For years, excimer lasers have been used for LASIK and PRK, to correct “lower order” abnormalities (aberrations), such as nearsightedness, farsightedness, and astigmatism. However, other visual distortions, called “higher order aberrations,” can decrease the overall quality of your vision.
These imperfections in your eye’s optical system may affect the clarity of your vision and how well you see at night or in low light conditions. Higher order aberrations are more apparent when the pupil is large and can cause glare, halos, and other unpleasant visual effects.
Unless these higher-order aberrations are kept to a minimum, the quality of your vision after your laser treatment may not be ideal, even if you have measurable vision of 20/20 in the exam room.
With Wavefront laser treatment, hundreds of individual sites on the cornea are treated to minimize higher-order aberrations, thereby diminishing glare, halos, starbursts, and decreased contrast sensitivity. The ALLEGRETTO WAVE® EX 500 customizes every treatment based on the patient’s individual prescription and the shape of their cornea. The Wavefront Optimized™ treatment considers the unique curvature and biomechanics of the eye to preserve vision quality by inducing fewer distortions that can cause glare and halos at night.
Allegretto Wavelight
We use the Allegretto Wavelight EX 500 wavefront and pupil/eye tracking laser with the latest software and hardware upgrade.
The excimer laser beam is centered on the eye in a team approach between the patient and our specialists. Specifically, the patient is coached and encouraged to maintain fixation on a blinking light and the surgeon, using a joystick and subtle manipulations of the patient’s head, maintains fixation and centration on the patient’s pupil.
Although most patients are concerned that they will be unable to fixate on the light, in reality most people fixate extremely well. However, some patients have a difficult time fixating on the light. Additionally, some medical conditions of the eye, such as nystagmus, can prevent the patient from fixating.
We use the latest technology to ensure your safety by employing only lasers with active tracking mechanisms, so there are no worries about slight eye movement. We have been thrilled with the results of the Allegretto laser tracking system. If, for no other reason than that this system has been very useful in allaying the anxiety of patients afraid that they will not be able to “watch the light” during laser treatment.
Benefits of Wavefront LASIK
Wavefront LASIK creates a treatment plan based on a detailed map of your eyes rather than relying only on your glasses prescription. Potential benefits include:
- More personalized laser vision correction
- Reduced dependence on glasses or contact lenses
- Treatment for nearsightedness, farsightedness, and astigmatism
- Improved visual clarity and sharpness
- A quick outpatient procedure
- Fast initial recovery for many patients
Candidates for Wavefront LASIK
You may be a good candidate if you:
- Are at least 18 years old
- Have a stable vision prescription
- Have healthy corneas with adequate thickness
- Have realistic expectations about your results
- Do not have an uncontrolled eye condition
- Want to reduce your reliance on glasses or contacts
A complete eye examination is needed to confirm whether Wavefront LASIK is the safest and most effective option for you.
Complications During the LASIK Procedure
Complications during the operation are uncommon and include the following: inability to seat the suction ring and/or inadequate suction, incomplete femtosecond laser pass, irregular flap or tearing of the flap. These may prevent us from performing LASIK or result in an inadequate flap requiring the procedure to be rescheduled at another time in the future. This could result in astigmatism or inadequate correction. Less common is the creation of a free unhinged cap (which requires suturing back in place) or loss of the flap (exceptionally rare). If the flap is lost, a PRK or possibly a partial or full-thickness corneal transplant would be required weeks to months following the flap loss. Vision without glasses or contacts is generally poor following these complications. It is theoretically possible that LASIK could result in blindness from disruption of the blood supply to the optic nerve or retina.
Possible excimer complications include decentered ablation (the treatment area is decentered), or improper focus by the patient on the target device. These can cause undercorrections, overcorrections, and astigmatism, which could require additional surgical corrections (laser or astigmatic keratotomy) and may result in loss of best correctable visual acuity, glare, ghost images, double vision, and halos that cannot be corrected. Generally, a decentered ablation cannot be corrected surgically and results in the need to wear a gas permeable or scleral contact lens.
Post-Operative Complications and Side Effects of LASIK
Pain: During the procedure, LASIK is basically painless. Topical anesthetic drops provide excellent anesthesia. No injections are required. Patients experience pressure when the suction ring is applied. This lasts for approximately 60 seconds. There is usually minimal to no post-operative pain following LASIK. Some initial soreness may occur due to the suction ring. A feeling of scratchiness may be experienced the first night and will usually be gone by the following morning.
Subconjunctival Hemorrhages: Small broken vessels on the white of the eye due to the suction ring are common. They cause no problem and clear within two weeks.
Light Sensitivity: Your eyes will be somewhat light sensitive, and you may experience glare during the day and at night during the first few months.
Overcorrection, under-correction or induced astigmatism: There can be a mild overcorrection, under-correction or astigmatism initially after almost all refractive surgeries. This will usually diminish over the following weeks to months. Significant permanent overcorrection, under-correction, or astigmatism can be corrected with glasses or contact lenses or a laser “touch-up.”
Ghost Images and Double Vision from One Eye: This is due to the surface of the cornea healing with a “wavy” configuration or from the induction of “higher order aberrations.” This can also give rise to image distortion and a decrease in spectacle-correctable vision, glare, halos, starbursts, and decreased contrast vision. Many cases of visual distortion resolve within a year. However, if they do not, these symptoms can sometimes be diminished by the use of a gas permeable or scleral contact lens. While the lens is in place, the distortion and ghost images will not be as noticeable. However, when the lens is removed, the distortion and ghost images will reappear. A very small number of patients may be required to wear gas permeable or scleral contact lenses full-time following LASIK to achieve their best vision and diminish distortions.
Sometimes visual distortions can be caused by a LASIK-induced “dry eye.” If this is the case, with the use of non-preserved artificial tear drops, oral omega 3, plugs in the tear drains, and possibly Restasis or Xiidra eye drops, and/or “serum tears.” Most cases of post-LASIK “dry eye” resolve within 12 to 18 months.
Folds (like the striations seen just before tearing a piece of cellophane off of a roll) occur in about 5% of flaps in people with high amounts of myopia (6.00 diopters or more), and occasionally lower myopes who require large zones of treatment. Most of the time the folds do not cause symptoms, but occasionally they can result in distorted vision, decreased vision, or a decrease in contrast appreciation. Additionally, patients may notice starbursts, glare, and halos at night. If patients have symptoms from microfolds, the flaps may be lifted and an attempt to “iron-out” the folds undertaken. However, in some cases, the folds cannot be “ironed out,” and patients may have persistent symptoms and be required to wear a gas permeable or scleral contact lens to decrease these symptoms.
Night Vision: Glare, halos, and starbursts around lights are very common initially following LASIK. These symptoms may last 6 to 12 months. They generally diminish significantly by one year but may persist. A decrease in night vision quality (contrast) may be noticed. Patients occasionally require night driving glasses following refractive surgery.
Enhancement Procedures: Enhancements or touch-ups may be necessary following LASIK. Enhancements may be requested due to regression, undercorrection, overcorrection, or induced astigmatism. In the milder myopic corrections (under -4.00 diopters), enhancements are usually needed in less than 2% of cases. In moderate myopic corrections (-4.00 to -6.00 diopters), the enhancement rate is approximately 5%. Higher myopic corrections (-6.00 diopters and above) have a higher percentage of enhancements. The higher the myopia, astigmatism, or hyperopia, the higher the enhancement rate. When astigmatism correction is combined with myopic or hyperopic correction, the need for enhancements is slightly increased. This is especially true with astigmatism corrections over 3.00 diopters. Occasionally, astigmatism will be created by the LASIK or laser procedure where none existed pre-operatively. In most (but not all) cases, this induced (regular) astigmatism can be reduced with an astigmatic keratotomy or a laser touch-up procedure. The enhancement rate for higher amounts of hyperopia/farsightedness (+4.00 and above) is about 20%. Also, patients who are long-term hard contact lens wearers (RGP lenses) will have a higher enhancement rate.
Infection: This can be a serious complication, but fortunately is extremely rare in all types of refractive surgery. Most can be treated effectively with antibiotics, but in the extremely rare case, vision or the eye could be permanently lost.
Permanent Decrease in Vision: All refractive surgery results in some decrease in what is known as contrast vision – the ability to discern subtle shades of gray. This is a qualitative measurement of vision. Clinically, some patients will notice a decrease in the quality of their night vision. Rarely is this a significant decrease.
The chance of reduced correctable (with glasses) vision (greater than two eye chart lines of vision) is 0.5% to 2.0%. It is highest in myopic corrections above -7.00 diopters and hyperopic corrections above +4.00 diopters, and in cases of high astigmatism above 4.00 diopters. The chance of extreme or total loss of vision is exceedingly low with LASIK. Potential causes include severe infections, corneal scarring, optic nerve or blood vessel damage, or retinal detachment.
Rarely, following LASIK, the cornea progressively becomes thinner and steeper. This is called “ectasia” and is essentially the development of (or progression of) pre-existing but subclinical “keratoconus.” If this occurs, patients must wear gas permeable or scleral contact lenses or undergo additional surgery such as Intacs, with or without corneal cross-linking, or corneal transplantation.
Additional Post-Operative Complications: Material under the flap (usually of no consequence) may rarely need to be rinsed from underneath the flap. If the flap becomes dislocated, the flap may need to be lifted and repositioned. Epithelial in-growth is growth of the corneal surface epithelial cells beneath the flap. This requires lifting the flap and removing the epithelium. Melting of the cornea from epithelial in-growth is rare, but if occurs can be a serious problem. In-growth may require suturing (with or without gluing) of the flap if it reoccurs. Sterile white blood cell infiltration can occur beneath the flap (DLK or CTK). This is treated by increasing the frequency of the use of your topical cortisone drops. Occasionally the flap must be lifted to help treat DLK. Sometimes this inflammation can cause a poor visual result.
There are other possible complications and side effects, which are not mentioned because of their extreme rarity.
Fortunately, refractive surgery procedures are safe and effective, and complications are rare. However, like any operation, problems can occur, and patients must always weigh the risks and the benefits before undergoing surgery.
Why Choose Optima Ophthalmic Medical Associates, Inc. for Wavefront LASIK
Optima Eye Care uses advanced wavefront-guided technology to create a detailed map of how light travels through your eyes. These measurements allow the surgical team to personalize laser treatment beyond a standard glasses prescription, addressing your unique visual pattern while supporting clearer, more precise vision.
Mark R. Mandel, MD, and Robin Kuriakose, MD, are fellowship-trained corneal and refractive surgeons with experience in multiple vision correction procedures, including Wavefront LASIK, PRK, EVO ICL, and Custom Lens Replacement. They are supported by Optima’s dedicated laser team, whose knowledgeable technicians, optometrists, nurses, and coordinators guide you through your evaluation, treatment, and follow-up care.
Answers to the Most Common Patient Concerns
Schedule a Consultation Today
Wavefront LASIK is one of the most advanced laser technologies currently available. Your surgeon and the team at OPTIMA Eye are pleased to offer this sophisticated treatment to patients throughout the East Bay Area. If you would like to learn more about Wavefront LASIK or schedule a consultation, contact us today at (877) 210-2020. OPTIMA has convenient locations in Hayward, CA.
