LASIK has it’s roots in a procedure first performed over 50 years ago. A Columbian ophthalmologist described performing a procedure termed “keratomileusis” or corneal reshaping procedure to correct extreme amounts of nearsightedness using a bladed microkeratome and a lathe. Others began performing the procedure and refined it with better instrumentation and techniques to yield better results and improved safety. Eventually the excimer laser was introduced to replace the lathe in the reshaping part of the procedure and the term LASIK (laser assisted in-situ keratomilieusis) was applied to the “new” procedure. With the improved precision brought about by the excimer laser came wider acceptance of the procedure and eventual FDA approval.
As with most things in medicine, continued improvements and refinements have taken place. Two of the bigger refinements were the addition of wavefront technology to improve the final optics of the reshaped cornea and the introduction of a second laser: the femtosecond laser (IntraLase). Today’s LASIK procedure is far advanced from earlier generation procedures. Outcomes are improved with higher levels of 20/20 vision, lower levels of side-effects such as night vision difficulties and a safety profile that surpasses that of contact lens wear.
If you are contemplating LASIK or any other vision correction procedure, you should not presume that you will automatically benefit from all the refinements that have taken place. Upgrading and replacing equipment is an expensive proposition and some doctors and LASIK centers may not be willing to invest in new technology. That puts the responsibility on you, the patient, to investigate and determine if you are comfortable with the technology to be used in your procedure. If you have made the decision that improvements in the LASIK procedure have now made it a viable option for you, it is up to you to determine whether you, in fact, will be receiving this better procedure.
Archive for the ‘lasik’ Category
LASIK: A Good Procedure Gets Better
Tuesday, August 2nd, 2011
New iFS Laser Minimizes Dry Eye from LASIK
Sunday, July 24th, 2011Most patients appreciate the improved safety afforded by the IntraLase laser in creating the flap during the LASIK procedure. An additional benefit of the latest model of IntraLase laser is the reduction in both severity and duration of dry eyes after LASIK.
Our last blog post discussed the mechanism of dry eye production from LASIK. Dry eye symptoms result from the severing of corneal nerves during the procedure. So how can the iFS minimize dry eye? By limiting the number of severed nerves and promoting quicker healing of the cut nerve fibers.
An Oval LASIK flap with a wider hinge will help to minimize dry eyes from LASIK
Like all lasers used to create corneal flaps, the iFS has the ability to create very thin flaps which helps to limit the number of cut corneal nerves. The IFS, in addition, has a unique surgical planning dashboard and customization features not available on other lasers. Surgeons using the iFS have the capability to create oval shaped flaps with wider hinges that are just large enough to cover the dilated pupil. This insures that an unnnecessarily large number of nerve fibers are not cut thus minimizing dry eye symptoms.
In additon, the iFS has the ability to create an inverse beveled flap edge assuring near-perfect alignment of the flap. Because the two ends of the cut nerve are apposed closely to each other, the nerve has only a short distance to grow before healing back together.
Thinner smaller flaps and wider hinges minimizes the invasiveness of the LASIK procedure which in turn minimizes the severity and duration of dry eye symptoms from LASIK. Dry eyes often last several weeks after a LASIK procedure and are an almost universal side-effect. If you are concerned about dry eyes and wish to limit its severity choose thin-flap LASIK with the iFS laser. And if you live anywhere near Raleigh NC there’s only one place to get this procedure: the Laser Eye Center of Carolina.
Why Do Patients Get Dry Eyes After LASIK?
Thursday, July 14th, 2011The LASIK procedure may cause many patients to experience dry eye symptoms after their surgery. This is especially true if there was 
tendency toward dry eyes before LASIK. But why do so many patients experience dry eyes after LASIK? The first step of the LASIK procedure is the creation of a corneal flap, a thin layer of tissue under which laser pulses are applied to reshape the cornea in order to correct nearsightedness, farsightedness and astigmatism. Anatomically, when the flap is created, the very fine cornea nerves may be severed as part of the LASIK procedure. These nerves detect how wet the eye is and signal the lacrimal gland to produce tears. So, sometimes, the temporary interruption of the corneal nerve impulses can actually cause a lesser amount of tears to be produced, resulting in dry eyes after LASIK. If the Dry Eyes after LASIK are moderate or severe, your vision may actually be blurry due to the tear film instability. Because normal sensation may not be present as a result of severed corneal nerves patients may not feel the sandy, gritty sensation normally associated with dry eyes. Fortunately, virtually all dry eyes symptoms after LASIK are temporary and gradually decrease over time as the corneal nerves grow back. Most patients will have a resolution of dry eye symptoms within a few months of having their LASIK procedure. In some extreme cases, symptoms may persist for over one year. All LASIK patients will need to use lubricating drops frequently during the first few weeks after their LASIK procedure. Other measures are occasionally necessary to improve comfort and visual clarity. These include the use of oral Omega 3 supplements, punctal plugs and prescription eye drops such as Restasis. During your consultation it is important to disclose any symptoms you may have of dry eyes and to disclose any medications you are taking that might predispose you to dry eyes after your LASIK procedure. Your LASIK surgeon can then take the necessary steps to prepare you for your LASIK procedure and minimize the severity of dry eyes from LASIK. Working together with your surgeon will maximize your chances of a smooth post-operative course and allow you to obtain the best possible results from your LASIK procedure. Watch this blog for further tips on how to minimize symptoms of dry eyes after LASIK.
LASIK Can’t “Do It All”
Sunday, July 3rd, 2011
Consider LASIK Alternatives
This Independence Day got me to thinking about patients and their desire to be independent of their eyeglasses. For patients seeking LASIK, often there is a ‘tipping point’ such as a contact lens related problem or it’s time to go in for their exam with the prospect of exam fees, contact lens fitting fees and the purchase of new glasses or contact lenses. Sometimes the patient just got back from a vacation or participated in an event where glasses got in the way. Or maybe the patient just got tired of pushing their glasses up their nose, putting in their contact lenses every morning or waking up unable to see. This is the point where they come in to see me. Often they are happy with what I tell them but a significant number are disappointed to learn that LASIK may not offer them everything they are looking for or is just not advised.
LASIK is a great procedure and has been around for a number of years. However, there remains a very specific ‘subset’ of patients for which LASIK is ideal. This subset includes patients between the ages of 18 and 40 without pre-existing dry eye problems, keratoconus or certain other eye diseases. The patient may have small amounts of farsightedness, or nearsightedness and/or astigmatism below a certain amount. Now don’t misunderstand me, almost half of my LASIK patients are not in this ideal category (usually because they are over the age of 40) but what I am saying is that patients who are not ideal may want to consider LASIK alternatives like Visian Implantable Contact Lenses, PRK or refractive lens exchange. The alternative is to accept certain compromises: an example might be the need for reading glasses.
The Laser Eye Center of Carolina offers more than just LASIK because LASIK is limited in who can benefit from the procedure and what it can offer. If you have a desire to become independent of glasses, consider all your options: not just LASIK.
Cost Effectiveness of LASIK vs Contact Lenses
Wednesday, May 25th, 2011
LASIK will save you money over the cost of contact lenses.
One of the most common barriers to vision correction sited by patients interested in LASIK is cost. But LASIK eye surgery, compared to contact lens and eyeglass correction of vision is actually a more cost effective option. Consider the cumulative cost of contact lenses and extra office visits/contact related fitting fees as well as backup eyeglasses over the course of several years and it can be astounding how quickly the total price tag of vision prosthetics adds up. Over the course of a decade or more of vision correction, the cost differential between LASIK eye surgery and contact lens correction can amount to thousands of dollars. Of course, the younger the patient, the more impressive the savings but, even older individuals can benefit financially. And, the cost differential included in this article include only direct costs: they don’t take into account the cost of time spent in doctor’s offices, purchasing lenses and glasses, inserting and removing contacts or lost time related to contact lens related infections or other difficulties. If you have a productive business or career, time lost from income producing endeavors translate into even more lost dollars than the examples illustrated here.
How much money are we talking about? Well, for a patient in their forties, LASIK vision correction surgery, on average, will save the typical patient $10,000. A patient in their twenties will save even more: about $25,000. AMO has developed a savings calculator that you can use to estimate the cost effectiveness of LASIK eye surgery compared to contact lenses.
Now, let’s say you’re convinced of the financial wisdom of correcting your vision rather than monthly “rent” of vision through the purchase of contact lenses and related services. Even the most convinced investigator may simply not have the $4000-$5000 necessary to pay for LASIK eye surgery at their disposal. Does that mean you should continue expenditures for contact lenses until you can accumulate the total necessary to pay for the procedure? For most people the answer is no. Consider applying what you normally are paying for contact lenses and related services and applying that amount toward your LASIK eye surgery. If your credit is reasonably good, most LASIK surgeons can arrange financing for your procedure: and, as illustrated earlier, the sooner you can stop paying for contacts, the more your savings.
Hesitant to take on more debt? Well, while we admire your frugality, the argument about avoiding debt really only holds water when talking about certain luxury items. Most people will not continue paying rent until they can afford to pay cash for their house because it does not make financial sense to do so. The same is true for LASIK eye surgery if you view it as an investment designed to save you money over years.
So if you’ve been considering vision correction surgery, cross “cost” off your list of excuses for postponing your procedure. Contact us for a free consultation and we’ll help develop an affordable plan for losing your dependence on glasses and contact lenses. The sooner you have LASIK or other vision correction procedure, the more you’ll save and the sooner you can begin to enjoy visual freedom.
Maximizing Safety in LASIK
Sunday, May 1st, 2011 There is no such thing as any medical procedure that is completely risk free. If you are considering vision correction, obviously your number one concern is safety. But how do you make sure you have done everything possible to minimize the risk of LASIK? And why do some patients suffer from complications?
The first thing to understand is that the risks of LASIK are not the same for every patient. Some patients may inherently have a higher risk of certain complications such as infection, flap complications, healing problems, dry eye and night time driving difficulties. It is important that you have a preoperative evaluation by a qualified physician experienced with the LASIK procedure to insure that pre-existing conditions that increase the risk of a LASIK procedure be identified. For some patients, the risks can be minimized with preoperative measures such as initiating Restasis therapy before the procedure. For other patients, the risks associated with the procedure may just be too great. There are several alternative procedures, such as implantable lenses or refractive lens exchange that may be a better fit.
The other thing to know is that not all LASIK surgeons and LASIK technology are equal. Optimizing your chance of success requires choosing an experienced surgeon and choosing the technology associated with the lowest risk. There are two steps to the LASIK procedure and there now exists technology designed to improve the safety of both steps. The IntraLase laser to make the LASIK flap is the safest way to achieve this step. The IntraLase laser decreases the risk associated with flap creation and in addition decreases the risks after flap creation (such as flap displacement and dry eye). CustomVue technology by AMO is the cornea reshaping technology designed to maximize vision quality and decrease the risk of night time glare and halos. When IntraLase is combined with CustomVue, the resulting LASIK procedure is termed “iLASIK”. Potential LASIK patients can therefore minimize the risks associated with a LASIK procedure by 1. Insuring they are evaluated by an experienced surgeon who performs alternative procedures to LASIK and 2. Looking for a surgeon who performs “iLASIK”. Looking for someone in the Raleigh area that meets these requirements? See Dr. Dean Dornic at the Laser Eye Center of Carolina. iLASIK Procedure on YouTube
Night Vision and LASIK
Sunday, March 13th, 2011
CustomVue technology actually increases patient night vision satisfaction.
- Night glare and starbursts are a potential side-effect of any eye surgery.
Many people who have never had eye surgery, if they are careful observers, can notice some starburst, halo, glare, or shadows in their vision under low light conditions, especially if they need to wear glasses or contact lenses. It is common to notice one or more of these after LASIK eye surgery, especially during the early postoperative period. These side effects generally diminish with time but some patients will notice one or more of these even with excellent correction, sometimes for a long time or even indefinitely. Of those patients who do notice these side effects, most will find them annoying and it is possible that some patients may feel they cause mild to serious visual impediments.
The LASIK procedure creates a change in curvature in the central part of the cornea. If changing the corneal curvature also results in distortion of the cornea then aberrations in vision quality may result. These aberrations in vision may be most noticeable at night, when the pupil opens wide. This can result in seeing a halo type effect or perhaps just a decreased contrast or sharpness of vision. Regardless of how it is described, there are some patients who feel that their night or reduced light vision is poor even when their uncorrected vision is good or excellent in normal lighting. This may be a significant issue for some patient for night driving, playing tennis or baseball at night or other similar activities, even before refractive surgery is performed. A technology developed by AMO/VISX termed CustomVue and utilized in the iLASIK procedure was developed in an effort to improve night vision. The CustomVue technique makes use of a wavefront analyzer to measure and correct visual aberrations. Clinical studies show that more patients are actually satisfied with their night vision after LASIK when this technique is used. The wavefont guided CustomVue technique should not be confused with the wavefront optimized technique utilized by the Wavelight/Allegretto laser. Only the CustomVue technology associated with iLASIK results in better night vision.
I’m Afraid to Have LASIK
Saturday, March 5th, 2011One of the most common phrases we hear is “I’d like to have my vision corrected but I’m afraid to have LASIK”. Patients verbalize a fear of having an eye procedure because they are afraid of the risk of vision loss. There is not much worse fate one can imagine than to have to go through life blind or with greatly diminished vision. Some patients may even relate the story of “a friend of an acquaintance” that they ‘heard’ had vision loss from a LASIK procedure but yes, everyone that they know who had LASIK seems to be doing just fine. Just like many urban legends, the details of this alleged vision loss are not really known by the reporter.
Yes, there are cases of patients who have lost vision from LASIK; but those cases are exceedingly rare, and, with advances in technology, becoming rarer. Most patients are surprised to hear that the risk of vision loss is actually greater from contact lens wear than from LASIK. You mean you can lose vision from contact lenses? Yes, and every year patients, some of who were afraid to have LASIK, lose their vision from contact lens associated corneal infections.
So, if you don’t want to wear glasses or find they interfere with your ability to function in your job or leisure activities, making the transition from contact lenses from LASIK really does not increase your risk of vision loss. And, as numerous studies bear out, actually saves you money in the long run.
How then do you maximize your chance and minimize your chance of vision loss from a LASIK procedure? Well, first make sure you actually are a good LASIK candidate. Go to a surgeon who can offer more than just LASIK. If you are not an excellent LASIK candidate,just don’t have it: do something else like implantable contact lenses or advanced surface ablation. If you are a good candidate, make sure you are being offered the best and safest technology. IntraLase LASIK has been shown to be the safest LASIK technology for the great majority of patients so insist on this. The decision to have vision correction is one of the most important decisions you will make in your lifetime so why would you go to someone who offers only LASIK and worse yet, why would you choose someone because they offered the lowest price? Over the years, thousands of Raleigh are patients have chosen Dr. Dean Dornic of the Laser Eye Center of Carolina. His opinion can be trusted because he can offer more than just LASIK. To make an appointment for a free, no obligation consultation just call 1-888-376-EYES and we’ll get you started on the road to visual freedom.
A LASIK Eye Surgeon’s Valentine’s Day
Monday, February 14th, 2011Medicine is a rapidly changing field. LASIK eye surgery has changed a lot since I was first trained in this technique 13 years ago. Back then, LASIK flaps were all made with bladed instruments either on gears or rails and surgeons had to be adept at centering the laser on a moving pupil with a joystick device. Over the years the technique, technology, our understanding on who is a good candidate and management of side-effects have all evolved. As a result, the procedure has been made safer, side-effects have been minimized and the overall quality of vision along with patient satisfaction all have increased. A LASIK eye surgeon who fails to keep up with the changes in the vision correction field does a disservice to his patients by cheating them out of the tremendous improvements in results and safety. One of the ways of achieving continued competence is through reading: and there is a tremendous amount of articles written and available in books, professional journals and on line. On-line bulletin boards and forums are another way to share and gain valuable information. One of the best ways to advance knowledge is through professional meetings or “conventions”. Such meetings allow innovators to present their work and allow attendees to question and challenge presenters.
But attendance at such meetings requires time away from the office. An efficient way to minimize practice down time is to combine continuing education with vacation time and that is precisely what I did this Valentine’s weekend. You see, Valentine’s is a special time for my wife and I. Our first date was on Valentine’s Day. As a young college student, I finally got the nerve to ask my wife out. I prepared a home cooked meal and took her to a $2 movie on campus. This weekend, we celebrated with a long weekend in St. Thomas where there just happened to be a great ophthalmology meeting: the Caribbean Eye Meeting. So I woke up early and attended courses and lectures from 7AM until noon, then spent the rest of the day enjoying the island. I took home some great new information on LASIK and other eye surgeries plus I got my batteries recharged. How did I find time to write this blog? Well, I’m writing this well waiting for my flight from Miami to Raleigh. Hope you enjoyed your Valentine’s Day as much as we did.
View from our hotel window
The McDonald’s Approach to Vision Correction.
Saturday, January 8th, 2011
McDonalds revolutionized the fast food industry with mass production.
Perhaps you’ve seen the LASIK only centers advertising proudly an incredibly high number of LASIK procedures. They triumphantly exalt the thousands and thousands of LASIK procedures they have performed as though this should be a source of pride much like the McDonald’s restaurants that boast of the billions of burgers served. But doesn’t this expose exactly why you would want to avoid such a facility for a once in a lifetime medical procedure?
McDonald’s became a corporate success by automating the production of low cost fast food: not by hiring the finest chefs or providing a fine dining experience. The menu at McDonald’s is somewhat limited. The menu at a LASIK only center is even more limited: everyone gets LASIK. McDonald’s doesn’t have the best hamburgers (some may disagree). Cut rate LASIK centers don’t offer the best technology (although their claims are that they do). You wouldn’t take your spouse out to McDonald’s to celebrate an important occasion so why would you skimp on yourself for such an important event as vision correction? For patients in the Raleigh North Carolina area contemplating LASIK, why not take the step to consult with the Laser Eye Center of Carolina and explore all your options? We can customize a treatment approach that is just right for you.