Should I do LASIK surgery on the same day as my assessment?
Should LASIK surgery be done on the same day as assessment and consultation? What are the risks vs benefits, especially in terms of safety or outcomes? Please advise thank you!
The main reason that patients choose to have Laser Refractive Surgery performed on the same day as their assessment is that both the assessment and the surgery require the patient to be off their contact lenses for a minimum of 1-2 weeks (1 week for soft contact lenses, and 2 weeks for RGP lenses).
We have many patients who simply cannot tolerate using spectacles for an extended period of time, and want to minimise the duration of time that they are in spectacles. Hence they choose to only have one period of 1-2 weeks where they are spectacle dependent. This obviates the need to have a second duration of spectacle-use only.
Having the assessment and surgery performed on the same day is a common request, however this makes the day extremely long. Some patients choose to have surgery performed on a different day as they cannot spare an entire-day in the clinic. The advantage of splitting the examination and the surgery into 2 half-days instead of a long-day, is that it allows another refraction to be performed on the day of surgery itself. This advantage lies in the consistency of another refraction performed that is separated by date and time.
Either option is perfectly acceptable, and we help patients who choose both options in equal measure. Discuss your concerns with your ophthalmologist, and together you’ll decide whether surgery on the same day is suitable for you!
There is some variation in practice here, but I do not recommend assessment and LASIK surgery on the same day too.
In terms of risks and benefits, the major downside (to doing everything on the same day) is that pre-LASIK assessment requires dilation of the pupils of your eye. This is obligatory to:
- Relax the focusing muscle of your eye and ensure the most accurate spectacle power measurement possible
- Allow a full eye check including the retina and lens of the eye, which are not fully visible otherwise
However, pupil dilation affects the size and position of the pupil, which is used by most lasers to determine the location on your cornea to treat. Lasering an eye with a dilated pupil could result in a decentered treatment, which can cause an irregular cornea with blurred vision.
It is therefore essential to only perform LASIK on an undilated eye. If the pupil has been dilated on that day, it is necessary to wait until the pupil size has returned to normal before performing LASIK. The time taken for this to happen is different for different people, but could be 5-6 hours or more.
For assessment and LASIK surgery to be done on the same day, you would need to do the assessment early in the day, and then go back or hang around for some hours waiting for the pupil to return to normal size, before having LASIK surgery. Sometimes the pupil has not yet returned to normal size at the scheduled time for surgery. So in such centers, eyedrops are instilled to cause faster constriction of the pupil, but a pharmacologically constricted pupil may also not be in the same position as a natural pupil.
Doing LASIK on a different day than the assessment ensures that the pupil has returned to a normal size at the time of treatment, thus ensuring the best possible treatment centration.
The possible benefit of doing everything on the same day is that the logistics could be simpler, with one fewer visit to the clinic. But remember that even with same day LASIK, there is a need to wait some hours for the pupil to return to normal size. You could be hanging around for the better part of a day not being able to do too much while staying close to the clinic. Either that or getting home and then coming back again, which is really not that different from doing it on 2 separate days.
Another reason why I prefer to do it on separate days is to allow patients time to think over their decision and most importantly, not feel rushed into doing something that is still an operation after all, with its attendant risks and benefits, pros and cons.
But for someone who has already made up their mind, and taken the (whole) day off to have everything done on that one day, and who has a pupil that recovers from dilation pretty fast, I suppose having everything done on that one day can work too.
Great question about when to perform LASIK after the assessment.
Many patients are confused about the variation in practices on when to perform LASIK. Some practices do perform the assessment and LASIK all on the same day primarily for the patients’ convenience.
Many practices however do not encourage same day surgeries. There are several reasons why. The most important reason is that the suitability assessment requires dilation of the pupil. Once the pupil is dilated, it takes at least 6 hours or longer for the pupil to regain its natural size and position. It is important to understand that many laser systems rely on the pupil position to find the right location on the eye. Hence, the pupil is very important for the laser to mark its targeting accurately. As you can imagine, a poorly targeted laser treatment could result in a unsatisfactory result. Some practices use eye drops to artificially constrict the pupil quickly. To us, this is still inadequate as the pupil in this artificially contracted state may still not be in the natural position.
My practice is to separate the LASIK treatment from the day of the suitability assessment. This allows me to maximise the quality of the surgical results and reducing the risk of resultant haloes and glare for my patients by way of greater precision in centring the laser.
In my view, the risks of same day LASIK having a de-centred treatment far outweighs the benefits of convenience. We should prioritise good long term results over short term convenience.