If you read yesterdays post you are up to speed on wavefront technology. OK, so far so good. It seems wavefront correction improves quality of vision after laser eye surgery. And indeed clinical trials confirm that vision results are much better after laser makers added the ‘wavefront‘ upgrades to their machines.

For example, the American made VISX lasers, used at all Optical Express laser clinics, have much better results when using their wavefront upgrade from 2002. I would not recommend having laser eye treatment today in 2008 without choosing the wavefront package on that system.

Wavefront laser eye surgery - is it the whole truth?

So now you want ‘wavefront‘ in your laser eye treatment! Of course, as the results are better. But when laser manufacturers introduced ‘wavefront’ they actually bundled in other improvements which may account for much of the jump in results! They just didn’t tell you. Why? Because it is complicated to describe all these improvements to someone who isn’t familiar with the technology – such as you, the patient!!

And honestly, I bet the sales people at most clinics talking on the phones who want to sell you a consultation don’t really understand it either! However, they have been trained to explain the wavefront part only, as something like this… “we take a scan, a unique fingerprint, of your vision and the use that fingerprint to perfectly correct your vision“. Go on, call them and check it out!

But for you, as a patient or customer, don’t really care about which part of that technology is helping you the most, you just want great vision, right?

So don’t let clinics blind you with science about wavefront scanners, wavefront maps, measuring hundreds of points of light or how much better their scanner is than other clinics scanners. It is usually marketing spin! Take it all with a pinch of salt.

However, you should choose the ‘wavefront option’ because within that package are the big improvements in laser eye treatment over the past several years. The success of surgery may actually be less to do with the true wavefront technology that has helped astronomy, but rather other improvements that may be confusing to patients but get wrapped up in the marketing of wavefront LASIK.

We come back to ethics again here. Is it ethical for some clinics to still sell ‘non-wavefront’ laser eye surgery technology that was replaced back in 2002?

For my own clinic, we do not offer non-wavefront treatments at all. None at all. I want every one of my patients to have the benefit of the newer laser eye surgery results. So we made it very affordable. In fact, we charge less for wavefront LASIK than other clinics do for their ‘entry level’ lower price non-wavefront LASIK. Really.

That’s my plug for FOCUS done! So, do choose wavefront but don’t pay more than you have to!

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To recap from earlier this week, there are two ways you can upgrade your laser eye treatment: (1) upgrading on the quality of the final vision (you will see better afterwards) and (2) improving the safety and accuracy of the laser eye surgery. These are upgrades on what used to be the best treatment only a few years ago, which is known as non-wavefront LASIK and using a blade device to cut a thin flap in the surface of the cornea (the clear window at the front of the eye).

Upgrading on (1) involves paying for what is called ‘wavefront‘ laser eye surgery over ‘non-wavefront’.

Upgrading on (2) means getting rid of a metal razor-type blade in favour of a laser for the first part of the LASIK treatment (lots of names here… blade-free, dual laser, femtosecond, Intralase, Ziemer, Z-LASIK).

Kay’s questions have been about: is it really worth it to pay more? The short answer is that, yes, you should always look for ‘wavefront’ laser eye treatment. But why?

Well, the reason for this is not as obvious as laser eye clinics may tell you!

Wavefront refers to a technology adapted from astronomy which allows better resolution and clarity when looking at images of space. The principle is to remove tiny imperfections of focus, rays of light that are not getting focused properly and which cause blurriness, glare or hide details. Let’s look at an example from astronomy. In this image you can see how a blurry image of a star was improved though wavefront technology to reveal in fact two stars, known as a ‘binary star’.

'Wavefront' laser eye surgery can improve quality of vision

These imperfections of focus (known usually as aberrations) are not corrected by glasses. They are still there even after putting on your glasses or contact lenses. So after correcting your prescription fully and getting clear vision, you can still have imperfections in your vision which are usually more obvious at night.

Check back tomorrow for the next installment and the full answer on whether it is worth it to pay more  in order to get the best vision results (at most clinics – not mine, I add, FOCUS Laser Vision! – we don’t charge extra for you to get wavefront correction! In fact we charge less for wavefront surgery than other clinics do for their non-wavefront treatments).

See you tomorrow!

Let’s look at the second of Carlo’s questions on laser eye surgery:

My name is Carlo and I have recently discovered this great blog. I would like to ask a couple of questions regarding eye surgery:
Question: Is it true that the LASIK procedure has not been approved for air-force pilots and astronauts in the US but PRK and LASEK has?

No, this is not true.

LASIK was approved for use on consumers a decade ago and reportedly more than 11 million LASIK procedures have been performed in the US. This means LASIK laser eye surgery is the most-common American elective surgical procedure.

NASA has approved LASIK for use on pilots, mission and payload specialists who face extreme and often physically demanding conditions in space. The all-laser LASIK technologies, using a blade free femtosecond laser approach, have also been cleared for U.S. military personnel, including most recently Air Force pilots.

“NASA’s approval is further evidence that today’s LASIK exceeds all established standards of safety and effectiveness,” said Steven Schallhorn, M.D., retired captain of the U.S. Navy.

Though LASIK has been around for a long time, concerns about the harsh environment in aviation prevented its use. To date, aero-medical professionals have been cautious of employing the procedure on military pilots who often encounter environmental extremes such as high altitude, dry air, wind exposure and “G” forces. In space, other conditions further add even higher levels of concern due to the very high level of precision needed during flight and space walks.

Defense Department’s research into laser vision correction included the following results:

# In a study of different methods to create the LASIK flap, 370 naval personnel underwent bilateral (both eyes) wavefront-guided LASIK with either the femtosecond laser (blade free) or microkeratome blade. One week after surgery more than 76 percent of femtosecond laser patients achieved an uncorrected visual acuity of at least 20/16 (better than 20/20) compared to only 58 percent of microkeratome patients

# In an evaluation of 785 pilots, 89% of Navy aviators evaluated their ability to land on an aircraft carrier as moderately to significantly better after laser eye surgery. None said it was worse after treatment

# A separate study determined that over 90 percent of marksmen had improvement in marksmanship skills after laser eye surgery; an impressive finding given the visual precision of marksmen

LASIK, particularly blade free femtosecond LASIK, appears to have established itself as a very effective and reliable procedure. The move from blade to laser blade free has allowed another significant improvement in results (now targeting better than 20/20 as a standard of care) according to the above research findings.

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!

Since we introduced the Z-LASIK blade free LASIK laser eye surgery procedure into the UK in January 2008, more than 90% of our patients have opted to go dual laser (no blade) for their vision correction.

The LASIK procedure has two parts – the first is the preparation of a thin flap followed by the second stage of vision correction itself. Traditionally, a bladed device has been used to cut this flap and gave some people pause about going ahead with the surgery.

Laser blade free flap makers were introduced in 2002 by the Intralase Corporation in the US. A next generation system was released in 2007 by Swiss ZIemer Group.

The added level of safety offered by eliminating the need for a physical blade cut has proved to be very popular for patients at FOCUS Laser Vision, with 9 out of every 10 people choosing to have Z-LASIK (blade free Ziemer technology). The additional cost of Z-LASIK leaves 1 in 10 people going with the traditional blade version, M-LASIK.

The high cost of femtosecond lasers means somewhat higher LASIK prices, usually around £300 per eye higher than bladed LASIK. The reason is that the blade systems cost around £30,000 per machine compared to £200-250,000 for a femtosecond laser.

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!!

The Daily Mail featured a half page article this week on the new Z LASIK surgery procedure that took place at FOCUS Laser Vision (www.focusclinics.com) on January 18th. Jenny Hope from the Mail wrote a great piece covering the new technology and the impact for Bella Roberts, the first UK patient to get rid of her glasses through Z LASIK surgery.

You can read the full article on LASIK eye surgery on the Daily Mail website

Z LASIK uses a brand new technology to create a corneal flap in the first part of the LASIK laser eye surgery procedure. The new system from Swiss company Ziemer uses a different principle to create much lower energy pulses at 20 times the speed of older technology lasers from Intralase in the US, commonly used in other UK clinics.

[tags] LASIK, London, laser eye surgery, Technology, femtosecond, new [/tags]