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.


How 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.

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

Reasons To Get LASIK, The Top 10 Countdown!

LASIK 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.

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

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.

Recognize the Symptoms of Eye Strain to Prevent It!

A stressed woman working on a laptop

Because it is a common condition, particularly among those who read, work at a computer, or drive a car for extended amounts of time, it is important to know the symptoms of eye strain. The condition is not usually serious, but sometimes it can mean a deeper problem, for which you may need to seek professional attention. Acuity laser Eye & Vision Center can help! Because it is a common condition, particularly among those who read, work at a computer, or drive a car for extended amounts of time, it is important to know the symptoms of eye strain. The condition is not usually serious, but sometimes it can mean a deeper problem, for which you may need to seek professional attention. Acuity laser Eye & Vision Center can help!

Symptoms of eye strain include sore, tired, itchy, or burning eyes, watery or dry eyes, blurred vision, sore neck, sore back, shoulder pain, and sensitivity to light. Computer use can aggravate the condition, and additional computer eye strain symptoms include difficulty shifting your focus from paper to monitor, and seeing afterimages when you look away from the computer. If you develop an eye strain headache, a noticeable change in vision, eye discomfort or double vision, and you cannot improve these symptoms,  you should see an eye doctor.

DigitalEyeStrain_slideshowComputer eye strain is one of the most common types of eye strain, but there are other causes as well. Reading for extended times, especially in dim light, and any other activity that involves intense focus for long periods can cause eye strain and eye strain headache symptoms. You are more likely to develop symptoms of eye strain if you are stressed or fatigued, if the air is extremely dry, or if you have an underlying eye problem, especially one that results in dry eye. If you are not aware of an underlying problem, but you have symptoms, eye strain may be the reason you need to seek medical attention, to rule out other conditions.

Often, symptoms of eye strain can be alleviated with home care. Consider these modifications to your behavior, and you may find relief:

  • Make sure your light source is sufficient, especially during close up work. Keep the light from shining directly in your eyes, and make sure it is not shining on your computer in a way that creates glare.
  • Adjust your computer monitor. For those with eye strain symptoms, computer placement is key. It should be at least twenty inches from your eyes, with the top of your screen at eye level or below.
  • Keep your reference materials nearby. Keeping reference materials on the same level as your monitor can keep you from having to constantly readjust your eyes.
  • Take frequent breaks. Follow the 20/20/20 rule, and take a 20 second break from the screen every 20 minutes, focusing on a distance object 20 feet or more away. Get up and move around at least every hour, and close your eyes for a few minutes, if possible. Keeping your eyes trained on something for a long period is exhausting, and trained eyes quickly become strained.
  • Keep your eyes lubricated. Prolonged computer use can lead to symptoms of dry eye. Make a conscious effort to blink more and, if that does not work, consider preservative free artificial tears. Make sure you are well hydrated at all times. Avoid caffeinated beverages which can dehydrate you.

If none of these home remedies help, contact us. We can provide you with eye strain treatment, headache_at_work_imageand may suggest corrective measures, prescribe gleasses or laser vision correction or recommend eye exercises.

Whether or not you suffer from symptoms of eye strain, it is recommended that you have your eyes checked regularly, to prevent small issues from becoming larger problems. Acuity Laser Eye & Vision Center, under the direction of pioneering LASIK surgeon, Steven Vale, M.D., benefits from his over twenty years of diagnostic and surgical experience. The competent staff is committed to exceptional customer care, and dedicated to improving your eye health. Visit the website for more information or, for regular updates, join our online community on Facebook and Google Plus.

What Is PRK and How Does It Differ From LASIK?

 

psychedelic_eye_by_ivankorsario-d38m028PRK
(Photorefractive Keratectomy)

is a type of laser vision correction, refractive surgery to correct myopia (nearsightedness), hyperopia (farsightedness) and astigmatism. PRK was the first type of laser eye surgery developed for vision correction and is the predecessor to the popular LASIK procedure. Though PRK recovery takes a bit longer than recovery from LASIK eye surgery, PRK is still commonly performed and may offer advantages over LASIK for some patients.

Similar to LASIK and other types of laser eye surgery, PRK reshapes the cornea using an excimer laser, allowing light entering the eye to be properly focused onto the retina for clear vision.

The main difference between PRK and LASIK is that in LASIK surgery a thin, hinged flap is created on the cornea to access the treatment area, whereas in PRK the cornea’s entire epithelial (outer) layer is removed to expose the area to be treated and no flap is created. For both PRK and LASIK, the excimer laser then sculpts the stromal layer of the cornea to correct vision.

PRK vs. LASIK

The final results of PRK surgery are comparable to LASIK outcomes, but initial PRK recovery is delayed relative to LASIK because it takes a few days for new epithelial cells to regenerate and cover the surface of the eye. When those cells grow back, they are generally irregular or cuboidal in shape. Additional time is required for these cells to normalize and compact down to provide a smooth refractive surface for light to pass through.

LASIK patients may have less discomfort, and their vision stabilizes more quickly, whereas vision improvement with PRK is more gradual. The final outcome can take several weeks to a month to reach optimal uncorrected visual acuity.

PRK does, however, offer some distinct benefits because PRK surgery does not involve creation a corneal flap. This is of particular benefit if the cornea is too thin for LASIK or if the patient has undergone LASIK previously and therefore has a thinner residual cornea. There also is no risk of flap complications with PRK.

KEY DIFFERENCES BETWEEN LASIK AND PRK:60049_15373812_i

1. PRK is a slower recovery than LASIK
2. PRK is suitable for patients with thin corneas
3. PRK has more eye discomfort during first 48 hrs of recovery

How Is PRK Performed?

First, your eye surgeon removes a central area of corneal epithelium with a solution. Next, as with LASIK, an excimer laser is used to precisely reshape the curvature of your cornea’s surface. This computer-controlled, highly specialized laser delivers pulses of cool ultraviolet light that remove microscopic amounts of tissue in a precise pattern.

Following the PRK procedure, a soft contact lens is then placed on the cornea to help protect your eye. New epithelial cells grow back in five days typically, after which the protective contact lenses are removed by your eye doctor. An eye test will determine your readiness to drive.

What To Expect From PRK Surgery

You will undergo a thorough eye exam to ensure your suitability for laser eye surgery. This will include an evaluation of:
• The size of your pupils.
• The moistness of your eyes, to evaluate the risk of developing dry eyes after laser eye surgery and treat accordingly.
• Corneal curvature, using a corneal mapping device to precisely measure the contours of the front surface of your eye.
• Corneal thickness.

Your eye doctor also will assess your general health and medical background, as well as any medications you are taking, to determine if you are a suitable candidate. If you wear contact lenses, you will need to stop wearing them for a period of time* before your eye exam, as contacts can change the natural shape of your cornea.

While LASIK is used more often for vision correction surgery, PRK may be the best procedure in certain circumstances.

joseph-gross-sebastian-wahl-third-eye-visionTHE PROCEDURE:

PRK eye surgery is an ambulatory procedure, meaning it is performed on a walk-in, walk-out basis. In fact, the actual surgery generally takes only 15 minutes. You will be awake during the procedure, but your eye surgeon may give you a mild oral sedative to help you relax.

Numbing eye drops are applied to your eyes, and an instrument is used to keep your eyelids open. Your surgeon then directs the excimer laser over your eye, which is programmed for your exact prescription. You will be asked to look at a target light for a short time while your surgeon watches your eye through a microscope as the laser sends pulses of light to your cornea.

The laser energy removes microscopic amounts of tissue and reshapes the cornea. Most people do not feel any discomfort. Your surgeon has full control of the laser and can turn it off at any time. Your surgeon covers the treated corneas with clear non-prescription contact lenses. Within 4-5 days, new epithelial cells grow back, and the contacts can be removed.

Immediately after surgery you will be rest for a short period, after which you can return home (someone else must drive you).

Your surgeon will prescribe topical antibiotics as well as anti-inflammatory and pain medications to reduce post-operative discomfort, minimize any swelling and expedite healing. As with any other surgery, it is imperative that you follow your doctor’s instructions to help ensure optimum results. You will need to attend several follow-up appointments with your doctor** over the next several weeks to monitor the healing process.

PRK recovery takes longer than recovery from LASIK surgery. Most PRK patients usually can resume driving a car one week after surgery, but it can take up to three to six months before vision is completely stable.

Long-Term Results of PRK

PRK laser eye surgery has been performed overseas since the 1980s and in the United States since 1995 and has a very high success rate. It has undergone significant advancements during this time and remains the treatment of choice in certain circumstances.

PRK and LASIK results are similar. Most people achieve 20/20 vision after PRK surgery. SomeGeometric-Design patients, generally those was very high prescriptions, may still need to wear eyeglasses or contact lenses, but the prescription will be significantly lower than before the procedure.

While unlikely, you may need additional or enhancement surgery to improve your vision further or to correct a gradual worsening of your eyesight over time. Reading glasses may still be required after PRK surgery once you hit your 40s, due to an age-related loss of near vision called presbyopia.

While LASIK is by far the most popular laser eye procedure today, it’s important to follow the guidance and judgment of your eye surgeon to determine whether PRK or LASIK is best for your individual circumstances.

*Dr. Vale requires that soft lens wearers be out of contacts for one week before their pre-operative exam and one week before surgery. It is better to remain out of contacts until surgery is performed than to resume using them again. Toric lens wearers must be out of contacts for three weeks before the pre-operative exam and remain out of contacts until surgery.

** Dr. Vale requires a visit the day after surgery, another 4 or 5 days after surgery to remove the bandage contact lens, then one week following surgery, one month following surgery and sometimes three months following surgery as well.
Edited for Acuity Laser Eye and Vision Center by Lori Greenberg

How Does LASIK Correct Astigmatism Better Than Glasses or Contact Lenses?

family-easy-hikes-topic-ttd-fall
– By SCOTT W. TUNIS, M.D., F.A.C.S.

In order to understand how laser vision correction corrects astigmatism, it is important to understand the nature of astigmatism, how it causes blurred vision, and how it can be corrected by different methods.

Astigmatism is not a disease, but rather a refractive error of the eye which simply causes blurred vision. If the cornea (the front window of the eye) has a surface curvature which is spherical, such as the shape of a basketball, the eye has no astigmatism. If the cornea has a toric shape, like the surface of a football, it has two different curvatures on the surface, and hasGeometric-Design astigmatism. These two curvatures are usually at right angles to each other with one curvature steeper and one flatter. A greater difference in curvatures creates a larger amount, or magnitude, of astigmatism.
imagesIn addition, astigmatism also has an axis (direction) which is determined by the orientation of the steeper curvature of the cornea. Put another way, the football shape of the cornea can be pointed in any direction like the needle of a compass.  Thus, astigmatism has a magnitude and a direction which are equally important.

Glasses and contacts correct blurred vision from astigmatism by using the opposite shape of the correcting lens to “cancel out” the abnormal shape of the eye. For this reason, the frame of the glasses or the fit of the contacts must match exactly the correct magnitude and direction of the astigmatism of the eye. Any deviation in the compensating lens will cause blurred or fluctuating vision. This is why patients with astigmatism and glasses can tolerate very little twisting or maladjustment of the frame as it sits on their face.

Similarly, patients with toric 85(astigmatism correcting) contact lenses frequently notice large fluctuations in vision as the contact lens spins on the eye. These problems arise because glasses and contacts simply compensate for the abnormal shape of the underlying cornea by adding the opposite shape in the correcting lens in front of the eye.

Laser vision correction and LASIK, on the other hand, actually correct the astigmatism by reshaping the cornea, eliminating the two different curvatures, thereby creating the correct spherical shape of the cornea. Laser vision correction actually corrects astigmatism, it does not compensate for the refractive error in a similar manner to glasses and contacts.  As a result, patients with astigmatism frequently notice better vision with LASIK than with contacts or glasses. In fact, with the newest laser software, LASIK can frequently correct larger magnitudes of astigmatism than can even be placed in glasses or is available in contacts. In addition, patients with small amounts of astigmatism who do not wear toric contacts notice better vision after LASIK than with spherical contacts.

“Does LASIK Correct Astigmatism Better Than Glasses or Contact Lenses?”

Is Custom/Wavefront LASIK, Individualized Vision Correction Really Better?

by Keith Croes; reviewed by Brian S. Boxer Wachler, MD, and Vance Thompson, MD

karliekloss_snapchatchallenge_201604
Custom LASIK surgery, also known as wavefront LASIK or wavefront-guided LASIK, uses 3-dimensional measurements of how your eye processes images to guide the laser in re-shaping the front part of the eye (cornea). With a wavefront measurement system, some extremely precise, individualized vision correction outcomes may be achieved that would be impossible with traditional LASIK surgery, contact lenses or eyeglasses.

You should be qualified under FDA guidelines before custom wavefront LASIK is considered for your eye condition. Depending on the custom laser system used and other factors such as appropriate thickness of your cornea, you might be considered a candidate if you have mild to moderately high degrees of common vision defects such as myopia, hyperopia and astigmatism.

With custom LASIK, your eye’s ability to focus light rays is measured, and a 3-D map used in wavefront technology is created that demonstrates irregularities in the way your eye processes images. Information contained in the map guides the laser in customizing the treatment to reshape your eye’s corneal surface so that these irregularities can be corrected.

Standard prescriptions for glasses, contacts or traditional LASIK procedures can correct ordinary vision defects such as myopia, hyperopia, and astigmatism. But other irregularities associated with the eye’s optical system could not be addressed until the advent of wavefront and related technology used in custom LASIK.

Potential Benefits of Wavefront-Guided Custom LASIK

Wavefront technology is groundbreaking because it has the potential to improve not only how much you can see, visual acuity measured by the standard 20/20 eye chart, but also how well you can see, in terms of contrast sensitivity and fine detail.
This translates into a reduced risk of post-LASIK complications, such as glare, halos and difficulty with night vision.
How much you see depends on vision defects known as lower-order aberrations associated with common refractive errors including myopia, hyperopia and astigmatism, which traditional LASIK can treat.

How well you see can depend on presence of the type and numbers of visual distortions known as higher-order aberrations, which are optical defects other than common refractive errors.

custom-lasik-b-660x560Higher-order aberrations can create problems such as decreased contrast sensitivity or night vision, glare, shadows and halos. However, higher-order aberrations do not always affect vision. Unlike traditional LASIK, custom LASIK treats both lower- and higher-order aberrations.

Custom LASIK’s advantage lies in the area of quality of vision:
• Greater chance of achieving 20/20 vision
• Greater chance of achieving better than 20/20 vision
• Reduced chance of losing best-corrected vision
• Reduced chance of losing visual quality or contrast sensitivity
• Reduced chance of night-vision disturbances and glare

Potential also exists for custom LASIK to treat people who have lost best-corrected vision from any past refractive surgery: LASIK, PRK, RK, etc.

“Sometimes patients complain about vision quality problems, such as not being able to see in dim or low light. This is referred to as poor contrast sensitivity,” said Roger Steinert, MD, vice chair of clinical ophthalmology and professor at University of California Irvine.

“Prior to the advent of wavefront measurements, there wasn’t anything we could do to measure or treat higher-order aberrations,” Steinert said. “With this technology breakthrough, we can now measure these disorders, show the patient what’s going on in their eye, link that information to the laser, and actually correct higher-order aberrations that diminish contrast sensitivity. Wavefront technology enables the surgeon to improve overall vision quality better than in the past.”
Not all refractive surgeons agree that wavefront-guided LASIK can treat higher order aberrations. In fact, studies show that both wavefront LASIK and conventional LASIK can sometimes cause these aberrations because of artificial changes made to the natural shape of the eye’s surface.

However, wavefront-guided LASIK may be less likely to induce higher-order aberrations than conventional LASIK, according to discussion in the April 2005 issue of Ophthalmology Times.

Most refractive surgeons now use wavefront-guided LASIK in their practices, according to recent surveys such as those conducted by the American Society of Cataract and Refractive Surgery (ASCRS).

FDA-APPROVED CUSTOM LASIK SYSTEMS

Laser System and Manufacturer
FDA-Approved Indications
Features

LADARVision 4000 with CustomCornea (Alcon)

Myopia: up to -8 D with or without myopic astigmatism up to -4 D

Hyperopia and hyperopic astigmatism: up to +5 D (near vision problems) and astigmatism causing distance vision problems up to -3 D
Eye tracking, integrated wavefront, small spot system for precise laser application
Technolas 217z Zyoptix System (Bausch + Lomb)
Myopia: up to -7 D with or without up to -3 D myopic astigmatism and total refractive error equal to or less than 7.5 D
Integrated wavefront and “flying spot,” meaning fast, uniform application of laser beam with each pulse for smooth corneal surface

Star S4 ActiveTrak with CustomVue (Visx, now owned by Abbott Medical Optics or AMO)

Myopia: up to -6 D, with or without up to -3 D myopic astigmatism

Hyperopia: up to +3 D with or without up to +2 D for hyperopic astigmatism
Eye tracking, integrated wavefront, no pupil dilation required, which speeds up procedure, unique wavefront analysis system known as Fourier for increased resolution

Star S4 IR with CustomVue (Visx, now owned by Abbott Medical Optics or AMO)

Myopia: up to -6 D with or without up to -3 D of myopic astigmatism

Hyperopia: up to +3 D with or without up to +2 D of hyperopic astigmatism

Mixed astigmatism: up to 5 D
In addition to features of S4 ActiveTrak, includes Iris Registration (IR), which adjusts the laser treatment to take into account any rotation of the eye that may occur when the patient is in the prone position (lying down) during surgery

Allegretto Wave with Allegro Analyzer (WaveLight, now owned by Alcon)

Myopia: up to -7 D with or without up to 3 D of astigmatism
Scanning spot system, eye tracking, integrated wavefront, algorithm (mathematical measurement) based on population studies that helps minimize possibility that a vision error known as spherical aberration might be induced during vision correction
Note: D refers to diopters.

(Please note that the Nidek EC-5000 series excimer laser system used at Acuity Laser Eye & Vision Center locations was not approved for custom AT Geometric-DesignTHE TIME THIS ARTICLE WAS WRITTEN, but currently is FDA approved for custom laser vision correction, hence its absence from the list above.)

How Custom LASIK Works

The process for determining a custom LASIK treatment begins with the use of a wavefront device to transmit a safe ray of light into your eye. The light is then reflected back off the retina, out through the pupil, and into the device, where the reflected wave of light is received and arranged into a unique pattern that captures your lower- and higher-order aberrations.
All of these visual irregularities are then displayed as a 3-D map, referred to as a wavefront map. This information is then electronically transferred to the laser (in wavefront-guided systems), and computer-matched to the eye’s position, enabling the surgeon to customize the LASIK procedure laser treatment (or “ablation”) to your unique visual requirements.

Getting Wavefront-Guided Custom LASIK

Custom LASIK costs usually are significantly more than traditional LASIK, partly because surgeons pay a higher royalty fee to the device manufacturer for each procedure.

Research is continuing into expanding the degree of vision errors (such as high myopia) that can be corrected with custom LASIK. Investigations also are underway for use of custom LASIK to create multifocal corrections in a procedure known as PresbyLASIK, which would enable older eyes that have developed presbyopia to see at near, middle and distant ranges at the same time.
Investigators have reported early promising results of wavefront LASIK, combined with automated topographical measurements of the eye’s surface during a procedure, to help reduce surgically induced aberrations and astigmatism. Early studies also indicate that night vision might be further improved with this approach.*

Like conventional LASIK, custom LASIK won’t cure all vision-related problems, so it’s important to discuss its applications with your eye doctor or surgeon to determine if you are a good candidate.
http://www.allaboutvision.com/visionsurgery/custom_lasik.htm

FYI: Blue-light Blocking Glasses May Help Sleep

college-students-using-digital-devicesBY KATHRYN DOYLE

(Reuters Health) – The blue glow from televisions and other screens suppresses natural mechanisms that help us fall asleep at night, but blocking just the blue wavelength may restore normal nighttime sleepiness, according to a new study.

Teen boys who used computers and other digital devices while wearing the glasses every evening for a week felt markedly more relaxed and sleepy at bedtime than when they just wore clear glasses, Swiss researchers found.

“LED screens are widely-used in smart phones, tablets, computer monitors and TVs,” said study coauthor Vivien Bromundt of the Centre for Chronobiology at the Psychiatric Hospital of the University of Basel.

“The effect of screen light on the circadian physiology is particularly high in devices which are used in close distance to our eyes,” Bromundt told Reuters Health by email. “Looking at these screens in the evening can keep teenagers awake since it involves light exposure, particularly in the blue-wavelength range to which the biological clock and its associated arousal promotion has its greatest sensitivity.”15-450x300

Looking at computer screens in bed has been linked to insomnia and to difficulty waking up in the morning in previous studies. Light impacts circadian rhythms and sleep-wake cycles, the authors note.

Teenagers already have a pronounced preference for staying up late, the study team writes in the Journal of Adolescent Health. But having to wake up early for school builds up a chronic sleep debt that affects teens’ mood and focus.

Light-emitting diode (LED) screens give off short-wavelength light, which has been shown to block a natural evening rise in the hormone melotonin that promotes sleepiness. Exposure to this blue light keeps the brain alert and “activated” when it should be slowing down to shift into sleep mode, the researchers say.

friends chatting with their smartphones

For the new study, they used orange-tinted “blue-blocker” glasses that filter out short wavelengths of light in the blue portion of the visible spectrum.

The researchers recruited 13 healthy boys between ages 15 and 17 and for one week, the teens kept to their regular sleep schedule at home but did not go out in the evenings or have caffeine drinks.

They wore blue-blocker glasses from 6 p.m. until bed time each evening, while keeping diaries of how long they wore the glasses and how much time they spent with LED and non-LED screens as well as a sleep-wake log.

At the end of the week, the participants spent one overnight in the laboratory, sitting for two hours in dim light, darkness for half an hour and then three hours in front of a backlit LED computer screen wearing the blue blocker glasses. They completed cognitive tests and provided saliva samples.

Then the participants went to sleep for eight hours, and performed the same cognitive tests and saliva samples upon waking in the lab again.

All participants went through the weeklong study protocol twice, once wearing blue-blocker glasses and once wearing clear glasses for comparison.

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The kids reported spending the same number of hours with LED screens with blue-blocker and clear glasses. They reported feeling sleepier with the blue blocker glasses, especially toward the end of the evening.

Based on their saliva samples, kids who wore clear glasses had less melatonin, called the “darkness hormone,” at bedtime. Kids who wore the blue blocker glasses had higher melatonin levels from 90 minutes to five minutes before sleep.

The type of glasses did not seem to make a difference on the length or perceived quality of sleep itself.

The short-wavelength photoreceptors in the eye which respond to blue light act to reset the timing of the internal clock, suppress melatonin production, improve alertness and performance, and elevate brain activation, Bromundt said.

“Blue blockers therefore can prevent those light responses which are not helpful in the evening hours when our body and mind has to prepare for sleep,” she said.

But the blue-blocker glasses also blocked a significant amount of light generally, not just blue light, said Mary A. Carskadon, who researches associations of sleep regulatory mechanisms with sleep-wake behavior of children, adolescents and young adults at Brown University in Providence, Rhode Island.

“Not only were they blocking blue, but they were also blocking a lot of light so it was dimmer in general,” said Carskadon was not involved in the new study. “So it’s hard to detect what really is inducing the effects that they see, which were not very large.”

If it is not the blue light, but the general dimness making a difference, there might be the same effect if kids just turn down the brightness on their devices, she said.

Kids wearing clear glasses performed better on the cognitive tasks and had faster reaction times than those wearing blue blocker glasses.

“If kids are looking at screens, playing a videogame, they are not going to want to have their performance affected,” Carskadon said.

Although they did not change sleep timing, latency or other measurable aspects of sleep quality after one week of use in this study, the blue-blocker glasses did seem to increase sleep readiness for the male teens, Bromundt said.

UnknownThe results would likely be the same for female teens as well, she said.

“More and more suppliers of light therapy devices offer blue-blocker glasses in their range of products, because both bright light at the appropriate time of day and darkness or light-blocking devices in the evening and night are applied to consolidate our sleep-wake cycle and can therefore improve sleep and well-being,” Bromundt said.

Brown or yellow tinted glasses may reduce light transmittance also, but do not block as much light in the blue wavelength range as orange glasses, she said.

Having and setting limits on screen time can be as difficult for adults as for kids, Carskadon told Reuters Health.

“Many adults spend more time than is probably healthy using these devices when they could be and should be sleeping,” she said. “Common sense has gone out the window a bit.”

SOURCE: bit.ly/1vOgtb0 Journal of Adolescent Health, online October 3, 2014.
http://www.reuters.com/article/us-health-sleep-blue-light-idUSKCN0IC21W20141023

The High Definition Visual Experience of Custom Laser Vision

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All human eyes suffer from optical aberrations or distortions. Most people have mainly lower-order aberrations; myopia or near-sightedness, hyperopia or far-sightedness, and astigmatism. These are easily corrected by glasses, contact lenses, or standard laser vision correction procedures such as LASIK, PRK or Epi-LASIK.

Acuity laser Aberrometer

This is the OPD Scan aberrometer used by our staff at Acuity Laser Eye and Vision Center

Before the laser vision correction procedure the information about the anatomy of each eye derived from the wavefront map is transferred and loaded into the excimer laser. The laser ablation pattern used to reshape the cornea then includes both the refraction used for standard laser vision correction, and for the higher order aberrations identified on the map.

Lasik-Acuity-noCustom

Higher order aberrations effect the quality of vision more so than the actual visual acuity, as demonstrated here

Specifically, higher order aberrations are often described as the inability to see well in low or dim light, ” This is referred to as poor contrast sensitivity,” said Roger Steinert, MD, vice chair of clinical ophthalmology and professor at University of California Irvine. Bright lights can also be a problem with higher order aberrations, particularly when the pupils are more dilated at night. This often manifests as glare, halos, spoking or starbursts around lights.

“Prior to the advent of wavefront measurements, there wasn’t anything we could do to measure or treat higher-order aberrations,” Steinert said. “With this technology breakthrough, we can now measure these disorders, show the patient what’s going on in their eye, link that information to the laser, and actually correct higher-order aberrations that diminish contrast sensitivity. Wavefront technology enables the surgeon to improve overall vision quality better than in the past.”

STUDIES ON WAVEFRONT-GUIDED LASIK & CONTRAST SENSITIVITY
While visual outcomes as noted on familiar eye charts can be similar for wavefront-guided and conventional LASIK, research has linked wavefront-guided procedures to better results in areas such as improved contrast sensitivity.

A study reported in June 2009* found that 84 percent of 324 eyes that underwent wavefront-guided LASIK procedures for myopia with or without astigmatism achieved 20/20 uncorrected vision or better. In specific tests measuring contrast sensitivity and night vision, significant improvement was noted. Custom LASIK was found to induce certain types of aberrations, which did not appear to affect good visual outcomes.

In August 2004, the U.S. Navy announced that patients at its refractive surgery center were achieving better distance vision and night vision after custom LASIK than after traditional LASIK.US_Navy_SEALs_SEAL_jumps_over_side_boat
In a small study, 88 percent of contrast sensitivity measurements improved after wavefront-guided LASIK, while only 40 percent improved after regular LASIK. This was one month after surgery. Uncorrected visual acuity of 20/20 or better was achieved by similar numbers, however: 72 percent of the wavefront group and 70 percent of the regular LASIK group. The study was published in the March 2004 issue of Ophthalmology, the clinical journal of the American Academy of Ophthalmology. Many people, however, have higher-order aberrations which cannot be measured with a standard refraction or treated with glasses or contacts. They are measured by scanning the eye with a computerized instrument called an aberrometer, which measures the total amount of aberrations in the eye, including the familiar refraction, and transforms this data into a wavefront map.In most cases, improved visual outcomes with regard to night vision with use of wavefront-guided LASIK appear to surpass results that can be achieved with conventional LASIK.

 

About Our Laser: The Nidek EC-5000 Excimer Laser System

IMG_0740The Nidek EC-5000 Excimer Laser
at Acuity

What is it? The Nidek EC-5000 Excimer Laser System is an ophthalmic laser system for refractive surgery of the cornea designed to correct the vision of patients with refractive errors (nearsightedness and astigmatism) by laser assisted in-situ keratomileusis (LASIK).NIDEKCOLTD

How does it work?

LASIK corrects nearsightedness and astigmatism by changing the shape of the cornea, the clear covering of the front of the eye, using an excimer laser. A thin flap is cut in the cornea and a hinge is left at one end of this flap. The flap is folded back revealing a middle section of the cornea. The laser fires a stream of up to 40 pulses of invisible ultraviolet light per second. Each pulse removes a tiny bit of tissue by evaporating it. To treat nearsightedness, the pulses are placed in a pattern that makes the cornea flatter.  After the procedure, the flap is replaced.

Excimer laser light does not go through the cornea so it does not harm the iris, lens, or retina. The laser produces very little to no heat and is controlled by the doctor during the operation, with the aid of an electronic eye tracking system so that all laser pulses reach the intended point of correction.

Like regular LASIK, Topography-Assisted LASIK measures the natural seeing ability of the eye for your nearsightedness and astigmatism to plan the treatment for your eye. In addition, however, it uses a map of the shape of your cornea to treat small, local defects that cannot be corrected by glasses.IMG_0739

This approval includes software, called Final FitTM, which uses data about the surface of the cornea in addition to eye prescription information to determine the pattern of corneal tissue to be removed during treatment to correct nearsightedness and/or astigmatism.

When is it used?

LASIK is a surgical procedure intended to reduce a person’s dependency on glasses or contact lenses. This particular device may be used in cases where there are minor topographical variations in the cornea that may not be best captured using wavefront aberrometry (technique to measure optical imperfections in the eye), as in use with other types of LASIK devices.

The Nidek EC-5000 Excimer Laser System is approved for topography-assisted LASIK treatment using the Final Fit™ custom ablation treatment planning software for the reduction or elimination of nearsightedness with astigmatism.  You would be a good candidate if you are 21 years of age or older and your vision is:
•  from -1.0 to -4.0  diopters  with astigmatic refractive errors more than -0.5 diopters up to  -2.0 diopters  at the spectacle plane with a manifest refraction spherical equivalent (MRSE) of -1.0D to -5.0D.
•  unchanged no more than ±0.5 diopters in the last year.

What will it accomplish?

Even if astigmatism and nearsightedness is properly corrected, there still may be other types of optical defects, such as halos or glare, which can reduce the quality of vision.  These irregularities may be caused by problems with the cornea or with the natural lens inside the eye.  Normally, custom wavefront-guided LASIK treats these defects for the whole eye as a system, but if most of the irregularities are from the natural lens, the treatment can leave the cornea more irregular, or “bumpy” than it was before the treatment.
In contrast, topography-assisted LASIK assumes that it is more important to create a smooth corneal surface than it is to treat irregularities from the lens.

When should it not be used?

You should NOT have LASIK if any of the conditions below apply. In these cases, the risk is greater than the benefit. Therefore LASIK should not be used in:

• Patients with severe dry eye.
• Patients with recurrent corneal erosion.
• Patients with advanced glaucoma.
• Patients with collagen vascular, autoimmune or immunodeficiency diseases.
• Pregnant or nursing women.
• Patients with thin and cone-shaped bulging of the cornea (keratoconus), suspected keratoconus, or unstable or irregular central keratometry readings.
• Patients with uncontrolled diabetes.
• Patients with eyes that have a calculated residual stromal bed thickness that is less than 250 microns (correction too high for the amount of tissue present).
• Patients with thin corneas or eyes for which a preoperative OPD-Scan (containing certain information regarding irregularities for eye alignment) cannot be obtained.
• Patients who have uncontrolled eye movements (nystagmus) or another condition that prevents a steady gaze. You need to be able to keep your eyes still during treatment. The accuracy of your refractive results will be affected if you cannot keep your eyes still during treatment.

How to Take Care of Your Eyes

 

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Your eyes are your windows to the world, so it’s important to take good care of them.
Things like seeing an eye doctor regularly, getting enough sleep, and giving your eyes regular breaks while you are using a computer can help keep your eyes in good health. If you are having problems with your vision, you should schedule an appointment with an optometrist as soon as possible. Keep reading to learn about some of the things you can do to help keep your eyes in good shape.

1Visit an eye care practitioner regularly.

These are trained professionals who specialize in looking after the health of your eyes. They can be ophthalmologists (eye doctors), opticians or optometrists. To keep your eyes in good health, have your eyes checked regularly or when you are having problems with your vision. Learn more about your eyes and ask your eye doctor questions when you have them. Learning more about your eyes and how to prevent eye diseases will help you to feel more in control of your health.[1]
◦ If you don’t have any vision problems, you should visit an eye care practitioner every 5-10 years during your 20s and 30s.
◦ If you don’t have any vision problems, you should visit an eye care practitioner every 2-4 years between the ages of 40 and 65.
◦ If you don’t have any vision problems, you should visit an eye care practitioner every 1-2 years after the age of 65.

2Take your contacts out at the end of the day.

Avoid wearing contact lenses for more than 19Unknown-1 hours. Wearing contact lenses for too long can cause permanent vision damage as well as extreme discomfort to your eyes.[2]
◦ Never sleep with your contact lenses in unless your doctor specifically instructs you to do so. Your eyes need regular supplies of oxygen, and lenses block the flow of oxygen to the eyes, especially during sleep, so doctors recommend a normal break from wearing contact lenses for your eyes during the night.[3]
◦ Do not swim in contact lenses unless you are wearing tight fitting swimming goggles. It’s better to use prescription goggles if needed. It is fine to wear them in the shower providing you keep your eyes closed and avoid getting soap or shampoo in them.
◦ Always follow the instructions about using the contact lenses and the solutions from the manufacturer and your eye care practitioner. Also always wash your hands before handling them.

3) Remove your eye makeup at the end of the day.

Always take time to remove your eye makeup before you go to bed. Never go to bed with your eye makeup still on. If you go to bed with mascara or eyeliner on, it can get into your eyes and cause irritation.
◦ Sleeping in your eye makeup can also cause the pores around your eyes to become clogged, Unknownwhich can lead to styes or (hordeolum) . A severe sty can require antibiotics or even need to be removed by a doctor.[4][5]
◦ Keep makeup remover pads near your bed for times when you are too tired to go through your nighttime cleansing routine.

4Use allergen-reducing eye drops sparingly.

Using an allergen-reducing eye drop during allergy season may help ‘get the red out’ and sooth itchiness, but daily use can actually make the problem worse. It can cause something called rebound redness, which results in excessive eye redness because eyes no longer respond to eye drops.[6]
◦ Allergen-reducing eye drops work by constricting the blood flow to the cornea, which deprives it of oxygen. So while your eyes don’t feel inflamed and itchy anymore, they’re actually not getting enough oxygen from blood. That’s not ideal, because the eye muscles and tissues need oxygen to function. The lack of oxygen can even result in swelling and scarring.[7][8]
◦ Read the labels of eye drops carefully, especially if you wear contacts. Many eye drops cannot be used while wearing contacts. Ask your eye care practitioner what kind of eye drops are okay to use with contacts.

5) Wear UV protective sunglasses.

Always wear sunglasses when you are outside and the sun is shining. Look for sunglasses that have a sticker that specifies that the lenses block 99% or 100% of UVB and UVA rays.[9]

◦ Prolonged exposure to UV rays can harm your eyesight, protection in youth can help prevent loss of eyesight in later years. Exposure to UV rays has been linked to cataracts, macular degeneration, pinguecula and pterygium, harmful conditions for the eyes.[10]
◦ Since the damage to eyes from UV rays builds up over a lifetime, it’s important to shield children from harmful rays. Make sure your children wear hats and protective glasses when they are out in the sunlight for prolonged periods.
◦ Be sure to wear sunglasses even if you’re in the shade. Even though shade lessens UV and HEV exposure significantly, you’re still exposing your eyes to UV rays reflected off of buildings and other structures.
◦ Never stare directly into the sun even if you are wearing UV sunglasses. The sun’s rays are very powerful and can damage the sensitive parts of the retina if exposed to full sunlight.

6Wear goggles when appropriate.

Be sure to wear goggles or other eye protective wear when working with chemicals, power tools, or any place with harmful airborne particulates. Wearing goggles will help protect your eyes from any large or small objects that might hit you in the eye and cause damage.

images7) Get plenty of sleep.

Inadequate sleep may contribute to eye fatigue. Symptoms of eye fatigue include eye irritation, difficulty focusing, dryness or excessive tears, blurred or double vision, light sensitivity, or pain in the neck, shoulders, or back. Make sure that you get enough sleep every night to help prevent eye fatigue. Adults require about 7-8 hours of sleep per night.[11]

8Exercise regularly.

Regular exercise can help prevent other diseases such as diabetes. By getting at least 30 minutes of exercise three times per week, you can reduce your chances of developing serious eye diseases like glaucoma and macular degeneration.

9) Place cucumber slices on your eyelids to reduce puffiness.

Press cold cucumber slices gently against eyelids for 10-15 minutes before going to sleep at night to help treat and prevent eyelid and under eye puffiness.[13]
◦ Green tea bags may also help prevent puffiness if applied to the eyes. Soak the tea bag in cold water for a few minutes and place over eyes for 15-20 minutes. The tannins in the tea should help reduce inflammation.

http://www.wikihow.com/Take-Care-of-Your-Eyes

Sunglasses After Laser Vision Correction and Forever!

Acuity Laser Eye & Vision Center provides each patient with a pair of wrap around style UV protection dark tinted sunglasses for use following their laser vision correction procedure. These are the best style to protect your eyes from exposure to sunlight in the critical weeks just following surgery. Although these sunglasses are excellent protection, you may choose to purchase another pair that’s more your own style and feel more comfortable wearing.

If you’re doing some research and shopping for sunglasses prior to your laser vision correction procedure, here are three tips to keep in mind:

  1. If you are an active individual and spend a lot of time near water; pools, lakes, streams or the ocean, we recommend polarized lenses that reduce the impact of reflected light and glare caused by sunlight reflected off of shiny surfaces.
  2.  Select darker lenses to protect your eyes from UV radiation. Black tinted lenses are best and if you can clearly see your own reflection in a mirror when you wear them, they are probably not dark enough to provide adequate protection.
  3. Really wear your sunglasses! If it takes choosing a stylish pair or keeping an extra pair in your glove compartment or backpack invest in that insurance that you are really protecting your eyes from sun damage when you are outdoors.

    google-luxottica-deal-to-bring-glass-technology-to-ray-ban-and-oakley

    Yes, you look cool but thats not the point!

The Reasons Why You Need Sunglasses When You’re Outdoors
By Gary Heiting, OD

Many misconceptions exist about the right
sun protection for your eyes. Keep these
tips in mind:

• Not all sunglasses block 100 percent of UV rays. If you’re unsure about the level of UV protection your sunglasses provide, take them to your eye doctor or optician for an evaluation. Many eye care professionals have instruments such as spectrophotometers that can measure the amount of visible light and UV radiation your lenses block.

• Almost all sunglasses block a portion of HEV rays, but some tints block more blue light than others. Blue-blocking sunglass lenses usually are bronze, copper or reddish-brown in color.

• Remember to wear sunglasses even when you’re in the shade. Although shade reduces your UV and HEV exposure to some degree, your eyes still will be exposed to UV rays reflected from buildings, roadways and other surfaces.

• Sunglasses are important especially in winter, because fresh snow can reflect 80 percent of UV rays, nearly doubling your overall exposure to solar UV radiation. If you ski or snowboard, choosing the right ski goggles is essential for adequate UV protection on the slopes.

• Even if your contact lenses block UV rays, you still need sunglasses. UV-blocking contacts shield only the part of your eye under the lens. UV rays still can damage your conjunctiva and other tissues not covered by the lens.

images-1• Wearing sunglasses protects these delicate tissues and the skin around your eyes from UV damage.

• If you have dark skin and eyes, you still need to wear sunglasses.

• Although your dark skin may give you a lower risk of skin cancer from UV radiation, your risk of eye damage from UV and HEV rays is the same as that of someone with fair skin.

You need not fear the outdoors and sunny days, as long as you are equipped with the right eye and skin protection to reduce your UV exposure.

Read original article: http://www.allaboutvision.com/sunglasses/spf.htm

Presby-LASIK On the Horizon for Treatment of Presbyopia

Presbyopia and Solutions for the Aging Eye

About Vision Before the Onset of Presbyopia

Normal Pre-Presbyopic Vision enables sight of both near and distant objects in similar sharp focus through to the mechanism of accommodation.  In youth, accommodation is achieved by the natural crystalline lens in the eye as it can adjust focus on close-up as well as distant objects.  With aging, however, the natural lens gradually loses its elasticity. At around the age of 45 years the crystalline lens starts to develop difficulty accommodating to focus at near.  There may also be accompanying progressive failure of the Ciliary Muscle, the muscle that facilitates accommodation by rounded up the crystalline lens. Due to both of these factors, near vision continues to deteriorate with age. This is known as Presbyopia.

Presbyopia and Options for Treatment

The most common treatment for presbyopia is reading glasses, which enable clear vision of close-up objects, but have to be removed for distance vision.  Alternatively, bifocal lenses in spectacles or contacts can also be used to facilitate near vision in individuals who already wear glasses or contacts.

There is, however, an alternative solution to this problem.  Just as most individuals have a dominant hand, every person also has a dominant and non-dominant eye.  It is possible to use this physiological phenomenon to one’s advantage by using glasses, contact lenses or laser vision surgery to correct one eye for distance vision and the other eye for close-up vision.  The brain then chooses the respective eye, depending on the distance of the object of interest.  For those that are able to make this adjustment, it is possible to see close-up as well as distant objects in focus without the need for reading glasses.  This visual arrangement is called Monovision.

By convention, Monovision typically is done by using the non-dominant eye for close-up vision and the dominant eye for distance vision, since most people require the dominant eye to be set for distance in order to drive and perform other tasks that require crisp distance visual acuity. Some people, however, such as elderly non-drivers, prodigious readers and people who work at home on a computer prefer to have the dominant eye set for near and the non-dominant used for distance visual tasks. In either instance, the brain has to merge the two separate images into one, which may be hard for some people.  Scientific studies show that approximately 85% of the general population over age 45 can successfully adapt to monovision to produce binocular functional vision at both near and far.

To successfully conventional-monovisionadapt to Monovision, the brain may need some time to fulfill these new demands.  People that can adjust to this situation are generally very happy, since they are able to see at near and far despite their presbyopia.

Those that manage to tolerate the difference between the two eyes, are often left with a “gap” in the intermediate range.  It is known as the “Blur Zone”, as illustrated on the left.  It may also cause other side effects, like reduced contrast sensitivity and mildly reduced binocular vision (stereopsis).

Before Monovision correction is attempted with a vision correction laser, a trial period with trial frame lenses or contact lenses is mandatory to determine whether this type of correction will work. Conventional Monovision is  a compromise which, for most but not all people, works well.

Presby-LASIK or Laser Blended Monovision is a more recent development, not yet approved by the FDA, which provides a more permanent and longer term solution to presbyopia.  In contrast to conventional Monovision, this technique combines the simplicity and accuracy of laser refractive surgery with the additional benefit of increased depth of field.  This is similar to the visual result obtained using progressive contact lenses. This result is achieved by a modification of the asphericity of the cornea in the dominant as well as the non-dominant eye, using the same Excimer laser technology we currently used to perform standard as well as Monovision laser vision correction. By increasing the asphericity of the cornea, the depth of field of the eye is increased. By adjustments to the asphericity of the eye set for near vision, it is possible to tweak the result to optimize the visual performance of each patient and meet their personal requirements for spectacle free vision at both near and distance.

The Presby-LASIK treatment is performed in a manner similar to Monovision LASIK, but as a result of the change in corneal asphericity, the intermediate vision also improves.  The result is that the patient experiences vision in focus at all distances – not only at near and at distance – when using both eyes in tandem. This same result can also be achieved by performing Presby-PRK or Presby-EpiLASIK, for those who are not candidates for LASIK but can have other vision correction procedures.

PresbyLASIK-monovisionThe intermediate area is known as the “Blend Zone”, as illustrated on the left. When FDA clearance has been issued, Dr. Vale will be performing this procedure, in addition to traditional Monovision laser vision correction (LASIK, PRK or Epi-LASIK) at Acuity Laser Eye & Vision Center. To meet with an experienced laser vision correction counselor at Acuity in Scranton or Bethlehem, or our affiliated co-management locations throughout eastern and central Pennsylvania, the Southern Tier region of New York and New Jersey to discuss visual options available to you today, as well as those on the horizon, click here.

CUSTOM and Contrast Sensitivity Testing

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By Gary Heiting, OD
http://www.allaboutvision.com/eye-exam/contrast-sensitivity.htm

Your contrast sensitivity test results can help your eye doctor determine if you have vision errors known as higher-order aberrations or some other problem that could be corrected with eye surgery. Custom or wavefront LASIK can reduce higher-order aberrations and improve contrast sensitivity. The FDA has required contrast sensitivity testing since 1991 for the evaluation of new ophthalmic devices, including excimer lasers used for LASIK!

Contrast sensitivity is a very important measure of visual function, especially in situations of low light, fog or glare, when the contrast between objects and their background often is reduced. Driving at night is an example of an activity that requires good contrast sensitivity for safety. Even if you have 20/20 visual acuity, you can have eye or health conditions that may diminish your contrast sensitivity and make you feel that you are not seeing well.

Symptoms of Reduced Contrast Sensitivity

If you have low contrast sensitivity, you may have problems with night driving, including difficulty seeing pedestrians walking alongside poorly lit streets. Or you might notice that your eyes tire more easily while reading or watching television.
Poor contrast sensitivity also can increase your risk of a fall if you fail to see that you need to step down from a curb onto similarly colored pavement. Low contrast sensitivity can be a symptom of certain eye conditions or diseases such as cataracts, glaucoma or diabetic retinopathy.

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Contrast Sensitivity Testing

Contrast sensitivity testing often isn’t included in a routine eye exam. Your eye doctor might perform the test because of a specific visual complaint you have or because he or she suspects you have a condition that is affecting your ability to discern contrast.

Probably the most widely used device to test contrast sensitivity is the Pelli Robson contrast sensitivity chart. The Pelli Robson contrast sensitivity chart tests your ability to detect letters that are gradually less contrasted with the white background as your eyes move down the chart. Like a standard Snellen visual acuity chart, the Pelli Robson chart consists of horizontal lines of capital letters. But instead of the letters getting smaller on each successive line, it is the contrast of the letters (relative to the chart background) that decreases with each line.

Other, more sophisticated devices also may be used to test your contrast sensitivity. These devices often use targets called sine-wave gratings that consist of a number of fuzzy, parallel bars of light and dark. These bars can vary in width (spatial frequency) as well as contrast from target to target, to give a more thorough evaluation of how sensitive your eyes are to differences in contrast.
Some sine-wave grating tests include a bright light source that can be directed toward your eyes during the test to simulate glare situations such as oncoming headlights during night-driving.

If your eye doctor determines that you need a contrast sensitivity test, it likely will be administered after a standard visual acuity test and before your pupils are dilated. In more elaborate contrast sensitivity tests, you may be shown images such as dots and bars with different contrasting backgrounds under varying conditions such as glare. The testing typically is done while you wear your eyeglasses or contact lenses if you require vision correction.

For evaluation of eye disease, contrast sensitivity usually is tested on each eye individually. For other reasons, such as sports vision testing or to evaluate vision after contact lens fitting, LASIK or cataract surgery, the testing might be done with both eyes open.

Contrast Sensitivity Function (CSF)
Detailed contrast sensitivity measurements that include both size (spatial frequency) and contrast are used to plot a person’s contrast sensitivity function (CSF).

Sine-wave grating targets with thicker bars represent low spatial frequencies; targets with thinner bars represent higher spatial frequencies. In this regard, determining a person’s CSF is much like evaluating the sensitivity of his or her hearing, which involves using tones of low and high pitch as well as variations in volume.

Your contrast sensitivity function essentially is a plotting of the curve that defines the lowest contrast level that you can detect for each spatial frequency tested.
Generally, objects with high spatial frequencies (sine-wave gratings with very thin bars) must have significantly higher contrast than objects with lower spatial frequencies (gratings with medium-width bars) to be detected by the human visual system.

The Benefits of Custom LASIK Surgery

Custom LASIK surgery refers to the use of wavefront technology to create a three-dimensional digital map of a person’s cornea. This cornea map is highly detailed, able to identify even the most minute of imperfections on the corneal surface. These minute imperfections in combination with large corneal imperfections are what cause people to experience poor vision.
While all LASIK is technically “custom,” modern custom LASIK is different from the LASIK of the past thanks to this digital mapping and scanning technology.

 

Custom really means greater accuracy to truly customize the procedure!

Custom LASIK Addresses Both Higher and Lower Order Aberrations
Given the above, one of the benefits of custom LASIK is its ability to treat both lower order aberrations and higher order aberrations.

Lower order aberrations you may know better by the following terms:

• Nearsightedness (Myopia)
• Farsightedness (Hyperopia)
• Astigmatism

Higher order aberrations, however, refer to vision problems caused by the minute imperfections we mentioned above. These vision problems can range from anything from glare and halos, to starbursts, ghost images, poor contrast in low light conditions, rain glare and so forth.

Traditional LASIK could only address lower order aberrations with any reliability. Custom LASIK, however, can treat both lower order and higher order aberrations.

Custom LASIK Is Computer-Guided for Added Safety

Custom LASIK is not just more accurate than traditional LASIK, it’s far safer as well. The digital map of the cornea is loaded into the surgical laser that carries out the actual LASIK procedure. Since the surgery is computer-guided, that means that there is far less chance for human error and surgical mistakes to be made.

Custom LASIK Results Are Superior to the Results of Traditional LASIK

With increased safety and improved accuracy, it should come as no surprise that custom LASIK also offer patients better overall results when compared to the LASIK of the past. Custom LASIK patients have vision that is clearer and sharper, and they also tend to notice fewer issues with glare and halos as they recover from the LASIK procedure.