LASIK is something that provides an almost immediate lifestyle change that frees you from the hassles of wearing glasses or contacts, yet many people jump right into it without asking questions.
But like with any other life-changing decision, we at Schneider LASIK Centers feel it’s important to be well informed. There’s no doubt that laser eye surgery is an amazing technology that has revolutionized eye care and provided glasses-free living for millions of people, but there are still things every person considering LASIK should know.
Over 60 million Americans suffer from nearsightedness, or myopia. A person is considered nearsighted when the eye has too much focusing power. This occurs when the eye is either too long or the cornea is too steep to allow light to focus directly on the retina (the film of the eye). Instead, light focuses in front of the retina causing distant images to appear blurry. A minus power lens in the form of eyeglasses or contact lens is needed to subtract focusing power from the eye.
Hyperopia (or farsightedness) is a condition where light rays entering the eye are focused behind the retina instead of directly on it, as in the normal eye. It may be present in childhood but does not usually become apparent until people are in their late 20s or 30s when they can no longer see up close. When these patients get into their 40s or 50s, they begin having difficulty seeing distant objects as well.
Astigmatism is a condition that occurs when the cornea or lens is steeper in one axis than another, similar to a football or the back of a spoon instead of completely spherical or round like a basketball. Light entering the cornea focuses on more than one point within the eye resulting in blurred vision. Astigmatism is either regular when steep and flat axes are 90 degrees apart or irregular when they are not separated by 90 degrees.
Literally “old vision”, it represents a natural aging process of the eye. It starts to affect most people around the age of 40. Normally, when a close object is viewed, the lens will change shape or “accommodate” to focus light on the retina. With presbyopia, the lens can not sufficiently reshape and glasses are required for close viewing. If someone has laser vision correction for nearsightedness and is already presbyopic (40+ years of age), they will then need correction for reading. These are typically just the store bought magnifying glasses.
A diopter is a unit of measurement that determines your prescription. A minus sign in front of the number means you are nearsighted, a plus sign means you are farsighted.
They can be corrected with glasses, contact lenses, or procedure.
A procedure called orthokeratology has been available for many years. In it, a series of progressively flatter gas permeable hard contact lenses are used to flatten the cornea. When the cornea has reached its desired correction, a retainer contact must be worn for several hours per day to prevent the cornea from returning to its original shape. Therefore, it does not cause a permanent correction.
These are a group of procedures that have been designed to permanently reduce or eliminate the need for corrective eyewear to see distant objects. They include laser assisted in-situ keratomileusis (LASIK), photorefractive keratectomy (PRK), radial keratotomy and astigmatic keratotomy (RK/AK), Laser Thermal Keratoplasty (LTK), Conductive Keratoplasty (CK) to name a few. These procedures offer an alternative to glasses or contact lenses. These procedures can only improve vision if it can be improved with glasses or contact lenses.
These are refractive procedures performed with an excimer laser. The excimer laser generates ultraviolet light of a specific wavelength (193 nanometers) by sending high-voltage electrical energy through a cavity containing Argon Fluoride gas. The beam that is emitted has enough energy to break the bonds between the molecules that make up the tissue on your eye’s surface (the cornea). Because it is a photochemical and not a heating process, it allows the surgeon to sculpt very precise amounts of corneal tissue from above without any damage to the neighboring/adjacent surface.
The excimer laser was developed at IBM in 1976, and was used to etch computer microchips. Its extreme precision with negligible damage to adjacent surface made it a very attractive tool for other applications, and in 1983, Stephen L. Trokel, M.D., in cooperation with R. Srinivasan, a physicist, applied it to corneal tissue in a New York laboratory. The first sighted eye was treated with the excimer laser at LSU on January 14, 1987. Between 1987 and 1995 numerous laser manufacturers, including VISX and Summit Technology, worked toward U.S. approval to use the Argon Fluoride excimer laser.
LASIK, or laser in-situ keratomileusis, and PRK, or Photorefractive Keratectomy.
In both procedures, a specially trained ophthalmologist uses the computer-guided excimer to gently reshape the cornea to achieve a desired correction. Prior to the procedures, drops are placed in the eye to numb it (like the ones your eye doctor uses to check your eye pressure for a glaucoma test) and an instrument called a speculum is placed in the eye to prevent you from blinking. There are no needles and no pain.
In PRK, the surgeon first removes the surface cells of the cornea using a laser or other technique, and then sculpts the underlying tissue with the laser. In LASIK, an instrument called a microkeratome or a femtosecond laser is used to gently create a “flap” – which is simply a superficial, thin layer of corneal tissue. This flap remains attached to the eye by a “hinge” which improves stability, safety, and the accuracy of repositioning of this flap after the laser treatment. The laser is used to sculpt tissue from the layer of the cornea just beneath the flap, and the flap is then gently placed back into its original position where it instantly reattaches without the need for sutures.
During the LASIK procedure, there is no pain. Instead, there is a sensation of firm pressure for 8 to 10 seconds while the corneal flap is being created (this pressure sensation does not occur during the PRK procedure). Following the procedure, LASIK patients are often more comfortable then patients who have PRK. LASIK patients will usually experience the sensation of having an eyelash or two floating on the surface of the eye for several hours, whereas PRK patients may have a greater degree of discomfort for a somewhat longer period of time. However, with the unique and powerful combination of numbing drops that we have utilized for the past several years, the discomfort level after PRK has been significantly reduced. In fact, most patients tell us that their level of discomfort after PRK is equivalent to the excellent level of comfort experienced by patients after LASIK.
Most patients are in the laser suite for no longer than 10 minutes. The actual laser treatment time takes just 15-90 seconds, depending on the degree of correction required. Total time at the center on the day of the procedure will be about 2-3 hours.
Since the healing after LASIK occurs within the cornea rather than on the surface, a minimal degree of discomfort is experienced by the patient after this procedure. The corneal flap also protects the treated area from contact with the lids during blinking which also makes the procedure more comfortable. Visual improvement is faster with LASIK and the use of long term eye drops is unnecessary since the cornea after LASIK tends to have a gentler healing reaction than with PRK surface treatment.
Astigmatism simply means that, on a microscopic level, the cornea is shaped more like a football than a basketball. The treatment of astigmatism by the laser essentially reshapes the two different curvatures of the “football-shaped” cornea into the single curvature of the “basketball-shaped cornea”. Different laser technologies accomplish this process by either steepening the flatter curvature of the cornea, or by flattening the steeper curvature of the cornea.
Radial Keratotomy (RK) is a surgical procedure that can also correct nearsightedness by changing the shape of the cornea. Microscopic incisions of 90% depth, placed in a radial pattern, like the spokes of a wagon wheel, reshape and flatten the central cornea, allowing light to focus more precisely on the retina. The length and number of incisions determine the effect of the prodecure. Patients with less than 3 diopters of nearsightedness and stable prescriptions are the best candidates.
A variation of RK, called astigmatic keratotomy or AK, is a somewhat effective means of reducing smaller amounts of astigmatism. By making incisions in an arc-like or segmental fashion parallel to the white of the eye where the cornea is steep, it is caused to relax and become more spherical.
In the past ALK was used. In this procedure a thicker layer of the cornea was folded back with the microkeratome. Pressure inside the eye causes the corneal bed to steepen, the opposite of what occurs in LVC. The cap was placed back into position without the removal of additional tissue. Although it has been shown to effectively reduce or eliminate farsightedness in the +1.00 to +5.00 range, enough cases of corneal instability have been reported nationwide that this procedure has fallen out of favor. Now LASIK for hyperopia is considered by most to be the best option.
Conductive Keratoplasty (CK) uses a fine tipped probe to deliver radio-frequency energy to the corneal collagen in a ring of individually placed spots to steepen the cornea. Farsighted patients with a prescription between +0.75 to +3.25 and no more than 0.75 diopters of astigmatism are the best candidates for this procedure. Because of mild regression and a lack of long-term results, the procedure has been labeled as temporary.
Now both PRK and LASIK are possible and effective for hyperopia. The procedure is identical to the myopic (nearsighted) procedure, however by blocking the laser from treating centrally and allowing it to remove more tissue in the periphery of the cornea, a steepening rather than a flattening of the cornea is produced.
The results are quite remarkable. In the U.S. clinical trials that were reviewed during the approval process for laser correction of nearsightedness, 100% of the patients studied experienced improved uncorrected vision. Over 90% were returned to 20/40 sight or better — the “driving standard” in most states — and were able to enjoy life and perform most activities without glasses or contacts. With refinement in techniques since the studies, 95-98% of eyes with mild to moderate myopia who undergo PRK vision correction achieve 20/40 vision or better – enough to pass a driver’s exam without glasses with a single procedure. Two-thirds achieved 20/20 vision.
Yes, both the PRK and LASIK procedure have been FDA approved. Specific amounts of correction approved for treatment vary according to specific laser manufacturers.
The great majority of all nearsighted Americans are potential candidates for the laser treatment. Patients must be at least 18 years of age, have mild to moderate near sightedness with a stable prescription, and have no ocular or health issues. The best candidates tend to be people who are dissatisfied with their glasses or contact lenses and are motivated to make a change, whether it’s due to occupational or lifestyle reasons.
Although a patient’s prescription may make him or her a suitable candidate for laser vision correction procedure, it is very important that the patient have the appropriate level of expectations regarding the outcome of the procedure. Although uncorrected post-op vision (after healing) is usually excellent, no one can promise you 20/20 vision.
A person is a good candidate for laser vision correction if he or she expresses the following sentiments in discussing whether or not to undergo the procedure:
A person is probably not a good candidate for Laser vision correction if he or she expresses the following sentiments in discussing whether or not to undergo the procedure:
A patient is also not a good candidate for laser vision correction, if any of the following conditions are present:
Most refractive surgeons now believe that -10D is the upper limit for good patient satisfaction, although LASIK can be used effectively under certain circumstances for prescriptions as high as -12D. Above these levels, other procedures involving the implanting of lenses inside the eye will probably become the procedures of choice. PRK is approved by the FDA for treatments of up to -12D. However, most surgeons prefer LASIK to PRK when treating more than 4D of myopia. Corneal thickness measurements are very important and this also limits the amount of correction that is performed.
A full eye exam is needed in order to determine if you are a good candidate. If you have had a corneal injury, it will depend upon the size and type of injury.
During the LASIK procedure, there is no pain. Instead, there is a sensation of firm pressure for just 8 to 10 seconds while the corneal flap is being created. Following the procedure, patients may experience some mild scratchiness (usually described as the sensation of having an eyelash or two floating on the surface of the eye) that is relieved by the use of artificial tears and several hours of rest.
There is no discomfort at all during the PRK procedure. Following the procedure, you may experience a gritty sensation with some mild to moderate discomfort which we alleviate by putting in a contact lens and giving you anesthetic drops and pain medication to use during the first 24 hours in the event of severe discomfort. All discomfort should be completely resolved within 2-3 days as the surface layer fills in to cover the exposed area. All discomfort should be completely resolved within 2-3 days except in the rarest of cases.
Most patients undergoing LASIK and PRK prefer to have both eyes treated on the same day since it is more convenient for them, however this is a decision entirely between the patient and the doctor.
Yes. Your doctor will ask you to look at a blinking light within the laser during the procedure. This will ensure that the laser treatment will be centered properly over the center of your vision during the treatment
Dr. Schneider will continuously observe your eye and head position during the laser treatment. If necessary, he will stop the laser treatment if your eye (or head) moves too much, but this almost never occurs. Several of our lasers have computerized tracking devices that also monitor the position of your eye. These trackers detect and compensate for small movements of the eye by guiding the laser beam to compensate for these small movements. As a result, the laser remains precisely centered over the treatment area. The combination of Dr. Schneider’s constant attention and this amazing tracking technology provides the highest level of precision, comfort, and safety.
Most patients will be able to return to their normal activities within a few days as long as they work in a clean environment. Procedures are performed on a variety of days to accommodate your work schedule.
In PRK, because the laser removes tissue from the surface of the eye, the body will attempt to fill in the defect much like if you had a cut on your hand. Since corneal tissue has different healing properties, the process can normally be regulated with the use of topical steroid drops which patients may be required to use over a five-week period.
In LASIK, these drops are only used for a week. These drops will rarely cause any problems. However, eyes must be monitored to fine tune the drop dosage and check for any unwanted side effects such as delayed or too rapid healing and elevation in eye pressure (glaucoma). Antibiotic drops are also used for about a week with both procedures. Please see – Post Operative Instructions.
Plan on about 4 short visits in the first three months following procedure. Even if you are seeing well, there are things that must be monitored during the first few months following your procedure to ensure that you achieve the best possible outcome for your vision.
You can shower or bathe the day after procedure. Avoid getting soap or water in the eyes or immersing in the ocean, in a pool or in a Jacuzzi for al least 2 weeks after the procedure.
It is a good idea to buy new mascara after the procedure to avoid infection and it is best to wait 1 week before using eye makeup.
You can resume driving as soon as you feel comfortable with your new vision. Approximately 90% of patients are able to drive on their own on the day following LASIK. With PRK, it usually takes about 4 – 5 days to feel comfortable with driving. You should avoid driving while under the influence of any oral medications, especially pain medications, taken following your procedure.
You may resume exercises as you wish. Don’t get sweat in your eyes. Try to keep your hands clean and away from your eyes. Swimming, however, should also be avoided for at least two weeks.
The first day after LASIK, most patients have experienced a large improvement in their vision, to approximately 20/40 or even better. This greatly depends on your preoperative prescription. You can expect to regain approximately 75% to 80% of your vision in the first two to three days after LASIK. The remainder of your vision will improve gradually over several weeks. If you have significant astigmatism, or are very nearsighted/farsighted sight recovery and stabilization are slower.
Vision is greatly improved but typically blurry immediately after the procedure (20/80-20/200). It generally starts to improve once the surface layer of the cornea (epithelium) has grown back, which in most cases takes 3 to 4 days (approximately 20/40). Vision typically starts to get good within 7-10 days but can continue to be blurry for a number of weeks. For most patients, vision stabilizes within 3 months (some may take 6 months or longer). The healing process varies for each patient, and it is difficult to predict precisely when you will achieve your best visual acuity. However, most patients who have both eyes treated at the same time report that they are able to drive a car safely and resume their normal activities between 3-5 days following PRK.
If the patient opts to have only one eye treated at a time, your doctor will need to fit your untreated eye with a contact lens for use during your wait before the second eye is done. This can be done in almost all cases, even if you have not been able to tolerate contacts in the past. The optics of removing the glass in front of your treated eye in your spectacles, while giving clearer vision to each eye individually, will often cause disorientation and headaches due to image size discrepancy, unless your original prescription was less than -3.00.
As people enter their 40s, they start to develop presbyopia (see #4). Regardless of whether or not you’ve had laser vision correction, this process will happen to you. Your surgeon can create an effect known as monovision. This means that one eye will be left slightly nearsighted, thus allowing you to focus on print such as labels and menus without reading glasses, and perhaps allowing you to read into your 50s. As one gets older, it will be necessary to wear reading glasses. Furthermore, if you are over the age of 40 and are used to removing your glasses to read, you must realize that this will no longer be an option following a full correction of your nearsightedness with the procedure.
Shortly after you have had the procedure, it is possible that you may require a temporary pair of reading glasses if you are approaching your 40th birthday since the laser, by design, causes an early overcorrection that normally goes away with time.
If you were able to wear contacts prior to procedure, you should be able to wear contacts afterwards. There may be some increase in difficulty due to the new shape of the front of the eye, however, it is very unusual for patients to require significant corrections after procedure.
Given the results of the U.S. clinical trials and the results reported internationally, the treatment appears to be permanent, however LVC will not prevent age related conditions such as cataracts or presbyopia.
Most patients are very pleased with the results of their refractive surgery. However, like any other medical procedure, there are risks involved. That’s why it is important for you to understand the limitations and possible complications of refractive surgery.
Before undergoing a refractive procedure, you should carefully weigh the risks and benefits based on your own personal value system, and try to avoid being influenced by friends that have had the procedure or doctors encouraging you to do so.
Additional Risks if you are Considering the Following:
Monovision is one clinical technique used to deal with the correction of presbyopia, the gradual loss of the ability of the eye to change focus for close-up tasks that progresses with age. The intent of monovision is for the presbyopic patient to use one eye for distance viewing and one eye for near viewing. This practice was first applied to fit contact lens wearers and more recently to LASIK and other refractive surgeries. With contact lenses, a presbyopic patient has one eye fit with a contact lens to correct distance vision, and the other eye fit with a contact lens to correct near vision. In the same way, with LASIK, a presbyopic patient has one eye operated on to correct the distance vision, and the other operated on to correct the near vision. In other words, the goal of the surgery is for one eye to have vision worse than 20/20, the commonly referred to goal for LASIK surgical correction of distance vision. Since one eye is corrected for distance viewing and the other eye is corrected for near viewing, the two eyes no longer work together. This results in poorer quality vision and a decrease in depth perception. These effects of monovision are most noticeable in low lighting conditions and when performing tasks requiring very sharp vision. Therefore, you may need to wear glasses or contact lenses to fully correct both eyes for distance or near when performing visually demanding tasks, such as driving at night, operating dangerous equipment, or performing occupational tasks requiring very sharp close vision (e.g., reading small print for long periods of time).
Many patients cannot get used to having one eye blurred at all times. Therefore, if you are considering monovision with LASIK, make sure you go through a trial period with contact lenses to see if you can tolerate monovision, before having the surgery performed on your eyes. Find out if you pass your state’s driver’s license requirements with monovision.
In addition, you should consider how much your presbyopia is expected to increase in the future. Ask your doctor when you should expect the results of your monovision surgery to no longer be enough for you to see near-by objects clearly without the aid of glasses or contacts, or when a second surgery might be required to further correct your near vision.
You may choose to have LASIK surgery on both eyes at the same time or to have surgery on one eye at a time. Although the convenience of having surgery on both eyes on the same day is attractive, this practice is riskier than having two separate surgeries.
If you decide to have one eye done at a time, you and your doctor will decide how long to wait before having surgery on the other eye. If both eyes are treated at the same time or before one eye has a chance to fully heal, you and your doctor do not have the advantage of being able to see how the first eye responds to surgery before the second eye is treated.
Another disadvantage to having surgery on both eyes at the same time is that the vision in both eyes may be blurred after surgery until the initial healing process is over, rather than being able to rely on clear vision in at least one eye at all times.
If you are considering refractive surgery, make sure you:
Even the best screened patients under the care of most skilled surgeons can experience serious complications.
Under the care of an experienced doctor, carefully screened candidates with reasonable expectations and a clear understanding of the risks and alternatives are likely to be happy with the results of their refractive procedure.
Be cautious about “slick” advertising and/or deals that sound “too good to be true.” Remember, they usually are. There is a lot of competition resulting in a great deal of advertising and bidding for your business. Do your homework.
All eye procedures carry with them the possibility of infection. The worst case scenario of infection is that it could damage the cornea or retina and result in loss of sight. It is important to put this possibility into perspective when considering laser vision correction. However, the risk of a catastrophic complication from LVC is probably less than the risk of loss of sight through the use of extended wear contact lenses. In addition, there are other corneal irregularities which can rarely occur. The worst case scenario could be corneal scarring which could require corneal replacement.
While more comfortable and yielding quicker rehabilitation of vision, LASIK is technically more difficult to perform than PRK and carries with it a slightly higher complication rate. This is because there is an extra step involved – the creation of the corneal flap. This is rarely associated with any considerable or permanent vision loss, however, there are occasional circumstances which could cause flap wrinkling, or incomplete flaps which could lead to vision difficulty, requiring further procedures.
In the U.S. clinical trials’ 3-year follow-up, no sight-threatening complications were reported. And with over seventeen million treatments performed in the United States as of 2014, very few sight-threatening complications have occurred.
Many of our patients have expressed understandable concern by asking, “What happens if there is a power outage during my laser treatment?” The answer is that we have a very sophisticated uninterruptible power supply (UPS) that will take over and supply needed power to the laser to complete any treatment started.
The laser will run for more than 20 minutes following a power outage, more than enough to complete any procedure. Our UPS unit provides pure sine wave technology for perfect mains voltage reproduction and regulation. This means that no matter what happens to the mains voltage, including current sags, or “brown outs,” all of our 3 lasers are provided with continuous alternating current power, exactly the same power that operates them under normal conditions.
Understandably, patients are often confused as to why LASIK pricing may differ from one office or laser eye center to another. Below are the principal factors that distinguish premium LASIK centers such as Schneider LASIK Centers from the discount centers:
Because Dr. Schneider has dedicated his entire professional career as an eye surgeon to just performing refractive prodecure procedures, he has successfully performed over 20,000 LASIK procedures. This is all that he does, and as such, is not distracted throughout the day or week with glaucoma patients one day and cataract procedure patients the next as so many of his colleagues are. Dr. Schneider has carefully hand-picked and brought to Schneider LASIK Centers an incomparable, highly skilled professional team with over 50 years of collective experience in the refractive procedure field. With this team, Dr. Schneider believes that the patient experience is optimized with personalized education and a detailed, no cost consultation to best determine which laser technology is most beneficial to you. We are singularly focused to meet and even exceed your expectations, as this is all that we do at Schneider LASIK Centers. Dr. Schneider stands behind your results by several post-procedure plans for your enhancements. We encourage patients to visit the center and even observe Dr. Schneider perform a live LASIK procedure, if they wish. For your convenience, we also offer Saturday morning laser vision correction consultations..please call for Saturday appointments.
If members of these companies trust their precious eyes and professional careers to Dr. Schneider, so can you – the Schneider LASIK Centers Difference.
Not limited to just one laser, Dr.Schneider is able to choose which technology will provide the very best results for each patient, personalizing each treatment plan every step of the way – another Schneider LASIK Centers difference.
By having our own dedicated laser centers we have control over the entire process, each step of which actually allows us to achieve the very best possible results for each of our valued patients. Together with this most advanced laser technology and dedicated expertise and uniquely personalized treatment planning, we are able to provide you with a premium laser vision correction experience. Premium LASIK at Schneider LASIK Centers can certainly be an exciting alternative to the more traditional annoyance of glasses and contact lenses for most people.
Dr. Mark Schneider and the professional team at Schneider LASIK Centers are recognized as the leader in LASIK laser vision correction in SoCal. Here’s why:
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