Laser Vision Correction

LASIK

With its ability to safely deliver to a wide range of patients the opportunity to return to work the following day without glasses or contact lenses, LASIK remains our most commonly performed refractive procedure. LASIK combines 2 refractive surgery techniques: keratomileusis and LASER photoablation. The procedure consists, in essence, of raising a thin flap of the superficial anterior part of the cornea followed by corneal sculpting with the EXCIMER LASER according to the desired vision correction.

The Excimer Laser uses a rare gas mixture to emit laser light with a wavelength of 193nm that is capable of removing molecules of tissue without producing heat or burns. This correction process is called "photoablation," signifying, in essence, the vaporization of tissue by LASER light.

The gases are mixed in a high voltage cavity that emits cold ultraviolet light rays. These rays, guided by a very precise computer system, are used to vaporize the anterior layers of the cornea by breaking intermolecular bonds.

Each laser vision correction pulse is so precise that it can photoablate one-millionth of a millimeter of corneal tissue in one millionth of a second. The deeper layers of the cornea remain completely untouched. In other words, the cornea is sculpted in a matter of a few seconds.

Finally, the thin flap is carefully repositioned. In other words, the entire ablation takes place in the anterior part of the cornea, leaving the most superficial layers untouched and intact. Because the hinged flap is formed, there is no need for epithelial removal as in PRK.

The larger the refractive error, the more corneal tissue must be ablated. The total ablation, however, never exceeds 25% of the original corneal thickness. The final result is a refocusing of the eye with a diminution or elimination of preexisting nearsightedness, farsightedness or astigmatism. Read more about Custom Lasik / Zyoptix Laser Vision Correction, or find out if you're a Candidate for LASIK.

Lasik Vision Correction Procedure:
The Lasik procedure is performed under topical anesthesia (drops only). When finished, the patient returns home with the eye unpatched. With laser vision correction, both eyes may be operated on the same day, if the patient desires. The vast majority of laser vision patients can see well enough to drive the day after their procedure, and pain is usually minimal.

The best vision correction candidates have less than 10 diopters of myopia, less than 4 diopters of hyperopia, and less than 4 diopters of astigmatism. Under some circumstances higher lasik eye corrections may be corrected, but the predictability, efficacy, and safety begin to diminish. Serious complications with long-term adverse sequelae are rare.

Click here to request more information regarding Dr. Davidorf's latest book on Lasik.

WAVEFRONT/CUSTOM LASER VISION CORRECTION

Custom ablations or wavefront treatments may be performed with either lasik or surface ablation. These treatments are designed to correct optical abnormalities (known as “higher order aberrations”) in addition to myopia, hyperopia and astigmatism. While customized treatments may be used on most laser refractive surgery patients, they are of particular benefit for patients who have higher levels of higher order aberrations or larger pupil sizes preoperatively.

There are some patients that come for consultations regarding unwanted visual side effects that developed following their laser refractive procedure. The wavefront technology can be used to measure the higher order aberrations in these eyes, and a wavefront-guided custom LASIK or surface ablation retreatment can be performed therapeutically. Therapeutic wavefront retreatments are capable of, among other things, enlarging small optical zones or correcting decentered ablations that may have created unwanted visual symptoms such as nighttime glare or halos.

The IntraLase Method (“Intra-LASIK,” “All Laser LASIK,” “Blade-Free LASIK”)

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. Ultra–fast pulses of laser light position microscopic bubbles at a precise depth and diameter determined by the surgeon. The laser light passes harmlessly through your cornea, creating the flap in about 20 seconds. It’s quiet and it’s comfortable. Because of the superior accuracy of the IntraLase method, certain patients who were ineligible for LASIK may now be able to have treatment. A consultation is needed to determine if you are a candidate for LASIK with the IntraLase method.


SURFACE ABLATION

PHOTOREFRACTIVE KERATECTOMY (PRK), EPI-LASIK, and LASEK

Surface ablation is the term used to refer to classic photorefractive keratectomy (PRK), laser subepithelial keratomileusis (LASEK), and Epi-Lasik, depending on whether or not the epithelium is removed and discarded (PRK) or removed and reposited (Lasek and Epi-Lasik). The surface ablation procedures have sometimes been referred to as “Flapless Lasik.” With surface ablation, the same EXCIMER laser used in LASIK is employed to sculpt the cornea and the visual results are equivalent.

In order to apply laser energy to the permanent portion of the surface of the cornea, the very top layer of temporary cells, the corneal epithelium, must be removed. The corneal epithelium, will heal in approximately 3 days after surgery. A clear, prescription free contact lens is placed on the eye for the few days that it takes the epithelium to regenerate. While the surface ablation procedures, like LASIK, are essentially painless, it is common for surface ablation patients to experience 24 to 36 hours of tearing, light sensitivity, and discomfort following their procedure. Special eyedrops and medications are given to help keep patients as comfortable as possible.

While custom ablation confers incremental gains in safety compared to LASIK, most patients who are good laser vision correction candidates for LASIK prefer its quicker recovery. Surface ablation is most commonly reserved for situations in which a patient’s cornea is too thin or irregularly shaped for LASIK. Surface ablation is able to correct the same levels of nearsightedness, farsightedness, and astigmatism as LASIK.

The ultimate visual outcomes with the surface ablation techniques (PRK, LASEK, and Epi-LASIK) mirror those with LASIK, but it takes longer for the results to be realized. Most surface ablation patients are able to return to work 4 to 5 days after their vision procedure, but will likely still experience some blurring and visual fluctuations during the subsequent three weeks. While the US military is beginning to allow laser refractive procedures for its recruits, there have been some stipulations that certain divisions (ie: Special Forces) may only undergo surface ablation and not LASIK.

Laser Vision Correction Conclusions
If you are looking for freedom from your glasses and contact lenses but are not a candidate for laser eye surgery such as custom ablation, wavefont or custom laser vision correctoin treatments, you may be a candidate for other services we offer. Call us today at 818-883-0112 or fill out our online form to schedule a laser vision correction consultation.

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Dr. Davidorf and colleagues published early LASIK data in 1998, prior to the FDA approval of LASIK. The most significant risk in LASIK surgery is operating on a poor candidate. Careful preoperative evaluation and counseling are tantamount to successful outcomes.

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