Quality Checklist
This checklist highlights all of the main features that an eye care center should possess in order to be able to properly and effectively treat patients. There are very few centers that meet all of these standards and Fichte Eye Associates is proud to say that it meets or surpasses them all!
Full Consultation with eye exam and discussion
The testing components of a quality, thorough surgery evaluation are detailed below. After a thorough eye examination it is important to have a detailed discussion of options. If any of the tests and options listed below are not included in your refractive surgery evaluation, then we feel it is not complete. This checklist will help define for you what a quality refractive experience should be.
Back to TopPupil Measurement in dark room with light amplification technology to lessen risk of glare at night
We consider this one of the most important tests a person
should have prior to undergoing any refractive surgery.
How big your pupil gets in low light can be very important
in how good your image quality at night is after refractive
surgery.
How your pupil is measured in your exam is very important.
In the old days we would use a penlight or other light source
and compare the pupil with round circles on a card to estimate
the pupil size in low light. This test was not as accurate
as we would like because even a little bit of light from
any light source can make your pupil measure smaller than
it truly is in low light. Modern day pupil size measuring
technology involves either light amplification or infrared
technology. Both can accurately measure your pupil size
in low light without making your pupil artificially smaller
while performing the measurement.
After knowing what your pupil size is in low light conditions,
the next question to ask is: "Will the laser treatment
I have cover my pupil adequately in low light so as to maximize
my night vision quality?" If you cannot have a treatment
that will cover your pupil in low light then serious consideration
should be given to not undergoing refractive surgery.
Remember there is always the option of doing nothing and
waiting for new technology that will cover your pupil in
low light. Read below to understand how scanning technology
can treat large areas on the cornea to maximize the chance
for a quality night image. We use scanning technology on
most people with moderately sized pupils and all patients
with large pupils in low light.
Orbscan computerized corneal topography that analyzes the front and back corneal surface
Computerized corneal topography looks at the curvature of your cornea like a topographic map of the earth's surface shows its curvature. There are some curvatures of the cornea that are irregularities that can lead to a poor result with refractive surgery. One example is keratoconus. Keratoconus is an irregularity that people are born with. This irregularity in the cornea can lead to an irregular response to refractive surgery and blurry vision. So if we find one of these irregularities on the computerized topography of your cornea, we recommend that you do not have refractive surgery. A topographic analysis of the front and back of your cornea is a very important test to have before undergoing any refractive surgery. If refractive surgery is performed without one of these topographic maps, it is difficult to know if the patient has early keratoconus.
Back to TopCorneal Thickness Measurement
Flap surgery itself has been performed for many years. It
was first performed in the form of keratomileusis. Flap
surgery has evolved into a more accurate surgery because
of the laser. But there are principles we learned from flap
surgery even before the advent of the laser component.
One important principle is we know we do not want to thin
a cornea too much. If we do, it could become irregular in
shape and create an irregularity in vision that could be
a problem. So we feel it is very important to accurately
measure the thickness of your cornea. Since we know the
thickness of the flap we are going to make and since we
know the amount of tissue the laser is going to remove to
get our correction, we can calculate how much of your cornea
we are going to leave behind untouched. We feel the number
to be respected is to leave at least 250 microns of the
back portion of the cornea untouched. If we do your calculations
and it shows it would be less than 250 microns, we will
recommend you not undergo laser vision correction and either
have nothing done at this time or consider implant technology.
We will discuss both of these options during your consultation.
Corneal thickness is measured two different ways in our
office. A pachymeter is a device that measures the thickness
of your cornea by ultrasound. The Orbscan topography instrument,
which is mentioned above under Corneal Topography, measures
the distance between the front and back curvature of your
cornea optically.
Tear Film Analysis that looks at important tear film healing factors
The cornea of your eye is where laser surgery is performed.
The cornea does not have blood vessels. The cornea gets
nutrition from the tear film on the surface and the fluid
inside the eye (the aqueous). The way the front of the cornea
heals after laser surgery is dependent on how healthy the
tear film is.
An important factor is lactoferrin. We feel it is important
when there is any suspicion of dry eye to have the tear
film lactoferrin measured. If it is low, studies have shown
that there is an increased chance of needing a fine tune
surgery. Enhancement or fine tuning surgery is common in
refractive surgery and helps people achieve their best vision
but it is also important that we do whatever is in our control
to minimize the chance of further surgery. This test can
be helpful in accomplishing that.
Tear film lactoferrin is also helpful in healing of the
cornea. So if we find the level low before refractive surgery
we will treat it and correct it so the level is normal before
proceeding. This can help the healing process and lessen
the chance of a complication. If our exam and studies show
that your tear film is reduced then we need to consider
enhancing your tear film. Punctal plugs are a way of plugging
the tear drainage system so that your own natural tears
stay on your cornea longer. Punctal plugs can increase the
tear film quantity and also increase the concentration of
important healing factors such as lactoferrin.
1% Cyclogyl Dilated Eye Exam
There are two reasons to perform this part of the exam prior
to refractive surgery. Most people understand that a dilating
drop makes the pupil big. The reason this is important is
that it allows us to look inside your eye with our lights
to make sure the retina and internal eye are healthy prior
to proceeding. The second reason is a bit more complicated
but let us make sense of this for you since it is so important.
To understand why it is important you must first understand
the process of accommodation.
Accommodation is the process our eyes use to read. When
we read, the lens inside your eye that sits right behind
your pupil gets more fat or curved. This curvature of the
lens makes a person more nearsighted so they can read. During
an eye exam when a person is looking at the eye chart, they
can involuntarily try to focus on the eye chart and stimulate
the accommodation response. If a person does this, they
will measure more nearsighted (or less farsighted) than
they really are. So how do we handle this accommodation
response in your exam? This is the second reason for the
dilating drops. The drop called Cyclogyl not only dilates
the pupil but it relaxes the muscle that changes the shape
of the lens. This relaxing of the lens muscle process allows
us to measure the level of nearsightedness or farsightedness
when your eye is in its totally relaxed state. Often we
will find that someone is quite a bit less nearsighted than
we thought they were.
This test helps us maximize the chance that you will have
a stable, unchanging correction after we are done with your
laser vision correction. There are some types of dilating
drops that make the pupil big but do not relax the lens.
Just making the pupil big is good for an internal exam but
it does not relax the lens and give us the important information
necessary to deliver an accurate treatment to you. This
also is an important test for a fine tune surgery. Remember,
you want to have drops put in your eyes not only to make
your pupil big, but to relax your lens for accurate measurements.
The drop we believe works the best and is most practical
for this is 1% Cyclogyl.
Tracking Technology available to follow eye movements if you cannot hold your eye still
Tracking technology is the most fascinating technology to
enter the refractive surgery arena in recent years. Tracking
means it helps the laser follow any eye movements. For some
people this is the only way to have laser vision correction.
If they can't hold their eye still, the tracker just follows
the eye and makes sure every laser pulse is put in an accurate
location. For some patients who can hold their eye still,
the tracker gives them great peace of mind that they do
not need to worry about eye movement. We tell you in your
exam whether or not we feel you should have a laser treatment
with tracking. If we do not feel you need a tracker but
you want it for peace of mind, just let us know. You do
not feel anything different… the tracker just follows
your eye.
It is important to realize that there are different tracking
technologies out there. Some companies have tracking technology
that is not fast enough to compensate for eye movements.
So if tracking technology is important to you, it is important
to know that to be effective a tracking system should have
a sampling rate of at least 1000 samples per second to move
the laser faster than any eye movements and maximize the
chance that the laser pulses will be placed in an accurate
location. Our Autonomous laser has a sampling of 4000 samples
per second. This is why our patients have confidence in
our tracking system.
Scanning Laser Technology available to maximize the ability to treat with an area 1 mm larger than your pupil size in low light
If your pupil stays smaller than your laser treated area,
the night image has a better chance of being good after
refractive surgery. If your pupil gets larger than the treated
area, than a halo of uncorrected image can create night
vision problems.
We feel it is important to have a treatment zone at a minimum
as large as your pupil in low light. In our opinion, it
is actually ideal if your treatment is 1 mm larger than
your pupil in low light. This is because as we sit in low
light for a period of time, the pupil can get even larger.
Again, if your pupil gets larger than the treated area on
your cornea, a halo or glare can occur.
Thus, two very important questions need to be answered before
undergoing refractive surgery. Number one is: "How
will my pupils be measured in low light? Are you using modern
day testing that involves light amplification or infrared
technology?" Number two is: "Now that we know
the size of my pupils in low light, can we perform a treatment
that maximizes my change of night image quality in low light?
Can we do a treatment that is 1 mm larger than my pupil
in low light?"
Specialist in Refractive Surgery - a surgeon and team who spend the majority of their time analyzing and performing refractive surgery
It is important that your surgeon be comfortable with refractive
surgery. Fichte Eye Associates happens to be a center that
practices pure refractive surgery. It is not something we
just do on the side. It is our total focus so that the doctors
and the staff in our center really never have to switch
gears. We specialize in refractive surgery.
A quality refractive surgery can be performed by centers
that are not pure refractive surgery. We have seen responsible
surgeons who do a wide range of eye care and still do a
very nice job in refractive surgery. If you are considering
going to a center that practices more of a wide range of
services, it is important to know the total number of refractive
surgery cases a doctor has performed. There also needs to
be a certain number of refractive surgeries performed per
month for the doctor to maintain his/her skills. It is helpful
to be specific when doing this type of research because
there are many different types of lasers in eye surgery
that have nothing to do with refractive surgery.
The best way to handle this is to find out which refractive
surgery option is best for you. Then you can ask your surgeon
how many of that specific type of procedure he/she has performed.
For example, if it is LASIK you are considering, you should
feel comfortable asking your doctor how many LASIK procedures
he/she has performed. It builds confidence in the patient
knowing that their doctor is comfortable with the procedure
and is open about their professional experience.
Long term Caring Service
After care is an important part of any surgery. You want to make sure that you have good, quality follow-up after your refractive surgery. At a minimum your refractive surgery should be checked at 1 day, 1 week, 1 month and more if we feel we need to see you. This can vary based on your individual healing response. Having a caring team to take care of you is important in the long run.
Back to TopFull Service Refractive Surgery - Ideally your surgeon should be experienced in all aspects of refractive surgery options including laser, Intacs and Implants
This level of experience ensures a quality decision will be made in the best interest of your eyes. If your surgeon only performs one type of refractive surgery, you may be inclined to have that surgery when it may not be the best option for you. It is important to fully understand all of your options for vision correction so you can make a decision that maximizes your sight and happiness.
Back to TopFor Immediate Release
Alcon PMA Filing for Customized LASIK Surgery
Recommended by FDA Ophthalmic Devices Panel for Approval
Hünenberg,
Switzerland - August 1, 2002 - Alcon, Inc. (NYSE: ACL)
announced today that the U.S. Food and Drug Administration
(FDA) Ophthalmic Devices Panel unanimously recommended approval
of its customized wavefront-guided laser eye surgery application
for myopia between 0 and -7 diopters.
Utilizing the LADARVision®
4000 excimer laser and the LADARWave™ wavefront
measuring device, Alcon brings a system approach to custom
laser eye surgery. High and low order aberrations unique
to each patient eye are captured by the LADARWave
aberrometer. This information is then transferred to the
LADARVision 4000 excimer laser where it is electronically
registered and computer matched to create the precision
ablation required in customized laser eye surgery.
"Unlike current
laser modalities for correcting refractive errors, wavefront
guided customized LASIK should provide surgeons the ability
to control the visual effects of higher-order aberrations.
Treating aberrations, which impact low contrast visual activities
such as night driving, should improve the patient's quality
of vision," said Dr. Stephen Brint, Associate Professor
of Ophthalmology at Tulane University School of Medicine and one of the five
surgeons participating in the clinical investigations.
"The refractive
community has eagerly anticipated this new technology,"
said Bill Barton, VP and General Manager, Surgical Division.
"We are proud to be the first in the industry to offer
an approach that has the potential to improve visual acuity
and enhance overall vision quality as compared to today's
conventional LASIK Surgery. We will work proactively with
the FDA to address the labeling recommendations set forth
by the Panel."
Alcon was the first
company to initiate FDA clinical trials for customized LASIK
surgery using a wavefront measurement device and an excimer
laser. Clinical trials are continuing for the treatment
of myopic astigmatism, hyperopia with and without astigmatism
and other ocular irregularities utilizing this technology.
Alcon, Inc. is the world's
leading eye care company. Alcon, which has been dedicated
to the ophthalmic industry for more than 50 years, develops
manufactures and markets pharmaceuticals, surgical equipment
and devices, contact lens solutions and other vision care
products that treat diseases, disorders and other conditions
of the eye. The LADARVision 4000 excimer laser and other
refractive products are commercially available in the United
States and International markets.
Alcon PMA Filing for Custom LASIK Surgery
Approved by FDA for Further Review
Add one
Caution Concerning Forward-Looking
Statements. This press release contains forward looking
statements within the meaning of the Private Securities
Litigation Reform Act of 1995, relating principally to the
acceptance by the FDA of our PMA and the expected benefits
of custom wavefront-guided laser eye surgery. These statements
involve known and unknown risks, uncertainties and other
factors which may cause our actual results, performance
or achievements to be materially different from any future
results, performances or achievements expressed or implied
by our forward-looking statements. These statements reflect
the views of our management as of the date of this press
release with respect to future events and are based on assumptions
and subject to risks and uncertainties. Given these uncertainties,
you should not place undue reliance on these forward-looking
statements. Factors that might cause future results to differ
include, but are not limited to, the following: we may never
gain FDA approval of the PMA or approval of the PMA may
take longer than we expect; general economic conditions
in the United States and internationally; technological
advances attained by our competitors; challenges inherent
in new product marketing; and government regulation and
legislation. You should read this press release with the
understanding that our actual future results may be materially
different from what we expect. Except to the extent required
under the federal securities laws and the rules and regulations
promulgated by the Securities and Exchange Commission, we
undertake no obligation to publicly update or revise any
of these forward-looking statements, whether to reflect
new information or future events or circumstances or otherwise.