Refractive Surgery, LASIK, CK
Refractive Surgery
What is Refractive Surgery?
"Refractive surgery" is a term for several procedures designed to treat "refractive errors," such as nearsightedness, farsightedness and astigmatism. These procedures attempt to alter refractive errors by changing the shape of the cornea.
How does the Eye Work?
Clear vision in the normal eye is the result of light rays passing through the cornea, pupil and lens and focusing directly upon the retina.
Nearsightedness occurs when the cornea is too curved or the eye is too long. This causes light to focus in front of the retina, resulting in blurry distance vision.
Farsightedness occurs when the cornea is too flat in relation to the length of the eye. This causes light to focus at a point beyond the retina, resulting in blurry close vision and sometimes distance vision as well.
Astigmatism occurs when the cornea is shaped like a football, more curved in one direction than the other, and often occurs with nearsightedness and farsightedness. This causes light not to focus on any point, resulting in blurry and distorted vision.
The goal of refractive surgery is to reduce or eliminate dependence on corrective lenses. Although the vast majority of patients see 20/40 or better post-operatively, individual results cannot be guaranteed. Patients over 40 years old who have surgery to treat nearsightedness may find they need reading glasses for close work after surgery. Refractive surgery is performed on an outpatient basis, and most people return to work within one to three days.
The Excimer Laser
In the early 1980s, researchers found that IBM's new Excimer laser, used initially for etching computer chips, had refractive surgery applications as well. Unlike other lasers that tend to damage surrounding tissue, the "cool" light from the Excimer laser created no thermal damage to surrounding tissue and left a very clean margin.
LASIK
Laser In-Situ Keratomileusis (LASIK) can be used to treat low to severe levels of nearsightedness and moderate amounts of farsightedness and astigmatism. LASIK combines the computer-controlled precision of the Excimer laser with the faster healing benefits of another type of refractive surgery called Lamellar Keratoplasty. While PRK treats the surface of the cornea, LASIK treats the inner tissue of the cornea. First, an instrument known as a microkeratome makes a flap in the outer layer of the cornea, at about 25 percent of its depth from the surface. The flap, which remains attached on one side, is then folded back. Next, the Excimer laser sculpts the internal corneal tissue to the desired shape. The corneal flap is laid back in its original position, where it is allowed to dry for a few minutes. Due to the cornea's extraordinary natural bonding qualities, stitches are usually not required. LASIK results are usually realized sooner than with PRK.
There's a new standard for laser vision correction that's making things easy for physicians (just ask for AMO) and patients (just ask for the iLASIK™ procedure). The iLASIK solution is an advanced platform, yielding clinical benefits at every step ...
WaveScan™ Technology
- WaveScan technology captures unique imperfections in each individual's eye that could not have been measured before using standard methods for glasses and contact lenses
- This new level of measurement provides 25 times more precision than phoropter-driven prescriptions
- Provides the physician a new level of information to measure and correct unique imperfections in each individual's eye
IntraLase™ Technology
- IntraLase technology gives you the capability to precision-design your patient's intracorneal architecture in terms of diameter, depth, edge angle and morphology — creating the optimal stromal bed for the refractive procedure. IntraLase technology delivers many of the essential components of the ideal LASIK flap, including:
- Stronger flaps through improved wound healing, preservation of Bowman's layer and flap edge healing results in corneal strength comparable to PRK1
- Enhanced safety through less ectasia, reduced epithelial ingrowth and folds, and less risk of infectious keratitis than PRK3
VISX™ Technology
Advanced CustomVue™ treatment can deliver Personal Best Vision™ that:- Can potentially produce better vision than is possible with glasses and contact lenses4
- Is approved to treat the broadest range of individuals, even those with astigmatism
Treating Nearsightedness, Farsightedness, and Astigmatism
To treat nearsightedness, the cornea must be made flatter. This is accomplished by removing tissue from the center of the cornea.
To treat farsightedness, the central cornea must be made steeper. This is accomplished by directing the laser beam to remove tissue from around this area.
To treat astigmatism, the cornea must be made more spherical. By changing the pattern of the beam, more tissue is removed in one direction than the other.
Q: Who is a good candidate for a refractive procedure?
A: The only way to know whether or not someone is a good candidate for a refractive procedure is to be evaluated by a qualified refractive surgeon. At West Coast Eye Care, we make it easy for someone to schedule an appointment for an evaluation. Candidates for laser vision correction must be at least 18 years of age, have a stable prescription for glasses or contact lenses for a year prior to the procedure, be without certain diseases of the cornea or retina and have realistic expectations about the outcome of the procedure.
Q: How does laser vision correction improve vision?
A: Laser vision correction uses cool pulses of ultraviolet light to remove a very small amount of tissue from the cornea at the front of the eye. This corrects the curve of the cornea and allows light to properly focus on the retina. The result is clearer distance vision.
Q: What is LASIK?
A: LASIK is an acronym for " Laser In-Situ Keratomileusis." It is a laser vision correction procedure that combines the technologies of the microkeratome and Excimer laser. LASIK can correct nearsightedness, farsightedness and astigmatism by reshaping the curvature of the cornea. Once a very precise, thin flap or corneal tissue is made, the Excimer laser is used to make the desired correction, and the thin corneal flap is replaced.
Q: What are the advantages and disadvantages of LASIK?
A: The Excimer laser must be applied to the inner layers of the cornea in order for the procedure to be effective. One of the advantages of LASIK is that the top layer is not scraped off. As a result, patients experience much less discomfort. The eyes may burn or hurt for a few hours, but afterwards, there is little discomfort. LASIK also preserves the second layer of the cornea (Bowman's membrane). Some refractive surgeons believe that preservation of this layer results in a better quality of vision. Disadvantages of LASIK are that the procedure is very surgeon-dependant. This means that it is important to choose an experienced LASIK surgeon.
Q: Is LASIK painful?
A: No. Our patients are required to arrive at the surgery center at least 30 minutes prior to their appointed surgical time. An oral sedative is given to alleviate anxiety. Topical eye drops are used to numb the eyes. The procedure lasts only a few minutes and is usually not painful. The sensation is one of pressure more than pain. This pressure sensation is felt at the beginning of the procedure and lasts less than a minute. Many patients do not require pain medication following the procedure. Post-operatively, antibiotic and steroid eye drops are used to aid in the healing and prevention of infection following surgery. The patient will have to wear a protective eye shield over his or her corrected eye for the first day and night to avoid any rubbing or interference while sleeping. It is best to keep your eyes closed for the first four hours after the procedure. The clear plastic eye shield should be worn at night for the first three nights.
Q: How long does the treatment take?
A: The laser treatment itself takes about 15 to 40 seconds, based on the degree of correction necessary. Patients will be in the laser suite for about 20 minutes. Patients should plan on being at the laser center for about an hour and a half and will need someone to drive them home.
Q: When can a patient go back to work?
A: The day of surgery, you need to go home and rest. The next morning, you must see the doctor for your one-day post-op visit. Following this visit, patients can report to work. Some patients generally note great improvement in their vision on the first morning of post-op, but crystal clear vision may take a week or more.
Q: Can both eyes be done at the same time?
A:Yes. For more information please visit www.visix.com
Q: Do most patients have perfect vision after the procedure so that they'll never need glasses?
A: Experience has shown us that laser vision correction has been overwhelmingly successful in reducing myopia and astigmatism. While vision improves following the procedure, the degree of improvement may vary. Overall, 98 percent of typical patients achieve 20/40 vision or better, which means they can drive legally, play sports and join the police or fire departments, all without their glasses. The need for reading glasses usually begins at age 40 to 45 and is caused by a hardening of the natural lens of the eye. This hardening process results in an inability to focus on close objects, and reading glasses or bifocals become necessary. Refractive surgery cannot, as of yet, restore youthful softness to the natural lens of the eye. However, just as many people do with contact lenses, refractive surgery can set the focus of one eye permanently for near vision and reading. This is called monovision, because the individual then reads with one eye and sees at a distance with the other. Monovision works very well for most individuals, but it is not for everyone.
Q: What are the long-term effects of the procedure?
A: The Excimer laser procedure has been used in many countries around the world since the late 1980s. Many clinical studies have investigated the long-term effects of the Excimer laser on the cornea. We are not aware of any studies that demonstrate any long-term negative effects on the integrity of the eye. Patients who require an enhancement procedure or develop a problem will typically do so within the first few months following the procedure.
Q: What are the risks of the laser vision correction procedure? How does a patient know it's safe?
A: It is essential that a patient understand as much as possible about the risks associated with the Excimer laser procedure. Over millions have been performed. Furthermore, some of the nation's top eye institutes are working with an independent medical council on an ongoing basis to ensure that the highest standards of safety are met. In general, serious complications with refractive surgery are very rare.
Q: Can a patient go blind from the procedure?
A: Millions of patients in 52 countries have improved their vision as a result of laser technology. To our knowledge, no cases of blindness have been reported from either PRK or LASIK procedures. While there is still a small risk of blindness, this is true for contact lens and glasses users as well. All procedures have the inherent risk of complications albeit very rare.
Q: Is this a good time to have a refractive procedure? Will something better come along in the near future?
A: The decision of when to have a refractive procedure is highly personal. Some facts to consider are the patient’s age, visual needs and personal attitudes.
Other considerations are related to the technology involved. It would be discouraging to think that refractive surgeons will not improve their current abilities. We certainly will come up with innovations. One thing is certain: there are no guarantees with any type of surgery. If a person requires a guarantee to make a decision, then the answer is clear - that person should not have the procedure at this time.
Visit the Intralase website
The flap can be created with the keratone or with a laser. The intralase is more precise and painless and will not only “preserve” the corneal tissue but will give a smoother more precise flap.
Q: What does the cost of the procedure include?
A: The fees for LASIK at West Coast EyeCare Associates are inclusive. They include pre-operative evaluations, computerized corneal mapping, personal consultation, the facility and instrument fees and follow-up care for one year. Our patients can pay for their procedure using a variety of payment methods including cash, certified check, major credit cards, personal checks or payment through an extended payment plan. West Coast EyeCare will provide all services that can be provided for by WCEC at no extra charge for one year.
Q: How does someone find out more information?
A: A potential patient can call us at (619) 697-4600 and ask for a free consultation with one of our refractive surgeons. We offer convenient appointment scheduling to perform a private evaluation, explain laser vision correction in more detail and determine if someone is a perfect candidate for this exciting procedure.
For additional information from the American Academy of ophthalmology, click here.
Conductive Keratoplasty
Conductive Keratoplasty SM (CK) is the only FDA-approved procedure for mild to moderate hyperopia that uses radiofrequency instead of a laser.
CK builds upon the principles of thermokeratoplasty, using radiofrequency (RF) energy to reshape the cornea and therefore adjust its refractive characteristics.
What happens during the procedure?
After applying drops to numb the eye, the doctor imprints a treatment pattern on the cornea using rinse-away dye. The doctor will have determined the pattern in advance of the procedure, based on the individual patient’s amount of hyperopia and details of their examination. The pattern guides the doctor’s treatment; each point represents a place where radiofrequency (RF) energy will be applied. Once the cornea is marked, the doctor uses a small probe to apply the energy in a circular pattern to reshape the cornea
Is CK painful?
The CK procedure is considered painless. The most common sensation that patients experience is a feeling of pressure on the eye. Patients may also be aware of a support or speculum that helps to hold the eye open. After surgery, there may be some mild discomfort, and many patients experience a foreign-object sensation or "scratchiness" in the eye. This usually subsides within 24 hours of the procedure.
After CK?
Most patients report an immediate improvement within the first day. For others, the improvement may not be apparent for the first few weeks. It usually takes a few weeks for the eye to adjust to the final level of treatment.
Who is a good candidate for CK?
To be eligible for CK, the eye must be in good health and vision must be stable. However, some people are better candidates than others and consultation with the doctor prior to surgery is important to determine estimated benefits and possible complications.
NearVision Conductive Keratoplasty
Are you having trouble reading up close?
It seems to happen overnight. You suddenly can’t read a menu, see your alarm clock or review the scores on your golf card. But you’re not alone. Millions of baby boomers like you are losing their near vision as part of the natural aging process.
Why vision loss with age?
When we turn 40, our eyes begin losing their ability to easily focus on near objects. This can be the result of two different conditions.
- Farsightedness (hyperopia): When the surface of the eye (cornea) is too flat, changing the way our eyes focus light. Young eyes are often strong enough to compensate, which is why it may only be a problem after 40.
- Presbyopia: When the lens in the eye loses flexibility because of age. This also causes problems in the way our eyes focus light. Everybody over age 45 will eventually suffer from this condition.
NearVision CK can help improve your vision, allowing you to see clearly like you could 10 years ago. It’s an exciting new advancement in vision correction because it uses radio waves instead of a laser to treat your vision problem.
- No cutting – helps minimize side effects and speed recovery.
- Convenient and safe – your doctor performs the procedure in his or her office.
- Fast and easy – takes only 3 to 5 minutes and is virtually painless.
NearVision CK can change how the eye focuses light by reshaping the surface of your eye (cornea). When the shape is changed, light can be refocused on the correct part of your eye (retina). To produce this reshaping, NearVision CK uses the controlled release of radio waves to heat and shrink corneal tissue. This steepens the cornea and allows light to properly focus on the retina again.
What to expect during a NearVision CK procedure.
Once your doctor has determined that you are a candidate for NearVision CK, your eye will be photographed to determine its current and individual shape. This will be used to plan the procedure and measure results.
What to expect before and after a NearVision CK procedure.
Before the procedure, the only requirements are to not wear makeup and arrange for transportation to and from your doctor’s office. The procedure itself is fast and simple and will take just a few minutes to perform.
After the procedure, and as with other vision correction procedures, you may experience some eye discomfort and light sensitivity for a few days. Your doctor will recommend that you apply eye drops for a few days after the procedure. Ask your doctor or ophthalmic technician for more information.
Are you a candidate for NearVision CK?
- Are you over 45 years of age?
- Have you had great distance vision without glasses for most of your life?
- Are you tired of your reading glasses?
You may NOT be a good candidate for NearVision CK if:
- You have had significant changes in your vision over the past year.
- You have any chronic eye disorders.
- You are pregnant or nursing.
- You have a chronic illness or disease.
NearVision CK improves your ability to focus on near objects without reading glasses. In the clinical study for NearVision CK, 9 out of 10 patients could see 20/20 or better in the distance and could read newspaper-sized print after the procedure without glasses.
If you are interested in the NearVision CK procedure, talk to your doctor and get a full eye examination. He or she will determine your specific vision needs and treatment plan and establish if NearVision CK is the right procedure for you.