Answers to Your LASIK Surgery Questions [Interview]

LASIK InterviewWe always suggest to people looking to get LASIK surgery to come in and we’ll answer any and all questions regarding what to expect with always-improving eye surgery technologies and procedures.

We decided to take some of the work out of even that part of LASIK curiosity. We asked a person who knows very little about LASIK to join BDP surgeon Dr. David McGarey in a conversation, who knows a lot. Below is what happened. We hope you get your question asked. If not, we’ll let you know at the end how to contact us.

Our Interview With a Surgeon

Dr. David McGarey has performed more than 20,000 cataract surgeries. He opened his private practice in Flagstaff in 1997 before joining BDP 10 years later. He graduated from Wright State University School of Medicine in Dayton, Ohio. McGarey is board certified by the American Board of Ophthalmology and the American Academy of Family Physicians. In other words, he knows eyes. Read on to enjoy his expertise.

Q: The first question is, “What results can I reasonably expect after LASIK surgery?”

Dr. DM: Nearly everyone can expect to have excellent vision after Lasik surgery. Most people will have 20/20 vision within the first few days after surgery.

Q: Would you say that there are any misperceptions around what those results will be immediately after the surgery?

Dr. DM: One of the misconceptions is the need for reading glasses when you’re over 45 even after LAISK surgery. You still need reading glasses as you age. And then it’s not uncommon to need an enhancement or some sort of touchup after LASIK.

Q: Can you speak to that for a moment?

Dr. DM: I’m not sure of our exact numbers, but I’m thinking less than 10% of the patients may need a touchup or enhancement after a LASIK procedure. That means, while we are shooting for as close to zero prescription as possible, occasionally there’ll be some leftover nearsightedness or astigmatism that needs to dealt with or enhanced.

Q: Would you still go under the laser at that point?

Dr. DM: Yes. If the patient needed an enhancement, in LASIK we already have a flap created from the first procedure. So, all that needs to be done is to lift the flap and do the extra treatment. That makes it pretty convenient that way.

Q: How long does it take to recover from LASIK?

Dr. DM: Most people feel pretty good the very first day after LASIK, but there would be restrictions in activities for the first week.

Q: Should patients restrict activities for the first week to be safe ?

Dr. DM: Yes. Rubbing the eye or swimming in freshwater lakes and ponds, or rivers and hot tubs. And then straining is another thing, for some surgeries. You can’t lift or strain. It’s not such a big deal with LASIK, but things that would get your eyes dirty, shoveling horse stalls or something like that, take some time off from that.

Q: Are there other general health or eye conditions that might rule out LASIK?

Dr. DM: There are certain eye conditions, which would rule out LASIK, like certain problems with the cornea, such as keratoconus or other cornea problems. Dry eyes can be made worse with LASIK. That usually recovers with time, but that is a relative contraindication.

In terms of medical problems, it’s not 100% clear. We usually have restrictions on that, like people who are keloid formers, they develop heavy scars. People who have conditions such as rheumatoid arthritis might not do as well. But the medical conditions are limited, there are not that many. We can usually do LASIK on most anybody with other medical problems, but eye problems definitely, there are eye conditions that will block and prevent it.

Q: Obviously there’s the initial consultation prior to going through the LASIK process. Would these problems with the cornea be identified in that process?

Dr. DM: Right, that’s the biggest thing we do is check for problems with the cornea and get accurate numbers for the treatment.

Q: What is the best age to have LASIK done?

Dr. DM: Patients are eligible to have LASIK when they are 21 and older. However, some people will go down to 18. The most common age range for LASIK is in the 30s.

Q: Why do you think that’s the case in the 30s? I mean, obviously folks in their 20s and 40s and 50s could have surgery, as well.

Dr. DM: People can afford to do it. Because they’ve earned the money, they can afford to have their eyes fixed without depending on somebody else to help them. They’re not dependent on reading glasses, yet. And it just seems to be a good age to do LASIK, it seems to me I’d say, mid-30s..

Q: What are some best practices? We’ll start with pre-surgery.

Dr. DM: For the pre-surgery, from the doctor’s standpoint, good preoperative testing is key. If there’s a place where they don’t do good preoperative testing, they can’t guarantee good post-operative results.

The best practices would be to be thorough with the preoperative testing, to not push the envelope on the restrictions or on borderline cases, and then just educate the patient well to understand the appropriate – what do I want to say? – expectations.

Then best practices post-op, is just use your eye drops. When LASIK is done, people should use their drops until they’re gone. Post-op care is right after surgery. You should expect to have some pain or discomfort from the surgery itself for the first day. Then by the very next day, generally most people are doing well. There may be some redness of the eye and things like that early on, but other than using eye drops as directed by the doctor, there’s not much else to do.

Q: What percentage of patients have had secondary procedures to correct or improve eye surgery results, so after the fact?

Dr. DM: That enhancement that we discussed when the prescription doesn’t come out just so is a certain percentage. We should have a correct number on that.

Then the other thing that rarely happens is to have some problem with a flap after LASIK. So if you’ve got a wrinkle in the flap or a fold, or something like that, or some debris under the flap, about 10% of patients may need another procedure on the flap or an enhancement for residual nearsightedness.

Q: I know Barnet Dulaney Perkins is well-known for the technology, the experience, doctors on staff. Would you say that your percentage of follow-up work that’s needed to be done is probably lower than, say…?

Dr. DM: The national average?

Q: Yes. Versus a competitor or is this industry standard, like 10% across the board. Is it an industry standard number or is this a Barnet Dulaney Perkins Eye Center number?

Dr. DM: Industry-wide, the follow-up work is usually something simple, is 8 to 12% of patients. In general, you can say that having better technology yields better results.

So, yes, it makes sense for the patient to seek out the best technology they can find. I tell people that’s more important than the surgeon. If you have good technology, you can get really good results. Barnet Dulaney Perkins stands in good stead with that because we have invested in really top-of-the-line technology.

Q: So better technology yields better results, but then what you said in the last statement, is technology may be better than the surgery itself.

Dr. DM: You want an experienced surgeon for those rare problems, but good technology in the hands of a bad surgeon will probably give better results than bad technology in the hands of a good surgeon.

Q: What are some of the best questions to ask your LASIK surgeon?

Dr. DM: I think you can ask them how long they’ve been doing LASIK. How many cases they’ve done? What technology are they using? What laser do they use? How old is their laser? That sort of thing. The other thing to think about with LASIK is what you want after surgery. And remember, I told you about people needing reading glasses when they’re older.

If you are older, do you want to have a reading vision in one eye and distance vision in another eye? That’s called monovision and that’s a common procedure now. Some people do that, and they’re pretty happy with their results. It’s a way of giving reading vision to one eye and distance vision to another eye. For certain patients, it’s a nice thing to do.

One of the things patients should think about is, what is their goal after surgery. If their goal is to have excellent distance vision in both eyes, then that’s simple. But if they want to have a reading vision in one eye, if they’re older, then they should think about that and talk about it with their doctor prior to surgery.

Q: In your general experience, what’s the percentage of people who are interested in monovision?

Dr. DM: Of course, they have to be the right age, this is probably people in their 40s, and maybe 20% of people, maybe less. About 10% to 20% of patients in their 40s would be interested in monovision.

Q: So what about questions like… “Oh, what do you do?” And you mention that you’re a LASIK surgeon, inevitably they might be asking you some questions. Like “Doctor, is LASIK safe?” Is that something that you hear often?

Dr. DM: That would be a reasonable question for somebody to ask. The way I look at it is, when LASIK is done using appropriate safeguards that we have in place, in terms of health of the cornea, then it’s very safe. The instance of adverse outcomes is very low.

Safety is a big concern for people. When it’s done appropriately in the right hands it’s very, very safe. Nowadays, modern LASIK is safe. I would perform this surgery on my family. I have no problems with that if they needed it. Especially with modern technology and the safeguards we have, the incidence of adverse outcome has to be less than 1%. It’s very safe.

Q: How long does the procedure last?

Dr. DM: The procedure itself lasts, from start to finish, maybe five minutes. So it’s very quick. Once we get settled in, we can do both lasers in both eyes in maybe 5, under 10 minutes.

Q: Do you see that as something that might sort of confuse people – in terms of pricing? If they’re paying thousands of dollars and the procedure is five minutes, do you think there’s a value issue? Or do they look at five minutes as being a good thing?

Dr. DM: What I try and explain to people, what they’re paying for is the technology, and as the technology gets better, it gets faster. And in the case of eye surgery, the faster you have it done, the better your odds of doing well are. It’s a good thing to be able to have your surgery, be done with it, and then go about your business after that.

It’s interesting that way. You kind of feel like, “Hell, I’m paying all this money, I want the doctor to break a sweat to earn the money.” And that’s all fair, I get that but what we’re doing is you’re paying me to operate this super expensive high-tech equipment.

It’s like if you were flying from New York to L.A., but somebody developed a transporter – like on “Star Trek.” You could go from here to L.A. instantly; would you be willing to pay more for it or at least pay the same price? I think most people would, even though it takes less time.

In general, being quick doesn’t come out as negative.

Q: Any advice you would give a family member going in for LASIK?

Dr. DM: It’s very helpful to try and be as relaxed as possible, because when people are squeezing or struggling, it just makes everybody’s job harder. So, try to be comfortable or relaxed. And then we do give Valium and equivalents to help people relax. That’s the big thing, don’t set yourself up for a big negative. Be excited about it and try and relax and let the doctor take care of your eye.

Doctors are very practical and it comes across here, doesn’t it? They know what works and as a result are confident about the results. But, you’re a prospective patient – you just want it to work, right? Yet, you still worry about the, “What ifs?”

That’s just being human. People worry about the unknown, so we hope after reading this conversation with Dr. McGarey, that you know more and worry less. We have many professional doctors here at Barnet Dulaney Perkins who are equally confident about what they do.

If you still have any questions, any at all, whether it’s on LASIK surgery or eyelid lifts or surgery to relieve glaucoma or anything else, please let us know. Send us a message online, here or call, 866-742-6581.

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