Precision, Comfort, Safety with the VISX STAR S4™ Laser

World renowned for precision, comfort and safety, VISX® lasers have been used to perform millions of laser vision correction procedures in the U.S. and around the world. During your CustomVue™ LASIK procedure, the VISX STAR S4 uses WaveScan® Technology, the WavePrint® Map, and 3D ActiveTrak™ to make sure you get the best LASIK results possible.

The Technology behind the procedure

WaveScan® Technology:

The new CustomVue system takes LASIK to an entirely new, personalized level with the addition of WaveScan™ Technology. WaveScan™ technology provides your LASIK eye doctor with a unique map of your vision, allowing the surgeon to custom tailor your LASIK procedure to the unique characteristics of your vision. WaveScan™ technology is groundbreaking because it has the potential to improve not only how much you see, but also how well you can see, in terms of contrast sensitivity and fine detail.

WavePrint® Map:

The WavePrint Map provides a precise, more detailed analysis of the way your entire optical system operates. With the WavePrint™ Map, your surgeon can create a detailed understanding of your vision correction needs for the development of your personalized laser vision plan. This information is then transferred to the VISX STAR S4 Laser, enabling the surgeon to customize your LASIK procedure. The final result is a treatment as unique as your DNA or your fingerprint.

3D ActiveTrak:

VISX’s CustomVue exclusively features 3DActiveTrak®, the only system that allows your doctor to track eye movement in all three dimensions. The 3D ActiveTrak feature allows for pinpoint accuracy by automatically tracking the tiny motions of your eye in all three directions during the laser procedure. ActiveTrak adds a new level of precision, comfort, and safety not previously available.

Questions about CustomVue™

Who is a candidate for the VISX CustomVue procedure?

If you’re over the age of 21, and are nearsighted and/or astigmatic, you may be a candidate for the CustomVue procedure. The first step is to contact us for a free CustomVue consultation.

Why is WaveScan® technology so important to the CustomVue procedure?

Until now, physicians were forced to practice one-size-fits-all vision. Now, with WaveScan technology, we can custom tailor a correction for the unique characteristics of each individual’s vision.

Will I need glasses or contacts after the CustomVue procedure?

One year after the VISX CustomVue™ procedure: 100% of the clinical study participants could pass a driving test without glasses or contacts, 98% of the participants could see 20/20 or better without glasses or contacts, and 70% of the participants could see better than 20/20 without glasses or contacts.

What does “better than 20/20″ mean?

20/20 is the current standard for excellence in vision. But, with the CustomVue procedure, individuals have the potential to see even better than 20/20. In fact, six months after the CustomVue procedure more than 74% percent of clinical study participants saw 20/16 or better.

Taking the Mystery out of Laser Vision Correction

The CustomVue™ LASIK process begins with a consultation to inform you about the technology and the procedure. This is followed by an evaluation assess the overall health of your eyes and to measure and create a detailed and unique WavePrint® map of your eyes. On the day of the procedure, your unique correction information is transferred directly from the WaveScan™ to the Visx STAR S4™ Laser. Next, the CustomVue LASIK surgeon gently reshapes your cornea with the cool beam of laser light to remove microscopic amounts of tissue—less than the thickness of a human hair in most cases—to create a new corneal curvature. The procedure typically takes several seconds and the majority of patients feel no discomfort. Many CustomVue™ patients notice immediate results and vision continues to improve over several days. Routine follow-up visits complete the process.

Some of the benefits of CustomVue™ LASIK include:

• Uses the smallest and fastest laser beam for precision and overall improved health of the cornea.
• CustomVue is 25 times more accurate than the traditional method of measurement
• CustomVue allows for completely customized LASIK
• Better night vision
• Better overall quality of vision
• According to national statistics, 98% of treated eyes achieved 20/20 vision or better!

For your personal best vision set up a CustomVue consultation today with a professional LASIK surgeon such as Dr. Richard A. Levinson of the Levinson Eye Clinic in Denver, Colorado and learn more about the innovative Visx Star S4™ CustomVue LASIK procedure.

Source: http://www.the-lasik-directory.com/article_customvue1.html

By Michele Boyer

Clear Lens Exchange (CLE) is used to correct nearsightedness, farsightedness, cataracts and, indirectly, astigmatism. With CLE the natural lens is removed and replaced with an artificial, implantable intraocular lens (IOL) in its place. Since CLE involves the actual removal of the natural lens, it is, basically the same as traditional cataract removal surgery.

The incision through which the lens is removed and the new one inserted may offer the additional benefit of changing the shape of the cornea. As an indirect result, this surgery may offer some correction for astigmatism as this incision may allow the cornea to resume a more normal shape.

Either single-focus or multi-focal. lenses (the accommodating CrystaLens®, or the multi-focal ReZoom® or ReStor®) can be implanted. Single-focus lenses don’t accommodate (change focus), so you may still need glasses. If you were presbyotic prior to surgery, your lenses didn’t accommodate (the hallmark of presbyopia). Accommodating lens implants will allow some automatic focusing as they respond to the muscle-movement in the eyes. Multi-focus lenses give you a good range of close and distant vision, but are stationery (non-accommodating). Varying magnification levels are part of the construction of the lenses allowing you to see clearly at different distances.

CLE has been used successfully for cataract removal for many years. It is a well-established, safe and reliable procedure, the most common surgery in medicine.

CLE can also correct for monovision, by implanting a distance-focused lens in one eye, and a near-focused lens in the other. If you choose CLE, you can change lenses at a later time if your vision changes, if you decide that you no longer want monovision, or if technology offers a more progressive lens option in the future.

The purpose of CLE is to reduce dependence on corrective lenses, so, the degree of correction you can expect to gain from surgery will be an important consideration. You will also want an idea of your need for corrective lenses for those distances not corrected by your new IOLs to be sure the risk of surgery is worth the gain in vision.

CLE is one the more invasive vision corrective procedures, and as such will carry more risk than LASIK and related refractive correction procedures. Damage to the retina, including detachment, or to the vitria (the gel between the lens and the retina) are possible, reinforcing the importance of finding a surgeon well-experienced in this surgery, as experience reduces the likelihood of error.

If you choose CLE, you will probably want to see a cataract surgeon as most surgeons who specialize in refractive laser correction do far fewer cataract surgeries (lens exchanges) than cataract surgeons do. If you can find a surgeon with considerable experience in both surgeries, all the better, as he would be more capable of giving you an objective prognosis of how each surgery could affect you, personally.

If you need to correct either nearsightedness or farsightedness, CLE may be a good alternative to LASIK surgery. This is good news for people who don’t qualify for, or prefer not to have one of the laser correction surgery procedures. Since CLE leaves the cornea intact with little likelihood of damage to the corneal tissue, laser corrective surgery may still be an additional option (for those who qualify for one of these procedures) if further correction is needed.

LASIK is one of the most common surgeries used to correct refractive error (nearsightedness and farsightedness.) It is also used to correct astigmatism and presbyopia. Using a laser beam to ablate corneal tissue, LASIK reshapes the cornea allowing the eye to focus near and far naturally. Quite often, LASIK patients are able to see well without glasses or contacts, with a small percentage only requiring them part time.

Source: http://www.the-lasik-directory.com/article_lasik_cle.html

LASIK patients have faced an elevated risk of vision loss from glaucoma, but that may be changing. LASIK does not cause glaucoma but can interfere with detection of the condition. Early detection plays a critical role in preserving eyesight. Since glaucoma does not present symptoms in the early stages it can only be discovered during an eye exam.

Glaucoma causes damage to the optic nerve which eventually leads to vision loss. Normally this damage is caused by high intraocular pressure (IOP). The standard method of initial detection of glaucoma is to test IOP. The problem with this method is that people with thin corneas will test with a lower IOP than they really have, leading doctors to believe that they do not have glaucoma. A few people have naturally thin corneas, and LASIK surgery thins the cornea.

It is not uncommon to develop glaucoma in the later years of life. With LASIK vision correction becoming more popular, the fear is that in a few years glaucoma will go undetected on a regular basis. This inaccurate form of testing may also lead to a false spike in “normal pressure” glaucoma.

In early 2005 the Food and Drug Administration approved a device called the TonoPach which measures both IOP and corneal thickness simultaneously in order to produce a more accurate reading.

If you have had LASIK surgery you must discuss it with your ophthalmologist before your eye exam and make sure that he or she is equipped to test IOP and corneal thickness together.

LASIK surgery if you already have glaucoma.

IOP is drastically increased during the LASIK procedure. For this reason, glaucoma patients may not make good LASIK candidates. Some ophthalmologists will recommend against LASIK for anyone with glaucoma. Many will recommend PRK as an alternative since it does not raise IOP as much as LASIK.

In reality, having glaucoma does not necessarily mean that you cannot have LASIK. Patients with mild glaucoma or who have their IOP under control with medications can still make good candidates for the procedure. If you have glaucoma and refractive error look for an ophthalmologist who has experience with LASIK procedures for glaucoma patients to find out if you are a good candidate and if not which alternatives may be right for you. Your ophthalmologist will need to determine the health of your optic nerve before making a recommendation.

Glaucoma patients must have their IOP measured on a regular basis. After LASIK measurements will need to be taken in a manner that adjusts for a thinner cornea. If you change doctors you must always tell your new doctor that you have had LASIK surgery so that he or she can measure your IOP properly.

LASIK is a wonderful option for correcting refractive error. As new technology emerges, the long term outlook for LASIK patients becomes even better. Just like any other surgery or procedure you may have, you should always talk openly with your doctor if you have had LASIK and discuss any concerns that you may have.

Source: http://www.the-lasik-directory.com/article_glaucomalasik.html.

By Michele Boyer

A Microkeratome is the blade used in LASIK surgery to cut the corneal flap.

The microkeratome blade has been the standard method of cutting the corneal flap in LASIK since LASIK was first developed. Previously, the microkeratome was used in other corneal procedures such as ALK. The microkeratome blade is used to cut a flap that remains hinged on one side. The flap is laid back exposing the corneal tissue for shaping with the excimer laser. This has been a safe and effective means of creating the flap for many years. While there are few complications resulting from LASIK surgery, the many of the complications result from cutting this flap. All of these are correctable. They include post-operative epithelial in-growth, aberrations resulting from healing the edges of the flaps, and dislocation of the flap post-operatively. Some of the advantages of using this procedure are lower cost, longer history of success, and surgeons greater experience with this technology than with IntraLase®.

IntraLase, also known as IntraLASIK, Blade Free LASIK and All-Laser LASIK, is new technology used to create the corneal flap during the LASIK procedure. It “cuts” the flap using a computerized laser light rather than a blade. Since the cornea is also reshaped using a laser, this procedure, which replaces the microkeratome blade with a laser, is often called “all laser LASIK”. Because most LASIK complications are associated with using the microkeratome blade, IntraLase has been touted as a safer method. It not only cuts the flap with more precision, but it is, also, a completely sterile procedure.

In addition, with the IntraLase method, more patients achieve 20/20 vision than with a microkeratome. IntraLase is a computer-controlled laser that delivers pulses of femtosecond laser light to the cornea at a specified depth and position. Each pulse creates a bubble. All the bubbles are connected together forming a space, which in turn creates the corneal flap. The edges of the corneal flap are vertical, not tapered. These vertical edges of the “cut” make improve healing compared to the tapered edges created by the microkeratome blade. Since it is the tapered edges that are associated with corneal dislocation, aberrations and epithelial in-growth, post-op corrective surgery is required far less often using IntraLase.

With IntraLase, the flap can be designed and cut with great precision, qualifying patients for IntraLASIK who didn’t qualify for traditional LASIK (e.g., due to the shape or thinness of their corneas). Although InterLase technology uses a different laser to cut the flap than the excimer laser used to shape the cornea, this new technology provides the same precision in creating the flap as has been associated with shaping the cornea in traditional LASIK.

The greatest disadvantage of the microkeratome over the IntraLase® is the cost. Another disadvantage is that the procedure takes a little more time with the IntraLase®. Expect to pay as much as $300 additional per eye for IntraLase®. However, some LASIK surgeons are NOT charging an additional fee simply because they prefer this technology, consider it safer, and prefer that all their patients have all-laser LASIK.

If you are considering LASIK, a thorough screening by a qualified LASIK surgeon is a must. Finding a qualified surgeon means identifying one who has plenty of experience performing a variety of laser eye surgeries. A qualified surgeon will be ready to provide statistics about his or her practice that are well within the standards and guidelines established by the FDA. Find out what diagnostic testing will be done to determine your specific surgical needs and the type of surgery that is best for you.

Source: http://www.the-lasik-directory.com/article_intramicro.html

Is One Clearly Superior to the Other?

When it comes to vision problems, it can sometimes be difficult for patients to “see” the correct answer. Although the technology has evolved to the point where most people no longer need to wear glasses or daily contacts, there are many choices available, and it can be difficult to determine what is best for you.

There are two main types of procedures that can be used to replace glasses and daily-wear contacts – they are continuous wear contacts and corrective surgical procedures like LASIK.

Continuous, or extended, wear contacts are made of silicone hydrogen – a material which allows oxygen to pass through the lens, thus keeping the eye healthy. They can be worn, day and night, for 30 days, after which they need to be replaced.

LASIK is a procedure where a laser light reshapes the cornea. The cornea is the clear front part of the eye which covers the pupil. LASIK a very precise procedure, approved by the FDA, and has been successfully performed on over three million people. Now, wikth custom LASIK, most patients end up with at least 20/20 vision or better.

Both procedures work in a similar fashion. When a person is nearsighted or farsighted, it’s the result of an improperly shaped cornea. Normally, light enters the cornea, which reflects the light onto the back of the eye, creating a clear image. If a person’s cornea is too flat, images close up become blurred (this is called hyperopia.) If the cornea is too steep, it’s the far away images which become blurred (which is called myopia.)

To improve poor vision, one or both corneas must be corrected. Contacts – continuous wear contacts included – change the angle with which light enters the cornea. So even though the cornea itself is still misshaped, the eye receives light in such a way that the blurriness is eliminated.

LASIK, however, actually corrects the problem on a deeper level. An excimer laser, using a three-dimensional map of the eye as a guide, reshapes the actual cornea. After undergoing LASIK, most patients no longer require glasses or contacts of any type.

So, which is better – LASIK or extended wear contacts? There are pros and cons to each.

Both are effective at correcting all sorts of vision problems: myopia, hyperopia, presbyopia, and more. Neither procedure is painful. However, there are two key differences: price and maintenance.

LASIK averages about $1,900 per eye. However, in the long run, LASIK is actually cheaper than extended wear contacts, which cost, on average, about one dollar a day. While patients must continually purchase extended wear contacts, the LASIK procedure is a one-time cost, and the results typically last a lifetime.

Extended wear contacts have some advantages – the prescription can be changed over time, and there is no surgery. However, for patient’s whose vision problems have stabilized, LASIK treatment is actually cheaper and more effective – especially now that the LASIK procedure is faster, safer and less invasive than ever before.

If you wear glasses or daily-wear contacts, and are interested in a more permanent solution to your vision problems, please see your eye doctor today. While there are many options available, only a personal consultation with a professional can give you the specific information you’ll need to make a “clear” decision.

Source: http://www.the-lasik-directory.com/article_contacts.html

The reported amount of serious complications following LASIK surgery is about 5% or slightly lower. The most important factor affecting surgical outcome is the experience of the surgeon: many studies show that as surgical experience increases, complications decrease, with the surgeon reaching a plateau around 1,000 procedures. Other factors that can affect surgical success include:

• High degrees of hyperopia (farsightedness), myopia (nearsightedness), or astigmatism
• Large pupils (if the diameter of the pupil at full dilation is greater than the diameter of the treatment zone, vision can be impaired, especially at night or under low lighting)
• Pre-operative dry eyes
• Eye diseases or problems such as keratoconus or “floaters”

Most complications are treatable or manageable, while others can pose serious risks to your vision. Below is a list of possible complications and how they can be treated if they do occur:

Night vision and contrast problems

• Contrast sensitivity
• Double Vision and Ghosting
• Halos
• Starbursts

Flap Complications

• Striae
• Ectasia
• Buttonhole flap
• Free flap

Other complications

• DLK
• Central Island
• Dry eye
• Infection

Night Vision and Contrast Problems

Contrast sensitivity - the ability to differentiate an object from its surrounding background. The decrease in contrast sensitivity is a relatively common occurrence following LASIK surgery, especially in patients with high amounts of myopia. Like the Snellen eye chart (the one with the big E at the top) that measures visual acuity, there are similar charts and tests to measure contrast sensitivity, with 20/20 quantified as normal contrast. Visual acuity measures how well the eye can see objects that are black and white at a given distance, while contrast sensitivity measures the ability to see under low light conditions, such as driving at night.

After LASIK, almost all patients experience some (usually small) amount of decrease in contrast sensitivity, but usually return to normal within the first few weeks or months following surgery. If loss of contrast sensitivity is excessive, it can lead to increased night vision problems.

Double Vision and Ghosting - the appearance of a second, usually fainter, image of an object creating a blurred vision. This complication is usually a result of irregular astigmatism induced by surgery. Like many other LASIK related vision problems, ghosting has a tendency to subside over time as the cornea heals, although both mild and severe cases have been reported as permanent complications.

Initially, anti-inflammatory drops are prescribed to help reduce corneal swelling. In persistent cases an enhancement or re-treatment could be possible to help correct vision, but in most instances a proper fitting with rigid gas permeable contact lenses (RGPs) is the best option for reducing ghosting.

Halos - the appearance of a halo around lights. Due to corneal swelling, the appearance of halos for the first few weeks following LASIK is quite normal. If halos persist, however, it may be necessary to have a re-treatment or use corrective lenses or glasses.

Starbursts - describes the complication that causes lights to appear blurred with spikes or rays of light radiating from the center of the light source. Starbursts usually only affect nighttime vision, but in some cases can appear around lights at any time of the day. For many patients this complication will subside within a month to six weeks. For other patients, treatments can include additional surgery, the diagnosis and treatment of dry eye (if this is thought to be the cause), prescription eye drops that restrict the pupil size at night, or contact lenses. The type of treatment necessary will be different for each individual case.

Flap Complications

Striae - wrinkles that occur in the corneal flap following LASIK surgery. Striae are usually a result of correction of myopia, but can occur during hyperopic correction as well. In some cases striae may not impede vision, and will not require correction. In other cases surgical correction is necessary to re-lift and smooth the flap.

Ectasia - When performing LASIK on a myopic and/or astigmatic eye, the purpose is to flatten the cornea, allowing proper refraction. When the corneal flap is cut too deep, too much tissue is removed, or the cornea was too thin for such a procedure, the remaining corneal tissue can be too thin to handle normal pressure and begin to weaken. As it weakens it can bulge or otherwise deform, causing residual myopia and induced astigmatism. The occurrence of such a complication is referred to as ectasia.

In some cases contact lenses can be worn to increase visual acuity, while in severe cases of ectasia a corneal transplant is necessary.

Buttonhole flap - this refers to a tear, rip, or uneven cut resulting in a partial cornea flap. When the microkeratome blade is placed incorrectly, too worn or used, or is not the right fit for the given eye, a partial an uneven cut can result. In other cases the corneal flap will tear or rip when it is being lifted or placed back over the eye. When a buttonhole forms the surgery is stopped and the flap gently replaced. If surgery is continued after a buttonhole flap is created, scarring and astigmatism can increase, worsening vision.

In 3 to 6 months, once the flap has had time to heal, the flap can be recut, usually with the use of a different microkeratome or by increasing the diameter of the intended flap.

A buttonhole flap can produce scarring that will impair vision, making close follow up with your ophthalmologist important. Patients with extraordinarily steep corneas are at higher risk for the buttonhole flap complication.

Free Flap - this occurs when the flap is cut all the way through, leaving no connecting hinge. This usually occurs as a result of loss of suction while the microkeratome blade is passing across the eye. As long as there are no irregularities of the flap, including rips and an uneven cut, the surgery can be performed as normal and the flap replaced without further complication. In the most serious cases the flap can be lost or suffer irreparable damages.

Other Complications

DLK (Diffuse Lamellar Keratitis also called “Sands of Sahara”) - inflammation of the cornea caused by a reaction to debris accumulated underneath the flap. DLK is usually indicated in stages from 1, which consists of debris outside the center of the eye, to 4, which includes stromal melting and central tissue loss. An estimated 1% of LASIK patients develop DLK with approximately 1 in 5,000 progressing to stage 4 status. Most ophthalmologists will treat stage 1 and 2 DLK with topical steroids or oral anti-inflammatories, but if the patient does not respond to treatment within a few days, additional surgery to lift the flap and irrigate the infected area may be necessary.

Central Islands - when treatment with the laser is not consistent across the entire treatment area, a protruding section of the cornea that is not in proportion with the rest of the surface can cause vision problems. This raised area, or central island, is basically an under treated area of the cornea, usually in the center, while the rest of the eye was treated to the correct specifications. In some cases this complication can be self-correcting within a month. Most of the time, however, a central island requires re-treatment, where the flap is raised and laser energy applied to create a more uniform corneal surface.

Dry Eye - In some cases LASIK can induce the occurrence of chronic dry eye. To correct this problem or help relieve the symptoms, your ophthalmologist may recommend treatments including artificial tear eye drops or punctual plugs that impede the draining of eye moisture. In many instances the effects associated with dry eye will disappear and treatment can be stopped. In other cases symptoms will persist and treatment continued for an indeterminate amount of time.

Infection - Though infection is extremely rare, if it does occur it can lead to permanently damaging eye problems. As with any surgery, a sterile operating room and careful attention to post-operative care are essential in preventing infection. Avoiding such activities as swimming, basketball, and other like pastimes for the first few weeks will help reduce the chance of infection. If any signs of infection are detected you should visit your ophthalmologist immediately, as treatment and medication can cure infection if it is caught early enough.

Source: http://www.locateadoc.com/articles.cfm/372/1370

If you have read or heard anything about LASIK in the past year or two, then you probably know about the new Wavefront technology, touted as the newest advancement to help give you better vision than traditional LASIK can offer. What you may not have heard of is the newest add-on to Wavefront LASIK, called iris registration.

How it Works

Here is how Los Angeles LASIK surgeon Dr. Robert Maloney describes iris registration in action: “Traditional lasers track your eye moving left, right or up, down. And, so, if you move your eye left or right or up or down the laser beam follows you and that’s good…There’s other ways, however, you can move your eyes: you can, for example, move closer or further from the laser.” Iris registration tracks this movement and communicates it with the laser so that the eye tracking points are perfectly matched with the laser during surgery.The new technology can also track rotational movements of the eye. When you lay down your eyes can rotate slightly clockwise or counter clockwise. “Until now it hasn’t been possible to track that movement,” says Dr. Maloney. “And when your eyes rotate the laser treatment has to rotate with it. Until now it didn’t. So the laser treatment was basically rotated at the wrong direction compared to where your eye is. With the iris tracking, now the laser rotates during the laser treatment to match the rotation of your eye…It takes Wavefront to the whole higher level.”

This can mean an even greater chance of 20/20 vision than with conventional LASIK or even Wavefront alone. With Wavefront, about 95% of Dr. Maloney’s patients achieve 20/20 vision and he is expecting that number to rise to 99% now with the iris tracking technology.

These improved results are even starting get noticed by some of Dr. Maloney’s colleagues. “A doctor I worked with for years said to me recently, ‘what are you doing differently? Everybody’s coming out perfectly.’ I attribute that to iris registration.”

Complications

The good news is that iris registration does not present any additional complications that can be attributed to it specifically. The bad news is that it does not reduce the occurrence of complications normally associated with LASIK (such as dry eye). However, Dr. Maloney has seen fewer problems with quality of vision using iris registration over traditional LASIK. “Because of that perfect alignment of the eye and the laser, you’re less likely to have problems with hazy vision or ghost images or night glare.”

Cost

At Dr. Maloney’s office the fee for LASIK is the same with or without iris registration. However, adding iris registration to an existing laser can cost a doctor several thousand dollars. As this option is added by more and more doctors, some may choose to charge a little bit more for LASIK with iris registration. However, the enhancement rate (that is the number of patients that require a touch up after surgery) is greatly reduced by iris registration. This can cost an additional $200 or more, so a small increase in price initially may pay off in terms of comfort, quality, and follow up care.

Limitations

Though this new technology can mean great results for a large number of people, there are still some that will be left without the option of iris registration. In the one year period that Dr. Maloney has offered iris registration, he was unable to use it in about 10% of his patients, either because he could not get a good image of the eye or the eye was too difficult to measure using the available instrumentation.

There are also currently a limited number of surgeons that offer iris registration in their office. “Many surgeons have taken the point of view let’s wait and see what the results look like,” says Dr. Maloney. “Well, now that the results look good, more and more surgeons have started getting it.”

Right now only the VISX brand laser is equipped with iris registration, but all of the other major lasers are developing similar technology. This means that within the next year or two this now limited technology will probably be the norm, and will most likely include additional developments that will help reach a larger portion of that 10% that have to go without now.

“What iris registration is it takes Wavefront to the next level,” says Dr. Maloney. “There will be further improvements and refinements, but it is a big leap forward.”

Source: http://www.locateadoc.com/articles.cfm/372/1407

The national average cost of LASIK surgery is about $1,800 per eye. Include wavefront technology and/or IntraLase and the endeavor can become even pricier. To help lower the price or make surgery more affordable, there are a number of options available without compromising technology or surgical experience:

• Medical Insurance Coverage - Unfortunately this option is rarely available unless specified in your coverage plan or surgery is deemed a medical necessity. If you believe either of these to be the case, most practices will assist you in filing your request.
• Financing Options - There are many companies that offer financing options for LASIK surgery, with payment plans of up to five years with monthly payments as low as $60, depending upon the cost of surgery and your credit history. In many cases practices are available to help you find financing options.
• Payment Plans - In some cases you may be able to make monthly payments for 3, 6, or 12 months without incurring interest fees. Each practice or financing company has different policy, so you should address this issue at your initial consultation.
• Flexible Spending Plans - Some companies allow their employees to set aside pre-tax dollars into a flexible spending account. If this is the case with your employer, money from this plan can be used toward LASIK.
• Credit Card Payments - Most LASIK practices accept major credit cards. Many patients will choose this option if it offer a better financing opportunity than the above two options.
• Tax Deductible - According to section 213 of the Internal Revenue Code patients may file a deduction for medical care for which they are not otherwise reimbursed for any amount in excess of 7.5% of their adjusted gross income. The allowance of such a deduction is a matter of interpretation so your accountant should apply for approval in writing from the IRS.

Source: http://www.locateadoc.com/articles.cfm/372/1369

Choosing LASIK surgery for vision correction is not the same as it was 10 or 12 years ago. In 1994, when Baltimore ophthalmologist Anthony Kameen had LASIK surgery to correct nearsightedness and astigmatism, his options were not very extensive: a small mechanical blade, called a microkeratome, created a flap on his cornea, after which a conventional excimer laser was used to reshape the tissue underneath so that the cornea would be able to focus light directly on the retina, as it would in a normal eye. That was, in a nutshell, the only way LASIK was performed then. Now, of course, the technology is much more advanced including smoother and more precise lasers, allowing patients to achieve better vision than ever possible before. The newest technological addition to Dr. Kameen’s refractive surgery office is a machine called IntraLase, which allows patients to avoid operation via a metal blade, using a special laser that is used only for the purpose of flap creation.

Intralase in Practice

Touted as “all-laser” LASIK, the most significant claim of the IntraLase machine is that it can greatly reduce the risk of flap complications associated with microkeratome created flaps. When a microkeratome is used, there is the possibility that a flap will be cut too thin, will tear, or will not cut completely. With IntraLase these possibilities are negated. Dr. Trevor Woodhams has used the IntraLase system in his Atlanta office for the past two years and reports very few major complications, and a re-operation rate similar to that with a microkeratome, about 5%. Dr. Kameen reports even better results during his year of use. In fact he has only needed to do “touch-ups” on 6 of his approximately 960 procedures, compared to an 8-9% rate with the mechanical device. Of this statistic he says, “I personally didn’t believe it. I thought it was just marketing hype. I am a believer now.”

However, this does not mean that it will eliminate flap problems, in fact flap wrinkles and other related problems are still possible, though less likely, with the IntraLase laser. Proponents of the IntraLase created flap, such as Dr. Woodhams and Dr. Kameen, use the system for the majority of their LASIK patients, claiming that they can achieve better visual acuity while cutting down on the occurrence of major complications. Detractors say that there is no clinically substantial evidence that better vision is possible or that such risks are significantly reduced, while surgery takes longer and additional complications are introduced.

How Intralase Works

During flap creation, the IntraLase laser beam places a series of small bubbles inside the cornea, removing corneal tissue, and allowing the flap to be dislodged and exposing the cornea. Because the surgeon can determine the depth and diameter of the flap, the result is a more precise and usually smoother cut. With the laser, surgeons have better control, and even have the ability to make adjustments after beginning the cut. While using IntraLase on one of his patients, Dr. Kameen realized halfway through that the flap wasn’t centered correctly so he stopped, re-centered, then continued the cut. This would not have been possible if he were using a mechanical blade. In addition, many practitioners say that they can achieve better vision with IntraLase. Dr. Woodhams says that recently about 94% of his patients are achieving 20/20 vision and all reach 20/30, though studies, he says, are ongoing.

The Learning Curve

The biggest knock against IntraLase is that it has an unacceptably high rate of late occurring photophobia (abnormal sensitivity to light). Dr. Woodhams noticed this trend, and even stopped using the machine in his office for two months. IntraLase made adjustments, introduced a new laser, and Dr. Woodhams began using the system again in August 2004 without the problems of photofobia. He says, “I have been impressed with the way the company has been responsive to user complaints.”

As with any device, there is also the learning curve factor. Dr. Kameen had a short period during which the machine in his office had energy settings that were too high. While he emphasizes that no one was hurt as a result of this miscalculation, there were instances of post-operative inflammation and additional patient discomfort. Dr. Woodhams agrees that learning to get the energy set correctly is an issue for beginners. He also says that the more you use it, the more you develop a softer touch, better accuracy, and even achieve better visual acuity for patients.

Supplementals Diffences

Of course, not everyone agrees with Dr. Woodhams and Dr. Kameen’s findings. In a report published as a supplement to the November/December 2004 issue of Cataract and Refractive Surgery Today, studies showed that there were no significant differences in visual acuity and instances of higher order aberrations between eyes with IntraLase created flaps and eyes with flaps created by the Hansatome microkeratome manufactured by Bausch & Lomb. In addition to not offering any statistically better outcomes, the report showed that IntraLase introduced its own possible complications including photophobia, inflammation, and a less-than-smooth stromal bed (the part of the cornea exposed after flap creation). As mentioned above, however, some doctors believe that the risk of these complications can be avoided after significant experience and setting changes. The additional negatives sighted by the report included a higher cost that is passed along to the patient at the price of about $250 per eye and a longer operating time.

In contrast to this report, however, there have been several other findings suggesting that the IntraLase system does offer better vision along with lower instances of complications. One, in fact, was published as the March 2004 supplement to Cataract and Refractive Surgery Today by Dr. Daniel Durrie, in which he stated, “the INTRALASE FS laser was at least equal to or better than the Hansatome in every category. I consider these results impressive across the board.”

A Case by Case Basis

Looking solely at report statistics, however, will probably not determine what option will offer the most benefits to a given patient. IntraLase flap creation offers more potential benefits for specific patients, while for others it may not even be a good option at all. For this reason, patients may be better served trying to answer the question “is IntraLase a better option for me” rather than, “is IntraLase better than a microkeratome?”

For patients who have had RK (radial keratotomy), a surgical refractive surgery, in the past, IntraLase cannot be used (other vision correction surgeries could make the use of laser flap creation undesirable as well). In addition, patients needing only minor correction, especially patients with only mild myopia, or nearsightedness, may not necessarily find the benefits that IntraLase can offer them any greater than what a microkeratome can, and may view the extra money and longer surgical time as unnecessary.

On the other hand, Dr. Kameen will use only IntraLase on patients with any amount of hyperopia, farsightedness, never a microkeratome. Because IntraLase offers better control and more flap precision, the flap is wider and is removed in a more symmetrical shape. When hyperopia is corrected with LASIK, it is the periphery of the cornea that is treated, and the wider flap that IntraLase provides offers the possibility of better surgical correction. In addition, IntraLase makes LASIK available to patients for whom it would not have been a good option before. These types of patients include ones with high myopia or thin corneas. Again, because flap creation can be tailored to meet the specifications of an eye individually, creating laser flaps in these patients can greatly reduce the risks and offer better possible vision.

IntraLase and Custom LASIK

IntraLase also seems to offer greater advantages when it is combined with wavefront-guided lasers, in which a specialized computer maps specific corrections for each individual eye. In studies in which wavefront lasers were used, often referred to as custom LASIK, instead of the older technology of conventional LASIK, the visual results achieved with IntraLase are substantially better than those achieved with a microkeratome using the same technology. The anecdotal information reported by Dr. Woodhams and Dr. Kameen, both of whom use wavefront LASIK almost exclusively, corroborate the results of such studies.

IntraLase has been FDA approved since 2001 and has been used in the treatment of more than 250,000 eyes. Through the years the technology has been adjusted and doctors have honed their technique, and, in many instances, patients are reaping the benefits of LASIK without the blade.

Source: http://www.locateadoc.com/articles.cfm/372/1352

Photo-Refractive KERATECTOMY (PRK)uses the excimer laser to correct low to moderate amounts of refractive errors. PRK treats nearsightedness by removing corneal tissue from the surface of the cornea, causing the central optical zone to flatten. This allows light rays to focus more directly on the retina, thereby reducing nearsightedness. The amount of tissue to be removed is determined by the amount of nearsightedness to be corrected. For most patients, only five to ten percent of the cornea is removed to obtain the desired results.

Photo-Astigmatic Refractive KERATECTOMY (PARK) can be used to treat low to moderate amounts of astigmatism. Since regular astigmatism is caused by the cornea being steeper in one direction, like a football, the excimer laser beam is shaped to remove more tissue in one direction than the other. The result is a more spherical cornea that allows light to focus more directly on the retina. PARK can usually be done in the same session as PRK or LASIK.

LASIK is an acronym for LASer In-situ Keratomileusis, which simply means “to shape the cornea within using a laser.” It corrects vision by reshaping the cornea (outer window of the eye) so that light rays focus more precisely on the retina, thereby reducing or eliminating refractive errors.

Source: http://www.locateadoc.com/articles.cfm/372/33