Monthly Archives: April 2009

Calgary LASIK, Epi-LASIK, PRK: Patient Satisfaction

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April 1, 2009 Ophthalmology Times reported on a study by Dr. Kerry Solomon on LASIK satisfaction.

Dr. Solomon was asked by the American Society of Cataract and Refractive Surgery (www.ASCRS.org) to review the world literature in response to a US FDA inquiry into complaints by LASIK patients. It is estimated that over 16 million people have had laser vision correction worldwide. In 2006 the FDA initiated an inquiry based on concerns raised by a group of LASIK patients.

Dr. Solomon’s study identified 2,915 articles of which 309 were judged to be well designed. From these studies the data was pooled and analyzed. Satisfaction following LASIK was found to be 95% up to 6 months after surgery and 98.6% for questionnaires completed more than 6 months following LASIK. The most common reason for dissatisfaction was residual refractive error (a need for corrective lenses due to under correction, over correction, or regression). Some of these people may have been candidates for enhancement, and in studies that included people who had enhancements the satisfaction rate was higher. Other factors that lead to dissatisfaction after LASIK included dry eye and night vision symptoms.

LASIK involves cutting a corneal flap, lifting the flap, and performing the laser application on the underlying bed. Epi-LASIK and PRK are no-cut surface laser vision correction treatments that avoid the risks of creating a corneal flap and have been shown in many studies to have equally good or better results than LASIK. These surface treatments are safer than LASIK but do take longer to heal in the first days to weeks. Surface treatments like Epi-LASIK and PRK do not disrupt the corneal nerves as deeply and may be less likely to trigger a worsening of dry eye. With the use of CustomVue Wavefront treatment which corrects the individual higher order aberrations there may be less risk of significant permanent worsening of night vision.

For more information about laser vision correction or to book your free consultation, contact Western Laser Eye Associates today.

April is Sports Eye Safety Awareness month

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LASIK is still the most common laser vision correction procedure performed in Calgary and around the world, but surface treatment with PRK (photorefractive keratectomy) is becoming popular again along with a new surface treatment called Epi-LASIK.

One of the reasons some surgeons in Calgary and elsewhere favor surface treatments over LASIK is the risk of flap dislocation following LASIK.
For many sports activities specialized eye wear is recommended. Unfortunately for some higher risk sports such as basketball safety glasses may not be routinely recommended. Other sports such as mountain biking or hunting may pose a risk when traveling through wooded areas. Recreational activities such as paint ball are also a risk for eye injury. More information about eye injuries can be found at www.geteyesmart.org .

Following LASIK the corneal flap heals around the superficial edge. It can be lifted surgically or shifted following an eye injury even years later. Although only a few people per year require treatment for shifted LASIK flaps, it can lead to a loss of vision if not properly treated within a short time. Epi-LASIK and PRK do not require the creation of a corneal flap. Instead just the very outer layer of cells called the epithelium is removed and the treatment is applied to the corneal surface. The long term results of Epi-LASIK and PRK equal to LASIK. The healing following surface laser treatments takes longer in the first few days to weeks, but there is no flap that could be damaged or shifted due to sports related or other eye injuries.

Whether you choose to undergo laser vision correction or not, always wear safety glasses for any activities where they are ordinarily recommended. For hockey a visor is recommended. When working in the yard with mowers or weed trimmers safety glasses will guard against stones that may be launched by these machines. Table saws, grinders, and other shop equipment also pose a risk for eye injuries. The few extra seconds it takes to put on a pair of safetly glasses can save you from a lifetime of poor vision.

For more information about your laser vision correction options, contact us today to book a free consultation.

Calgary LASIK: What is Epi-Lasik?

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Western Laser Eye Associates is pleased to announce the acquisition of the Moria Epi-LASIK epikeratome.

Epi-LASIK is the latest advancement in laser vision correction. Epi-LASIK combines the keratome technology of LASIK with the safety of surface PRK.

In Calgary as well as around the world LASIK has become very popular in the past decade due to the fact that there is more rapid recovery of vision and less discomfort in the first few days following surgery as compared to PRK. For LASIK corneal flap is made with a keratome blade or femtosecond laser in order to lift the flap and apply the laser energy to the deeper bed underneath the LASIK flap. Within the past few years some surgeons in Calgary have followed the worldwide trend to move back to surface treatments such as PRK due to the superior level of safety with equally good long term vision results.

Surface treatments like PRK and Epi-LASIK are safer because the surgery is simpler and avoids the possible flap related complications such as a buttonhole or partial flap that can occur with LASIK. Epi-LASIK and PRK are also safer than LASIKdue to the fact that the treatment is not as deep and preserves more of the natural cornea to maintain the corneal strength and avoid the rare but serious complication called ectasia in which the cornea becomes unstable which results in poor vision within months or years following LASIK. This condition is uncommon following surface laser vision correction. Surface treatments such as PRK and Epi-LASIK also avoid the possible future risk of flap shifting which can occur even years afterLASIK if there is an eye injury.

Surface laser vision correction eliminates the need to cut a LASIK flap. The surface cells are removed in order to apply the laser energy to the smooth membrane which is just underneath. For PRK these surface cells are either removed with a special brush or with a dilute alcohol solution (sometimes this technique is called alcohol assisted PRK). Both of these methods have been in use for many years and may be recommended for certain people with corneal scars or other conditions. Epi-LASIK uses an epikeratome with a blunt separator which can remove these surface cells more cleanly and without the use of chemicals.

For both Epi-LASIK and PRK a contact lens is placed for approximately 3 days. There is some discomfort with either of these treatments for those first few days until the contact lens is removed. The amount of discomfort varies from person to person with some people who need nothing more than frequent artificial tears and others who will need additional drops or oral medication such as Tylenol #3. It is important to rest and keep the eyes closed as much as possible for these first few days.

The difference between PRK and Epi-LASIK is most obvious after 3 days. There are more people who will be able to read the 20/20 line within 3 to 4 days following Epi-LASIK as compared to PRK where it may take 7 to 10 days to be within this range of vision. It is important to understand that surface laser vision correction involves a healing phase of up to 6 months over which time the vision continues to sharpen. Many people who have Epi-LASIK will be able to return to usual activities within 3 to 5 days, but it is important to keep in mind that while the vision may be in the legal range for driving it may still be somewhat blurred. Some people will limit their night time driving or have to take more frequent breaks from computer or other visually demanding work for a few weeks to a few months following Epi-LASIK.

Several studies have shown that the long term results are equally good for surface treatments like Epi-LASIK and PRK as they are for LASIK. Some studies have shown better results with surface laser vision correction than for LASIK for people having custom wavefront treatments such as CustomVue which is done at Western Laser Eye Associat
es.

Epi-LASIK offers excellent safety, more rapid recovery of vision compared to PRK, and outstanding long term results. For more information or to book a free consultation, contact Western Laser Eye Associates today.