LASIK Surgery: Is It Right For You?

If you’re tired of wearing eyeglasses or contact lenses, you may wonder whether LASIK surgery is right for you. LASIK is a type of refractive eye surgery. In general, most people who have laser-assisted in-situ keratomileusis (LASIK) eye surgery achieve 20/25 vision or better, which works well for most activities. But most people still eventually need glasses for reading as they get older.

LASIK surgery has a good track record, most people are satisfied with the results. Certain side effects, particularly dry eyes and temporary visual disturbances, are fairly common. But these usually clear up after a few weeks or months, and very few people consider them to be a long-term problem.

Your results depend on your refractive error and other factors. People with mild nearsightedness tend to have the most success with refractive surgery. There are several variations of laser refractive surgery. LASIK is the best known and most commonly performed. Many articles, including this one, will use the term “LASIK” to refer to all types of laser eye surgery.

Normally, images are focused on the retina in the back of your eye. With nearsightedness (myopia), farsightedness (hyperopia) or astigmatism, they end up being focused elsewhere, resulting in blurred vision.

Nearsightedness (myopia) is a condition in which you see nearby objects clearly, but distant objects are blurry. When your eyeball is slightly longer than normal or when the cornea curves too sharply, light rays focus in front of the retina and blur distant vision. You can see objects that are close more clearly, but not those that are far away.

Farsightedness (hyperopia) is a condition in which you can see far objects clearly, but nearby objects are blurry. When you have a shorter than average eyeball or a cornea that is too flat, light focuses behind the retina instead of on it. This blurs near vision and sometimes distant vision.

Astigmatism causes overall blurry vision. When the cornea curves or flattens unevenly, the result is astigmatism, which disrupts focus of near and distant vision.

Traditionally, blurry vision is corrected by bending (refracting) light rays with glasses or contact lenses. But reshaping the cornea (the dome-shaped transparent tissue at the front of your eye) itself will also provide the necessary refraction and vision correction.

Before a LASIK procedure your eye surgeon will assess detailed measurements of your eye. Then he or she will use a special type of cutting laser to precisely alter the curvature of your cornea. With each pulse of the laser beam, a tiny amount of corneal tissue is removed, allowing your eye surgeon to flatten the curve of your cornea or make it steeper.

Most commonly, the surgeon creates a flap in the cornea and then raises it up before reshaping the cornea. There are also variations in which a very thin flap is raised or no flap is used at all or no flap at all, is raised. Each technique has advantages and disadvantages.

Individual eye surgeons may specialize in specific types of laser eye procedures. The differences among them are generally minor and none are clearly better than any others. Depending on your individual circumstances and preferences you may consider:

• Photorefractive keratectomy (PRK). With PRK, rather than forming a flap, the top surface (epithelium) is scraped away. This corneal abrasion takes three or four days to heal, resulting in moderate pain and blurred vision in the short term. It was thought that these drawbacks were outweighed by the theoretical advantage that PRK was safer for people who are more likely to be struck in the eye — for example, those involved in contact sports, law enforcement or the military. But even with standard LASIK, the risk of eyeball rupture is still very low, so there is probably no significant advantage with PRK. LASIK is also a better option than PRK for correcting more severe nearsightedness (myopia).

• Laser-assisted subepithelial keratectomy (LASEK). LASEK is similar to LASIK surgery, but the flap is created by using a special cutting device (microkeratome) and exposing the cornea to ethanol. The procedure allows the surgeon to remove less of the cornea, making it a good option for people who have thin corneas. For people at greater risk of eye injuries, LASEK does not have any significant advantages over LASIK.

• Epithelial laser-assisted in-situ keratomileusis (epi-LASIK). In an epi-LASIK procedure, your surgeon separates the epithelium from the cornea using a an epikeratome and reshapes the cornea with a laser. This procedure is similar to LASEK.

• Implantable lenses. Corrective lenses can be surgically inserted in the eye to improve vision. This is routinely done as part of cataract surgery (in which the old, cloudy natural lens is removed). It may also be an alternative to LASIK for older adults who may need cataract surgery in the future.
Younger people with high degrees of nearsightedness that cannot be satisfactorily treated with corrective lenses may also be offered implantable lenses. But this is not a routine option for most people.

• Bioptics. Bioptics combines one or more techniques, such as implantable lenses and LASIK, to treat nearsightedness or farsightedness. Again, this is not an option for most people seeking refractive eye surgery.

Are your eyes healthy?

In general, laser eye surgery is most appropriate for people who have a moderate degree of refractive error and no unusual vision problems. Your eye surgeon will ask detailed questions about your eye health and evaluate your eyes to make sure you don’t have any conditions that might result in complications or poor outcomes of surgery. These include:

• An eye disease that results in a progressive deterioration of your vision and thinning of your cornea (keratoconus). In fact, if keratoconus runs in your family, even if you don’t have it, be very cautious about elective eye surgery.

• Keratitis, uveitis, herpes simplex affecting the eye area, and other eye infections.

• Eye injuries or lid disorders.

• Dry eyes. If you have dry eyes, LASIK surgery may make the condition worse.

• Large pupils. If your pupils are large, especially in dim light, LASIK may not be appropriate. Surgery may result in debilitating symptoms such as glare, halos, star bursts and ghost images.

• Glaucoma. The surgical procedure can raise your eye pressure, which can make glaucoma worse.

• Cataracts.

You might also rethink having LASIK surgery if:

• You have severe nearsightedness or have been diagnosed with a high refractive error. The possible benefits of LASIK surgery may not justify the risks.

• You have fairly good (overall) vision. If you see well enough to need contacts or glasses only part of the time, improvement from the surgery may not be worth the risks.

• You have age-related eye changes that cause you to have less clear vision (presbyopia).

• You actively participate in contact sports. If you regularly receive blows to the face and eyes, such as during martial arts or boxing, LASIK surgery may not be a good choice for you.

Are you healthy?

Your eye surgeon will also ask detailed questions about your general health. Certain medical conditions, unrelated to your eyes, can increase the risks associated with LASIK surgery or make the outcome less predictable. These include:

• Any disease or condition that affects your immune system and impairs your ability to heal or makes you more prone to infections, such as rheumatoid arthritis, lupus, HIV and other autoimmune disorders.

• Taking an immunosuppressive medication for any reason.

• Diabetes.

• Depression or certain chronic pain conditions, such as migraine, irritable bowel syndrome and fibromyalgia. If you have one or more of these conditions, you may have more problems with dry eyes and postoperative pain than other people. The reasons for this are not entirely clear but may be related to how you perceive pain.

Is your vision stable?

If you have myopia, your vision may continue to change throughout your teenage years, or even longer, requiring periodic changes in the prescription of your glasses or contact lenses. Therefore, people must be over age 18, and preferably older, before considering LASIK eye surgery.

Certain conditions and medications — pregnancy, breast-feeding, steroid drugs — may cause temporary fluctuations in your vision. Wait until your vision has stabilized before considering LASIK eye surgery.

Can you afford it?

Most insurance plans consider laser eye surgery to be an elective procedure and don’t cover the cost. Know what the surgery will cost you.

Do you understand possible side effects and complications?

While complications that result in a loss of vision are rare, certain side effects, particularly dry eyes and temporary visual disturbances are fairly common. But these usually resolve after a few weeks or months, and very few people consider them to be a long-term problem.

• Dry eyes. LASIK surgery causes a temporary decrease in tear production. For the first six months or so after your surgery, your eyes may feel unusually dry as they heal. Even after healing, you may experience an increase in dry eye.
Your eye doctor might recommend that you use eyedrops during this time. If you experience severe dry eyes, you could opt for another procedure to get special plugs put in your tear ducts to prevent your tears from draining away from the surface of your eyes.

• Glare, halos and double vision. After surgery you may have difficulty seeing at night. You might notice glare, halos around bright lights or double vision. This generally lasts a few days to a few weeks.

LASIK versus reading glasses

By their early to mid-40s, all adults lose some ability to focus on nearby objects (presbyopia), which results in difficulty reading small print or doing close-up tasks.
One possible benefit of having been nearsighted most of your life is that this condition actually compensates for the presbyopia that inevitability develops as you get older. A nearsighted eye will focus near objects by itself without reading glasses. LASIK surgery removes this near focus because the nearsightedness has been corrected. This means that as you get older you will need to use reading glasses. Many people are happy to trade clear distance vision when they are younger for having to wear “cheaters” for reading when they are older.

If you are an older adult considering LASIK, you might choose to have your vision corrected for monovision, to maintain your ability to see objects close up. With monovision, one eye is corrected for distant vision, and the other eye is corrected for near vision. Not everyone is able to adjust to or tolerate monovision. It’s best to do a trial with contact lenses before having a permanent surgical procedure.

Can you go without your contact lenses for several weeks before surgery?

This is usually not an issue, but know that you’ll have to completely stop wearing your contact lenses and switch to glasses for at least a few weeks before your surgery. Contact lenses distort the natural shape of your cornea, which can lead to inaccurate measurements and a less than optimal surgical outcome. Your doctor will provide specific guidelines depending on your situation and how long you’ve been a contact lens wearer.

What are your expectations for LASIK?

Most people who undergo LASIK surgery will have good to excellent vision in most situations, for many years or decades. You’ll be able to play sports and swim, or even just see the clock first thing in the morning, without having to worry about your glasses or contact lenses. But as you get older or in low-light conditions, you may still need to wear glasses.

Most people report high satisfaction after LASIK surgery. But long-term results often aren’t available or haven’t been well-studied. Part of the reason for this is that people are overall satisfied after surgery, so they don’t feel a need for repeat examinations and follow-up data is not collected. Also, the LASIK procedure has been refined over time — the techniques and technology is continually changing. This makes it difficult to draw conclusions from the data that is reported.
Keep in mind that even when postoperative follow-up is done and reported, vision is measured under optimal testing conditions. Your vision in dim light (such as at dusk or in fog) may not be as good as published reports suggest it will be.
Over time your refraction may slowly worsen with age and your vision may not be quite as good as it was immediately after surgery. This does not seem to be a large problem, but the exact degree of change to be expected is sometimes unpredictable.

How do you choose an eye surgeon?

Most people don’t have firsthand knowledge about LASIK or an eye surgeon. A good starting point when choosing an eye surgeon is to talk with the eye professional you know and trust. Or ask friends or family members who have had successful LASIK.
Your eye surgeon will probably work with a team, who may help with your initial evaluation and measurements. But it is your surgeon who takes the ultimate responsibility for determining whether LASIK is an appropriate choice for you, who confirms the measurements to guide the procedure, who performs the procedure, and who provides postoperative care.

Talk with your eye surgeon about your questions and concerns and how LASIK will benefit you. He or she can help you understand the benefits and limitations of surgery.

The final decision

When it comes to LASIK eye surgery, there are no right answers. Carefully consider the factors outlined here, weigh your preferences and risk tolerance, and make sure you have realistic expectations. Talk to an eye surgeon in whom you feel confident and get your questions answered. In the end, if it feels right, then proceed, but if it doesn’t, don’t rush into anything.

This article is an edited version of a report that was written by the Mayo Clinic Staff

 

The FIVE Best Reasons to Have Laser Vision Correction!

LASIK surgery offers a wealth of benefits for the average eyeglasses wearer. If you’ve been wearing eyeglasses for a long time, consider the benefits of LASIK.

1. Improved vision. Studies have shown that about 95% of patients who receive LASIK surgery achieve uncorrected visual acuity (UCVA) of at least 20/40 and 85% achieve 20/20 vision or better. Patients can enjoy greatly enhanced vision following one outpatient procedure.

2. Long-lasting results. Following a stabilization period of about 3 months for the eye to adjust, LASIK results are expected to be permanent. There is no need for follow-up procedures, unless the surgery over or under-corrected to repair a vision, and the patients improved eyesight will last barring any normal loss due to aging or illness.

3. Quick results and quick recovery. You won’t be able to drive immediately after a LASIK surgery but most ophthalmologists estimate that patients can return to their normal schedule as soon as the day after surgery, unless you have an especially dirty or dusty workplace. Imagine having near perfect vision within a day!

4. No more contacts. It’s estimated that the annual cost of contact lenses is 375 to 450 dollars per year. Granted, LASIK surgery costs several times that amount but you only have to pay for it once- after several years LASIK surgery will pay for itself by eliminating the need for contacts and even begin to save you money. Not to mention that you won’t have to bother with solutions, sticking your finger in your eye, or crawling around on the floor looking for a lost contact.

5. No more glasses. It’s safe to say that we’re past the days of being called “four-eyes” when pro athletes wear glasses without lenses in them but isn’t it nice to have the option of not wearing glasses? Your look can radically change as simply as taking off your glasses. Plus you can wear all the styles of shades you please, without shopping for special lenses for your eyeglasses or purchasing expensive prescription sunglasses.

 

An Overview and Tips for Your FREE Consultation

 

At Acuity we offer a free, no obligation LASIK consultation to all prospective patients. This is an information session about the  procedures, recovery and required appointments. Any questions
you may have about the overall experience will be addressed. During this session, our patient counselor will use an auto-refractor to determine your prescription. Based on this reading, a price for LASIK or PRK surgery will be determined. Unless we are offering a special LASIK price or limited time offer, your price will be based on your prescription, including any astigmatism. You will not definitively know if you are a candidate for laser vision correction until you have a pre-operative exam. You may schedule your pre-operative exam and consultation together if you wish.

Feel free to bring a friend or your spouse to your consultation!

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To schedule your consultation and/ or pre-operative exam call  877-520-EYES (3937)

Contact Lens Wearers: Because laser vision correction involves the reshaping of the cornea, it’s imperative that our patients refrain from wearing prescribed contact lenses for specific periods prior to surgery, depending on the type of lenses. Contact lenses change the shape of the cornea and your cornea must be in it’s natural shape to make a precise correction possible. The recommended time periods to be out of your contact lenses are listed on the graphic below.

TIP: Verify the type of contact lenses you wear with your optometrist or ophthalmologist and plan to stop wearing your contact lenses for the recommended time period before scheduling your pre-operative exam.  

If you are beyond 40 years of age and notice a need for reading glasses:
Please be aware that laser vision correction is a reshaping of the cornea, and does not involve Geometric-Designsurgery inside the eye. The need for reading glasses or bifocals that occurs in most individuals around age 44 is believed to be the result of a weakening of the focusing muscle inside the eye. Laser vision correction can compensate greatly for this weakening but cannot stop the gradual weakening of the muscle.
We recommend Monovision for those who would like to reduce their dependence on reading glasses in addition to removing astigmatism and/or correcting farsightedness or nearsightedness. Monovision involves correcting the dominant eye for distance viewing and the non-dominant eye for close up viewing or reading.  We recommend a “monovision trial” during your pre-operative exam. Most people find they are quickly able to adapt to using their non-dominant eye for their close-up viewing/reading. Those with a monovision correction describe the shift between close and distant viewing as similar to the difference between how you see things in the periphery when your eyes are focused on an object or person. The brain selects the view that is desired between close up, mid-range or distant.

HERE IS AN OVERVIEW OF THE INFORMATION GIVEN IN A CONSULTATION AT ACUITY Laser Eye and Vision Center:

Click here to enlarge or print the brochure:

Click on thumbnail to enlarge:

Color-Brochure-for-Lasik-outsideColor-Brochure-for-Lasik-inside

 

Prep for the Pre-Operative Exam; Lid Scrubs, Warm Compress Therapy

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PREPARING FOR 
THE PRE-OPERATIVE EXAM
PLEASE CALL THE OFFICE
WITH ANY QUESTIONS! 877-520-3937

CONTACT LENSE WEARERS:

YOU MUST BE OUT OF YOUR CONTACT LENSES FOR CERTAIN PERIODS OF TIME BEFORE YOUR PRE-OPERATIVE EXAM:

1. Soft Daily Wear = 7 days
2. If you sleep in soft daily wear lenses = 21 days
3. Toric Lenses or Lenses Treating Astigmatism = 21 days
4. Hard/ Gas Permeable Lenses = 30 days per 10 years of wear.

Do not wear your contact lenses again after your pre-operative exam.

Cosmetics:10-Best-Tips-For-Eye-Care-Frequently-Wash-Your-Eyes-And-Properly-Remove-Eye-Makeup-500x332

Please do not wear make-up for 3 days prior to your pre-operative exam and 3 days before surgery.

LID CARE/ LID SCRUBS and WARM COMPRESS THERAPY:
Should be done twice a day for one week before your pre-operative exam and again twice a day for a week before your surgery day. This will clear the oil producing pores in your eyes of any debris blocking the expression of oil into the eye. This oil is important to your comfort and healing process following surgery.

This should be done twice a day for the week before your pre-operative exam and again twice aimages day, the week before your laser vision correction surgery.

  • Place a wash cloth under the tap and rinse it thoroughly with hot water.

pumpApply Ocusoft (one pump) to the wash cloth creating a lather.
Gently close your eyes and apply the face towel to your eyelids. With a gentle side to side motion, scrub your eyelids and the margins of your eyelashes on both your upper and lower eyelids, thoroughly cleaning the base of your eyelashes.
Perform the scrubs 2-3 minutes, two times daily for each eye.

Warm Compress Therapy:

This will open the oil producing pores in your eyes and allow the oil they produce to be expressed into the eye.

Place a wet wash cloth in a microwave for 10-30 seconds or use tap water as hot as possible but do not burn yourself! The washcloth should be warm but not hot or scalding when applied to the face.
Lightly wring out the wash cloth so it is warm and moist then place it gently over closed eyes making sure the cloth is in contact with the base of your eyelashes or the lid margins.
When the wash cloth is no longer warm, reheat and wring out the cloth and reapply immediately. Perform this therapy for 5-10 minutes, making sure to reheat the wash cloth 2-3 Blepharitis2times.

Lid Margin Compressions:
This assists the expression of oil produced in the eyes to be expressed into the eyes.

Apply gentle pressure to lid margins, up and in for lower lids and down and in for the upper lids by placing your finger tips on the base of your lashes. Compress either the upper or lower lid completely before moving to the other eyelid. You will feel a mild tenderness as you compress, if done correctly.
Look in the mirror while compressing. Use the white of your eye to apply pressure against.
Press with fingers from one edge of the eye-lid to the other, over-lapping the areas where pressure is applied.
Repeat procedure on upper and lower lid margins for 2 minutes.

http://visiononesource.com/eye-health/69-how-to-clean-your-eyelids.html

Acuity’s 3 Steps to Surgery

Consultation: Aproximately 30 minutes images

  • You will be quoted a price for surgery based on your prescription following a brief exam on an auto refractor. We will also discuss the procedures we offer, recovery periods and recovery details, preparation for surgery and financing options in that meeting, then address any questions you may have.
  • Your quoted price for surgery will include all follow-up exams for the first three months and your pre-operative exam.
  • We will not determine whether you are a candidate for LASIK (2-3 day recovery) or PRK (5-7 day recovery) in the consultation. This determination will occur in your pre-operative exam.
  • Acuity offers 24 months interest free financing through CareCredit. You may want to call CareCredit to apply for the card. Call 800-365-8295 or apply online at www.carecredit.com .

Your free, no obligation consultation will be an information session about the procedures offered at Acuity, including recovery times for each procedure offered. Call 877-520-3937 to schedule your free consultation.

Eye-Exam-with-Sam

Dr. Vale of Acuity performing a pre-operative exam.

Pre-operative Exam: 90-120 minutes

  •  You will be asked to pay an exam fee the day of your pre-operative exam, but that fee will be deducted from the price quoted for your surgery in your consultation. The balance will be due the day of surgery.
  • Your pre-operative exam should be scheduled a minimum of one week before surgery or a maximum of two months before you intend to have surgery.
  • You may call Acuity for the scheduled surgery dates available, or ask for dates during your consultation, in order to plan for your surgery and recovery.
  • View this graphic for useful information. Be sure to verify the type of contact lenses you wear with your optometrist, to determine the number of days or weeks that you must refrain from wearing them to be prepared for your pre-operative exam and surgery.Color-Brochure-for-Lasik-outsideColor-Brochure-for-Lasik-inside

Surgery: approx. 10 minutes 

You will need someone to drive you home after surgery and during your immediate recovery period.

 

A History of Wavefront Mapping and Custom

 

Clinical Study Results
Some of the early trial results, such as the 2003 VISX multi-center clinical study, that led to FDA approval for wavefront-guided laser vision correction showed the following:

 

• At one year after the Custom procedure:

• 100% of the clinical study participants could pass a driving test without glasses or contacts
• 98% of the clinical study participants could see 20/20 or better without glasses or contacts
• 70% of the clinical study participants could see 20/16 or better without glasses or contacts
• Four times as many clinical study participants were very satisfied with their night vision after the VISX CustomVue procedure compared to their night vision before with glasses or contacts.

What Is Wave Front Mapping?
Wavefront mapping is the technology that makes custom laser eye surgery possible by precisely measuring and diagraming the imperfections of an optical system, such as the eye. These imperfections are divided into lower-order aberrations, such as myopia, hyperopia, and astigmatism, and higher-order aberrations that affect night vision. Wavefront-guided technology is used in CustomVue laser eye surgery to correct refractive error and to improve night vision.
Wavefront Analysis and Mapping:

Wavefront analyzers are used to map aberrations in the eye. Several types of visual imperfections, referred to as lower and higher-order aberrations, exist within the eye and can affect both visual acuity and the quality of vision. Prior to wavefront technology, only lower-order aberrations such as myopia, hyperopia, and astigmatism could be measured and treated. However, these do not account for all potential vision imperfections. Higher-order aberrations can also have a significant impact on quality of vision and are often linked to glare and halos that may cause night vision problems.

Wavefront analyzers use a Hartmann-Shack sensor, which maps both lower and higher-order aberrations by projecting waves of light into a patient’s eye and mapping the waves that bounce back through the pupil. A perfect wavefront would be completely flat. When light rays enter the eye and traverse the different refractive indices, the wavefront surface changes, taking on a shape unique to that eye. These variations are called wavefront aberrations. The aberration data is collected and then converted into a treatment formula by using Zernike polynomials, which are also called modes. Each mode describes a certain three-dimensional surface and the Zernike polynomials correspond with ocular aberrations. For instance, second-order Zernike polynomials represent the conventional aberrations such as defocus and astigmatism. Zernike polynomials above the second order represent the higher-order aberrations that are suspected of causing night glare and halos. Zernike polynomials help to simplify the wavefront technology by combining all aberrations into one simple map. This is called Zernike decomposition.

History of Wavefront Technology:
Wavefront technology was originally developed for use in astronomy. In the 1900s, an astrophysicist named Johannes Hartmann devised a method of measuring the ray aberrations of mirrors and lenses. The Hartmann test used a metal disk in which regularly spaced holes had been drilled. The disk or screen was then placed over the mirror that was to be tested and a photographic plate was placed near the focus of the mirror. When exposed to light, a perfect mirror will produce an image of regularly spaced dots. If the mirror does not produce regularly spaced dots, the irregularities, or aberrations, of the mirror can be determined.

In the 1970s, Dr. Roland Shack and Dr. Ben Platt advanced the concept by replacing the screen with a sensor based on an array of tiny lenslets, thus creating the Hartmann-Shack sensor. In 1978, Dr. Josef Bille of Germany was the first person to use the Hartmann-Shack sensor in ophthalmology. Other wavefront pioneers include Dr. Junzhong Liang and Dr. David Williams who developed a wavefront device that could be used in a clinical setting.

In 1997, Drs. Liang and Williams presented a paper at the Association for Research in Vision and Ophthalmology that discussed the early clinical results attained with the wavefront device. At this time, ophthalmologists and major laser manufacturers, such as VISX, Bausch & Lomb, and Alcon, began to look at the possibilities of wavefront technology for correcting refractive error and to develop their own wavefront analyzers. In 2002, the FDA approved the first wavefront-guided custom LASIK application. Today, there are many integrated wavefront-guided LASIK systems that first generate a wavefront map of a patient’s unique optical imperfections, then send this information to an excimer laser that performs the custom LASIK procedure.

Zernike Polynomials Shapes

The wavefront analyzer software condenses the wavefront information into a conventional refraction in diopters as well as in Zernike form. This map is then transferred to the laser, enabling treatment of the patient’s lower and higher order aberrations.

 

Learn More About Astigmatism And How LASIK Can Help

About one in three people suffers from astigmatism, yet many would be surprised to know so many others also suffer from this condition. While common, astigmatism is often misunderstood, and many don’t know that LASIK surgery can treat it.

What is Astigmatism?
A normal cornea’s shape should mimic that of a baseball. A person with astigmatism has a cornea that is shaped more like a football. Because the cornea is oddly shaped, light bends unequally as it enters the eye, causing vision distortion or blurriness.
Some people with astigmatism might frequently squint in an effort to see clearly because astigmatism can make it hard to focus on fine details or objects. Squinting too much can cause headaches from the strain of trying to focus.

Regular vs. Irregular Astigmatism
Regular astigmatism, the most common type of this condition, is found in almost half of the adult population. Irregular astigmatism is less common and can be caused by eye disease, surgery or injury. The most common cause of irregular astigmatism is a disease called keratoconus, which gradually thins the cornea, typically in the second decade of life. Irregular astigmatism can be difficult to treat with eye glasses. Custom contacts may be useful depending on the severity of irregular astigmatism.

Can Laser Eye Surgery Treat Astigmatism?
Depending on the type and severity of astigmatism, the condition can often be treated with laser eye surgery. Laser-assisted in situ keratomileusis (LASIK) is a type of laser eye surgery that reshapes the inner layer of the cornea to correct astigmatism. It is important to determine which type of astigmatism you have in order to determine which eye treatment option is best for you.
LASIK eye surgery has proven an effective treatment for people with mild or moderate astigmatism. LASIK is also a convenient option for physically active people who find eye glasses or contacts a nuisance, even if they don’t have astigmatism.
Outdoorsman Angus Chan suffered from astigmatism and wore prescription lenses for 24 years before he opted for LASIK eye surgery.
Chan had worse than 20/500 vision, which means what a normal person could see from 500 feet away, Chan could not see from 20 feet away.
“Prior to LASIK, my world was really just a big blur unless something was about a foot in front of my nose,” Chan said. His eye doctor suggested LASIK five years ago, but Chan didn’t think he’d need it. He changed his mind later, as he became a father of kids who liked to snatch his eye glasses from his face, and as he was a swimmer and snowboarder. Eye glasses tended to get in the way, and contact lenses dried his eyes.
I’ve been giving my daughter swimming lessons,” Chan said. “Being able to demonstrate how to do front floats and glides without worrying about my glasses falling to the bottom of the pool is a joy.”
It’s been three months since LASIK eye surgery corrected Chan’s astigmatism. He noticed significantly improved vision immediately after LASIK, and his eyesight continued to improve over the following days.
“After experiencing the results, I regret not taking advantage of the procedure when I first could have,” Chan said. “Not having to worry about glasses or contact lenses provides much more freedom than I realized.”

http://www.lasik.com/articles/astigmatism-and-lasik/

Over 40? Monovision. It Might Fit Your Life Best!

Ultimately, deciding between a Full Distance correction and a Monovision correction after laser vision correction is an individualized choice that is based on multiple factors. There is not one ‘right’ answer or ‘one size fits all’ solution. After getting to know your goals and lifestyle, Dr. Vale can help guide you to the most appropriate procedure for your specific needs.

The customary goal of laser vision correction is usually stated as, “to reduce or eliminate the need for glasses and contacts”. If you are over 40, you may wonder, “What about reading glasses and near vision problems that occur with age?” For patients over age 40, Monovision
may be a great choice. It can help the majority of patients achieve good distance and near vision without glasses. Keep reading if you are trying to figure out if Monovision may be right for you.

First, a brief tutorial may be helpful. Presbyopia is the normal age related change in vision in which the natural lens of the eye loses the ability to “accommodate ” or focus at near. Presbyopia causes a gradual worsening of near vision in most individuals in their forties. Whether or not you have laser vision correction, you can expect to eventually become “presbyopic” during those years. That is why people begin wearing bifocals, reading glasses, or taking off their distance glasses (if they are nearsighted) to read small print. Yes, even after laser vision correction, if you are corrected for perfect distance vision (“Full Distance”) in both eyes, you will eventually need reading glasses for near work. Many patients are not opposed to using over-the-counter reading glasses for near work after surgery. Other patients truly want to be “glasses-free”, and the mere thought of needing reading glasses would defeat the point of having laser vision correction in the first place.

With Monovision, one eye is “set” for distance focus, and the other eye is set for better near focus. Having mild nearsightedness in one eye can help negate the effects of presbyopia and both restore and preserve near reading ability. Monovision allows a patient to see both distance and near images without glasses by having blended visual focal points. The goal of Monovision is to be independent of glasses for most day-to-day activities. After Monovision it is realistic to be able to read a menu, do computer work, watch TV, and still drive a car legally without glasses.

While Monovision is not a “perfect” solution to presbyopia, for carefully selected patients, it is well tolerated and very satisfactory over 85% of the time. Most patients who choose Monovision are satisfied with both near and far vision without glasses. Alternatively, about 15% of Monovision patients notice certain tradeoffs, including difficulty with high performance sports or night driving, or with intricate close work. Monovision may be appropriate for a 50 year-old accountant, but not appropriate for a 50 year-old motorcycle police officer. Our goal at Acuity is to help our patients be satisfied with their vision, for their specific lifestyle and activities, regardless of their age. Ultimately, deciding between a Full Distance correction and a Monovision correction is an individualized choice that is based on many factors. Accordingly, there is not one “right” answer. After getting to know your goals and lifestyle, Dr. Vale and his staff can help guide you to the most appropriate procedure for your specific needs.

 

Reasons for considering Monovision Laser Vision Correction:

  •  Age 40 or older seeking the convenience of “glasses-free” lifestyle.
  • Opposed to needing reading glasses for near work.
  •  Not active in high performance sports (i.e. tennis, motorcycle riding.)
  •  Tried Monovision with contact lenses and liked it.
  • Being ‘okay’ at the possibility of using distance glasses to fine-tune distance vision for sports or night driving (so both eyes see 20/20).
  • Understanding that LASIK re-treatment can “un-do” Monovision at a later date, if desired.

Reasons for considering Full Distance/not Monovision:

  •  Age 40 or younger (eventually will use readers in mid-forties.)
  •  Over age 40, but seeking the most “perfect” distance vision possible for sports or night driving
  • Being “okay” with needing over-the-counter reading glasses for close work (usually after age 43)
  •  Tried Monovision with contact lens trial, but did not like it
  • Difficulty adapting to changes to vision (new bifocals, new glasses prescription) or just “feeling” that Monovision will not work for you
  •  Having a very large amount of Farsightedness
  •  Having a weak/lazy eye (amblyopia)

Real Case Scenarios and Teaching Points:

To help you decide if Monovision may be right for you, read these real patient situations to help clarify certain issues that may still be confusing. See if you identify with any of these situations listed below:
Case 1: Should a 30 year-old computer programmer consider Monovision?
Case 2: Can Monovision be fine-tuned, if distance vision is not good enough?
Case 3: “Doc, just make me 20/20, I can deal with readers”
Case 4: “I want better distance vision, but don’t want to lose my near vision”
Case 5: “I want better near vision, but don’t want to ruin my distance vision”
Case 6: A change of heart!
Case 7: Some expectations just can’t be realistically fulfilled.
Case 8: Still on the fence? What is Mini-Monovision?

Case #1:
Mary S. is a 30 yr old woman with mild nearsightedness, who works for a high-tech company as a software programmer.
• Goal: She does not want to need any glasses after LASIK.
• Recommendation: Full distance correction. Because of her young age, she should have no problem with her near vision after LASIK. I explained to her about the eventual age related presbyopic changes that will be expected about age 43. She will eventually need reading glasses, or I could do a LASIK enhancement to adjust for Monovision at that time, if she desires.
• Take home point: Age is THE key factor. Until the early 40’s, near vision should be very good after laser vision correction.

Case #2:
Jose H. is a 56 year-old attorney with moderate nearsightedness and mild astigmatism. He currently uses progressive bifocals. He spends most of his workday on a computer or doing deskwork. He does drive at night a few times a week, if he works late. He also plays recreational tennis during the day about twice per month and skis a few times per year.
• Goal: He wants to be glasses free, as much as possible.
• Recommendation: Monovision. After trying a simulation of Monovision with trial lenses, he was pleasantly surprised with the clarity of his distance and near vision and elected to have Monovision LASIK. Since Jose spends a large percentage of his time doing near work, and a small percentage doing distance tasks, Monovision seemed appropriate. We told Jose that there is a possibility that he may want to wear glasses (glove compartment glasses) to fine-tune distance vision at night, which he rarely does. Also, since he usually wears sunglasses when he skis and plays tennis, he could opt for a pair of prescription sunglasses (with the distance prescription placed in the near eye and no correction in the distance eye) for optimal distance vision during sports.
• Take home point: With Monovision, distance vision can be fine-tuned with glasses, if desired, for optimal distance vision. Whether or not you choose Monovision, you WILL be able to feel safe driving after LASIK. Likewise, if distance with Monovision is not quite to your satisfaction, you could elect to have a LASIK retreatment to “un-do” Monovision, and then use reading glasses.

Case #3:
Seymour R. is a 44 year-old contractor with farsightedness and astigmatism. He only rarely does any deskwork, but he wants to be able to comfortably see his dashboard instruments and GPS navigation system in his car.
• Goal: To have great distance vision and be able to read his dashboard and GPS navigation without glasses.
• Recommendation: Full distance correction. Seymour initially told me that he wanted to be “glasses-free”. Since his job requires him to do a lot of driving, we explained the potential problems with Monovision. After learning about Monovision, he thought that “it sounded weird” and that he didn’t think that he would get used to it. Because Seymour is only 44 years old (barely presbyopic), we explained that he should still have fairly good near vision with a full distance correction, but would eventually need readers for near work. After demonstrating Monovision and Full distance options with a loose lens trial simulation in our office, he was most satisfied with a full distance correction, and able to read his dashboard gauges.

• Take home point: During the early stages of presbyopia, near vision may still be adequate for many near tasks. A full distance LASIK correction will improve distance vision, and a patient will gradually notice a need for reading glasses with age. For patients over 40 who are not opposed to reading glasses, a full distance correction is tough to beat.

Case 4:
Sandy K. is a 53-year-old nurse with mild nearsightedness. She only occasionally wears her distance glasses for driving at night and watching movies. She has excellent near vision without glasses. She normally does not even wear glasses when she is at work or home.
• Goal: She wants to improve her distance vision for driving, but she does not want to “lose” her near vision.
• Recommendation: Monovision (LASIK in just one eye). We recommended that Sandy do LASIK in only her dominant right eye. This will improve her uncorrected distance vision for driving, and will preserve her near vision that is important for her job. Though Sandy has never had any difficulty with near work, it was important to inform her that if she did LASIK in both eyes for distance, her near vision would not be as good after surgery.
• Take home point: For a patient with mild nearsightedness, We may suggest doing LASIK in only one eye. LASIK could be performed on the other eye in the future, if desired. After assessing the patient’s lifestyle and goals, it is best to do the least “amount” of surgery to fix the problem.

Case #5:
Lyndall S. is a 46 year-old women who always had great distance vision without glasses, but now requires reading glasses for close vision. She is tired of having to put glasses on & off throughout the day. She wants to be able to see her cell phone, price tags in a store, a menu, and putting on makeup. She also wants to be able to watch TV and feel safe driving. After a contact lens trial in her non-dominant left eye, Lyndall was reassured that her distance vision would still be good enough after having Monovision LASIK to improve near vision.
• Goal: Ease and convenience of being independent of reading glasses. 
Recommendation: Monovision (LASIK in her non-dominant eye)
• Take home point: For people with naturally good distance vision, Monovision LASIK can improve near vision. Often only one eye needs to be treated.

Case #6:
Nancy S. is a 55 year-old paralegal with moderate nearsightedness and mild astigmatism. She doesn’t play sports but she does a fair amount of driving at night. As a paralegal, most of her job entails near/computer work. She was primarily interested in good near vision, but was slightly skeptical if she would tolerate Monovision. Because she was “on the fence”, We suggested a Monovision trial with contact lenses. With the Monovision contact lenses, she said that her near vision was good, but distance was still a little blurry with night driving. Weighing all the pros and cons, Nancy felt comfortable with the tradeoffs and benefits of Monovision.
• Goal: Good distance and near vision, preferably without glasses.
• Recommendation: Monovision LASIK. Since Nancy liked her Monovision trial, she elected to have Monovision with LASIK.
• Update: Nancy initially liked Monovision with contact lenses and with LASIK, but 4 years later, she decided she would prefer full distance instead because she was working less often. She requested an enhancement in her near eye (to be set for distance). She decided that she would be happier with optimal distance vision, and wouldn’t mind needing readers. When Nancy’s needs changed, our recommendations change.
• Take home point: Our goal is to help our patients be satisfied with their vision, for their specific lifestyle and activities, regardless of their age (even as time passes). A retreatment can be performed to adjust vision, if necessary to accomplish a patient’s goal.

Case #7:
Will M. is a 72 year-old retired banker. He has mild farsightedness and advanced presbyopia. He has moderate signs of cataract formation.
• Goal: Glasses free, if possible.
• Recommendation: Refractive Lens Exchange (RLE) Due to Will’s age and cataracts, the RLE option can treat the cataract and the farsightedness at the same time. Currently, Multifocal and accommodative lens implant technology can also improve near vision.
• Take home point: Laser Vision Correction is not the best choice for everybody.

Case #8:
Cliff is a 47 year-old business owner who is very active in sports and fitness. He would like to have “some” near vision, but is worried about the potential tradeoffs of Monovision. He is not completely opposed to reading glasses, but it would be nice to be able to check emails on his blackberry without glasses.
• Goal: Cliff’s primary goal is to have good distance vision for sports. His secondary goal is to have decent near vision.
• Recommendation: “Mini” Monovision.
• Take home point: Mini-Monovision is a hybrid between full distance and Typical Monovision. For some patients, we may leave one eye very slightly nearsighted (i.e. -0.75 D) to get some of the benefits from Monovision, but with less of the possible tradeoffs. Laser Vision Correction is not “one size fits all.”

Custom LASIK, The Latest in Laser Eye Surgery

Custom LASIK is the most advanced laser technology available. Custom LASIK laser treatments are based upon the unique visual characteristics of your eye. Up until now, with glasses, contacts and conventional LASIK surgery, corrections were quite similar for each type of prescription. Custom LASIK involves measuring the eye from front to back with a special laser, using what’s called “wavefront” technology, to create a three-dimensional (3-D) image of the eye. The information contained in the wavefront-map guides the laser in customizing the treatment to your individual visual system.

Possible Benefits of Custom LASIK

Custom LASIK wavefront technology is revolutionary because it has the potential to improve not only the quantity of your vision (i.e. the visual acuity measured by the standard 20/20 Snellen eye chart), but also the quality of how well you can see (i.e. visual acuity measured in terms of contrast sensitivity and fine vision). This may translate into a reduced risk of post-LASIK untoward side-effects, such as difficulty with night vision.

How much you see depends on what lower-order and higher-order aberrations you have; lower-order aberrations are also called refractive errors (i.e nearsightedness, farsightedness and astigmatism). Conventional LASIK treats these lower-order aberrations. How well you see can also depends on what higher-order aberrations you have; higher-order aberrations are irregularities other than refractive errors, and can cause such problems as decreased contrast sensitivity or night vision, glare, shadows and halos. Higher-order aberrations do not always affect vision. Custom LASIK has the potential to treat both lower- and higher-order aberrations. Some of the potential advantages of wavefront LASIK are:

· Potentially a greater chance of achieving 20/20 vision without glasses
· Potentially a greater chance of achieving better than 20/20 vision
· A potential reduction in the chance of losing best-spectacle corrected vision
· A potential reduction in the chance of losing visual quality or contrast sensitivity
· A potential reduction in the chance of night-vision disturbances
· The potential to use wavefront-LASIK to treat eyes that have previously had laser surgery and suffer from untoward side-effects (Off-label use of technology)

Wavefront-guided excimer laser technology

The Visx Wavescan system was the first laser to be approved by the U.S FDA for the treatment of nearsightedness and astigmatism. The VISX WaveScan system is made up of the Star S4 laser and the WaveScan wavefront device. The company calls its custom LASIK procedure “CustomVue.” The FDA approval is for eyes with up to -11 diopters of myopia, with or without up to -3 diopters of astigmatism. Surgeons can, for the first time, measure and treat visual disorders that previously could not be detected.

In the U.S. FDA clinical trials, 94% of patients who had the Visx CustomVue procedure achieved 20/20 or better vision. The trial participants were four times more likely to say they were “very satisfied” with their night vision following CustomVue than they were with their night vision with their glasses or contacts.

How Custom LASIK Works

The ophthalmic technician  will begin by using the wavefront device to transmit a safe ray of light into your eye. The light is then reflected back off the posterior portion of the eye, out through the pupil, and into the aberrometry device. The reflected wave of light is received and arranged into a unique pattern that measures both lower- and higher-order aberrations.

All of these visual measurements are then displayed as a 3-D map, referred to as a wavefront map. This information is then electronically transferred to the laser, and computer-matched to the eye’s position, enabling the surgeon to customize the LASIK procedure to your unique visual requirements.

Getting Custom LASIK

Like conventional LASIK, custom LASIK is a surgical procedure and has risks associated with it. It’s important you discuss its applications and potential complications with Dr. Vale to determine if you are a good candidate for this procedure.

What is Wavefront Technology?

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Let’s Begin with a Quick Look at How Laser Vision Correction Works:

It’s helpful to look at common vision problems and the solutions that treat them. When you first realize you have a problem with your vision, you take a trip to the eye doctor and get checked for errors in your refraction. This helps determine how light is focused through your eye.

Errors in refraction or refractive errors, are the main cause of problems with visual acuity.  The most common are called lower order aberrations. Examples of which are nearsightedness, farsightedness, and astigmatism. They are basically subtle imperfections in the way light passes through from the cornea—through the lens of the eye—to the retina—where the light is focused, which allows the eye to see images properly.
Treating individual refractive errors through glasses, contacts or laser vision correction are all successful ways of delivering clear vision to people. But the reality is each individual’s eyes also have their own, unique irregularities outside of the lower order aberrations. These can include ghost images, decreased contrast sensitivity in low light, glare, after-images, ghosting, and halos. This is where wavefront technology comes in.

What is Wavefront Technology?

The difference between a standard LASIK procedure and one that is wavefront optimized is that the former corrects only what your glasses fix, near- or farsightedness and astigmatism. This is around 90% to 95% of the total refractive error you have and are the lower order aberrations. Wavefront-guided technology allows us to measure the smaller amount of higher order aberration that’s left over, using what’s known as a wavefront aberrometer.

This technology measures the higher-order aberrations of the eye—the unique irregularities which affect the finer quality aspects of your vision. It does this by picking multiple spots in the visual pathway and producing a computerized, detailed map showing all the imperfections which exist in the visual system of an individual eye.

This is important point! Different aberrometers have different capabilities. Some are only able to record data from 60 points, whereas others as many as 1500. Think about the detail a watercolour captures compared to the accuracy of a HD camera. At Acuity, our aberrometer is manufactured by the samecompany that makes our laser system, and measures 1500 individuals points in the visual pathway for the most accurate determination of all the eye’s aberrations, both lower and higher order.

Today, advances in laser vision technology allow us to take a more holistic approach to vision correction. Now we can Geometric-Designnot only adjust your eyesight to correct common refractive errors, but according to your unique and individual optical irregularities as well. It’s only natural that such advances in technology should be embraced as the new norm rather than offered as expensive or rare add-ons. So make sure you choose Acuity and Dr. Steven Vale to get the best laser vision correction available anywhere at the most affordable prices!

Flaxseed Oil And Fish Oil To Relieve Dry Eye

Flaxseed oil and fish oil contain important dietary fatty acids that have multiple health benefits, including prevention or treatment of dry eyes.

Other benefits include a lower risk of heart disease and a reduction of chronic inflammation that can lead to a variety of serious diseases, including cancer and stroke. Chronic inflammation also has been indicated as an underlying cause of osteoarthritis and Alzheimer’s disease.

Daily supplements of flaxseed oil or fish oil, when used alone or in tandem with lubricating eye drops, appear to reduce dry eye symptoms, including burning, stinging, redness and intermittent visual disturbances. For this reason, many eye doctors now are recommending flaxseed oil and fish oil supplements for their patients who suffer from dry eyes.

Research also suggests these same fatty acids may reduce the risk of macular degeneration and cataractsSo which is better — flaxseed oil or fish oil?

Flaxseed Oil For Dry Eyes

The nutritional value of flaxseed oil (and fish oil) comes from its omega-3 fatty acids that are needed for optimum health. Flaxseed oil contains high levels of an omega-3 called alpha-linolenic acid (ALA). During digestion, ALA is converted into two different omega-3 fatty acids — called EPA and DHA — that are used throughout the body to protect cell membranes.
Freshly ground flaxseeds are a good alternative to flaxseed oil for dry eye nutrients.

Flaxseed oil supplements are available both in capsule and liquid forms. Although flaxseed oil capsules are more convenient, you may need to take a large number of capsules to achieve the daily dose your eye doctor recommends to treat dry eyes.

The nutritional value of flaxseed oil is easily destroyed by light, heat and oxygen. When purchasing liquid flaxseed oil, look for a cold-pressed variety and keep it refrigerated.

As an alternative to flaxseed oil, you can get the same omega-3s by grinding whole flax seeds in a coffee grinder and sprinkling the ground seeds over a salad, adding them to a smoothie or mixing them in fruit juice. If you choose this option, be sure to use the seeds immediately after grinding them to get the full omega-3 benefits.

Popular eye vitamins that contain flaxseed oil include: TheraTears Nutrition (Advanced Vision Research), Dry Eye Formula (EyeScience) and Tears Again Hydrate (Ocusoft).

Comparison Of Fish Oil With Flaxseed Oil

Fish oils and fatty fish — such as salmon, tuna and sardines — are excellent food sources of omega-3 fats essential to brain and eye health.

Fish fat contains the “long chain” omega-3s (EPA and DHA), which are the omega-3 fats the body needs for vital functions, including eyesight.

In contrast, the “short chain” ALA omega-3 fat found in plant foods such as flaxseeds must be converted to EPA and DHA in the body for beneficial eye effects. When you eat plant foods, your body converts only about 5 percent of dietary ALA into essential EPA and DHA.

Also, most Americans’ diets are too high in omega-6 fatty acids — an imbalance that further reduces the amount of ALA from plant foods that gets converted to EPA and DHA. This imbalance also blunts the benefits of EPA and DHA omega-3s obtained directly from fish and fish oil.

Omega-6 fats are found in vegetable oils (corn, soy, cottonseed, safflower and sunflower) used in most snacks and prepared foods — whether packaged, frozen, restaurant or take-out.

Researchers agree that most people need to reduce their consumption of these otherwise healthful omega-6 fats, which block omega-3 absorption and promote inflammation when eaten in excess.

Fish oils, like flaxseed oil, are available in capsule and liquid forms. Some contain lemon flavoring or are processed in other ways to reduce any “fishy” taste. Cod liver oil is another good source of EPA and DHA omega-3 fatty acids.

A more enjoyable way to obtain fish oil benefits is by eating grilled cold-water fish at least three times a week. Good sources of EPA and DHA omega-3s are salmon, sablefish, tuna and halibut.

Popular eye supplements that contain fish oil or cod liver oil include: TheraTears Nutrition (Advanced Vision Research), BioTears (Biosyntryx) and HydroEye (ScienceBased Health).

So Which Is Better: Flaxseed Oil Or Fish Oil?

Because fish oil contains natural EPA and DHA omega-3s (that don’t have to be converted from ALA), many nutrition experts recommend fish oil over flaxseed oil.

Grilled salmon is an excellent source of omega-3 fatty acids to fight dry eyes.

But other factors are worth considering:

  • If you are a vegetarian, ground flax seeds or flaxseed oil will likely be your preferred choice.
  • Ground flax seeds are more economical than either fish oil or flaxseed oil supplements.
  • The U.S. Food and Drug Administration (FDA) classifies omega-3 fatty acids from fish as GRAS (Generally Regarded as Safe). However, fish oil can cause stomach upset and/or diarrhea in some individuals, especially in high doses. Other possible side effects include increased burping, acid reflux, heartburn and abdominal bloating or pain. Risk of these side effects can be minimized if you take fish oils with meals and if you start with low doses.
  • A fishy aftertaste is common with some fish oil supplements. This can be reduced by refrigerating the capsules or liquid, or by purchasing brands that promise no such problems.

Concerns about mercury poisoning from fish oils generally are unfounded. When present in waterways, methylmercury accumulates in fish meat more than in fish oil, and testing of fish oil supplements show they generally contain little or no mercury. Still, if this is a concern, using flaxseed oil as an alternative eliminates this issue.

Precautions

As with any nutritional supplement, it’s a good idea to consult with your family physician or eye doctor before taking significant quantities of flaxseed oil or fish oil for dry eyes. This is particularly true if you take any prescription or non-prescription medicines, as adverse drug interactions can occur.

Be especially careful if you take blood thinners (even aspirin), as both flaxseed oil and fish oil can increase the risk of bleeding and reduce blood clotting when used along with these medications.

Long-term use of fish oil may cause a vitamin E deficiency in some individuals. Therefore, it’s a good idea to look for fish oil supplements that also contain vitamin E, or take a multiple vitamin that contains this vitamin if you take fish oil supplements for dry eyes. 

By

  Epi-LASIK: Procedure of Choice


This article by doctor Richard Lindstom discusses the benefits of Epi-LASIK using the Epithelial Separator: The Moria Epi-K. This is the same instrument used by Dr. Vale at Acuity to perform all Epi-LASIK procedures.

by Richard L. Lindstrom, M.D.

There have always been good arguments for surface ablation, but in most cases I have personally preferred LASIK. Yet every year I find myself performing more and more surface ablation cases—and I am not alone in this.

The question of which surface technique offers the best comfort, safety, and visual recovery has been highly debated. My procedure of choice is now Epi-LASIK with the Epi-K by Moria because of the speed of visual recovery compared to other alternatives. I was, frankly, surprised by these results. Earlier on, I tried another epikeratome and was not impressed, so when I agreed to evaluate the Moria Epi-K, my expectations were fairly low. I did not expect it to be an improvement over PRK, but it is.

INDICATIONS FOR SURFACE ABLATION

The number one reason I recommend Epi-LASIK is to treat patients with thin corneas, but increasingly I also recommend it for patients with some inferior steepening or other unusual topographies, dry eye, or lifestyles that carry an increased risk of flap dislodgment.  However, Epi-LASIK is not appropriate for anyone with a history of previous refractive surgery, or a corneal scar. Furthermore, there will always be a segment of the population that doesn’t want a flap, doesn’t want anything to cut their eye, or wants the “safest” procedure. Despite the excellent safety profile of LASIK, when a patient requests the safest procedure, I choose surface ablation.
Epi-LASIK vs. PRK

 Speed of visual recovery: Epi-LASIK has replaced PRK in my practice primarily because it speeds visual recovery and epithelial healing. We analyzed results in 74 eyes of 38 patients who had bilateral Epi-LASIK with epithelial flap removal. They were followed for three months and compared retrospectively with published PRK results. More than half our Epi-LASIK patients were already 20/40 the day after surgery. At one week, 91% were seeing 20/40, compared to published rates of 40% to 58% following PRK. By one month, visual acuity results with Epi-LASIK and PRK are about the same, but the significant difference in the early post-operative period is important for patient satisfaction. Most of our patients are able to drive and return to work within three to four days, and many can do so after only one to two days. Vision recovers faster with Epi-LASIK because the epithelium heals more rapidly. This may also improve the safety of the procedure by limiting the risk of infection and haze to a shorter period of re-epithelialization. High myopes (>6 D) may take longer to fully heal, up to one to two weeks.

Epi-LASIK may allow surgeons to reduce the number of topical and/or oral medications, as some of my colleagues have done, without increasing discomfort. The safety of Epi-LASIK, as with PRK, is very high. There are almost no meaningful complications.

Obtaining Optimal results with Epi-LASIK

I still perform LASIK for the majority of my laser refractive surgery patients, but we are increasingly turning to surface ablation for cases in which it may be safer or more desirable for the patient. When I do choose surface ablation, my clear preference is for Epi-LASIK using the Moria Epi-K.

Dr. Lindstrom is adjunct professor emeritus at the University of Minnesota and in private practice at Minnesota Eye Consultants. He does not have any financial interests with Moria. Contact him at (612) 813-3633 or rllindstrom@mneye.com.

http://www.eyeworld.org/article.php?sid=4095

How Custom Surgery Goes Beyond Contacts and Eyeglasses!

Light Beam Through Glass Prism --- Image by © Matthias Kulka/Corbis

The pre-operative exam at Acuity includes wavefront mapping. This is a test that will tell Dr. Vale if you have any “higher order aberrations”. These are more complex vision errors than those treated by contact lenses or eyeglasses. These distortions to vision are often not identified by patients on their own because they assume everyone sees the way that they do. These distortions can be corrected through a customized version of laser vision correction and can often greatly improve night vision for safer driving as an example. There are 22 different visual distortions that will be indicated in the testing and doctor Vale will discuss the results with each patient and describe what the patient may be experiencing and how it can be corrected. The symptoms often include double vision, blurriness, ghosts, halos, starbursts, poor perception of contrast and poor night vision.

This article by Madeleine Vessel; reviewed by Vance Thompson, MD explains Higher Order Aberrations:

Higher-order aberrations or HOAs are more complex vision errors than lower-order aberrations, which have more familiar names such as nearsightedness, farsightedness and astigmatism. If your eye doctor tells you that you have a higher-order aberration, you may wonder exactly what this condition means and what impact — if any — it has on the quality of your vision.

Higher-order aberrations have relatively unfamiliar names such as coma, spherical aberration and trefoil. These types of aberrations can produce vision errors such as difficulty seeing at night, glare, halos, blurring, starburst patterns or double vision (diplopia). No eye is perfect, which means that all eyes have at least some degree of higher-order aberrations. If you are diagnosed with higher-order aberrations, you need not be concerned unless they are significant enough to cause vision symptoms.

What Exactly Is A Higher-Order Aberration?
A higher-order aberration is a distortion acquired by a wavefront of light when it passes through an eye with irregularities of its refractive components (tear film, cornea, aqueous humor, crystalline lens and vitreous humor).
Abnormal curvature of the cornea and crystalline lens may contribute to the distortion acquired by a wavefront of light. Serious higher-order aberrations also can occur from scarring of the cornea from eye surgery, trauma or disease.
Cataracts clouding the eye’s natural lens also can cause higher-order aberrations. Aberrations also may result when dry eye diminishes your eye’s tear film, which helps bend or refract light rays to achieve focus.

marble-1-1-600x400How Are Higher-Order Aberrations Diagnosed?
Higher-order aberrations are identified by the types of distortions acquired by a wavefront of light as it passes through your eye. Because light travels in bundles of rays, a common way of describing an individual wavefront involves picturing a bundle of light rays. The tip of each light ray in the bundle has its own point. You create the wavefront or wavefront map by drawing lines perpendicular to each point.

The shape of a wavefront passing through a theoretically perfect eye with no aberrations is a flat plane known, for reference, as piston. The measure of difference between the actual wavefront shape and the ideal flat shape represents the amount of aberration in the wavefront. Because no eye is perfect (emmetropic), a wavefront passing through an eye acquires certain three-dimensional, distorted shapes. So far, more than 60 different shapes, or aberrations, have been identified.

Wavefront eye exams can detect significant amounts of aberrations, which create vision problems because they interfere with the eye’s ability to see clear and distinct images (focus).

Two categories of aberrations are commonly used to describe vision errors, including:
Lower-order aberrations consist primarily of nearsightedness and farsightedness (defocus), as well as astigmatism. They make up about 85 percent of all aberrations in an eye.
• Higher-order aberrations comprise many varieties of aberrations. Some of them have names such as coma, trefoil and spherical aberration, but many more of them are identified only by mathematical expressions (Zernike polynomials). They make up about 15 percent of the total number of aberrations in an eye.vwgsifoxiyiq8ddips2y

Order refers to the complexity of the shape of the wavefront emerging through the pupil — the more complex the shape, the higher the order of aberration.

What Impact Do Higher-Order Aberrations Have On Vision Quality?

The impact of higher-order aberrations on vision quality depends on various factors, including the underlying cause of the aberration. People with larger pupil sizes generally may have more problems with vision symptoms caused by higher-order aberrations, particularly in low lighting conditions when the pupil opens even wider.

But even people with small or moderate pupils can have significant vision problems when higher-order aberrations are caused by conditions such as scarring of the eye’s surface (cornea) or cataracts that cloud the eye’s natural lens. Also, specific types and orientation of higher-order aberrations have been found in some studies to affect vision quality of eyes with smaller pupils.
Large amounts of certain higher-order aberrations can have a severe, even disabling, impact on vision quality.

An eye usually has several different higher-order aberrations interacting together. Therefore, a correlation between a particular higher-order aberration and a specific symptom cannot easily be drawn. Nevertheless, higher-order aberrations are generally associated with double vision, blurriness, ghosts, halos, starbursts, loss of contrast and poor night vision.

http://www.allaboutvision.com/conditions/aberrations.htm

What Is Monovision LASIK?

By Troy Bedinghaus, OD

600_449755068If you are over the age of 40 and considering Lasik eye surgery, ask your doctor about monovision LASIK. While LASIK is great for improving far vision, people with presbyopia must still rely on reading glasses for clear near vision. Monovision LASIK can be used to help older people reduce their need for bifocals or reading glasses.


What Is Monovision LASIK?

Monovision is a technique used by doctors for correcting presbyopia with contact lenses.
With monovision, one eye is fit to fully correct your distance vision, while the other eye is fit to correct your near vision. While it may sound strange, monovision actually works well. The same approach doctors use to fit monovision contact lenses can be applied to LASIK. With monovision LASIK, your surgeon performs LASIK to make your dominant eye perfect and your non-dominant eye nearsighted. If you are already nearsighted, the surgeon may laser your dominant eye only and leave your non-dominant eye alone, or he or she may laser your non-dominant eye just partially.

Does Monovision LASIK Work for Everyone?
Monovision LASIK works well in people who have already worn monovision contact lenses for several years. Your doctor will decide if monovision LASIK is right for you based on your prescription. Just as monovision contact lenses take awhile to adapt to, so does monovision LASIK. There is usually a period of adaptation of 1-3 weeks that most patients go through.

Are You Ready for Monovision LASIK?
If you think monovision LASIK may be right for you, your doctor may want you to try monovision contact lenses first for 6-12 months to make sure you will able to adapt to this type of vision correction. While some people adapt quickly to the effects of monovision, others find that both eyes may not work together as well as they did before.

What is Mini-monovision LASIK
If you are a little leery of the procedure, and do not mind wearing some type of reading glasses after your LASIK procedure, you may be interested in “mini-monovision LASIK.” Mini-monovision is the lay term for a mild amount of near correction with LASIK. Your vision is not expected to be perfect with mini-monovision but it does afford you a little wiggle room to get along while shopping and other activities so you will not have to wear reading glasses all the time. You may only need reading glasses when you sit down to perform intense reading or other close-up work.

Should I do Monovision LASIK if I am younger than 40?
Having a monovision procedure, whether it is with laser vision correction or contact lenses, does not work well in younger people, but it depends on the age. For example, if you are 25 years of age, monovision LASIK is not recommended because it may be 20 years before you experience near vision problems.


Plus, people adapt to monovision only because once you reach the age when you develop presbyopia, usually sometime over 40, there is mental motivation to adapt to it because it delivers greatly improved near vision. When you can read better, your brain adapts quickly. When younger, you still have reserve near focusing power so there really is not any benefit and therefore, no motivation for your brain to accept monovision. Mini-monovision is considered and is often discussed with patients when they are close to the age of 40. Mini-Monovision may be a very good way of delaying the need to reach for reading glasses when completing near tasks.

What You Should Know About Monovision LASIK
While monovision LASIK is not a perfect fix for everyone, it is a great alternative for people who wish to lessen their dependence on other vision-correction devices. Monovision LASIK is a viable option for many people who hope to achieve clear vision at both distance and near.

https://www.verywell.com/monovision-lasik-3421959

How Custom Laser Vision Correction Uses Wavefront Mapping to Perfect Vision

hiking-with-friendsCUSTOM LASIK, PRK and Epi-LASIK are good choices for most patients. Custom is a laser vision correction technology that allows Dr. Vale to individualize the correction to your own eyes by eliminating glare, halos, poor contrast and other visual disturbances at the same time the refractive error is corrected. It allows for a more perfect or higher definition visual experience, especially under low light conditions. Custom LASIK may result in your vision becoming clearer and sharper than it ever was before.

How Does Custom Laser Vision Correction Work?
Custom LASIK, PRK and Epi-LASIK use wavefront technology to measure the way individual light waves travel through your eye. This technology performs a detailed analysis of your eye that examines the entire optical system, not just the parts that are operated on during LASIK surgery.

The wavefront analyzer used at Acuity is manufactured by the same company that makes our Excimer vision correction laser.

The wavefront analyzer used at Acuity is manufactured by the same company that makes our Excimer vision correction laser.

The wavefront analyzer provides information about the unique visual characteristics of your eye, allowing for an additional level of data about your vision.  This in turn allows Dr. Vale to further customize your vision correction. The data is used to guide the laser during your Custom laser vision correction procedure for optimal results.

Better Quality Vision
Custom LASIK, PRK or Epi-LASIK may be necessary for patients with bad glare or poor contrast in low light, and may be desirable for many others. Everyone’s eyes are different. A pre-procedure comprehensive eye exam with Dr. Vale will help determine if Custom laser vision correction is right for you based on your particular prescription, healing profile and expectations.
Compared to other forms of laser vision correction, Custom laser vision correction has been shown to provide patients with:

• A greater chance of achieving 20/20 vision
• The potential, in many cases, for vision better than is possible with contacts or glasses
• Much lower incidence of glare, halos and night vision disturbances such as poor contrast

Wavefront Technology

About Visual Aberrations
Two classes of visual imperfections, referred to as lower- and higher-order aberrations, exist within the eye. These imperfections can affect both the sharpness (acuity) and quality of vision.
Lower-order aberrations, which people are familiar with and are  commonly measured and treated with standard LASIK, PRK or Epi-LASIK include:
• Myopia
• Hyperopia
• Astigmatism
Higher-order aberrations cannot be corrected with glasses, contact lenses or standard laser vision correction treatments. In fact, some researchers have found that some imperfections may actually be increased by conventional (non-customized) laser eye surgery.

About Wavefront TechnologyCouple-Hiking
Wavefront analyzers (also known as aberrometers) measure aberrations in your visual system by send light into the eye and measuring how it is distorted upon exit. When light rays enter the eye and pass through the different structures inside, the wavefront surface changes, taking on a shape unique to that eye. These variations are called wavefront errors.
The wavefront analyzer’s software performs complicated measurements and presents a graphical and numerical representation of how light is aberrated by your eye for the surgeon to evaluate. Data from this process may be transferred to the laser and used by your surgeon to create a treatment plan for your refractive error that includes treatment for both low and higher-order aberrations. Treating a patient with the information taken from the wavefront analyzer can result in greater clarity of vision and fewer complaints of glare or night halos.

How Does the Wavefront Analyzer Work?
Most laser manufacturers provide compatible wavefront analyzers  for their laser systems that are based on Hartmann-Shack aberrometry.  At Acuity, we use a different technology based on a principle known as Dynamic Skiascopy. With Dynamic Skiascopy, A specially designed lenslet array measures the change in the wavefront of light as it passes through your visual system at over 15,000 individual points. The system essentially performs a refraction on each of these individual points, then numerically and graphically represents this information for each eye as a whole to the doctor.

Correcting Aberrations

Zernike Polynomials

The Zernike polynomials represent the optical characteristics of the aberrations within the visual system.

The Zernike polynomials represent the optical characteristics of the aberrations within the visual system.

One way the Wavefront laser eye surgery data is analyzed is by using Zernike polynomials, also called modes. Each mode describes a certain three-dimensional surface and the Zernike polynomials correspond to the ocular aberrations. For instance, second-order Zernike polynomials represent the conventional aberrations such as defocus and astigmatism. Zernike polynomials above the second order represent the higher-order aberrations that cause night glare and halos. Zernike polynomials help to simplify the Wavefront technology used in laser eye surgery by combining all aberrations into one simple map. This is called a Zernike decomposition.

Zernike Polynomials Shapes and Relation to Real Life Vision

Eye surgeons are given information by the aberrometer as a conventional refraction in dioptersGeometric-Design as well as in Zernike form. The data is processed and presented in a fashion similar to a topographical map and can easily be read by Dr. Vale. However, determining what aberrations require treatment is actually somewhat trickier and requires a skilled and experienced eye surgeon, not just one who will rely on the recommendations the aberrometer spits out.
Dr. Vale is one of America’s most experienced laser vision correction specialists, and has performed over 28,000 vision correction procedures since 1994.
This information is then transferred to the laser, enabling the surgeon to address the patient’s unique visual imperfections. Trust the experience of Dr. Vale to make your vision as clear and aberration free as possible through this phenomenal technology!

Reasons To Get LASIK, The Top 10 Countdown!

27289_hdLASIK eye surgery is becoming more and more common with advances in technology, causing many people to ask themselves if LASIK eye surgery is right for them. If you have never heard of LASIK laser vision correction, it is a permanent surgery that reshapes your cornea and corrects your vision. The surgery shapes your eye to correct the incoming light the same the way your glasses or contacts were before. Here are the top ten reasons you should get LASIK eye surgery:

10. LASIK pays for itself by not having to buy contact lenses or glasses anymore. Add up how much you have spend over the last few years buying new prescriptions and I can guarantee the cost will be close to what you will pay for LASIK. Also, many insurance providers will pay for some or all of your LASIK surgery. If insurance will not pay, many Flexible Spending Accounts (FSAs) allow use of the funds for LASIK. You will also save time not having to worry about maintaining your contact lenses and putting them in!

9. You can wake up in the morning and actually see the world clearly! Many people have LASIK surgery done for this reason alone. How nice would it be to be able to wake up without having to  search around for your glasses, or stumble around and put your contacts in.

8. No more coordinating your wardrobe. For the fashion conscious amongst us, this is a great benefit. Not having to figure out what goes best with your glasses is great. You can where whatever you want whenever you want.

7. For the athletic folks, LASIK is a fantastic option. Many sports are difficult or impossible to
play while wearing contacts or glasses. How many times have you jumped into a swimming pool and lost a contact? You will never have that problem again with LASIK. You can swim as much as you want without any concern of losing a contact or spending the money on prescription goggles.

6. Visual freedom. Just imagine never having to think about your vision again…ever. This is what LASIK will do for you. All you have to do is open your eyes to see. Never again deal with eye drops because your contacts dried out.

img_24505. Freedom while traveling. No more worrying about bringing along the back up set of contacts or glasses. No more solutions or cases. All you need to bring are the items you want to bring while traveling. Being able to see the world with no strings attached is worth it in itself.

4. You can finally be comfortable. Many LASIK patients complain of discomfort while wearing their glasses or contacts. Contacts often cause allergic reactions, itchiness, red eyes, burning and other irritations. Glasses can even be worse causing painful headaches due to pressure or a slightly off prescription. With LASIK you will never have these problems again.

3. Better vision then before. Many patients experience better sight after LASIK then they did with corrective eye wear.

2. Instant gratification. No long recovery times here. After you come home from your surgery you will be able to see the world around you in all its glory within hours. I hope the family cleaned the house before you got home?

1. Self-esteem and a new you. Many of us feel uncomfortable in glasses. Playground sayings like “four eyes” comes to mind. You will never again have to feel self conscious about yourself, so go out and have some fun!
There you have it – 10 great reasons to have LASIK eye surgery. Honestly, with the lowering costs and improved technology, can you think of one reason not to have LASIK?

by Long Island Eye Surgical Care, P.C.

http://www.li-lasik.com/blog/detail/2012/03/07/top-ten-reasons-to-get-lasik-surgery.html

About Astigmatism and How Laser Vision Correction Can Help…

What is Astigmatism?

Many people have never heard of astigmatism, although it is an extremely common eye condition.

Astigmatism is one type of refractive error. Nearsightedness and farsightedness are other types of refractive error. Refractive errors are not eye diseases. Refractive error is a result of and imperfection of the size and shape of the eye, which results in blurry or double vision.

Causes of Astigmatism

Astigmatism is generally caused by a cornea with an irregular shape.  With astigmatism, the cornea is not round and spherical and is instead irregular having two curves instead of one curve. Astigmatism in some cases can also be caused by a lens, located inside the eye, that is non-spherical in shape.

Eyes with astigmatism distort the light that comes into the eyes because the cornea is not spherically shaped. This causes the light rays entering the eye to create two images in the back of the eye (because of the two curves), instead of one image. This is what causes the distortion in sight.

A normal cornea’s shape should be like that of a baseball. The cornea is the front, clear layer of the eye. A person with astigmatism has a cornea that is shaped more Toric, similar to a football. Because the cornea is toric, light bends to focus on a line instead of a point as it enters the eye, causing vision distortion or blurriness. Some people with astigmatism might squint frequently in an effort to see clearly because astigmatism can make it hard to focus on fine details or objects. Squinting too much can cause headaches due to the strain from trying to focus.

Symptoms of Astigmatism

Small amounts of astigmatism can go unnoticed, however, those with significant astigmatism may experience eye fatigue, eyestrain, and headaches.

Astigmatism is a condition that usually develops in  early childhood. According to a study from The Ohio State University School of Optometry, 28% of school age children suffer from astigmatism. Parents should know that their children might not be aware that their vision is blurry, as they lack a reference of experience regarding what is clear vision. Nevertheless, astigmatism should be treated because vision problems can lead to learning problems and difficulty with extracurricular activities.Children should have their eyes examined at an eye doctor’s office at least once a year, and especially before starting school.

Regular vs. Irregular Astigmatism

Regular astigmatism, the most common type of this condition, is found in almost half of the adult population. Irregular astigmatism is less common and can be caused by eye disease, surgery or injury. The most common cause of irregular astigmatism is a disease called keratoconus, which gradually thins the cornea, typically in the second decade of life. Irregular astigmatism can be difficult to treat with eye glasses. Custom contacts may be useful depending on the severity of irregular astigmatism.

Can Laser Eye Surgery Treat Astigmatism?

Astigmatism can be fully corrected using prescription glasses or contact lenses. Soft contact lenses are the most common option, but do not provide the best vision as they do not treat the astigmatism and only mask it. RIgid gas permeable (RGP or GP) are a better choice as they actually change the shape of the cornea while they are being worn. Rigid gas permeable lenses usually give the clearest vision but the adaptation process will be significantly longer.

Geometric-DesignAnother option are hybrid contact lenses. These contacts have a center made from a rigid gas permeable (RGP) lens and an outer ring made of soft contact lens material. This type of lens provides both excellent clarity and comfort. 

Depending on the type and severity of astigmatism, the condition can often be treated with laser eye surgery. Laser-assisted in situ keratomileusis (LASIK) is a type of laser eye surgery that reshapes the inner layer of the cornea to correct astigmatism. It is important to determine which type of astigmatism you have in order to determine which eye treatment option is best for you.

LASIK eye surgery has proven an effective treatment for people with mild or moderate astigmatism. LASIK is also a convenient option for physically active people who find eye glasses or contacts a nuisance, even if they don’t have astigmatism.

The Unexpected Benefits of LASIK!

 

LASIK and other refractive procedures don’t just result in noticeably clearer vision. There are also unexpected benefits to having one of these procedures. For many of our patients, laser vision correction results in noticeable improvement in other important aspects of vision.

Here are Four Additional Advantages that Acuity Patients Frequently Mention:

Improved Peripheral Vision:

In addition to improved straight-ahead vision, many of our patients note how much better their peripheral vision has become since they no longer wear glasses. Glasses do not always wrap around the eyes, so peripheral vision can be blurry unless one turns their head. Once the glasses are gone, peripheral vision is improved as well.

Reduced Discomfort and Allergy Symptoms:

Many of our patients say their allergy symptoms improve after treatment. They note much less eye itch, as well as fewer headaches and less sinus pain without glasses sitting on their noses. Contact lens wearers also note much less random eye irritation and redness because they don’t put contacts in their eyes anymore.

Improved Night Vision:

With or without “Custom” many people say that their nighttime vision improves after LASIK, PRK and epi- LASIK. It may have to do with no longer having to deal with the light reflecting off the lenses in their glasses. For people who wear contact lenses, end-of-day or prolonged wear may also cause fuzzy nighttime vision as a result of corneal edema or surface dryness. Without having reflections or a poor refractive surface because of edema or dryness, many of our patients actually see better at night. Custom laser vision correction further enhances the improvement in night vision.

Additional Lines of Sight:

Some patients with high levels of myopia or astigmatism gain additional lines of vision after laser vision correction by Dr. Vale at Acuity. As you may know if you wear glasses or to a lesser degree contacts, and have high degrees of either myopia or myopic astigmatism, images are minimized by wearing these devices. There is no image minification after laser vision correction! Also, vision can fluctuate with glasses or contacts that move with each blink. Not happening ever again after laser vision correction at Acuity Laser Eye and Vision Center!

 

https://www.lasikplus.com/blog/four-more-unexpected-lasik-benefits

Why Would I Have Epi-LASIK Instead of LASIK or PRK?

 

 

Generally, eye surgeons will recommend either PRK or Epi-LASIK to patients who have small eyes or very thin corneas. This is because it may be difficult or even impossible to safely use the tools to perform standard LASIK surgery in those cases. Epi-LASIK or PRK may also be desirable for those individuals who want laser vision correction, but do not want to have a flap made in their corneas.

During LASIK surgery a  tool is used to create a circular flap in the protective layer over the cornea, leaving a hinge. After the cornea is reshaped to correct the patient’s vision, the flap is then placed back over the eye. This procedure allows for a fast recovery but the procedure carries some potential risks. Post-operatively the flap can wrinkle if a blunt force is applied to the eye (such as a stick or a punch). Even long after surgery when the eye is fully healed, the flap can be vulnerable to dislocation as the result of an extreme physical force such as an accident or altercation. This can effect vision temporarily and will require immediate attention.

In addition to the size and shape of a patient’s cornea, other factors can influence the choice of procedure. When I examine patients before their vision correction surgery, I ask if they are in the military or police force, if they box or are very active in sports or outdoor recreation. I will then counsel them to choose Epi-LASIK or PRK vision correction procedures instead of LASIK, so that they will not have any risks associated with the creation of that circular flap.

 

While LASIK requires the creation of a flap, Epi-LASIK is an advanced type of corneal surface ablation that allows removal of a very thin layer of the surface tissue. The surgeon uses a plastic squeegee-like device called an epi-keratome or epithelial separator to separate the protective top layer of the cornea before reshaping the corneal tissue below to correct vision. The procedure is similar to PRK (PhotoRefractive Keratectomy), however no alcohol based solution is applied to loosen the top layer. Epi-LASIK avoids the chemical reaction between alcohol and epithelial cells that can cause the release of prostaglandins and the resulting eye discomfort that is associated with PRK in the days immediately following surgery. This discomfort can be relieved by over the counter pain relievers.

At the conclusion of the Epi-LASIK procedure, the doctor may on occasion place the thin top layer of the cornea back over the eye, after the laser has been used to reshape the cornea and correct vision, but usually this is just removed, as it grows back itself in 3 to 4 days. A clear soft contact lens is then placed on the eye to protect and aid the healing process. The lens is worn for about 3-4 days, then removed by the doctor. Vision will not be perfect right after surgery but many people are able to drive the day after the lens is removed with Epi-LASIK. PRK generally requires another 2-3 days of healing with the protective lenses over the eyes and dependence on others to drive you. Recovery time varies and each individual must determine when they are comfortable returning to driving and other activities.

family-easy-hikes-topic-ttd-fallAs a general rule, Epi-LASIK provides a much more rapid recovery of vision than PRK, but not as rapid as the ‘WOW’ effect that is seen with LASIK. With Epi-LASIK, patients often obtain 20/20 or better uncorrected vision in 1½ to 2 weeks, while PRK can take as long as 3½ to 4 weeks to reach that level of visual acuity. That does not mean patients are disabled or unable to drive or work during that period. The vision in the intervening period is almost always good enough to legally drive and perform routine daily activities, but the optimal visual recovery takes longer to achieve with either of these procedure when compared to the very rapid recovery of vision associated with LASIK, which is generally just 24-36 hours. While we will require follow-up examinations for the first 3 months to monitor the recovery, the full healing time for PRK and Epi-LASIK laser vision correction surgery may be as long as 6 months.

Click Here for a link to Acuity’s Epi-LASIK information pamphlet

By Dr. Helen Chandoha O.D.

Overcoming Your Fear of Laser Vision Correction:

The Most Common Fears of LASIK

Unknown-41. I’m afraid of pain during the procedure.
2. I’m afraid of being awake during the procedure and feeling it.
3. I’m afraid of going blind.
4. I’m afraid of bad outcomes.
5. I’m afraid of potential complications.

During your free, no obligation laser vision correction consultation, you’ll learn that Dr. Vale has performed over 28,000 Laser Vision Correction procedures since 1994, resulting in 20/20 or better vision in 96% of our patients following their initial procedure, with the remaining 3-4% getting there through an enhancement or “touch-up”.

On the day of surgery, Xanax will be offered to you to help you relax. Numbing drops will be used in each eye, so little or no pain sensation is experienced. The procedure takes only about 10 minutes per eye.Unknown-3 copy

Getting through fear is a skill that anyone can learn. If you are working to overcome fear of Laser Vision Correction, or anything else for that matter, this is a great list of techniques that may help.

The problem is that most people cling to their fears, because it’s part of who they are.images-1
If you aren’t ready to face your fears, you probably won’t transcend them.And there’s nothing wrong in that. Everything happens in its own time. If you’re reading this article though, I’m pretty sure that you’re ready to take another step forward. You searched for this information, or you bumped into it, which isn’t just a coincidence. Let’s have a look at some very useful ways of dealing with fear.

How to start overcoming fear, right now. Read over this list and try the techniques that seem to fit or just feel right.

Identify your fear. Get specific about what exactly you’re afraid of. Look at the pictures you have in your head about the situation. What is happening in them? What are you really scared of? Become an observer of your inner space.

Follow Your Curiosity.  Get curious about what  generates your fear,  how do you react to it?  Be an observer of what is going on in yourself.

Gratitude. Whenever you feel fear, switch over to what you are grateful for instead. If you’re afraid of LASIK, be grateful for the opportunity to have clear vision and freedom from contacts and eyeglasses!

Unknown-2Write it down. Getting your fears down on paper is important, because trying to think them through doesn’t work. You can get caught in endless loops of negativity. It helps to write it out and read it.

 Action Over Imagination. An action taker knows that fears are just fears. They are created by the imagination to make reality seem scarier than it is. When you take action and face your fears, they become weaker, because you realize that reality isn’t nearly as bad as what you imagined.

 Positivity. Whenever fear strikes, flip it over. Instead of thinking of something bad that can happen, think of something positive. What’s the positive outcome, 20/20 vision and freedom from the hassles and costs of lenses and glasses.Unknown-2 copy

Perspective. Learning to deal with fear is all about putting your negative thoughts in perspective. We tend to focus too much on the negative, so by looking at all the options, you often realize that you’re making a big deal of nothing.

Your Story. We all tell ourselves a story about our fears. What’s your story? Think about it.

Find the Meaning. I believe we all go through things for a reason. That includes the fears we have. It also includes overcoming fear and learning the lessons that come out of it. This may not be the case 100% of the time, but when I look back at the challenges and fears in my life, I see that more often than not, they delivered exactly the message I needed at that time.

images-3Find a Model. find someone who had the fear you have, but managed to transcend it. Get in touch with them, ask them how they did it, and see if it could work for you. A co-worker, friend or relative who had LASIK will help you to relax and do it yourself.

Ask Yourself Why You’re Afraid. Your feelings are there to tell you something, ask yourself what the purpose is. Ask your heart, God, the universe, or whatever you feel comfortable with.

Explore the Roots of Your Fear. This may require some meditation. Look inside and ask yourself when the fear started. Look at your past for clues to help you overcome the fear.7-ways-meditation-changes-your-brain-and-body

Breathe. Your breath can set you free. It can anchor you in the now and help you vanquish and overcome your most pervasive fears. I saved it for last, because it’s one of the simplest and most powerful ways of overcoming fear.

And Please Remember
Whatever fears you’re facing, remember that the only thing that matters is that you listen to yourself.

More reading to overcome fear:

33 Powerful Ways of Overcoming Fear … Right Now

Top Reasons You Should NOT Wait To Get LASIK:

Unknown-1by Nitin Yawalkar

Many people wait to get LASIK done until they can’t tolerate wearing glasses or contacts any longer. Most patients after getting LASIK, wish they had done it years ago!

If you’re in your 20s and are considering LASIK, here’s why you should choose to do it now!

Save Money

The price of LASIK may deter you from getting the procedure done, but the money you spendUnknown-7 on contacts and glasses can easily be invested in getting laser eye surgery. If you wear glasses, you should be getting your eyes checked often for changes in your sight. If your sight changes, so does your prescription. This means you may need to purchase a new pair of glasses or lenses, which can end up costing a lot more than you anticipated. If you use contact lenses, the amount of money that’s spent on contacts and the solution over the course of a lifetime is actually more than the one-time cost of LASIK. We also offer financing options to help patients find a solution that works for their budget.

Experience Clear Vision Sooner

fog

The sooner you get LASIK, the sooner you will be able to see the world clearly without the hassle of glasses or contacts.

With LASIK, you won’t have to deal with:

• The fog on your glasses that hot beverages or soup causes
• Making sure you take out your contacts every night before bed to avoid possible infection
• Looking for your glasses because you constantly misplace them
• The annoying pressure on your nose from wearing glasses all daynose-pinch
• The war between wearing your glasses or sunglasses on sunny days
• Dry, itchy eyes from contacts
• The glare from your glasses in pictActive Lifestyle: 
Sports: If you play sports and wear glasses or contacts, you’re aware of how irritating it can be. With LASIK, sports can be much easier and a lot more enjoyable when you don’t have to rely on glasses or contacts.

Travelling:

Young adults are travelling more and more, but who wants to travel the world with the inconvenience of wearing contacts or glasses? LASIK can prevent aggravating dry eye symptoms that contact lenses can cause while being on an airplane, and can allow you to see the world clearly. You also won’t have to worry about packing your glasses or calculating how many contacts you will need for the duration of your trip.

Career Advantage: 

One of the biggest advantages of LASIK is how it can positively affect your career. Here are some jobs where the benefits of LASIK are tremendous:

Unknown-6Office Jobs: 

People who work at an office are already susceptible to eyestrain, dry eye, and stress on the visual system. Contacts can significantly worsen dry eye symptoms and can cause a glare for those with astigmatism, which is the last thing you need at work. Glasses can also be irritating because of the pressure they can cause on your face. Additionally, if your prescription is not up to date, you may even experience headaches and excessive eye strain. With LASIK, you don’t have to worry about any of those things!

IMGP1019aConstruction Worker:

Construction workers are relatively active and are often required to wear safety glasses on the job. Wearing glasses and safety glasses at the same time while working can be aggravating. Contacts may not even be an option for construction workers, as contacts are not recommended for those who work in a dusty, debris-filled environment. Good vision is crucial in this field of work due to the high risk of injury, which is why LASIK is an exceptional option!WeldingFaceProtection

First Responders:

First responders are constantly active, and poor vision is unacceptable. First responders work in many different environments that can be dusty or contain exposure to heavy chemicals, which is not recommended for contacts. Glasses can fall off, break easily, and may even be uncomfortable. LASIK is ideal for first responders because eye sight is crucial, especially during 080730-N-5277R-003 ATSUGI, Japan (July 30, 2008) A Commander, Naval Forces Japan firefighter douses a fire on a dummy aircraft during the annual off-station mishap drill at Naval Support Facility Kamiseya. Emergency response and rescue teams were tasked with putting out a simulated fire, and rescuing two personnel from a plane crash scene. U.S. Navy photo by Mass Communication Seaman Barry Riley (Released)emergencies.

https://www.realself.com/question/what-ideal-age-lasik-eye-surgery

LASIK-PRK-EPILASIK-call-today

Epi-LASIK: The Perfect Procedure

 

As patient discomfort is minimized and recovery time shrinks, more surgeons are trying it—and many prefer it to LASIK.

As a patient-pleasing refractive procedure, LASIK has been hard to beat. Some other ablative procedures have offered equally good visual results, but most have had comparative drawbacks such as greater patient pain or longer healing times.

Now, advanced versions of epi-LASIK (in which an epithelial flap is mechanically pushed back using a blunt, plastic oscillating plate, followed by laser ablation at the surface) are eliminating many of these drawbacks. These improvements have made believers out of many surgeons andGeometric-Design their patients. If their enthusiasm is any indication, this could signal the beginning of a major shift in the marketplace.

To find out more about the latest iterations of epi-LASIK, we asked five experienced surgeons to share their experience and insights in response to four questions: Why did they decide to shift away from LASIK toward epi-LASIK? How do they minimize patient pain and prevent haze? Should the epithelial flap made during epi-LASIK be replaced on the eye or removed? And what pearls could they offer to help make epi-LASIK more efficient and successful?

The Move to Epi-LASIK

Most of the surgeons we spoke to began using epi-LASIK because some patients were poor candidates for LASIK; eventually, they ended up favoring it. Rick Milne, MD, who is in private practice at the Eye Center in Columbia, S.C., is a case in point. Dr. Milne has now performed close to 1,000 epi-LASIK procedures; his practice was one of the 10 international investigational sites for the prerelease of Moria’s epi-K system.

The epithelial sheet made during epi-LASIK avoids a host of potential flap complications associated with LASIK, and many surgeons now believe removing it speeds healing.
Barrie D. Soloway, MD, FACS
“Ninety-nine percent of the laser vision correction I do today is epi-LASIK—specifically, a version that most people are calling ‘advanced surface treatment,’ or AST, in which you completely remove the epithelium,” he says. “Initially, I reserved epi-LASIK for patients who weren’t good LASIK candidates, but they did so well that I kept finding more and more excuses to ablate the surface instead of performing LASIK. Eventually I asked, why am I still doing LASIK at all?”
Dr. Milne and others we interviewed mentioned a number of specific reasons they’ve come to favor epi-LASIK:

• It eliminates potential flap complications seen with LASIK

Richard Rashid, MD, associate clinical professor of ophthalmology at the West Virginia School of Medicine in Charleston, estimates that he’s performed more than 500 epi-LASIK procedures, and says that in the past year he’s done about 75 percent epi-LASIK (with flap removal). “LASIK has a very low rate of complications,” he notes, “but 90 percent of the complications that do occur are associated with making the flap, postop slipping of the flap or epithelial ingrowth. Epi-LASIK avoids all of that. And it’s a safer eye in case of trauma in the future.”

• More patients can be treated

Epi-LASIK can be used to treat many patients with thin corneas who would have to be excluded from LASIK treatment.

• Epi-LASIK doesn’t weaken the cornea

Mark A. Swanson, MD, director of the Swann Institute in Sonora, Mexico and Douglas, Ariz., says his group has performed more than 800 epi-LASIK surgeries to date. “In my practice more than 40 percent of our procedures are epi-LASIK, and the number is growing,” he notes.

One of the reasons he lists for this shift is that making a LASIK flap can, in rare cases, compromise the biomechanical strength of the cornea, whereas epi-LASIK does not. “I’ve checked that with many instruments, including Reichert’s Ocular Response Analyzer,” he says. “This can be especially important when the patient has glaucoma. Epi-LASIK avoids weakening or thinning the cornea further, so we can continue to accurately monitor IOP.”

• Healing is better and faster than with PRK and LASEK

Dr. Swanson notes that some surgeons wonder why purchasing an epikeratome is necessary. “We compared a normal PRK to epi-LASIK done with a keratome,” he says. “We found that it’s better to take the epithelium off with the tool rather than the solution used in PRK. The reason is that the healing is a lot faster and discomfort is almost nonexistent, especially with the medications we use.”

http://www.reviewofophthalmology.com/article/epi-lasik-closing-in-on-the-perfect-procedure

Presbyopia: The 40-something Eyesight Challenge

architect working on the office

Many a 40-something guy or gal has experienced that seemingly sudden shortening of the arms. Your arms don’t actually shrink, but somehow they don’t seem long enough to get that newspaper or book far enough away to read. That’s how the actual condition of age-related farsightedness (where you can’t see very well close-up), or Presbyopia, got the nickname “long-armed sight.” Or maybe you’ve heard it referred to as TMB syndrome – too many birthdays.

Okay, so maybe if you’re in that 40-something group, none of this is humorous to you. Any sign of aging never is! If you’ve gone your whole life without needing glasses, the news that you do can be especially surprising and a bit shocking. But it’s a completely normal part of aging.

The term presbyopia comes from a Greek word meaning ‘old eye,’ and it describes a predictableGeometric-Design
process in which the lens of the eye gradually becomes increasingly rigid and inflexible over time. For most people, the process becomes noticeable somewhere between 40 and 45 years of age. At that point, the muscles that control the focusing of the eye’s lens aren’t able to induce it to focus as effectively, and we begin losing our ability to focus on nearby objects, such as the daily newspaper.

While prevention is the order of the day in healthcare, it won’t help with this aging process. But correction is usually easy – if a little damaging to the ego. For people who have existing vision correction needs, the most common treatment calls for bifocal or progressive glasses or contacts. For newbies to the vision correction world, reading glasses may be the ticket. Laser vision correction with Monovision is also an excellent treatment for this loss of near vision.

Ipocono-mountain-pennsylvania-sunset-over-a-lake-a-gurmankint’s not hard to figure out if you might be developing presbyopia.The symptoms are pretty easy to identify. One common symptom is the gradual realization that you have to hold reading material farther away from your eyes than you used to. Another sign is eyestrain when you’re doing close-up work, or the need for more light in order to read. Accommodative spasm, in which prolonged focusing on a near object of interest results in blurring of vision at distance when one looks away from the near object, is another common symptom.

Presbyopia is a progressive condition, which means that it will gradually worsen over time.  But patients can rest assured that its effects are easily treatable. During regular annual checkups, your eye care doctor can accurately measure your near vision and prescribe glasses or contacts that will compensate for the loss of focusing ability. Or you can opt for laser vision correction options such as monovision or Presby-LASIK.

Don’t let presbyopia cause added distress as you age.  It’s only natural! If you’re holding things farther away to see them, call Acuity to schedule a free consultation and learn about options for treating Presbyopia.

 

No More Reading Glasses, Monovision Is Here!

Portrait of a pretty relaxed middle aged woman using laptop on couch

Another surgery for presbyopia that can reduce the need for reading glasses is monovision LASIK. In this technique, the LASIK surgeon fully corrects the distance vision of one eye (usuallyGeometric-Design the dominant eye), and intentionally makes the non-dominant eye mildly nearsighted.

Monovision LASIK is effective in lessening near vision problems caused by presbyopia because a mildly nearsighted eye sees near objects clearly without glasses. So, after monovision LASIK, the dominant eye takes the lead to provide clear distance vision and the non-dominant eye is responsible for sharpening near vision.Unknown

Though the two eyes continue to work together as a team, distance vision typically is not as crystal-clear after monovision as it would be if the non-dominant eye wasn’t nearsighted.

Still, most people who undergo monovision LASIK feel the convenience of being able to see acceptably well at all distances without glasses is worth the tradeoff of accepting the minor loss SkHwy11ShoulderBumpsof clarity in distance vision that monovision entails.
Also, if additional distance vision clarity is desired for specific activities (such as driving at night) after monovision LASIK, special-purpose eyeglasses or contact lenses can be prescribed that correct the nearsightedness in the non-dominant eye and optimize distance vision.

http://www.allaboutvision.com/visionsurgery/presbyopia_surgery.htm

LASIK Lasers: Which is Best for You?

By Steven Vale, MD

LASIK and other forms of laser refractive surgery, such as PRK and Epi-LASIK, all use advanced excimer lasers to reshape the cornea and correct refractive errors including myopia (nearsightedness), hyperopia (farsightedness) and astigmatism. Excimer lasers have revolutionized the field of corneal refractive surgery over the last two decades and have greatly increased the safety, efficacy and predictability of laser vision correction surgery.joseph-gross-sebastian-wahl-third-eye-vision

Excimer lasers have the ability to remove, or “ablate,” microscopic amounts of tissue from the cornea’s underlying stromal layer with a very high degree of accuracy and without the possibility of damaging the surrounding corneal tissue.

Several FDA-approved excimer lasers are on the market presently, but one is not necessarily better than another. The most suitable excimer laser for you will depend on your specific requirements, such as your degree of refractive error, the size of your pupils and the thickness of your corneas. Your eye surgeon will advise you as to which excimer laser is best for you.

Most experts agree that your eye surgeon’s experience and abilities, as well as a thorough evaluation of whether you’re a suitable LASIK candidate, are far more critical factors affecting final LASIK outcomes than subtle differences between excimer lasers.

How Do Excimer Lasers Work?
The excimer laser emits a non-thermal beam of ultraviolet light of a specific ultraviolet (invisible) wavelength (typically 193 nanometers) to precisely remove corneal tissue. When the surface of the cornea is reshaped in the proper way,  light rays can focus properly onto the retina for clear vision.
The high-energy pulses of ultraviolet light penetrate only a tiny amount of the cornea and have the ability to remove as little as 0.25 microns of tissue at a time. (One micron is a thousandth of a millimeter.)

An excimer laser corrects nearsightedness by flattening the cornea; it corrects farsightedness by making the cornea steeper. Astigmatism can also be corrected by reshaping the cornea into a spherical shape.

Excimer lasers are controlled by computer settings programmed to correct your specific refractive error. Your surgeon will program the excimer laser with the desired measurements in order to reshape your cornea and treat your prescription. The quantity and pattern of tissue removal are unique to each patient.

Acuity_operatingsuiteMost modern excimer lasers have automated eye-tracking systems that monitor eye movements and keep the laser beam on target during surgery. Studies have shown that eye trackers produce better outcomes and decrease LASIK complications compared with past lasers that did not use eye-tracking systems.

Pupil Size, Ablation Speed and Patient Comfort

In recent years, increasing evidence has indicated that larger pupil sizes may affect laser vision correction outcomes. If your pupil expands in low light beyond the diameter of the laser treatment zone on the cornea, you may experience vision problems such as glare and halos at night.

Some surgeons believe the diameter of the laser ablation should be at least as large as your pupil in dim light. If you have larger pupils, the type of excimer laser may be important in relation to how large the treatment zone (diameter) the laser is capable of creating. You should discuss this with your surgeon.

Treatment times also differ among lasers, ranging from 30 to 60 seconds or longer. You may consider that important in terms of your comfort as you undergo a procedure.

You also might want to ask whether your surgeon uses a femtosecond laser or a surgical instrument (microkeratome) to create the corneal flap in LASIK eye surgery and how these two approaches might differ in terms of your comfort. Many surgeons take opposing sides in the microkeratome vs. femtosecond LASIK debate.

What To Consider When Comparing Different LASIK Lasers

When evaluating lasers for LASIK, PRK or other corneal refractive surgery, you may be drawn to information gathered during FDA clinical trials leading up to approval. But you should keep these points in mind:

FDA clinical trial results for LASIK lasers can’t be directly compared, since each study used different goals and patient selection criteria.

Today’s results are often better than FDA data. By definition, FDA trials occur during the early60049_15373812_i period of a laser’s life cycle. Manufacturers are allowed to and often do make technical improvements to the instruments, sometimes even while the lasers are still under investigation. One such improvement has been the introduction of wavefront LASIK technology, which delivers a more precise and customized refractive correction than earlier lasers.

The surgeon’s technique evolves as well, and usually becomes more advanced than the technique used in the FDA trials. This, together with increasing surgeon experience over time, means that results in actual clinical practice often are better than the initial FDA data.

FDA data in one study cannot fairly be compared with FDA data in another study. Manufacturers go to the FDA with various study designs, which often have differing patient-enrollment criteria and endpoints. Although all studies must answer certain basic questions regarding safety and effectiveness, they are not designed to be compared with one another.

A true comparison of Laser A and Laser B would require randomized clinical trials, in which patients would be randomly assigned to receive surgery by one laser or the other over the same time period by the same surgeons. FDA trials don’t do that — although other, non-FDA studies sometimes do.

Studies don’t cover every possibility. Even if a certain characteristic or condition appears to exclude you from treatment because of how the approval for the excimer laser is worded, your eye surgeon still may consider you a candidate.
Also, another laser with specific approval for your characteristic or condition may not necessarily do a better job.

Remember that studies have differing designs, and people with your characteristic or condition
may have been excluded. Even if they were included in the study, results may have been inconclusive because of factors such as too few people or insufficient data for determining statistical or clinical significance.

Once the FDA approves a laser, your surgeon can use it any way he or she deems appropriate. This is true of all FDA-approved drugs and devices. This is commonly referred to as “off-label” use of an FDA-approved drug, device or laser. It’s called a physician’s practice-of-medicine prerogative, and there’s nothing inherently wrong with it. It’s 100 percent legal for physicians to use devices and medications in “off-label” mode.

While specific excimer laser technology plays a key role, ultimately it is your surgeon’s skill and experience — and your suitability as a candidate — that will be the most important factors affecting your LASIK outcome.