Following a recent question posted on this blog, I can add the following CAA PDF download which has additional information:

Download CAA Pilots and LASIK or PRK PDF file or visit the CAA website

There are three main treatment choices for anyone thinking of having laser eye surgery. But which one will be right for you?

The final choice will be determined between you and your laser eye surgeon. BUT, of course, you have the eyes and your surgeon has the expertise so you will be heavily influenced by what the doctor or another clinic staff member says. It will be better to be prepared. With just a little knowledge you can be actively involved in making the right choice.

I will outline the 3 main options to help you have an informed discussion when the time comes to select which approach is best for your individual eyes. After all, you only have one pair so you want to get it right.

You will be overwhelmed at first by all the terminology, treatments and brand names. Don’t worry. There is no need to be blinded by science or some of the frankly misleading marketing information that is out there.

Firstly, whichever of the 3 treatment types (more on these coming in a couple of days in part 2) you go for, you must go for the wavefront option. The wavefront (or custom) technology has made a huge improvement in vision success rates with many more people getting 20/20 sight or even better.

Different clinics use different names for this technology: custom, wavefront, wavefront guided, wavefront optimised, CustomVue.

Many clinics will charge you more for wavefront based treatments over older non-wavefront options. Is it worth it? Definitely.

Back in 2000 when we were doing LASIK without wavefront, the benchmarks for success were getting 65% of patients to 20/20. In 2008 we expect more than 95% of patients to see 20/20 or better. This improvement has come from better technology, in large part from custom or wavefront based corrections.

Also wavefront laser eye treatment will give better vision at night or in low light situations. Patients will notice less halos and glare from light sources such as car headlights. It is like buying a more expensive camera with a much, much better lens.

This is the year 2008, so get the best current technology for your sight correction – you only will have this done once and you will live with the results for the rest of your life. Think about the computer you had back in 2000 and what is now available in 2008 – that is the level of difference in laser technology too. No brainer, really.

If you can’t afford the price, either don’t have it done yet and save up until you can afford it, or think about financing.

So if you go to Optical Express, go for the more expensive CustomVue wavefront version. Without it, the results really are not at a level that is satisfactory in 2008. If you go to Optimax or Ultralase, pay and get their wavefront guided option.

If you go to FOCUS Laser Vision, wavefront is already included in the quoted price. They don’t do any non-wavefront treatments.

Come back in a couple of days to read part 2 where we will finish this post by looking at safety and healing in laser eye surgery.

The excimer laser produces a high-energy, cool ultraviolet light beam in pulses and delivers the pulses to a surface of the eye’s cornea. These pulses break the bond between molecules and tissue cells so that a controlled amount of tissue can literally be vaporized away to reshape the cornea — one microscopic layer at a time.

With some lasers, e.g. the WaveLight system from Germany, it only takes 5-10 seconds to complete the entire laser process to correct most levels of glasses or contact lens prescription.

You can see above and below to the right just how precise and gentle the excimer laser can be. Above a human hair has been etched into precise grooves. Below even words have been carved into the hair!

The excimer laser is computer controlled and programmed to custom treat each individual eye with a high degree of precision. For most cases, the thickness of the layer removed by the laser is less than the thickness of a human hair. The laser only needs to remove 13 thousandths of a millimeter to correct one unit of glasses strength (dioptre)!

The most common reason I hear from people who have not yet decided to go for laser eye correction is that they are cautious and worried that something might go wrong. This is very understandable.

LASIK eye surgery is not for everyone. Some people are very happy with glasses. Some like to have a designer accessory prominent in their appearance. Many people would definitely choose to have laser sight correction if someone could ‘guarantee’ that nothing would go wrong.

LASIK eye treatment has, in fact, become a very safe procedure BUT (there’s always a but!) you need to have certain boxes ticked before you go ahead.

The results you will get, and live with, will depend on four factors:

1. The laser technology used – your surgeon cannot get better results than the laser can deliver
   QUESTION FOR YOU: Which laser is the best? 

    

2. Your surgeon – the laser will only perform as well as the surgeon ‘driving’ it! And even then, never better than the manufacturer made it capable of – see point 1
   QUESTION FOR YOU: How can I know who the best surgeon is? 

    

3. The clinic – will they take good care of you before, during and especially after your treatment?
   QUESTION FOR YOU: How can I select the best clinic? 

    

4. The price you will pay - you don’t always get what you think you are paying for
   QUESTION FOR YOU: How much should I pay for LASIK laser eye surgery – if I pay more, will it be better or safer?

Tune in again next week to see the answers to these questions! The truth is out there! (old X-Files fan – sorry!)

OK. lots of new laser eye surgery names appearing, so let’s confirm what they mean!

Z-LASIK: means blade free LASIK using the new Swiss Ziemer laser to make a corneal flap, rather than a traditional blade.

iLASIK: means blade free LASIK but using the American Intralase laser to make a corneal flap.

So, simple so far. Z for Ziemer’s laser and i for Intralase’s laser. Both of these devices allow elimination of a blade to make a physical cut in the cornea. Instead they use millions of precise laser pulses to create a very accurate flap, removing the potential risks associated with a metal-blade mechanical system.

Click here to watch an FDA animation of mechanical blade LASIK (N.B. Caution: watching this will put you off ever having bladed LASIK in the future! You will definitely want to opt for all laser LASIK after this!)

So what’s the difference between Ziemer and Intralase lasers?

The Ziemer laser is a new system, with potential advances upon the older American Intralase laser flap maker. Ziemer’s lasers, called the LDV, appears to eliminate occasional complications found with iLASIK. Some iLASIK patients (around 7%) get a marked discomfort and aversion to light for several days after laser vision correction, know as “transient light sensitivity”.

This side effect is not seen with Z-LASIK, possibly because of a much more tightly focused laser energy pulse and greatly reduced energy per pulse, compared to Intralase’s looser focus and wider dispersion of energy through the cornea.

Studies are ongoing to compare the two systems in greater detail.

Background on the LASIK procedure:

Creating the corneal flap is the first stage in a LASIK procedure. Treatment to correct your eyesight is actually done on the corneal tissue that’s below the surface and access to it is done by making a surface flap and folding it back (quite painlessly!).

This flap creation is critical for a successful result of your LASIK surgery – it needs to be of exactly the right thickness and in exactly the right place. When the surgery is completed, it’s easily folded back into position and acts as a delicate bandage over the treated eye. It heals up by itself.

The microkeratome devices used in traditional LASIK surgery are hand-held tools with a steel blade that oscillates, moving back and forth at very high speeds. When used expertly it makes a good flap but the thickness can vary more than laser flaps and they can be more irregular, tending to be thinner in the centre.

LASIK complications are quite rare. Fact. But when they do happen, they often arise from a poorly created corneal flap. Use of new femtosecond lasers (Ziemer or Intralase) greatly reduces the likelihood of any such complications.

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Here is Part 2 of the Essential UK Guide to Laser Eye Surgery slideshows. It covers how to read your prescription and know what all the numbers mean.

This is really useful to know for when you call up a clinic to find out if you are suitable for LASIK or PRK laser eye surgery, they will ask you for your prescription. They can also tell you what the maximum prescription treatable limit is, so you will know if you are within the range or not.

You can see it here:

Essential UK Guide to Laser Eye Surgery Part 2 – Reading Your Prescription

[tags]clinic, guide, laser eye surgery, LASIK, London, PRK, UK [/tags]

What is the difference in the two laser eye surgery procedures?
There are basically two laser refractive procedures to correct myopia (short sight), hyperopia (long sight) and astigmatism: 1) LASIK and 2) LASEK. [You can consider LASEK and PRK as basically the same procedure for most discussions - they are both forms of 'surface' laser eye surgery with pretty much identical results].

Both LASIK and LASEK procedures are very safe and will give you the same final results. It can be quite confusing if you are thinking about laser vision correction and want to know which procedure would be best for you. While both LASIK and LASEK can give you excellent vision in a safe and reliable way, some surgeons prefer one or the other, or may indeed only offer one type anyway!

How is the prospective patient supposed to decide?!
What happens in practice is that patients are greatly influenced by what their particular clinician says, and understandably so. It is always worth seeking a second opinion and comparing the findings and comments of each centre. This shouldn’t threaten any clinic worth its salt. Some patients feel more confident with one person or another, based on perhaps only “chemistry”, but it is very important to know the difference in the techniques.
LASIK and LASEK are both very effective procedures and can be used to treat myopia (short sight), myopia myopia(long sight), astigmatism (irregular corneal shape) and reading vision problems.
Please note that most clinics do not have the correct technology required to correct reading vision problems and higher levels of long sight.

[tags]astigmatism, FOCUS Laser Vision, LASEK, laser eye surgery, LASIK, long sight, short sight, surgeon, Technology[/tags]

I have put together a short slide show for Part 1 of the Essential UK Guide to Laser Eye Surgery Slideshows.

You can see it here:

Essential UK Guide to Laser Eye Surgery Part 1 – Why You Need Glasses

It covers the 4 reasons why you need to wear glasses and what is happening inside the eye. Great as an introduction to refractive errors (focusing problems requiring the use of glasses or contact lenses).

More slide shows coming soon.

Watch this video to learn more about why you need glasses. It explains about short sight, long sight, astigmatism and presbyopia.

I get asked about the so-called ‘femtosecond‘ lasers now being used in LASIK laser eye surgery, and what these devices do. OK, here are the answers.

First of all, LASIK eye surgery is a laser procedure with two parts. First we have to make a thin flap from the top part of the cornea, basically a thin hinged layer we can temporarily fold to the side (painlessly!).

Next we use an ‘excimer‘ laser to reshape the exposed cornea to correct the vision focusing problem. The laser will polish away certain areas, depending on your prescription, to bring back clear vision.

The flap is put back in place and heals over very quickly. The eye feels gritty or scratchy for about 3-4 hours only. OK, so far so good.

For the first stage, making a flap, we have used a mechanical device called a keratome (or microkeratome). Keratomes have been around for 50 years and use a blade to make a controlled cut. This stage is where significant complications can occur, so we have been looking for a way to make this corneal flap but without the need for a blade.

Along come femtosecond lasers.

The eye lasers use ultra-short infra-red low energy pulses to create microscopic bubbles at a precise depth below the surface of the cornea. If you do this millions of times, you can create a super precise separation as a sheet, and hence a near-perfect corneal flap, which you can now fold to the side ready for vision correction with a second laser.

The femtosecond laser means we no longer run risks from using a blade to cut a flap. This means safer LASIK eye surgery.

You can watch a video of femtosecond laser eye surgery here.

More on femtosecond lasers coming soon.

Definition for femtosecond:

(This definition follows U.S. usage in which a billion is a thousand million and a trillion is a 1 followed by 12 zeros.)

A femtosecond is one millionth of a nanosecond or 10^-15 of a second and is a measurement sometimes used in laser technology. So that’s one billionth of a millionth of a second! As a comparison, one femtosecond to a second is like one second to 32 million years.

For comparison, a millisecond (ms or msec) is one thousandth of a second and is commonly used in measuring the time to read to or write from a CD-ROM player.

A microsecond (µs) is one millionth (10^-6) of a second.

A nanosecond (ns or nsec) is one billionth (10^-9) of a second and is a common measurement of read or write access time to random access memory. A picosecond is one trillionth (10^-12) of a second, or one millionth of a microsecond. An attosecond is one quintillionth (10^-18) of a second and is a term used in photon research.

[tags] LASIK, femtosecond, laser eye surgery, safety, risks, compications [/tags]

Video showing a very brief overview of the PRK surface laser procedure, as well as covering short sight, long sight and astigmatism. LASIK remains the most popular laser eye surgery procedure worldwide. In Italy, though, surface laser (PRK, LASEK) is very popular.

Video showing a very brief overview of the LASIK procedure, as well as covering short sight, long sight and astigmatism. Simple and to the point.

Follow this blog for regular updates on what is happening in the LASIK world.You can sign up for the feed for blog postings, podcasts and webcasts on what is going on in the world of laser eye surgery (LASIK, LASEK and PRK). Find out if LASIK or another procedure is right for you.

• Is it safe?
• What is blade free LASIK?
• Does it wear off?
• What should I pay?
• What is Z-LASIK?

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