 To date, Laser Vision Correction has received much media coverage. The purpose of this document is to educate you with straightforward facts regarding Laser Vision Correction and the different options that exist. Please read this material carefully and discuss any questions you may have with Dr. Baharozian or his knowledgeable ophthalmic technicians.
Laser Vision Correction consists of three different procedures that use a computerized laser to correct a person's refractive error. A refractive error may consist of nearsightedness (myopia), farsightedness (hyperopia) and/or astigmatism. These procedures are PhotoRefractive Keratectomy (PRK) and Bladeless LASIK (Laser Assisted In Situ Keratomileusis). Laser Vision Correction has been performed for over 12 years.
Both procedures are performed on a person's cornea using the same excimer laser. The cornea is the clear tissue in the front of a person's eye. The cornea is responsible for two thirds of the focusing process performed by the human eye.
The fashion in which the cornea is reshaped is slightly different with each technique. A general overview including advantages and disadvantages of each procedure are described below.
Dwayne B. Baharozian, MD uses the STAR S4 IR ® laser, made by VISX ®,
( www.visx.com ). He has performed over 1500 Laser Vision Correction procedures and operates in Waltham at Talamo Laser Eye Consultants.
PRK is the original procedure performed using the excimer laser in order to achieve Laser Vision Correction. PRK corrects a person's vision by reshaping a higher level of the cornea. When performing PRK, a speculum is used to hold open a person's eyelids. The surface layer of the cornea (the epithelium) is removed with a rotating brush or with a dilute solution of alcohol. The surface layer immediately below the epithelium is then reshaped using the computerized excimer laser**. Acting as a bandage, a clear contact lens is placed over the reshaped cornea for comfort and protection. The entire procedure is done under topical anesthesia (numbing eye drops) and is painless. PRK takes roughly 10 minutes to perform on each eye.
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PRK is an outstanding procedure for those patients who qualify. When compared to LASIK, PRK has both advantages and disadvantages. For instance, PRK is less invasive than LASIK because the procedure is performed on the surface layers of the cornea. It is not necessary to create a corneal flap thus eliminating all potential flap complications associated with LASIK.
On the other hand, the immediate post-operative recovery period can be fairly uncomfortable for some PRK patients. Healing of the top layer of cells (the epithelium) usually takes 3 to 5 days. During the recovery period, topical numbing drops and oral pain medication may be needed to reduce whatever pain or discomfort a patient may experience. The vision in a PRK patient is hazy for anywhere between 3 to 7 days after which it steadily clears. After roughly 10 days, the vision should be quite clear.
**Mitomycin C, an anti-metabolite medication, may be applied to the corneal surface immediately following the actual laser treatment. This medicine greatly reduces the chance of developing post-operative stromal haze in patients who have higher levels of nearsightedness or farsightedness.
Bladeless LASIK is a procedure that utilizes two different lasers in order to reshape a person's cornea and thus correct their vision. First, an ultra-short pulsed laser known as Intralase ® ( www.intralase.com ) is used to create a thin corneal flap. Next, a computerized excimer laser (the same one used in PRK) is used to treat a slightly deeper layer of the cornea known as the stroma. Simply put, utilizing the Intralase ® is the safest and most accurate way of creating a corneal flap. (The corneal flap can also be created with a mechanized instrument utilizing a metal blade known as a microkeratome. At the time of this writing, roughly 3 out of 4 eye surgeons still create the corneal flap with this older technique of using a microkeratome.).
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The steps taken to perform Bladeless LASIK are as follows: First, a suction ring is applied to the eye in order to elevate the internal pressure of the eye as well as to immobilize the eye. Next, the Intralase ® laser is used to create a thin corneal flap. At this point, a speculum is used to hold open a person's eyelids. This hinged flap is lifted and folded back superiorly. Laser vision correction is then performed on the underlying corneal bed. After this tissue is reshaped, the corneal flap is placed back down over the treated area in its proper, original position.
The corneal flap seals itself quickly to the underlying corneal bed. A bandage contact lens may be placed over the reshaped cornea for protection. The entire procedure is performed under topical anesthesia (numbing eye drops) and is painless. Bladeless LASIK takes roughly 20 minutes to perform on each eye.
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The corneal tissue prior to LASIK. |
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A hinged corneal
``flap" is created
with a special laser named Intralase®. |
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The laser treatment
is performed on
the corneal bed |
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The ``flap" is repositioned. |
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The cornea is now reshaped. |
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Bladeless LASIK is an outstanding procedure for those who qualify. Bladeless LASIK is usually the procedure of choice on patients who have high levels of nearsightedness (myopia). When compared to PRK, Bladeless LASIK has both advantages and disadvantages. For instance, a patient who undergoes LASIK usually experiences rapid improvement in his or her vision (i.e. the next day). Also, a Bladeless LASIK patient experiences minimal discomfort if any during the healing process. On the other hand, the risks of Bladeless LASIK are slightly higher than those of PRK. Although meticulous attention is paid to surgical techniques, rare complications may occur during the creation of the flap or during the healing phase. The overall rate of a serious complication for Bladeless LASIK is roughly 0.5 % and for PRK is 0.1%.
It is very important that all Bladeless LASIK patients be very careful not to accidentally dislodge the flap during the first two weeks of the healing process. This includes eliminating some physical activities (i.e. all contact and ball sports, swimming, horseplay, etc.) In addition, protective clear plastic shields must be taped over the eyes when sleeping for at least one week.
Dwayne B. Baharozian, MD performs Laser Vision Correction using the STAR S4 IR ® made by VISX ® . This laser is the most technologically advanced laser in the world today. Two different treatment delivery systems are available with this laser. In addition to the Traditional method of laser delivery, this laser has the capability to perform a state-of-the art laser delivery known as Custom Wave Front Ablation . A brief description of each type of Laser Vision Correction is as follows:
Traditional Laser Vision Correction using the STAR S4 IR ® system utilizes advanced technology such as iris registration and variable spot scanning to reshape a person's cornea.
A wide range of refractive errors can be corrected:
VISX®
- nearsightedness (myopia) up to -14.00 diopters with or without astigmatism up to -5.00 diopters. Maximum spherical equivalent is -14.00 diopters.
- farsightedness (hyperopia) up to +5.00 diopters with or without astigmatism up to +3.00 diopters. Maximum spherical equivalent is +6.00 diopters.
- for the reduction or elimination of naturally occurring mixed astigmatism when the magnitude of cylinder (up to 6.0 diopters) is greater than the magnitude of sphere and the cylinder and sphere have opposite signs .
These vision problems are known as " lower order aberrations ". A patient undergoing treatment can have an underlying pupil size of up to 8.00 mm.
Customized wavefront ablation is a new variation of Laser Vision Correction that customizes the treatment to the eyes of each individual patient. The cornea of each person's eye has unique characteristics similar to a "thumbprint". Going beyond the "traditional" treatment, customized wavefront ablation treats these individual characteristics specific to each person. In turn, customized wavefront ablation can help other vision problems, known as " higher order aberrations ", which previously could not be detected. Experts believe that correcting higher order aberrations will help lead to improved "quality of vision".
Customized wavefront ablation available through VISX® is known as " CustomVue ® "
CustomVue ®
At this point in time, the FDA-approved treatment range available for CustomVue ® (VISX ® ) is:
- for the reduction or elimination of myopia and myopic astigmatism up to -6.00 diopters spherical equivalent, with cylinder between 0.00 and -3.00 diopters
- for the reduction or elimination of high myopia and high myopic astigmatism up to -11.00 diopters spherical equivalent, with cylinder between 0.00 and -3.00 diopters
- for the reduction or elimination of hyperopia and hyperopic astigmatism up to +3.00 diopters spherical equivalent, with cylinder between 0.00 and -2.00 diopters
- for the reduction or elimination of naturally occurring mixed astigmatism when the magnitude of cylinder (from 1.0 to 5.0 diopters) is greater than the magnitude of sphere and the cylinder and sphere have opposite signs
The patient's refractive error, pupil size and corneal features will be the major factors in determining if a patient is a candidate for customized wavefront ablation. This qualification is confirmed prior to the day of surgery, using corneal topography and the Visx ® WaveScan. Not all patients are candidates for customized wavefront ablation (CustomVue ® ). In comparing, "traditional" Laser Vision Correction to customized wavefront ablation (CustomVue ® ), "traditional" is analogous to the picture seen with regular cable television whereas customized wavefront ablations in theory have the capability of delivering the picture seen with "high definition" television. When a patient qualifies for either form of laser delivery, it is thought that customized wavefront ablation will be more advantageous to the patient.
In order to determine if you would benefit from Laser Vision Correction and to answer more of your questions, a consultation can be scheduled with Dr. Baharozian. Current data regarding your refractive error (eyeglass prescription) needs to be available. A comprehensive eye exam performed within the past year at The Family Eye Care Center is necessary. For your convenience, a Laser Vision Correction consult can be scheduled on the same day as your eye exam. (If you would like a consultation on the same day as your comprehensive eye exam, please state this when scheduling your appointment.) During your consultation, Dr. Baharozian will review your individual ocular findings and lifestyle to help determine if Laser Vision Correction is right for you.
Please note, this consultation carries a non-refundable fee of $99.00 due on the day of your visit. This fee is credited toward your Laser Vision Correction should you proceed with the surgery.
The decision to have Laser Vision Correction is an important one that ultimately only you can make. It is important that you have realistic expectations. Your decision needs to be based on facts not hope, hype or misconceptions. Also, it is important to understand that all surgeries come with some risk. The goal of any refractive surgical procedure is to reduce your dependence on corrective lenses.
Although over 98% of patients achieve a visual acuity of 20/40 or better after undergoing Laser Vision Correction, it is important to realize that any individual's outcome can not guaranteed before undergoing the procedure.
Carefully consider the pros and cons of each form of Laser Vision Correction. Do not feel pressured by anyone to make a decision about having surgery. In the end, only you can decide if Laser Vision Correction is right for you.
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Once you have decided to proceed, please contact the Laser Vision Correction coordinator at The Family Eye Care Center to help guide you through the scheduling and pre-testing process. There are 3 pre-operative testing visits needed. During these visits, we do a thorough evaluation of your eyes including, refraction, pachymetry, topography, an OrbScan® and a WaveScan®. (Unfortunately, in some instances, we may discover an underlying condition that limits your Laser Vision Correction choice or even worse, may eliminate you as a Laser Vision Correction candidate altogether.) We also review each detail of the Laser Vision Correction procedure you are having, including its risks, benefits and alternatives. You will have a firm understanding of the entire process prior to having your surgery. It is imperative that all contact lens wear be discontinued prior to your first pre-operative visit. Specifically, soft contact lenses need to be discontinued 3 weeks prior and rigid gas permeable lenses 4 weeks prior.
As a service to our patients, we are pleased to offer you several payment options.
During a pre-operative visit punctal plugs* are inserted in the lower tear duct drainage openings of each patient regardless of the Laser Vision Correction procedure to be performed. Punctal plug insertion is an office procedure that is safe, quick, painless and totally reversible. Once inserted, a person should not feel their presence and they do not require any special care. These tiny devices, made of flexible silicone, act much like a cork, occluding (blocking) the drainage duct that carries tears away from the eye's surface. Often used to treat dry eye syndrome, punctal plugs will allow for better healing during the Laser Vision Correction post-operative period.
*Punctal plug insertion is considered a medical procedure and will be billed to your medical insurance for payment.
In conclusion, Laser Vision Correction is a commonly performed procedure that corrects a person's refractive error. The high rate of patient satisfaction is the reason for its popularity. Dr Baharozian has over 12 years experience performing Laser Vision Correction procedures and will personally handle your care from start to finish. He has a full service medical practice that will care about you and your vision for a lifetime. Some Laser Vision Correction Centers are financially driven to "sell" you on Laser Vision Correction. As health care professionals, we are motivated to provide you with superior medical care using state-of-the-art equipment. Your ocular health is our bottom line. To see if we can help you achieve a life less dependent on glasses or contact lenses with Laser Vision Correction, please call the office and schedule an appointment.
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