Anne asked:

Hi Dave,
I am in contact with your clinic re: having Lasik. I just have a couple of questions:

1/ What is your re-treatment rate?
2/ How many dry eye cases are persistent/long-term?

Thanks, Anne

Anne, our enhancement rate is under 1% for short-sghted patients, and slightly higher for blended vision patients (distance plus reading correction).
Our “20/20 or better” rate is 99.4% for short-sighted patients up to -9.00D.

We have seen long-term dryness in a handful of patients, out of thousands of treatments. I find it is a rare problem when patients are properly screened, and treated pre-op if there is some dryness present. The way we keep these rates very low is by being vary careful on who we operate on, and excluding those with significant dry eye.

Faisal asked:
I am short sighted, wearing glasses for almost 15 years. Just wanted to know whether I am a suitable candidate for laser eye surgery or not. Thanks

Faisal,
Being short sighted and wearing glasses for many years is typical. You will need a full consultation to determine if you are suitable for laser eye surgery. Some of the main factors will be the scans of your corneas, prescription, corneal thickness, and eye examination.

Sally asked:

I am considering laser eye surgery but am prone to keloid scars. Would this be a problem?

My reply was:

Hi Sally
Keloid scarring should be no problem with LASIK laser eye surgery. I have done several patients with keloid and had excellent LASIK vision results. No problems with healing at all.
Best regards, Dave

Anthony asked:

Hi Dave
I am 67 years old and currently use daily contacts. Left eye D + 1.50 Right D + 1.75, the left eye has a slight astigmatisum. I use + 2 reading glasses. I have been told that due to some mild furring around the edges of the cornea, expected at my age, I will need Intra – Ocular Lenses, one for long distance and one for reading. Also I have some dryness in both eyes, again expected at my age.
Do you think I am too old and would Z-Lasik be able to correct my vision in both distance and reading or just distance. I live in London so travelling to Wimpole Street is not a problem should I decide to have a consultation.

My reply was:
Hi Anthony, Certainly not too old, and I have done blended vision for patients in their 70s. All depends on the condition of your natural lenses and presence of any cataracts. Sometimes IOLs can be the better choice but not always. Your prescription is certainly in range of those I treat for correcting distance and near. Dryness can be assessed and treated if not too bad. If severe, would likely be a block to laser eye correction, but not to IOLs.

We can certainly have a look at consultation with one of my team as a first step. Price wise, the IOLs are the more expensive option, at £2,500-3,000 per eye, the latter being if you opt for multifocal lenses to help with reading and distance. Laser blended vision is £2,200 per eye, again correcting far and near.

Peter asked:

I had laser eye surgery in 1995 for short sightedness. Long distance has become blurred e.g. night driving affected. Will naturally occurring long sightedness change this over time I’m 47?

Peter, you have become somewhat myopic (short-sighted) again, either through progression of your condition (can be associated with high amounts of near work, although that story is not straight-forward), or regression of your treatment, or both combined.
At 47, most people will be showing signs of presbyopia, or age-related loss of near vision. Your myopia will mask those symptoms if you are not wearing glasses or contact lens correction, and so in fact is of some benefit to you. Your presbyopia will have minimal effect on your distance vision though, and will not neutralize it. One option is to get one eye retreated to fix the distance and get a blended vision combination, and so see well for far and near. Will depend on your current prescription though.

Liz asked:

Hello, I do not suffer with headaches etc but I do have to be at least a 12 inches away to be able to for example focus on the smallest words of this website. Any nearer and the words are out of focus but I can read them at a distance. How much would it be for you to correct this to at least 20/20 vision please? Many thanks, Liz.

Liz, you have presbyopia so reading vision is getting blurry, but the distance vision remains clear. This happens to everyone starting in their 40s. Sometimes only one eye needs to be treated if there is no distance glasses prescription, which is about 15% of presbyopic patients. Presbyopic treatments need to be performed very accurately and choice of surgeon (and technology) becomes even more important that in myopia correction (distance vision, short-sight). The cost at Focus is £2,200 per eye. Regards, Dave

Terry asked:

I am thinking of laser eye treatment. I have a squint in my left eye and long vision. The consultant has told me the squint and vision will be corrected by the surgery. I will be having wavefront laser. Can you tell me if this will work? My glasses correct the squint and my vision,

Terry, There are different causes for squints. The laser correction itself will only change the focus of your eyes, but as some squints are linked to focusing of your vision, especially long-sight, the squint can be helped or removed through e.g. LASIK. You said your glasses correct your vision and the squint. If your glasses do NOT contain a prism to correct the misalignment of your eyes, then laser correction will likely do the same job as your glasses. The closest test is how your vision and squint is when fully correcting your focus with contact lenses, but glasses can perform a similar role. If your glasses contain a prism, then you will still need to wear glasses with a prism afterwards.

I was recently asked by Kaz to explain the Z-LASIK procedure in more detail. Watch this video and in a second post I will run through why I consider Z-LASIK combined with the WaveLight excimer laser to be the ultimate in LASIK laser eye surgery.

You are interested in laser eye surgery. You have been doing what everyone else does first, which is search through the websites of various laser eye surgery clinics including the big three chains: Ultralase, Optical Express and Optimax, plus independent clinics such as FOCUS Laser Vision, Centre for Sight, London Vision Clinic etc.

The first thing you notice is that some clinics outline some or all their prices, while others give a headline price and give more details after you contact the clinic directly. One very handy site that can help you get all that information quickly is www.lasik-eyes.co.uk where patients can post independent reviews of their experiences at all of the UK’s laser eye clinics plus the price they paid for surgery.

There is a huge variation in the prices paid at UK clinics. Prices paid for both eyes for laser eye treatment vary from around £1,500 up to over £6,000.

But what does this mean for you? What about quality? Do you get what you pay for? Or do prices not correlate well with the quality of the surgery, vision result or service?

I recently treated Denise Van Outen at my clinic and you can see the full story in today’s Daily Mail. We also made the front page with a leader. The phone’s are ringing non-stop!
You can click here to see the full story on Denise Van Outen and her laser eye surgery in London at the Daily Mail’s website.

Denise can now see better than 20/20 in each eye and is delighted with the result. She had the operation to get ready for climbing Kilimanjaro next month for Comic Relief without her contact lenses.

How would you like advanced laser eye surgery and then get all your money back?

The Full Refund Referral Plan from FOCUS Laser Vision means that really is now possible. You can have laser eye treatment to see once again without glasses… and then you could get all your money back! Brilliant.

Sounds too good to be true?

First of all, FOCUS Laser Vision offer the UK’s best price for advanced blade free laser eye correction, so you are happy you saved money over more expensive clinics but without compromising skill, quality or safety. NHS Corneal Consultants, best and safest lasers, superb team. But you can go even further. You can get a full refund on your treatment, every penny.

Here’s how it works. You are delighted with your new vision after your laser eye treatment. Of course you want to tell everyone! You tell your family, friends, work mates. Now they want to have laser eye surgery too.

Once 5 people you know have come along and had treatment you can get 50% of your money back. Once another 5 come along and have treatment, 10 people total, you will get all of your money back. All of it, in full.

In effect, you will then have back everything you paid and had your laser eye surgery for free!

Your family, friends and colleagues are delighted with their new vision and also because they got the UK’s best price! They really like you! And they too can spread the word to benefit from our Full Refund Referral Plan.

This is a common question about laser eye surgery safety I get asked by patients:

What happens if my vision isn’t right after treatment?

Most people don’t realise that the effect of laser eye surgery, including LASIK, LASEK and PRK procedures, CAN be fully reversed.

Although this isn’t necessary because if the prescription for glasses hasn’t been fully corrected then a second treatment is easily performed to fix that and stay free from the need for glasses or contact lenses. If the effect of the laser correction is a bit too strong or too weak, we call this an over-correction or an under-correction respectively.

All over- and under-corrections can be treated easily. In fact, as I mentioned, the whole laser eye treatment can be reversed. The move over to the Ziemer blade free system (Z-LASIK) has dramatically reduced the need to re-do LASIK treatments.

Most clinics quote enhancement rates of around 5%.  BUT with Z-LASIK for short-sight I have only had to adjust one case in the last 200, so that’s a 0.5% rate. Without any hype or spin, that’s just very impressive and a great step forward.

To fully reverse the effect of e.g. a short-sighted laser eye treatment, we remove some tissue from the outer part of the cornea to put the corneal curvature back to where it started. So now an equal amount of tissue has been removed across the cornea and so the focus would be back where it started. Of course, the cornea is a little thinner than before, but still strong enough for its role.

It’s the accuracy of the dual laser approach that allows such a very low enhancement rate, which means 99.5% of short-sighted patients are on target and very happy with only one treatment and without the need for a top-up.

The number of people having laser eye surgery in the UK has increased following a boost in March 2006 when the National Institute for Health and Clinical Excellence (NICE) issued their guidance that laser eye treatment was sufficiently safe and effective to be carried out on appropriately selected patients.

Since then, the number of clinics offering laser eye surgery has increased. The three UK laser eye chains – Optical Express, Optimax and Ultralase – have all stated plans to increase the number of clinics they run.

The credit crunch and stock market falls have led to a dip in recent weeks reported by most consultants doing private laser eye correction. However the overall trend has been a rise in the number of procedures carried out in the UK.

Continuing from yesterday:
Some surgeons recommend PRK or LASEK (both forms of surface laser eye treatment and basically the same) over LASIK. The article referred to by Kay in her original post and advocating LASEK was written by ophthalmic surgeon Sunil Shah, who was one of the creators of that particular approach (and so has some personal interest in writing about it one presumes).

One of the very vocal and respected advocates of surface laser (PRK) over keratome LASIK was Professor John Marshall in London, UK, a founding father of laser eye surgery back in the 80s. Prof Marshall argued convincingly that the cornea was considerable stronger after PRK compared to mechanical (thicker flap) keratome LASIK.

However, the game has changed with the introduction of femtosecond lasers with much thinner flaps. Even Professor Marshall now supports the move to thin-flap LASIK using a dual laser, blade-free approach.

So if a clinic cannot offer dual laser LASIK (and many still can’t) they may offer PRK/LASEK instead. There are some clinical reasons to perform PRK instead of LASIK but the percentage of these cases has shrunk from 10-15% down to around 5% today, with dual laser technology. Patients much prefer femto-laser LASIK over PRK, as the latter is fairly unpleasant for a few days post-op.

In summary, there are definite clinical reasons why we as treating clinics have moved over to wavefront LASIK and using a blade-free dual laser approach. More accurate treatments so better vision, removal of an older mechanical device technology and improved long-term safety.

We discussed in the last post about the two options you have: LASIK or PRK (surface laser), and how 90%+ of treatments are done via LASIK.

LASIK comes in two flavours now: blade or blade-free. The older traditional LASIK technique uses a mechanical device containing a blade (called a keratome or microkeratome) to cut a flap during the first part of the procedure. The newer, more advanced method is to use a special laser (known as a femtosecond laser) to create a flap without a blade.

These femtosecond lasers are hugely expensive (about a quarter of a millions pounds each!) so expect to pay more for this technology. Some clinics have not yet invested in femto lasers due to the high cost involved and continue to use a blade.

The benefits of a laser flap over a blade flap are becoming clear: more accurate treatment, better healing of the flap, greater strength in the cornea post-op due to significantly thinner laser flaps and greater residual thickness. Blade flaps have been used for many years and have been proven safe to date, but thinner laser flaps have added better accuracy and strength. You will see a gradual phasing out of blade flaps over laser flaps over the coming few years.

More tomorrow!