Posts Tagged ‘complications’

When LASIK is “Iffy”

Sunday, September 18th, 2011

LASIK may not be your best option.

Some patients are great candidates for LASIK: they have an eyeglass prescription associated with a high success rate, they have no contradictory conditions and they have reasonable expectations. Other patients may not be a candidate for vision correction surgery and another, third group of candidates may be described as “iffy”. We’ve seen a number of these patients over the years. Many are seeking a second opinion or may have some misconceptions about LASIK eye surgery and need to be educated on why they are not ideal candidates.
The unfortunate truth is that LASIK cannot correct every vision malady. There are some prescriptions that cannot corrected with final good optical quality and there are some eyes for whom LASIK is not suitable and can even be dangerous. Most reputable LASIK providers will not offer surgery to patients when it is clearly contraindicated. Of course, there are various shades of gray. Some eyes may have a reasonable chance of having good results from LASIK but may not be ideal. Now suppose you are a “LASIK-only” provider dependent on high volume in order to be financially viable. Chances are you will be tempted to offer LASIK to a patient with less than perfect credentials under the assumption that the odds are in your favor.
But what if you were the patient? Wouldn’t you want to know that you were a less than ideal LASIK candidate and be interested in hearing about other procedures offering a safer side-effect profile and higher success rate? Today there are numerous options, besides LASIK, that are available to reduce dependence on glasses. Some of these options include PRK, OmniLase, Implantable Contact Lenses, CK and Refractive Lens Exchange. To insure you are offered all available vision correction options, our advice is to seek the opinion of a surgeon offering various procedures. Listen carefully to the risks and side effects of each option. If LASIK is “iffy” you might just want to cross it off your list and choose a procedure more suitable to you and your particular vision problem.

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The Evolution of LASIK

Sunday, January 23rd, 2011

Like many medical procedures, LASIK eye surgery has evolved and improved with time. Many patients are surprised to find out just how long LASIK has been around.
In 1949 a Columbian ophthalmologist by the name Barraquer performed a corneal procedure to correct refractive error termed automated lamellar keratoplasty (ALK). ALK involved the use of a microkeratome to create a flap and remove a disc of corneal tissue in order to decrease nearsightedness.
With the introduction of the excimer laser to the ALK procedure the name of the procedure was changed to LASIK. The excimer laser made the procedure more precise and resulted in more widespread acceptance but this was, by no means, the only important advance in vision correction technology. Over the years, a number of innovations such as eyetrackers, iris registration, wavefront technology and introduction of the IntraLase laser have improved safety and outcomes.
Today, the safety of LASIK exceeds that of contact lens wear and the risk of such side-effects as night halos is reduced to such a low level that most patients will actually experience an improvement in night vision.
Of course, patients should be aware that there are different technologies available all with different safety profiles and success rates. Some of the more important innovations: IntraLase and CustomVue are associated with increased costs but if you’ve been holding off on LASIK waiting for the procedure to get better, the increased costs may well be worth it.

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Patient Satisfaction with LASIK

Sunday, December 27th, 2009

Patient satisfaction after LASIK remains consistently high but no medical procedure has a satisfaction rate of 100%. Why are so many patients delighted with their results and others disappointed? Obviously there exists a group of patients who have had had unanticipated complications but this is fairly rare. One of the more common reasons may be unrealistic patient expectations.
Why should a patient seek vision correction surgery? To reduce dependence on glasses or contact lenses. Occasionally however, patients undergo LASIK or other refractive surgery because of dissatisfaction with the quality of their vision in glasses or contact lenses. If the surgeon is not attuned to this, expectations may not be met and dissatisfaction results.
For example, around the age of forty, patients commonly develop presbyopia, or a reduction in focusing ability. In glasses, a common solution is bifocal glasses in which the top of the glasses are utilized to view distance objects and the bottom correct for near. The LASIK procedure can eliminate the need for glasses for distance (ie driving) but patients may still need reading glasses for near tasks. If the patient is not aware of this before undergoing the procedure, disappointment can result.
Another example is the patient who notices a decline in the quality of his vision who repeatedly has his glasses remade because he feels the doctor “just can’t get the prescription right”. Finally, out of frustration he seeks the counsel of a LASIK surgeon. If the surgeon fails to extract the real reason the patient is seeking vision correction, the opportunity to perform diagnostic testing to detect subtle cataracts, retinal or optic nerve disorders may be missed. The patient may be free of his glasses but still be left with quality of vision issues and dissatisfaction with the result.
LASIK is a safe and reliable procedure which has had years of refinement. It may not, however, be the best procedure for all patients and all vision problems. Because we are not a “LASIK only” center we can treat a wide variety of vision disorders and customize a treatment program specifically for you. Our goal is no surprises and total patient satisfaction. Come in today for a free, no-obligation, consultation.

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Sorting Through Conflicting LASIK Data

Friday, June 19th, 2009

Patients researching LASIK often get bogged down by conflicting data on the success rates or complication rates of the LASIK procedure. I’ll often see success rates published that vary anywhere from 80% to 98%. Likewise the incidence of night driving difficulties after LASIK has been listed to be “as high as 16 percent”. Why the conflicting data? Well, there can be several reasons.

1. Different “yardsticks”. For instance, what do we call success? Does success mean the patient no longer wears glasses? Or, that they are 20/20? How about lowering the bar to 20/40 (the level of vision necessary to have an unrestricted driver’s license in most states)? Success means different things to different people.

2. Advances in technology. LASIK has been around 18 years. As with all medical procedures, newer equipment and evolutions in technique tend to increase “success” rates and decrease complication rates. Often when I see printed data that describes a higher than expected complication rate for LASIK, I find that the author has obtained their information from studies submitted years ago. Unless your surgeon is using outdated lasers and techniques, this older data would not apply.

3. Differences in equipment/lasers used. Certainly you can talk about the fastest speed a car can travel but there is a difference in the maximum speed attainable by a Maserati vs. a Smart car. Likewise there are many different lasers that can be used to perform a LASIK procedure. The VISX Star S4 remains the gold standard for laser vision correction. This laser has the highest reported rate of 20/20 vision in an FDA trial ever reported. When the US military and NASA approved LASIK, it was the VISX laser that was used in their trials. It is also the laser currently being used by military surgeons to perform vision correction on our enlisted personnel.

Patients interested in vision correction are wise to become informed. Skepticism can be a helpful trait and the prudent investigator takes the time to ask: Is the data presented current? Is the information reliable i.e. from an FDA trial vs. unreviewed conclusions provided by a manufacturer or provider with a vested interest in the outcome? Does the data pertain to me? Reviewing conclusions about LASIK done mainly on nearsighted individuals may not have relevance if you are farsighted.

You can maximize your chance of success by insuring your procedure is done with the best available equipment and performed by a reputable, experienced surgeon.

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