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Laservision Correction

Laservision correction has come a long way in a relatively short period of time.

 

History

In 1991, Ionas Pallikaris, MD, in Heraklion, Crete, was probably the first to use a microkeratome to cut a thin flap of cornea and then apply the excimer laser to remove tissue from within the cornea. He coined the term laser in-situ keratomileusis (LASIK) for this procedure. "Keratomileusis" is derived from two Greek word that literally mean "to shape the cornea." "In-situ" means "in  place." Therefore, the term LASIK means "to reshape the cornea in place using laser."

Technique

The LASIK procedure combines two sophisticated techniques of surgery to correct refractive errors. The first technique involves the use of an automated instrument, the microkeratome, to create a thin protective layer of corneal tissue that covers the area to be sculpted by the laser. This flap allows for rapid recovery of vision and reduces discomfort after surgery. The second  technique uses a computer-controlled excimer laser -- a cold, invisible, ultraviolet laser -- to sculpt the underlying cornea, correcting the refractive error. This is the same laser that is used in PRK. The protective layer of tissue is repositioned without sutures and is secure after  a few minutes so that a patch is not required. Visual recovery is typically rapid, and there is little or no post-operative pain. Eye drops need only to be taken for a week. For a detailed pictorial display of how the surgery works, click here.

Our Results

Many patients ask us what kind of results we achieve. In order to help you with this We present the uncorrected vision of the last 50 consecutive patients upon whom we have Performed 'Down-up' Lasik. As of this date August 1,1998 we have not had a single vision threatening complication with this procedure. These results have been audited by an independent outside Accounting firm and while they do not gaurantee future results they do provide an overview of the most recent results achieved in our practice

    • 20/40 or better - 100%
    • 20/30 or better - 95%
    • 20/25 or better - 85%
    • 20/20 or better - 75%

Patients refractive errors vary from -1D to -15D spherical equivalent, with or without astigmatism.

20/40 is the vision required to pass the drivers test in the State of California. Many of these patients vision can be further improved with glasses or contact lenses after surgery, or if they choose to undergo enhancement surgery ("touch ups"). 

Complications

In experienced hands the complications of LASIK are extremely rare. Most of the complications  relate to the cutting of the flap and are thus dependent on surgical skill. The worst possible complication would be an infection with a permanent central opacity or a wrinkled flap requiring a cornea transplant. Since Dr. Rabinowitz is an experienced cornea transplant surgeon and often has to fix up other surgeons problems he is ideally suited to deal with any serious complications relating to the flap and since he  routinely performs Cornea Transplants on a weekly basis he would be best suited to deal with this problem which to date has not occurred in any one of our LASIK patients. Other complications beside the flap  relate to the Laser itself.

Possible Side Effects

Even though the refractive error may be corrected and the visual acuity may be good after LASIK, some patients experience one or more of the following side effects of the procedure:

    • Optical Aberrations: As with any refractive procedure, it is common for patients to notice  halos, ghost images, shadows, and slight distortions for the first months after surgery. In unusual circumstances, these optical aberrations may interfere with normal visual activities.
    • Night myopia: Because only the central portion of the cornea is reshaped, eyes may become more nearsighted when the pupil dilates and allows light to enter through the peripheral cornea that had not been reshaped. Even if excellent unaided vision is obtained during the daytime, a thin pair of glasses may be required at night for optimum vision.
    • Dry Eye: During the healing process, your eye may feel dry, and you may need to use artificial tear replacement for comfort temporarily.
    • Discomfort: Most of the discomfort following LASIK occurs within the first 24 hours and can easily be controlled with Tylenol or similar mild pain relievers. The eyes may be transiently more sensitive to sunlight following surgery.

Advantages

Consider these important points when you are making your LASIK vision correction decision.

    • Rapid Recovery -- Most patients are back to work the day after surgery. There is typically very little pain, and patients recover vision within the first 24 hours, because the epithelium is minimally disrupted. RK and PRK are more uncomfortable.
    • Correction  of a Full Range of myopia -- Among the three procedures offered at Laser Eye Associates, Cedars-Sinai Medical Center, Mark Goodson Building (RK, PRK and LASIK), LASIK is the only one that can treat up to -15 diopters of myopia. RK and PRK can correct only up to 5-7 DIOPTERS.
    • Repeatability -- In the case of under-correction, LASIK may be repeated by lifting the pre-made flap and adding additional laser treatment. Once software is available for correcting astigmatism and hyperopia, it will be  possible to repeat the surgery to treat these two disorders as well.  Retreatment with PRK requires several weeks of recovery time, several  weeks or months of treatment with steroid drops, and may induce corneal  scarring.
    • Long-term  Stability -- Because there is minimal disruption of the normal corneal architecture and minimal wound healing, it is likely that there will be minimal refractive change over time. Although long-term  data are not yet available, there seems to be little or no change in the result between two weeks and three months after surgery. There are no reports, thus far, of myopic or hyperopic shift; however, many years of observation will be required to know about the long-term stability of the procedure.
    • Structural  Integrity -- The flap is secure after the first day, and the eye is not weakened as it is with RK.
    • No Scarring -- There is little or no scarring in the central cornea, as can occur with PRK.
    • No Need for Long-term Post-operative Eye Drops -- There is no need to suppress wound healing with the use of steroids as there is with PRK. LASIK patients can stop much more rapidly after surgery.

Disadvantages

While when weighed against the many advantages, the potential disadvantages to LASIK vision correction are few, they should be considered nonetheless.

    • Requires a Skillful Surgeon -- Because of the complexity of the microkeratome, manual dexterity and operative experience are required.
    • Cost - LASIK is typically more expensive than PRK.

'DOWN-UP' LASIK

Down-Up is the new LASIK technique performed at Laser Eye Associates, Cedars-Sinai Medical Center, Mark Goodson Building and the Cornea Genetic Eye Institute. Laser Eye Associates is one of the few Centers in the Western United States that Uses the Chiron Hansatome®, the very latest in Microkeratome technology. This keratome has the following advantages:

    1. fewer gears- so less risk for complications.
    2. superior hinge of flap - the natural physiological position the flap should be in, so less risk for dislocation compared to the ACS (Automatic Corneal Shaper) which has a nasal hinge.
    3. large 10mm flap- allows you to perform hyperopia treatment in overcorrections.
    4. large flap allows more rapid and painless visual recovery.

LASIK and the FDA

Though LASIK is performed routinely in the United States, the procedure itself is not FDA approved. The Laser and the Microkeratome both the very latest technologies available in the USA are however Both FDA approved. For your protection LASIK at Laser Eye Associates, Cedars-Sinai Medical Center, Mark Goodson Building was initially performed under very strict guidelines set forth by our Institutional Review Board (IRB) until we determined that it was safe for our patients.

Frequently Asked Questions (FAQs)