Refractive Laser Surgery (LASIK, LASIK with INTRALASE, PRK)
Our refractive surgery specialists are skilled in procedures that can change your lifestyle forever. We offer comfortable, safe, and effective outpatient procedures that correct a wide range of vision problems.
What is LASIK?
LASIK, or Laser Assisted in-Situ Keratomileusis, is an FDA-approved surgical procedure intended to reduce dependency on eyeglasses or contact lenses. The most commonly performed vision correction procedure, LASIK has become the procedure of choice for millions of people each year. LASIK involves the use of the Excimer laser to emit a “cool beam” of ultraviolet light that reshapes the cornea by removing microscopic amounts of tissue. Removal of these small amounts of tissue creates a new corneal curve that corrects for myopia (nearsightedness), hyperopia (farsightedness), and astigmatism. Corneal reshaping increases the eye’s focusing power and improves vision.
What is Custom LASIK?
Wavefront-guided Custom LASIK requires even more surgical expertise and judgment than conventional LASIK. Conventional LASIK is based on the patient’s eyeglass prescription. Custom LASIK takes into account not just the eyeglass prescription but also subtle irregularities in the way each individual’s eye focuses light. Two people can have the same eyeglass prescription, but no two people have the same wavefront map. In other words, with Custom LASIK more sophisticated measurements are used and a more precise correction is obtained. Some Custom LASIK patients achieve better than 20/20 vision. While not all LASIK patients will benefit from custom cornea ablation, Custom LASIK is most valuable for patients with greater than average irregularities in their prescription. Only a doctor experienced in LASIK can determine the value of Custom LASIK for each individual patient. With Custom LASIK, many patients who were previously told they could not have their vision corrected because of large pupils or unusual prescriptions may now safely reduce or eliminate their need for glasses or contacts.
Am I a Good Candidate for LASIK?
The LASIK procedure allows for correction of nearsightedness, farsightedness, and astigmatism. Our treatment range is about -9.00 to +3.50 and up to -4.00 diopters of astigmatism. Because of its many advantages, LASIK is our procedure of choice in most cases, even for lower prescriptions.
After a thorough eye examination, your doctor can tell you whether or not you are a good candidate for LASIK. Whether laser vision correction is right for you depends on a number of medical considerations. It also depends on you, your lifestyle, and your expectations. Assuming your doctor determines that you are a good candidate for laser vision correction, the decision to have LASIK surgery is ultimately yours. Only you know what impact wearing glasses and/or contact lenses has had on the quality of your life and only you know the value to you of reducing your dependency on these visual aids.
The LASIK Procedure
Before the LASIK procedure, your eyes will be anesthetized with eye drops and a speculum will be used to restrict eyelid movement. You will be instructed to fixate on a flashing red light with one eye while the other eye is taped shut.
During LASIK surgery, the surgeon will painlessly lift a thin, hinged flap of corneal tissue with a precise, automatic surgical instrument called a microkeratome. During these few seconds, you may feel some flight pressure, but no pain, and your vision will go dim. After the flap is folded back to reveal the cornea’s midsection, called the stroma, you will be asked to look at the flashing light again, which will then be very blurry. Next your surgeon reshapes the corneal surface by positioning the excimer laser for abut 30 to 60 seconds. Lastly, the flap is repositioned and given sufficient time to self-adhere. This occurs in just a few minutes by natural pump mechanism, without any sutures or glue. The procedure may then be repeated on the second eye.
The Risks
As with any surgical procedure, there are risks involved with LASIK. Side effects may include overcorrection or undercorrection, excessively dry eyes, corneal scarring, corneal edema, infection, persistent eye pain or discomfort, inability to wear contact lenses, glare and halos in the line of vision, and a decreased ability to see well at night or in fog. However, most of these subside as the healing progresses after LASIK surgery.
The Benefits
According to the Eye Surgery Education Counsil (ESEC), more than 90% of patients who undergo LASIK experience vision improved to 20/40 – the minimum vision standard for driving an automobile or playing sport without corrective eyewear and 56% report postsurgery 20/20 vision. Although LASIK will not prevent age-related eye conditions or diseases, results are permanent. Most patients return to their normal daily activities one day after surgery.
The results for Custom LASIK with wavefront technology are even more impressive. Custom LASIK postoperative results are more predictable and unprecedented, with over 20% of patients achieving 20/12/5 vision or better, over 70% of patients achieving 20/16 or better, and 98% of patients achieving 20/20 or better without lenses after surgery. This result has been referred to as “super vision” – significantly better than 20/20. The evidence of postoperative complications such as glare, halos, and difficulties with night vision that occur for a small minority of LASIK patients can also be significantly reduced with wavefront technology.
What to Expect
Immediately after the LASIK procedure, your vision will still be quite blurry. It is common for one eye to be less comfortable than the other for the first few weeks and for one eye to see faster than the other. This is normal. It takes several weeks and often people feel as though they’re looking through Vaseline, fog, or a dirty contact lens. Often they can see objects but the contrast or sharpness and clarify have not yet returned. It usually takes a few weeks for full vision to return and by three months, most peoples’ eyes have stabilized.
It’s also common for your vision to fluctuate from moment to moment or day to day during this period. Even though your eyes don’t feel particularly dry, please use the artificial tears provided in your postop kit several times a day.
It is critically important to not rub your eyes or get hit in the eye during the first few weeks following LASIK. This is similar to any surgical procedure in that one should protect the area as it heals. Most people can swim and start exercising within a week. Check with your doctor to see when you can return to normal activities. At your first and second visit after surgery your doctor will also tell you whether you need temporary glasses to improve your vision while your eyes are healing. Red spots on the white of your eye are perfectly normal and those will usually fade within a few weeks.
Complications after LASIK surgery by expert surgeons are uncommon. There are a few symptoms that may indicate that there may be something that needs your doctor’s attention. These include discomfort that is getting worse during the first week following surgery, a significant reduction in your vision and not just a mild fluctuation, a lot of discharge or redness or swelling of your lids.
We know the decision to have LASIK surgery is a big one, so we take great care to determine what’s best for you as our patient. That’s why we offer bladefree LASIK treatment using the IntraLase method. With the IntraLase method, pulses of laser light create your corneal flap, which is then lifted so the next step of LASIK—the reshaping of your cornea—can be performed. When your LASIK treatment is over, the flap is securely repositioned into place.
This bladeless computer-guided technology is 100% more accurate than most of the mechanical microkeratomes (hand-held devices with a thin metal blade) that surgeons may also use to create a corneal flap. The IntraLase method has been used successfully on hundreds of thousands of eyes and we trust this advanced technology to deliver exceptional results. Our commitment is to provide you with the ultimate in comfort, safety, and outstanding vision. LASIK with IntraLase can help you achieve all of this—while it delivers the added assurance of knowing you’re being treated with the most advanced technology there is.
LASIK performed with IntraLase is preferred by patients. In a survey of clinical practices, the vision in the IntraLase-treated eye was preferred up to 3 to 1 by patients over the vision in the mechanical blade–treated eye (among those who stated a preference). LASIK performed with IntraLase delivers superior visual results. In a clinical study comparing the IntraLase laser to the leading microkeratome, more patients achieved 20/20 vision or better in standard and custom LASIK surgery when the IntraLase method was used to create the corneal flap.
How the IntraLase Method Works
Unlike mechanical instruments, IntraLase technology is uniquely able to program the dimensions of your flap based on what’s best for your eye. Then the IntraLase laser creates your flap from below the surface of the cornea—without ever cutting it.
How? Ultra–fast pulses of laser light position microscopic bubbles at a precise depth determined by your doctor. The laser light passes harmlessly through your cornea. Then the laser creates rows of these bubbles just beneath your corneal surface as it moves back and forth across your eye in a uniform plane.
Next, the IntraLase laser stacks bubbles around your corneal diameter to create the edges of your flap. These bubbles are stacked at an angle that is determined by your doctor and is individualized to the way your eye is shaped.
The process takes only about 30 seconds from start to finish—it’s quiet and comfortable.
Your doctor then gently lifts the flap to allow for the second step of your LASIK treatment. When treatment is complete, the flap easily “locks” back into position and rapidly begins to heal.
PRK or Photo Refractive Keratectomy is much like LASIK, however, it is performed on the corneal surface instead of on the underlying layers of the cornea. PRK is generally utilized for patients that have thin, steep or flat corneas.
CK, or Conductive Keratoplasty, utilizes radiofrequency waves applied to the peripheral cornea to gently reshape the cornea and correct for low to moderate degrees of farsightedness. The ideal CK patient is someone who relies solely on reading glasses for their visual correction.
ReSTOR is a multifocal implant used for clear lens exchange in young patients or for lens replacement after cataract removal in older patients. This lens provides the patient a full range of vision correction, thus minimizing the dependence on glasses including reading glasses and bifocals.
For some patients whose prescription is too high even for LASIK or epi-LASIK to correct, the ICL (Implantable Collamer Lens) may be an excellent option. This implantable lens to correct vision has been available internationally for nearly a decade with worldwide experience in tens of thousands of patients.
Visian ICL, sometimes referred to as the Implantable Contact Lens, is placed within the eye during a brief outpatient surgical procedure providing excellent quality of vision for many patients who cannot safely have LASIK or other laser vision correction. The Visian ICL is invisible to you and others and requires no maintenance. It is made from Collamer, a collagen copolymer.
Collagen is the same naturally occurring substance present in the eye and in many other tissues of the human body. In one study, over 99% of patients in the clinical trial were satisfied with their new vision after the ICL procedure. Collamer is very compatible with the eye’s natural environment and the lens contains an ultraviolet filter that provides protection to the eye.
Am I a Good Candidate for Visian ICL?
In general, ICL candidates:
Are between the ages of 21 and 45
Are nearsighted (-3D t -20D eyeglass prescription) with mild or no astigmatism
Have adequate anterior chamber depth and eye tissue cell density (determined by an ophthalmologist after a comprehensive eye exam)
Have not had a significant change in their eyeglass prescription of more than 0.5D in one year
Are not currently pregnant
Have no known allergies to medications used during the procedure and have no other contraindications to the procedure
Are not good LASIK candidates because of severe nearsightedness, thin corneas, severe dry eyes, or some other reason
Where is the Visian ICL Placed?
A trained ophthalmologist will insert the Visian ICL through a small microincision, placing the implant inside the eye just behind the iris and in front of the eye’s natural lens. The Visian ICL is designed not to cause trauma to other eye structures and to stay in place with no special care.
Does it Hurt?
No. Most patients tell us they are very comfortable throughout the procedure. Your ophthalmologist will use anesthetic eyedrops before the procedure and may administer a light sedative as well.
What if My Vision Changes after Visian ICL?
One advantage of Visian ICL is that it offers treatment flexibility. If your vision changes dramatically after receiving the implant, your doctor can remove and replace it. If necessary, another procedure can usually be performed at a later date to further correct your vision. Patients can wear glasses or contact lenses as needed following treatment with the ICL. The implant does not treat presbyopia (difficulty with reading and people 40 years and older), but you can use reading glasses as needed after the ICL has been implanted.
How is the Visian ICL Implanted?
Your doctor will prepare your eyes one to two weeks prior to surgery by using a laser to create a small opening between the lens and front chamber of your eye. This allows fluid to pass between the two areas, thereby avoiding the buildup of intraocular pressure following the surgery. The implantation procedure itself takes about 20 minutes and is performed on an outpatient basis although arrangements should be made for someone to drive you to and from the procedure.
The day after surgery you will return to your doctor for a follow-up visit. Another follow-up visit at one month and six months will allow your doctor to monitor your progress.
Is the Visian ICL Visible?
No. the Visian ICL is positioned behind the iris (the colored part of the eye), where it is invisible to both you and others. Only your doctor will be able to tell that vision correction has taken place.
Can the Visian ICL be Removed?
Although the Visian ICL is intended to remain in place permanently, a certified ophthalmologist can remove the implant if necessary.
Will I be Able to Feel the Visian ICL?
The Visian ICL is designed to be completely unobtrusive after it is put in place. It stays in position by itself and does not generally interact with any of the eye’s structures.
Verisyse Phakic IOL is a permanent correction for high myopia or very nearsighted people who are not candidates for LASIK. By implanting the micro lens just in front of the iris, light rays that enter the eye are redirected to focus on the retina to provide clear vision.
