Two areas are changing rapidly. The first is the use of computer assisted custom ablations for complex refractions. Companies such as Summit are well positioned to provide this technology. Secondly, the introduction of Hyperopic correction is now available:

LASIK For The Treatment of Hyperopia

LASIK for the treatment of hyperopia has been performed outside the United States for several years. In November 1999 the FDA approved Summit for the correction of up to +4.00 diopters, for people 21 years or older.

Hyperopic LASIK Procedure

The basic LASIK procedure is the same whether it is performed for the treatment of myopia or hyperopia. The changes for the correction occur within the laser program. Using the microkeratome, a flap is made in the cornea; the flap is then folded back to expose the stromal bed of the cornea. The Excimer laser is used to remove corneal tissue in a pattern that will steepen the central cornea, changing the way the light rays focus on the retina . This will result in an improvement in the uncorrected distance vision.

• Treatment of Hyperopic Astigmatism
  At this time, the FDA has not approved the treatment of hyperopic astigmatism. It has been our experience that for best results we first treat the hyperopia and at a later date decrease the astigmatism; or, depending on your refractive error, we may treat the astigmatism first and then treat the hyperopia.

Complications of LASIK Surgery

While we expect over 95% of our patients to be at least 20/40 or better and over 75% to be 20/25 or better without correction by the time the refractive surgery process is complete, complications can occur. Our commonest complication is that you may still need to wear glasses after surgery , particularly for reading if you are over 40 years. But there can be other infrequent risks such as:

• Over Correction
  Over correction following LASIK for low-to-moderate degrees of farsightedness occurs much less commonly than does under correction. However, over correction is relatively easily corrected. As with under correction, it is not possible to accurately predict how your eyes will respond to the treatment. A mild degree of over correction may be perfectly well tolerated. More significant degrees of over correction may necessitate the wearing of eyeglasses (in some cases bifocals) or contact lenses. Over correction may also require further refractive surgery.

• Under Correctionor Over Correction
  Some people will require an enhancement procedure or other surgical correction to attain this satisfactory visual results. In general, there is approximately a 5 to 15 % enhancement rate with LASIK. With regard to LASIK, the enhancement rate increases proportionately to the degree of your nearsightedness and astigmatism. A patient in the very low range of myopia (-2.00 to -3.00) can expect only a 3 % chance of needing an enhancement, while patients in the very high range (approximately -10.00 to -18.00) can expect an enhancement rate of closer to 10%. You may need to wear glasses for specific instances such as night driving, watching or participating in sports events held at night, and near vision demands such as needle point. Remember, if you aimed for good distance vision and are over 40 you can expect to need reading glasses. Under correction and over correction are the most common undesirable results of surgery.

• Irregular Astigmatism
  Irregular astigmatism can result from irregular healing or complications from the use of a microkeratome following any kind of refractive surgery. A contact lens might help the eye see well and wearing a contact lens might be a solution to seeing well if you should have irregular astigmatism following surgery. In our experience, once the initial healing period is complete (usually about three months), irregular astigmatism is quite uncommon following LASIK. It is our experience that when present it tends to improve with time, but there could be cases in which it remains. Today, Custom Excimer Ablations utilizing Corneal Topography can eliminate this complication (Autonomous Ladar (tm))
  
• Epithelial Cell In growth or Abnormality
  The surface of the normal cornea is covered by a layer of epithelial cells, that regenerate easily and grow quickly so that they rapidly cover areas of scratches, abrasions, and incisions. The negative aspect is that they can sometimes grow where they are not wanted, such as beneath a corneal flap as is used in LASIK. These cells can occur as either isolated pockets or nests which can come from a little nest of cells inadvertently left beneath the flap or from cells which grow in under the edge of the flap if any part of it is not sealed down well at the end of the procedure. We take great care to try to avoid both of these situations, but small groups of cells are impossible to see (until they grow larger) and small areas of poor sealing of the flap edge are at best difficult to identify. As a result in about 1 case in 400, we see a significant area of cells present beneath the flap. Fortunately, most of these are fairly easy to eliminate successfully, but it is possible that they could damage the flap or cause enough permanent haze or scarring that the flap would have to be removed and/or replaced by a donor flap. This could conceivably result in permanent visual loss or the attempts at treatment of it could result in serious complications (such as infection) with bad results.