Category Archives: Epilasik

LASIK (flap) versus Surface PRK (no flap)

By | Calgary, Dry eye, Epi-lasik, Epilasik, Intra-LASIK, Laser Eye Surgery, Laser vision correction, LASIK, Ophthalmologist, Ophthalmology, Opthamologist, Photorefractive, PRK, Refractive Surgery, Surgeon, VISX | No Comments

STAR S4According to some reports over 28 million laser vision correction surgeries have been performed worldwide since the excimer laser was developed in the 1980s.  Both PRK surface laser and LASIK surgeries use the excimer laser to reshape the corneal surface.  The main difference between the two types of laser vision correction methods is the creation of a corneal flap with LASIK and treatment on the surface of the cornea after removing the thin layer of epithelial cells with PRK.  eyelabeled

 

Advances in both the excimer laser and in flap creation technology have resulted in a variety of names for laser vision correction surgeries.  Flap surgeries include LASIK and IntraLase and no flap treatments include PRK, LASEK, and Epi-LASIK.  With LASIK a small oscillating blade in a device called a microkeratome is used to cut the LASIK flap.  With IntraLase the femtosecond laser is used to create a corneal flap.  Originally called “flap and zap”, with LASIK and Intralase the flap is lifted and the excimer laser reshaping is done on the underlying corneal tissue.  With no flap treatments the excimer laser energy is applied directly to the surface of the cornea.

PRK surface laser vision correction gained in popularity from it’s introduction in the 1980s over the next decade.  LASIK was introduced in the 1990’s  and became the most popular laser vision correction by the early 2000’s due to faster recovery.  Within the past several years there has been a shift back towards surface treatments due to the improvements in post operative management and in excimer laser technology.  It has also been determined that for some people PRK surface treatments may be a better choice.  The reasons that PRK may be recommended include:

1. Risk of flap shift or trauma with job or sports activities.

2. Thin corneas that may be a risk for ectasia (unstable cornea with progressive thinning) with LASIK flap.

3. Very steep or very flat corneal curvatures that may increase LASIK flap complication risk.

4. Previous injury or eye or eyelid surgeries that may raise the risk of LASIK flap complications.

5. Moderate dry eye might be worsened by the deeper disruption of corneal nerves with LASIK flaps.

Both LASIK and PRK have be demonstrated to produce equally good results over 6 months or more.  In the short term of days to weeks LASIK patients will recover vision more quickly.  So taking a short term perspective it makes sense that people may choose a LASIK flap laser vision correction method.

Taking a long term approach there are advantages to forgeting the LASIK flap and choosing a no flap PRK surface treatment.  Advantages of a no flap PRK approach include:

1. no LASIK flap = no flap complictions such as incomplete flaps, buttonholed flaps, partial flaps

2. no LASIK flap eliminates the risk for flap dislocation in the future

3. no LASIK flap means there can not be complications like epithelial ingrowth, diffuse lamellar keratitis, interface debris, flap wrinkles,  or other LASIK flap related complications.

4. Less risk of a weak and unstable cornea called corneal ectasia due to the LASIK flap disrupting the cornea more deeply than surface PRK.

5. Possibly less risk of severe dry eye with surface PRK.

To make the choice that is right for you, first find out if you qualify for laser vision correction and then learn the pros and cons of the treatments available to you.  If you have questions about laser vision correction or wish to book a complimentary evaluation with Dr. Anderson Penno, contact Western Laser Eye Associates.

 

Vision & Vitamins: Ginkgo Biloba, Glaucoma, and Macular Degeneration

By | Epi-lasik, Epilasik, Eye health, FDA, Food for thought, Ginkgo Biloba, glaucoma, Health Canada, Laser Eye Surgery, Laser vision correction, macular degeneration, Mayo Clinic, Ophthalmologist, Ophthalmology, Opthamologist, Optometry, Pubmed, Refractive Surgery, science, Uncategorized, Vision & Vitamins | No Comments

Vitamins and natural herbs have become more and more popular for alternative treatment as additional treatments for medical conditions.  Ginkgo Biloba has been used for centuries as a traditional treatment which may help blood flow to the brain and aid in treatment of dementia or Alzheimer’s disease.  It might help treat leg pain that results from blood vessel disease, and there is some suggestion that ginkgo biloba might also help PMS symptoms, depression, multiple sclerosis, and ADHD.  Ginkgo Biloba is extracted from the leaves of the Ginkgo Biloba tree.  As far as vision and eye health are concerned, it is possible that Gingko Biloba might be helpful to eye health but as with many natural products the scientific studies show some favorable and some unfavorable results.

There are some scientific studies that have been reported in the peer reviewed literature which is a data base of articles that have been reviewed by scientists with expertise in the particular field of study before the article is allowed to be published.  Peer review helps to make sure that studies are done in a way that will provide strong statistical evidence for or against a specific area of study.  The most powerful studies are randomized and double-blinded which means the researcher and the subject who is taking the supplement do not know if it is the actual supplement or a placebo being taken.  The “placebo” effect has been well studied and up to 30% of people taking a fake pill who are told it will have beneficial effects will report that it helps whether or not there is any measurable effects.  By double-blinding and using large and randomized numbers of subjects the results will show with more confidence that a particular supplement is helpful or not for a specific condition.  Because there are a lot of different conditions that are being studied, so far there are only a few published peer reviewed scientific studies that have been done to find out if Ginkgo Biloba is good for your eyes.

According to the Mayo Clinic there is some scientific evidence suggesting that Ginkgo Biloba may be helpful in preventing worsening in age related macular degeneration which can lead to central vision loss, but there is little evidence to suggest it might be helpful for treatment of glaucoma.  In the peer reviewed literature there are a few studies including this 2012 study by Cybulska-Heinrich, Mozafferieh and Flammer that suggests supplementation with Ginkgo Biloba might be helpful in addition to traditional medical treatment in cases that are not responding as well as needed to these traditional treatments.  They suggest that antioxidant effects along with a variety of other effects on blood flow might be responsible for the beneficial effects of supplementation with Ginkgo Biloba.  The American Academy of Ophthalmology reported there was a single small randomized trial that showed promise for using Gingko Biloba to slow macular degeneration.

A commonly reported dose of Ginkgo Biloba is a standardized extract, standardized to 24% flavone glycosides and 6% terpene lactones starting at 40 milligrams of that extract three times daily, but there does not seem to be enough evidence in the scientific studies to prove the most effective doses for a specific condition.  Risks and side effects of Ginkgo Biloba supplements include headaches and dizziness, bleeding, and other side effects.  If you are on a blood thinner or aspirin, or are on other medications you should talk to your pharmacist and/or doctor to make sure that there won’t be dangerous interactions.  There is also some question about the quality of the products in some cases and as with all supplements it is important to be sure you are getting a high quality product.  In Canada a DIN or NPH number can be found on products that have been reviewed by Health Canada.  In the US the FDA does not require approval of supplements before the product is marketed but does collect information on adverse events.  The other thing to consider is the cost of a product like Ginkgo Biloba versus the proof that it will be helpful for your health.

Whether you already had LASIK, Intralasik, EpiLasik, PRK, wear glasses or contacts, reading glasses or no glasses at all you should be sure to get regular checks with your eye care specialist (optometrist or ophthalmologist) in order to optimize your vision for the rest of your life.  If you have questions about laser vision correction or wish to book a complimentary evaluation with Dr. Anderson Penno, contact Western Laser Eye Associates.

 

 

Eye-Whitening: do your homework

By | Epilasik, Laser vision correction, LASIK, PRK, Refractive Surgery | No Comments

American Society of Cataract and Refractive Surgery has rescinded a clinical alert about complications that may result from eye whitening treatments

Eye-whitening procedures involve removing the outer layers that cover the white sclera and using medications which slow healing in order to result in a whiter looking eye.  In some early reports using specific surgical eye whitening techniques there were reports of complications.  For any elective surgery involving the eyes or other areas of the body there will always be some risk even if the procedure is done perfectly.  This is due to difference in responses to surgery and differences in healing for each individual.  Some health conditions such as smoking, autoimmune diseases, or diabetes can also affect healing.  When considering any type of elective surgery you need to find out the specific techniques that are being used, expected rates of complications, and any factors in your specific case that might raise your risk for a specific treatment.  In general most of the elective surgeries that are now considered routine (such as laser vision correction) will carry a low risk of significant complications.  When looking for information about a specific treatment it can be helpful to look at respected websites such as the American Academy of Ophthalmology , or the National Eye Institute.   The US National Library of Medicine National Institutes of Health has a data base with peer reviewed articles that can be searched for more in depth information called PubMed.

Red eyes are common and may be caused by anything that irritates the eyes, most commonly dry eye and allergies.  If the vision is not affected then most people can safely try over the counter artificial tears up to several times per day and warm compresses twice per day.  For many people regular use of lubrication drops can help to minimize red eye.  Over the counter allergy medications can also be used safely as directed for short periods of time. Red eye formulas are available over the counter but are not recommended for continuous every day use.

Whether you don’t need glasses at all, wear contacts or glasses, or have had laser vision correction such as PRK or LASIK, an occasional red eye that responds to artificial tears is most likely not serious.  Signs that you should see your eye doctor include a red eye with vision changes, significant pain or discomfort, or a large amount of discharge.  If you have any of these symptoms or a persistently red eye it is a good idea to consult your eye doctor.

If you have questions about laser vision correction or wish to book a complimentary evaluation with Dr. Anderson Penno, contact Western Laser Eye Associates.

Ophthalmologist & Optometrist: what does it mean when you are considering PRK or Epi-LASIK?

By | Epilasik, Laser vision correction, LASIK, Optometry, PRK, Refractive Surgery | One Comment

Whether you are looking for general eye health care, eyeglass prescriptions, or laser vision correction such as LASIK, PRK, or Epi-LASIK, it is important to understand who is caring for your eyes.

“Eye Doctor” can mean an ophthalmologist or an optometrist.  The main differences are:

Ophthalmologist

  • has an M.D.
  • has completed 4 years of medical school + 4-5 years of residency
  • some will have completed additional 1-3 years of fellowship training
  • may provide general eye care, surgery, or specialized care
  • sub-subspecialities include: glaucoma, retina, cornea, plastics
  • in addition to surgery, can prescribe a wide range of medications
  • can order specialized testing such as CT, MRI, X-ray, blood work
  • find an Eye MD

Optometrist

  • has an O.D.
  • has completed 4 years of optometry training  in addition to university
  • may provide general eye care as well as prescribing glasses and contacts
  • often will comanage with ophthalmologists
  • can prescribe glasses and contacts and some medications
  • can refer to sub-speciality ophthalmologists such as retina or glaucoma
  • find an optometrist

In many laser vision correction centres the initial assessment is done by an opometrist with experience in refractive surgery.  At Western Laser Eye Associates all potential laser vision correction candidates are seen by an ophthalmologist in order to insure they are a good candidate for surgery.

In some cases it can be helpful to comanage with both an optometrist and ophthalmologist.  For example some people from smaller towns may not have convenient access to an ophthalmologist.  In these cases an optometrist can do preliminary testing to determine if laser vision correction may be an option.  It it is not a good option due to the degree of correction or other eye health issues then it may save the time and travel to attend an assessment.  In cases where laser vision correction is a good option, you may return to your optometrist closer to home for follow up care.

Co-management between an ophthalmologist and optometrist works well for a number of common eye conditions.  The key to successful comanagement is good communication between you, your ophthalmologist, and your optometrist.

If you are interested in booking a complimentary laser vision correction assessment with Dr. Anderson Penno, contact Western Laser Eye Associates.

 

5 Steps to Successful LASIK, PRK, Epi-LASIK or Intra-LASIK vision correction

By | Epi-lasik, Epilasik, Intra-LASIK, LASIK, PRK | No Comments

Step 1:  Do your research.

The more you know about the different procedures available the better you can understand which choice might be right for your eyes.  Look for information from trusted websites such as http://www.geteyesmart.org/eyesmart/  or http://www.mayoclinic.com/health/lasik-surgery/MY00375 .

Dr. Anderson Penno’s book Laser Vision Correction:  What You Need to Know has information about who can safely have laser vision correction, what types of procedures are available, and how to choose a surgeon or surgery center.  This book is available at http://www.amazon.ca/Laser-Vision-Correction-Anderson-Penno/dp/143926497X and in Kindle edition at http://www.amazon.com/Laser-Vision-Correction-What-ebook/dp/B003F77DV4.

Having the right expectations will make you happier with the results.

Step 2:  Have a laser vision correction evaluation.

An evaluation, also sometimes called an assessment, is a complete eye check that includes specialized testing in order to find out if laser vision correction is a safe option for you.  During this eye check a qualified eye care provider will usually give information about what options are available at that surgery center and tell you if you qualify for LASIK, PRK, Epi-LASIK or Intra-LASIK.

Sometimes serious eye conditions are detected during this evaluation and additional testing may be recommended.  This evaluation also includes a medical history since there are some medical conditions like rheumatoid arthritis that may disqualify you from laser vision correction.

Step 3: Get a second opinion.

It can be a good idea to have a laser vision correction assessment at more than one center.  This can give you more information about the types of surgeries available and also allows you to compare the style of care to see if it is a good fit.  Some centers may be lower cost but may not offer as much face to face time with the surgeon.  Other centers may have a higher cost but other features that are important to you such as specific technology or more individualized care.

Step 4: Talk to your friends and family.

It can help to talk you people you know who have had LASIK, PRK, or another type of laser vision correction.  Keep in mind that each person may have variations in healing and that the recovery times may be different between different procedures.  Ask them about their experience.  Was the staff courteous?  Were their questions answered?  Were they comfortable with the surgeon?

If you have a trusted optometrist or other health care provider like a family doctor, talk to them too.

Step 5: Take some time to consider your options.

Rushing to make a decision because your wedding is coming up or you want to squeeze in surgery before your vacation may not be a good idea.  You need to understand the healing process and book enough time to recover.  For some procedures you need to book more time off than others.  It is uncommon to have a complication but it is better to allow for the possibility of needing more time off ahead of time rather than having to cancel or change your plans if your vision recovery is slower than expected.

If you are a good candidate for LASIK, Epi-LASIK, PRK, or Intra-LASIK these steps will help you make the choice that is right for you and understand what laser vision correction can do for you.

For more information or to book a complimentary assessment, contact Western Laser Eye Associates.