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Dr. Miller: Hi, I'm Dr. Miller and I'm here with Dr. Mark Mifflin. He's a Professor of Ophthalmology and his practice includes refractive surgery, otherwise known as to many.

Understanding the LASIK Procedure

Now if we go to the operative day where they're going to have the procedure, is that a fairly involved surgery or is it fairly straightforward, done under local anesthetic, or do they have to be under general anesthesia? Just describe that procedure a little bit more.

Dr. Mifflin: Yeah, the actual procedure itself is outpatient and pretty user-friendly. I like to think of it that way. Amazingly, most modern eye surgery, at least on the anterior part of the eye, and this would include laser vision correction surgery, is done with what's called topical anesthesia which means we just actually numb the eye with several eye drops, maybe three or four sets of numbing drops. Amazingly, that can result in pain-free surgery. And typically, for vision correction surgery there's no sedation, no IV, and it's done in a kind of a clean setting in a laser room but the person doesn't have to change into a hospital gown or anything like that.

Addressing Patient Anxiety Before Surgery

Dr. Miller: So patients coming in for the surgery might be anxious on the operative day. Some people are very concerned about having their eyes touched, and I can understand that. That gives people a sense of squeamishness. How do you calm patients who are coming in for surgery?

Obviously, they're going to be awake. You mentioned that you're going to use a topical anesthetic so they're going to know pretty much what's going on during the surgery, and I would suspect a number of people would be anxious. How do you calm them and how do you get them through the surgery so that you have a really good outcome?

Dr. Mifflin: The day of surgery is actually a culmination of a long process of teaching the patient and kind of letting them know what the whole experience is going to be like, not only preoperatively, but during the surgery itself and then also the recovery phase. It's actually very easy for most people to go through.

We literally handhold. We have a staff of about three or four people in the laser room. We have nurses and technicians who have been doing this for decades, some of them. So anything from gentle coaching by the surgeon in which there is constant verbal interaction. Some people even call it a vocal local, meaning kind of calming the patient by talking to the patient and coaching them and kind of telling them what to expect.

What Happens During LASIK Surgery?

Dr. Miller: So I'm assuming that they've got to be completely still while that laser is performing the procedure, doing the changes, sculpting on the lens.

Dr. Mifflin: Interestingly and that . . . you're absolutely right. It's a great source of anxiety for patients. Not only that, number one, we have really strong reflexes to keep things away from our eyes. That's just ingrained in us. The concept of somebody doing something to your eye is unpleasant, but again, through the educational process and also a very stepwise process where we kind of ease into the surgery, it's amazing that pretty much anybody can tolerate it.

Part of that process again is the fact that it is pain-free and the laser technology actually tracks the eye just like a weapons technology laser or something would track a target. That's how the laser technology works, so even though the patient is a little bit worried about not looking in the right place . . .

Dr. Miller: The laser is sophisticated enough to be able to do that automatically.

Dr. Mifflin: That's absolutely right. The patient looks at a target. The surgeon is aligning the laser, and then the laser has a camera and/or lasers in it that is tracking the pupil. Between those things, I've never seen one of these laser trackers fail. It's very, very accurate. So if the patient should look away more than about half a millimeter the laser automatically quits firing.

The actual sculpting or laser ablation typically would last between 5 and 20 seconds per eye, so it's very quick. In LASIK surgery the initial stage of the surgery is cutting a flap and that takes about maybe 30 seconds, so the actual time under the laser where there are really kind of critical things going on is really usually less than a minute per eye.

Dr. Miller: Do you usually do one eye per session or do you do them both?

Dr. Mifflin: Very early, we recognized that this was extremely reliable technology and by doing one eye at a time it was mostly just inconveniencing the patient. Rarely, do we still see patients who are a little bit uncomfortable with the thought of doing both eyes and we offer that option. Most people are afraid to have this surgery, but by the time we have finished educating them and getting them to the day of surgery, they are very comfortable.

The other fear that patients have is that they are able to do something to cause a bad outcome, and that is actually not true. It is such a safe surgery and we have such a low tolerance for risk in an elective eye surgery like this that we have literally made it risk-free in terms of anything the patient can do to cause a bad outcome.

Postoperative Care for Optimal Results

The patient can put themselves at risk by being non-compliant with postoperative care. There are medications, and prescription eye drops that are necessary. There are certain protective and common sense things that are required during the healing period. Barring that, it's almost risk-free, and that really boils down to having a good conservative screening process that steers away people who are better served by wearing glasses or contact lenses.

_{updated: January 30, 2025
originally published: February 16, 2016}