Laser Vision Correction Overview
S. Ejaz Husain MD, FACS
Laser Treatment for Correcting Near-sightedness, Far-sightedness and Astigmatism
To Our Patients
Laser Vision Correction is an exciting alternative to contact lenses and glasses. Since 1995, tremendous progress has been made in the field of laser vision correction in treating refractive errors of the eye such as near-sightedness, far-sightedness and astigmatism. This technology has proven remarkably effective in reducing or eliminating dependence on glasses and contact lenses. The following information provides you with an overview of laser eye surgery in general. We use the most advanced VISX STAR ActiveTrak excimer laser with CustomVue technology & Variable Spot Scanning, which utilizes the latest and very best technology available today. This is the only laser that uses the advanced 3-Dimensional eye tracking system, developed specifically for tracking the human eye during laser vision correction.
We truly care for our patients and Dr. Husain personally examines every patient himself. Our belief is that laser vision correction is a surgery, and it is in the best interest of every patient to follow up with their surgeon both pre-operatively and post-operatively. We believe in a conservative approach and with this philosophy have enjoyed among the lowest complication and enhancement rates in the field. Being a part of an established and reputable practice in Des Moines, Dr. Husain’s patients like the easy access to their surgeon. Patients choose us primarily because of our excellent outcomes and quality of care.
To discuss these matters further, please call Dr. Husain’s Laser Vision Coordinator at (515) 244-EYES (3937) or e-mail us.
When it comes to your eyes, there should be no compromise.
It is important to understand that Laser vision correction is a surgery. As with all surgery, the results are dependent on the skills, experience, judgment and ethics of the surgeon. Please do not be misled by inaccurate, aggressive and overly sensational advertising that is commonly seen in the newspapers and the media. Since Lasik is economically driven, some practices tend to trivialize the procedure in order to gain market and patient share. Since all surgery has some risk associated with it, the critical thing the patient needs to understand is that an experienced surgeon is the most qualified individual to evaluate, perform surgery and do follow up care. Therefore, it is important for you to know who will be evaluating your eyes, and who will be providing follow-up care after your surgery. If an improper claim is made by someone that the surgeon will not need to see you after surgery, then this should raise a red flag and prompt appropriate questioning by the patient. A medical procedure on your eyes is not a product that should be commissioned. It is also important to understand that excellent results come from being very selective in choosing the right candidates and not by doing surgery on everybody who walks into the clinic. Not everyone is a candidate for refractive surgery.
All technological devices used in Laser Vision Correction should be approved by the FDA. The FDA studies show that all these devices are equivalent in their efficacy, safety and predictability. It would be inappropriate for the FDA to approve lasers or devices that are unequal in their safety profile. Therefore be wary of claims in ads that try to attract patients with claims of superior technology and safety. Numerous studies have shown that it is in fact the surgeon’s experience, judgment and quality of care which drives the results. The technology is only as good as the surgeon utilizing it. If the surgeon is meticulous in managing the patients and is attentive to detail, the chances of a successful outcome are maximized. It is also better to use state of the art technology that has undergone rigorous and exhaustive testing over a long period of time in millions of patients (industry standard), rather than jumping on the bandwagon of a new technology that has just been approved and has not undergone extensive long-term follow-up. A conservative approach to surgery is very important. Although we all look forward to better technology for our patients, be wary of claims in ads that just seem to push technology. Similar claims were made over the last few years with Intacs and LTK, which despite the great hype, have been discarded by most ophthalmologists.
Make sure your surgeon is accessible to you when you need him or her. Non-medical personnel care is not equivalent to the care that the surgeon can provide. Your goal is to find a center that will provide the best surgery and state of the art equipment; and a surgeon who will provide an honest assessment about your likely outcomes and risks and personalized quality care after your surgery.
Make sure your surgeon personally answers all your questions and concerns. The surgeon should also discuss other alternative procedures, their risks and benefits. A lot of places are becoming like factories, and patients are literally getting in and out of chairs. In our desire to promote the positive aspects of refractive surgery, one should not minimize the potential for complications nor forget that everyone is not a suitable candidate for existing technology.
- Careful and meticulous pre-operative evaluation by your surgeon is probably the most important factor leading to a successful outcome in Laser Vision Correction. Make sure your surgeon personally evaluates your eyes and does not rely entirely on non-medical personnel.
What is laser eye surgery?
Lasers are used to treat many eye conditions. Since 1995 one of the most exciting advances has been the development of lasers in treating refractive errors of the eye, that is, near-sightedness, far-sightedness and astigmatism. In fact, the laser we use to treat these eye-focusing problems is FDA approved for both Lasik and Advanced Surface Ablation (ASA).
What are refractive errors of the eye?
How Does The Eye See
The eye is like a camera that has two lenses. One of these lenses is the crystalline lens inside the eye. The other lens is the cornea, which is positioned in the eye like a watch crystal which actually provides 2/3 of the eye’s focusing power. When the light rays entering the eye are perfectly focused on the retina, the eye is neither nearsighted nor farsighted. This condition is called “emmetropia.”
Myopia, or near-sightedness, occurs when the eye has too much focusing power. As a result, objects at distance are blurry, whereas objects that are close can be clearly seen (unless astigmatism is present). Typically, the myopic eye is slightly longer or has a steeper cornea compared to the normal eye.
Hyperopia, or far-sightedness, occurs when the eye lacks sufficient focusing power. This usually causes objects at a distance to appear blurry, and near objects are seen even less clearly. Typically, the far-sighted eye is slightly shorter or has a flatter cornea than the normal eye.
Astigmatism is a condition in which light rays in different orientations are brought to different points of focus. A useful analogy is the comparison of a basketball to a football. The surface of a basketball has equal curvature in all directions, whereas a football is flatter in one orientation and steeper in the other. The surface of the football represents the situation that is present when the eye has astigmatism. Usually, the astigmatism occurs in the cornea. This can often be corrected with glasses or contact lenses, or in many instances, treated with refractive surgery.
Presbyopia is a natural condition that typically becomes noticeable around age 45. In children and young adults, the crystalline lens inside the eye can focus at a distant object and then easily increase its focusing power to look at a near object. As we get older, the lens inside the eye loses this capacity to focus in and out. When this occurs, individuals find that they need to hold reading material at greater distances. Ultimately, reading glasses are needed, typically by the mid-40s.
What is Refractive Surgery?
Refractive surgery involves the use of lasers or other devices to treat the refractive errors of the eye.
LASIK (laser in situ keratomileusis)
LASIK is an excimer laser surgical procedure that treats the middle layers of the cornea to correct near-sightedness, far-sightedness, and/or astigmatism. LASIK is FDA approved and is the most advanced procedure for correcting focusing problems of the eye. LASIK is performed using numbing drops to prevent pain during the procedure. A vacuum ring secures the eye while a thin layer of the cornea is formed into a flap. This is done with a microkeratome, which is a specialized instrument that makes the corneal flap. This flap is folded over, and the laser surgery is performed on the bed of the cornea that is exposed. The laser treatment reshapes the cornea to treat the refractive condition. The actual laser portion of the procedure lasts 10 to 60 seconds. The flap is then placed back into its original position and observed for 2-3 minutes to insure that it is fully adherent.
Advantages of LASIK include:
- Little or no discomfort following the surgery
- Recovery of vision often within 1-2 days
- Little or no risk of developing haze following treatment
- Ease of doing additional laser treatment should this be necessary.
Flap Free Laser Vision Correction
ASA/PRK (Advanced Surface Ablation/Photorefractive keratectomy)
ASA uses the excimer laser to reshape the front surface of the cornea to change its focusing power. Surface cells of the cornea (the epithelium) are gently removed from the central portion of the cornea, without creating a flap, to expose the region of the cornea that is treated with the laser. The actual laser time is similar to that with LASIK. The surface cells require two or more days to heal. A soft contact lens is placed over the eye during this period to serve as a bandage. ASA has been FDA approved for treatment of near-sightedness, far-sightedness and astigmatism with the VISX Star laser and long term safety and efficacy has been well established. ASA has been very useful for eyes that have thin corneas as well as those with corneal dystrophies, corneal irregularities or those who have occupational safety needs. Many of our patients like the concept of flap free surgery and choose this option.
We use the VISX Star ActiveTrak excimer laser system to treat near-sightedness (myopia), far-sightedness (hyperopia) and astigmatism. Dr. Husain has been specially certified to use the VISX laser. VISX is the choice of more eye doctors for their patients, and more people have been treated with the VISX laser, which is FDA approved for LASIK and advanced surface ablation (ASA).
We also use CustomVue Wavefront technology to provide our patients with individualized laser vision correction, which is more precise than conventional laser treatment.
About Our Physician
Dr. S. Ejaz Husain graduated Magna Cum Laude from the Ivy League Brown University in 1986. In 1990, he received Doctorate in Medicine with honors from Brown University School of Medicine. He completed his Ophthalmology residency at Baylor College of Medicine in Houston, Texas where he also completed a two-year surgical fellowship program in Cornea, Cataract and Refractive Surgery. Dr. Husain was then invited to stay on as faculty at Baylor College of Medicine where he taught Anterior Segment and Refractive Surgery.
Dr. Husain has been involved in laser vision correction since 1994. He has authored over twenty research articles and educational chapters in peer-reviewed medical journals. He is the recipient of the prestigious Paul Kayser scholarship awarded by the Pan American Association of Ophthalmology for Refractive Surgery. He is also certified to perform LASIK as well as PRK/ASA and has performed thousands of procedures. He is certified by the American Board of Ophthalmology.
He is a fellow of the American Board of Ophthalmology, the American College of Surgeons and a member of the American Society of Cataract and Refractive Surgery, Pan American Association of Ophthalmology, American College of Eye Surgeons, American Medical Association and Iowa Medical Society.
Who is a candidate? Is it right for me?
If you are over 18 years of age and have myopia (near-sightedness) with or without astigmatism, you may be a candidate for refractive surgery.
If you are over 21 years old and have hyperopia (far-sightedness) with or without astigmatism, you may be a candidate for refractive surgery.
Refractive surgery can reduce and even eliminate refractive errors in most patients. Depending on the degree of near-sightedness, far-sightedness or astigmatism the chances of seeing 20/40 or better after surgery (legal to drive without glasses) may exceed 95%.
While results are good in most patients, no one can promise that you will be able to “throw away your glasses” after surgery. If, however, your goal is to reduce your dependence on glasses or contact lenses, then refractive surgery may be for you.
If you elect to have refractive surgery, several conditions are necessary to maximize a good result. Your refractive error (spectacle prescription) should not have changed significantly over the previous year -- this ensures that your correction is stable and that the treatment will be more precise. Your eyes must be healthy without conditions such as keratoconus (a progressive thinning of the cornea), or corneal scars.
Since the results of refractive surgery depend to a large extent on normal healing, patients should not have any eye disease (such as glaucoma or severe dry eye) or medical illness (such as lupus or rheumatoid arthritis) that may interfere with recovery. Your suitability for the procedure can be determined following a complimentary screening and a personal consultation with Dr. Husain. We appreciate that the decision regarding refractive surgery is very personal and we believe that it should be made only after you are fully informed about your options.
Prior to the procedure you will have a screening exam with Dr. Husain to determine whether you are a good candidate for the surgery. Since contact lenses may have temporarily changed the curvature of the cornea, we ask you to discontinue soft lens wear for two weeks and rigid gas permeable lens for three weeks prior to the “final examination” with Dr. Husain, which is usually the week before your procedure. This allows the cornea to return to its “normal” shape. Pregnant patients may also have undergone temporary corneal changes, and therefore we do not recommend refractive surgery until several months after delivery. If, after the screening examination you are determined to be a good refractive surgery candidate, an appointment will be made for the procedure.
On the day of your procedure, you will be shown the laser room, and all the events of the surgery will be explained to you. You will also be asked to listen to the different sounds of the equipment so you are prepared for the noises that you will hear during surgery. Anesthetic eye drops will be placed in your eyes, and a small instrument will be placed between your eyelids to help you keep them open during the treatment. Dr. Husain will then perform the procedure and afterwards recheck your eyes. You can return home immediately after the procedure. We ask that you arrange for transportation to and from the laser center, as you will not be permitted to drive yourself home after your Laser Vision Correction.
Following your surgery you will be given drops to use on the evening of surgery and for several days afterwards. You can expect some discomfort following the procedure, but this is highly variable depending on the individual patient and the specific procedure performed. You will be instructed not to get water in your eyes and to avoid eye make-up or lotions around the eye for one week following the surgery. You will also be cautioned against eye rubbing in the early post-operative period. Postoperative examinations will be scheduled for the day after surgery and, (generally) depending on the procedure, 2-7 days later. We request that our patients be accessible to us for at least 7-10 days after surgery. Additional examinations will be planned for 6-8 weeks following surgery and as needed to ensure that all is going well with your eyes.
Risks and Benefits
When considering refractive surgery, as with any procedure, the patient and the physician work together to evaluate the relative risks and benefits for each individual patient. The benefits of the procedure are a reduction (and possible elimination) of near-sightedness, far- sightedness and astigmatism. A successful outcome decreases an individual’s dependence on glasses or contact lenses, and in some cases allows one to function without the need for any glasses or contact lenses. This has permitted many patients undergoing the surgery to participate in a variety of activities not previously possible due to their need for glasses (such as water-skiing or scuba diving). When patients discuss their individual experiences following refractive surgery, they frequently describe a general improvement in their overall quality of life as exemplified by such experiences as being able to see the alarm clock in the morning without glasses.
As with all procedures, refractive surgery is not without risk and side effects. One side effect of the successful correction of myopia is that you will need reading glasses at about age forty-five to see near objects. For nearsighted individuals before surgery, “nearer is clearer”. However, after surgery, if you are older than 40 years of age, you may experience the same difficulty with reading fine print experienced by all “normal” individuals that have never been nearsighted. This may be improved somewhat by intentionally adjusting the treatment of one eye to allow it to remain somewhat nearsighted (blended vision). If you are in this age range, we will discuss this option with you.
Because the surgery involves removal of tissue to change corneal shape, other complications are possible, although they are rare. Infection, if it occurs, can cause corneal scarring and reduce vision, which may not be correctable even with glasses or contact lenses after surgery. Other complications that may occur during or after the surgery include little or no reduction in near-sightedness, inaccurate correction resulting from surgery, scarring of the cornea, healing problems or other unexpected results. Any of these, if they are significant, may require the use of glasses or contact lenses for good vision. In rare instances, as with any surgical procedure on the eye, vision may be permanently reduced as a result of a complication.
Fortunately, the occurrence of significant complications with refractive surgery is very rare. It is important, however, to realize that even though the risks are low, there is no such thing as risk free, guaranteed surgery for any condition.
The fee for surgery covers the initial evaluation, surgery, postoperative surgical care, enhancement (touch ups), and any follow-up for up to one year related to the procedure. We will discuss surgery fees with you at the initial complimentary screening exam with Dr. Husain.
There is a fee for digital corneal topography and Wavescan diagnostics. Dr. Husain will perform an extensive eye exam at the pre operative evaluation as well in preparation for your procedure.
Financing options are available to assist those who are unable to pay the full fee for the procedure at one time. Please ask us regarding financing options.
The cost for Laser Vision Correction is currently not covered by insurance. The financial advantage of laser refractive surgery is that the high cost of contact lenses, solutions and spectacles may be reduced, which could result in savings of up to several hundred dollars per year.
Medical saving accounts and FLEX spending accounts have been used for laser vision correction by a large number of our patients. Please ask us for details. It is important to have a screening exam before you decide to use the FLEX/medical saving accounts option.