Monthly Archives: July 2009

The role of the brain in Epi-Lasik, PRK, LASIK, and Intra-LASIK

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Proper functioning of the visual areas of the brain is critical in visual functioning.

There are numerous disorders that can affect the brain causing visual disturbances. One of the more common disorders that is seen in people who are interested in laser vision correction is called amblyopia which is also known as a “lazy eye”. An eye that is “lazy” does not develop the proper connections with the brain and will have poor vision compared to a normal eye. Unfortunately laser vision correction can not improve an amblyopic eye beyond what the best acuity is with glasses or contacts.

Other conditions of the brain that can affect vision include stroke, and tumors. If you have a stable condition with some vision impairment you should discuss your condition with your surgeon before considering laser vision correction.

The brain is also important in the ability of adjust to changes in vision. For example some people will easily adjust to monovision where one eye is corrected for distance and the other for near vision. Other people can not tolerate this imbalance. For people that are very particular about their glasses or contact lenses laser vision correction may not be advised. It is not possible to guarantee that the two eyes will be exactly equal in acuity or that it will be exactly the same as the previous glasses or contacts. If you have trouble adjusting to new prescriptions you may not be a good candidate for laser vision correction.

Another factor in satisfaction with laser vision correction is your ability to cope with adversity. Although uncommon, complications may happen which might delay the recovery of vision or in rare cases cause a permanent loss of vision. If you suffer from depression or anxiety it may be more difficult for you to cope with a poor outcome. Don’t forget, the risk of laser vision correction is low but it is not zero.

To schedule a free laser vision correction assessment, contact Western Laser Eye Associates today.

PRK, Epi-LASIK, LASIK, and Intra-LASIK in Calgary: how to they compare?

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There are a variety of options available to anyone considering laser vision correction in Calgary. In order to make a good choice it is important to understand the similarities and differences between procedures.

Similarities Between PRK, Epi-LASIK, LASIK, and Intra-LASIK

The following things are the same regardless of the type of laser vision correction procedure you choose:

– You will have to undergo an assessment to determine if you qualify for laser vision correction.
– There is some risk to any of the laser vision correction procedures – no technique is risk free.
– The most common side effects of all of the laser vision correction techniques are dry eye and rarely glare or halo with night vision
– The goal of all laser vision correction procedures is to reduce your dependence on glasses – none of the techniques will result in better vision than you have with your most up to date glasses or contact lenses.
– If you are 40 to 45 years old or older you will need reading glasses for close work unless you choose monovision.
– PRK, Epi-LASIK, LASIK, and Intra-LASIK all have excellent long term results. To date there have been no large scale studies to prove that the visual outcomes are better with any one of these laser vision correction techniques.
– Custom Wavefront or other types of customized laser vision correction can be done with any of these techniques.

Differences: Flap (LASIK and Intra-LASIK) Versus No-FLAP (PRK and Epi-LASIK)

As mentioned above, the long term outcomes of any of these procedures are equally good. The main difference between a flap based procedure and a no-flap surface treatment is that creating a flap carries a higher level of risk and gives more rapid recovery of vision in the first few days following surgery.

The risk of complications with flap creation is low, but it is possible that irregularities in the flap such as a buttonhole or partial flap may occur at the time of surgery. With no-flap techniques there is no flap to become involved in that type of intra-operative complication so the risk is lower. The flap may also be damaged or shifted months or years after surgery. This is very uncommon and in most cases the flap can be replaced and smoothed back into position with additional surgery.

There are a number of additional possible complications that are uncommon but can occur following a flap based procedure. I have co-authored the book “LASIK Complications” which has been translated into Spanish and Japanese and has gone into three editions – there is not a book called PRK Complications. While the risk of the no-flap procedures is not zero, it is lower because there is no flap that can become involved in these types of complications.

The reason the flap based procedures are so much more popular is due to the more rapid recovery of vision and earlier return to work. Most people are back to work within one to two days, although the night vision may take longer to recover. With no-flap procedures approximately one week is required to recover useful vision and the vision may sharpen up over a few weeks to a month following surgery. Most people undergoing laser vision correction with a no-flap technique will plan to take about a week off of work and may need assistance with young children or other duties for the first 3 days following surgery.

The other reason that flap based procedures became quickly popular when introduced in the 1990’s has to do with the older excimer laser technology and the past tendency for the formation of scarring and haze with PRK. Due to advancements in laser technology, medications, and surgical techniques the risk of visually significant haze is very low now.

The most feared complication of the flap based procedures is corneal instability called ectasia. Ectasia has been reported following PRK but is much more common with LASIK. Intra-LASIK and newer SBK (sub-Bowmans keratomeleusis) microkeratomes create very thin flaps which are thought to reduce the risk of ectasia. Thin flap techniques are very new and the prevalence of ectasia with thin flaps may not be known for several years as this condition can develop any time from immediately post-operatively to several years following surgery.

There is a significant amount of discussion recently about the risk factors for ectasia and the corneal biomechanics of creating a corneal flap. Some risk factors have been identified but there are some cases of ectasia in which no risk factors were apparent. Risk factors may include corneal mapping abnormalities, thin corneas, and family history of keratoconus.

Ectasia can not be corrected by further laser vision correction and requires treatment with customized contact lenses or in severe cases with corneal transplant. There are some surgeons who will only perform no-flap procedures due to this risk of ectasia, some are turning to thin flap procedures to reduce the risk, and others feel the risk of ectasia is so low that it is reasonable to give people a choice of procedures.

Differences Between Surgeries

PRK & Epi-LASIK: no flap treatment with laser applied to corneal
surface after surface epithelial cells are removed
LASIK & Intra-LASIK: flap is created and the laser is applied to
the interior corneal bed under the flap
PRK: surface epithelial cells are removed using a brush or by using
a dilute alcohol solution to soften the cells followed by manual removal
Epi-LASIK: surface cells are removed using an epi-keratome device
with an epithelial separator which uses a suction ring to stabilize the eye
LASIK: the flap is made using a microkeratome device with an oscillating
blade; a suction ring is used to stabilize the eye.
Intra-LASIK: a femtosecond laser is used to create a corneal flap; a
suction ring is used to stabilize the eye
Qualifying: some people may not qualify for flap procedures due to thin
corneas or other factors
Risk: PRK is the lowest risk followed by Epi-LASIK; flap procedures
have a mildly higher risk with Intra-LASIK felt to be safer than LASIK
Outcomes: depending on the study there have been some differences
discussed between procedures but there are no large scale studies to
show that one type of surgery is better than another over the long term
LASER: each center will have a particular type of laser which may
have the capacity to do customized treatments; the laser application will
be essentially the same regardless of the procedure type.

When given a choice between a low risk flap based procedure with a return to work within a few days and a lower risk no-flap procedure many people will choose the more rapid return to work and others will choose the lower risk treatment and accept the longer recovery. What it comes down to is each individual’s choice. If you would like more information or to book a free assessment contact our staff or call 403-547-9775.

What is Co-management for LASIK, Epi-LASIK, PRK, and Intra-LASIK?

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In cases where the surgery center is located far away, some surgeons are agreeable to co-managing with another ophthalmologist or optometrist. For this type of arrangement to work there must be good communication between providers.

Both the surgeon the eye care provider who will be doing follow up care must agree in advance in order for co-management to be effective. If there is a late complication the follow-up provider must be able to communicate with the surgeon and arrange additional visits or treatments with the surgeon if necessary. This arrangement works well for those who may live in more rural areas where they may have to travel into a metropolitan center to access laser vision correction.

Co-management

Co-management: describes an arrangement between the surgery center
and another eye care provider such as an optometrist.
Communication: for co-management arrangements to work there must
be excellent communication between the surgeon and the co-manager.
Benefit: for some people co-management is a great option due to
geographic reasons, if their usual provider has better hours, or if they
wish to continue care with a trusted provider

If you are interested in considering a co-management arrangement ask your current eye care provider if this is an option or speak to your laser vision correction surgeon. If you need more information about this topic or about laser vision correction, contact our staff or call 403-547-9775.

PRK, Epi-LASIK, LASIK, and Intra-LASIK in Calgary: how to they compare?

By | Uncategorized | No Comments

There are a variety of options available to anyone considering laser vision correction in Calgary. In order to make a good choice it is important to understand the similarities and differences between procedures.

Similarities Between PRK, Epi-LASIK, LASIK, and Intra-LASIK

The following things are the same regardless of the type of laser vision correction procedure you choose:

– You will have to undergo an assessment to determine if you qualify for laser vision correction.
– There is some risk to any of the laser vision correction procedures – no technique is risk free.
– The most common side effects of all of the laser vision correction techniques are dry eye and rarely glare or halo with night vision
– The goal of all laser vision correction procedures is to reduce your dependence on glasses – none of the techniques will result in better vision than you have with your most up to date glasses or contact lenses.
– If you are 40 to 45 years old or older you will need reading glasses for close work unless you choose monovision.
– PRK, Epi-LASIK, LASIK, and Intra-LASIK all have excellent long term results. To date there have been no large scale studies to prove that the visual outcomes are better with any one of these laser vision correction techniques.
– Custom Wavefront or other types of customized laser vision correction can be done with any of these techniques.

Differences: Flap (LASIK and Intra-LASIK) Versus No-FLAP (PRK and Epi-LASIK)

As mentioned above, the long term outcomes of any of these procedures are equally good. The main difference between a flap based procedure and a no-flap surface treatment is that creating a flap carries a higher level of risk and gives more rapid recovery of vision in the first few days following surgery.

The risk of complications with flap creation is low, but it is possible that irregularities in the flap such as a buttonhole or partial flap may occur at the time of surgery. With no-flap techniques there is no flap to become involved in that type of intra-operative complication so the risk is lower. The flap may also be damaged or shifted months or years after surgery. This is very uncommon and in most cases the flap can be replaced and smoothed back into position with additional surgery.

There are a number of additional possible complications that are uncommon but can occur following a flap based procedure. I have co-authored the book “LASIK Complications” which has been translated into Spanish and Japanese and has gone into three editions – there is not a book called PRK Complications. While the risk of the no-flap procedures is not zero, it is lower because there is no flap that can become involved in these types of complications.

The reason the flap based procedures are so much more popular is due to the more rapid recovery of vision and earlier return to work. Most people are back to work within one to two days, although the night vision may take longer to recover. With no-flap procedures approximately one week is required to recover useful vision and the vision may sharpen up over a few weeks to a month following surgery. Most people undergoing laser vision correction with a no-flap technique will plan to take about a week off of work and may need assistance with young children or other duties for the first 3 days following surgery.

The other reason that flap based procedures became quickly popular when introduced in the 1990’s has to do with the older excimer laser technology and the past tendency for the formation of scarring and haze with PRK. Due to advancements in laser technology, medications, and surgical techniques the risk of visually significant haze is very low now.

The most feared complication of the flap based procedures is corneal instability called ectasia. Ectasia has been reported following PRK but is much more common with LASIK. Intra-LASIK and newer SBK (sub-Bowmans keratomeleusis) microkeratomes create very thin flaps which are thought to reduce the risk of ectasia. Thin flap techniques are very new and the prevalence of ectasia with thin flaps may not be known for several years as this condition can develop any time from immediately post-operatively to several years following surgery.

There is a significant amount of discussion recently about the risk factors for ectasia and the corneal biomechanics of creating a corneal flap. Some risk factors have been identified but there are some cases of ectasia in which no risk factors were apparent. Risk factors may include corneal mapping abnormalities, thin corneas, and family history of keratoconus.

Ectasia can not be corrected by further laser vision correction and requires treatment with customized contact lenses or in severe cases with corneal transplant. There are some surgeons who will only perform no-flap procedures due to this risk of ectasia, some are turning to thin flap procedures to reduce the risk, and others feel the risk of ectasia is so low that it is reasonable to give people a choice of procedures.

Differences Between Surgeries

PRK & Epi-LASIK: no flap treatment with laser applied to corneal surface after surface epithelial cells are removed
LASIK & Intra-LASIK: flap is created and the laser is applied to the interior corneal bed under the flap
PRK: surface epithelial cells are removed using a brush or by using a dilute alcohol solution to soften the cells followed by manual removal

Epi-LASIK: surface cells are removed using an epi-keratome device with an epithelial separator which uses a suction ring to stabilize the eye

LASIK: the flap is made using a microkeratome device with an oscillating blade; a suction ring is used to stabilize the eye.

Intra-LASIK: a femtosecond laser is used to create a corneal flap; a suction ring is used to stabilize the eye

Qualifying: some people may not qualify for flap procedures due to thin corneas or other factors
Risk: PRK is the lowest risk followed by Epi-LASIK; flap procedures have a mildly higher risk with Intra-LASIK felt to be safer than LASIK

Outcomes: depending on the study there have been some differences discussed between procedures but there are no large scale studies to show that one type of surgery is better than another over the long term

LASER: each center will have a particular type of laser which may have the capacity to do customized treatments; the laser application will be essentially the same regardless of the procedure type.

When given a choice between a low risk flap based procedure with a return to work within a few days and a lower risk no-flap procedure many people will choose the more rapid return to work and others will choose the lower risk treatment and accept the longer recovery. What it comes down to is each individual’s choice.

If you would like more information or to book a free assessment, contact Western Laser Eye Associates today.

Why is the price of LASIK, Epi-LASIK, and PRK different at different Calgary laser vision correction centers?

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Laser vision correction centers are businesses. Just as different retail chains offer different levels of service and products, laser vision correction centers vary on their business models.

Some do higher volumes and have many centers and so can benefit from volume pricing on surgical supplies and pass that savings to their clients. Some centers offer more individual care with the surgeon before and after surgery such that lower volumes of patients are being treated but at a higher price.

Pricing can also be difficult to judge at first glance. Sometimes the advertised low price may only apply to very simple corrections and may not include enhancements. When searching for the right center to have vision correction surgery, it is wise to shop around to find the combination of price and service that fits you best. Be sure to find out what is included in the base price and who will be providing your pre- and post-procedure care.

Pricing not only will vary between centers, and it will also likely vary between procedures. For example, a standard laser treatment may be less expensive than a custom wavefront treatment due to the costs of providing the custom treatment. Some centers may have different prices for PRK, LASIK, and Intra-LASIK due to the costs associated with providing each of the different procedures. Some centers may price according to the strength of your prescription and some prices may not include retreatments or enhancements.

Price is an important factor but should not overshadow safety, effectiveness, and the level of service that you may need as an individual. As in all other consumer services you can not judge on price alone – each individual needs to weigh the price and levels of service offered by the various centers and decide which one is right for them.

Questions you may wish to ask about pricing include:

1. What are the prices for the surgeries you are considering for your individual case (some centers use a price scale based on your level of correction)?
2. Does the price include enhancements (touch up surgery) and for how long?
3. Who provides the pre- and post- operative care and when will you meet your surgeon?
4. Are all the pre-operative and post-operative visits included in the price?
5. Are there payment plans available?
6. Can the center provide documentation for spending accounts or insurance if needed?
You may be able to have some of the questions answered by speaking to staff at the laser vision correction center, but you may need to have a full assessment to get an accurate price for your individual case. Laser vision correction assessments can be time consuming, typically taking about 2 hours or longer and you will be asked to have a driver or alternate transportation due to the use of dilating eye drops; however it can be a good investment to have an assessment at the centers that you might be considering. This way you can learn what services you will get for the price. Price is one of many factors you will need to consider if you are thinking about having laser vision correction.
Find out more about financing at Western Laser Eye Associates and then contact us for a free consultation.