patients. As laser eye correction is a medical procedure, please make allowances for the possibility of an extended stay according to the healing process of your eyes.
Driving Arrangements
- You will need someone to drive you home the day of your procedure. Please arrange for someone else to drive you home on the day of your laser eye surgery. After laser eye surgery your eyes will be irritated and light sensitive. This usually dissipates within 24 hours after surgery. You should not plan on driving long distances for approximately 3 days after LASIK eye surgery and 7 days after PRK eye surgery.
Time Away From Work
- Depending upon your occupation, you may need to arrange to be away from work for a day or so following LASIK eye surgery. We will advise you as to how long according to your specific work and physical requirements. Many patients can drive to their 1-day post-op visits with no problem!
Child-Care
- Please arrange for any children to be left under someone else’s care for the duration of your procedure and immediate recovery, which takes approximately 2 hours.
What To Eat Or Drink
- There are generally no restrictions on eating or taking medications before or on your surgery day, however, please advise us of any medications you are taking. We do advise that patients eat a light snank prior to coming into our office. This will help with the small dosage of Valium, Ativan or Xanax you will be given. Avoid alcohol at least 24 hours prior to and 48 hours after laser eye surgery, as alcohol dehydrates the tissues and may alter the effect of the laser on your eyes.
What To Wear
- You will be wearing your own clothing during your procedure, so choose clothing that is loose, very clean, and comfortable. The operating room is kept at a cool temperature, so you may want to dress a bit warmly. Avoid all clothing that might possibly generate lint.
What NOT To Wear
- Your face must be meticulously clean and free of all additives. Certain items will alter the effect of the laser on your eyes and, as a safety precaution, surgery will be cancelled if any are present.
On The Day Of Your Surgery, You Must Refrain From Using
- Facial or eye makeup: lipstick, foundations, powders, etc.
- Products that contain alcohol
- Perfume, colognes, deodorant
- Hair products that could leave residue on your face: conditioners, hair spray, mousse, etc.
- Creams or lotions on or near your face
Medication
- No medications are prescribed before your procedure.
How To Feel Before Your LASIK Procedure:
- It is completely natural and normal if you feel nervous, anxious or excited prior to LASIK eye surgery. We will do everything possible to make this an excellent and positive experience for you. We will also give you a small dosage of Xanax, Ativan or Valium to help you relax.
Step Three: LASIK Procedure
It Is Important To Arrive One Hour Prior To Your LASIK Appointment Time And Be As Well Rested As Possible. The Entire LASIK Process, Including Recovery, Will Take Approximately Two Hours Or Less. The Actual Procedure Can Take Less Than Five Minutes!
Pre-Op Instructions And Considerations Before Your LASIK Procedure
Overview Of Procedure
Prior to your LASIK procedure, it is very natural to feel a mixture of eager anticipation and nervousness. Most LASIK patients describe similar experiences, so be reassured this is both common and absolutely normal. You will be given a mild sedation, such as Valium, Xanax or Ativan, to help you relax during your procedure (and to nap at home afterwards).
LASIK eye surgery is an out patient procedure, which means that you walk into our surgery facility, have your procedure and then walk out again.
LASIK Step-By-Step
- First, you will be lying on a comfortable bed underneath the laser. Your eyelid area will be cleaned with a disinfectant; then your eyes will be numbed with special eye drops – no general anesthetic is required.
- Dr. Cutarelli will position your head under the laser. A device called a lid speculum will be placed over one eye, to gently and comfortably hold your eyelids open – a soothing balanced salt solution is used to keep your eye moist and comfortable.
- Your eyelashes will be draped and kept out of the surgical field. A lightweight suction-ring will be placed on your eye to create a very gentle pressure (for creating the flap); the lights may appear to go out for a brief period.
- Dr. Cutarelli maintains view of your eye through a surgical microscope to ensure ultimate precision and guidance. He always has complete control over the laser, being able to instantly pause or stop it at any time.
- Dr. Cutarelli will create a corneal flap between 8.5 to 9.5 mm in diameter and 90 to 120 microns thick. The flap is intentionally not cut completely of possible so that it has a remaining hinge, which connects to the rest of the cornea . He will gently lift up this flap, like the cover of a book, to expose the tissue just below the flap’s surface, called the corneal stroma.
- The excimer laser will follow the tiny motions of your eye instantaneously, in three dimensions, and automatically repositions the laser to ensure accuracy. You simply need to focus on a special fixation light for a minute or less.
- Through a series of pulses, the excimer laser reshapes the cornea to the desired shape.
- Dr. Cutarelli then replaces the flap over the cornea. No stitches are required to keep the protective corneal flap in place. Typically overnight, the cornea will re-adhere.
- Dr. Cutarelli will remove the drapes and eyelid holder, and apply antibiotic, anti-inflammatory eye drops.
- Next, you will get up the chair and rest for a few minutes. Clear protective eye shields will be positioned over both eyes to protect them from injury. There may be some temporary discomfort after treatment, similar to having an eyelash or sand in your eye, this typically last less than 4-hours. Dr. Cutarelli can prescribe pain medication if necessary, although it is only very rarely used.
What To Expect After LASIK
After LASIK, your vision will most likely be somewhat fuzzy at first, like looking though plastic. This is completely normal. You’ll go home to rest and relax for approximately four hours to facilitate the healing process of the flap. After this period, many patients can watch television without glasses! Still expect some fuzziness or cloudiness throughout the night. Someone must be present to drive you should you need to go somewhere.
Step Four: LASIK Recovery
As With Other Surgeries, Recovery Is A Very Important Component Of The LASIK Process. It’s Up To The Patient To Follow Our Instructions.
Post-Op Instructions After LASIK
Before you leave to go home, your eyes will be examined again (usually 15 minutes to 1 hour following the surgery) to ensure that the flap is positioned correctly. Along with your anti-inflammatory and antibiotic medications, you will be given mild sedatives to help you sleep.
After about 30 minutes after your LASIK procedure, the anesthetic drops used in the laser procedure will begin to wear off and you may experience some minor discomfort such as sand or an eyelash in your eye. It is usually unnecessary to take medication for these symptoms, but should you need it, Tylenol, Advil or any non-aspirin analgesic is recommended. Artificial teardrops, included in your supplies, often provide some relief. No matter what, do not rub your eyes!
Any Of The Following Symptoms Are Common And Normal:
- Watery eyes and nose
- Light sensitivity
- Stinging
- Redness and swelling of eyes
- Dry eyes
- Foreign-body-in-the-eye sensation
- Blurry vision
Your vision might be foggy or blurry because of the swelling on the cornea. It might be similar to looking through plastic or being under water.
Rest
Once your LASIK procedure is complete you will be able to go home almost immediately to rest. Try to sleep for at least 4 hours to facilitate the healing process of the flap. Most of our patients wake up from their nap with little or no discomfort and notice a significant improvement in their vision.
Plan to relax for the remainder of the day following your procedure. Although you can, it is recommended that you wait to drive until Dr. Cutarelli verifies your vision during your one-day post-operative exam.
By the next morning, you should notice a dramatic improvement in your vision. Be sure to enjoy this moment as it only happens once! Take a look at your alarm clock. Look out your bedroom window and see the neighborhood, as it has never appeared to you before. The quick recovery of functional vision is impressive and often described as miraculous.
It is typical to have up to an 80-90% improvement in vision by the next morning after your procedure and return to most routine activities promptly.
Follow-Up Care
Follow-up care can be just as important as the actual procedure. You will be required to use anti-inflammatory and antibiotic eye drops on a regular basis for a several weeks.
- Prescription eye drops: (1 drop each application)
- Fluroquinolone (antibiotic) 4 times daily for 5 days, then discontinue
Wait about 1 minute between drops
- Prednisolone Acetate (steroid) every hour while awake on the day of surgery, every 2 hours while awake on the day after surgery, then 4 times a day for 5 additional days.
- Lubrication eye drops: (minimum of 1 drop four x per day)
- Bion tears, or any comparable lubricant, as needed for lubrication, for 4-6 weeks. It is okay to use up to every 1 or 2 hours if needed.
Temporary Lifestyle Changes
Adopt These Habits As Soon As Your Procedure Is Complete:
- Wear the protective eye shield for the first 2 hours and then whenever you sleep for the next 3-4 days
- Rest and sleep as often as possible the first 48 hours
- Relax your eyes whenever possible over the next few months
- Keep them well lubricated
- Wear dark, wrap-around sunglasses to shield against bright lights
- Shower or take a tub bath, but avoid getting anything in your eyes for 3 days after surgery.
- Avoid doing very intense exercise for at least 72 hours
- Keep your hands away from your eyes
- Protect your eyes from dust and abrasion
- Avoid all water sports and activities (hot tubs, whirlpools, swimming, etc.) for 2 weeks post-operatively. Avoid scuba diving for 6 weeks.
To monitor healing, it is essential that you see Dr. Cutarelli the day after surgery, again at three weeks, and then at three months and six months following the surgery.
Step Five: LASIK Post-Op
You Will Be Required To Return To Our Office After Your LASIK Procedure For The Vital Post-Operative Appointments. These Appointments Will Be Scheduled Either Before Or After Your Laser Vision Correction Surgery.
Patient Care After The LASIK Procedure
After Your First Post-Operative Visit, There Are Two Additional Post-Operative Examinations Required:
- Additional visit at 1 year for PRK
- Regular yearly checkups thereafter
Each post-operative appointment is vital to the success of your treatment, even if it seems your vision is perfect. Sometimes complications can start small and be unnoticeable to the patient. Most of the time, Dr. Cutarelli can detect an arising complication during your post-op visit before the situation escalates.
If You Were Referred By Another Eye Doctor
You may schedule post-operative care with your original eye care professional if you prefer. We are happy to work with other practices to manage your post-op care. Please keep in mind that you must make your follow-up appointments with that office prior to your surgery date and that you are responsible for any additional fees. Be prepared to furnish Cutarelli Vision with the pertinent information and completed forms necessary for the transfer. We are happy to facilitate this process for you.
Address All Concerns Immediately
Additionally, Dr. Cutarelli will want to know if you have any concerns about your vision or your eyes at any time.
