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 Both procedures
use an “excimer” laser to reshape the
corneal curvature. Laser eye surgery is
becoming increasingly more popular as people with
vision problems are discovering how much it can
change their lives. Many celebrities
have benefited from laser eye surgery.
There are several types of laser eye surgery
available. To learn more about a particular procedure,
click on the links below
LASIK surgery checklist issued by the FDA
Facts
you need to know if you are thinking about having
LASIK to correct nearsightedness (myopia) with
or without treatment for any astigmatism
LASIK
(Laser Assisted in-Situ Keratomileusis) &
PRK (Photo-Refractive Keratectomy)
With LASIK, the middle portion of the cornea is
treated by first using a machine called a microkeratome
to lift up the surface of the cornea. The laser
is then used to reshape the exposed corneal surface.
With PRK, or photorefractive keratectomy, the
laser light is used to reshape the front surface
of the eye. Both procedures can be used to correct
near sightedness, farsightedness, and astigmatism.
PRK has been performed in this country for about
ten years, and LASIK for about eight years. Dr.
Kawesch has been a clinical investigator for several
FDA LASIK and PRK studies.
The goals of surgery
are reduce or eliminate the need for glasses and
contact lenses. By improving the uncorrected visual
acuity in patients, LASIK and PRK are often able
to allow patients to go about their daily routine
without needing corrective lenses. These procedures
may also be used to treat residual amounts of
nearsightedness (undercorrections) or farsightedness
(overcorrections) following other forms of refractive
surgery, such as RK and LK.
Your eye is anesthetized
with eye drops. A shaving is made with an instrument
known as a microkeratome, to expose the inner
layer of the cornea, creating a “flap.”
The laser is then used to vaporize a very thin
layer of corneal tissue, 0.2 microns at a time.
The corneal flap is then reflected back to restore
the corneal surface. Surgery takes only a few
minutes. Typically, a protective eye shield is
worn over the eye, for the first day.
 During
your examination, we gather important information
regarding the health of your eye, including various
measurements regarding your prescription, your
pupil size and the shape and thickness of your
cornea. Our goal is to help you select the procedure
which will have the highest chance of getting
you to your goal of clear vision without glasses,
while at the same time having the least risk possible
of any complications.
Some patients have corneas that are thinner than
average, and, depending on the amount of correction
needed in these cases, a LASIK procedure could
be riskier than in a patient with a cornea of
normal thickness. With LASIK, a flap is created
and lifted aside, and the laser is used to sculpt
the exposed corneal bed, which is usually 130-180
microns deeper into the cornea from the surface.
The laser sculpts the cornea by vaporizing corneal
tissue. So, the laser will make the cornea thinner
than it was. If the thickness of the corneal bed
is reduced too much with LASIK, a complication
known as ectasia can occur, which is a destabilization
of the cornea, causing high levels of nearsightedness,
astigmatism and possibly cornea irregular curvatures
to result. This is something which needs to be
avoided. The amount of corneal tissue vaporized
with the laser depends on the degree of correction
being attempted, and the treatment zone diameter
programmed into the laser. Bigger treatment zones
are helpful in reducing nighttime side effects,
but they do go deeper into the cornea.
 Patients
with thinner corneas might be better off with
a procedure other than LASIK. A procedure which
does not create a flap would give us more cornea
to work with, to enable a more complete correction
and/or a bigger treatment zone diameter. There
are surface treatments available, known as LASEK
or PRK. These techniques are extremely similar.
They involve removing the very surface layer of
the cornea, known as epithelium (usually about
50 microns thick), then lasering the exposed corneal
bed. This way, the laser is not vaporizing tissue
as deep in the cornea as with LASIK, and the risk
of ectasia is lowered. With LASEK, a form of alcohol
is applied to the cornea, which loosens (and kills)
the surface epithelium. After the laser part of
the procedure, the layer of dead and dying epithelial
cells is replaced over the treated area to act
as a bandage, and a contact lens is placed over
that. Much of the healing involves the regeneration
of new epithelium cells, over the course of a
week. With PRK, no alcohol is used, and the surface
epithelial cells are removed with a soft brush.
After the laser treatment, as with LASEK, a disposable
contact lens is placed on the eye, without replacing
the damaged epithelial cells. New epithelium regenerates
naturally, over two to three days. Both techniques
are effective, however I have found that the alcohol
used with LASEK causes significant inflammation
and delayed recovery of vision. In other words,
patients seem to see and recover more quickly
with PRK, without trying to salvage the surface
epithelium cells.
Your eye is anesthetized
with eye drops. The outermost layer of the cornea
is removed with the laser, or mechanically with
a special instrument. The laser is then used to
vaporize a very thin layer of corneal tissue,
0.2 microns at a time. The amount of cornea removed
depends on the amount of correction needed. The
surgery takes less than 2 minutes. Following the
procedure, a special contact lens may be applied,
and is worn for 2-5 days.
Yes. In the U.S., there are several approved
machines: Visx, Summit, Nidek, Autonomous, and
Bausch & Lomb are a few. There are many differences
among them, which the doctor would be happy to
discuss with you at your exam.
The surgery itself is generally painless. After
the surgery, there may be some mild to moderate
pain for one to three days (mostly with PRK, not
with LASIK), which may be relieved by oral medications
and topical eye drops.
Usually, but they can be done separately. This
is an issue that you may wish to discuss with
the doctor.
In the U.S., the excimer
laser PRK procedure is approved for the treatment
of nearsightedness within the range of -1.00 to
-13.00 diopters, and astigmatism from 0.75 to
5.00 diopters. We generally only offer PRK as
an option for lower levels of correction. LASIK
is currently the best surgical option to treat
low, moderate and high levels of nearsightedness.
Dr. Kawesch has successfully treated up to 24
diopters with the laser.
The excimer laser
is approved to treat both near sightedness and
astigmatism. Both LASIK and PRK are able to treat
astigmatism right along with any nearsightedness.
No additional procedures are necessary - it is
all done at once.
Dr. Kawesch has conducted FDA clinical
studies to treat farsightedness up to 6 diopters
with the laser (using PRK and LASIK) for several
years.
In the fall of 1998, the FDA approved the treatment
of farsightedness using the excimer laser. Results
have generally been excellent.
With PRK, rarely will you want to return to work
the next day. The visual results of PRK surgery
are not quite instantaneous; it may take several
days for the vision to become clear enough to
drive. LASIK generally provides good vision the
next day, enabling most patients to return to
work immediately.
Some patients experience a regression of effect
following surgery, but not to the preoperative
level. Fine-tuning or enhancement surgery can
often be done to further improve the vision if
necessary.
The most common side effects are light sensitivity,
halos, and dryness. Undercorrection or overcorrection
may occur, and glasses may be needed after surgery
to restore perfect vision. In some instances,
irregular corneal curvatures and/or haze might
be created and glasses may not restore perfect
vision. A more detailed discussion of these issues
will take place during your Comprehensive Eye
Examination.
This question can be best answered by the doctor.
Generally speaking, for low corrections, both
LASIK and PRK can provide excellent results. LASIK
offers the advantages of quicker healing, less
pain, less regression of effect (more stable results),
and lower incidence of corneal scarring. Additionally,
retreatments are generally easier to perform with
LASIK. Currently, most patients choose to have
LASIK. PRK may be the preferred technique in certain
special situations, such as patients with thin
corneas.
The doctor would prefer patients to be at least
18 years old, with a stable prescription. There
is no upper age limit.
When you schedule a Comprehensive Eye Examination,
it is important to note the following: if you
are wearing hard or gas permeable contacts, they
must be out of your eyes at least three weeks
prior to your exam. Soft lenses must be out at
least 72 hours. Also, bring in your glasses if
available.
If you are reading this web page, you’re
well on your way. We suggest you read everything
in this web site. The next step is to call us
for an appointment. A Comprehensive Eye Exam with
our doctor will take about one and a half hours,
and will specifically determine your chances for
success with surgery. The eye exam consists of
a thorough evaluation and analysis of your eyes
and your visual system. You will have time to
have all of your questions answered by the doctor.
A few insurance companies do cover PRK and LASIK.
This is not a “cosmetic” surgery, but
rather the laser produces a functional change
of vision. If covered, it is under major medical
and not a vision plan. We will be happy to make
a copy of your insurance card and check coverage
for you. If there is no coverage, several medical
finance companies that we work with can help you
obtain financing should you need it. It is easy
to apply and your payment schedule is flexible.
Monthly payments are kept to a minimum. We can
usually give you an answer within an hour whether
or not you can qualify (ask to speak to one of
our staff about the patient financing program).
We also accept cash, personal checks, Visa and
Mastercard.
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Ray
Brown 