Astigmatic Keratotomy (or AK for short) is a surgical procedure designed to reduce or eliminate astigmatism. Astigmatism occurs when the shape of the cornea (or rarely the lens) is elliptical (like a football) rather than spherical (like a basketball). This results in light being focused in more than one place inside the eye. Left undercorrected, or when severe and corrected by glasses only, visual distortion can result.
AK reduces or eliminates astigmatism by flattening the steep area of the cornea (the clear window in the front of the eye). Small arc-like incisions are made in the periphery of the cornea to achieve this flattening. The corneal shape becomes more like a basketball.
AK, developed over 20 years ago in Russia and Japan, has been carefully studied and performed for over 20 years in the United States. Thousands of Americans have AK surgery each year.
Who is a candidate for Astigmatic Keratotomy?
Candidates for AK may experience difficulty wearing glasses and contact lenses. Most people have tried contact lenses and have difficulty wearing lenses due to allergies, dryness of the eyes, astigmatism, or other irritants. Generally the best candidates have low to moderate levels of astigmatism (1.00 to 4.00 diopters). In addition, their lifestyle or career may require good vision without the use of glasses or contact lenses to function well.
In most cases, AK surgery will be performed in conjunction with another refractive surgical procedure such as iLASIK, Refractive Lensectomy, or Photorefractive Keratectomy.
AK may be indicated after cataract surgery or corneal transplantation. In these cases, the previous operation may have caused the astigmatism. In this situation, most insurance companies will pay for the operation.
Candidates are encouraged to attend a free educational seminar or visit the office for a FREE Complementary Consult. A thorough eye examination and evaluation is required prior to having AK surgery. The evaluation session allows patients the opportunity to have their questions answered.
How is the procedure performed?
Surgery is performed in the professional atmosphere of Valley Eye Associates. The staff provides your care in a relaxed and comfortable atmosphere.
With conservative AK, the surgeon begins with the fewest number of incisions needed to achieve the amount of reduction in astigmatism desired. If more incisions are needed, they can be added at a later time (additional surgeries are known as enhancements). This technique gives you and the doctor more control over the results of the surgery. Greater predictability with AK is possible by using this technique. This technique reduces the risk of overcorrecting the eye and causing astigmatism in the opposite direction.
What happens before the day of surgery?
Prior to your treatment date, you will receive a list of preoperative instructions including food and liquid restrictions for the day of surgery. No preoperative history or physical examination is required by your family doctor.
You will be asked to wear comfortable clothing and you do not need to change your clothes for the operation. You are required to make arrangements for a relative or friend to drive you home after the surgery.
What happens the day of surgery?
Surgery is performed on an outpatient basis in an operating suite. In this relaxed atmosphere, you will receive professional experienced care. The staff is there to answer your questions and assist you in understanding the procedure.
Before the operation you may receive a preoperative sedative (usually a valium pill). A topical anesthetic (numbing drops) is all that is needed so that you will not feel pain during the operation.
During the procedure you will be positioned in a surgical chair or on a surgical bed under an operating microscope. The surgical microscope is used to view your eye during AK. You may feel slight pressure from the instrument that keeps your eyelids open. The actual procedure will take about 5 minutes.
After the surgery antibiotic drops will be placed on your eye. The staff will discuss postoperative written instructions with you.
How do I care for my eye after surgery?
You should avoid rubbing or bumping the eye after surgery. You may experience mild discomfort such as scratchiness or tearing. This is normal and may last for a few days. Pain relievers are occasionally needed and are prescribed if necessary. Women should refrain from wearing eye make-up for a few days.
The limitations on activities may vary from person to person. However, generally speaking, you may immediately resume normal activities like bending, watching TV, taking a shower, or reading. Contact and racquet sports should be avoided for several weeks after surgery. We recommend that you wear protective eye ware anytime you participate in racquet sports, regardless of whether or not you have had AK or other eye surgeries.
What follow-up care is necessary?
Patients are generally seen 1 day, 1 week, 1 month, and 6 months after surgery. More frequent visits may be necessary. Visits during the first six months after surgery are included in the surgical fee so no additional payment is required. Of course, regular eye examinations by your eye care provider are essential to maintain healthy eyes. Patients referred by their optometrist may receive a portion of their postoperative care from this doctor. There is no additional fee for this service.
What are the risks of Astigmatic Keratotomy?
As with any surgery, there is always a slight risk of postoperative infection, although this is minimized by the use of preoperative and postoperative antibiotics. With AK there is a chance that the eye will still have some astigmatism afterwards which would mean that glasses or contact lenses would be needed to obtain your best possible vision.
In the first days after surgery, you may be sensitive to bright lights or see star bursts around lights at night (glare). This usually decreases several days after surgery.
Other complications that have been described with AK (but are rare) include continued problems with glare or vision fluctuations, development of irregular astigmatism with distortion of vision even with glasses, monocular diplopia (double vision), elevated intraocular pressure, cataract, and loss of vision. These complications are less common with a conservative approach to AK which includes fewer incisions, larger optical zones, and a stepwise approach.
Will I have "perfect vision"?
The goal of AK is to reduce your dependence on glasses or other optical aids. A small amount of correction may be needed for near vision or far vision. Contact lenses can be fit in most cases after AK if necessary.
The results of AK will depend on your cornea's response to the incisions and the healing process. While the procedure can be done more than once, it cannot be performed an infinite number of times.
How much will surgery cost?
Typically there is no charge for AK unless it is the only refractive surgery you will have. In this situation you will be charged a surgeon's fee, and if applicable, a co-management fee paid directly to your optometrist, for each eye. The surgeon's fee is reduced by the co-management fee when your optometrist provides part of the post-operative care. Your payment covers all related post-operative visits for the next six months and any necessary enhancements for the following 12 months.
Prior to surgery, you can meet with a financial counselor who will answer your questions about the fees. For our patients' convenience, we accept cashier checks, cash, MasterCard, VISA, and Discover. A discount for cash payment is available, as well as a 0% down, 0% interest financing plan.
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Payment in full is required 5 business days before the first eye is scheduled to be performed, unless a financing arrangement has been made. If payment is not received 5 business days before the procedure, the procedure will be postponed. No surgery will be done on your second eye until this fee is paid as well.
Very few insurance companies cover refractive surgery. However, we do encourage you to check with your insurance provider before the surgery.
