WHENEVER a patient undergoes any type of surgical treatment there is a possibility for a complication. The main questions are: are these complications serious and could affect the final outcome – or minor and short lived and which do not affect the ultimate vision? Also, what are the chances of a complication occurring that would require adjustment or follow-up correction?

LASIK surgery is no different from any other operation, despite how it may be pitched by some clinics, in that it IS a surgical correction and should be approached as such. However, and fortunately, most complications are in fact minor and easily resolved.

Technology

LASIK risk continues to drop as doctors and engineers perfect the equipment used in the treatment. Advances in technology have made a big part of the difference here so make sure you are getting that latest equipment and not an older fashioned approach.

The risks drop as doctors continue to screen for the right candidates to have the procedure, and screen out those with any chance to have a problem. Research also shows that with the right pre-testing and surgical handling, the risk of complications in LASIK surgery is less than 1% and most of these are minor problems which will be fully corrected afterwards without undue ongoing problems.

The most common risk with LASIK surgery is a complication with the flap, created by the surgeon in the first part of the procedure.

In the original LASIK procedure, the flap is cut by a surgical blade device known as a microkeratome. The blade cut is, however, less precise than those from newer femtosecond lasers.

Blade Free LASIK

LASIK risk is reduced by the newer “bladeless” dual laser technique.

In bladeless (blade free) LASIK surgery, the risk of complications is lower because the blade or microkeratome is no longer used. It is replaced by special type of infra-red laser that greatly reduces human or machine error.

The original laser to make a LASIK flap came from the USA, manufactured by Intralase. You may see this surgery called IntraLASIK or iLASIK.

The newer machine is from Switzerland and produced by the Ziemer Group of companies. There appear to be some advantages of the tighter focus of the Swiss laser. This procedure may be called Z-LASIK.

Summary

When assessing these LASIK risks it is recommended that when you are considering surgery that you ask your doctor what technology the clinic has and whether or not a blade free dual laser approach will be used.

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 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!)

I keep getting asked about how to choose a good laser eye surgery clinic and what to look out for when considering LASIK.

So, as you may know, there are FOUR key things to look out for when considering laser eye surgery and picking out a laser clinic for vision correction:

1. Laser technology used (Your surgeon CAN’T get better results than the laser can deliver)
2. Your surgeon (Your 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))
3. The clinic itself (Will they take good care of you before, during and especially after your treatment?)
4. The price you will pay (You don’t always get what you think you are paying for)

So, as requested, I will posting a map of all the laser eye surgery clinics in the UK, PLUS which laser they use, PLUS what results those lasers are capable of delivering!!

The truth is out there… and will be here very soon!

Representatives from the American Society of Cataract and Refractive Surgeon (ASCRS) made presentations yesterday in Fairfax, Virginia. The Food and Drug Administration (FDA) Ophthalmic Devices Panel (ODP) had committed to hold an open public discussion to allow people to make comments about LASIK and PIOLs. The presentations highlighted LASIK and its effect on quality of life, as well as restating the commitment of ASCRS to the upcoming LASIK Quality of Life Study. The military’s experience with LASIK was presented from members of the United States armed forces.

In preparation for today’s meeting, written and spoken testimony from both satisfied and dissatisfied LASIK patients had been sent to Karen F. Warburton of the Center for Devices and Radiological Health. Satisfied patients discussed improvements to their individual safety, ability to work effectively, enjoyment of social functions plus ability to drive.

The results of the first 50 people to poll our blog are now in!

Nearly 4 out of 5 people want to pay no more than £1,000 per eye for their LASIK laser eye surgery. This price is considerably lower than most clinics are actually charging for laser vision correction per eye.

Despite headline grabbing prices of ‘from £395 per eye’ coming through our doors, the actual price charged at LASIK laser chain clinics is significantly over £1,000 once you have added in the extras not included in that advertised price. Such as modern wavefront advanced optics and blade-free all laser surgery.

Please ensure that you check the final price you will be charged at any clinic you are evaluating prior to going ahead. But be careful – one laser chain seems to not want to disclose any prices until you have arrived for your consultation. You may well be very surprised as just how much the final bill will come to.

Prices do vary considerably and often without apparent differences in the quality of care offered. You can see a comparison of LASIK laser eye surgery prices here.

Please note that only Moorfields Eye Hospital and FOCUS Laser Vision routinely offer a fellowship trained NHS consultant specialist surgeon for laser vision correction surgery.

Yes, it’s true! Prospective laser eye surgery patients really do not ask about or are concerned with which laser is used to correct their vision.

Well, first of all let’s look at the TWO factors which have the biggest impact on the quality of the person’s vision after treatment. And bear in mind that this is how well their eyes will be able to see for the rest of their lives.

The first is the laser that is used. The second is the knowledge and skill the surgeon.

Laser eye surgery results have got better and better over the past 15 years – and this is mainly because the lasers have got a lot, LOT better! Yes, we know more about good surgical technique and what to do and what not to do. But mainly it is better technology that has improved results.

So why don’t patients care about this? (Because they really don’t!!) When we surgeons start talking about this or that laser, you can see patients’ eyes start to glaze over!

The truth is that they feel they are not qualified to make any judgments about laser performances. After all, it’s a complex piece of machinery. So people adopt a head in the sand approach and just HOPE that all lasers are pretty much the same (they are NOT).

Patients assume “a laser is a laser is a laser…” and don’t want to get involved in some serious thought about laser performance. It looks like a difficult subject.

Even though it is pretty easy to see how these machines stack up. Because ALL the information is publicly available. The US government clinical trials run by the Food & Drug Administration (FDA) compare all lasers side by side.

We have published all these laser eye surgery results on our www.focusclinics.com website (see them here: http://www.focusclinics.com/treatments_results.php

The clear winner so far is the WaveLight Allegretto laser from Germany. We at FOCUS Laser Vision use it for that reason. So do Accuvision in London. You can also find it (although the older model) at Manchester Royal Eye Hospital.

So PLEASE! before you have laser eye surgery, look at which machine that clinic uses and check here for the results from using that laser. Because no matter how good the surgeon, they CANNOT get better results than the laser is capable of giving. It simply is not possible. Lewis Hamilton still needs a world beating McLaren car to win the race.

You have ONE pair of eyes. You need a great surgeon AND a great laser.

So remember… your eyes and your choice, always. All lasers are not made equally!

Moria will unveil their new One Use-Plus SBK microkeratome at the upcoming 2008 meeting of the American Society of Cataract and Refractive Surgery in Chicago. Moria will present the clinical outcomes of their clinical trials. In eyes receiving this Moria SBK (ultra thin-flap LASIK), the flap thickness accuracy, speed of sight improvement, higher order aberrations and smoothness of corneal bed underneath the flap all compared favorably or equally to femtosecond (dual laser) SBK flap technology, according to Moria.

With many surgeons wary of creating ectatic (excessively weakened) corneas with their LASIK procedures, the interest in using thinner flaps has risen. Some surgeons routinely use flaps in the 130-µm range or thinner, using either mechanical microkeratomes or femtosecond lasers. I myself routinely create flaps that are 110 microns using the Ziemer femtosecond laser, without problems.

However, there can be additional risks when working with ultra-thin flap (less than 100 microns), such as microstriae (micro wrinkles) appearing in the flap afterwards.

I will be visiting their stand at the ASCRS meeting to check these results for myself and will report back to you!

The BIG eye surgeons meeting is coming up this week, starting on Friday April 8th 2008. Yours truly will be there, bringing you all the latest news from the world of refractive surgery.

ASCRS stands for the American Society of Cataract and Refractive Surgery – which is quite a mouthful, so we shorten it to ASCRS. This has the unfortunate pronunciation of ‘ass-criss’, but what can you do?!

More news coming soon from Chicago!

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]

There are FOUR key points to look at when choosing a clinic:

1. The laser technology
2. The surgeon
3. The clinic
4. The price

Let’s look at these in more detail:

1. Laser technology
The improvements in success rates and safety of laser eye surgery, including LASIK and PRK, have been mainly down to improvements in sophistication of the laser technology. The lasers are dramatically better than they were even a few years ago.
NOTE: not all lasers are made equal, so you MUST look at clinical results to get accurate performance information.

Focus’ data are available on the results page of the Focus Laser Vision clinics website.

99.4% of patients saw 20/20 or better 6 months after Z-LASIK. 100% saw 20/25 or better.

Also note that each clinic makes a claim that they have the best technology, but this of course cannot be true. They can’t ALL have the best laser equipment, as they all have different systems. Focus Laser Vision bought the WaveLight Allegretto system from Germany as it had the best overall FDA clinical results in extensive trials.

2. Surgeon
Equally important for your result and safety is the surgeon who will perform the procedure and assess your suitability for treatment. The most important decision is who NOT to operate on. In the UK you can look for one or more of the following points in your surgeon: 1. NHS Consultant appointment, 2. Fellowship training in refractive surgery and corneal disease, 3. Extensive experience in treating your kind of prescription, 4. Has performed more than 5000 procedures, 5. Works in refractive surgery on a full-time basis or at least two days every week if involved in other areas of ophthalmology (the more time in refractive surgery, the better), 6. Teaching and presenting on refractive surgery skills, vision outcomes and research.

3. Clinic
Look at the support that each clinic will offer to you. Individual independent clinics can usually offer excellent continuity of care so you see the same clinician each time, but may not be as well geographically placed as some of the nationwide chain centres. Ask if you will get your surgeons private phone number after treatment in case of problems or advice being needed. This number is very reassuring for patients.

4. Price
Last of all, look at the price. You want the above three factors to be the best you can get first of all. If you are completely satisfied you have not compromised there, then you can look at price, but ONLY then. High price is not a guarantee of quality, of having the best laser technology, of getting the best surgeon. It may give you these things, but you have to look and make sure for yourself.

In summary, look for yourself and ask the right questions. I have more information of the FOCUS Laser Vision clinics website on this and other related topics.

It is quite confusing for people looking at where to go for their laser eye surgery treatment. Especially so in London where there are many laser eye clinics to choose from.

In other cities you can usually find one or more of the big three chains: Optical Express, Ultralase and Optimax and these centres are probably doing about 80% of all laser eye surgery in the UK, partly because of their wide geographical footprint and so easy access for many people.

Most people really are not sure what to look for in a laser eye surgery provider. They don’t understand the difference between different laser systems and they don’t have easy access to the true performance or knowledge about individual surgeons.

So most people default to the ‘look and feel’ of the website and clinic if and when they attend for a consultation, or follow up from a word of mouth referral to a centre where someone has already had treatment.

Most of the brochures are pretty interchangeable, all making the same claims about experience, technology etc. You could swap the company name and not really notice the difference in various claims.

There are FOUR key points to look at when choosing a clinic, and these are coming tomorrow in my next blog post. Watch this space!!

Here you have a comparison of what LASIK costs at London LASIK clinics. You can see 4 typical prescriptions and what each clinic charges – and you will see the huge variation in LASIK laser eye surgery prices!

For example, for a simple -1 dioptre correction there is an enormous variation in LASIK cost. The lowest is £295 per eye for wavefront LASIK and £595 for femtosecond laser blade free LASIK at FOCUS Laser Vision (http://www.focusclinics.com). The highest are £2145 at Moorfields eye hopspital (www.moorfields.nhs.uk) and £2250 at Centre for Sight in East Grinstead (www.centreforsight.com).

All three centres offer fellowship-trained specialist NHS London teaching hospital consultant surgeons and advanced wavefront LASIK treatments. Yet the difference in price (money you will save) is up to £3,000-£4,000 for both eyes treated for a -1D correction. For an common prescription, e.g. -2.75/-1.50 x 90, you will still save up to £2,600 from the cheapest to most expensive. And this includes teaching hospital NHS consultant surgeons at both centres, plus the best blade free all laser LASIK option. It’s a remarkable price difference.

The chart below shows prices for wavefront keratome (mechanical) LASIK laser eye surgery. Optimax and Optical Express will charge approximately £300 more per eye for all laser blade free LASIK, as do FOCUS Laser Vision. London Vision Clinic and Centre for Sight include blade free in the prices shown. Ultralase only now offer blade free LASIK but curiously still offer non-wavefront treatments, and so are not in the chart below. They charge £1895 per eye for wavefront blade free LASIK.

Check out this chart for London centres. More on this coming soon.

OK, it’s here at FOCUS Laser Vision in London. The video of our breakthrough next generation Z-LASIK laser eye surgery procedure! I can tell you the results have been amazing. Twelve treatments on our first day, and everyone can see better than 20/20, 60% of them seeing an incredible 20/12! (that’s two lines smaller than 20/20 on the vision test chart, clarity usually seen by teenagers, and approaching the finest limit of human vision) And that’s just 24 hours after treatment. Wow.

Enough talking, it’s time to watch the video. just keep rolling after the procedure to hear Bella talking the following morning about her ‘miracle’! As a surgeon, this is the best bit of the job.

Z LASIK at FOCUS in London starts from £595 per eye for short sight – FOCUS want to make this treatment affordable for everyone. You can reach the clinic on 0845 5000 500.

[flashvideo filename=http://www.youtube.com/watch?v=A61T5mFG730 /]

You can hear Bella Roberts talking with me just 24 hours after her breakthrough Z-LASIK laser eye treatment. You can read more about Z-LASIK in my previous posts, and compare to Bella talking about her LASIK just before having the surgery!

Why have Z-LASIK all-laser eye treatment? Why have FOCUS Laser Vision spent more than £300,000 on this next generation laser technology, when a mechanical bladed microkeratome is only(!) £30,000? The answer. Safety, accuracy and vision results.

Femtosecond lasers have been shown to be more accurate, safer and give better vision results for LASIK laser eye surgery. Many UK clinics have installed the Intralase femtosecond laser as up until now it has been the only game in town. That will change now the Ziemer LDV has arrived. So watch this space!

Z-LASIK laser eye treatment at FOCUS Laser Vision in London starts at £595 per eye.

[tags] femtosecond, Z-LASIK, Ziemer, FOCUS Laser Vision, Intralase, LASEK, laser eye surgery, LASIK, long sight, longsight, PRK, short sight, shortsight, surgeon, technology [/tags]