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How long does LASIK take?

By Joel Hunter, MD | 8/4/17 7:57 AM
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As you read these words on your phone, tablet, or computer, there’s a lot happening behind the scenes. There’s a CPU with about a billion transistors so small they are measured in nanometers (millionths of a millimeter). All that circuitry helps direct around a million pixels on your screen. All those pixels are working in concert to create images that move within a couple milliseconds of you deciding to scroll up or down. And they do all that over and over again, 30 to 60 times a second. I guess what I’m trying to say is, computers are neat.

They were neat to begin with as the computer revolution began in the late 70s. At that time, however, even the most starry-eyed, geeky optimist would have never believed the speed of its evolution as the computer moved from their garage in California to, well, everywhere. Since this is a story about LASIK, now may be a good time to explain the reason for starting with the story of computers. It’s because LASIK and computers share a history. For the last 30 years, the evolution of laser eye surgery matches closely with the computers driving those lasers.

In the 80s, some ophthalmologists started toying with the idea of using computers to control a particularly precise type of laser. “Particularly precise” is selling it a little short, since this new excimer laser could sculpt a human hair with patterns measured in thousandths of a millimeter. There is an electron microscope image of steps etched into a human hair from around this time. As the 80s became the 90s, the computers controlling the excimer laser got faster and smarter leading to more real-world, useful applications for the ability to etch human tissue. Photoablation (which means sculpting with energy from light) was able to sculpt the cornea. This gave us PRK and some very early LASIK procedures. Then the 90s became the 2000s, and somewhere during the rise and fall of the boy band *NSYNC, excimer laser got fast enough—and LASIK became fine-tuned enough—for modern, popular LASIK to become commonplace. I had my LASIK done during this time. At a mind-blowing speed of 30 pulses per second, my eyes were photoablated to 20/15. They have stayed that way ever since.

As you know, however, computers have come a long way since then. And as you may have guessed by contextual clues, LASIK has done the same. Now, in 2017 we have an excimer laser unimaginably more efficient and precise than the one that cured me of glasses. At 500 pulses per second, the newest Wavelight laser—the brand name for the newest excimer laser system—would be able to shorten my 53-second-long LASIK procedure to about 3 seconds. In reality, however, my treatment would take 14 seconds if done today. Why? Well, the great thing about this speed isn’t just that people can add an extra 30 or 60 seconds to their day in saved time. Instead, because the system is so fast, some really smart engineers decided to dramatically shrink the diameter of each laser spot. So there’s this wonderful increase in precision—much the same way a fine-tipped paintbrush can outperform a roller for detail work.

Sometimes people will ask why it’s so expensive to have LASIK if the treatment only takes a few seconds. The answer I give is always the same: It’s expensive because it’s fast. No one is bothered because the expensive new computer they bought boots up in five seconds instead of five minutes; in fact, they expect performance like that when paying for the best. Most of the cost of the best technology in any area is because it outperforms the generations before it with faster speeds, more functionality, and more precision. And as it is with computers, so it is with LASIK, which uses those computers to cure vision with accuracy once unimaginable. I guess what I’m trying to say is, LASIK is neat.

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