I’ve had this question come up a lot. Four times in the last week, in fact. I guess it’s time to put it in writing!
LASIK stands for Laser-Assisted In Situ Keratomileusis. It is the most common form of refractive surgery procedures, which generally are intended to decrease or eliminate the patient’s need for glasses or contact lenses to see clearly far away. Tissue on the clear front dome of the eye, known as the cornea, is usually taken away to reshape that surface which changes how light focuses on the retina.
For many patients who are intolerant to contact lenses or have a higher prescription, it is a positive, life-changing procedure. I should know. I had it done in 1998. For someone who had been in glasses and contacts for 15 years, battling with dry eyes and contact lens tolerance for over 5 years, it was AWESOME!
Here’s where the “except” comes in. If the patient is in a neurologically-driven, biomechanically inappropriate pattern of muscle use, aka not “neutral” as defined by PRI principles, it can help “lock” them into this pattern. One of the reasons for this is because this takes away any momentary times of change in their life, which naturally occur when they change from their contacts to their glasses and vice versa, or take either of them off for any period of time. Technology has also gifted surgeons with the ability to make people see a lot better than 20/20. This can increase the brain’s attention to small visual detail, sacrificing the amount of attention to peripheral visual information, which is what the brain uses to decide where we are in relationship to the environment around us and guide our posturing system.
When we see patients in PRI Vision who have had a refractive surgery procedure done, I try to get pre-surgical records whenever possible. What I’ve noted clinically is that many patients are showing changes in their need for prescription to see clearly far away that are in the same refractive pattern from their pre-surgery days. I personally am a great example of this. My left eye subjectively wants 0.25 more power to see clearly than my right eye does, which is exactly the way it was before surgery, and I now wear about 40% of the power I did pre-surgically. This change really showed up around the same time my back problems got worse, which was not long after I had my twins. I won’t share the picture of me right before I gave birth, but let’s just say their combined 13 lbs put a bit of stress on my narrow hips and lumbar scoliotic curve.
If you are a patient to whom this happens, I’m not sure you feel great about thousands of dollars you spent to have the refractive procedure done.
The other time refractive surgery can really be a problem is when it is performed in a manner to give someone “monovision”. This is also a common practice for fitting contact lenses. It gives one eye clear vision far away but not up close, and the other eye clear vision up close but not far away. It’s a way for those of us over 40-ish to avoid wearing reading glasses. For many patients, they have a hard time using both sides of their body equally, which leads to appropriate biomechanical upright function, when they don’t use information from both eyes equally to guide movement. We’ve had several experiences where just taking a patient out of monovision contact lenses, and putting them back into the best correction for far away in both eyes, takes them out of their inappropriate pattern of muscle use. Eye doctors are not really taught about this in school, except from a developmental standpoint. We know crawling and bilateral gross motor integration sets the stage for eye teaming skill development, known as binocularity.
When is a good time to have a refractive procedure such as Lasik done? When you are in a state of neutrality and physically, functionally stable in that position for at least 6 months. That’s just my two cents!
Keep moving beyond sight!