Last updated: 11/24/2009

Before LASIK, patients need to have a complete eye evaluation and comprehensive medical history taken. Soft contact lens wearers should stop wearing their lenses at least one week before the initial exam. Gas permeable lens wearers should not wear...

their lenses from three weeks to a month before the exam. Contact lens wear can alter the cornea's shape, which should be allowed to return to its natural shape before the initial exam.

The initial exam

During the first exam, the surgeon's staff will take a comprehensive medical history to determine if there are underlying medical problems that will prevent a successful surgery. This screening process will determine patients who should not have the procedure including:

• pregnant women or women who are breastfeeding
• patients with very small or very large refractive errors
• patients with low contrast sensitivity
• patients with scarred corneas or macular disease
• people with autoimmune diseases
• diabetics
• glaucoma patients
• patients with persistent blepharitis

The physician will also ask about medication. Some prescription medicines have been known to cause post-surgical scarring or cause flecks under the corneal flap. It's important for the patient to disclose any prescriptions or over-the-counter medicines taken regularly. Allergies to prescription medicine must also be discussed.

A complete eye exam will be performed to determine refractive error, uncorrected visual acuity and best corrected visual acuity. A cycloplegic refraction using eye drops to dilate the pupils also will be performed. Other examination procedures include corneal mapping, a keratometer reading to determine the curvature of the central part of the cornea, a slit lamp exam to determine any damage to the cornea and evidence of glaucoma and cataracts. A fundus exam also will be performed to check for retinal holes and macular degeneration and macular disease. Other tests are done to rule out glaucoma.

While those tests check general eye health, others more closely relate to the outcome of LASIK surgery. A corneal pachymeter measures the cornea's thickness. This is important because surgeons remove tissue during surgery. A pupilometer measures the pupil when it is naturally dilated in a dark room without drops. Patients with large pupils have been known to have complications after LASIK, such as glare and halos.

Treatment options/Informed consent

After the exam, the patient and physician discuss treatment options and expectations. Patients who expect to see perfectly after LASIK are usually not considered good candidates because they usually are dissatisfied with the results. Surgeons also discuss how patients will handle presbyopia, which occurs during the patient's 40s. LASIK does not correct for presbyopia, and patients will need reading glasses to accommodate for reading when presbyopia occurs. Sometimes patients 40 and older opt for monovision to treat presbyopia, where one eye is left untreated or one eye is only partially corrected. Monovision means one eye is for short-term vision and the other is for distance vision.

The doctor will advise the patient of any possible LASIK complications, explain the procedure and answer questions. After deciding on a treatment option, the patient is required to sign an informed consent form.

At this time, payment will also be discussed. Insurance usually does not cover LASIK, although some offer a limited benefit for the procedure. Some laser centers offer payment plans and some physicians have begun using credit companies to handle payments. LASIK can cost anywhere from $999 to $3,000 per eye. The cost varies greatly from surgeon to surgeon. Most of the fees are global, and cover all the pre-operative and post-operative exams as well as the procedure. Patients should be advised of what the fee covers, and if retreatments to the original surgery are included in that price.

Pre-surgery preparations

The patient is advised to discontinue contact lens wear immediately and refrain from using creams, lotions, make-up or perfume for at least two days before surgery. Patients may also be asked to scrub their eyelashes for a period of time to remove any debris. Patients also must find transportation to and from the surgery, and also to and from the first post-operative visit. Medication and distorted vision make it unsafe for the patients to drive after LASIK.