LASIK & Refractive Surgery Co-Management
Understanding LASIK & Refractive Surgery Co-Management
Co-management is a partnership between our eye doctor and a refractive surgeon. We handle your pre-surgery evaluation, help you understand your options, and provide all of your follow-up care after the procedure. The surgeon performs the actual operation, but we remain your primary eye care provider throughout the journey.
Most visits happen close to home. Your surgery is performed by a specialist who does these procedures every day. You can request direct surgeon follow-up at any point.
We co-manage several types of refractive procedures tailored to different vision needs and eye structures. LASIK reshapes the cornea using a laser after creating a thin flap, while PRK removes the surface layer of the cornea and allows it to regrow. SMILE is a small-incision technique that removes a small piece of tissue through a tiny incision, and implantable lenses can be an option when corneal procedures are not suitable.
Each method has unique benefits and recovery profiles, and we will help you understand which aligns best with your eyes and lifestyle.
Refractive surgery requires highly specialized equipment and surgical expertise that few practices can maintain. By working with surgeons who perform these procedures daily, we help you receive care from someone with extensive experience and access to advanced technology.
Our ongoing relationship with these surgeons means we stay current on techniques and outcomes, and we communicate directly about your care to provide seamless coordination.
Co-management happens only with your consent. You can choose to have all or some follow-up visits with the surgeon at any time. We provide clear, written roles and transparent fees so you know what is included and who to contact for specific issues.
Your active participation improves outcomes and helps us catch potential issues early. We rely on you to attend all scheduled appointments, follow pre-surgery instructions precisely, and report any concerns during recovery.
- Complete all testing appointments before your surgery date
- Use prescribed eye drops exactly as directed
- Avoid rubbing your eyes during the healing period
- Contact us promptly if you notice unexpected symptoms
Determining If You Are a Candidate
Refractive surgery primarily treats nearsightedness, farsightedness, and astigmatism. If you currently wear glasses or contacts to see clearly at various distances, you may benefit from these procedures. The degree of correction possible depends on how much refractive error you have and the health of your eyes.
Most people with mild to moderate prescriptions are good candidates, though higher prescriptions may require specific procedure types or may not be fully correctable.
We typically recommend waiting until at least age 18, and preferably into your mid-twenties, to ensure your prescription has stabilized. Your vision should be stable for at least one to two years before surgery. Beyond age, your eyes must be healthy, with no active disease or uncontrolled conditions that could interfere with healing.
People over 40 may still be excellent candidates but should understand that refractive surgery does not prevent age-related reading vision changes. Options like monovision or blended vision can reduce the need for reading glasses, but they have tradeoffs that we will demonstrate in the clinic.
Certain health conditions can slow healing or increase complication risks. Autoimmune diseases like rheumatoid arthritis or lupus, uncontrolled diabetes, and conditions that affect wound healing may disqualify you or require special precautions.
- Chronic dry eye or insufficient tear production
- Thin or irregularly shaped corneas
- Glaucoma or cataracts that need treatment first
- Herpes infections of the eye
- Keratoconus or other corneal diseases
- Active allergic eye disease or significant blepharitis
- Medications that impair healing or corneal health such as isotretinoin or amiodarone
- Unstable autoimmune disease or poorly controlled systemic disease
Your daily activities and career may guide which procedure we recommend. Contact sports, jobs with high eye injury risk, or careers requiring exceptionally stable vision might make one technique preferable to another. For instance, procedures that do not create a corneal flap may be better for athletes or military personnel.
We will discuss your lifestyle in detail to match you with the safest and most effective option.
Hormonal fluctuations during pregnancy and breastfeeding can temporarily change your vision and corneal shape. We recommend postponing refractive surgery until at least several months after you finish nursing and your menstrual cycle has returned to normal. This waiting period ensures the measurements we take accurately reflect your stable prescription.
Hormonal medications and certain birth control methods may also affect candidacy, so inform us of any medications you take.
Surgery is optional. Many people choose non-surgical options that meet their vision needs safely.
- Glasses or contact lenses
- Orthokeratology for overnight reshaping in select cases
- Continuing current correction and re-evaluating later
- For age-related near vision, options like monovision or blended vision can be discussed
Pre-Surgery Evaluation and Testing
Your evaluation begins with a thorough eye exam to confirm your current prescription and check for any eye disease. We examine the front and back of your eyes, measure your eye pressure, and assess your overall ocular health. This baseline visit helps us identify any issues that could affect surgery or recovery.
If we find conditions that need treatment, we will address them before moving forward with refractive surgery planning. We use corneal tomography and other screening tools to detect subtle corneal weakness that could increase the risk of post-surgery ectasia.
Advanced imaging devices create detailed maps of your cornea, measuring its thickness, curvature, and surface irregularities. These measurements are critical because they determine how much tissue can be safely reshaped and which procedures are appropriate for your eyes. Thin corneas may rule out LASIK but still allow other options.
We use this data to calculate the precise treatment plan the surgeon will program into the laser. We also calculate a safe residual stromal bed to reduce the risk of corneal weakening.
We measure your pupil diameter in various lighting conditions because larger pupils can increase the risk of nighttime glare or halos after surgery. We also test how well your eyes produce and maintain a healthy tear film. Inadequate tear production may need treatment before surgery to reduce dry eye symptoms afterward. If dry eye or meibomian gland dysfunction is present, we may treat it first to improve comfort and visual quality after surgery.
- Tear breakup time tests show tear film stability
- Schirmer tests measure the volume of tears produced
- Pupil measurements in dim light reveal maximum dilation
We will have an honest conversation about what refractive surgery can and cannot achieve. While most people attain excellent vision, perfect vision is not guaranteed, and some may still need glasses for certain tasks like night driving or reading. Understanding realistic outcomes helps you make an informed decision and reduces disappointment.
We encourage you to ask questions about success rates, potential side effects, and what your vision might be like in different situations.
- Temporary dryness, light sensitivity, and glare or halos at night
- Over or undercorrection that may need glasses, contacts, or enhancement
- LASIK-specific risks like flap wrinkles or displacement, epithelial ingrowth, and inflammation
- PRK-specific risks like corneal haze and a longer recovery
- Rare corneal weakening called ectasia
- Infection or inflammation that needs urgent treatment
- Elevated eye pressure from steroid drops in susceptible patients
- Future aging changes may still require glasses
After gathering all diagnostic information, we analyze your unique eye characteristics to recommend the most suitable procedure. Factors like corneal thickness, prescription strength, pupil size, and lifestyle needs all contribute to this decision. Some eyes are ideal for multiple options, while others clearly benefit from one specific technique.
We will explain why we suggest a particular approach and what advantages it offers for your individual case.
What to Expect Before and During Your Procedure
Proper preparation improves surgical precision and reduces complications. If you wear contact lenses, you must stop using them for a period before your measurements and surgery because contacts can temporarily alter corneal shape. Soft lens wearers typically need to switch to glasses for one to two weeks, while rigid lens users may need several weeks.
During this time, continue your regular eye care routine and avoid any new eye makeup or skincare products that could introduce irritants.
- If you wear orthokeratology lenses, plan to stop them for 2 to 3 months or longer before final measurements
- Treat eyelid inflammation if present with warm compresses and lid hygiene before surgery
- Remove lash extensions and avoid new lash treatments to reduce infection risk
We will provide specific instructions about which medications to continue or pause before surgery. Some supplements and medications can affect bleeding or healing. You will also receive a final contact lens removal schedule based on your lens type.
- Stop wearing soft contact lenses 1 to 2 weeks before final measurements
- Discontinue rigid gas permeable lenses at least three weeks prior
- Orthokeratology lens wearers usually need a longer holiday of 2 to 3 months or more
- Inform us of all prescription medications and supplements
- Do not stop blood thinners, aspirin, or any prescription medications unless both your prescribing clinician and the surgeon instruct you to
- Tell us about all medications and supplements, especially isotretinoin, amiodarone, and acne or hormone therapies that can affect healing
On the day of your procedure, arrive with a clean face, free of makeup, lotions, and perfume. The surgical center will verify your identity and review your consent forms. You will receive numbing eye drops, and the surgeon may offer a mild sedative to help you relax, though you will remain awake and aware throughout the brief procedure.
Arrange for someone to drive you home, as your vision will be blurry immediately afterward and you should not operate a vehicle. You can request to see your surgeon at any time if you have concerns on the day of surgery or during recovery.
During LASIK, the surgeon creates a thin flap in the cornea, lifts it, and uses a laser to reshape the underlying tissue before repositioning the flap. PRK removes the surface cells and applies the laser directly to the cornea, allowing the surface to heal naturally over several days. SMILE involves creating a small lens-shaped piece of tissue within the cornea and removing it through a tiny opening.
Each procedure takes only minutes per eye, though preparation and post-procedure checks extend your time at the surgical center.
For implantable lenses, the surgeon places a thin lens inside the eye in front of or just behind the iris through a small incision. This can be a good option for higher prescriptions or thinner corneas. Lens-based procedures have different risks than corneal laser surgery, including cataract formation, pressure changes in the eye, and the need for future lens exchange.
Most corneal procedures such as LASIK, PRK, and SMILE use numbing eye drops. Lens-based procedures such as implantable collamer lenses or refractive lens exchange usually involve additional local anesthesia and IV sedation. General anesthesia is rarely needed for routine adult cases. Tell us about any prior anesthesia reactions and any history of motion sickness or severe anxiety so we can tailor your comfort plan.
You will feel pressure and see lights or movement, but you should not experience sharp pain. After the numbing wears off, you may feel mild discomfort, scratchiness, or burning, especially with surface procedures like PRK.
We will provide pain relief recommendations and prescribe medications if needed to keep you comfortable during the first day or two of recovery.
Recovery and Post-Operative Care
Your vision will likely be hazy or fluctuating immediately after the procedure, and your eyes may water, burn, or feel gritty. Rest with your eyes closed as much as possible during the first day, and wear the protective shields provided to prevent accidental rubbing or pressure while you sleep. Many people notice significant vision improvement by the next morning, though this varies by procedure type. If you had PRK, a bandage contact lens will be placed and should remain in place until we remove it at a follow-up visit.
Avoid screens, bright lights, and any activities that strain your eyes during this initial recovery window.
We will see you for your first post-operative visit within 24 to 48 hours after surgery to check your healing progress and vision improvement. Additional appointments typically occur at one week, one month, three months, and six months. These visits allow us to monitor your corneal healing, adjust medications, and ensure your vision is stabilizing as expected. For PRK, we typically remove the bandage contact lens around day 4 to 7 and may see you more frequently during the first month.
Attending every scheduled follow-up is crucial for detecting and addressing any issues early.
You will use several types of eye drops after surgery, including antibiotics to prevent infection and anti-inflammatory drops to control swelling and promote healing. Lubricating drops help manage dryness and keep your eyes comfortable. We will give you a detailed schedule showing when and how often to use each medication. PRK patients often need a longer steroid taper over several weeks to months, and we will monitor eye pressure during this time.
- Antibiotic drops for the first week to prevent infection
- Steroid or anti-inflammatory drops for several weeks
- Preservative-free artificial tears used frequently for comfort
- Never skip doses or stop medications early without our approval
- We will check your eye pressure during steroid use to watch for steroid response
Most people return to work and light activities within a few days to a week, depending on the procedure type. You can usually resume driving once your vision meets legal requirements and we clear you at a follow-up visit.
- Avoid eye makeup for at least one week
- Keep water out of the eyes for one week
- Do not swim or use hot tubs for at least two weeks
- Avoid contact sports for about one month or until we clear you
Your eyes are vulnerable during the healing period, and protecting them from trauma and irritants is essential. Wear sunglasses outdoors to shield against UV light and wind. UV-blocking sunglasses are especially important after PRK to reduce the chance of corneal haze. Use your protective eye shields at night for at least the first week to prevent rubbing. Keep soap, shampoo, and other irritants out of your eyes when showering.
Avoid dusty or dirty environments, and do not rub your eyes even if they itch, as this can dislodge the healing cornea.
Vision recovery speed varies by procedure. LASIK patients often see well within a day or two, while PRK recovery is slower, with noticeable improvement over one to two weeks and continued refinement for months. SMILE typically falls between the two. Fluctuations in clarity and sharpness are normal as your eyes heal and adjust.
Final visual results usually stabilize within three to six months, though some people notice minor changes for up to a year.
Recognizing Complications and When to Seek Care
Mild discomfort, light sensitivity, tearing, and fluctuating vision are all expected in the days following surgery. However, certain symptoms indicate potential problems. Sudden severe pain, rapidly worsening vision, intense redness, or discharge that looks like pus are not normal and require prompt evaluation. After LASIK, sudden blur or pain after rubbing can indicate a flap problem and needs same-day assessment.
Trust your instincts and contact us if anything feels wrong, even if you are unsure whether it is serious.
Dry eye symptoms are very common after refractive surgery and usually improve over weeks to months as nerves regenerate. We manage this with frequent preservative-free artificial tears, and in some cases, we may recommend punctal plugs to help retain moisture. Omega-3 supplements and environmental adjustments like using a humidifier can also provide relief.
If dry eye persists beyond the typical recovery period, we will explore additional treatment options to restore comfort.
While gradual improvement and daily fluctuations are expected, sudden vision loss, new floaters or flashes of light, or a curtain or shadow in your peripheral vision require urgent evaluation. These symptoms could indicate retinal issues or other serious complications unrelated to the surgery itself but important to address immediately.
- Sudden decrease in vision in one or both eyes
- New onset of many floaters or flashing lights
- A dark curtain or shadow moving across your vision
- Persistent double vision that does not improve
- Severe light sensitivity with pain in the first week can signal inflammation and requires urgent evaluation
Eye infections after refractive surgery are rare but serious. Signs include increasing pain, worsening redness, thick yellow or green discharge, and swelling of the eyelids. Preventing infection requires strict adherence to your antibiotic drop schedule, avoiding touching your eyes with unclean hands, and staying out of contaminated water.
If you suspect an infection, contact us the same day so we can examine you and start treatment if necessary.
Rare but serious complications include corneal ectasia, epithelial ingrowth after LASIK, and diffuse lamellar keratitis. We screen to reduce risk and monitor for these at follow-up.
Call our office during business hours for concerns like increased dryness, minor discomfort, or questions about your medications. Contact us urgently or use our after-hours number for severe pain, sudden vision changes, signs of infection, or eye injuries. If you experience trauma to the eye or symptoms that could indicate a retinal emergency, go to the nearest emergency room if you cannot reach us immediately.
We provide clear contact instructions and emergency numbers so you always know how to get help when needed.
Frequently Asked Questions
Most people achieve their best vision within three to six months, although many notice excellent vision much sooner. The exact timeline depends on the procedure type, your individual healing response, and your pre-surgery prescription. Minor fluctuations in clarity can continue for up to a year as your eyes fully settle.
Many people achieve vision good enough for most daily activities without correction, but some still benefit from glasses for tasks like night driving or reading fine print. If you are over 40, you will eventually need reading glasses due to natural age-related focusing changes called presbyopia, which refractive surgery does not prevent. We discuss these possibilities during your consultation.
Yes, surgeons typically treat both eyes in one session for convenience and faster overall recovery. Treating both eyes together means you experience the healing process once rather than twice. However, in rare cases where specific risk factors exist, your surgeon may recommend spacing procedures apart.
Yes, some patients choose one eye set slightly for near and the other for distance. A contact lens trial is recommended first to make sure you like the visual balance.
LASIK often has faster visual recovery but has flap-related risks. PRK has slower recovery and more discomfort early but no flap. SMILE uses a small incision and may reduce dry eye symptoms for some. ICL is a lens placed inside the eye and is useful for higher prescriptions but has lens-related risks such as cataract and pressure changes.
Your eyes can still change over time due to aging, hormonal shifts, or natural progression of conditions like presbyopia. If your distance vision regresses significantly, an enhancement procedure may be possible, depending on your corneal thickness and overall eye health. We will monitor your vision at regular eye exams and discuss options if changes occur.
Refractive surgery is usually considered elective, so most medical insurance plans do not cover the procedure itself or related appointments. However, some vision insurance plans or flexible spending accounts may offer partial coverage or discounts. We recommend checking with your insurance provider beforehand and discussing all costs during your consultation so there are no surprises. Co-management fees and surgical fees are typically separate. We will provide a written estimate that itemizes what is included in the surgeon's fee and in our pre and post-operative care so there are no surprises.
Getting Help for LASIK & Refractive Surgery Co-Management
If you are considering refractive surgery, schedule a consultation with our eye doctor to learn whether you are a candidate and what to expect. We will perform a thorough evaluation, answer all your questions, and coordinate with trusted surgeons to provide seamless care from your first visit through complete recovery.