"Refractive errors" are conditions in which differences in the length of the eye, shape of the cornea and/or power of the lens cause problems in the way light enters the eyeball and is "refracted" or bent and focused onto the retina. Refractive errors are mechanical problems (optical distortions)—not actual diseases. They come on gradually and are characterized by blurred vision. Glasses or contact lenses can usually correct focusing errors. A "refraction" is the eye examination which determines the degree and nature of an optical error, plus the appropriate correction for the error.
Nearsightedness is a condition in which objects that are near are seen more clearly than objects that are far away. The term "myopia" comes from a Greek word meaning "closed eyes"—because nearsighted people often squint to see in the distance. Myopia is among the most common visual disorders, affecting nearly 25 percent of Americans. It typically begins in childhood and stabilizes by age 20.
Myopia is usually the result of either a slightly elongated eyeball or a cornea with too steep of a curve. Because the eye is longer, light converges and focuses at a point before reaching the retina at the back of the eye. As a result, objects in the distance are seen as blurry. Heredity is believed to be the major cause of nearsightedness. Other conditions, however, may affect the presence and/or degree of myopia.
With astigmatism, the cornea is more oval-shaped, like a football, rather than round, like a basketball. As a result, light rays passing through the cornea cannot meet at a single focal point, thus forming imperfect, or blurred, images (somewhat like the distortions which occur when viewing objects on a wavy surface, such as a "funhouse" mirror). Astigmatism is usually inherited, may be present at birth, and may be associated with myopia or hyperopia. Most eyes are at least slightly astigmatic, but do not need correction unless it is severe enough to cause blurred vision (both near and far).
With farsightedness, objects that are far away are seen more clearly than objects that are close. Hyperopia is due to a relatively flat curvature of the cornea, a shorter than normal eyeball, or both. As a result of this shortened distance, light rays reflected from objects reach the retina before having a chance to properly converge and focus. Thus a blurred image is produced for near objects. Hyperopia is most often hereditary.
Ever since the invention of glasses, scientists and doctors have been looking for newer, more convenient ways to improve vision. Since 80 percent of the focusing power of the eye comes from the front of the cornea, research has concentrated on changing the cornea's shape to improve its natural focusing capabilities. The cornea can be made flatter to treat nearsightedness, steeper to treat farsightedness, and more spherical to correct astigmatism.
In the 1970s, incisional "refractive surgery" became an established method in the U.S. for reducing or eliminating the need for glasses or contact lenses. Then, in the 1980s, lasers were introduced as a new option offering enhanced precision and predictability for surgical vision correction.
Laser vision treatment was not new to ophthalmology. In fact, ophthalmologists were the first doctors to use lasers in the medical profession, treating a variety of eye diseases and conditions, including diabetic retinopathy, advanced glaucoma, macular degeneration, and cell regeneration after cataract surgery. The concept of using lasers to treat nearsightedness came about when Dr. Srinivasin, a photochemist at IBM, saw the potential biological applications of an Excimer laser used to etch computer chips. Srinivasin shared his ideas with ophthalmologist Steven Trokel. Together they pioneered the idea of employing a computer-guided laser beam to remove several layers of cells from the cornea to change its shape and thus improve the focusing of light onto the retina.
LASIK is considered by many surgeons to be the optimal method for performing laser vision correction. With LASIK, a very thin corneal flap or "cap" is created and folded back. Next, ultraviolet light from the laser is used to microscopically reshape the underlying tissue. 
Unlike other surgical lasers, which operate by producing heat and burning tissue or by producing micro-explosions that separate tissue, the excimer laser produces a "cool" or non-thermal light beam that breaks the molecular bonds between cells. Thus it vaporizes tissue, one layer at a time, with little to no effect on surrounding tissue. Data fed into the laser's computer determines the area and number of pulses needed to appropriately change the cornea's curvature.Each pulse then carefully removes tissue with accuracy of up to 0.25 microns (0.00004 of an inch). The entire procedure removes approximately only 100 microns (about the width of a human hair) of the cornea's total 500 microns of thickness and takes just minutes to perform. Upon completion, the cap is returned into position where it quickly seals down on its own without the need for stitches.
LASIK is very patient friendly, offering fast visual recovery, little to no discomfort, and few post-operative complications. It also involves minimal use of eye drops. These benefits are a result of the LASIK technique of reshaping the cornea's inner layers rather than recontouring its surface (as with PRK as described below). This method does, however, require greater surgical skill and training.
This vision enhancement procedure also utilizes the laser to treat nearsightedness, farsightedness and astigmatism. With PRK, laser pulses reshape the top surface of the cornea, one layer at a time, with little to no effect on surrounding tissue. As with LASIK, PRK involves only a small fraction of the cornea's total thickness and takes only minutes to perform. PRK is typically reserved for use on people with corneas too thin for LASIK treatment.
Eye Care Specialists is pleased to provide exceptional LASIK surgery services for our patients utilizing the newest development in excimer laser technology—the Bausch & Lomb Zyoptix™ Personalized Laser Vision Correction System. The Zyoptix system is so advanced, it lets us treat higher-order aberrations that could not previously be corrected with conventional LASIK techniques. Prior to its approval by the FDA, Zyoptix was used outside of the U.S. for years in hundreds of thousands of successful procedures.
A variety of reasons, including the ability to change the diameter of the laser treatment area coupled with an advanced diagnostic system that utilizes innovative wavefront technology. Unlike conventional LASIK, the Zyoptix system maps each eye individually and analyzes up to 9,600 data points to create a precise, three-dimensional picture of the eye's shape and characteristics. This information is then used to plan a personalized laser vision correction procedure completely individualized for each patient.
The Zyoptix system measures and treats "higher order" aberrations beyond a 6mm diameter optical zone. (Higher order aberrations are flaws in the optical system—beyond mere nearsightedness, farsightedness and astigmatism—that also reduce best possible vision.) As such, Zyoptix is the only laser system which has clinically demonstrated the ability to improve night vision and contrast sensitivity and to reduce higher order aberrations—key factors to determining overall patient satisfaction (as shown below).
The wavefront-guided, custom correction platform consists of the following equipment to provide state-of-the-art diagnostic and therapeutic technology for LASIK procedures.
Because you care about your satisfaction, and you want to experience the best possible results. According to clinical study researchers, Zyoptix patients noted statistically significant, subjective improvements in terms of light sensitivity, headaches, pain redness, excessive tearing, and burning. The Zyoptix procedure also significantly improved upon bright-light vision, dim-light vision, and difficulties with night driving. Zyoptix researchers believed that the greatest benefits would be experienced by people with: more than 0.3 um of RMS wavefront error; large pupils; and thin corneas that require less tissue removal.
Results from a multicenter clinical trial within the United States for the Zyoptix system were submitted to the FDA and showed impressive patient outcomes (as summarized, below). The data involved single treatments only—making it all the more remarkable since other laser companies reported their data with enhancements (fine-tuning procedures) included. The results clearly show that Zyoptix technology produces excellent visual outcomes as determined by customer satisfaction.
Patients often want to be less dependent upon glasses and contact lenses for any number of medical, financial, occupational, physical, personal or cosmetic reasons. Some people are unable to wear or are dissatisfied with glasses or contact lenses. Others would like greater freedom to enjoy sports and recreational activities. Nearsighted people may want to improve their distance vision enough to reduce or eliminate the eventual need for bifocals and thus only use glasses for reading. Whatever the reason, refractive surgery may be the answer. Before deciding, you should consider the following points.
The accuracy of refractive surgery is dependent upon many factors, including individual healing responses and the degree of refractive error being treated. Although outcomes are continually improving, the latest studies indicate that at least 96% of patients (within the mild to moderate myopia range) attain 20/40 or better vision uncorrected (the level needed to legally drive without glasses or contacts).
The best measure of results, however, is the improvement in day-to-day functioning that each patient experiences on his or her own personal level.
Although the predictability of procedures keeps improving, under- and over-corrections can still occur. With an under-correction, there is still residual refractive error. In these cases, the option often exists to perform additional treatment (called an "enhancement"). Although these patients may need glasses or contact lenses or further surgical intervention, their vision is usually better than before surgery.
As with any surgery, complications are possible. These may include corneal scarring, infections, corneal perforations, alignment difficulties and other possible risks. However, millions of surgeries have been performed worldwide and serious or long-term complications (like infection) have been extremely rare. In fact, some researchers believe the chances of developing a serious complication are similar to those associated with daily contact lens wear (such as infections caused by improper/unclean handling and storage).
The most common side effects of surgery are:
As people approach their mid-forties, they often notice a blurring at normal reading distance that creates a need to hold items further away. This is a natural aging condition known as presbyopia—the decreased ability of the eye to focus on near objects, as we grow older. Symptoms are usually relieved by reading glasses or bifocal lenses. People with low amounts of nearsightedness can often just remove their glasses to read. Contact lens wearers can either use reading glasses over their contacts or wear one lens corrected for near vision and the other for distance. This second technique is known as "monovision" and has the advantage of reducing or eliminating the need for reading glasses, but the disadvantage of decreasing depth perception.
Patients should also be aware that even if they achieve near normal vision through refractive surgery, depending upon their age, they will still have or may later develop a need for reading glasses. As a result, some refractive surgery patients elect to have their vision surgically adjusted for monovision in order to be able to both read and see in the distance without corrective lenses. This is particularly helpful for people who frequently shift their vision between near and far distances, such as public speakers, clergy, teachers and politicians.
For patients with mild myopia, the dominant eye is corrected for distance vision, while the other eye is left untreated. Patients with higher degrees of myopia may have surgery on both eyes, but have one under corrected for better near vision and the other corrected for distance. With this monovision, patients often must give up a little distance sharpness to gain near vision. Other disadvantages include decreased depth perception and blurred vision when vision is blocked to one eye. To avoid these problems, some people with monovision elect to wear corrective lenses for activities like driving. Your doctor can help you to determine if monovision is a viable option for you.
A secondary procedure (called an "enhancement") may be necessary for some patients to get the full effect of refractive surgery and maximize their visual improvement. If some form of correction is still necessary after surgery, a light glasses prescription or, in most cases, contact lenses can be worn as needed to further refine vision.
Due to the age-related changes of refractive errors, you must be at least 21 years old with a prescription that has not significantly changed for at least one year. You must also have a healthy cornea with no sign of disease or severe distortion, such as glaucoma, keratoconus, diabetic retinopathy, or other major vision-related conditions. And, your refractive error must fall within the recommended range of correction for treatment. Patients outside of these ranges may not be surgical candidates today, but advances in technology may allow them to benefit in the future.
The best candidates for any procedure are those who fully understand the potential risks and benefits and have realistic expectations for their results.
Studies have shown that it can take up to 18 months from the time a person first hears about laser vision treatment until they decide to go ahead with the procedure. Concerns about potential risks and complications, finances, outcomes, and other issues become part of the decision process. And, of course, there is the matter of whether or not your medical and ocular histories make you a candidate at all.
At Eye Care Specialists, we recognize and appreciate the importance of taking your time and feeling comfortable with a decision regarding your eyesight. That is why we encourage people considering laser vision correction to schedule a free screening and consultation. This is a one-on-one visit with our highly trained Laser Surgery Coordinator who has guided numerous patients though the process to reduce or eliminate their need for glasses or contacts.
Prior to meeting, whenever possible, the Coordinator will obtain your prescription to determine if you actually qualify for treatment. She will then send you an information packet, including this booklet, our credentials, common Q&As, a Financial Policy, website resources, etc.
These materials are sent in advance so that you may review them at your leisure with friends and/or family. This also helps to answer many initial questions and thus makes your time in the office more effective. Once you meet with our Coordinator, you'll further discuss any concerns you have, as well as the risks and benefits of surgery. Feel free to ask questions. By gathering as much information as possible, you will develop realistic expectations for results and will most likely move on to the next step.
If you feel that laser vision correction may be right for you, your next step is to schedule a comprehensive eye examination to gather the medical data and precise measurements necessary to conduct your surgery. If you wear contact lenses, you will need to keep them out for a period of time before your visit so that your cornea can return to its natural shape (2 weeks for soft, 3 weeks for extended wear, and 4-6 weeks or more for gas permeable or hard lenses).
This examination will include a medical history to record your age, general health and known allergies; a glaucoma test to measure the fluid pressure inside your eye; and a cycloplegic refraction (dilated exam) to obtain a precise measurement of your degree of myopia, hyperopia and/or astigmatism. A simple, painless corneal topography procedure will be conducted to develop a computerized color "map" of the curvature of your eye. All of this information is compiled to achieve the best possible surgery results.
If everything proves to be in order, you are then ready to schedule surgery. In preparation, you will receive complete pre- and post-operative instruction sheets. You will also be asked to review and sign a legal document called a "written consent form" which attests to your having read and understood the possible risks and benefits associated with refractive surgery and gives permission to operate on your eyes.
Eye Care Specialists is pleased to be able to offer our patients the comfort and convenience of having their vision treatment performed at the Eye Surgery & Laser Center of Wisconsin. This is our own outpatient surgery center, which features a state and federally certified sterile operating room for performing LASIK.
On the day of your LASIK procedure, you will check in at the front desk and be escorted by a nurse to review the surgery process. For those patients who wish, a mild oral sedative is available to assure relaxation. After donning a surgical hat and booties, you will move to the surgical suite where you will rest in a reclining position under the laser and focus on a target light. A small, painless instrument will be used to keep your eyelids from blinking. A simple eye drop is all you will need for anesthesia. There are no injections and you will remain awake and comfortable.
The doctor will then see that the machine is aligned and the desired refractive change is programmed into the computer. After the numbing eye drops have taken effect, the doctor will create and fold back a thin corneal flap to provide a uniform surface for the laser to achieve maximum results. The doctor will then let you know when the laser pulses will occur. During this time, you will hear a clicking sound as the laser vaporizes each microscopic portion of tissue. The actual laser time is approximately 20 to 120 seconds; the entire procedure takes just minutes to perform. Upon completion, the corneal flap is returned into place and seals on its own.
For patient convenience and prompt return to a visibly different life, whenever medically appropriate, both eyes are treated at the same time.
After surgery, eye drops are given to promote proper healing and prevent infection. Clear plastic shields are placed over your eyes to protect them the first day and while you sleep for the next two weeks. After reviewing your post-op instructions, you are ready to go. Since your vision will be blurry, you need to have a friend or relative drive you home where you can relax for the rest of the day.
Following LASIK, patients usually experience minimal discomfort. Medications (prescription or Tylenol) and eye drops are usually adequate in relieving any discomfort. You will receive detailed handouts explaining what to expect, what to avoid, and how to care for your eye during your recovery period. Your eye will be examined the day after surgery, as well as at the one-week and one-, three- and six-month marks.
Most patients notice a change in their vision within a day after surgery. However, some fluctuation in vision is expected for approximately three to four weeks and varies with the individual patient's healing response. Many patients are ready to return to work the next day with only minor restrictions, such as avoiding swimming and vigorous sports for two weeks. Your vision will generally stabilize within one to four months.
Realistic expectations are crucial to positive results. No doctor can or should guarantee perfect eyesight. Be aware that refractive surgery may not result in the same crispness of vision as that achieved with glasses or contact lenses. As a result, many patients choose to have a light glasses prescription for occasionally fine-tuning their distance and/or night vision. Also, keep in mind that you are still susceptible to normal aging changes of the eye and will probably need reading glasses sometime after age 40.
If you understand and accept the potential benefits and complications of refractive surgery, and elect to proceed with treatment, you can look forward to an exciting new "outlook" on life. Just imagine, you'd be able to go swimming without worrying about finding your way back to the towel. . . . Renew your driver's license without dreading the eye exam. . . . And, check how much longer you can sleep without fumbling for the clock.
At Eye Care Specialists, we have had the privilege of enhancing the vision and lifestyles of everyone from physicians and pilots to working mothers and Olympic gold medalists.
We'd like to have the opportunity to make a visible difference in your life. Call us today and we'll show you how.
Since 1985, Eye Care Specialists has provided comprehensive medical, surgical and laser care for virtually every eye condition to more than 121,000 people in Milwaukee and southeastern Wisconsin. If you would like a detailed informational packet and/or to schedule a free consultation/screening for laser vision correction, please contact our Laser Vision Correction Hotline at 414-321-EYES (3937).
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