Patricia Woloch asked:


LASIK is not a good option for everyone, and that has been known for many years. When the FDA first approved LASIK, in the mid 1990s, many ophthalmologists rushed to offer it to all and sundry. You could even say that some vision clinics operated like LASIK assembly lines, whisking people in one door and out the other without adequately screening them.

Some kept their expenses down by buying cheap equipment, not changing the microkeratome blade for each patient, not sterilizing instruments often enough, and keeping a small staff. The eye surgeon did not meet with patients before or after the actual surgery, but delegated that to assistants. With low expenses, such clinics were able to offer low prices to attract a lot of patients.

The result was that many people had LASIK who should not have had it. They were poor candidates.

How LASIK is Done

Briefly, it reshapes the eye’s cornea, the clear part in front. The cornea, being curved and transparent, bends light as it enters the eye. In a 20/20 eye, it bends it at just the right angle to give clear vision. If you are near- or far-sighted, it bends it at the wrong angle. If you are astigmatic, it bends light in multiple ways, giving blurry vision.

To reshape the cornea, a small, thin flap is first cut with a tool called a microkeratome. The flap is folded back out of the way, and the treatment laser (Excimer laser) vaporizes tiny pieces of corneal tissue beneath the flap area, according to a pre-determined plan. This gives the cornea a new curvature: flatter for nearsighted people and steeper for farsighted people.

The corneal flap is then replaced carefully and heals up by itself. Now that the cornea has a modified curvature, incoming light will be bent correctly and will focus clearly on the retina at the back of the eye. You will have clear vision at all distances.

LASIK Developments

More information has been gathered since the early days. More follow-up studies have been done, and modified forms of LASIK have been developed which are safe for people who cannot have standard LASIK.

• Wavefront-guided LASIK delivers a more precise treatment, preventing many of the side effects that often resulted from standard LASIK, such as halos and starbursts around light sources, ghosting (kind of double vision), and poor night vision.

• Intralase uses no microkeratome blade to create the corneal flap, but instead uses a second laser. This makes a thinner flap and enables those with thinner corneas to still have vision correction

• LASEK and epi-LASIK also do not use a blade to cut the corneal flap. They use alternative methods to make thinner flaps, making vision correction possible for more people.

Public FDA Hearing today

Today, April 25, 2008, the FDA is beginning a second look at LASIK. The plan is to work with eye surgeons and do a major study on many hundreds of people who have complained about their LASIK results. What exactly are their complaints? Were they poor LASIK candidates to start with? Depending on their findings, they may issue a new warning about LASIK.

About 7.6 million people have had a LASIK procedure in the U.S., and the percentage of people who achieve 20/20 vision or better is in the high nineties. LASIK is truly something of a miracle for anyone who has lived their lives with poor vision and suddenly has clear vision. It is almost always a huge success. But the first line of defense against any complications afterwards is to choose a good LASIK surgeon.

The FDA’s website has a page on all the LASIK devices and systems they have approved. There are links to more detail on each one, and to warning letters issued by the FDA, press releases and patient information. If you are considering LASIK for yourself, this would be a good place to start your self-education about it.

Be sure and choose an experienced and highly-trained LASIK surgeon, who will give you a thorough eye examination, check your medical history and general health, and listen to your goals and concerns. Make sure that this same surgeon will personally do your follow-up checks. If you feel any reservations or discomfort about working with a particular eye surgeon, move on and schedule a consultation with another surgeon. An educated patient is always the best kind, so do your homework, choose a good surgeon, and you will likely be jazzed and delighted at the results.



Erin

Patricia Woloch asked:


In the 1990s, in the rush to offer this miraculous new vision correction to the public, some ophthalmologists failed to screen potential patients well enough. LASIK is not safe for everybody. This was quickly realized, and screening became more careful and strict.

If a LASIK surgeon has said you are not a good candidate for LASIK, there could be various reasons for that – related to your eye health, general health, prescription stability, or expectations. But there are also various ways of doing LASIK that have been developed to correct vision for people who are not good candidates for traditional LASIK.

If you have corneas which are too thin or too steep in curvature for LASIK, you can consider Intralase, LASEK, or epi-LASIK, all of which have modified ways of creating the corneal flap. That flap is done to expose the next layer down in the cornea, the stroma, where your LASIK surgeon will direct the laser. Intralase, LASEK and epi-LASIK cut the flap more thinly so as not to weaken the cornea.

Complications vs Side Effects

Keep in mind that complications are different from side effects. A side effect is temporary and minor, although it may be annoying or uncomfortable at the time. LASIK side effects are such things as dry eyes, itching, or a scratchy feeling, which last only a few days, if you have them at all. If you tend to have dry eyes before LASIK is done, that is a disqualifying condition.

Complications are more major conditions which may require a second surgery, or more long-term treatment, and some can even give permanent trouble, but this is very rare.

Wavefront-Guided LASIK

In the early days of LASIK, before wavefront technology was developed, there was a higher rate of complications after LASIK. Wavefront technology is an extremely precise way of diagnosing the eye’s refractive error. It gathers detailed information from which it creates a 3-D map of each eye. Your LASIK doctor then bases your treatment on this information. Most LASIK surgeons now offer LASIK in this form.

Use of wavefront-guided technology gives a more precisely customized treatment for each eye – in fact each treatment is one-of-a-kind. Nobody ever has or ever will receive the same treatment that your right eye will receive. Not even your left eye. By being so exact, it prevents some of the vision distortions that used to be side effects or complications from traditional LASIK. They are things like:

• Poor night vision

• Double vision (also called ghosting)

• Halos

• Starbursts

• Glare around light sources

Potential LASIK Complications

No matter how sophisticated technology becomes, or how many LASIK techniques are developed to expand the pool of safe candidates, LASIK is still a surgery. All surgery brings a certain amount of risk. It is one of the requirements of good candidacy that you accept that fact, and are willing to take a very small risk to obtain a very large and amazing improvement in your vision.

LASIK complications are very rare, less than one percent.

• Infection beneath the corneal flap – usually prevented by antibiotic eyedrops, but sometimes a person doesn’t use them according to the LASIK surgeon’s directions

• Faulty flap healing – can often be corrected by subsequent surgery

• Corneal ectasia – can be an ongoing problem, treated as keratoconus

• Irregularities resulting from faulty flap creation – these can give you those vision distortions listed above

The best way to minimize any chance of LASIK complications is to choose a highly-trained and experienced LASIK surgeon. Choose one who screens patients very thoroughly, answers your questions clearly, has invested in a wavefront-guided LASIK system, and does not pass you off to an assistant.



Ann

Charles Moore asked:


Most people are likely familiar with the term “LASIK,” understanding it to be a form of eye surgery; however, many may not know what the acronym “LASIK” stands for, exactly what type of eye surgery it is, which techniques it involves, if this procedure is right for them, and how to find a LASIK clinic.

LASIK stands for Laser-Assisted in Situ Keratomileusis, which actually translates to (and involves) reshaping the inside of the cornea – the clear “dome” that covers the eyeball – using a laser. Ophthalmologists, who are medical specialists and surgeons specifically trained to perform eye operations, perform this form of refractive laser eye surgery on individuals to treat a number of different eye-related medical conditions’ astigmatism (when an irregularly shaped cornea affects the vision), myopia (”near-sightedness”), and hyperopia (”far-sightedness”), as well as to provide an alternative to wearing corrective eye glasses or contact lenses.

But what does LASIK actually do? Basically, this surgery involves intricate procedures that change the cornea’s shape permanently, allowing it to better and much more accurately refocus light rays on the retina, thus enhancing and improving overall vision in the afflicted eye (or eyes).

A highly specialized device, called the excimer laser, is used for reshaping the cornea. Other devices commonly used include the microkeratome (a special knife that cuts a flap into the cornea) and a hinge, which is left at one end of the flap. Specific techniques and procedures can vary, depending on the LASIK surgery services and the particular surgeon performing the operation.

Not sure if you need or qualify for LASIK? Houston, Texas offers guidance through its private practices, clinics, and LASIK surgeons to help you determine whether or not this type of eye surgery is right for you. Not everyone with eye troubles needs or should undergo this intricate surgical procedure, but if you are near-sighted, far-sighted, have astigmatism, or would like to once-and-for-all get rid of your glasses or contact lenses, then LASIK is probably a good fit for you.

Whatever your eye troubles or problems, if you are considering LASIK, this city is home to a number of public and private practices either offering or dedicated to providing laser vision-correction services. While there are a number of LASIK Houston options for you, consider seeking out the services of a private practice or clinic that is dedicated to LASIK surgery and other laser vision-correction procedures and operations. This means that the medical specialists who work there specialize in eye-correction surgeries, including LASIK or, better yet, they may specialize in practicing LASIK surgery only. In this way, you can be assured you are receiving top-quality care from surgeons who not only know what they’re doing, but are highly trained, skilled, and experienced in LASIK surgery.

Besides specialization in LASIK surgery, there are other factors to consider when choosing a clinic or a specific LASIK Houston surgeon. You’ll want to find out what kind of equipment they use, what type of specific procedures and techniques they use, how long they’ve been in business, as well as the costs involved.

Ideally, you’ll want to choose to have the procedure done where they use only the latest, high-end, most technologically sophisticated diagnostic equipment, which helps surgeons to determine exactly how to reshape the cornea and how much of the cornea actually needs reshaping. Further, it’s best if you select a surgeon or LASIK surgery clinic in Houston that utilizes the best and latest technology to improve upon LASIK techniques and procedures for the actual operation. The latest technology available for this type of eye surgery is the highly advanced WaveLight Allegretto Excimer Laser System, officially named the “ALLEGRETTO WAVE Eye-Q Laser System.”

A good laser eye-surgery clinic will also work to match each patient with the right technique or procedure for LASIK surgery, since every patient has different needs. This individualization ensures that every LASIK patient receives the proper attention and care and receives the best possible outcome after the operation. Finally, make sure to check out how long a clinic has been in business, the qualifications of the LASIK surgeons, and how much the surgery is going to cost you.

Not sure how to find the right (or the best) LASIK services or surgeon? Check around locally in Houston, whether you live right in the city or close by, or head online to find out what’s available, and then research and compare each option thoroughly before making your decision so you can be sure you’ll be receiving the best LASIK Houston care possible for your vision correction.



Ella