Not all patients are good candidates for Lasik. Some people have too thin of a cornea to have the Lasik procedure. Other individuals have an irregular shape to their cornea called karatoconus. In caritokonis the cornea is weaker than normal and the Lasik procedure can make the cornea buckle or become unstable. It’s critical to have a very thorough, comprehensive evaluation prior to the Lasik procedure. In our office we measure and map the cornea looking for any disorders which would make you a poor candidate.
Presbyopia is a normal process of aging. One begins to lose the flexibility of the eye’s lens, which restricts the ability of the eye to change its point of focus from distance to near. Monovision may be a possible solution for this problem.
In working with pediatric patients and their parents over the years, I hear many of the same questions over and over again:
“Will it hurt my child’s eyes if he reads in dim light?” Reading in dim light is not bad for the eyes. It’s a myth. And kids can read better in dim light than adults can!
“Will it hurt my child’s eyes if she sits too close to the television?” Nope. Back in the 1950s when TVs first came out, it could have been harmful, but that is no longer the case. Keep in mind that your child may want to sit close to the TV because she can’t see very well. Or she may like the stimulation similar to the desire to listen to loud music.
Someone recently asked me, “If one has Fuchs’ corneal dystrophy and vision corrected to 20/40, what are the chances of improving vision to 20/20 or 20/25 with DSEK surgery?” Here’s what I had to say:
Most people with Fuchs dystrophy have problems not only with visual acuity, but also contrast sensitivity, glare, and often pain from blisters that can appear on the corneal surface. Most Fuchs patients then are looking to DSEK not only as a way of improving their visual acuity, but also alleviating many of the other symptoms. That being said the chances of being correctable with glasses or contact lenses to 20/25 or better is around 80-90% percent. For more information regarding Fuchs Dystrophy, DSEK, and the differences between this procedure and a traditional corneal transplant or penetrating keratoplasty, please visit our website.
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Fiction : LASIK and Laser Vision Correction is new and there is little long-term experience.
Fact: Although laser vision correction became widely available in the United States in the mid-1990s, the technology was developed in the early 1980s. In fact, during that time, Dr. Clinch was involved in many of the FDA clinical trials which were ultimately responsible for making LASIK a mainstream procedure. Now Laser Vision Correction is over 20 years old and there are millions of people who have had it done.
Fiction: LASIK and Laser vision correction is not really surgery.
Fact: LASIK is a surgery and should be treated as such. While it is true that we perform this procedure in our office in Chevy Chase, MD, it still takes surgical skill as well as excellent pre and postoperative care to maximize your chance for an optimal result. There are risks associated with LASIK as there are with any other procedure. However, several clinical studies have identified the chance of serious vision-reducing complications as being extremely low.
Fiction: Custom LASIK or CustomVUE LASIK is not for all patients and is not significantly better than standard LASIK.
Fact: Custom LASIK is far superior to standard LASIK. To be convinced, all you have to do is look at the clinical outcomes. With custom LASIK, the number of patients with 20/20 vision or better is much higher than those who had standard LASIK. The reason for this is the treatment that a patient receives through custom LASIK is based on measurements taken at a much higher resolution than standard LASIK.
I like to use the analogy that custom LASIK is like having a high definition plasma TV; whereas, standard LASIK is like having a standard analog TV. Does a person absolutely have to have a plasma TV? No, but no one can deny that the picture in high definition is clearer. At Eye Doctors of Washington, whenever possible, patients receive Customvue treatments.
Surprisingly, there are some LASIK centers that still routinely perform standard LASIK. I believe that patients at these places are not getting the best advice for their vision. To me the equivalent it’s like walking into a electronics store and having someone try to convince you that VCR is every bit as good as a DVD player. It is just not the case. You can read more about CustomVue LASIK here.
Fiction: It does not matter who performs your procedure, the outcomes are all the same because the laser does all the work
Fact : The surgeon’s skill and the level of care he/she offers is an essential element in the success of any surgical procedure. The laser is one of the tools that the surgeon uses to perform the procedure. While it is true that the laser is automated and very advanced, I liken it to owning and operating a computer. You can take two people who own the exact same make and model computer. One person may really know how to use all of the features and programs, creating music, desktop publishing, and the like, while the other may only use it to check their e-mail. In the same way that the computer user makes a difference in what the computer can do, the LASIK surgeon can also influence the ultimate outcome of the laser.
Moreover, the surgeon must also create and manipulate the corneal flap, an extremely delicate surgical procedure. Dr. Clinch and I are fellowship trained in corneal surgery. This means that above and beyond being general ophthalmologists, or eye surgeons, we are cornea specialists. When we are not doing LASIK, we routinely perform corneal transplants and other corneal procedures.
You may find it surprising to know that there are many physicians that are not fellowship trained performing LASIK. Some physicians go to a weekend certification course and then are officially “certified” to perform this procedure. These crash courses cannot replace the training and experience of a true cornea specialist. For all of these reasons, I firmly believe that the surgeon does make a difference in your outcome.
Fiction: The best indication of a surgeon’s ability is the number of procedures he or she has performed.
Fact: While the number of procedures performed by a surgeon can be a good indication of his or her level of experience, a surgeon should not be judged solely on the number of surgeries they have completed. After a physician has passed the learning curve (400-500 cases), what becomes of greater importance is the quality of the care and not just the number of cases. In other words, individualized, personal care by a meticulous surgeon is extremely important. That being said, Dr Clinch and I have combined to perform over 20,000 cases making us some of the most experienced Laser Vision Correction specialists in Washington DC, Northern Virginia, and Maryland.
Fiction: There is no difference between microkeratome and Intralase in making the flap for LASIK.
Fact: Although LASIK is a safe procedure and the rate of complications is low, making the flap is usually where complications can occur. With a microkeratome, a blade oscillates across your cornea creating the flap. With the Intralase, a femtosecond laser creates microdissections across your cornea. Flaps with the INTRALASE are much more uniform and precise than those created by a microkeratome. This results in better vision. In addition, there are more and more published reports of Intralase flaps being more predictable that those cut with a microkeratome, making the INTRALASE safer for patients. At Eye Doctors of Washington we use the INTRALASE whenever possible. You can read more about Intralase here.
Fiction: Anyone who wants to have LASIK is a candidate.
Fact: Not everyone is an appropriate candidate for LASIK. In fact after evaluating patients, we routinely reject many people as candidates for the surgery. There are many options for vision correction including LASIK, PRK, implantable contact lenses (Visian lens), cataract surgery with the ReSTOR and REZOOM intraocular lenses, or just glasses and contact lenses. The nice thing about our practice at Eye Doctors of Washington is that we can do it all. We are a full service eye care practice, not a laser center. The doctors here will help choose the appropriate procedure for you without high pressure sales tactics.
I tell patients if you were a carpenter and the only tool you knew how to use was a hammer, everything would look like a nail to you. Similarly, if you are an eye surgeon and all you know how to do is LASIK, you are extremely limited in the options you can provide our patients. At Eye Doctors of Washington, we know that all patients are unique and have individual needs.
Fiction: Because all outcomes are the same the cheapest surgery is no different that the most expensive surgery.
Fact: We all know the old adage “you get what you pay for.” This also applies to laser vision correction. Patient should remember they have only one set of eyes and it’s probably not a good place to compromise. LASIK and refractive surgery IS surgery. In my opinion, it should not be performed in LASIK mills in strip malls across the country. Patients should be cautious of discount centers that may not be as focused on patient screening and care. Consumers should make sure they are comparing equivalent care, expertise, and experience when doing their research.
Believe it or not, there are some LASIK centers where the surgeon never sees the patient until the day of surgery and never pre or post-operatively. There are some places that offer discount prices, but only if you use far inferior technology (microkeratome and standard treatments) or if you have low levels of nearsightedness and astigmatism. At Eye Doctors of Washington you will never be exposed to “bait and switch” tactics. There is one price for laser refractive surgery and we will provide you with only the best technology. In addition, you are welcome to see Drs Clinch and myself at anytime before or after the surgery.
Fiction: LASIK is still being developed, and new technologies are being introduced every year. Patients might be best served waiting until doctors find the best one.
Fact. The current LASIK technologies provide better outcomes than ever before. In fact many LASIK surgeons have had LASIK on their own eyes. Actually, I performed custom LASIK with the Intralase on Dr. Clinch, and he loves it. Ask him about it. New technologies introduced in the future may make LASIK available to a wider group of potential patients whose vision cannot be currently corrected.
We have created this blog to answer our patients’ detailed questions about LASIK, PRK, Visian, and other vision correction surgeries. All questions and comments must be approved by our moderator before being published to the site. Thank you for your interest in vision correction surgery!