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LASIK-
(Laser in-situ keratomileusis)
The excimer laser is combined with an instrument called the microkeratome
to produce the most advanced laser vision correction procedure available.
The microkeratome has been used for eye surgery for over thirty years.
The instrument has a diamond blade which gently glides over the cornea
to create a thin flap. The laser is then used to reshape or vaporize corneal
tissue to correct the refractive error. The flap is then laid back in
place where it self-seals again within minutes.
PRK- (Photo-refractive keratectomy)
The excimer laser is used directly on the superficial cornea to reshape
or vaporize corneal tissue to correct refractive errors. This was the
procedure used to gain FDA approval of the excimer laser, and is still
used in a small percentage of the laser vision correction procedures.
Wavefront assisted LASIK
Special instrumentation is used to measure the front and back surfaces
of the cornea. By doing this, a more custom treatment pattern can be developed
for each patient. This is especially important in people who have irregular
corneas. It can also reduce aberrations, which would decrease problems
with glare and halos around lights. This the more customized LASIK procedure,
which uses the latest technology.
LTK
(Laser Thermal Keratoplasty)
This procedure is for correction of low amounts of far-sightedness with
very little astigmatism. This thermal laser creates small, round spots
of treatment on the peripheral edges of the cornea, causing the central
cornea to be relatively steeper and reducing far-sightedness. LTK as not
been as popular as LASIK for correcting far-sightedness. One reason might
be that LTK needs to be repeated to be effective, whereas LASIK is more
precise and accurate. Also, LTK has a more limited range of treatment.
The advantage is that the central cornea is not treated.
LASeK
This is very similar to LASIK, however, the microkeratome is not used.
Instead, in LASeK a solution is placed on the cornea to allow the surface
(epithelial) cells to be easily moved out of the treatment area. The excimer
laser is then used to vaporize cells and reshape the cornea. Next, the
epithelial cells are spread out along the surface in the treatment area
to form a protective shield while the cornea heals. LASeK is less comfortable
than LASIK and takes as long to heal as PRK; but is vaporizes less tissue
and is a better procedure for thinner corneas.
Dr. Kossol has so much confidence in laser vision correction that he has had the procedure himself. He considers it a life-changing experience. In fact, his brother and sister have also had laser vision correction, as well as many patients in his care. All preliminary measurements and the follow-up care is meticulously looked after at Chancellor Eye Care to provide patients with the best surgical results possible. Dr. Kossol has been involved with laser vision correction since it's approval by the FDA. He has provided this pre and post operative laser care for over eight years. The staff at Chancellor Eye Care is very friendly, professional and knowledgeable on all aspects of laser vision care, so feel free to ask questions.
Frequently Asked Questions Regarding Laser Surgery
Is it painful? Most people do not experience any pain with LASIK. Some notice a pressure sensation. Others experience mild dryness and a gritty feeling for a few hours after the procedure.
What is the cost? Individual cost varies, but generally fees are $1500 per eye for LASIK, including one year of follow-up care. Payment plans are available.
How much time will I need to take off work? Most people do not need to take any time off work. Because the procedure is virtually painless, and vision is functional right away, people usually do not find that it interferes with their schedules at all.
Is there general anesthesia? No. Only topical anesthetic eye drops are necessary to numb the eyes. There are no injections either. However, there is valium available to reduce any anxiety about the procedure.
What if I look away during the procedure? During the procedure a lid retainer is used to hold the eyelid open. The surgeon is watching your eye to make sure that you are looking directly at a blinking red light during the procedure. The procedure is so quick, that people do not find it difficult to look straight ahead for a short time (usually less than a minute for the laser treatment). However, if you had to cough, sneeze, or for any other reason stop the procedure, let the surgeon know you need to stop, and it can be done without any affect on treatment results.
What
are the most common side effects? Some people experience "glare
or halos around lights at night" after the procedure. This usually
goes away, but may not in all cases. Generally people with larger pupils
in dim light are at higher risk for this, and Dr. Kossol makes careful
measurements and advises those people with larger pupils about this side
effect. Others experience some dryness or gritty sensation right after
the procedure (which does not last long). This seems to be more common
in contact lens wearers or others with dry eyes prior to the procedure.
Dr. Kossol advocates using non-preserved lubricating eye drops prior to
the procedure, especially for dry eye patients and contact lens wearers.
There is also the possibility of over and under correction of the prescription.
The eyes are a biological system and sometimes heal irregular. It is not
uncommon for one eye to heal slower than the other. Meticulous measurements
pre-operatively can reduce the possibility of any residual prescription,
however, there are some factors which are variable such as individual
healing. Sometimes the eyes are more sensitive to the touch after the
procedure. There may also be complications in creating the flap in LASIK,
however, usually this is more of an inconvenience because it is necessary
to stop the procedure and wait three months to do the procedure again.
Do people who are farsighted have the same rapid recovery as people who are nearsighted? No. Except in higher prescriptions, most people who are nearsighted prior to the procedure experience a rapid visual recovery. They usually have good functional vision the next day and even sharper vision by the end of the first week. However, it is a slower recovery time in farsighted individuals after laser treatment. In fact, it is normal for a farsighted individual to become nearsighted for a period of time right after having the procedure. Dr. Kossol has loaner glasses available to help these patients through this period. Also, farsighted individuals take longer to have clear, stable vision after the treatment. It is not uncommon for the vision to be unstable for a month and in cases of high amounts of farsightedness it can take a few months. However, once the vision is stable, patients find that not only has laser vision correction helped correct their distance vision, but also helped with their near vision.
What are some of the risks? The main risk is infection. We try to eliminate that by using prophylactic antibiotic eye drops before, during, and after the procedure. There are also some conditions which can occur after the procedure, even when it is successful. These conditions affect the health of the cornea (not necessarily the vision) and need to be treated aggressively in order to control and eliminate them so they do not progress into more serious conditions.
What are some limitations after the procedure? No swimming for two weeks. Avoid contact sports for two weeks, then wear appropriate eye protection. Absolutely no eye rubbing, which can dislodge the flap. For women, no eye make- up the week before and the week after the procedure. Also, clear eye shields are worn while sleeping for two weeks after the procedure.
Does insurance cover Laser Vision Correction? Most insurances do not cover this procedure because it is elective. However, some vision insurance plans are now covering up to 20% of the cost of the procedure.
Dry Eye Risk with LASIK- Dry eye is the most common complication of this popular procedure. Tear production appears to decrease while surgically severed corneal nerves heal. As a result, many patients develop dry eye symptoms that last for a few weeks or even months after surgery. If you already have dry eye, be aware that your symptoms may worsen for a period of time after surgery. Ask Dr. Kossol for pre-operative testing to determine if you?re likely to experience severe dry eye symptoms after surgery. Special treatment before and after undergoing your LASIK procedure can help reduce discomfort.
Other Types of Refractive Procedures
RK - (Radial keratotomy) Incisions are made on the cornea in a "spoke-like" or radial pattern to cause a flattening of the cornea in order to reduce or eliminate nearsightedness. With the introduction of the excimer laser, this procedure is not as popular. RK cannot correct high refractive errors and some of the side effects involve fluctuating vision and over-correction leading to farsightedness.
Corneal implants-(Intacs) These are the most recent type of refractive surgery to be approved by the FDA. In this procedure small, "tube-like" implants are placed in the cornea which causes a flattening of the cornea to correct mild nearsightedness. The advantage of this procedure is that it is reversible in that the implants can be removed. However, the long-term risks are not known. Also, the criteria for patients who qualify is limited.
Intraocular implants These intraocular implants (IOL's) are normally used to replace the crystalline lens when it becomes dense and the layers separate with age (this is known as a cataract). The purpose of the IOL's in cataract surgery is to protect the retina from UV exposure. In clear lens extraction, the crystalline lens is removed before it becomes a cataract and an IOL with a correction for a particular refractive error used. This procedure is an option for people with very high refractive errors. It is less precise and more invasive than LASIK, but it is fast becoming another option in refractive surgery. In fact, now the IOL's can be multi-focal to help reduce the dependency on reading glasses. There is a lot of research and potential in this area of refractive procedures.
There are many types of treatment for refractive surgery. Dr. Kossol can discuss the best options for you depending on many factors such as: refractive error, corneal thickness, pupil size in dim light, corneal curvature, corneal health, systemic diseases and medications. Not everyone is a candidate for these procedures. There are many new procedures being studied and tested.
Co-managing Your Laser
Surgery
Dr. Kossol
provides pre-operative and post-operative care for his patients seeking
PRK (Photo-refractive Keratectomy) and LASIK (Laser Assisted in-Situ Keratomuleusis),
as well as for Cataracts.
Dr. Kossol has personally had laser vision surgery and will be happy to
discuss his experience with you.
Your pre operative evaluation with Dr. Kossol is an important step in the surgery process. The pre operative data gathered at this evaluation includes a history of your past medical and ocular condition, an assessment of your current visual status, and an eye health evaluation, including dilation, will be performed. Dr. Kossol will also discuss with you your expectations and lifestyle needs.
Your pre operative consultation appointment with your surgeon will be scheduled after your pre operative evaluation with Dr. Kossol is complete. During this consultation, the surgeon will review your visual data, verify the health of your eyes, and a computerized Corneal Topography will be performed. Questions or concerns you may have about the procedure will be discussed and you will be given instructions needed prior to the procedure.
After
surgery, your post operative evaluations will begin with your laser surgeon.
Your first post operative visit with Dr. Kossol will usually be scheduled
two weeks after surgery. To insure the best possible results, additional
post operative visits with Dr. Kossol will be scheduled over the next
six months.