A Professional Guide To Laser Vision Correction.

Introduction

Traditionally, glasses or contact lenses provided the source of correction for imperfect vision. Glasses are relatively trouble-free and many people regard them as a fashion accessory to enhance their appearance. With the advent of newer technology, and people's intense desire to be free of glasses or contact lenses, ophthalmic surgeons and engineers developed surgical alternatives for refractive correction.

Today, procedures such as LASIK, PRK, LASEK, and EPI-LASIK are the procedures of choice for laser vision correction using the excimer laser. We only use state-of-the-art FDA approved VISX Star S4 and Autonomous LADAR lasers equipped with the most recent software upgrades, active eye trackers, iris registration, and large pupil capability. Most importantly, our lasers feature "custom cornea" wavefront technology to achieve the most personalized vision correction. We are also one of the few centers to offer the all-laser approach to refractive surgery employing the IntraLase laser to create the flap and the excimer laser to reshape the cornea.

What is laser vision correction?

Laser vision correction emcompasses several procedures (LASIK, Custom LASIK, PRK, LASEK, and EPI-LASIK) which utilize the excimer laser to correct nearsightedness, farsightedness, and astigmatism. During the treatment, the laser's cool ultraviolet light removes a small amount of corneal tissue to reshape the corneal surface in order to allow light to be more sharply focused onto the retina, thereby improving vision.

Patients considering laser vision correction should have a stable refraction for at least one year. There is no upper age limit. After the procedure, eyeglass correction for distance vision will not generally be required, although some patients may desire them for certain activities, such as driving at night. If you are in the age range where bifocals or "readers" are normally required for close vision (40+ years of age), you will need reading glasses following the procedure. This condition is known as presbyopia and is part of the natural aging process. Presbyopia currently cannot be corrected with laser vision correction, unless one eye is adjusted for near vision. This is called "monovision".

LASIK

Laser Assisted In-Situ Keratomileusis (LASIK), combines the precision of the excimer laser delivery system with the benefits of a sophisticated surgical instrument known as a microkeratome or the IntraLase laser. First, by utilizing either a microkeratome or the IntraLase laser, a thin layer of cornea, or corneal flap, is created and lifted up. Then, ultraviolet light energy pulses from the excimer laser to reshape the exposed cornea with accuracy up to 0.25 microns. By adjusting the pattern of the laser beam, it is possible to treat nearsightedness, farsightedness, and astigmatism. After the cornea has been reshaped by the laser, the flap is replaced in its original position.

Because of the cornea's extraordinary natural bonding qualities, sutures are not required. The entire procedure takes less than 15 minutes for both eyes. LASIK is an FDA approved procedure.

Advanced Surface Procedures - PRK / LASEK / EPI-LASIK

Photorefractive Keratectomy (PRK), LASEK, and EPI-LASIK are methods of surgically reshaping your cornea using the excimer laser. They are called "advanced surface procedures". They are very similar to LASIK, but no corneal flap is created.

Surface procedures are generally performed for patients who are not good candidates for LASIK because of a thin or mildly irregularly shaped cornea. The side effects, risks and complication rate are about the same for LASIK and the surface procedures. Fortunately, all of the procedures are safe and effective. However, every surgery carries some inherent risk.

In PRK, after removing the surface cells (epithelium) of the cornea, the excimer laser is applied to the surface of the cornea making the central zone flatter in the case of nearsightedness, and steeper in the case of farsightedness. The modified corneal contour is then able to focus light more precisely onto the retina, thereby reducing nearsightedness, farsightedness, and astigmatism.

LASEK and EPI-LASIK are similar to PRK (but not similar to LASIK). In these advanced surface procedures, the superficialb corneal cells (epithelium) are peeled back in a thin sheet. The excimer laser is applied to the cornea and the epithelial cell sheet is laid back down over the treated area.

The visual results of LASIK and the various surface procedures are the same. However, because the surface cells must become smooth, it takes about a month for the vision to become clear after a surface procedure.

The Benefits of Wavefront Guided Custom LASIK

Conventional LASIK attempts to replicate the vision obtainable with the best glasses and contact lenses by correcting "lower order aberrations" (nearsightedness, farsightedness and astigmatism). The results with conventional LASIK are excellent. However, we know that the eye is not perfectly regular and that ideally, each spot on the eye actually requires its "own" particular prescription. This is clearly impossible with glasses, contact lenses, or conventional LASIK. However, with Wavefront Guided Custom LASIK hundreds of individual locations are measured, and each microscopic area of the cornea is specifically treated with the laser in order to attempt to optimize vision.

Higher order aberrations such as spherical aberration, coma, and trefoil may pre-exist in the eye or be induced by laser treatment. Conventional LASIK, PRK, LASEK, and EPI-LASIK - even if perfectly performed - can induce higher order aberrations from the treatment itself. The advantages of Wavefront Guided Custom LASIK is that it induces fewer higher order aberrations, thereby allowing patients to achieve sharper vision and fewer side effects such as glare, halo, starburst, and poor contrast vision.

However, it is important to realize that results will vary from patient to patient depending upon how each individual eye heals. Although the FDA studies and our extensive clinical experience have shown that many patients achieve superior quality of vision following Wavefront Guided Custom LASIK compared to glasses, contact lenses, or conventional LASIK, it is impossible to predict which patients will benefit even if pre-existing higher order aberrations are present. There can be no guarantee that Wavefront Guided Custom LASIK will be any better than conventional laser treatments for any given individual. However, Wavefront Guided Custom LASIK offers the very latest in technology and the greatest chance to achieve the best possible vision.

Will I have perfect 20/20 vision?

If you would nbe dissatisfied with anything less than perfect vision, then a refractive procedure may not be in your best interest. The goal of refractive surgery is to restore natural vision. However, even for those who do not wear corrective lenses, vision can fluctuate during the day due to lighting conditions, pupil size, and fatigue. Following refractive surgery, patients may need to wear glasses to sharpen their vision, especially for certain tasks such as night driving.