A cornea flap in preparation for LASIK surgery.

Laser Surgery Can Improve Vision Problems

Laser vision surgery is a popular treatment for vision problems. It reduces or eliminates the need for eyeglasses or contact lenses.

Laser procedures can help correct refractive errors. These are problems caused by an imperfectly shaped eyeball or cornea. The cornea is the clear part on the front of the eye that bends and focuses light. Refractive errors cause light from an object to be imprecisely focused on the retina of the eye. This causes a blurred image. Refractive errors often occur in otherwise healthy eyes.

These are the 4 basic types of refractive errors:

Nearsightedness (myopia). Close objects appear sharp, but those in the distance are blurred. The eyeball is longer than normal from front to back or the cornea is curved too much. Images focus in front of the retina instead of on it.
Farsightedness (hyperopia). Distant objects can be seen clearly, but objects up close are blurred. The eyeball is shorter than normal or the cornea is too flat. Images focus behind the retina.
Astigmatism. Objects are blurred at any distance. The cornea, lens, or both are shaped so that images aren't focused sharply on the retina.
Presbyopia or aging eye. The eye loses its ability to change focus because of the natural aging process. This often occurs between ages 40 and 50. Refractive surgery can't correct this problem. It can make distance vision clearer. But it may make near vision worse.

Laser procedures

LASIK (laser in-situ keratomileusis). This makes up 90% to 95% of all laser vision correction surgery. It has the broadest range of uses. LASIK is a procedure that permanently changes the shape of the cornea, the clear covering of the front of the eye. Sometimes, a knife called a microkeratome is used to cut a hinged flap in the cornea. This flap may also be created with a special laser designed for this procedure. The flap is folded back revealing the middle section of the cornea (the stroma). Pulses from a computer-controlled excimer laser remove a part of the stroma and the flap is replaced. Intralase LASIK uses a laser to create the flap. This results in a thinner flap. It allows for higher prescriptions to be corrected.
PRK (photo refractive keratectomy). This method uses a laser to remove the cornea's outer covering and reshape it. This type of refractive surgery gently reshapes the cornea by removing tiny amounts of tissue from the outer surface. Recovery takes a bit longer than it does with LASIK.
LASEK (laser epithelial keratomileusis). This surgery combines LASIK and PRK methods. It may be used for people who can't have LASIK. The cornea's surface is loosened with an alcohol solution and moved aside before a laser reshapes the cornea. No flap is cut.
LTK (laser thermal keratoplasty). This is a less invasive laser procedure to correct farsightedness and astigmatism. LTK uses heat to reshape the cornea. The advantage of LTK is that it's a "no touch" procedure. This means there's little chance of infection or loss of vision. This method is being done less often than in the past.

Is refractive surgery for you?

Health insurers rarely pay for this type of surgery, which is considered cosmetic. Prices vary — from $300 to $2,400 per eye — But experts warn that cost shouldn't be your only concern.

Laser surgery may not be right for you. These are factors that show you are not a good candidate:

You aren't a risk-taker. Some people do have complications. No long-term data are available for current procedures.
It will affect your career. Check with your employer, military service, or professional organization, before undergoing surgery. Some jobs ban certain refractive procedures.
You required a change in your contact lens or eyeglass prescription in the past year. This is called refractive instability. You are more likely to have refractive instability if you: are in your early 20s or younger, have changing hormones because of a disease like diabetes, are a woman who is pregnant or breastfeeding, and are taking medicines such as steroids.
You have a disease or are on medicines that may affect wound healing. Illnesses include autoimmune diseases, like rheumatoid arthritis, HIV, and diabetes. Medicines include retinoic acid and steroids.
You have an eye disease.
You participate in contact sports.These are sports like boxing, wrestling, or martial arts. Blows to the face and eyes are common with these sports.
You are not an adult. No lasers are approved for children or teens under 18.

Besides the illnesses listed above, other diseases may negatively affect the outcome of LASIK surgery:

Herpes simplex or herpes zoster (shingles) around the eye area
Glaucoma, ocular hypertension, or are at risk for glaucoma
Eye injuries or previous eye surgeries
Keratoconus, a thinning disorder of the cornea

These are other risk factors that may affect the outcome of your surgery:

Large pupils. Younger people and people on some medicines may have large pupils in dim light. This can cause glare, halos, starbursts, and double vision after surgery. The symptoms may be severe enough to hamper normal activities like driving.
Thin corneas. Refractive surgery done on a cornea that is too thin may lead to blindness.
Previous refractive surgery. Talk with your healthcare provider if you've had RK, PRK, LASIK or another refractive procedure. Additional surgery may not be recommended.
Dry eyes. LASIK surgery can worsen this condition.
Under- or over-correction can occur if too little or too much tissue is removed.
Astigmatism can occur if an uneven amount of tissue was removed.
Glares, halos, or double vision can result.

Finding a good surgeon

Only ophthalmologists are permitted to do LASIK. Ask your eye healthcare provider or optometrist for a referral to an ophthalmologist who does LASIK. Ask for a referral from an ophthalmologist who does not do refractive surgery. You can also visit the American Academy of Ophthalmology's website, which offers a list of its members who do LASIK. About 95% of all ophthalmologists are AAO members. Ask your surgeon the following questions:

How long have you been doing LASIK surgery?
How much experience do you have with the LASIK procedure?
How do you define success? What's your success rate?
What is the chance for me (with my correction) to achieve 20/20?
How many of your patients have achieved 20/20 or 20/40 vision?
How many patients return for enhancements?
Which laser will you be using for my surgery?
What's involved in after-surgery care?

If you are uncomfortable asking these questions, bring a friend or family member with you who will ask them for you. It is vital to your decision about surgery, and your safety, that you have this information.

Make sure your surgeon is using a laser approved by the FDA. The FDA has approved 5 lasers for LASIK. They are manufactured by VISX, Summit, Bausch and Lomb, Nidek, and ATC.

Many people don't have 20/20 vision after surgery, but most are 20/40 or better. About 8% to 10% need an added procedure. Some need eyeglasses or contact lenses to make up for over- or under-correction.

Complications

Complications include:

Night glare
Infiltration of the cornea
Ripples
Infection
Regression of correction
Under correction
Loss of visual acuity
Dry eyes
Trouble fitting contact lenses for additional correction
Need for retreatment

The complication rate is around 10%.

If you're a good candidate for a LASIK procedure, have realistic expectations, and choose the right surgeon, chances are very good that you will do well.

Medical Reviewers:

Fraser, Marianne, MSN, RN

Griggs, Paul B., MD

Haupert, Christopher L., MD ((

LASER VISION TECHNOLOGY

Z500 LASIK With EX500 Technology

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The iFS® is the latest and most advanced generation of femtosecond lasers. The iFS® laser creates what has also been called “The 10-Second Flap” through unprecedented speed and accuracy, and is designed to deliver biomechanically engineered flaps customized for each individual cornea. Because of its extraordinary speed and precision, the iFS® Femtosecond laser offers less discomfort for the patient, reduced tissue response and less inflammation for a more comfortable post-operative recovery.

The iFS® Femtosecond laser is designed uniquely with an inverted bevel-in side cut angle to effortlessly lift the corneal flap. The iFS® laser also enhances the adhesion of the post-operative flap and the stability of the cornea after LASIK. Additionally, it provides advanced options like the elliptical flap, by customizing the LASIK flap dimensions according to individual refractive errors and the corneal anatomy.

The new iFS® Advanced Femtosecond Laser system takes LASIK surgery — and more specifically, LASIK flap creation — to a whole new standard of speed and control. It’s designed to deliver superbly engineered flaps that can be customized for every individual cornea.

San Antonio Eye Specialists is proud to offer iFS femtosecond technology to our patients!

Z-LASIK

Our commitment to safety and advanced technology is evidenced by the technology Dr. Iskander chooses to perform the first portion of his Z-LASIK Allegretto Wave LASIK procedure. We strongly believe the Ziemer Femtosecond LDV laser is one of the world’s most advanced laser system for creating the thin protective layer in the outer portion of the cornea.

Presently, the Ziemer LDV system is one of the fastest femtosecond lasers on the market. Faster treatment times for patients means more comfort, increased safety and less trauma to the eye. Compared to more conventional femtosecond lasers, the Ziemer LDV operates at a higher pulse rate with lower light pulse energies and a specially designed optical system that provides maximum tissue disruption in the focal spot and no thermal or radiation effects to the surrounding tissue. In layman’s terms, it’s simply the most advanced and precise method available today for creating a corneal flap.

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The Ziemer laser produces approximately 400 million tiny, closely-spaced gas bubbles at a predetermined depth in the corneal layer. These microscopic bubbles create a separation, which in turn creates the corneal flap. This level of precision allows Dr. Iskander to create LASIK flaps of precise thickness, orientation and size. Due to the tiny size of the gas bubbles, they disappear as soon as the flap is lifted by Dr. Iskander.

The Ziemer Femto LDV laser is also designed for maximum safety when compared to more conventional femtosecond lasers. Because we use a lower light pulse and lower pulse energy to create our flaps, there is a lower level of light intensity to the eye and less chance for an inflammatory response in the eye. As a result of Ziemer’s unique designs, patients enjoy faster recovery times, less discomfort and optimal visual outcomes.

Z-LASIK: The Future Of Bladeless Laser Surgery

Z-LASIK is the most advanced innovation in bladeless surgery.

This procedure uses a high-frequency laser. It is designed to create truly customized flaps, precisely, safely and pain-free. Its beam is 100 times less intense than that of the first-generation femtosecond lasers.

Never before have safety, accuracy and patient comfort in laser eye surgery been so good, as proven by 100,000 successful Z-LASIK treatments.

Z-LASIK IS DIFFERENT!

Z-LASIK offers many advantages that lead to better results:

Z-LASIK is gentle on the eyes: The procedure takes only a few seconds per eye, and usually 12 seconds for the creation of the corneal flap. The time the laser is in contact with the eye is reduced to a minimum.
Z-LASIK is comfortable and painless: head is not fixed during the procedure.
Z-LASIK helps in severe cases: Thanks to the extremely high frequency of the laser pulses, the layers of the cornea are separated with unprecedented precision, creating an ultra-thin flap. Z-LASIK is therefore effective in patients who were previously not candidates for laser surgery, including those patients with extreme myopia or thin corneas.
No inflammation: The laser energy used for Z-LASIK is 100 times less powerful than with other laser procedures. This is more gentle to the corneal tissue and prevents temporary inflammatory reactions of the eye.
Fast result: The recovery period is shorter than for other techniques. Visual improvement is noticeable within a few hours.
Fewer side effects: Z-LASIK enables the surgeon to enlarge the treatment zone. This reduces the risk of undesirable side effects such as dry eyes, deteriorated night vision or haloes (rings of light that surround point sources of light).

Expectations After LASIK

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Your procedure will take less than 10 minutes for both eyes and will be minimally uncomfortable. As soon as you sit up right after surgery, you will be able to see distances that you could not see before. However, your vision may be “foggy” for the rest of the day. You may experience discomfort in your eyes for about 4-6 hours.

Closing your eyes, combined with regularly applying lubricating drops to the eyes is the best remedy for discomfort.

When you wake up in the morning, your eyes will feel normal with no or little discomfort and your vision will be clearer.

It will continue to improve over time. It is common for patients to see halos and star bursts around lights when they are driving at night. This generally disappears in a few weeks.

Expectations After PRK

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Your procedure will take about 5 minutes for both eyes and will be minimally uncomfortable. You will see very well as soon as you sit up after surgery. After half an hour, when the anesthesia wears off, you might experience some discomfort. Your vision will remain good. Use of pain medications, eye drops and ice packs may be used if pain is severe.

The discomfort will progressively improve dramatically over the next 2 days. The vision will sharpen and stabilize over the next few weeks. The recovery is partially dependent on healing and age. For example, younger patients generally recover faster than older patients.

Improved Night Vision After PRK

At night and in dark conditions, the pupil becomes larger to permit the maximum amount of light to enter the eye. Laser eye correction needs to take this fact into account. If the optical zone is smaller than the size of the pupil at its largest, there is a good chance that the patient will experience poor night vision or problems with glare and halos around bright objects such as oncoming headlights. ALLEGRETTO WAVE® is able to produce a larger optical zone, virtually eliminatinNew high tech laser power for better vision

Posted in Blog, Posts | Comments Off on New high tech laser power for better vision

Liberty Laser Eye Center continues to pioneer eye surgery technology
with brand-new topography guided excimer laser system – first in the U.S.

The average sci-fi action hero might get a little envious of the significant laser power that Liberty Laser Eye Center has to offer. Our laser eye surgery center boasts the most advanced technologies available in laser technology.

Not bad for a small private eye surgery center in Tyson’s Corner, Va. – and we are especially proud of our latest addition.

In the middle of March, we installed our brand-new topography guided excimer laser system. It was the first installation of this FDA-approved equipment in the U.S., and will allow us to improve the vision of some patients who were not considered good candidates for laser eye surgery in the past. It also allows us to help people who developed night vision problems or other difficulties with treatments on other types of lasers in the past.

Our surgeon, Dr. Nancy Tanchel, has been on the forefront of Lasik eye surgery for years, and has been pioneering the use of this kind of cutting-edge technology in the Washington, DC area.

Here is some of the technology used for laser vision correction at Liberty Laser Eye in addition to our new topography guided excimer laser system:

All-Laser LASIK: All-Laser LASIK is a true advance in vision correction surgery. The femtosecond laser eliminates the most serious risks associated with the LASIK procedure. Originally LASIK procedures were performed by using a hand-held mechanical razor blade. Due to complications from the original LASIK procedure, all-laser technology was developed for added precision. Liberty Laser uses Z-LASIK, the most technologically advanced form of all-laser LASIK. Dr. Tanchel has been using the most advanced femtosecond lasers for over 10 years, and she has the experience to get the most from the technology with unsurpassed results for our patients.

Liberty Laser Eye Center was the first in 2008 to acquire the Femto LDV femtosecond laser in the region. This is the newest generation laser for creating an All-Laser LASIK flap. It creates a smoother flap and is easier for the patient during surgery. Due to its unique hand-held laser delivery system, which is attached to an easily maneuverable articulated arm, patients can be treated on the patient bed of the excimer laser and do not have to be relocated between flap creation and ablation procedures as in the past with the intralase laser. The surgeon can perform and control the entire procedure from a single working position, without having to move about or change microscopes.

Z-LASIK is a completely different treatment in fundamental ways. Ziemer’s FEMTO LDV is not just another femtosecond laser like Intralase, Femtec, or Zeiss. Compared to these conventional femtolasers, the FEMTO LDV operates at pulse rates that are many orders of magnitude higher, pulse energies that are much lower, and delivery optics that are very tightly focused for maximum flap creation in the focal spot and no thermal or radiation effects to the surrounding tissue. With the combined use of state of-the-art lasers and diagnostic equipment, Z-LASIK provides the best currently available treatment for superior vision correction.

Presby-LASIK: P-LASIK is a great advancement in treating patients age 40 and over who have developed trouble reading. P-LASIK seems to work by restoring negative spherical aberration to the eyes. This wavefront pattern is natural in younger eyes and changes as we age. The increased negative SA provides a greater depth of field. P-LASIK is not monovision, since both eyes see the same.

We are currently the only doctors offering this service in the Northern Virginia area.

Dr. Tanchel waited for some colleagues to perform a few hundred cases on the west coast and followed their results attentively. Once she was sure that the procedure was safe and effective, she started performing P-LASIK here at Liberty Laser Eye Center. Dr. Tanchel was the first and is currently the only surgeon able to perform P-LASIK in this region.

Wavefront Analysis: The key to correcting your vision is understanding your individual vision performance. Wavefront Analysis allows us to diagnose the necessary changes needed to make your vision clearer and sharper. It is a major innovation that provides Dr. Tanchel with more precise, comprehensive data on the patients’ visual performance. Wavefront data goes beyond Snellen acuity that is read on an eye chart and brings vision correction technology into the 21st century. Utilizing this data, we can optimize vision to be generally sharper, as well as clearer in dim light.

We then take measurements with the Nidek OPD-scan. Multiple detailed maps are compiled which describe the optical performance of the eye. This information is used to guide the laser treatment. When coupled with the Z-LASIK flap, which decreases flap related wavefront aberrations, this is the most accurate treatment available.

Better technology for better results: At Liberty Laser Eye, we have the technology and expertise to restore your vision and lead a happier life. We’ve performed LASIK procedures on thousands of our patients without a single vision threatening complication.

Schedule a free consultation to determine if you’re a candidate for LASIK surgery online or call (571)234-5678 to speak with a representative. Call today to take the first step to freedom from contacts and glasses!

g glare and night vision problems associated with older generation lasers.

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