Explainer

What Happens During a LASIK Consultation?

Dr. Matthew Sharpe- Founder of SharpeVision

By Dr. Matthew R. Sharpe

September 5, 2022

Many of you may wonder what exactly happens during a LASIK consultation. This blog post will hopefully answer any and all questions regarding this first step to getting out of your glasses and contact lenses.

How Long does the LASIK Consultation Take?

The answer to this may vary slightly between different clinics, but at SharpeVision Modern LASIK, our consultation can take up 90 minutes.

The vast majority of our patients have done a significant amount of research prior to booking an appointment with SharpeVision. There are many good sources online for “pros and cons” and things to consider when thinking about having LASIK eye surgery, including our blog posts. We sometimes call this “vision correction“ surgery because there are many different procedures and techniques we perform with the same laser to give people with differing eye anatomy the same clear vision result. But most people just know the name “LASIK” to include all vision correction surgery. In this blog post, we will make the distinction between LASIK, PRK, ICL, and lens replacement surgery which includes Cataract removal and RLE (Refractive Lens Exchange).

Comprehensive Examination Components and Why We Do Them

A comprehensive, dilated examination with an eye doctor is the only way to know which vision-correction procedure is best for you. At SharpeVision, we do a comprehensive exam absolutely free because we believe so strongly in giving patients all the information necessary to make the right treatment choice. While your exam involves comprehensive diagnostic testing, it is also our opportunity to learn more about you, your expectations, and your lifestyle. All of these factors play an important role in recommending the best procedure for you:

Diagnostic testing with a our technician (30 minutes):

  • Measure your current glasses: Often our patients are worried that we will use their glasses prescription for their treatment. This is not the case. The measure of your glasses prescription gives us a historic data point of what your prescription was at some time in the past. Actually, we are more confident about the stability of your prescription when your glasses are older.
  • Auto-refraction: This is an automatic measurement of your amount of nearsightedness and astigmatism. This is typically close, but not exactly what your true prescription is. Many people worry that their prescription is not stable. This is a bit of a myth, as virtually everyone’s prescription stabilizes in your late teens or early 20s. There are a few very rare exceptions to this. We always repeat the measurements of your prescription on the day of your procedure so that we have different measurements on different days. The second measurement (usually on the day of your procedure) is done without dilating your pupils, so we have at least six different ways of measuring your prescription (automatically, then before drops, after drops, measurements for your glasses, corneal topography, and OPD) to ensure that we have the most accurate measurements possible.
    Corneal topography: This gives a measure of your corneal thickness at any given point, the curvature, the symmetry, and the astigmatism of the front and back surface of your cornea. Corneal topography gives much more information than corneal pachymetry, as it shows the whole front and back of the cornea to allow your doctor to screen for any weak spots in your eyes.
    OPDIII: OPD stands for “optical path difference“. There are a handful of different diagnostic devices that measure similar parameters, but the OPD device is the best of its kind. It measures the aberrations in your visual pathway from front to back. Aberrations are defined as anything that distorts or diverts/diffuses the light as it enters your eye and makes its way to the retina through your cornea, people, crystalline lens and vitreous (the gel in the back of your eye). Any one of these parts of your eye can disperse light, which creates glare or blur.
    Intraocular pressure: The pressure in your eyeballs is generally considered normal between 10 and 21 mmHg. The implication of this is that long-term high intraocular pressure can cause loss of vision due to a condition called glaucoma. We always screen for glaucoma by checking your intraocular pressure as well as examining your optic nerve head.
  • Corneal pachymetry: This means corneal thickness. We measure the thickness of your cornea in two different ways, with light and with sound. The corneal topography measures the thickness with light waves and the corneal pachymetry measures it with sound waves. It is just a redundant measurement to make sure that they are consistent and that there are no errors. Corneal pachymetry can vary from measurement to measurement 10 µm give or take (1/1000 of a millimeter) The average thickness of a healthy cornea is about 540 µm (microns, which is 1/1000th of a millimeter)
  • Optos: The Optos device can image up to 200° of your retina (the back of the eye) and potentially show the doctor any retinal pathology as well as document for future comparison.
  • Dilation: Your visit will include dilation of your pupils, which will affect your eyesight for about 4-6 hours, as you may have experienced with a routine eye exam. For a nearsighted person after dilation, it may help to remove your glasses or contacts lenses when looking at near objects such as your phone or any other reading material. You would then have to put the glasses back on to see distant objects. The effect of the dilating drops will wear off in 4 to 6 hours. The other effect of the dilating drops is that you may be extremely light sensitive because your pupils are the gate keepers of light coming into your eyes, and when they are wide open, too much light comes in. This also will go away in a few hours. so it’s nice to bring sunglasses when you come to your free comprehensive exam.
  • Tour of our facility and informational video (12 minutes): We want you to feel very comfortable with us, enjoy the process and of course enjoy your clear uncorrected vision postoperatively. I always say that surgery starts the minute you walk in the door (or before), because making you feel comfortable during the pre-operative exam is part of making you feel comfortable during the surgery itself. Being comfortable and relaxed during the surgery itself helps the process to go more easily and quickly and get you past the nerve-racking part, and on to the “enjoying life with clear uncorrected vision” part.
  • Doctor exam (20 minutes): At SharpeVision we have Doctors of Optometry (OD) who assist our surgeons (MD) in performing much of the preoperative and postoperative examinations. Your doctor will give you a complete vision exam, similar to what you have experienced before with an optometrist that prescribes glasses and contacts. The exam is of course very important to put together all the pieces of information, as well as make a procedure recommendation, answer all the questions you have, and make sure you know the risks and benefits so that your expectations are in line with what we can actually deliver.
  • Patient assistance/billing questions (20 minutes): Our surgical coordinator will go over the drop regimen, get your procedure scheduled, and go over the total cost as well as financing, which we do for lots of our patients to help them get the procedure sooner rather than later.

“LASIK is the most commonly performed vision correction procedure in our office (about 80% currently) for patients under 40 years old.”

Factors that Help Determine the Procedure Recommendation

The most important factor to help determine the procedure recommendation is age. The second most important, in my opinion, is the amount of prescription. The reason that age edges out refractive error in importance is that the crystalline lens (which is your natural lens, about the size and shape of an M&M candy) changes throughout our lives. In our late 40s, we lose enough flexibility of the crystalline lens so that everyone has some difficulty seeing either distant objects, near objects, or both. No one can have perfect distance vision and near vision with a natural lens as they age. This is called presbyopia.

Questions to Ask During the LASIK Consultation

There are hundreds of questions that could be asked when considering vision correction surgery, but in my opinion, some of the most important are:

  1. What are some of the risks that may be greater for me? As stated above, age and the amount of your prescription are, in my medical opinion, the two biggest factors that place you in a statistical group as far as odds of getting a perfect vision result.
  2. What are the odds that I will need reading glasses? Hint: as we age, everyone will need some sort of help seeing either near or distant objects with one or both eyes. After age 45, you need to consider presbyopia, which is when we lose flexibility in the natural lens of our eyes and can have either good near vision or good distance vision, but not both in both eyes at the same time.
  3. Can you explain Monovision to me as well as demonstrate it, so that I can make a good decision? I feel it is very important to show someone as best we can what Monovision will look like. Most people have an idea that they won’t like Monovision but then when they see it in their own eyes, they can appreciate that it works pretty well and opt to have it. Monovision, which is where one eye is corrected to focus on distant objects and one eye is focused on near objects. It works well in almost anyone over 45 years old, although I believe people over 50 appreciate it even more. It is reversible, and yet we rarely reverse it. I would guess that less than 1% of our patients who opt for Monovision end up reversing it because they know that they would need reading glasses again if they do. People just “see“ and don’t really think about the Monovision once they are adapted to it.
  4. When should I have LASIK vision correction? I truly believe that anyone over 18 years old who is a candidate should have LASIK as soon as they are able. The highest likelihood of a perfect result occurs in our younger patients. I would say do it in your 20s or 30s, when you don’t have to worry about reading glasses. Dryness of the surface of your eyes tends to be greater in our older patients and significantly more symptoms of dryness in women as compared to men. So do it now and enjoy the benefits for longer! You will also save money by not purchasing glasses and contact lenses, and the earlier you do it, the more you save. Not to mention lifestyle. Whether you’re traveling, hiking, or pursuing water sports, it’s nice not to worry about remembering your glasses or contact lenses or worrying about losing them.
  5. Who should do my vision correction surgery? I say trust your judgment. If you have done your research online, looked at the practice reviews, asked your friends and family where they had their LASIK done and whether they are happy with it, as well as how good the overall experience was. The experience you have at the practice should significantly contribute to your decision. Did the team seem cohesive and communicate well? Did the process go smoothly, and were they able to answer all your questions? Was the office clean and organized?

How Long Do I Need to Be Out of Contact Lenses?

This is often a big source of anxiety for our patients. They sometimes read things online that say you need to be out of contact lenses for six weeks, more or less, prior to having a LASIK consult. That is a big ask! At SharpeVision, I have done laser vision correction for over 25 years and have some observations. Soft contact lenses do not significantly change your prescription. Toric lenses (which correct for astigmatism) also do not seem to significantly affect the shape of your cornea nor do they affect your prescription. We recommend that you just come in and see us. If you are a candidate, we can tell you that without having your contact lenses out prior to the comprehensive exam. If you are not a candidate, you are not inconvenienced by having your contact lenses out for a long period of time just to learn that you are not a candidate. In actuality, very few people are not candidates for any procedure because we have such a breadth of procedures to offer.

Rigid gas permeable contact lenses (RGP) are a completely different story. RGP Contacts definitely can change the shape of your cornea. I have seen patients who have little to no astigmatism come in three weeks after being out of their contact lenses and have a very large amount of astigmatism. Our process at SharpeVision tries to get the most stable and accurate measurement of your prescription while minimizing the inconvenience. We ask our patients to just come in first and have the exam. This way we can measure the thickness of your cornea etc., and let you know if you are a candidate, since astigmatism does not affect your candidacy. If you are a candidate, we ask you to be out of your rigid gas permeable contact lenses for at least three weeks before we measure again to get your most prescription and schedule your procedure at least two weeks later (for a total of five weeks minimum out of contact lenses). Regardless of the measurement, three weeks after being out of contact lenses we check the prescription again on the day of your procedure. If there is more than a quarter unit (diopter) of difference between the measurements, we postpone further. Yes, it is an inconvenience and a “pain” to wear glasses for that long, but people who have worn RGP lenses for a long time can have some fairly significant changes in their prescription after being out of contact lenses for several weeks. Sometimes patients don’t have glasses as a back up, but we can order them on Zennioptical.com very cheaply ($15-$40).

Can I Have Surgery on the Same Day as the Comprehensive Exam?

I generally don’t recommend same day surgery. By leaving the office and taking some time to think about any remaining questions etc., you can make your best healthcare decision. If there is some scheduling issue or travel issue that makes it necessary, same day surgery is possible, if you have not worn contacts for three or more days.

Can I Drive Home After the LASIK Consult?

In most cases, yes. However, if you are extremely farsighted (very few people are) or don’t have any glasses or contacts, it can be difficult. It is important to remember to bring sunglasses, although we do have temporary wraparound sunglasses, if you forget. You will be much more light sensitive after the dilation as well as have difficulty seeing near objects for 4 to 6 hours. Ideally, you would have a good friend or family member accompany you to the exam. That way you can catch up with them as well as have them ask questions you may have forgotten and provide moral support. It’s nice to have them drive you home after the exam because of the above disturbances to your vision. All in all, life is always better if you have a good friend or spouse with you to help you through the whole thing.

The comprehensive exam is actually kind of fun, and it’s exciting to think that you might soon be able to see clearly without needing any glasses or contact lenses. Give us a call or schedule your appointment online on our website. We look forward to helping you enjoy your life without needing glasses or contact lenses!

Dr. Matthew Sharpe- Founder of SharpeVision

Dr. Matthew R. Sharpe

Dr. Matthew Sharpe is an Ophthalmologist specializing in refractive surgery and the owner SharpeVision MODERN LASIK, with offices in Seattle, Austin, and Chicago. Dr. Sharpe is a world traveler, pianist, marathon runner, motorcyclist, and fluent French speaker. He enjoys every second of life, but finds he is happiest at home watching Netflix or cheering on The Ohio State Buckeyes with his wife, three children, and two dogs.
Signature of Dr. Matthew Sharpe, MD