Refractive Surgery – LASIK……and MORE!
Which Procedure Is Right For You?
It is likely that more than one of these procedures could reduce or eliminate your dependence on glasses or contacts. Every eye is different, and everyone has different visual needs. Your first step is to have a thorough eye examination to determine the health of your eyes. Together, you and your doctor will determine which option is best suited for your eye condition and lifestyle.
Refractive Error
Understanding how refractive surgery improves vision requires a basic understanding of refractive errors and how the eye focuses light. When light reaches a curved surface, it bends. This process of bending light is called refraction. The two main refractive surfaces of the eye are the cornea, the outer surface of the eye, and the lens, inside the eye. These two curved surfaces, along with other internal structures of the eye, work together to focus light onto the retina in the back of the eye. Light rays enter the eye through the cornea, which provides most of the focusing power of the eye. Light then travels through the lens where it is fine-tuned to focus properly on the retina. If light does not focus directly on the retina, the eye will be nearsighted, farsighted or astigmatic depending on the location of that focus. These problems are called refractive errors.
Myopia
Astigmatism
Hyperopia
Presbyopia
EXCIMER LASER SURGERY
If a person has a refractive error, then light is not properly focusing on the retina in the back of the eye. People who have refractive errors may wish to consider excimer laser surgery as an alternative to wearing corrective lenses. excimer laser surgery is a surgical procedure that corrects refractive errors by changing the shape of the cornea, and thus the way the eye focuses light internally. The goal of excimer laser surgery is to reduce or eliminate a person's dependence on eyeglasses or contact lenses. Although excimer laser surgery cannot guarantee 20/20 vision for every patient, it can significantly improve eyesight and generally eliminate the need for corrective lenses for distance activities.
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What is Laser Light?
Normal light from the sun or a light bulb is made up of a range of energy that scatters and radiates in all directions. A rainbow shows the spectrum of visible colors, from red to violet, that make up normal or white light. Laser light is not radiation, as are X-rays, cosmic rays and gamma rays. It is made of a single color or wavelength of light, with all the light rays traveling in the same direction (coherent light). The light itself is safe and does not become effective in medical treatment until it becomes highly concentrated through the use of special mirrors and lenses.
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The Excimer Laser
A laser contains a device to create light in a similar manner as a light bulb, but more sophisticated and precise. Like a child’s science project using a magnifying lens to start a fire from sunlight, special lenses and mirrors inside a laser focus and concentrate energy to an extremely fine point. An aspect of the Excimer Laser that makes it uniquely effective for refractive surgery, however, is that unlike other lasers, it does not produce heat. With an Excimer Laser, when an electric current is passed through a tube containing a special gas (Argon Fluoride), a reaction occurs that produces ultraviolet light energy. The direction, focal point, intensity and release of the light from the tube are precisely controlled by the surgeon and a computer. A laser light is produced, and it passes through a system of mirrors that results in all the light rays traveling in one direction (coherent light). When it first exits the laser, it is relatively weak. But then the light passes through a system of lenses that focus the energy to a fine point. As it gets closer to the focal point, the energy becomes more concentrated and the beam gains strength. Laser light reaches its maximum strength at the focal point, the point where all the rays converge. The strength of the beam rapidly diminishes after passing the focal point and can no longer affect other tissues in the eye.
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The Lasers
The 4th Generation IntraLase® FS Laser: Speed, Biomechanical Stability,
Precision, and Safety
The 4th Generation IntraLase laser works with microkeratome speed and laser
precision. Corneal flap creation is faster and better than ever. This
technology preserves biomechanical stability, increases precision, enhances
safety, and improves outcomes of the LASIK procedure.
www.intralase.com
Technolas® 217Z Excimer Laser is a flying spot/true scanning laser developed by Bausch & Lomb, and is designed to increase accuracy and produce an extremely smooth corneal surface in the delivery of laser vision correction. More laser vision correction procedures are done with Technolas® lasers worldwide than with any other system. Bauch & Lomb’s wavefront-guided procedure, the Zyoptix System,will advance your vision to a new level of precision and clarity. In a clinical study 91.5% of subjects achieved 20/20 or better vision.
Nidek EC-5000, one of the first lasers to gain FDA approval for use in the United States, is one of the most popular lasers worldwide and is the laser of choice for hundreds of top surgeons in the United States and Canada. The Nidek laser's patented technology offers a 7.5 mm transition zone, one of the largest available, meaning it has the range to safely and effectively treat patients with large pupils. This laser produces an extremely smooth surface on the cornea after the procedure. Smoother ablations, as they're known, promote faster healing and result in better vision.
Surgery
Before the surgery, anesthetic drops are applied to numb the eye. The surgery begins with the patient entering the laser room and being put in a relaxed position on the surgical bed. The laser system is quite large and includes both a microscope and a computer screen. The surgeon will adjust the laser bed so the patient's eye is positioned directly underneath the laser. The surgeon will then use a special device to keep the eye from closing during the procedure.
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Quality Checklist
To view our quality checklist please click here.
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Who’s A Good Candidate
In general, good candidates for excimer laser surgery are at least 18 years of age, they have not had a significant increase in their prescription in the past 12 months, they have a diagnosed refractive error, and they have healthy corneas. People with certain medical conditions, including eye disease, diabetes and pregnancy, may not prove to be good candidates for this procedure. In order to determine whether or not a patient is a good candidate for excimer laser surgery, their doctor will perform a special series of tests as well as a detailed medical history during their initial eye exam. If patients are interested in this procedure, they should ask their doctor to determine whether or not excimer laser surgery is a safe and viable option.
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Informed Consent
As part of the preliminary process prior to surgery, patients are asked to sign a surgical informed consent form. This form explains the procedure itself, its possible effects and all the potential problems that may occur during and after refractive surgery. Signing this form is the patient's verification that all of these potential complications are understood and accepted, and the patient still wishes to continue with the procedure. If questions arise after reading the informed consent, the patient should ask for clarification of all issues before signing the form.
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Complications
Although excimer laser surgery is a safe procedure, complications can occur. After the excimer laser surgery procedure, it is crucial that patients realize that their vision may not be perfect immediately and that total healing occurs over many weeks and months. It is also important for patients to understand that every eye heals differently, and it is impossible to precisely predict how each eye will heal. While most patients are happy with the results of the excimer laser surgery procedure, every patient should weigh the chance of experiencing complications against the potential benefits the procedure can provide. If after initial healing the patient's vision is not satisfactory based on expectations, their doctor may perform an enhancement procedure to fine-tune the patient's vision.
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THE LASIK PROCEDURES
Since LASIK was first approved in 1999, it has been regarded as a safe and successful method of vision correction. Because we are dedicated to providing our patients with the best possible vision, we offer both Traditional LASIK and IntraLASIK, also known as Blade-free or All-laser LASIK.
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Traditional Lasik Step-by-Step
Suction Tool
The doctor then begins the surgical procedure by placing a suction device on the eye. The device will block the patient's vision momentarily. The purpose of this suction device is to make the cornea firm enough for the surgeon to create the flap. At this time, a slight squeezing sensation can be felt, which may cause the patient minor discomfort.
Creating the Flap
Once the suction device is in place, the surgeon will attach a very sophisticated tool called a microkeratome. The microkeratome is the instrument used to actually create the corneal flap. This flap will allow the surgeon access to the underlying corneal tissue.
Folding the Flap
Once the corneal flap is made, the surgeon will use a special instrument to gently fold back the flap, so that the laser beam can gently re-shape the cornea.
Applying the Laser
With the laser positioned over the eye, the patient will be asked to stare at a fuzzy red light. At this point, the surgeon is ready to start the laser process. A sophisticated computer program controls the amount of laser pulses based on preliminary measurements taken by the patient's eye doctor during the pre-operative examination. This portion of the surgery only lasts a few minutes.
Flap Return and Smooth
Following exposure to the laser beam and correction of the refractive error, the surgeon will fold back the flap to its normal position on the cornea. Once in place, the surgeon will irrigate the eye and use a special medical sponge to smooth out any bubbles or wrinkles under the flap.
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After LASIK
After LASIK, the majority of people are able to pass a driver’s license test without glasses or contacts. Most patients report an immediate improvement within the first day. For others, vision may be blurry and fluctuate for several weeks or longer. Since an individual’s situation, healing powers and tissues are unique, not everyone should expect to achieve full visual correction. People with high to severe levels of myopia or astigmatism may require another procedure to achieve the desired results. People with extremely strong glasses, for example, may end up with significant correction but still need mild to moderate strength lenses part of the time for some activities.
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The IntraLase® Method for a Blade-Free LASIK Experience
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 blade-free 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.1
IntraLase Assurance and Comfort
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 it’s 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.
Because of the superior accuracy of the IntraLase method, certain patients who were ineligible for LASIK may now be able to have treatment. Ask your doctor today if you are a candidate.
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Advanced Surface Ablation
Advances surface ablation (ASA) became popular worldwide in the early 19990s and in the USA in 1995 when the Excimer laser was first approved by the FDA for laser vision correction. The Excimer laser brought tremendous advancements to refractive surgery.
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PRK
is performed in the comfort and convenience or our outpatient excimer laser suite. First, very powerful eye drops completely numb the eye. Next, the clear protective surface layer (epithelium) of the cornea is loosened from the underlying layers of the cornea and is then removed. Then in a matter of seconds, the Excimer laser is applied to the cornea, reshaping it to the eye to make it more comfortable during the healing process. It usually takes three to five days for the epithelium to fully heal.
Most PRK patients notice an improvement in their vision soon after surgery. However, vision is usually somewhat blurred during the epithelial healing process.
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EpiLASIK
is another type of surface ablation that eliminates or reduces many of the disadvantages of PRK and LASIK, and combines the safest and most effective advantages of each. A unique instrument mechanically separates the epithelium to make a flap, similar to a traditional LASIK flap. However, unlike LASIK, only the top layer is separated. And unlike PRK, this top layer is repositioned after the eye surface has been reshaped with the laser.
Advantages over LASIK include decreased risk of flap complications, decreased risk of surgical complications, decreased incidence of post-op dry eye syndrome, and better in treating thing corneas.
Advantages over PRK include quicker healing time, increased postoperative comfort and a more rapid visual recovery.
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NearVision CK
NearVision CK (Conductive Keratoplasty ) is a non-laser procedure developed specifically for baby boomers who have had clear vision all their life, but now struggle to see life's details with reading glasses.
NearVision CK is a safe, minimally invasive procedure that involves no cutting of your cornea. And it's performed using the ViewPoint® CK System, the only FDA-approved technology for the temporary improvement of near vision. This makes it an ideal procedure for people over 40, for whom safety is often the most important factor in their decision to undergo a vision correction procedure.
This section provides information about how NearVision CK works, who is a candidate for the procedure, and much more.
How NearVision CK works
NearVision CK (Conductive Keratoplasty ) is a quick procedure with no cutting involved. You don't even have to go to an outpatient surgery center. In just three minutes, a doctor can perform NearVision CK in his or her office.
The procedure
Using radiofrequency (RF) energy, NearVision CK can change how the eye focuses light by reshaping the cornea to make it steeper. After the doctor has applied a topical anesthetic (eye drops), controlled RF energy is applied in a circular pattern to shrink the corneal tissue. This pattern is applied in the periphery of your cornea and therefore minimizes interference with your line of sight (i.e., pupil). A device called a "speculum" holds your eye open during the procedure.
Once finished, you don't have to wear a patch and can usually return to work or normal activities the next day. Vision generally begins improving in about a week's time. As with other procedures, the level of improved vision may be temporary. While NearVision CK can turn back the clock on your vision, it cannot stop the clock entirely.
NearVision CK can also help patients with farsightedness, or hyperopia, a condition in which the eye is too flat. CK modifies the topographical (surface) curvature, making it steeper and therefore improving vision.
Risks and complications
NearVision CK is associated with a nominal amount of surgery-related complications. Some people who have had CK have experienced side effects that have impaired their vision for a few days after the procedure. Although these risks are relatively rare, they should be taken into consideration by anyone considering the NearVision CK procedure. Some side effects include:
- Discomfort and/or foreign body sensation
- Glare
- Halos
- Overcorrection
- Tearing
NearVision CK (Conductive Keratoplasty ) is intended for people over 40 who want to improve their near vision and reduce their dependence on reading glasses. CK is not intended for people with myopia (nearsightedness). All patients considering vision correction should undergo a complete examination by a doctor prior to the procedure.
You're likely a good candidate for NearVision CK if you:
- Are over age 40
- Had great vision your whole life
- Require reading glasses to compensate for fading near vision
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Refractive Lens Exchange (RLE)
Refractive Lens Exchange corrects nearsightedness, farsightedness and sometimes presbyopia by using an intra-ocular lens implant. RLE may be the procedure of choice for patients who are nearsighted, are too farsighted or have corneas that are too thin for laser vision correction. It is also a viable alternative for those over the age of 40 who are presbyopic or who may be showing signs of developing cataracts. Performed as an outpatient procedure, the natural lens is removed using ultrasonic vibrations through a very small, micro-incision with an intra-ocular lens. You will remain comfortable as the eye is completely anesthetized.
Most patients over the age of 45 who are nearsighted or farsighted are also presbyopic. Presbyopia is a condition that prevents the eye’s natural lens from changing shape, disallowing one to see clearly for both distance and near vision. Losing this ability is called “loss of accommodation.” In order to restore full vision, presbyopia-correcting IOLs are designed to provide a continuous range of vision for distance, intermediate, near and everything in-between.
ReSTOR
The
ReSTOR lens is a foldable multifocal lens made of acrylic, and utilizes a unique optic
design to provide near, intermediate and distance vision as well. The center zone has a
series of tiny steps that work together to focus light for near through distance
vision. Similar technology has been used for years in microscopes and
telescopes to improve image quality, and has now been patented for use in intraocular
lenses by Alcon. In addition to this central region, there is a surrounding
outer ring that is dedicated to focusing light for distance.
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Crystalens
An accommodative IOL, the Crystalens features a hinged design that allows
the lens to move forward when they eye attempts to focus on near objects, restoring some
of the accommodative function in prebyopic patients. It works most like the
eye’s natural lens, where the optic, or part of the IOL that you see through,
moves back and forth as you constantly change focus on images around you.
Crystalens Frequently Asked Questions >>>
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The
ReZoom lens is another type of multifocal lens made of clear, foldable
acrylic. It makes use of an optic design containing five focusing zones for a
full range of vision. Zone 1, the central portion, provides distance vision
under bright light conditions. Each of the surrounding rings are the four zones that
provide either distance or near vision under varying lighting conditions. The
outer rings are specifically designed for dim lighting conditions when the pupil is
large.
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Phakic IOL – Verisyse
“Phakic” refers to an eye that still has its natural lens in place. “Aphakic” refers to an eye that has had its natural lens removed. Therefore, a Phakic IOL is an artificial intra-ocular lens (IOL) that is implanted inside the eye without removing the eye’s natural lens.
Both the cornea and the lens are responsible for focusing light images on the retina. The most common forms of refractive surgery, PRK and LASIK, change the focusing power of the eye by removing tissue from the cornea. For those who were too nearsighted or farsighted to have their corneas reshaped, an intra-ocular procedure that replaced the natural lens with an IOL was the only viable alternative – until now.
When we are young, the natural lens inside the eye changes shape to help us see clearly in the distance and up close. This is called “accommodation.” Usually around age 40, the natural lens loses its ability to change shape. This condition is called “presbyopia.”
Phakic IOLs are ideal for younger patients whose natural lens can still change shape. Phakic IOLS can be thought of as implantable contact lenses. Some Phakic IOLs are designed to be placed in front of the iris (the colored part of the eye) while others are designed to be placed behind the iris.
Performed as an outpatient procedure, the IOL is placed inside the eye through a very
small, self-sealing incision. You will remain comfortable as the eye is completely
anesthetized. Everyone heals differently, but many patients report improvement in their
vision almost immediately and most resume their normal activities within a day or two. One
eye is done at a time, and the second eye is usually done a week or two later.
Verisyse Frequently Asked Questions >>>
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Intacs for Keratoconus
About Keratoconus:
Keratoconus is a disease that creates a thinning of the cornea or the clear front surface of the eye. Normal outward pressure within the eye causes the cornea to progressively bulge into a cone-like shape. The change in the cornea’s shape can have a dramatic impact on one's vision. In more severe cases, normal everyday activities such as driving and reading can be difficult to perform. Although keratoconus rarely results in total blindness, 20% of all patients will at some time undergo a corneal transplant, according to medical experts.
Nobody knows the cause of keratoconus for certain, although there is evidence that the disease has genetic origins and is possibly triggered and worsened by environmental factors. It normally affects both eyes, although at differing points of onset and rates of progression. In most people keratoconus begins during their teen years and progresses at varying rates until stabilizing in their 30s or 40s.
Keratoconus is estimated to affect one in 2,000 people across all races. It is normally treated with rigid contact lenses that reshape and flatten the pronounced bulge in the cornea while improving one’s vision. A proper contact lens fit is crucial to insure optimal vision, comfort, and eye health. Poorly prescribed or outdated contact lenses can lead to additional complications like corneal abrasions, scarring, and infection.
Intacs® provide an effective option to improve one’s vision prior to considering a cornea transplant. Intacs were originally designed and FDA approved to safely correct mild nearsightedness. Through the collaboration between physicians and Addition Technology, Intacs have emerged as a new therapy for patients with keratoconus.
About the Benefits of Intacs:
Clinical research, published in peer-reviewed ophthalmology journals, found that Intacs® inserts successfully improve patients’ visual acuity (best corrected and uncorrected), in most cases. In fact, patients’ uncorrected visual acuity and best-corrected visual acuity show marked improvements. The reshaped cornea, after the Intacs procedure, is typically aided by the use of glasses or soft contact lenses in order to provide improved functional vision to the patient and reduce the eye irritation previously experienced with the RGP contact lenses.
Researchers concluded that use of Intacs in patients with keratoconus is an effective way to manage the condition and restore functional acuity to patients. Further, experts believe that Intacs may ultimately be found to delay or perhaps prevent the need for a corneal transplant, by helping to keep the cornea nearer to its natural shape. Dr. Brian S. Boxer Wachler said, “Intacs is to be a logical addition to the stepwise treatment of keratoconus that improves visual acuity and, in a number of patients, has negated the need for corneal transplantation, thus far.”
About the Intacs Procedure:
Prior to any surgical procedure, it is common to experience a degree of anticipation and anxiety. It may be comforting to know that the Intacs® procedure is far less invasive than a corneal transplant or many other surgical procedures of the eye, and the Intacs success rate is high. The surgeons performing the procedure are typically corneal surgeons, having expertise with keratoconus. Each surgeon has also undergone a rigorous training process specific to Intacs.
Before the Procedure
Typically, your ophthalmologist, possibly working in tandem with an optometrist, will have you undergo a thorough eye examination. Your examination will include a variety of standard ophthalmic tests for this type of procedure, as well as general medical tests and a review of your specific medical history.
The Procedure for Intacs
Anesthetic drops are used to numb the eye, which is held open throughout the procedure to prevent blinking.
Step 1: A single, small incision is made in the surface of the cornea.
Step 2: The eye is prepared for Intacs placement. To stabilize your eye and ensure proper alignment of the Intacs inserts, the centering guide is placed on the surface for one to two minutes. During this time, the corneal layers are gently separated in a narrow circular band on the outer edge where the Intacs will be placed.
Step 3: The Intacs inserts are placed. After the second Intacs insert is placed, the small opening in the cornea is closed.
Step 4: The procedure is completed.
The placement of Intacs inserts remodels and reinforces your cornea, eliminating some or all of the irregularities caused by keratoconus, in order to provide you with improved vision. Follow-up visits will be required to monitor the healing process and to evaluate the visual benefits of the procedure. Even after a successful procedure, glasses or contacts may be required.
Corneal Transplants
In the U.S., corneal tissue is regularly available for transplant surgery (unlike outside the U.S.). The procedure requires the removal of your corneal tissue, where the disease is most prevalent, which is surgically replaced with donor corneal tissue, and then sutured into place.
The procedure takes between one to two hours and will require multiple follow-up visits to assess the healing process, apply anti-rejection medications, complete the removal of the sutures, and to perform refractive examinations and fitting for glasses or contact lenses. The overall recovery time differs by individual. However, the medical community indicates the recovery time can take more than a year.
- LadarVision: www.ladarvision.com
- Technolas: www.bausch.com
- Nidek EC5000: www.nidek.com
- IntraLase: www.intralase.com
- CK: www.myclearvision.com
- Verisyse: www.visioninfocus.com
- Lasik: www.seewithlasik.com
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