Robert Rivera, MD (license expired)

Dry eyes following LASIK can be very bothersome, even though you might never have been bothered by the symptoms before. Some patients even end up newly dependent on artificial tear drops following their procedure, which can be very frustrating. (I practice in the middle of the desert in the American Southwest, where nearly everybody, LASIK or not, develops dry eye at some point in our lives.) If you already suffer from dry eye syndrome and its attendant symptoms, it may stand to reason that LASIK could potentially worsen your condition, and certain medical diagnoses such as thyroid disease, collagen vascular disease and others, may interfere as well. Even certain medications, including over-the-counter allergy pills, can make things worse yet. Couple this with the understanding that as we age, our eyes produce less and less tears, plus the fact that hormonal imbalances don't help, and you may have reason to be concerned. So the question of whether you will have dry eyes forever is best answered, "yes, you may." However, most LASIK patients who have dry eyes following their procedure notice improvement over the first few months following their surgery. Nutrition in the form of flax seed oil and other supplements may be of benefit. Now, having said all this, there are other refractive procedures that may not worsen or bring on dry eyes as significantly as LASIK, and you should discuss these with your provider. They include such things as PRK (PhotoRefractive Keratectomy), ICL (Implantable Collamer Lens), and if you already have the formation of cataract, Lensectomy. In our experience, we have found that the ICL, for example, is an excellent alternative for patients with higher prescription amounts (such as yours), and dry eyes. Thanks for your post, and best of luck as you consider your options for excellent vision.

In thus electronic age, many patients have learned to utilize such things as email, Facebook, and other means (this website being a prime example) to get more information regarding their procedure, or to contact their physician's office for more details. Every indication is that this trend will continue to rise, and like it or not, physicians will also have to learn to use this medium to communicate with their patients. If your physician is not comfortable communicating via email, it may be due to any of a number of factors, but if it is important to you that your provider be available via email, then you should continue to look elsewhere. Also, most successful LASIK practices maintain a list of very helpful patients who have indicated their willingness to discuss their experience with other potential patients. If no such list exists for this practice, that doesn't mean that they're any better or any worse than the next one. However, if this is important to you, the same applies, and you should seek another provider who is more to your liking. My only other suggestion would be to let the practice know exactly what has led you to make your choice, if your decision is to find another surgeon to perform your LASIK. Best of luck as you make your decision, and thanks for posting your question!

PRK stands for Photo-Refractive Keratectomy, and is actually a very effective treatment for people with refractive errors--myopia or nearsightedness, hyperopia or farsightedness, and astigmatism.  In the simplest of explanations, this treatment involves the use of the excimer laser to remove corneal tissue and reshape the surface of the eye, similar to LASIK.  However, this differs from LASIK in that there is no corneal tissue flap created.  Rather, in PRK the surface or epithelial cells are removed from the cornea, and excimer laser is then used to reshape the tissue.  The procedure itself is painless, but the recovery can be somewhat uncomfortable.  To prevent postoperative pain, typically a very thin bandage contact lens is placed on the eye, and oral pain medications and mild numbing eye drops are prescribed.  From the patient's perspective, PRK is more uncomfortable than LASIK, and the vision takes longer to recover, typically becoming stable 3-4 weeks after the procedure, as compared to a few days with LASIK.  Once healed, however, the vision is very good following PRK; several studies have been performed to compare PRK to LASIK, and some studies show the vision very slightly better with one versus the other, and vice versa.

Astigmatism is simply a difference in curvature of the corneal surface of the eye, where the curve is steeper in one direction than another.  Think of it in terms of the curvature on the surface of a football (astigmatism), versus the curvature on the surface of a basketball (no astigmatism).  Astigmatism actually can be treated quite successfully with both LASIK and PRK.  All forms of astigmatism are not the same, however, so be sure to discuss your particular case with your doctor.  Incidentally, all lasers used to treat the cornea for LASIK and PRK are not the same, either. 

The implantable collamer lens, or ICL, is generally an excellent option to consider for patients who do not qualify for LASIK or PRK due to the health of their cornea.  Also referred to as a phakic intraocular lens, it avoids the risks caused by creating a flap (LASIK), removing corneal epithelium (PRK), or  removing tissue from the central cornea (both).  As such, although the procedure does involve entering the eye to implant the lens, many surgeons with extensive experience in ICL implantation actually consider the procedure less invasive than laser-based corneal refractive procedures.   The collamer substance, a very inert biomaterial, is in fact very well understood, and has been used for a number of intraocular lenses besides the ICL for many years without any reports of rejection or inflammation caused by the material.  While the first ICLs were implanted in human eyes in Europe and South America in 1993, the FDA study of the STAAR Visian ICL began in the US in 1997, and it was approved in December of 2005.  Consequently, we now have 17 years of international experience, with 13 years of followup in the US; ICL patients have fared exceptionally well over the years.  Not all patients are candidates for the ICL, however, so you should discuss with your surgeon why he or she feels this is the best option for you.  For general information from the manufacturer of the lens, you can also refer to their visianinfo website.