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Laser vision correction
is the most technologically advanced method for correcting
nearsightedness (myopia), astigmatism, and farsightedness
(hyperopia). This surgery is performed on patients who want
to decrease their dependence on glasses or contact lenses.
The popularity of this refractive surgery results from the
effective and predictable visual improvement achieved with
few side effects.
There are two laser techniques: LASIK (laser
in-situ keratomileusis) and PRK (photorefractive keratectomy).
Both procedures gently reshape the curvature of the eye
using an Excimer laser.
Laser vision correction is a miraculous
procedure! However, it is very important that patients have
proper expectations about what the surgery can do and what
it can't do. This section provides information not only
about the technical procedure itself, but also about what
you can expect regarding the speed and quality of your vision
improvement. Dr. Rosenberg, our LASIK surgeon, feels it
is important for you to have as much information as possible
while deciding if this procedure is right for you. This
information will be personalized to your specific eye condition
during your consultation. During your evaluation with Dr.
Rosenberg, she will explain excimer laser technology, describe
the painless laser procedure and how it works, and simulate
the results you can expect after surgery. Dr. Rosenberg
takes care in also presenting possible side effects of surgery,
and she'll clarify the risks and benefits of the procedure.
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Refractive
Error
The cornea
and lens of the eye focus light like a camera lens
to form an image on the retina at the back of the
eye. The cornea, where light first enters the eye,
provides about two thirds of the eye's focusing power,
and the lens inside the eye provides the rest. Nearsighted
eyes focus images of distant objects in front of the
retina, causing a blurred image. Nearsightedness,
or myopia, often starts in childhood and gets progressively
worse through adolescence. It usually stops changing
by the late teens, but myopia can sometimes worsen
during adulthood.
In farsightedness or hyperopia, images
focus behind the retina and look blurred.
In astigmatism, images are not evenly
focused upon the retina. Due to differences in corneal
curvature, light rays are divided into two parts that
focus at different distances from the retina.
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Nearsighted
eyes focus images of distant objects in
front of the retina, causing a blurred
image.
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In
farsightedness or hyperopia, images focus
behind the retina and look blurred.
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In
astigmatism, images are not evenly focused
upon the retina.
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A person who never
needed eyeglasses in youth but finds it difficult to read
and requires glasses to see up close is called presbyopic.
Presbyopia occurs because the focusing power of the lens
inside the eye diminishes and is a normal effect in the
aging eye. These individuals are usually around the age
of 40, and require the use of reading glasses. Laser vision
correction does not alter presbyopia because surgery takes
place on the cornea, and presbyopia is a condition of the
lens. There is an option with laser vision correction called
monovision which
can partially compensate for reading glasses; Dr. Rosenberg
will discuss this with you.
There are several laser techniques: LASIK
(laser in situ keratomileusis) and PRK (photorefractive
keratectomy). Both procedures gently reshape the curvature
of the eye using an Excimer laser. Also, there is a newer
procedure, called epi-LASIK or LASEK, that is similar to PRK.
In LASIK, a hinged corneal flap is created
with a keratome knife to expose the inner layers of the
cornea. The excimer laser beam is used to reshape the cornea,
and the flap is returned to its normal position. The corneal
surface is not disturbed in LASIK, and therefore visual
recovery is slightly faster compared to PRK
and epi-LASIK. Excimer laser light does not penetrate the
eye and leaves other eye structures (iris, lens, retina)
undisturbed. The removal of corneal tissue permanently reshapes
the cornea.
Medical studies indicate that for patients
with up to -6 diopters of myopia, the visual results for
PRK and LASIK are equal. For patients with higher myopia,
there appears to be an advantage to LASIK.
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What Is PRK and epi-LASIK?
PRK and Epi-LASEK is "laser only" surgery to reshape the surface of your cornea. First, the cornea's protective layer, the epithelium, is removed. Then the laser beam is used to change the front surface of the cornea. Immediately following surgery a clear bandage contact lens is placed on the eye to aid healing. It usually takes three days for the epithelium of the eye to heal. Patients may require eyedrops for as long as 3 months after surgery.
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The Surgery
LASIK, PRK, and epi-LASIK are painless
operations. Both procedures take minutes to perform and
are done as an outpatient procedure in a laser center. You
are awake. Anesthetic eye drops are used to numb the surface
of your eye. There are no needles. Patients are comfortable
throughout the procedure, and do not feel any pain. Your
eye might feel a foreign body sensation for a short time
after the surgery. Dryness in your eyes can last for several
days to a couple of months. You will use eyedrops during
the healing phase after your surgery to prevent infection
and to keep the eye comfortable.
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Are You A Good
Candidate For Surgery?
If you are considering
surgery, you must be at least 18 years of age and in good
general health with no eye diseases such as cataracts or
glaucoma. Also, an ideal candidate for laser vision correction
is willing to accept the potential risks for complications
and possible side-effects of surgery. Laser vision correction
can treat a wide range of nearsightedness, farsightedness,
and astigmatism. Your prescription for glasses or contact
lenses must not have changed very much during the year before
your pre-operative eye examination. Your eyeglass prescription
must fall within 1 to 14 units of nearsightedness, up to
6 units of farsightedness, and from 0.75 to 5 units of astigmatism.
Good candidates also have proper
expectations. No one can promise 20/20 vision. Most patients
do achieve 20/20 vision or are within one to two lines of
20/20 vision on the eye chart. These patients can drive,
play sports, watch movies, and read their alarm clock without
having to wear glasses or contact lenses.
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Consider This
Even though vision without glasses improves,
some patients still elect glasses or contact lenses at certain
times after surgery to achieve extremely sharp vision for
specific activities (distant seating at movies, ballgames,
concerts, for example). Also, laser surgery does not eliminate
the need for reading glasses, a condition called presbyopia.
You may need reading glasses after laser surgery even if
you did not wear them before. This situation normally occurs
in people around the age of 40 and over. Dr. Rosenberg will
explain this condition in detail so that you can make a
highly informed decision about surgery.
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Dr. Rosenberg's
Distinctive Style of Service
Patients seek doctors who are not only
qualified, but also trustworthy. They choose doctors with
whom they feel secure. You'll choose Dr. Rosenberg for the
same reasons. Dr. Rosenberg provides the highest level of
personal service for her patients by conducting all the
preoperative and postoperative eye examinations herself,
a distinctive feature of her practice. In addition to a
comprehensive eye examination, you will also undergo computerized
mapping of your cornea to detect astigmatism and rule out
surface irregularities. Ultrasonic measurement of your cornea
will ensure that you have sufficient corneal thickness on
which to operate. Multiple refractions (measurement of your
degree of nearsightedness, farsightedness, and astigmatism)
will be done. Some patients who wear contact lenses will
require multiple office visits before surgery to verify
stability in these measurements. Measurement of your pupil
size and refraction enables Dr. Rosenberg to counsel you
properly with regard to risk for glare or haloes. All of
your preoperative appointments are included in the surgical
fee. As your surgeon, Dr. Rosenberg will discuss in detail
with you the possible risks of surgery, and answer all your
questions.
Dr. Rosenberg's surgical results attest
to her significant experience in microsurgery, and to her
meticulous surgical technique. Dr. Rosenberg uses the most
current and sophisticated VISX Star 3 laser system. It has
a pupil-tracker and uses an enlarged corneal treatment area
that minimizes the risk of glare and halos. It also uses
a broad beam of laser light that accomplishes smooth surgical
ablations. The VISX laser is the leading laser with the
broadest FDA approved uses and the longest track record
in laser vision surgery.
In addition to the above exams, her fee
covers the surgery itself and eyedrops to be used for one
week after surgery.
Dr. Rosenberg will examine your eyes on the day following
surgery, again at one week , one month, three months, nine
months and one year postoperatively. If you request or require
additional exams related to your procedure, Dr. Rosenberg
will gladly oblige. If you require a laser enhancement prior
to your one year follow-up visit, this is free of charge.
Laser vision correction is considered by
most insurance plans to be an elective procedure. Check
with your insurance company to determine if refractive surgery
is covered. The procedure may be covered by medical flexible
spending accounts, medical reimbursement plans, or medical
cafeteria plans that allow pretax dollars to be set aside
for medical expenses. The pleasure and freedom you can experience
after surgery needn't be postponed because of financial
barriers. University Eye Specialists has a financing option
to pay for your procedure. Dr. Rosenberg's manager will
assist you in your application.
Dr. Rosenberg's priority is a happy patient.
That means that your laser procedure meets or exceeds your
expectations. It also means that you feel that Dr. Rosenberg,
her staff, and the laser facility, have your best interests
in mind at all times.
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Frequently asked questions
| Are the effects
of surgery permanent? |
| Yes. After initial
healing, the effect of surgery appears to last for years
in most patients. In some patients, the effect of surgery
may "regress" so that a small correction by
glasses or contact lenses will restore a patient's finest
vision. Some patients may benefit from retreatment with
the laser, and this is usually done within the first
year of surgery. |
| Is the surgery
safe? |
| All surgical procedures
carry potential risks. Laser refractive surgery carries
less risk than most other kinds of eye surgery because
few ocular instruments are used and surgery is quick
and precise. Although postoperative risks are small,
all patients should be well informed of the risks and
benefits of laser correction, and should follow their
postoperative instructions carefully. |
| What should
I know before I come in for my examination? |
| Bring your glasses
with you. If you have a dated prescription from one
year previously, bring that also. Soft contact lenses
should not be worn for at least 2 weeks and gas permeable
lenses should not be worn for at least 4 weeks before
your evaluation. This allows the cornea to regain its
natural shape and permits a more accurate examination
of your eyes. |
| How long does
the procedure take? |
| The actual surgical
procedure requires minutes, but there are some preoperative
preparations that will be done before treatment starts.
You will be asked to arrive at the facility approximately
15 minutes before the scheduled treatment time, and
you will be there approximately one hour. Arrange to
have someone drive you home, and plan to rest for the
remainder of the day. |
| What results
can I expect following surgery? |
| Your vision will
be somewhat foggy or blurry immediately after the surgery.
Almost everyone notices improvement compared to his
or her vision without glasses preoperatively. Your vision
will become clearer during the subsequent days and will
usually stabilize within 3 months. Laser vision correction
is very successful in reducing dependence on glasses
and contact lenses. How well and how quickly your vision
improves depends on your own healing pattern and how
strong your prescription was. |
| Will I need
to take time off from work or school after surgery?
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| You may need 1 to
2 days to rest the eyes prior to returning to work or
school. However, most people feel comfortable and see
sufficiently well to return to work and normal activities
the next day after surgery. |
| How much pain
should I expect following the procedure? |
| Eye drops will be
provided postoperatively in order to decrease discomfort.
Most patients describe a foreign body sensation for
the first 24 hours. |
| Are there any
restrictions following the procedure? |
| You must not rub
your eyes, or wear eye makeup for one week. No water
(including bath or shower water) should come in contact
with your eyes until Dr. Rosenberg advises it. She will
instruct you with regard to driving and exercising.
Swimming is not allowed for two weeks. Most normal activities
can be performed easily. |
| How long will
I need to use eye drops after surgery? |
| Some patients require
lubricating tear drops for 1-3 months after surgery,
and it is very important to the healing process that
these medications are taken exactly as Dr. Rosenberg
prescribes. |
| Will laser surgery
prevent the need for bifocals? |
| No. Bifocals are
required due to a condition called presbyopia. Presbyopia
occurs as an aging phenomenon of the natural crystalline
lens inside your eye. Laser vision correction is a procedure
done on the cornea, leaving the lens undisturbed. Therefore,
bifocals are needed beginning around age 40. |
| Will
I need reading glasses after surgery? |
| Generally, patients
under 40 years of age read well without glasses after
laser surgery. Reading glasses or bifocals will still
be needed by patients who have had laser vision correction
at a relatively younger age (for example 35 years or
less), and then approach 40 years old. If you presently
wear bifocals, or take your glasses off to read, then
you will need to use reading glasses after laser vision
correction. However, there is a type of correction called
monovision that you can select where one eye is corrected
for distance vision, and the other eye is corrected
for near vision. If you are thinking of this type of
correction, it may be wise to try this effect with contact
lenses prior to the treatment to ensure you like this
option. |
| Could this treatment
cause blindness? |
| As with all eye
surgeries, there is a small risk of infection. Infection
could damage the cornea and in very rare cases result
in loss of sight. Fortunately, this complication is
very rare. Some people experience poor night vision.
The surgery may result in overcorrection or undercorrection
of your refractive error, but this can usually be improved
with glasses, contact lenses, or with a second laser
surgery. Other risks that might alter your quality of
vision are glare, haloes around lights, and altered
contrast in bright light or at night. More rare and
serious complications include a dislocated corneal flap,
and epithelial ingrowth and inflammation underneath
the flap. Most of these complications can be managed
without any loss of vison. Permanent vision loss is
very unusual. |
| Is something
better coming along that I should wait for? |
| For those patients
who are good laser vision candidates now, the answer
is NO. Laser vision surgery will remain the preferred
refractive procedure of reducing dependence on glasses
and contact lenses. Future improvements in surgical
technololgy would benefit patients who are not good
candidates now, or who have special problems like irregular
corneas, both of which would be determined during your
personal evaluation with Dr. Rosenberg. |
| Is something
better coming along that I should wait for? |
| For those patients
who are good laser vision candidates now, the answer
is NO. Laser vision surgery will remain the preferred
refractive procedure of reducing dependence on glasses
and contact lenses. Future improvements in surgical
technololgy would benefit patients who are not good
candidates now, or who have special problems like irregular
corneas, both of which would be determined during your
personal evaluation with Dr. Rosenberg. |
| Can I make payments
on my surgical fee? |
| Yes. Payment options
are available. The alternatives will be discussed with
you at the time of your initial evaluation. In addition,
some insurance companies now cover laser treatment.
It is a good idea to check with your insurance carrier
to see if you are covered. The fee includes all preoperative
consultation and testing, surgery and prescription medication,
and postoperative office visits for the first year.
If a laser enhancement is indicated within this time
period, it will also be included in the surgical fee. |
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If you would like more information
about laser vision correction, try these website links:
Glaucoma
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