Surgery Overview
Hyperopic laser in-situ keratomileusis (H-LASIK) is the preferred
procedure for correcting
farsightedness (hyperopia). In H-LASIK, a thin flap is
made on the cornea using a blade or laser. The flap is lifted, and a laser is
applied to the central corneal tissue. The laser makes contact with the
cornea in a circular pattern around the central
optical zone. This changes the profile of the cornea, making it steeper. The
laser removes tissue from the cornea very precisely without damaging nearby
tissues. The flap is then replaced, allowing for rapid healing.
H-LASIK is performed in a surgeon's office or same-day surgery
center, It does not require a hospital stay.
This procedure may not be available in all areas, but it is done in
most large cities.
What To Expect After Surgery
H-LASIK usually requires less recovery time than H-PRK, though it
is longer than recovery from LASIK for nearsightedness. Most who have the
surgery see quite well the next day. In contrast to hyperopic photorefractive
keratectomy (H-PRK), there is little or no pain after the surgery.
Your doctor will want you to come in for an exam the day after the
surgery and for regular follow-up exams for about 6 months.
Following H-LASIK surgery to correct farsightedness:
- You will feel irritation and scratchiness in
the eye the day of surgery. And a lot of tears may come out of your eye.
- You may need to wear an eye shield for a few days after
surgery.
- Your vision may be hazy or blurry for a few days or a week
after surgery. Do not drive until your vision has cleared.
- Your
doctor may prescribe eyedrops to reduce inflammation and the risk of infection.
You may need to use them for several months after surgery.
- You
should avoid vigorous sports, eye makeup, and any activities during which water
may get in your eye. The surgeon may advise you to shower before the
surgery, then avoid showering for a day or two afterward to avoid getting water
in the eye.
- Dry eye symptoms are common but usually
temporary.
Why It Is Done
H-LASIK surgery may be used to correct mild to moderate
farsightedness. Treating severe farsightedness is not as effective as treating
mild or moderate farsightedness.
H-LASIK is an elective, cosmetic procedure, done to correct
farsightedness in otherwise healthy eyes.
The procedure may not be done for people who:1
- Have not had stable vision for at least 1
year.
- Are under age 18.
- Are pregnant, because pregnancy
may cause changes in the cornea.
- Have a disease or abnormality of
the cornea, such as keratoconus or corneal edema, or another eye disease, such
as advanced or uncontrolled glaucoma or cataracts.
- Have poorly
controlled diabetes or complications of diabetes that affect
vision.
- Have significant risk of injuring their cornea from a job
or hobby.
How Well It Works
H-LASIK is a relatively new surgery (it was approved by the U.S.
Food and Drug Administration in 2000). Little is known about the long-term
outcomes. Doctors continue to improve the technique and to study the long-term
results.
Over the short term, LASIK has been shown to be effective and
consistent in reducing mild to moderate farsightedness.
H-LASIK is better at treating lower levels of farsightedness than
higher levels. H-LASIK is not as consistent or safe for people with more severe
farsightedness.2
Risks
The risk of complications from H-LASIK surgery is low, and it
decreases even further with a more experienced surgeon. Look for a corneal
specialist or surgeon who does this surgery frequently.
The risk of regression, or loss of any improvement gained through
the surgery, is greater with H-LASIK than with LASIK for nearsightedness. The
exact cause of regression after H-LASIK is not yet known.
Complications and side effects from H-LASIK may include:
- Night vision problems, such as halos (often
described as a shimmering circular zone around light sources such as headlights
or streetlights).
- Glare, or increased sensitivity to bright
light.
- Double vision (diplopia), usually in one
eye.
- New
astigmatism caused by wrinkling in the corneal flap or
other flap complications.
- Loss of best corrected vision. This may
be even less common with H-LASIK than it is with H-PRK.
- New or
worse dry-eye symptoms.
- Clouded vision (clouding of the cornea as a result of healing).
This is sometimes also referred to as corneal haze. This is less common with
H-LASIK than it is with H-PRK and tends to go away quickly.
Serious vision-threatening complications are rare but may
include:
- Infection of the cornea
(keratitis).
- Elevated pressure inside the eye (intraocular
pressure) leading to
glaucoma.
Because H-LASIK is a relatively new procedure, long-term risks are
not yet known.
What To Think About
If you are thinking about having surgery to improve farsightedness, discuss
the different options (H-LASIK, H-PRK, intraocular lens implants, CK, and LTK)
with your doctor. H-LASIK is the refractive surgery of choice
for most people.
Though both procedures are relatively new, H-LASIK is being done
more frequently than H-PRK, largely due to the good results and quick, painless
visual recovery that H-LASIK offers. It is not yet clear whether H-LASIK is
superior to H-PRK for people who have mild to moderate farsightedness.
Be sure to keep a record of your original eye
measurements from this procedure (your doctor can give them to you), in case
you need cataract surgery in the future. This is helpful in calculating the
power of future post-cataract implants.
H-LASIK is a cosmetic procedure. The cost of refractive surgery
varies. Most
insurance companies do not cover the cost of refractive surgery.
Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
References
Citations
- American Academy of Ophthalmology (2007).
Refractive Errors and Refractive Surgery (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology. Also
available online:
http://one.aao.org/CE/PracticeGuidelines/PPP.aspx.
- Varley GA, et al. (2004). LASIK for hyperopia,
hyperopic astigmatism, and mixed astigmatism: A report by the American Academy
of Ophthalmology. Ophthalmology, 111(8):
1604–1617.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Kathleen Romito, MD - Family Medicine |
|---|
| Specialist Medical Reviewer | Christopher J. Rudnisky, MD, MPH, FRCSC - Ophthalmology |
|---|
| Last Revised | November 6, 2009 |
|---|
American Academy of Ophthalmology (2007).
Refractive Errors and Refractive Surgery (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology. Also
available online:
http://one.aao.org/CE/PracticeGuidelines/PPP.aspx.
Varley GA, et al. (2004). LASIK for hyperopia,
hyperopic astigmatism, and mixed astigmatism: A report by the American Academy
of Ophthalmology. Ophthalmology, 111(8):
1604–1617.
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