The Best Lasik Outcome Is Within Your Reach

If you want the best outcome from your LASIK surgery, there are a few small things you can do before and after your laser eye surgery that can improve the chances of a superb outcome and may even help you achieve better vision than you have ever had in glasses or contact lenses.  But first, you must remember that your eye and the clear part of your eye (the cornea) is a living, breathing part of your body, and it will be affected by any variables that you may purposely  or inadvertently, introduce.  

Understanding what those variables are and gaining knowledge as to what factors contribute to proper healing and what variables may prevent it is critical to the success of your LASIK, or any refractive or laser eye surgery you undergo.

 

Variables That Can Affect Your LASIK Outcome:

Your LASIK Surgeon

Of course, having an experienced surgeon with an experienced team is of paramount importance because every eye and every individual is different, and the more cases under the surgeon’s belt, the better they will be at recognizing potential challenges for surgery or post-surgical management.

 

If you’ve come to Diamond Vision, you can already check that box, as my head technician and I have over 120,000 combined refractive surgery cases under our belt, and I alone have performed over 80,000 cases.

Now, on to the variables that you must be aware can impact the success of your LASIK surgery.

 

Systemic Conditions

Diabetes, Rheumatoid Arthritis, thyroid disease, and other autoimmune conditions may have a negative impact on your LASIK outcome or require your surgeon to monitor you more closely both pre and post-operatively to ensure an optimal outcome, and if your condition is severe or uncontrolled, it may preclude you from being a candidate for LASIK surgery.  That said, it’s important to communicate with your LASIK surgeon about any medical conditions from which you suffer, as well as medications you take, in addition to any relevant ocular or family history.  Be particularly over-inclusive in your communication with your surgical team, and mention any over-the-counter medicines you may take as well.   Believe it or not, nasal decongestants and allergy medicines can contribute to a dryer eye, so let us know if you take these meds or plan to over the post-operative period. 

Finally, if you are pregnant or nursing, you’ll want to hold off on LASIK until at least a month after you’ve stopped nursing.

  

UV Light Exposure

In the first three months following your eye surgery, you should be conscientious about wearing UV light protective sunglasses when outside, anytime it’s not dark, rainy, or dismal.  This is because even a lightly cloudy day will provide a reasonable amount of UV light exposure, and your eye will be more sensitive to this exposure during these first few months post-LASIK. Too much UV light exposure will excite the living cells in the cornea to heal more aggressively, and this can translate to building back some of the tissue that was removed, which is called regression. If this were to happen, you might see your vision once again get slightly blurry.  In such a scenario, it may even be necessary for your LASIK surgeon to bring you back for a second surgery, which we refer to as an enhancement. But this is largely preventable if our patients are good about limiting such variables in the first place.

 

Management Of Dry Eye

Even though you will most likely be seeing very well within a day or two following your LASIK eye surgery, there is healing going on at the microscopic level and this healing generally takes 3 to 6 months to run through its full course.  Your cornea has nerves that communicate with the rest of your eye, and these nerves will be reconnecting and migrating through your traditional or all-laser LASIK flap within your cornea, so for several months following surgery, you will generally be more reliant on preservative-free artificial teardrops to replenish your ocular surface. These artificial tears should be used consistently for those first few months following your eye surgery because your cornea won’t be sending adequate signals to the rest of your eye to tell you that it needs more moisture until that corneal nerve reconnecting and healing has taken place. 

I performed a prospective study roughly ten years ago, which demonstrated that while patients tended to be slightly more dry immediately following their LASIK surgery, by six months post-LASIK, the vast majority of patients had either returned to their original baseline level of dryness/ocular surface health or had improved over their baseline.  This observation was explained by two factors.  Many of the patients in the study had been previous contact lens wearers, and no longer sticking a piece of plastic in their eyes every day resulted in improved ocular surface health.  More on that later. 

The second factor was the education of our patients, who had been thoroughly informed about what habits could be contributing to an unstable tear film and dry eyes and what habits can improve ocular surface health.  At Diamond Vision, we take this education and partnership with our patients very seriously.

Some individuals heal very quickly, and others heal more slowly, but we have found over many years of clinical practice that three months of consistent, preservative-free artificial tear drop use after your Lasik eye surgery is very helpful in maintaining a great visual outcome and preventing regression.

We encourage patients to use these drops at least eight times a day for the first month, six times a day for the second month, and four times a day for the third month. Of course, if patients want to use them more frequently than that, they can certainly do so without any risk as long as these artificial teardrops are preservative-free. We always recommend the best preservative-free artificial teardrops and keep them stocked at our offices so that patients don’t have to worry about getting the wrong drop over the counter. 

 

Computers

An unavoidable variable in our digital world now is the use of computers and smartphones, which we find ourselves on many more hours every week now than we were even just five years ago.  With the barrage of enticing smartphone apps being downloaded daily, this trend is not likely to improve, so I want to arm you with a very important observation I’ve made regarding computer work/smartphone use versus when we are just conversing with one another. First,  the rate at which we blink our eyes decreases to 1/3 or even 1/4 as often as what would be considered normal. So rather than blinking 10 to 12 times per minute, we may only blink 3 to 4 times per minute while on these devices.

 

In addition to this, 85% of patients, in my experience, partially blink their eyes while on the computer. Meaning their eyelids don’t come together when they blink. This not only results in improper movement of the eye’s tear film it also results in a lack of movement of the Meibomian oil glands, of which you have roughly 30 in each eyelid. A proper blink requires that your eyelids meet, and this compression, or minor collision of the eyelids, if you will, is a necessary force required to move the oil from within your eyelid glands onto your ocular surface.  The vast majority of patients who come to see me in my office suffering from dry eyes or fluctuant vision, which is a symptom of a poor tear film, have blocked Meibomian eyelid oil glands, which is almost always the result of improper blinking, or contact lens use, or eye rubbing, or a combination of the three. 

One of the easiest things you can do to improve your chances of making proper blinks more frequently and ensuring consistent movement of your eyelid oil glands is to do what I do on my computer and smartphone, which is that every 15 minutes, I will close my eyes consciously for five seconds. I refer to this with my patients as the “five-second mini-break.”  Believe it or not, even though this only takes 20 seconds an hour, it will help to reverse bad habits the computers have created and allow you to become a better blinker, which will result in a more consistent tear film and better vision performance throughout the day. Poor blinkers tend to be consistent only with eye rubbing, which is compensation for not blinking well, and while rubbing the eye may temporarily feel good and may even push a little of the oil out of the eyelid glands, it is a pro-inflammatory move that results in the release of histamine, which increases blood vessel growth and can even cause swelling of ocular tissues.  This can weaken the cornea, create astigmatism, and certainly make patients lose perfection of the fine outcome they might otherwise enjoy from their LASIK surgery.

So remember that good movement of your eyelid oil glands creates a “moisture insurance policy” for patients essentially because even if you miss an artificial teardrop every once in a while during your post-LASIK period, having a stable oil layer over your tear film will keep the cornea’s moisture in and prevent it from evaporating too quickly.

 

Humidity Levels

Speaking of ocular surface/tear film evaporation, it’s important to remember that as the temperature falls in the winter months and heaters come on, ambient humidity levels fall as well. So having a low threshold to have a desktop humidifier by your computer station and one by your bedside, like I do when humidity levels fall, will serve you well anytime you plan to be on the computer or a digital device for a long period, and this is particularly helpful in the few months following your Lasik surgery.

 

Warm Compress Use

Beyond proper blinking, patients who want to hit a home run postoperatively would do well to apply a warm compress on their closed eyelids before they go to bed at night at least a few times a week, as this helps liquefy the eyelid gland oil and allows it to flow more consistently, arming you the next morning with a more protective ocular surface, which will be less likely to breakdown over the following day’s prolonged computer work. 

At Diamond Vision, I worked with my sister-in-law, who is a craftsman, and created a specialized warm compress which we call an “eye pillow”  which utilizes organic flaxseed in a microwavable cotton pouch, which I have found to be better than anything I could find in the pharmacies or elsewhere.  They are available in all our LASIK surgical clinics.

 

Nutrition/Fatty Omega Acids

Embracing foods in your postoperative period that are rich in omega-3 fatty acids will also help provide your eyelid’s oil glands with the oil they need to best support the ocular surface.  So salmon, chia seeds, flaxseeds, walnuts, and avocados are just some of the ways that we can arm ourselves with the oil building blocks that will help our eyes provide us with solid vision. We have a great supplement that I get directly from a manufacturer in Norway in stock for my patients.  Since I know certain days, I’m just not going to eat the foods I mentioned above at the levels I should, I find that taking a supplement is a helpful way to make sure I’m getting the right amount of omega-3s in my diet.

 

Be careful, however, to make sure that if you take a fish oil supplement, the fish oil is triglyceride-esterified, and not alcohol-esterified, as alcohol esterification will strip the supplement of much of its nutritional value. The best brands are PRN De3, which we carry, and Nordic Naturals. Many of the brands featured at local pharmacies aren’t up to par unfortunately and do not use triglyceride esterification like De3 does, which is of course more costly to manufacture.

 

Eyelid Hygiene

Good eyelid hygiene also goes a long way to preventing chronic inflammation of the eyelids which, if that happens, can lead the blood vessel growth which may strangle the precious glands we’ve been talking about. Debris that can collect on the eyelash base will harbor bacteria and this lash debris can fall into the ocular surface. This results in redness irritation and increased dryness. So one week after your Lasik eye surgery, it’s a good idea to get in a habit in the morning, when you take your shower, to take a diluted gentle shampoo like Johnson and Johnson’s No More Tears shampoo on a wet washcloth and lightly move the washcloth over your closed eyelids from the nose to the temple to remove any of this debris.

You can also use a lid scrub, which can be purchased over the counter. Ocusoft and Optase both make good lid scrubs that resemble a tiny napkin and contain either diluted tea tree oil or hypochlorous acid, both of which do a good job of removing eyelash debris and preventing debris and bacterial eyelid buildup.  Just remember that in the  first week after your LASIK eye surgery, you shouldn’t be touching anything around your eyes- I refer to this area around the eyes as the “no-fly zone” because I’m an Air Force guy.

 

Contact Lens History

Finally, keep in mind that if you wear contact lenses for years, you will tend to have more blood vessel growth around the cornea, and also eyelid oil gland blockage as the blood vessels have become more prominent in your eyelids as well, often strangling those precious glands. It’s something the contact lens companies don’t want you to know about, but wearing a piece of plastic on the eye creates a de-oxygenated environment and the body is smart and will want to bring oxygen to where it’s being deprived. In this case, the cornea is being deprived of oxygen so it makes sense that inflammation is created, which is the only way that the body can build new blood vessels. This is why, over time, patients become dryer and dryer in their contacts, because in order to build those new blood vessels, the body must do so at the expense of the real estate that was previously there, and that real estate is the glands and goblet cells the produce your tears, mucin and oil in the first place, to provide you with a consistent and healthy ocular surface so critical to achieving and maintaining a great visual outcome following your Lasik surgery. 

So if you wore contact lenses for many years, and we see the changes I described above, we may recommend a more aggressive post-operative tear film optimization regimen which may include specific medicines to bolster your tear film and ocular surface health more quickly.  The good news is your eyes will soon thank you for finally letting them breathe without a contact lens starving them of much-needed oxygen.   So I hope you enjoyed the above pearls and keep in mind my team and I are always available to answer any questions that come up along the way during your LASIK journey.  

Ultimately, my job as a refractive surgeon is not only to perform a technically superior surgery that reshapes your eye to the ideal architecture for you, but it’s also to provide you with the education necessary to ensure the outstanding visual outcome you achieve is protected, preserved, and maintained for years and years to come. 

 

Eye Rubbing

Many patients rub their eyes out of habit, and some are unaware they’re even doing it.  Rubbing of the eyes often stems from poor blink rates and partial blinking, an irritant or allergen introduced, such as pollen or pet dander, and inflammation caused by oxygen depriving contact lenses. Patients who are on digital devices tend to rub their eyes subconsciously for reasons I’ve explained earlier:  they have reduced blink rates and poor blink function (partial blinks) which results in tear film stasis and inflammation which spurns them to rub their eyes.  It becomes a vicious cycle, because usually there is an inflammatory nidus, however subtle it may be that triggers the urge to rub the eyes.  However, the act of rubbing the eyes is a pro-inflammatory move because it activates mast cells in the skin of your eye (conjunctiva) and these mast cells release histamine, which increases blood vessel dilation and encourages blood vessel growth over time, so the eye gets redder and even the eyelids become more inflamed from the act of eye rubbing.

 

If this wasn’t enough, histamine is osmotically active, which means it pulls water toward it, so at a microscopic level, water is introduced to the cornea causing a slight swelling of the clear layers of the cornea and this results in increased dispersion of light, which patients interpret as loss of the crispness of visual images and sense that their vision has become more blurred. Beyond this, some patients develop what I refer to as ritualistic eye rubbing, not necessarily related to any of the above but because it “feels good” to them, at least momentarily, until the relief they feel dissipates and they eventually feel the urge to rub again.  Perpetual or ritualistic eye rubbers also tend to become dependent on eye drops like Visine,  designed to “get the red out,” but these drops provide only temporary relief and result in eyes that are even dryer and redder over timeJust as important as the above, patients must understand that eye rubbing, particularly the circular, knuckle or palm rub directed squarely over the eyeball, will encourage the development of astigmatism over time because the cornea collagen fibers can be weakened by this continuous external force and cornea tissues centrally may be directed peripherally, leaving the central cornea much thinner (and the peripheral cornea thicker) than it would otherwise be had the patient not been consistently rubbing their eyes for years. 

If you plan to have laser vision correction or any refractive corneal surgery, you should take care not to rub your eyes because those that do risk getting astigmatism back after it’s been removed.  Worse yet, eye rubbers have a much higher risk over their lifetime of developing keratoconus and corneal ectasia, which is the result of a weakened cornea that can no longer properly withstand the internal forces pushing from within the eye to maintain its spherical shape.  In other words, your eye’s intraocular pressure, which you must have at a reasonable level to maintain functional vision, can create a water balloon effect, because the cornea now lacks the structural integrity to properly hold itself together against the internal force, so the cornea moves forward and down with gravity, as would a balloon filled with water.

Fortunately, these disease processes can be mitigated with corneal cross-linking, which is an FDA-approved procedure designed to strengthen the cornea fibers so that such ecstatic processes can be stopped in their tracks and even reversed. It’s also worth noting that keratoconus and kerato-ectasia post Lasik are quite rare, occurring in less than one in 2000 to one in 4000 patients per year, but it is out there and so it’s worth mentioning because what you do to your eyes can either increase or decrease the chances of developing it.

The bottom line is that the cornea is a beautiful and vital element within the visual system, and as resilient as it may be, it is not designed to fight a war on two fronts.  It is designed to withstand the internal force from our intraocular pressure but if it’s also being hit with strong external forces in the form of consistent and deliberate eye rubbing, it may succumb to these combined forces over time which may lead to decreased vision, unless the condition is recognized quickly and addressed by your eye care professional.