eye laser surgery : Eye laser surgery 'risky'

People who undergo laser surgery to correct short sight could experience serious eye problems in the future, a leading specialist has warned.
Professor John Marshall, professor of ophthalmology at London's St Thomas's Hospital, said patients who opt for laser surgery should be aware of the risks involved.

He warned of a number of cases where patients suffered major complications and required a cornea transplant following laser treatment.


He said more research was needed to determine whether the treatment - known as the Lasik technique - was completely safe.

The technique corrects poor eyesight by cutting through the 'fibrils' that hold the cornea together and by scraping off a third or more off the thickness of the cornea.

It has become very popular in recent years with many people choosing surgery instead of wearing contact lenses or spectacles. More than a million procedures were carried out in the USA last year.

It is offered as a 'painless' treatment which takes minutes and restores vision almost immediately.

The old technique - called PKA - was painful and left patients with blurred vision for several weeks.

Lack of testing

But Professor Marshall said the older procedure was tested for 10 years before being authorised and has proven to be safe in follow-up studies.

"The follow-up studies for Lasik have not been as good and patients should be made aware of this when they are being advised by doctors.

"PRK, Lasik and cataract surgery are among the safest surgical operations carried out. But like any surgical procedures there is a risk. More research needs to be carried out to determine the risks involved with Lasik."

He called on doctors to make patients aware of the risks of laser surgery.

Dr David O'Bratt, a consultant ophthalmologist at the same hospital and part of a team from the Royal College of Ophthalmologists appointed to draw up guidelines on laser surgery, said he believed most patients were told about the risks.

"I would say the vast majority of doctors tell patients about the risks. Because this is a new treatment we do not know all of the risks, as with any new procedure."

© MMIII

eye laser surgery : Are these treatments safe?

All of these treatments have been approved for use in the UK and are therefore considered safe.

However, medical opinion is somewhat divided over some of the newer treatments.

This is largely because they have not been around very long and there are no long-running studies into the long-term effects of some of the treatments.

In addition, all surgery is not without its risks and eye surgery is no different. Doctors are expected to warn patients that the treatment does involve risk.

In some cases, patients have suffered major complications and required cornea transplants following laser treatment.

Can everyone have laser eye surgery?

No. Eye laser surgery is only suitable for certain people. It is usually only performed on healthy adults.

People who have just mild eyesight problems are not generally considered good candidates. Similarly, those whose eyesight has changed significantly in the past 12 months may also be refused because their eyesight is still getting worse.

Diabetes, pregnancy and arthritis and other similar conditions can also rule people out.

How popular is eye laser surgery?

Eye laser surgery is getting more popular every year not least because prices are coming down and the treatment is more widely available.

It is estimated that more than one million Americans are now having their eyes lasered in the US each year.

© MMIII

eye laser surgery : What is eye laser surgery?

Eye laser surgery

Sir Elton John is the latest star to say he is planning to throw his spectacles away and undergo eye laser surgery.
BBC News Online examines the procedure and why it is proving popular with so many people.


What is eye laser surgery?

Traditionally, eye sight problems are corrected with spectacles or contact lenses.

In recent years, lasers have become a popular alternative. The laser is directed on the cornea, the outer, clear round structure that covers the colored part of the eye (iris) and the pupil.

For people with short-sightedness, for instance, the laser is set to reduce the thickness of the cornea. This enables the eye to bring images into focus properly.

The cost of eye laser surgery varies between clinics but generally starts at around £500 per eye.

Are there different types?

Yes. There are three main types of eye laser surgery.


The newest and most popular type of eye laser surgery is called LASIK. Under this procedure, a thin layer of the eye's cornea is sliced off to create a flap. This enables the laser to target the tissue underneath. The flap is simply replaced and grows back naturally. Vision is restored almost immediately.

Another option is EPIFLAP or LASEK surgery. This involves the partial removal of the epithelium or outer layer of cells on the eye to reveal the cornea. The cornea is then flattened or reshaped by a laser and the outer cells are pushed back and the eye heals within a few days.

PRK was the standard eye laser surgery for many years. It involved the complete removal of the epithelium or the outer layer of cells on the eye.

LASIK is usually used on patients with severe long sight or short sight. LASEK is used on patients with moderate or mild short sight.

© MMIII

eye laser surgery : Can I Afford LASIK?

The eventual cost of your LASIK procedure will most likely be related to the quality of the eye doctor you choose.

Choose your eye surgeon carefully

If you’ve been considering LASIK eye surgery, one of the most important things to do is choose your eye doctor wisely. Put aside the question of cost for a while, and focus on finding the best quality surgeon. It’s wise to check on:

· Credentials

· Professional affiliations

· Extent of experience

The best LASIK surgeons have extensive experience. They select their patients carefully too, because not everyone is a good candidate for LASIK.

So take the time to interview several, ask lots of questions, and if the doctor seems more interested in processing great quantities of patients than in treating you as well as possible, move on.

Don’t believe advertisements

LASIK costs are quoted per eye, and they vary nationwide. If you see ads that offer “LASIK surgery from $499 per eye”, read any small print there might be. Not everyone will qualify for that low price and there could be hidden costs too.

Our eyes are as individual as our fingerprints, and each eye can be different from the other, requiring different treatment. A good LASIK doctor will customize your treatment to give you the best eyesight you can have. No matter what the context in life, customizing always takes more time and expertise, and yields a better result.

Wavefront-guided LASIK is an especially good choice from this perspective, because it so accurately maps your individual eye characteristics, and guides the treating laser accordingly.

LASIK costs have been rising

Over the past 3 or 4 years, several factors have contributed to rising prices:

· More demand for LASIK

· More expensive technology which yields a better result but isn’t used by all doctors

· Varying amounts of pre-op testing and screening

Overall, the cost for a LASIK surgery is in the vicinity of $2,000 or higher.

What’s covered in the cost

When shopping for your eye doctor, ask exactly what’s covered by the quoted LASIK price. The price may or may not include the cost of:

· Screening and testing

· Post-op medications

· Follow-up visits – and if some are included, how many, for what period of time?

· Doctor evaluations to decide whether any extra, or “enhancement” surgery will be appropriate in any given case

· Any enhancement surgery that might be deemed necessary

· Re-treatments during the rest of your life

Remember too that in order to give you a quality LASIK surgery, the surgical facility must cover many expenses, such as:

· Purchase or lease of the laser, microkeratome, and other equipment, and their maintenance

· Disposables which are essential for sterility, like gloves, masks and gowns

· Royalty fees to the laser manufacturer

· Specialized items used during the procedure, such as medications, surgical solutions and blades for the microkeratome

· Insurance

· Facility costs, such as staff salaries and benefits, office equipment, office supplies

· The surgeon’s fee

Financing choices

When choosing your eye doctor, ask what financing options his facility offers. Some centers offer low-interest or even no-interest plans. Some offer a plan that’s extended over a longer period so that the monthly payment can be lower.

Also consider the following:

· Some credit cards give free airline miles and a $2000 charge might qualify you for a free ticket

· Many employers offer Flexible Spending Accounts which set aside pre-tax dollars to cover medical expenses, and this could save you hundreds of dollars

· Depending on your circumstances, LASIK might be tax deductible, so check with your tax person

We have only one pair of eyes, so why not give them the best possible care and optimize their function? By doing our homework ahead of time in choosing a good doctor, by taking advantage of good financing options, and by careful financial planning within our own budget, most of us can probably afford this rather miraculous LASIK surgery.

By Sara Goldstein

eye laser surgery : Finding The Best LASIK Surgeon

If you have decided to undergo LASIK surgery you will need to choose a surgeon to perform the surgery. This individual will be responsible for vaporizing part of your eye with an ultraviolet laser. Shouldn’t you pick the best surgeon in your area for the job? Here are tips to help you find the best LASIK surgeon.

LASIK is a form of surgery that reshapes your eye so that images are focused correctly. It does this by vaporizing part of the cornea with a laser. There have been a number of technological advances with LASIK surgery including wave front and custom LASIK; however, you are still in the hands of your surgeon when it comes to getting the job done.

Picking a good LASIK surgeon is important. This is important not only for the quality of the surgery you receive, but the follow up offered in case additional treatments are needed or complications arise. Choosing a surgeon because they have an insert in the Sunday paper with the lowest price may not be the best thing for your eyes.

A good LASIK surgeon has performed LASIK surgery for a minimum of three years; this surgeon should have at least 500 LASIK procedures under their belt. You want a LASIK surgeon with a personal touch. The surgeon’s responsibility does not end after the LASIK procedure. If complications arise or you need additional treatment you want to know that your surgeon will be there for you. You can learn more about finding the best LASIK surgeon in your area by visiting the website LasikEssentials.com using the links below.

By Nick Harper

eye laser surgery : Is LASIK Right For You?

If you are considering refractive surgery such as LASIK to correct your vision problems, your eye care provider will screen you to see if you are a suitable candidate for LASIK surgery. Here is what you need to know when deciding if LASIK surgery is right for you.

LASIK vision correction is effective in correcting nearsightedness, farsightedness, and astigmatism. Presbyopia, a condition that requires reading glasses in older patients, cannot be corrected with LASIK surgery. When you have LASIK surgery the surgeon will reshape your cornea by vaporizing tissue with an ultraviolet laser.

Before you allow someone to do this to your eyeballs, you should probably do your homework about LASIK surgery. Talk to friends and family members that have undergone the surgery ask about their experiences. There are risks and side effects to LASIK surgery so it is best to know what you are getting into ahead of time.

Your eye doctor will evaluate you to decide if you are a suitable candidate for LASIK surgery. Not everyone is a good candidate; if your corneas are too thin for example LASIK will not be possible. Your ophthalmologist will cover all of the risks involved before you agree to LASIK surgery. You can learn more about LASIK vision correction by visiting the website LasikEssentials.com

By Nick Harper

eye laser surgery : Say Bye Bye to spectacles and Contact Lenses

Eye lasik surgery is a form of surgery which is done over the eyes. Eye lasik surgery is simply a procedure which is considered as effective for an individual who is virtually dependent upon the constant use of spectacles and contact lenses. The full form of LASIK is Laser-Assisted in Situ Keratomileusis. Eye lasik surgery is basically a procedure which is designed to make a specific and a permanent change to the contour of the cornea. Even the clear covering of the upper portion of the eyes can be removed through eye lasik surgery. Eye lasik surgery is done extensively with the paramount excimer laser use.

Immense success has been fostered in the process of Eye lasik surgery, but yet it involves certain amount of risk. It is basically advisable to know about the risks and the complications which might crop up after the Eye lasik surgery has been performed. Some of the probable risk factors which are related with Eye lasik surgery are vision loss, continuance of glasses, severe dry eye problem, lack of proper far sighted vision etc.

In order to undertake Eye lasik surgery, the procedures needed are as firstly, the eyes are provided drops of anesthetic. Secondly, a thin flap over the eyes is removed by the surgeon performing the surgery which is helpful in relieving the inner portion of the tissues which covers the cornea. Thirdly, cool computer proscribed pulses are applied in the inner part of the cornea. Fourthly, after this the flap which has been removed is again gently placed in its original place. Irritation at the initial stage is quite common but later on there is the gradual reduction of the complications which might have been caused due to the Eye lasik surgery.

I would like to add something out here. As I myself is a constant user of contact lenses, I sometimes feel like to opt for Eye lasik surgery and just get rid of its use forever. But while I made planning for it, I sat over the internet and made a study of all the signs and symptoms related to Eye lasik surgery and the precautionary measures which is needed to be followed for Eye lasik surgery. But the consequences which sometimes follow Eye lasik surgery had made me to think over the plan once again. But I am quite determined in this respect that when the right time comes for me to undergo Eye lasik surgery, I will definitely go for it.

by Farzina Naznin

eye laser surgery : Eye Surgery With Lasik

To reduce a persons dependency on glasses or contact lenses one can have Lasik surgery. The term LASIK stands for Laser-Assisted In Situ Keratomileusis and is a procedure through which you permanently changes the shape of the cornea. The cornea is the clear covering of the front of the eye.

Doctors use an excimer laser to perform this kind of surgery. A small knife, called a microkeratome, is used to cut a flap in the cornea. A hinge is left at one end of this flap. The flap is folded back revealing the stroma, the middle section of the cornea. The pulses from a computer controlled laser vaporize a portion of the stroma and the flap is replaced. Other techniques are also in use.

The cornea is a part of the eye that helps focus light to create an image on the retina. The bending and focusing of light is also known as refraction. The shape of the cornea and the eye are usually not perfect and the image on the retina is out-of-focus (blurred) or distorted. These imperfections in the focusing power of the eye are called refractive errors. There are three primary types of refractive errors: myopia, hyperopia and astigmatism. Persons with myopia, or nearsightedness, have more difficulty seeing distant objects as clearly as near objects. Persons with hyperopia, or farsightedness, have more difficulty seeing near objects as clearly as distant objects. Astigmatism is a distortion of the image on the retina caused by irregularities in the cornea or lens of the eye. Combinations of myopia and astigmatism or hyperopia and astigmatism are common.

Glasses or contact lenses are designed to compensate for the imperfections of the eye. Surgical procedures aimed at improving the focusing power of the eye are called refractive surgery. With Lasik surgery, precise and controlled removal of corneal tissue by a special laser reshapes the cornea and changes its focusing power.

Before Lasik there were other techniques developed to reshape the cornea for example Photorefractive Keratectomy. Often the exact same laser is used for the two types of surgery. The major difference between the two surgeries is the way that the stroma, the middle layer of the cornea, is exposed before it is vaporized with the laser. In PRK, the top layer of the cornea, called the epithelium, is scraped away to expose the stromal layer underneath. In LASIK, a flap is cut in the stromal layer and the flap is folded back.

Can anyone have a eye Lasik surgery? Most but not everyone and certain complications are unavoidable in a percentage of patients, and there are no long term data available for current procedures. Also, some jobs prohibit certain refractive procedures so be sure to check with your employer/professional society/military service before undergoing any procedure.

Most medical insurance will not pay for refractive surgery and the cost is still significant. If you have what is called refractive instability, like young people, you can not have this kind of surgery. If you are pregnant or have certain diseases like diabetes or are taking medications you should not have Lasik surgery. In these cases you should discuss the possible additional risks with your doctor.

by Keith George

eye laser surgery : 4 Referral Sources For Your Research

The internet is the top place to find sources for lasik eye surgery procedures. You can use any search engine such as http://www.google.com, where you can find information on just about anything you need to. Using a simple search term like “lasik” returns over four million websites. That’s right: four million. By being a little more specific you can narrow your results down dramatically. For example searching for “lasik pricing” produces two hundred thousand results. You can also use the internet to search for local eye doctors that do lasik in your area. For another example a search for “lasik in Shreveport, Louisiana” yields fifty three thousand results and like I said before you can use just about any search engine. You most likely won’t find the site you need with your first try, but you will be lead in the right direction. By using the internet you can have all your questions answered about lasik, the procedure, the side effects, the pricing, and just about everything else you wanted to know, but was afraid to ask. You possibly will even have some questions answered that you didn’t even think to ask. The internet is the most widespread referral source for lasik.

The second most frequent source for recommendations are magazines. If you have ever had to go to the doctor or the dentist, you have seen tons of medical publications in the waiting room. Nearly all new innovations in medical science can be found by skimming through these magazines. Doctors are in the business to make money, so it would make sense that they would publicize. If it is a new advancement you may even be able to read up on it in these magazines. The disadvantage of using magazines to do research is that there is no real organization or means to search them by topic. You have to plainly search through many magazines to find the one article you need that may or may not have all the information you need. The advantage to magazines is that they are good about getting your attention and making you conscious of certain innovations that you can shortly look up on the internet with a standard search engine.

Medical periodicals are an additional source that scores of people over look. You can more often than not find out all the details of a procedure using medical periodicals. The disadvantage is that these typically read like stereo instructions and they are rather dull. They are first-class to put you to sleep at night, and, similar to magazines, are good starting points. They can give you the guide you need to start an internet search.

The most disregarded resource you have is first hand information from people who have had lasik. You can ask any eye doctor and they ought to be able to give you a reference listing of patients that have approved to speak to potential patients. As a rule they will provide you the best thoughts of what to expect. They will most likely also tell you what the internet and doctors leave out. They have gone through the operation. They know what it feels like, what the after effects are like, and if it is worth it. Now don’t go by just what one person says. Ask several of them your questions so you can get a feel for what to actually expect. You can also ask anyone you know if they know someone who has had it done.

These four things are the top referrals there are on lasik eye surgery. The internet, by far, has the most information at your fingertips, but do keep the others in mind as well. They were around long before the internet and will be around for many years to come. The information they give is very valuable and should not be over looked. If you use these resources you will be very well educated on what to expect when you go into a consultation with any eye doctor. That learning will give you a leg up. You will be able to decipher when a doctor is just trying to sell you something, or if he/she is really trying to help you. You are a person too, not just a paycheck. You know that, so make sure he/she does too. Once those borders are set, then you can feel more at ease letting him/her work on you. Remember knowledge is power, and in this situation that old line holds true.

by Garry Allen

eye laser surgery : Lasik Vision Correction

Lasik Vision Correction for Presbyopia (aging eyes)

Around the age of 40, most of us who are farsighted or normal sighted become aware that our close up vision is no longer as clear. We find ourselves holding books and newspapers farther and farther away in order to see the printing clearly. The larger and less flexible crystalline lens in the eye no longer provides enough power for reading. Traditionally, as we age, we resort to wearing bifocals to be able to read or do close up work.

Is Lasik Vision Correction possible for Presbyopia?

The new trend in Lasik vision correction for Presbyopia is called monovision. Monovision is where one eye is corrected for near vision and the other for far vision. By focusing one eye for distance and the other for near, the goal is to be able to see both far and near when you use both eyes. Everyone has a dominant eye (this is the eye that takes the lead, tells your eyes where to point and how to focus) and a non-dominant eye. Your dominant eye would be corrected for distance and your non dominant eye for reading.

Does monovision work to correct Presbyopia in all older patients?

Monovision works well for about 50% of all patients with Presbyopia. How do you know if it would work for you before you make the investment in Lasik vision correction? Your eye doctor can allow you to ‘test-drive’ monovision and ‘try before you buy’, by letting you use contact lenses that slightly under-correct nearsightedness in your non-dominant eye. For some people who try monovision, they instantly know that this is a perfect solution for them. Their eyes are able to view a mountain in the distance one moment and switch to looking at their watch the next. They are able to view both far and near with reasonably clear focused vision. The other 50% of people (myself, included) find that this drives them crazy. If you spend most of your time doing highly technical, demanding, critical close up work, monovision may not be right for you. I complained to my eye doctor that using contacts to try monovision didn’t allow me to see as perfectly for close up work as bifocals did. He told me that in his experience, for his patients who are a type A personality, very picky about small details and demand absolute clarity in close up vision, monovision was not always a good choice. It’s a good idea to talk to your eye doctor and ‘try before you buy’ to make sure that Lasik vision correction is right for treating your Presbyopia.
eye laser surgery
by Beth Gabriel

eye laser surgery : What to Do Before Surgery

Step 1, do you know what to expect?

The absolutely, most important choice to make before having Lasik surgery is to select the best in Lasik Eye Surgeons. Need help in choosing which Lasik Eye surgeon to pick? Please click on the link in the next paragraph for help in deciding what to look for in Lasik Eye surgeons. After you have chosen your Lasik surgeon, you will be scheduled for an initial consultation. Your Lasik surgeon may ask you to stop wearing any contact lenses and return to wearing glasses for 2 to 4 weeks before your consultation. Why?

All contact lenses, but especially hard lenses, can change the shape of your cornea temporarily. During your baseline exam, your surgeon will thoroughly examine both of your eyes, taking precise, detailed measurements. These measurement help determine how much corneal tissue will need to be reshaped to give you the best possible outcome after surgery. Wearing contact lenses up to the day of your baseline exam may cause inaccurate measurements to be taken and this can result in inaccurate changes made to your vision. There's no way you want this to happen, so listen to your surgeon's recommendations if he or she asks you to stop wearing your contacts prior to your exam.

Need help in choosing which Lasik Eye Surgeon to pick? See Choosing Your Lasik Eye Surgeon for help in researching, questioning and selecting the best surgeon. The goal of your initial consultation and baseline exam is to help you and your surgeon determine if you are a good candidate for Lasik surgery. Your Lasik surgeon will discuss the medical history of your eyes with you and will also ask you about your general medical history.

Topics your Lasik surgeon will discuss with you:

when did you first began wearing glasses or contacts
do you have any history of eye injuries
have you had any reoccurring eye infections
do you have frequent headaches, blurred vision or double vision
what current medications are you taking (both prescription and non prescription medication as they may be important to your vision)
what are the possible risks of having Lasik surgery
what are the non-surgical alternatives to Lasik surgery
what questions do you have regarding your upcoming surgery
signing the informed consent form for Lasik surgery (signed agreement between you and your surgeon that you understand the risks, benefits and alternatives of your procedure)
do you have any long term, chronic, medical conditions that could affect the long term health of your eyes
are you pregnant or nursing
Don’t feel pressured to sign the informed consent form for Lasik surgery until you feel confident and comfortable with your surgeon. And don’t let anyone ‘talk you into’ having Lasik surgery. Your family and friends can give you advice but only you can decide what is best for your eyes. On the day of surgery, avoid using any lotions, perfume or make up to help avoid eye irritation and possible eye infections. Arrange for a friend or family member to give you a ride to and from your Lasik surgery for your safety and peace of mind. Look for my next article in the series on Lasik Surgery – Step 2, What to expect the day of your Lasik Surgery, coming out next week.

By Beth Gabriel

eye laser surgery : PRK Vision Surgery

Excimer laser PRK/PARK vision surgery for low to moderate myopia and myopic astigmatism respectively, is another established surgical technique which has proved to be very safe and effective. Studies have shown that the majority of patients with myopia of between -1.0 to -6.0 diopters enjoy a very satisfactory outcome (20/20 vision or better) following PRK vision surgery. About 80% do not require eye glasses or corrective lenses.

Where PARK is performed, the best outcomes are achieved for myopic eyes with associated astigmatism not exceeding 1.5 diopters. As higher corrections are attempted, the outcome becomes less predictable although satisfactory results are often achieved for moderate myopia and astigmatism.

H-PRK is the most recent form of surface-based laser vision surgery. It is generally used for low degrees of of hyperopia (farsightedness) as the procedure is still in its infancy. However, early results look promising.

The three PRK procedures outlined above are all performed in a very similar manner. Tissue immediately below the thin layer of corneal surface cells (epithelium) is rubbed away to reshape the cornea during a painless procedure. The sole difference between them is the pattern created on the cornea. LASIK vision surgery, by contrast, slices a thin, hinged flap from the top of the cornea and is used for higher corrections.

The benefits of PRK vision surgery.


PRK does not involve the creation of a hinged corneal flap which is a very exacting procedure. As a result, PRK is associated with fewer complications than LASIK surgery.


The complications, however, in LASIK can be serious and lead to permanent loss of best corrected vision if the corneal flap is incompletely reseated or damaged in any way.


Following PRK laser surgery minor symptoms are quite common in the first few months, but soon disappear altogether. However, problems like halo and distorted vision (now less common with the introduction of larger diameter treatment zones), or severe haze and scarring, which can result in permanently affected vision, only affect around 1-2% of patients.


Anisometropia (a difference in focus between the two eyes after one eye only has been treated) is more marked for patients who undergo LASIK surgery for higher levels of myopia. The difference in focus might be quite marked and make driving unsafe.

Those patients with moderate myopia who cannot wear contact lenses might well consider PRK instead. Their symptoms of anisometropia may well be less pronounced between the treatment of the first and second eyes.


The drawbacks of PRK vision surgery.


A PRK procedure generally requires a lengthy period between the first and second treatments of between 6 and 12 months. In LASIK, on the other hand, stabilization occurs earlier than after PRK and retreatment can typically go ahead between 1 and 3 months after the primary treatment.


As the period between primary and retreatment is a lengthy one in PRK, so several months need to elapse before 20/20 results are achieved, and then eye glasses may have to be worn.


While the actual laser treatment is usually pain-free, most patients will experience mild to moderately severe eye pain lasting up to 36 hours. Pain killers are prescribed for what is, in effect, a large abrasion on the cornea. LASIK is relatively pain-free.

What to expect from PRK vision surgery.

Before going ahead with a PRK procedure, your eyes will be assessed by an eye surgeon which will include computerized corneal topography capable of revealing otherwise undetectable irregularities in the cornea.

Such a detailed mapping of the cornea will allow the surgeon to remove tissue to a pattern pre-determined by the patient's own refraction.

Before this corneal tissue is removed, the epithelium (thin layer of surface cells) is rubbed off, a process which takes just one to two minutes. The corneal ablation is even quicker depending upon the degree of correction being treated.

After treatment, topical drops and ointment are applied to the eye. You will also wear a pad for 6-24 hours post-surgery. Eye drops will keep the tear film lubricated and quite possibly you will need to wear glasses, and best vision could take six months to achieve.

How to choose a PRK eye surgeon.

We finish with the most important question of all: choosing your eye surgeon. Personal recommendation is usually the best method, followed by an interview of likely candidates.

Be well prepared with your questions which should include accurate information about your likely outcome; the cost of treatment (and any retreatment); what the cost of treatment comprises (are clinic reviews and medication included?) and, of course, the surgeon's qualifications and track record. Oh, and read the fine print.

Be wary of expensive advertising and eye surgeons who offer substantial discounts. The best, who don't come cheap, though, at $2000 an eye, let their satisfied patients speak for them.

By Maureen Cook

eye laser surgery : Are You a Candidate for Laser Eye Surgery?

You may be a good candidate for laser eye surgery if you:
are at least 21 years of age for a Summit laser or 18 years of age for a VISX laser, since the eyes are still growing to this point
have healthy eyes that are free from retinal problems, corneal scars, and any eye disease (refractive errors are considered eye disorders, not diseases)
have mild to moderate myopia (nearsightedness) within the range of treatment (see your doctor to determine your range)
have a way to pay for the treatment since laser procedures are costly and probably not covered by health insurance policies
are fully informed about the risks and benefits of laser surgery compared with other available treatments.

by Carol Lewis

eye laser surgery : Is Laser Surgery for You?

For some, like Goldstein, laser surgery has been the ultimate freedom from the everyday hassles of contact lenses, and a second chance at having normal eyesight. But can everyone expect such dramatic results?

"The answer is no," says Rosenthal. "It's not a foolproof procedure and people need to know that some can end up with worse eyesight than before they went in."

Mary Ann Duke, M.D., a general ophthalmologist practicing in Potomac, Md., adds that there are other reasons why the expectations for eye laser surgery vary from person to person.

"People who are slow healers or who have ongoing medical conditions [such as glaucoma or diabetes] are not good candidates for laser surgery," she says. "That's why it's so important for patients to undergo a thorough examination with their doctor."

Poor candidates for this surgery also include those with uncontrolled vascular disease, autoimmune disease, or people with certain eye diseases involving the cornea or retina. Pregnant women should not have refractive surgery of any kind because the refraction of the eye may change during pregnancy.

Looking Ahead

At present, a number of other lasers for eye surgery are currently being tested in FDA-sanctioned studies to determine their safety and effectiveness. Investigational Device Exemptions (IDEs) filed with FDA allow for clinical studies involving the excimer laser and the correction of farsightedness. The IDE process is designed to investigate the safety and effectiveness of a device, or a new procedure with an already approved device, either to obtain information for publication or to generate the data needed to obtain marketing approval from FDA.

"If the refractive surgery center says the laser is approved by FDA, it probably is," Waxler concludes. "Still, it is wise for consumers to check that the device being used for their surgery is FDA-approved," he says, or that they make sure they are being treated with a laser that is under study in an FDA-sanctioned clinical trial.

During the first few weeks immediately following laser surgery, Goldstein says, "Every week I kept thinking, 'this is as good as it gets'?" Then, she discovered by the sixth week, as predicted by her surgeon, that her eyesight was noticeably better and eventually stabilized.

"I would tell others to be patient about their expected outcome," she advises. "Even though with LASIK you can expect quicker results, I'm happy with the choice of PRK."

Carol Lewis is a staff writer for FDA Consumer.

eye laser surgery : Is It Worth Looking Into

For Jeri Goldstein everything was a blur. Without her contact lenses she couldn't distinguish people, the scenes on television, the stars at night, and, generally, the world at large. Then, in March 1998, the 49-year-old California resident had eye surgery, and all that changed.

"After wearing contact lenses for 35 years, you can't imagine the freedom I felt," says Goldstein.

Goldstein underwent refractive eye surgery, an elective procedure intended to correct common eye disorders, known as refractive errors, such as myopia (nearsightedness), hyperopia (farsightedness), and astigmatism (distorted vision). Although there are several types of surgical techniques being performed today to correct refractive errors, laser refractive correction is fast becoming the most technologically advanced method available, according to the American Academy of Ophthalmology in San Francisco. Doctors say it allows for an unparalleled degree of precision and predictability.

"Laser surgery is the most exciting advancement in ophthalmology," says James J. Salz, M.D., clinical professor of ophthalmology at the University of Southern California in Los Angeles and the doctor who performed Goldstein's surgery. But surprisingly, he says, despite its sudden popularity, "only 20 percent of ophthalmologists in the United States today are trained in its operation."

The Food and Drug Administration first approved the excimer laser in October 1995 for correcting mild to moderate nearsightedness. With that approval, the agency also restricted use of the laser to practitioners trained both in laser refractive surgery and in the calibration and operation of the laser. Currently, the excimer laser has been approved for use in a procedure called photorefractive keratectomy (PRK), and, as of November 1998, for a procedure called laser in situ Keratomileusis (LASIK).

Precision Surgery

PRK is an outpatient procedure generally performed with local anesthetic eye drops. This type of refractive surgery gently reshapes the cornea by removing microscopic amounts of tissue from the outer surface with a cool, computer-controlled ultraviolet beam of light. The beam is so precise it can cut notches in a strand of human hair without breaking it, and each pulse can remove 39 millionths of an inch of tissue in 12 billionths of a second. The procedure itself takes only a few minutes, and patients are typically back to daily routines in one to three days.

Before the procedure begins, the patient's eye is measured to determine the degree of visual problem, and a map of the eye's surface is constructed. The required corneal change is calculated based on this information, and then entered into the laser's computer.

Since 1995, a limited number of laser systems has been approved by FDA to treat various refractive errors, both with PRK and LASIK.

According to FDA's Center for Devices and Radiological Health, clinical studies showed that about 5 percent of patients continued to always need glasses following PRK for distance, and up to 15 percent needed glasses occasionally, such as when driving. In addition, many patients experienced mild corneal haze following surgery, which is part of the normal healing process. The haze appeared to have little or no effect on final vision, and could only be seen by a doctor with a microscope. Some patients experienced glare and halos around lights. These conditions, however, diminished or disappeared in most patients in six months. For about 5 percent of patients, however, best-corrected vision without corrective lenses was slightly worse after surgery than before. In view of these findings, FDA and the Federal Trade Commission (which oversees advertising) issued a letter to the eye-care community in May 1996 warning that unrealistic advertising claims, such as "throw away your eyeglasses," and unsubstantiated claims about success rates could be misleading to consumers.

LASIK

LASIK is a more complex procedure than PRK. It is performed for all degrees of nearsightedness. The surgeon uses a knife called a microkeratome to cut a flap of corneal tissue, removes the targeted tissue beneath it with the laser, and then replaces the flap.

"With LASIK, the skill of the surgeon is important because he'll be making an incision," says Stephen Crawford, O.D., an optometrist practicing in Virginia, "compared to the PRK method where the machine does more of the work." Crawford urges people to find qualified, experienced doctors to perform this surgery. "You'll want someone who's done a number of LASIK procedures since this is a surgeon-dependent operation," he said.

According to Ken Taylor, O.D., vice president of Arthur D. Little, Inc., a technology and management consultant firm in Cambridge, Mass., "Last year, across the country, 40 to 45 percent of refractive surgeries performed by physicians were LASIK, which equates to approximately 80,000 procedures." Doctors not participating in clinical trials may choose to use the approved laser to perform LASIK procedures at their discretion, says Morris Waxler, Ph.D., chief of FDA's diagnostic and surgical devices section. But most uses are considered "off label" and are not regulated by FDA.

Ralph A. Rosenthal, M.D., director of FDA's division of ophthalmic devices, says, "The agency has ruled that individual physicians can perform LASIK under the general 'practice of medicine,' if it's in the patient's best interest."

Advantages of LASIK

Some doctors believe that LASIK is a suitable procedure for correcting the most severe refractive errors. They also say that there is generally a faster recovery time after LASIK than after PRK. In addition, LASIK patients can see well enough to drive immediately and have good vision within a week.

After studying the options, Goldstein first decided on the LASIK procedure, but was surprised to learn that her doctor advised against it.

"Initially, I wanted the quick recovery that LASIK offers," Goldstein says, "but the bottom line was, which surgery will give me the best results, and after considering everything, eventually we agreed on PRK."

James Salz is currently involved in an FDA-sanctioned clinical trial at Cedars-Sinai Medical Center in Los Angeles, which is now studying the laser system specifically for farsightedness (hyperopia) with astigmatism. Although routinely performing laser eye surgery, he still encourages a small percentage of his low to moderately nearsighted patients to undergo radial keratotomy, or RK, an earlier refractive correction procedure that does not require the excimer laser.

With RK, incisions are made in a "radial" pattern along the outer portion of the cornea using a hand-held blade. These incisions are designed to help flatten the curvature of the cornea, thereby allowing light rays entering the eye to properly focus on the retina. The number and length of the incisions determines the degree of correction attained.

"Typically, this is still a practiced procedure for select people with very small corrections of myopia," Salz says.

Conversely, Crawford says that although he will mention RK as an option to his patients considering eye surgery, he is not in favor of this method. He says studies indicate that incisions made during this procedure, which penetrate approximately 90 percent of the cornea, appear to weaken the structure of the eye. Also, once you've had RK done you can't repeat it or have PRK done.

"I think that patients should understand and consider all available options for correcting refractive errors," Crawford says, "but I would never recommend RK to anyone."

by Carol Lewis

eye laser surgery : Expectations vs. Reality

Laser Eye Surgery – What are your expectations?

The success of laser eye surgery (as with any elective surgery), is measured by how the outcome matches your before-surgery expectations. Are your expectations realistic? Can your expectations be met by laser eye surgery? It’s your surgeon’s job to help you consider all aspects of good vision prior to your laser eye surgery. Laser eye surgery can greatly improve your vision but no procedure can promise ‘perfect vision’ to every patient. When asked, most people say they expect to have 20/20 vision following laser eye surgery. In truth, most will be satisfied with 20/25 or 20/30 vision.

Laser eye surgery can give mild to moderately nearsighted (distant objects are not clear) patients a 90% chance to be able to drive during the day without glasses. Many of these patients will still need to wear glasses for night driving but most consider this a vast improvement to their vision before surgery. Extremely nearsighted patients who view the world through thick glasses are often not able to be fitted with contacts to correct their vision. For these patients, laser eye surgery can be a life saver and they are some of the most satisfied patients following eye surgery. These patients say that their ability to see without having to wear thick glasses is a life changing event. Many claim they feel more attractive and feel free to play sports for the first time since childhood.

It’s important to realize that good vision is more than being able to read the 20/20 line on your doctor’s eye chart. Having good vision means you also need to consider all the elements of vision:


depth of field – can you see clearly from near to far
night vision – can you see clearly in low light conditions
color vision – are you able to distinguish red from green
contrast sensitivity – can you distinguish different shades of gray
bi-ocular vision – do your eyes work together

Will you be happy with your results following laser eye surgery? The best way to insure your happiness is to discuss your expectations with your surgeon. Will you only be happy with ‘perfect’ vision or are you prepared to have slightly less than perfect vision if it means you won’t need to wear contacts or glasses on a daily basis?

by Beth Gabriel

eye laser surgery : Lasik Eye Surgeons - Who to Choose

How to choose who to trust with your eyes

The most important decision a Lasik eye surgery candidate can make is choosing the best in Lasik Eye Surgeons. Only ophthalmologists are permitted to perform Lasik eye surgery. Your optometrist who performs your regular eye exam, can give you a list of Lasik Eye Surgeons in your area to choose from but your optometrist is not licensed do your Lasik surgery. Look for a surgeon who is versatile and competent in several refractive procedures. Lasik isn't the only surgical procedure to correct your vision and isn't the best solution for everyone. Choose a surgeon who is familiar and experienced with many different techniques; PRK, Lasek, CK, clear lens replacement and Lasik.

By choosing a surgeon who is experienced in several of these techniques, they can better help you to decide which procedure is best at correcting your vision problem. A surgeon who has performed 20,000 PRK procedures isn’t necessarily the best at performing Lasik surgery. Once you and your surgeon have decided which procedure is best for your eyes, ask your surgeon how many procedures they have done using that particular technique. You might also ask your surgeon if they are board certified in ophthalmology. This means they have passed additional exams beyond medical school, internship and residency.

Ophthalmologists who are Lasik eye surgeons must take special courses in this technique and complete many hours of hands-on training. Hospitals, Lasik surgery centers and manufacturers of Lasik surgical equipment all require this special training before surgeons are allowed to practice Lasik eye surgery. All Lasik eye surgeons who are new to doing this specialized surgery are trained by a skilled Lasik surgeon. Don’t hesitate to ask to see documentation of the training and courses that your Lasik eye surgeon has completed. They should be proud to show you all that they have accomplished.

After your initial consultation with a Lasik eye surgeon, don’t worry that you will hurt their feelings if you choose to consult with a second (or third) surgeon. This is a common and accepted practice to ask for a second opinion. Choosing the best Lasik eye surgeon is probably the most important decision that you will make this year so take your time and do your homework before putting your eyes in their hands.

Eye surgery terminology

Lasik - laser assisted in situ keratomileusis, a flap in the cornea is created using a microkeratome and a laser reshapes the underlying cornea.

PRK - photorefractive keratectomy, a laser is used to remove the surface layer of the cornea

Lasek - laser epithelial keratomileusis; a form of PRK but the surface layer of the cornea is not removed, just pulled back to allow the laser to reshape the cornea.

CK – conductive keratoplasty,radio frequency energy used to correct farsightedness

Clear lens replacement – surgical removal of the crystalline lens through a tiny slit in the cornea and a clear lens is put in its place

by Beth Gabriel

eye laser surgery : Laser Surgery

A laser is a beam of light that is concentrated with energy. This beam can selectively transmit its energy onto tissue in order to cure skin troubles of any kind, from eruptions to stretch marks. It can even be used in the treatment of eye defects such as nearsightedness, farsightedness or astigmatism. Lasers hold in themselves a material that creates and magnifies light. Two mirrors are used to reflect the light back and forth via this material. This gives rise to a beam that is packed and powerful, composed of one pure color or many different pure colors. These qualities, which distinguish a laser from a light bulb, make the former indispensable to medical applications.

The deployment of lasers in medicine is intricate, and plastic surgeons are trained to use lasers judiciously. They will be the best ones to decide if the use of laser is warranted in a particular case. Physicians use lasers to make cuts where necessary, eliminate tumors, close blood vessels and treat the skin for anything from acne to wrinkles, besides treating eye defects. The laser has the potential to change tissue without actually cutting into the skin. This makes major surgery unnecessary in the treatment of various conditions.

Laser surgery can do plenty in dermatology, ophthalmology and in the removal of tumors, for instance. The laser is similar to a scalpel, only composed of light, not steel. In dermatology, lasers help in the eradication of birthmarks, warts or other facial growths. Surgeons will use low intensity beams while working on facial tissue. This is done in order to preserve as much of the tissue as possible, which in turn, preserves natural beauty. Lasers are used in hair transplants, mainly to prepare the part where new hair will be placed.

After surgery, some inflammation is not uncommon. This can be treated with topical antibiotic creams. Avoiding exposure to direct sunlight also helps the process of recovery. The full impact of the operation may not be noticeable for over two months, especially where vascular defects are concerned. Any follow-up treatments will have to be scheduled after the initial healing process is complete.

Laser Surgery provides detailed information on Laser Surgery, Laser Eye Surgery, Cosmetic Laser Surgery, Laser Surgery For Stretch Marks and more. Laser Surgery is affiliated with Corrective Laser Eye Surgeries.


By Marcus Peterson