Refractive Surgery Instructions

LASIK: The greatest risk after LASIK surgery is flap disruption or dislocation. Avoid activities that might cause trauma to the LASIK flap.

PRK: The greatest risk after PRK is cornea surface irritation and haze. Keep the eyes well lubricated and avoid activities that may cause exposure to UV light by wearing sunglasses when outdoors during the day.

Activities:

• Showering – You may shower after surgery but face away from the water and avoid getting water directly in your eye for a few days.
• Driving – Wait to drive until advised by your doctor. You can resume once you meet the driving vision requirement and feel comfortable, for most patients that is within the first week.
• Aerobic activity – You may resume exercise (walking, running, biking, weight lifting) once the initial pain and light sensitivity are gone, typically 2-4 days. Wear a headband to keep the sweat out of your eyes and wear eye protection so you don’t accidentally bump your eyes and to keep dust and dirt out of your eyes.
• Swimming – NO hot tubs, swimming pools, lakes, rivers, ocean, or Jacuzzi swimming for 1 month after surgery. These present serious eye infection risks!
• Gardening – NO gardening or lawn mowing for 1 month after surgery. This presents a serious eye infection risk!
• Make-up – wait 2 weeks to resume wearing eye make-up. The main concern is infection risk so throw out any old or previously used make-up. When you resume, start with new unopened products. Old eye make-up should be discarded.
• Contact sports – wait 1 month prior to resuming any martial arts, basketball, boxing, wrestling or other contact sports. For LASIK, there is a lifelong risk of flap dislocation so you MUST wear eye protection when participating in contact sports.

There will be clear shields in place over the eyes for comfort and protection after surgery. Take them down to put your eye drops in then replace them. You will sleep in these shields at night for the first week. Wear sunglasses outside and clear sunglasses inside to protect your eyes.

It is also normal for you to see glare and halos or foggy vision immediately after surgery. You can expect these changes in your vision to gradually improve in the days to weeks following surgery. It is normal for halos at night around lights and glare during the day to take weeks to months to fully resolve.

Pick up your medication eye drops PRIOR to surgery as you will need to start them right away after surgery. Your doctor will review your post-op medications with you so please bring them with you to your follow-up appointment.

You may resume your normal diet and medications immediately after surgery. Drink plenty of water, minimize caffeine drinks, and avoid alcohol while recovering. Light duty activities such as reading, TV, computer are ok but these activities can make your eyes feel more scratchy, sore, and dry especially right after surgery

The procedure is done in an outpatient surgery center and takes a few minutes each eye to complete. You should expect to be at the facility for several hours however as there are lots of preoperative testing and preparations as well as post-operative evaluation.

PRK refractive surgery is generally painless, though you will feel pressure and cold water. Numbing eye drops are used to keep you comfortable. Relaxing medication is sometimes given for patients who are very anxious, though it is not necessary.

The procedure involves removing the surface cornea epithelium with a brush and then an excimer laser used to ablate the cornea surface to change its shape. Mitomycin-C (anti-scarring chemo eye drop) is then placed on the cornea surface for a few seconds to reduce the risk of cornea haze. A bandage contact lens is then placed on the eye and the process repeated for the second eye.

Make sure you have your medications, eye drops, and your lubricating tears ahead of time as you will start them immediately after surgery. You should have a bottle of Ibuprofen (Motrin) or Acetaminophen (Tylenol), an antibiotic eye drop, a steroid eye drop, and an NSAID eye drop. You may also be given a prescription for a pain medication to help with any immediate post-operative pain. A bandage contact lens will be placed on the eye after the procedure for comfort, do not remove this bandage lens. We will remove it in the clinic when the skin of the eye has finished healing, typically 1-2 weeks later.

After PRK surgery you will need to WEAR SUNGLASSES when outdoors at all times, forever. The UV protective layer (Bowman’s Membrane) is removed during PRK so you will need to protect your eyes from the sun’s UV rays. These harmful UV rays pass right through clouds so sunglasses are needed even on cloudy days. Amber-colored and clear color sunglasses can be used for lower light outdoor conditions. Failure to protect your eyes from UV rays can lead to permanent cornea haze and scarring which can affect your vision.

Immediately after the procedure, you will start your eye drops and your mission from that moment forward is to lubricate your eyes! Here are some tips to help keep you comfortable and avoid disturbing the contact lens during the initial healing period.

• Don’t Squeeze your eyes – it can cause the contact lens to fall out
• Don’t Rub your eyes – it WILL cause the contact lens to fall out
• Moist eyes are happy eyes – don’t put your fingers or tissues or anything closer to your eyes than your upper cheeks and your eyebrows. Only dab tears as then run down your cheeks, do not dab your eyelids.
• If the contact lens falls out, do NOT put it back in. Come back to the clinic the following day and we will assess if you still need a contact lens.

Start your eye drops after your PRK surgery and wait 5 minutes in between each drop so that you don’t rinse out one drop with the next. After your surgery, you need to rest. Go home, put your eye drops in, put on your eye shields/goggles, and take a nap.

The key to pain control after PRK surgery is to keep well lubricated, this will help keep the contact lens “floating” on the eye. If the contact lens becomes dry or falls out of the eye you will likely have a significant increase in pain. To keep the eyes lubricated, use your lubricating tears every 30 min to 1 hour while awake. If you take a nap, don’t sleep for more than 2 hours without using a lubricating tear. The first few nights, don’t sleep for more than 6 hours without putting in a lubricating tear. A cool compress can help reduce eye pain as well. Take your Motrin or Tylenol 3 times a day (with food and liquid) for the first 1-2 days whether you think you need it or not. Staying ahead of the pain will help more than trying to treat it once pain sets in. If you are still having significant pain after doing all of the above, you may take your prescription pain medication.

It is normal for the eyes to feel sandy, gritty, scratchy and sore immediately after PRK. Use your lubricating eye drops anytime you feel that and it will help greatly. Keeping your eyes well lubricated is important to use a lubricating tear at least 6-8 times a day in the beginning. Wait 10-20 minutes after any medicated eye drop so that you don’t rinse out the medicine with a lubricating tear.

It is normal for your vision to fluctuate from day to day quite a bit for the first few weeks while your eye is healing. PRK takes several weeks to months for the vision to stabilize. Most importantly, remember to Rest and Take It Easy!

Do NOT remove the bandage contact lenses. Your eye doctor will remove it when the eye has healed. Do NOT rub the eyes as this will cause the contact lens to fall out and for you to have eye pain.

If the contact lens falls out, do NOT replace it. Call the office to notify your doctor and try to sleep and rest the eyes as much as possible. If necessary, we can put a new bandage contact lens in for you.

Medications: Start your eye drops the same day after your surgery

• Antibiotic eye drop – Vigamox (moxifloxacin – tan top) place 1 drop in the operative eyes 4 times per day and continue until the contact lenses are removed from the eyes
• Steroid eye drop – Fluoromethalone (FML) or Loteprednol (Lotemax/Inveltys) place 1 drop in the operative eyes 4 times per day for 2 weeks, then 3 times per day for 2 weeks, then 2 times per day for 2 weeks, then 1 time per day for 1 week, then stop. Shake well prior to using this eye drop. The long slow taper on the steroid eye drop is important to reduce your risk of cornea haze.
• NSAID eye drop – Bromsite or Prolensa place 1 drop in the operative eyes 4 times daily until the contact lens is removed
• Lubricating artificial tear – place 1 drop in the operative eye every 1-2 hours for the first week, then use 4 times per day or more frequently as needed
• Ibuprofen (Motrin) or Acetaminophen (Tylenol) – take 800mg of ibuprofen every 8 hours for the first 2 days, then take additional ibuprofen as needed. If you are unable to tolerate or take ibuprofen products, then take 1 gram of Acetaminophen (Tylenol) every 8 hours for the first 2 days, then take additional Tylenol as needed. Talk to your doctor if you are unable to take either of these products.

How to use eye drops:

• Wash your hands prior to instilling eye drops
• Do NOT let the tip of the bottle touch your eye
• Shake the eye drops well before using
• Administering the drop – tilt your head back and gaze upward, pull your lower eyelid down making a pouch. Drip 1 drop of the medication into the pouch and then gently close the eye. Keep the eye closed for the first minute and minimize blinking immediately after you put in an eye drop.
• Wait 5 minutes in between eye drops.

Call the office (941-499-1570) if you have any questions or concerns or if you experience any excessive pain not relieved by ibuprofen or acetaminophen, uncontrollable nausea or vomiting, or worsening vision.

The procedure is done in an outpatient surgery center and takes a few minutes each eye to complete. You should expect to be at the facility for several hours however as there are lots of preparations to be done. Prior to your arrival at the surgery center, you will need to have 2 peripheral laser iridotomies placed in each eye. These are done in the office using a YAG laser, typically a few days ahead of time.

Implantable Collamer Lens (ICL) refractive surgery is generally painless, though you will feel pressure and cold water. Numbing eye drops are used to keep you comfortable and IV relaxing medication is given for most patients, though it is not necessary.

The procedure involves surgery inside the eye so the eye is prepped as for any other intraocular surgery. ICL surgery involves making a small incision in the cornea and injecting the ICL lens into the eye. The lens is then gently positioned behind the iris and the eye closed. The majority of patients undergoing ICL surgery will not need sutures (stitches) to close the eye. Afterward, there is an immediate postoperative exam to confirm the lens is in perfect position prior to sending you home.

The RLE surgery is performed in an outpatient surgery center in the operating room similar to cataract surgery using a powerful microscope to remove the lens inside your eye and replace it with a lens implant.  It is normal to feel some pressure and cold water and see lots of interesting bright lights during the procedure. The eye is often treated with a femtosecond laser prior to the lens removal portion of the surgery to soften the lens inside the eye, make a well-centered capsulotomy, and treat low levels of astigmatism in the cornea. To gain access to the lens inside your eye, tiny incisions are made in the eye after the femtosecond laser treatment and the lens is broken into tiny fragments and vacuumed from the eye. Then the new lens is placed in the eye and the tiny wounds sealed. Often, the eye is sealed without sutures (stitches) and the “self-sealing” incisions heal over time. Typically, the surgery takes a few minutes to complete and in the end, a rigid shield is often placed over the eye to protect it.