Laser Vision Correction

Overview

Laser Vision Correction by Dr. Bryan Brooks

Lasik and PRK are offered at Richmond Eye Associates by Dr. Bryan Brooks. He is fully trained to use the latest technology available to give you freedom from glasses or contact lenses. Using state-of-the-art laser technology, which includes CustomVue™ Lasik to improve vision, many patients may see better than they ever could before surgery, even with their glasses or contact lenses.

Dr. Brooks offers complimentary eye examinations to evaluate whether or not you may be a candidate for Laser Vision Correction. If you are interested in having Laser Vision Correction to free yourself from dependence on glasses or contact lenses, call (804) 270-0330 for an evaluation.

Complimentary Screening Consultations

A Laser Vision Correction Screening is not a comprehensive eye examination, but rather a brief examination and discussion to determine if you are a possible candidate for Laser Vision Correction.

Laser Vision Correction Screenings are complimentary (no charge). If you have glasses, please bring them to the screening. If you normally wear contact lenses, please wear them to the screening. Please call (804) 270-0330 to schedule a complimentary Laser Vision Correction Screening Consultation with Dr. Bryan Brooks.

Customized Lasik Using CustomVue™

What is CustomVue™ LASIK?

CustomVue™ WaveFront guided LASIK is the latest advance in LASIK technology from VISX, the leader in excimer laser technology.

Each of us has unique vision characteristics, just like each of us has a unique fingerprint. To treat each patient individually we obtain a WavePrint examination of each eye, and then use the detailed unique information of the WavePrint to plan the laser treatment down to the micron level (about one millionth of a meter)

In Clinical Trials CustomVue™ treatment resulted in 98% of patients 20/20 or better and 70% 20/16 or better, and 23% 20/12 or better.

How does CustomVue™ LASIK work?

The CustomVue™ system first uses an infrared laser to intricately measure the entire optical system of each eye and record the minute irregularities (higher order aberrations) of the optical system, in effect creating a fingerprint of each eye. The doctor then reviews the WavePrint measurements and instructs the computer to calculate the best treatment for each individual eye.

The laser surgery itself is performed using the VISX S4 Variable Spot Scanning technique with 3-dimensional eye tracking to sculpt the cornea into the ideal shape. This is an improvement over standard LASIK, which treats based on the measurement of the corrective lens prescription, and does not use the fingerprint of the eye to customize the treatment.

When do I see the Results?

Many patients wake up the next day with reasonably sharp, clear vision, which continues to improve over several days. Some patients, while noting improvement, may have to wait longer.

Are there risks with CustomVue™?

All surgery has risks as well as benefits. These will be reviewed at the time of your consultation.

What about night glare and halos?

Most patients report less night vision problems after CustomVue™ LASIK than before the surgery.

How does CustomVue™ differ from regular LASIK?

Regular LASIK treats each patient based upon a prescription for glasses, CustomVue™ uses the individual WavePrint of each eye. The VISX Star S4 laser with its unique Variable Spot Scanning technology can precisely treat very small areas, to sculpt the cornea into the ideal shape for your eye.

Does CustomVue™ take longer?

The laser treatment is about the same, usually less than a minute, the whole operation usually lasts less than fifteen minutes! CustomVue™ does require extra time to obtain the most accurate WavePrint of your eyes. The thorough preoperative medical eye exam still takes about 2 hours.

With conventional LASIK we get excellent vision results, allowing patients to see clearly without contact lenses or glasses. With CustomVue™ the results are even better, reducing night glare, reducing vision problems, and achieving in many patients, sharper vision than possible with glasses.

Reasons to Consider Lasik

Ten Reasons to Consider Laser Vision Correction

1. Reduce or eliminate a person's dependence on glasses or contact lenses:
   A person does not necessarily have to dislike glasses or have a problem with contact lenses to consider laser vision correction. While spectacle correction or contact lenses are sometimes needed even after successful laser vision correction, minimizing the need for their use can simplify a person's life considerably.
2. Recreational reasons for laser vision correction:
   Anyone who participates in athletics and particularly in water sports knows the difficulties associated with glasses and contact lens use. On the other hand, protective eyewear is recommended in many sports.
3. Occupational reasons for laser vision correction:
   In many occupations requiring physical work, glasses use can be difficult, especially under safety goggles. Contact lens use may be difficult due to airborne debris creating ocular irritation.
4. Contact Lens Intolerance:
   Many people develop ocular irritation related to contact lens materials, solutions, and protein build-up on the lens surface. Some people may be unable to wear the lens for the entire day due to dryness or increasing discomfort as the day goes on.
5. Problems with Glasses:
   Especially in cases of high nearsightedness or astigmatism, glasses may give a distorted view of one's surroundings, and the rims may limit peripheral vision. Some people have difficulty finding comfortable frames. Other people simply do not like their appearance in glasses.
6. Risk of Contact Lens Wear:
   Overall, the lifetime risk of developing a vision threatening corneal infection is higher with contact lens use than it is with having Laser Vision Correction. Also, contact lenses may lead to distortion in corneal shape which may be difficult to treat. There may be a higher risk or conjunctivitis (pink eye) in contact lens wearers than in non-wearers.
7. Enhancement of personal appearance:
   Many people prefer their appearance without glasses, and in some cases this may have impact upon their career choice and success. Other people realize that their eyes may become red or irritated appearing with contact lens use, and that they have to frequently manipulate their eyes or eyelids when they wear contact lenses.
8. Reduce or eliminate the need of a prosthesis for normal functioning:
   Both glasses and contact lenses are examples of a prosthesis -- an external appliance required for the normal functioning of vision. While it may be impossible to surgically correct a condition requiring a prosthesis for walking, Laser Vision Correction can reduce or eliminate the need for a visual prosthesis.
9. Safety:
   Having to hunt for glasses or insert contact lenses during an emergency situation may be impossible and impractical. In those situations, a person has to rely on his own natural vision. The use of extended wear contact lenses may offer a solution to this problem, but these lenses also have a much higher rate of complication and infection.
10. Affordability of Laser Vision Correction:
    With financing plans and other payment options available, Laser Vision Correction can be affordable for everyone.

Lasik and PRK - About the Procedure

What is Laser Vision Correction?

Lasik and PRK the most common Laser Vision Correction procedures, and they are somewhat similar. Both use an excimer laser to painlessly reshape the front surface of the cornea to create the desired vision correction. The excimer laser is a non-thermal (cool) laser that is controlled by a computer. The actual time that the laser takes to do its work is usually less than one minute. Farsighted corrections and combinations of nearsightedness and astigmatism may take slightly longer.

In Lasik (Laser Assisted In-Situ Keratomileusis), the surgeon first creates a micro thin flap of the surface of the cornea using a sterile surgical instrument called a "microkeratome".

This flap is folded back, and the excimer laser is used to shape the cornea surface. The flap is then replaced and usually does not require suturing to stay in position. The vision typically returns rapidly after Lasik, and a bandage contact lens in not usually necessary because the eye is not usually painful after surgery. Thus, both eyes are often treated in the same session with Lasik. Lasik can be used to treat low to high levels of nearsightedness with low to moderate levels of astigmatism, and low to moderate farsightedness with low to moderate levels of astigmatism.

In PRK (Photorefractive Keratectomy), the surgeon prepares the surface of the cornea, and then uses the excimer laser to precisely and rapidly reshape the surface of the cornea. The corneal surface must then heal, and often a bandage contact lens is used for comfort. The vision may be blurred in the operated eye for a couple of weeks after the procedure. The excimer laser is FDA approved for PRK for low to moderate levels of nearsightedness and astigmatism, and low levels of hyperopia and astigmatism.

What is Refractive Error?

Laser Vision Correction treats refractive errors of the eye. A refractive error is an incorrect focusing of an image onto the retina by the cornea and lens of the eye. The cornea, just by its curvature, does about 80% of the focusing of the eye. The lens within the eye does the remaining focusing.

Myopia

Example of a Myopic Eye and Image

In myopia (nearsightedness), the cornea is curved too steeply for the length of the eye, and the image is focused in front of the retina. This leads to blurred vision at distance, while the vision may be clear at a closer distance (thus "nearsighted").

Hyperopia

Example of a Hyperopic Eye and Image

In hyperopia (farsightedness), the cornea is not curved enough to focus light onto the retina, or the eye is too short in length. This leads to blurred vision at both near and distance, but the vision will be less blurred at distance (thus "farsighted"). If the lens of the eye is capable of focusing, some or all of a farsighted refractive error may be self-corrected by the eye by focusing in the image.

Astigmatism

Example of an Astigmatism Image

In astigmatism, the cornea is curved more in one direction than another. This leads to different parts of an image being in focus at different places on the retina. Astigmatism can occur in combination with myopia or hyperopia. In the example below, the vertical lines of the image are blurred more than the horizontal lines. The direction of blurring can occur at any angle from horizontal to vertical, which is the axis of astigmatism.

Presbyopia

In presbyopia (the inability to focus at near), the lens in the eye loses its near focusing ability, so reading glasses or bifocals are needed for close vision. Presbyopia can occur in combination with any other type of refractive error.

All of the above refractive errors can be corrected by glasses or contact lenses, or with bifocals or reading glasses in the case of presbyopia. Laser Vision Correction can correct from low to high levels of myopia with or without astigmatism, and low to moderate levels of hyperopia with or without astigmatism. Laser Vision Correction cannot restore the focusing ability of the lens of the eye, and thus presbyopia cannot by treated at this time. However, one eye can be left intentionally nearsighted for reading, similar to the monovision effect with contact lenses.

What Happens Before Laser Vision Correction?

The preoperative examination is an extremely important step in achieving an accurate result from PRK or Lasik. While a screening evaluation can determine potential candidates, it is the actual preoperative examination that determines which procedure, if any, are best for the patient. Some details of this examination include:

• Discussion of the patient's motives and expectations of Laser Vision Correction.
• A review of the patient's medical and ocular health history.
• A complete dilated eye examination.
• Determination of the best corrected visual acuity, the uncorrected visual acuity, a refraction, and a determination of the stability of the patient's refraction over the past year.
• A specialized mapping of the corneal curvature called "corneal topography" and an evaluation of glare risk.
• A Wavefront analysis of the cornea can be performed to determine if a person is eligible for a customized treatment by the laser (CustomVue™).
• A determination of the thickness of the cornea.
• Contact lenses should be removed for 1-2 weeks prior to the preoperative examination as well as the actual surgery itself. They may have to be left out longer if rigid lenses or soft toric lenses are used.

Financing arrangements should be made prior to the day of surgery, and any post-operative medications required should be obtained prior to surgery.

The Day of Surgery

Both Lasik and PRK are painless to perform, and require only eye drop (topical) anesthesia. In some cases, an oral sedative can be given preoperatively, but the patient must be alert enough to be able to keep the eye in position during the actual application of the laser. The eyelids themselves are held open with a smooth metal device called a speculum, so the patient does not have to worry about keeping his eyes open during the procedure. Usually street clothes can be worn for the procedure, although eye makeup and perfume or cologne should not be worn, as this can interfere with the laser function. There should be a person available to drive the patient home.

The Laser Vision Correction Procedures

Procedure Overview

In Lasik, a microkeratome is used to create a paper-thin flap on the surface of the cornea prior to the application of the laser. In PRK, the surgeon prepares the surface of the eye more superficially prior to the laser application. After the laser creates the desired refractive effect, the flap is placed back into position in Lasik, where it stays firmly in place without the need for sutures. In PRK, the surface of the eye must heal back over after the laser application, and usually a bandage contact lens is placed for comfort during the healing process, which may take one to three days. Both eyes can be treated in the same session with Lasik, while with PRK the eyes are usually treated a few weeks apart.

The laser used is a state-of-the-art VISX Star S4 ActiveTrak Excimer Laser with the WaveScan WaveFront System . This system features an active eye tracking technology in all 3 dimensions (horizontal, vertical, and up and down motion of the eye), Variable Spot Scanning technology, and an 8.0 mm Blend Zone option. These features all help to give the smoothest possible laser application. Plus, unlike some lasers, dilation is not required for laser eye tracking during the procedure!

Procedure: Lasik

• Prior to the procedure, both the microkeratome and excimer laser are checked to insure proper functioning. The refractive error of the eye is programmed into the laser.
• The patient has anesthetic eye drops placed, and then reclines on the surgical chair with the eye facing upward toward the laser. Again, it is important not to wear eye makeup or use perfumes or cologne prior to the procedure.
• The eyelid speculum is place to hold open the eyelids of the operated eye, and the other eye is usually covered to prevent inadvertent exposure to the laser. Looking up into the laser, the patient can see a blinking fixation light, and it is important to stare directly at this light throughout the procedure.
• The surgeon will then place a suction ring onto the conjunctiva (white of the eye) around the cornea. This pressurizes the eye so that the microkeratome can be used. The microkeratome is then engaged onto the suction ring and is passed over the cornea to create the flap. The fixation light will disappear for a short period of time during this part of the procedure (seconds).
• The laser is then briefly retested and the corneal flap is folded back. The fixation light will now appear very blurry, but will be visible. The laser will then be used, which can take from 30 seconds to a couple of minutes. The laser makes a snapping sound, which is normal.
• After the laser application, the flap is repositioned and irrigated with sterile saline. The surgeon observes the flap for a few minutes to insure that it is adhering properly. A bandage contact lens is optional at this point, and is usually not needed. A protective shield is placed over the eye after the speculum is removed.

Procedure: PRK

• Prior to the procedure, the excimer laser is tested to insure proper functioning, and the refractive error of the eye is programmed into the laser.
• Anesthetic eye drops are placed into the operative eye, and the patient reclines onto the surgical chair, with the eye facing upward toward the laser. It is important not to use eye makeup or perfume or cologne on the day of the procedure.
• The eyelid speculum is placed to hold the eyelids open, and the other eye is covered loosely to prevent inadvertent laser exposure. Looking upward into the laser, a blinking fixation light is visible, and it is important to maintain the gaze at that light throughout the procedure.
• The surgeon will then prepare the surface of the eye for the laser, which takes a couple of minutes. The laser will then be used, and this takes from 30 seconds to a couple of minutes. The fixation light will become blurrier as the laser proceeds, but it will still be visible. The laser normally makes a snapping sound while it is working.
• After the laser application, the eye is irrigated with sterile fluid and a bandage contact lens is placed. The speculum is removed, and antibiotic and anti-inflammatory eye drops are given to the patient. Sometimes pain medication is necessary after the procedure.

After Laser Vision Correction

After Lasik: It is important not to rub the eye after the procedure. Postoperatively, antibiotic eye drops are used as well as lubricating artificial tears. Pain medication is usually not necessary, and the vision will clear within hours or days. The first follow-up visit is usually the next day.

After PRK: The operated eye is checked frequently until the cornea heals underneath the bandage lens, which can take from four to seven days. The bandage lens is then removed. The vision is usually somewhat blurred after PRK for days to weeks.

After Laser Vision Correction, follow-up visits are scheduled at regular intervals to insure that the cornea is healing properly. Usually patients are seen the first day after the procedure, followed by one week, two to four weeks, and then two to three months. More follow-up visits are initially required after PRK due to the initial healing stage of the cornea and the use of a bandage contact lens. Except for artificial tears, eye drops are usually discontinued one to two weeks after Lasik. Prescription eye drops are used for a few months after PRK.

It is important to protect the eyes from sun exposure after Laser Vision Correction by using ultraviolet protecting sunglasses. The eyes may feel somewhat dry after Laser Vision Correction, and artificial tears should be used liberally. Most activities are safe to engage in after Laser Vision Correction, but swimming should be avoided for at least one week.

Clinical Results of Laser Vision Correction:

CRS Clinical Research coordinated a physician led and funded study to evaluate the safety and effectiveness of LASIK using the VISX excimer laser. This laser has been FDA approved for the LASIK procedure based on the data collected from the CRS studies.

The CRS study looked at the results of LASIK from a variety of surgeons using the VISX excimer laser. 723 eyes were treated initially by the VISX laser.

• In myopia (nearsightedness) ranging from 1 to 12 Diopters preoperatively, 95% of eyes treated with the VISX had 20/40 or better uncorrected vision (without glasses or contact lenses) within 6 months after LASIK.
• In cases of less than 7 Diopters preoperatively, 63% of VISX treated eyes had 20/20 or better uncorrected vision after LASIK.
• The refractive result was found to be stable between 3 to 6 months after surgery, and less than 1% of treated eyes experienced an adverse event with LASIK.
• Only 0.6% of VISX treated eyes lost 2 lines of best corrected visual acuity after LASIK.

Further clinical studies have expanded the range FDA approved treatment for nearsightedness, astigmatism, and farsightedness by Lasik to what it is today. With the advent of CustomVue™ Lasik, visual acuity results after Lasik have continued to improve.

Complications of Laser Vision Correction:

All surgical procedures carry risk, although complications following Laser Vision Correction have generally been uncommon. A thorough discussion of the risks and complications of Laser Vision Correction can be found at Laser Vision Correction Risks & Complications.

Misconceptions about Lasik

Common Misconceptions about Laser Vision Correction

1. After the procedure, can one throw away their glasses for life?
   The goal of Laser Vision Correction is minimize a person's dependency on glasses and contact lenses. It is still possible that after the procedure, a person might need glasses for demanding visual tasks, such as driving at night. Also, a person over the age of forty will usually need reading glasses for near vision even after Laser Vision Correction.
2. Does the procedure (LASIK or PRK) take only 5 minutes to perform per eye?
   While the actual amount of time that the laser is used is often only one to two minutes or less, the full time of the procedure is somewhat longer, per eye. Time is spent getting everything into the proper position and in cleaning the area around the eye before surgery. In LASIK, several minutes are spent after the laser has been used to insure that the flap is returning to the proper position without slippage. A more realistic time that the procedure takes per eye is around 15 minutes (still a short period of time). After the person returns home, they will generally want to limit their activities for the first day, at least. Most people after LASIK can return to their regular daily routine within a few days of the procedure. This may take a little longer for PRK, due to a longer healing time with that procedure.
3. Does everyone see 20/20 the first day after surgery?
   This certainly is not true for PRK, as the vision may be blurred for a week or so after the procedure is done. In fact, with PRK, a person's best corrected vision seems to continue to improve even months after the procedure has been done. With LASIK, the vision returns much more rapidly. Many people see extremely well the first day after LASIK. However, due to individual healing responses, it is not realistic to expect the vision to be 20/20 the first day after LASIK.
4. Are PRK and LASIK such simple procedures to perform that there is no risk of any complication?
   There is risk of complication with any surgical procedure, PRK and LASIK included. While most risks are very rare after these procedures (as listed in the Complications section), there is a more significant risk of not achieving a perfect correction after the procedure, and a risk of seeing glare or halos around lights, especially at night. However, even the risks of these problems are fairly low. One should have a good knowledge about the expected outcome of the procedure, including risks involved.
5. Can a person not wear contact lenses after PRK or LASIK?
   If necessary, a person can wear soft contact lenses after PRK or LASIK. In fact, sometimes a soft bandage contact lens is placed to help with healing right after the procedure is performed (especially with PRK). With LASIK, it is not usually recommended to wear a rigid contact lens after the procedure. Sometimes the actual fitting of contact lenses is more difficult after refractive surgery has been done.
6. Can the results of Laser Vision Correction be enhanced repeatedly until the desired result is obtained?
   The vast majority of people never need any further procedure after the original PRK or LASIK. If a person has a significant under correction after the first procedure, an enhancement procedure can be done no earlier than 3 months after LASIK, or 6 months after PRK. It is very rare to have a third procedure. With every additional procedure, there are increased risks of surgery to the point that the risk of surgery outweighs any potential gain.
7. Is Laser Vision Correction not covered by medical or vision insurance because it is a cosmetic procedure?
   Since laser vision correction reduces the need for a prosthetic device (glasses or contact lenses), and since is improves the functioning of the eye with out the need of other devices, it is not really a cosmetic procedure. It does not change a person's appearance, only their dependency on glasses or contact lenses. Insurance companies do not cover these procedures simply because they choose not to cover them. Some vision plans are now offering discounts for Laser Vision Correction.
8. If a person is sensitive about their eyes, can Laser Vision Correction be performed with a person fully sedated?
   Some sedation can be given before PRK or LASIK. However, it is vital that a person be able to consistently gaze at the fixation light of the laser while the procedure is being performed, otherwise an unpredictable outcome could occur. Our VISX Star S4 ActiveTrak Excimer Laser offers a sophisticated eye tracking feature, but the results of Laser Vision Correction are best with good patient fixation.
9. Is Laser Vision Correction painful?
   Neither PRK nor LASIK are painful procedures. Eye drop anesthesia is extremely effective, for example, even cataract surgery can be performed with eye drop anesthesia. Some people are briefly bothered by the lid speculum that opens the eyelids. After the procedure, most people are comfortable with minimal discomfort, especially after LASIK. With PRK, a bandage contact lens and eye drops can help to ease discomfort while the corneal surface heals.
10. If person strongly desires Laser Vision Correction, should be done even if he cannot afford it?
    There are different options for payment for Laser Vision Correction, from credit cards to financing arrangements, that make Laser Vision Correction affordable for everyone.

Being a Good Candidate

Characteristics of a Good Candidate for Laser Vision Correction

A good candidate for Laser Vision Correction should have a thorough discussion with the operating surgeon about the surgery itself and the goals of the surgery. Potential risks, side effects, and alternative treatments should be discussed. The prospective candidate for surgery should understand that while the results of Laser Vision Correction have been excellent, every individual eye may heal differently from another, sometimes with unexpected results. Thus, there may be a need for retreatment after an initial healing period. The patient should understand his motives for desiring Laser Vision Correction, and have realistic expectations about the outcome of the procedure.

There may be certain medical or ocular reasons that may prevent a person from safely having Laser Vision Correction:

• Ocular conditions such as dry eye, thin corneas, keratoconus, unstable refractive error, glasses prescription out of the treatable range, corneal scars, and any other condition that might limit the visual potential might prevent a person from being a good candidate for Laser Vision Correction.
• There may be medical conditions that would make a person an unsuitable candidate for Laser Vision Correction, and there are some age limitations.  Being an elective procedure, Laser Vision Correction should not be done if the patient has uncontrolled medical problems.
• If the patient is unable to cooperate during the procedure or maintain fixation on the fixation light, then Laser Vision Correction might be impossible to perform.
• This is not a complete list, and there are many other medical and ocular considerations regarding Laser Vision Correction.