In certain circumstances, after performing the complimentary evaluation described in The LASIK Workup, we may advise that additional testing is necessary to complete our assessment, and give you our best recommendations. If this is the case, you will be advised that the complimentary portion of the evaluation has concluded, and that fees will be incurred for additional services. We will ask you to approve and authorize any further testing.
This may be warranted, for example, if any of the following apply:
- If measurements made as a part of our free consultation warrant extra time, caution, or consideration, as might be appropriate in the case of:
- Very high corrections
- Borderline or thin corneal tissue readings
- Excessively steep or flat corneal curvature on topography
- Small corneal diameter
- Unusual eyelid configuration, presence of lid disease, or incomplete eyelid closure
- Other conditions that might adversely affect healing
- Very large pupil size
- Presence of ocular surface disease, significant “dry eye” status, etc.
- If multiple visits are advised for any reason, such as (a)repeat refraction after stopping wear of hard lenses, to determine stability; (b) if treatment of medical conditions of the eyes or eyelids is advised prior to contemplating surgery; etc.
- If extended consultation is required due to individual circumstances or special needs. Examples might include (a) individuals with reduced vision in one eye; (b) if you have had prior laser or other eye surgery.
- If testing or a several-day trial in soft contact lenses is advised
- If you indicate an interest in monovision, and have not yet tried this yourself (typically with soft contact lenses), in which case we would recommend an appropriate fitting and trial of such lenses.
Tear Function Testing : When the LASIK flap is created, some of the nerves supplying sensation to the flap can be cut. These nerves typically grow back within a few months; but during that interval, no nerve signals can be sent to the tear gland to stimulate tear secretion. For this reason, LASIK is known to contribute to diminished tear production and aggravation of “dry eye” symptoms.
Schirmer Tear Test
It is prudent, therefore, to identify those with any history of significant “dry eye” problems. This may involve a series of questions, as well as a Schirmer Tear Test
to measure tear production. After placement of anesthetic eye drops, small sterile strips of filter paper are placed over the outer edge of the lower lids, and the wetting of the strips is measured after several minutes. Patients with severely dry eyes or a compromised tear film may be poor candidates for LASIK. These tests of tear production are variable and imprecise, and interpretations among professionals can vary as to their significance.
The presence or absence of “dry eye” is also definitely influenced by climate and environmental factors. Cooler temperatures and higher relative humidity can compensate for some diminished tear producing capacity, so people that live in San Francisco or Seattle, for example, might be expected to have less “dry eye” symptoms than people living in the southern California Inland Empire or Las Vegas. If interested, you can read about our approach to Managing Dry Eye and Optimizing Eye Comfort after LASIK.