Sofie got her LASIK surgery done 3 months ago in Dubai. She presented to the Center for Lasik Surgery at Advanced Eye Hospital and Institute in Navi Mumbai with complaints of headache and eye pain after working on computer for more than an hour. This was severely affecting her work efficiency and she was constantly troubled because of that. She was certain that her LASIK surgery led to some complications. We did a detailed eye evaluation for her. Her LASIK surgery had been done and had healed perfectly. However, on her eye muscle power checking, we found that she had severe convergence insufficiency. Basically the muscles in the eye which allow near work were weak. On closer questioning, she revealed that prior to getting her LASIK, she used to remove her glasses while working on the computer. The habit of removing glasses during near work caused her eye muscles to slowly develop weakness. When people like Sofie who have minus eye power do not wear glasses for near work, they are at risk of developing muscle weakness called convergence insufficiency. This can be missed before LASIK operation if muscle balance testing is not done prior to LASIK surgery as a part of pre LASIK evaluation. In patients like Sofie, eye muscle exercises can strengthen the muscles and then LASIK surgery can give best results without any muscle imbalance.
Just like Sofie there are a lot of us who have some or the other muscle imbalance or mild squint which needs to be detected prior to LASIK surgery. Eye Muscle balance, eye alignment and binocular function remains unchanged after LASIK laser surgery in most patients except those who have pre-existing muscle weakness, big difference in glass power between the two eyes and those with some post Lasik surgery factors like those where monovision surgery (one eye corrected for distance and one for near) is done.
A detailed muscle balance testing (orthoptic evaluation) goes a long way to detect those who are at risk of developing muscle balance related issues after different types of Lasik surgery like conventional Lasik, Bladeless Femto Lasik or ReLEx SMILE Lasik.
So, what are tests done during pre LASIK evaluation to detect muscle imbalance?
- Accommodation– This is the ability of the eye to see near objects clearly. Usually the normal ability to accommodate reduces after the age of 40 and that’s when we need reading glasses to read near objects clearly. Occasionally young people may have accommodation abnormalities and may not see near objects clearly at the distance normal for their age. It is important to identify the type of problem and recommend exercises prior to going ahead with Lasik. This is to ensure best results and satisfaction after Lasik surgery.
- Convergence– This is the ability to see near objects clearly without experiencing eye strain or doubling of objects at the right distance. Sometime a lot of people have convergence insufficiency which can get aggravated after LASIK. This is more likely to happen in those who wear thick glasses or those who do near work after removing their minus powered glasses. Thick glasses can sometimes mask the weakness due to minor prismatic effects.
- Minor Squint– Sometimes people have an obvious or hidden squint. Leena had a type of squint called Intermittent Exotropia–a condition that would become obvious sometimes, specifically when she was tired. Usually it is possible to have LASIK in this condition if you are not wearing any prism correction in your eyeglasses. It is important for the LASIK Surgeon to perform muscle balance testing both with eyeglasses and contact lenses to see if the potential for the squint to worsen increases with contact lens wear. In another young woman, Lata, who had a power of -10D in her eyes, her squint was worsening when we checked her with contact lenses. This gave us the indication of what can happen to her squint after her LASIK laser surgery. Our squint surgeon decided to perform her squint surgery first. The recovery after the squint surgery was quick and she was back to work within a week. She got her bladeless Femto Lasik surgery done 3 months after her squint surgery. Today she is not just free from glasses but also free from her squint problem.
- Fusional Amplitudes (Strength of eye muscles)- This test also gives us an indication of the muscle weakness and the possibility of squint development after Lasik surgery. If someone’s fusional amplitudes are poor it is better to give them eye exercises prior to considering their Lasik surgery.
- Stereopsis (Depth Perception)-Vinod wanted to be a pilot in the armed forces and he wanted to get rid of his glasses for that. All the tests done for pre-Lasik evaluation were normal but his depth perception was abnormal. To ascertain the cause he was referred to our squint specialist. He was diagnosed to have microstrabismus. He was informed that he may not be able to clear the tests to be the fighter pilot as depth perception may be an important criteria for that! He still got his ReLEx Smile LASIK done and got rid of his glasses. Even though we could not treat his depth perception problem but at least he was aware! It can be disappointing if one realizes that later and not before their Lasik.
As LASIK surgeons we are glad that with all the advancements and newer best LASIK procedures like SMILE Lasik, we have the ability to reduce eye powers safely. For the best of Lasik surgeons, we desire is to treat your eyes holistically. Muscle imbalance or presence of squint needs to be evaluated as a part of pre LASIK evaluation. If required either muscle exercises or squint surgery needs to be planned either before or after laser vision correction procedure.
About Dr. Vandana Jain:
Dr. Vandana Jain- Lasik Surgeon
Dr Vandana Jain is an expert cornea and LASIK surgeon. She manages and treats patients from Mumbai, Navi Mumbai and all over Maharashtra who develop complications like infections etc due to contact lenses. Due to her dual expertise in cornea and LASIK, she is in a great position to decide and chose the right lasik procedure for these patients who develop corneal infections and then want freedom from glasses. She always cautions and educates her patients who are using contact lenses to maintain healthy contact lens care practices. Dr. Vandana Jain is a fellowship trained Cornea and LASIK surgeon. After having performed more than 5000 Lasik procedures, she is counted as one of the best Lasik surgeons in India. She believes in following a systematic scientific approach towards evaluating the patients for LASIK or Femto LASIK or the latest ReLEx Smile. She ensures that a detailed pre LASIK evaluation is done for all patients. According to her a detailed Orthoptic evaluation ensures that patients do not get eye fatigue or develop squint after their LASIK surgery.
About Center for LASIK surgery at Advanced Eye Hospital and Institute Navi Mumbai- Center for Lasik surgery at Advanced Eye Hospital and Institute is one of the most advanced centers for LASIK surgery in India. Proper protocols are followed for all the patients. A detailed pre LASIK evaluation is done with the help of all the advanced machines which are part of the center. A separate vision therapy and orthoptic clinic supports the orthoptic evaluation of all the patients prior to their LASIK. A squint surgeons consult is taken in all cases where any abnormality is detected. Patients from all over Navi Mumbai like Vashi, Kharghar, Nerul and Panvel visit AEHI for lasik evaluation and treatment.
Center for Lasik Surgery at Advanced Eye Hospital and Institute is a modern well equipped center for managing all kinds of complicated clinical situations. All the great diagnostic machines like corneal topography, corneal tomography, corneal pachymetry, OCT and IOL Master and associated clinics such as dry eye clinic and orthoptic clinic ensures a meticulous and protocol based pre Lasik evaluation. Besides this there are advanced machines for laser vision correction which allows all the different LASIK surgeries like wave front optimized LASIK, FemtoLasik, PRK, ReLEx SMILE and LasikXtra.
Videos
Watch Dr Vandana Jain, Cornea and Lasik Specialist perform SMILE Lasik – the most advanced and the best laser vision correction surgery in the world.
Watch Dr Vandana Jain, Harvard trained Cornea & Lasik Surgeon at Advanced Eye Hospital and Institute (AEHI) in Navi Mumbai, India answer frequently asked questions on SMILE laser vision correction surgery
Dr Vandana Jain, Cornea and Lasik Surgeon, Mumbai, India 