Femto LASIK: Types, Procedure, and Recovery

Laser eye surgeries have gained popularity due to their effectiveness, shorter recovery times, and decreased post-operative complications. Over the years, advancements such as the incorporation of femtosecond laser technology have further improved these procedures.

What is Femto LASIK?

Femtosecond-assisted (Femto) laser in-situ keratomileusis (LASIK) is a form of laser eye surgery utilized for reshaping the cornea to address vision issues. Keratomileusis, the technique of reshaping the cornea to correct refractive errors, dates back to 1948 when it was initially performed using a microkeratome, a minor surgical device with an oscillating blade.

Initially known as anterior lamellar keratoplasty (ALK), this method evolved with the enhancement of technology by the late 1980s and early 1990s.

The advent of the Femto laser in the early 1990s revolutionized the procedure, enabling the creation of a corneal flap with a laser instead of a mechanical tool. This advancement allows for easier healing post-surgery without the need for sutures.

Types of Laser Surgery

There are two primary types of laser surgeries currently employed for corneal reshaping:

Photorefractive keratectomy (PRK):

This method involves the removal of superficial corneal layers, followed by precise laser shaping to correct refractive vision issues. PRK was first conducted in the 1980s.

Laser in-situ keratomileusis (LASIK):

LASIK combines aspects of ALK and PRK by creating a corneal flap that is lifted during the reshaping process. The flap is repositioned at the conclusion of the procedure and heals naturally over time.

Who is the ideal candidate for Femto LASIK surgery?

To qualify as a candidate for Femto LASIK surgery, you must meet the following requirements:

Age of 18 or older: LASIK procedures are strictly meant for adult patients.
Stable vision: Surgery can’t be performed if your prescription has changed in the past year, you take vision-altering medications, or experience hormonal fluctuations affecting your vision like those from breastfeeding or diabetes.
Good wound healing: You should not have any conditions or be on medications that hinder proper healing.
Thin cornea: Individuals with skinny corneas might face a higher risk during a LASIK procedure.
Previous refractive surgeries: Past refractive surgeries may disqualify you from undergoing Femto or other LASIK procedures.

Conditions that may make you ineligible for surgery include:

blepharitis
dry eyes
glaucoma
herpes simplex
herpes zoster
iritis
keratoconus
ocular hypertension
presbyopia
uveitis

How much does Femto LASIK surgery cost?

The cost of Femto LASIK surgery in India can vary based on several factors, including:

Hospital or Clinic: Premium eye care centers with advanced technology and experienced surgeons may charge higher fees. Reputed institutions often offer packages that include pre-surgery consultations, the surgery itself, and post-operative care.
Location: The cost may differ significantly between metropolitan cities and smaller towns. For instance, the cost in cities might be higher compared to smaller cities.
Technology Used: The type of laser technology and equipment used can influence the cost. More advanced, newer technologies tend to be more expensive.
Surgeon’s Expertise: Highly experienced and renowned surgeons may charge more for their services. Their expertise often ensures better outcomes and safety.
Pre- and Post-Surgery Care: Comprehensive care packages that include follow-up visits, medications, and tests can increase the overall cost.

Typical Cost Range

In India, the cost of Femto LASIK surgery typically ranges from INR 80,000 to INR 1,50,000 per eye. Some centers may offer discounts or packages that reduce the overall cost, especially if both eyes are treated simultaneously.

What is the mechanism behind Femto LASIK?

To comprehend how Femto LASIK functions, it is crucial to grasp the development of vision issues and the role of refractive surgery in addressing them. Refractive errors arise when the eye encounters challenges in refracting and focusing light. Varieties of refractive errors encompass:

Myopia: Difficulty in seeing distant objects, also known as nearsightedness. It is characterized by the cornea’s steep shape, prompting refractive surgery to lessen the cornea’s curvature for correction.
Hyperopia: Difficulty in perceiving nearby objects, also termed farsightedness. This condition results from the cornea being excessively flat, necessitating refractive surgery to augment the cornea’s curvature.
Astigmatism: Anomalies in the cornea’s shape attributed to irregular curvature. The shaping surgery can rectify these aberrations.
Presbyopia: Loss of eye lens flexibility due to ageing. This age-related occurrence involves the lens inside the eye becoming rigid, impairing its flexibility. While refractive surgery can alleviate this issue in select cases, it might exclude you from being an ideal candidate for refractive procedures.

Not all refractive errors are amendable through refractive surgery. It solely targets issues that can be rectified by reshaping the cornea. When refractive surgeries are employed to address these issues, an incision is made on the eye’s surface, followed by using a laser to reshape the cornea.

Preparing for Femto LASIK

Prior to your Femto LASIK surgery, consult with your surgeon to discuss your objectives, risk factors, and desired outcomes. Your surgeon should provide you with information on realistic expectations, risks, and costs associated with the procedure. If you wear contact lenses, you may be advised to refrain from wearing them for 1-3 weeks based on the type of lenses you use.
Before the procedure day, your surgeon will conduct a comprehensive examination and perform an eye scan to guide the laser.
Ensure your job requirements are in line with having refractive surgery by checking with your employer. Review the procedure costs, potential insurance coverage or discounts, and determine the payment method for the surgery. Make sure there is someone to bring you to and take you from the procedure. You will also be instructed to avoid using cosmetics, creams, or lotions near your eyes for at least one day before the surgery.

Procedure for Femto LASIK

On the surgical day, these steps will be carried out:

You will be led to a procedure room and positioned in a reclining chair.
You will lay on your back beneath the laser system and a computer monitor.
Numbing drops will be instilled into your eyes.
An eye speculum will be employed to keep your eyelids open during the procedure.
A suction ring will be precisely placed over the pupil, followed by the application of suction.
A glass lens will be used to stabilize the eye globe and flatten the cornea.
Once the laser is focused on the surgical area, your surgeon will apply the initial treatment.
The laser will pulse to form a flap on the cornea’s surface, with the subsequent release of suction.
After peeling back the flap, an exact excimer laser will utilize ultraviolet rays to reshape the cornea according to the needed correction.
You might perceive a ticking noise or a burning smell during this phase of the procedure.
In Femto LASIK, the flap is repositioned upon completing the reshaping.
The flap will naturally heal without the need for sutures.
The total duration of the procedure for each eye should not exceed 30 minutes. Ensure you have a companion to drive you home post-procedure.
Similar to traditional LASIK, Femto LASIK carries risks, and individuals with specific traits or conditions may not be suitable candidates for the procedure. Certain professions might require authorization for or restrict refractive surgeries due to limited long-term outcome data.

Risks of Femto LASIK Surgery

Treatment effectiveness may be minimal or ineffective.
Risk of permanent vision loss.
Reduced effectiveness of treatment over time.
Experience ongoing vision symptoms like halos around lights.

Complications specific to Femto LASIK

Opaque bubble layer (OBL): Gas bubbles accumulating in the flap can interfere with the laser’s function.
Transient light sensitivity syndrome (TLSS): May lead to extreme light sensitivity and vision issues post-surgery, with treatment using topical steroids.
Rainbow glare: Caused by minor irregularities on the back of the flap, resulting in coloured bands of light in vision.

After Femto LASIK Surgery

You may encounter discomfort such as mild pain, burning, itching, or irritation.
Experience watering or tearing of the eyes.
Encounter hazy or blurred vision.
Sensitivity to light, halos, or glare around lights.
Redness or bloodshot eyes may occur; these symptoms usually resolve within a few days.

Recovery

Wear an eye shield for the first 24 to 48 hours post-surgery to protect the eye.
Follow-up appointment within 24 to 48 hours after surgery to remove eye shields and assess vision. You may be given eye drops to bring home for preventing infection or inflammation.
Even if your vision is blurred, you will be instructed not to wear contact lenses on the operated eye.
It is recommended to refrain from using lotions, creams, and cosmetics for two weeks following surgery.
Your doctor will suggest limiting activities such as non-contact sports and strenuous activities for one to three days post-procedure.
Avoid swimming or using a hot tub for one to two weeks after surgery.
Stay away from contact sports and rigorous activities for a minimum of four weeks after your surgery.
Your vision may experience fluctuations during the initial months after surgery, with the full effects of the procedure taking three to six months to become apparent.
Your surgeon will arrange regular follow-up appointments with you for a minimum of six months post-surgery.

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