Frequently Asked Questions (FAQ) about
LASIK and Laser Vision Correction Procedures
DIFFERENT REFRACTIVE ERRORS
Over 60 million Americans suffer from nearsightedness, or myopia. A person is considered nearsighted when the eye has too much focusing power. This occurs when the eye is either too long or the cornea is too steep to allow light to focus directly on the retina (the film of the eye). Instead, light focuses in front of the retina causing distant images to appear blurry. A minus power lens in the form of eyeglasses or contact lens is needed to subtract focusing power from the eye.
2.What is hyperopia?
Hyperopia is a condition where light rays entering the eye are focused behind the retina instead of directly on it, as in the normal eye. It may be present in childhood but does not usually become apparent until people are in their late 20s or 30s when they can no longer see up close. When these patients get into their 40s or 50s, they begin having difficulty seeing distant objects as well.
3. What is astigmatism?
Astigmatism is a condition that occurs when the cornea or lens is steeper in one axis than another, similar to a football or the back of a spoon instead of completely spherical or round like a basketball. Light entering the cornea focuses on more than one point within the eye resulting in blurring vision. Astigmatism is either regular when steep and flat axes are 90 degrees apart or irregular when they are not separated by 90 degrees.
Literally “old vision”, it represents a natural aging process of the eye. It starts to affect most people around the age of 40. Normally, when a close object is viewed, the lens will change shape or “accommodate” to focus light on the retina. With Presbyopia, the lens can not sufficiently reshape and glasses are required for close viewing. If someone has laser vision correction for nearsightedness and is already presbyopic (40+ years of age), they will then need correction for reading. These are typically just the store bought magnifying glasses.
HISTORY OF REFRACTIVE SURGERY
These are a group of surgical procedures that have been designed to permanently reduce or eliminate the need for corrective eyewear to see distant objects. They include laser assisted in-situ keratomileusis (LASIK), photorefractive keratectomy (PRK), radial keratotomy and astigmatic keratotomy (RK/AK), Laser Thermal Keratoplasty ( LTK), Conductive Keratoplasty (CK) to name a few. These procedures offer an alternative to glasses or contact lenses. These procedures can only improve vision if it can be improved with glasses or contact lenses.
These are refractive procedures performed with an excimer laser. The excimer generates ultraviolet light of a specific wavelength (193 nanometers) by sending high-voltage electrical energy through a cavity containing Argon Fluoride gas. The beam that is emitted has enough energy to break the bonds between the molecules that make up the tissue on your eye’s surface (the cornea). Because it is a photochemical and not a heating process, it allows the surgeon to sculpt very precise amounts of corneal tissue from above without any damaging to neighboring/adjacent tissue.
The excimer laser was developed at IBM in 1976, and was used to etch computer microchips. Its extreme precision with negligible damage to adjacent tissue made it a very attractive tool for other applications, and in 1983, Stephen L. Trokel, M.D., in cooperation with R. Srinivasan, a physicist, applied it to corneal tissue in a New York laboratory. The first sighted eye was treated with the excimer laser at LSU on January 14, 1987. Between 1987 and 1995 numerous laser manufacturers, including VISX and Summit Technology, worked toward U.S. approval to use the Argon Fluoride excimer laser.
LASIK, or laser in-situ keratomileusis, and PRK, or Photorefractive Keratectomy.
REFRACTIVE SURGICAL PROCEDURES AND HOW DO THEY WORK
In both procedures, a specially trained ophthalmologist uses the computer-guided excimer to gently remove a thin layer of tissue from the cornea to achieve the desired correction. Prior to the procedures, drops are placed in the eye to numb it (like the ones your eye doctor uses to check your eye pressure for a glaucoma test) and an instrument called a speculum is placed in the eye to prevent you from blinking. There are no needles and no pain.
In PRK, the surgeon first removes the surface cells of the cornea using the laser and then sculpts the underlying tissue. The surface cells regenerate over the course of 48 to 72 hours under a bandage contact lens. PRK is usually done one eye at a time with a waiting period of usually two to three weeks between eyes. In LASIK, an instrument called a microkeratome, (similar to a carpenter’s plane) is used to lift a thin layer of the corneal tissue. This is left attached on a hinge. The laser is then used to sculpt tissue from the corneal bed and the flap is floated back into place, reattaching without the need for sutures.
During the LASIK procedure there is no pain, however, there is about 15 seconds of firm pressure while the corneal flap is being created. Following the procedure, patients are usually more comfortable than patients undergoing PRK, experiencing only four to six hours of scratchiness in the eye.
Most patients are in the laser suite for no longer than 20 minutes. The actual laser treatment time takes just 15-90 seconds, depending on the degree of correction required. Total time at the center on the day of the procedure will be about an hour
Because the healing occurs in the interior of the cornea, and no regrowth of surface cells are required. The corneal flap protects the treated area and there is usually little, if any, post-op discomfort. Visual rehabilitation is much quicker and regulation of the healing process with long term post-op drops is unnecessary since the center of the cornea tends to have much less of a healing reaction than the surface.
Utilizing sophisticated computer driven software, the excimer laser generates laser beam energy creating more treatment pulses in the meridian where the cornea is steeper or higher, and less so or none at all in the regions of the cornea where it is flatter, thus “rounding out” the more football shaped corneal surface in astigmatic eyes.
Radial Keratotomy (RK) is a surgical procedure that can also correct nearsightedness by changing the shape of the cornea. Microscopic incisions of 90% depth, placed in a radial pattern, like the spokes of a wagon wheel, reshape and flatten the central cornea, allowing light to focus more precisely on the retina. The length and number of incisions determine the effect of the surgery. Patients with less than 3 diopters of nearsightedness and stable prescriptions are the best candidates.
INTACS - Refractive Intra ocular lens (RIOL)
A variation of RK, called astigmatic keratotomy or AK, is a very effective means of reducing astigmatism. By making incisions in an arc-like or segmental fashion parallel to the white of the eye where the cornea is steep, it is caused to relax and become more spherical.
In the past ALK was used. In this procedure a thicker layer of the cornea was folded back with the microkeratome. Pressure inside the eye causes the corneal bed to steepen, the opposite of what occurs in LVC. The cap was placed back into position without the removal of additional tissue. Although it has been shown to effectively reduce or eliminate farsightedness in the +1.00 to +5.00 range, enough cases of corneal instability have been reported nationwide that this procedure has fallen out of favor. Now LASIK for hyperopia is considered by most to be the best option.
Conductive Keratoplasty (CK) uses a needle-like probe to deliver radio-frequency energy to the corneal collagen in a ring of individually placed spots to steepen the cornea. Farsighted patients with a prescription between +0.75 to +3.25 and no more than 0.75 diopters of astigmatism are the best candidates for this procedure. Because of mild regression and a lack of long-term results, the procedure has been labeled as temporary.
Laser Thermal Keratoplasty (LTK)
Now both PRK and LASIK are possible and effective for hyperopia. The procedure is identical to the myopic (nearsighted) procedure, however by blocking the laser from treating centrally and allowing it to remove more tissue in the periphery of the cornea, a steepening rather than a flattening of the cornea is produced.
The results of laservision correction are quite remarkable. In the U.S. clinical trials that were reviewed during the approval process for laser correction of nearsightedness, 100% of the patients studied experienced improved or uncorrected vision. Over 90% were returned to 20/40 sight or better — the “driving standard” in most states — and were able to enjoy life and perform most activities without glasses or contacts. With refinement in techniques since the studies, 95-98% of eyes with mild to moderate myopia who undergo PRK vision correction achieve 20/40 vision or better – enough to pass a driver’s exam without glasses with a single procedure. Two-thirds achieved 20/20 vision.
Yes, both the PRK and LASIK procedure have been FDA approved. Specific amounts of correction approved for treatment vary according to specific laser manufacturers
The great majority of all nearsighted Americans are potential candidates for the laser treatment. Patients must be at least 18 years of age, have mild to moderate near sightedness with a stable prescription, and have no ocular or health issues. The best candidates tend to be people who are dissatisfied with their glasses or contact lenses and are motivated to make a change, whether it’s due to occupational or lifestyle reasons.
Although a patient’s prescription may make him or her a suitable candidate for laser vision correction procedure, it is very important that the patient have the appropriate level of expectations regarding the outcome of the procedure. Although uncorrected post-op vision (after healing) is usually excellent, no one can promise you 20/20 vision.
A person is a good candidate for Laser vision correction if he or she expresses the following sentiments in discussing whether or not to undergo the procedure:
- I dislike being dependent on glasses for clear vision.
- I was never a good contact lens candidate/wearer.
- Wearing corrective lenses restricts my participation in sports and other activities.
- My overall appearance is improved without glasses.
- I worry about losing my corrective lenses (or breaking my glasses). Without them I fear that I would be totally disabled.
- Having good vision without corrective lenses is more important than having great vision with corrective lenses.
- I would be happy if my vision was greatly improved, even if I still had to wear corrective lenses some of the time.
- I usually adjust well to change.
- I am a fairly easy-going person.
- Not wearing corrective lenses would open new career opportunities for me.
- I have often wished I did not have to wear corrective lenses.
A person is probably not a good candidate for Laser vision correction if he or she expresses the following sentiments in discussing whether or not to undergo the procedure:
- I like wearing glasses and would feel uncomfortable without them.
- I don’t mind wearing contact lenses.
- They give me excellent vision for all activities.
- I don’t accept changes easily.
- I get upset or stressed out easily when things don’t seem to happen in just the way I had planned or expected.
- I am a perfectionist and little irregularities bother me.
- I would be very upset if I did not end up with perfect vision after my procedure and would probably consider the entire experience a failure.
- If I needed more correction after my procedure, I would be devastated.
A patient is also not a good candidate for Laser vision correction, if any of the following conditions are present:
- Less than 18 years of age
- Progressive myopia/unstable refractive error (>0.25-0.50/yr)
- History of keloid formation (there may be a relationship with significant post-operative haze in the cornea although no association has been proven)
- Keratoconus – an abnormal progressive weakening of the cornea that your doctor can detect with a sophisticated computerized machine called a corneal topographer as well as other tests
- Pupil size greater than 7 mm in diameter (in dim illumination) are only candidates for LADAR
- Cataracts – removal of the cataract with insertion of the appropriate implant lens will greatly reduce one’s dependence on glasses
- Unwilling to commit to post-procedure and follow-up care instructions
- Ocular herpes
- Uncontrolled diabetes
- Uncontrolled inflammatory diseases
Most refractive surgeons now believe that -10D is the upper limit for good patient satisfaction, although LASIK can be used effectively under certain circumstances for prescriptions as high as -12D. Above these levels, other procedures involving the implanting of lenses inside the eye will probably become the procedures of choice. PRK is approved by the FDA for treatments of up to -12D. However, most surgeons prefer LASIK to PRK when treating more than 4D of myopia. Corneal thickness measurements are very important and this also limits the amount of correction that is performed.
A full eye exam is needed in order to determine if you are a good candidate. If you have had a corneal injury, it will depend upon the size and type of injury.
WHAT TO EXPECT DURING THE PROCEDURE
There is no discomfort at all during the PRK procedure. Following the procedure, you may experience a gritty sensation with some mild to moderate discomfort which we alleviate by putting a contact lens and giving you anesthetic drops and pain medication to use during the first 24 hours in the event of severe discomfort. All discomfort should be completely resolved within 2-3 days as the surface layer fills in to cover the exposed corneal nerve endings. All discomfort should be completely resolved within 2-3 days except in the rarest of cases.
During the LASIK procedure there is no pain, however there is about 30 seconds of firm pressure while the corneal flap is being created. Following the procedure, patients may experience some scratchiness that is relieved by the use of anesthetic drops.
Most patients undergoing LASIK and PRK prefer to have both eyes treated on the same day since it is more convenient for them, however this is a decision entirely between the patient and the doctor.
Yes. Your doctor will need you to fixate on a red blinking light in the microscope during the procedure. This will ensure that the tissue removed will be centered over your pupil (the shutter of your eye).
Both lasers used at Millennium Laser Eye Centers, the WaveLight Allegretto and the VISX Star S4, have a tracking device. With that device the laser detects and compensates for small movements by guiding the laser beam to keep it centered precisely over the treatment area providing the highest level of precision, comfort, and safety.
Most patients will be able to return to their normal activities within a few days as long as they work in a clean environment. Procedures are performed on a variety of days to accommodate your work schedule.
In PRK, because the laser removes tissue from the surface of the eye, the body will attempt to fill in the defect much like if you had a cut on your hand. Since corneal tissue has different healing properties, the process can normally be regulated with the use of topical steroid drops which patients may be required to use over a one-month period.
In LASIK, these drops are only used for a week. These drops will rarely cause any problems. However, eyes must be monitored on a monthly basis to fine tune the drop dosage and check for any unwanted side effects such as delayed or too rapid healing and elevation in eye pressure (glaucoma). Antibiotic drops are also used for about a week with both procedures. Please see – Post Operative Instructions.
Plan on about 4 short visits in the first three months following surgery. Even if you are seeing well, there are things that must be monitored during the first few months following your procedure to ensure that you achieve the best possible outcome for your vision.
You can shower or bathe the day after surgery. Avoid getting soap or water in the eyes or immersing in the ocean, in a pool or in a Jacuzzi for al least 1 week after the surgery.
It is a good idea to buy new mascara after surgery to avoid infection and it is best to wait 1 week before using eye makeup.
You can resume driving as you feel comfortable with your vision. About 90% of patients are able to drive on their own on the day following LASIK. With PRK, it usually takes about 4-5 days to feel comfortable. You should avoid driving while under the influence of any medications taken following surgery.
You may resume exercises as you wish. Don’t get sweat in your eyes. Try to keep your hands clean and away from your eyes. Swimming, however, should also be avoided for at least two weeks.
WHAT TO EXPECT AFTER SURGERY
Vision is greatly improved but typically blurry immediately after the procedure (20/80-20/200). It generally starts to improve once the surface layer of the cornea (epithelium) has grown back, which in most cases takes 3 to 4 days (approximately 20/40). Vision typically starts to get good within 7-10, days but can continue to be blurry for a number of weeks. For most patients, vision stabilizes within 3 months (some may take 6 months or longer). The healing process varies for each patient, and it is difficult to predict precisely when you will achieve your best visual acuity. However, most patients who have both eyes treated at the same time report that they are able to drive a car safely and resume their normal activities between 3-5 days following PRK.
The first day after LASIK, most patients have experienced a large improvement in their vision, to approximately 20/40 or even better. This greatly depends on your preoperative prescription. You can expect to regain approximately 75% to 80 percent of your vision in the first two to three days after LASIK. The remainder of your vision will improve gradually over several weeks. If you have significant astigmatism, or are very near sighted/far sighed sight recovery and stabilization are slower
If the patient opts to have only one eye treated at a time, your doctor will need to fit your untreated eye with a contact lens for use during your wait before the second eye is done. This can be done in almost all cases, even if you have not been able to tolerate contacts in the past. The optics of removing the glass in front of your treated eye in your spectacles, while giving clearer vision to each eye individually, will often cause disorientation and headaches due to image size discrepancy, unless your original prescription was less than -3.00.
As people enter their 40s, they start to develop presbyopia (see #4). Regardless of whether or not you’ve had Laser vision correction, this process will happen to you. Your surgeon can create an effect known as monovision. This means that one eye will be left slightly nearsighted, thus allowing you to focus on print such as labels and menus without reading glasses, and perhaps allowing you to read into your 50s. As one gets older, it will be necessary to wear reading glasses. Furthermore, if you are over the age of 40 and are used to removing your glasses to read, you must realize that this will no longer be an option following a full correction of your nearsightedness with the surgery.
Shortly after you have had the procedure, it is possible that you may require a temporary pair of reading glasses if you are approaching your 40th birthday since the laser, by design, causes an early overcorrection that normally goes away with time
If you were able to wear contacts prior to surgery, you should be able to wear contacts afterwards. There may be some increase in difficulty due to the new shape of the front of the eye, however, it is very unusual for patients to require significant corrections after surgery.
Given the results of the U.S. clinical trials and the results reported internationally, the treatment appears to be permanent, however LVC will not prevent age related conditions such as cataracts or presbyopia.
SAFETY AND LVC
The most common side effects of laser vision correction are “halo” effect and some glare at night around lights. These effects most commonly diminish with the normal healing process in 2-3 months. These are related to the area of treatment on the surface of the eye and the size of your pupil in dim lighting. However, these problems are no worse than what most contact lens and eyeglass wearers often experience. Using the WaveLight Allegretto we can more effectively expand the treatment areas more so than any other laser, thereby reducing the risk of the side effects in patients with larger pupilsVision is greatly improved but typically blurry immediately after the procedure (20/80-20/200). It generally starts to improve once the surface layer of the cornea (epithelium) has grown back, which in most cases takes 3 to 4 days (approximately 20/40). Vision typically starts to get good within 7-10, days but can continue to be blurry for a number of weeks. For most patients, vision stabilizes within 3 months (some may take 6 months or longer). The healing process varies for each patient, and it is difficult to predict precisely when you will achieve your best visual acuity. However, most patients who have both eyes treated at the same time report that they are able to drive a car safely and resume their normal activities between 3-5 days following PRK.
All eye surgeries carry with them the possibility of infection. The worst case scenario of infection is that it could damage the cornea or retina and result in loss of sight. It is important to put this possibility into perspective when considering Laser vision correction. However, the risk of a catastrophic complication from LVC is probably less than the risk of loss of sight through the use of extended wear contact lenses. In addition, there are other corneal irregularities which can rarely occur. The worst case scenario could be corneal scarring which could require corneal replacement.
While more comfortable and yielding quicker rehabilitation of vision, LASIK is technically more difficult to perform than PRK and carries with it a slightly higher complication rate. This is because there is an extra step involved – the creation of the corneal flap. This is rarely associated with any considerable or permanent vision loss, however, there are occasional circumstances which could cause flap wrinkling, or incomplete flaps which could lead to vision difficulty, requiring further procedures.
In the U.S. clinical trials’ 3-year follow-up, no sight-threatening complications were reported. And with over five million treatments performed nationwide, very few sight-threatening complications have occured.
Many of our patients have expressed understandable concern by asking, “What happens if there is a power cut during my laser treatment?” The answer is that we have a very sophisticated uninterruptible power supply (UPS) that will take over and supply needed power to the laser to complete any treatment started.
The laser will run for more than 20 minutes following a power cut, more than enough to complete any procedure. Our UPS unit provides pure sine wave technology for perfect mains voltage reproduction and regulation. This means that no matter what happens to the mains voltage, including current sags, or “brown outs,” all of our 3 lasers is provided with continuous alternating current power, exactly the same power that operates them under normal conditions.
I WOULD LIKE TO HAVE LVC
Understandably, patients are often confused as to why LASIK pricing may differ from one office or laser eye center to another. Below are the principal factors that distinguish premium LASIK centers such as Millennium from the discount centers:
- Surgeon Experience and the Patient Experience
Because Dr. Lessner has dedicated his entire professional career as an eye surgeon to just performing refractive surgery procedures, he has successfully performed over 13,000 LASIK procedures and over 30,000 total refractive procedures. This is all that he does, and as such, is not distracted throughout the day or week with glaucoma patients one day and cataract surgery patients the next as so many of his colleagues do.
As any consummate surgeon, Dr. Lessner has carefully hand-picked and brought to Millennium an incomparable, highly skilled professional team with over 100 years of collective experience in the refractive surgery field. With this team, Dr. Lessner believes that the patient experience is optimized with personalized education and a detailed, no cost consultation with a doctor to best determine which laser technology is most beneficial to you. We are singularly focused to meet and even exceed your expectations, as this is all that we do at Millennium.
Dr. Lessner stands behind your results by offering a two year post-procedure period of no cost enhancements, if necessary. Discounts centers cannot afford to offer this benefit and would have to charge extra for it, as they often do with other parts of the process as well. We are happy to provide a permission-based list of our patients upon request, which can additionally include similar prescription as well as similar occupation. We encourage patients to visit the center and even observe Dr. Lessner perform a live LASIK procedure, if they wish.
- Dr. Lessner is the team LASIK surgeon for all professional sports teams in South Florida.
If members of the Miami Dolphins, Florida Marlins, Miami Heat and the Florida Panthers trust their precious eyes and professional sports careers to Dr. Lessner, so can you – the Millennium Difference.
- The Latest Technology, Exclusive to all of Florida to Jacksonville
LASIK is a two-step procedure. Firstly, the femtosecond laser (FS200/IntraLase) more safely creates the delicate corneal flap to better prepare the eye in a uniquely precise manner than with the traditional, bladed microkeratome. Secondly, the actual prescription correction is performed utilizing the ultrafast, wavefront optimized Wavelight Allegretto laser, featuring perfect pulse technology to better preserve the eye’s more natural shape, and the only one of its kind in all of Florida to Jacksonville. To complete our commitment to premium laser technology, we also have the VISX Star 4 for CustomVue wavefront-guided vision correction for those who measure with higher order aberrations that may account for poorer quality of vision. All of these FDA approved premium technologies, when taken together is exclusive to Florida and onto Charlotte, NC, serve to enhance both the quantity as well as the quality of vision, especially for those who may already suffer from some nighttime glare and halo.
Not limited to just one laser, Dr.Lessner is able to choose which premium technology will provide the very best results for each patient, personalizing each treatment plan every step of the way – another Millennium Difference.
- The Premium Practice – A Center of Excellence
By having our own dedicated laser center we have control over the entire process, each step of which actually allows us to achieve the very best possible results for each of our valued patients. From the exclusive temperature and humidity control offered by our 24 hour Liebert system to our commitment to frequent, ongoing scheduled maintenance and calibration of all our medical equipment and laser technologies, these investments serve to yield better care for our patients. Dr. Lessner and the entire professional team at Millennium Laser Eye Center are involved all year long in continuing medical education to stay abreast of any new developments in the refractive surgery field. Indeed, many of our staff are recognized experts in their areas of refractive specialty, participating as featured lecturers to other doctors and technicians at national and international conferences.
The state-of-the-art combined use of the femtosecond laser (FS200/IntraLase) blade-free creation of the corneal flap and either wavefront-optimized (Wavelight Allegretto) or wavefront-guided (Visx S4 CustomVue) laser vision correction make for an All-Laser LASIK procedure with unprecedented safety, accuracy and results.
Together with this most advanced laser technology and dedicated surgical expertise and uniquely personalized treatment planning, we are able to provide you with a premium laser vision experience.
Premium LASIK at Millennium can certainly be an exciting alternative to the more traditional annoyance of glasses and contact lenses for most people.
Dr. Cory Lessner and the professional team at Millennium Laser Eye Center are recognized as the leader in LASIK laser vision correction in the Southeast. Here’s why:
- 20 years of exclusively dedicated LASIK refractive eye surgery – it is all that we do.
- Extensive training and expertise of our eye surgeon – Dr. Cory Lessner.
- Entire staff boasts over 100 years of collective experience in the refractive surgery field.
- The most advanced laser corrective and flap technology available in the entire Southeast US – for uniquely safe and precise corneal flap creation for premium results.
- We are first and only laser eye center in the Ft. Lauderdale/Broward County area to offer the IntraLase laser for uniquely safer flap creation.
- Dr. Lessner is the official team laser eye surgeon for all four professional sports teams in South Florida – Miami Dolphins, Miami Marlins, Miami Heat and Florida Panthers.
- We have the advanced Pentacam and also the orbscan corneal mapping technology for more definitive diagnosis and treatment planning.
- Dr. Lessner is now more often consulted for treating the more complex cases that other less experienced surgeons are uncomfortable with.
- Our laser theater has a Liebert system, the most sophisticated air quality and filtration system available in the world.
- Our medical lasers and instruments are more frequently maintained and calibrated than the industry standard.
- A fresh set of sterilized instruments are used for each patient.
- Our very unique and comprehensive information systems technology allows us to track and analyze our outcomes to achieve the best possible results, significantly lowering your need for possible retreatment to less than 7%. This unprecedented computer-based technology is now coveted by many surgeons around the US.
- Included in your care are two years of free enhancement, no matter what your prescription, if necessary.
Please contact Millennium Laser Eye Center at 1-888-93-LASIK to speak with a counselor who will be happy to schedule a complimentary appointment for you, or you can contact us by email by filling out the “Ask Millennium” form at the top left of your screen. You can also learn more about your candidacy by taking our exclusive online consultation
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