Category Archives: LASIK

Vision & Vitamins: No clear evidence Coenzyme Q10 helps eye health

By | Calgary, Cataracts, LASIK, Mayo Clinic, Ophthalmologist, Refractive Surgery, Vision & Vitamins | No Comments

eyelabeledCoenzyme Q10 (CoQ10) has become a popular supplement which is said to help with a number of health issues including cataract and macular degeneration in the eye, but the Mayo Clinic gives it a “C” grade for its benefits in the eye (meaning the evidence is unclear to support its use).  CoQ10 is also called Q10, Vitamin Q10, ubiquinone, and ubidecarenone.  It acts as an antioxidant in the body and has a role in producing ATP which is a molecule which provides energy to cells.  CoQ10 deficiency has not been reported in the general population and it is estimated that a varied diet will provide up to 25% of the measured plasma CoQ10 and that the body naturally makes the remainder.  Primary CoQ10 deficiency is a rare inherited disorder that causes neurologic and muscular dysfunction.

For healthy individuals there is not strong evidence to show that CoQ10 supplements improve athletic performance or prolong life.  There may be some specific circumstance where CoQ10 supplementation may be helpful.  There is some scientific evidence to show that it may be helpful in chronic heart failure and in the treatment of high blood pressure but more studies are needed.  CoQ10 has also been thought to be helpful in specific cancer patients who are undergoing chemotherapy.  There are not enough studies to show that CoQ10 is helpful for eye conditions such as macular degeneration.  According to some sources CoQ10 should not be used for diabetes, hepatitis C, or Huntington’s disease.

There have been some studies that use CoQ10 eye drops for some specific conditions affecting the retina, cornea, and optic nerve.  While early studies are promising for specific diseases, more studies are needed.  More commonly studies have used a tablet or capsule, injection, or intravenous (IV) CoQ10.   There are some side effects including insomnia, elevated liver enzymes, rash, heartburn, and fatigue that have been reported when using CoQ10.  As with all supplements be sure to check with your doctor or pharmacist before starting to take CoQ10 as it may interact with other medications (in particular blood thinners).

Foods that contain higher amounts of CoQ10 include beef, herring, chicken, soybean, canola oil, rainbow trout, roasted peanuts, sesame seeds, pistachio nuts, broccoli, cauliflower, orange, strawberries, and eggs.  A varied diet is helpful in providing a wide variety of nutrients and since CoQ10 appears to act in concert with other vitamins such as vitamin E, having a dietary source of this vitamin may help provide CoQ10 along with other nutrients and co-factors that will aid in absorption and in action.  CoQ10 naturally declines with age so maintaining a healthy diet is increasingly important.  Given the scientific evidence to date it seems unlikely that CoQ10 supplementation is helpful for vision in healthy people.

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

 

 

 

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.

 

Happy Birthday PRK!

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

Photorefractive keratectomy (PRK) is the original laser vision correction surgery that was first performed in the US in the 1980’s and on June 12, 1990 at the Gimbel Eye Centre in Calgary Alberta Canada.  In the 25 years that followed PRK first gained in popularity over radial keratotomy (RK) in which incisions were made in the cornea to flatten the surface of the eye for treatment of nearsightedness.  PRK has the advantage of precision laser modification of the corneal curvature using the excimer laser.  The excimer laser was originally intended for industry and manufacturing but when a curious researchedr took some leftover Thanksgiving turkey back to to lab laser vision correction was born.

PRK quickly replaced RK as a more stable and precise way to eliminate the need for glasses or contact lenses.  As the search for improvements continued into the 1990’s the older technology of cutting a corneal flap was combined with the excimer laser reshaping in a treatment that was first called “FLAP & ZAP” and later laser in situ keratomileusis (LASIK).  LASIK quickly overtook PRK as the most popular laser vision correction method into the early years of this century due to the faster healing the flap allows.  Throughout this time PRK remained a trusted method and was considered safer than LASIK for thinner corneas and for athletes and people with occupations that might risk eye injury due to the risk of a LASIK flap shirt.

As the early 2000’s progressed a new and difficult to treat complication became recognized – corneal ectasia. Ectasia after LASIK is uncommon but can result in an unstable corneal surface that is analgous to a weak spot in a tire, which makes the surface of the eye bulge out and become irregular over time.  There has been a lot of debate about ectasia after LASIK, but many eye surgeons believe that PRK may be a lower risk for this specific problem due to the fact that the cornea is not disrupted as deeply as compared to LASIK.  The LASIK flap does not leave the eye but once it is cut it may no longer contribute as strongly to the corneal structure.  This weakening in addition to a number of other risk factors appears to play a role in post LASIK ectasia.  All the while PRK has continued to be offered as an option for laser vision correction in particular for people who might not qualify for LASIK.

In the past few years many surgeons around the world have moved “back to the surface” and choose not to cut corneal flaps in order to affect the smallest amount of corneal tissue needed to improve uncorrected vision.  Advances over the last quarter of a century since PRK was first done include significant advances in excimer laser technology including iris recognition, cyclotorsion adjustments, and the ability to do individually customized treatments using wavefront technology.  In addition, improved bandage contact lenses and medications have been developed to reduce post-operative discomfort and risk for haze following PRK.

PRK turns 25 this year in Canada and is still going strong!

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

Bionic Lens: can everyone have perfect vision?

By | Food for thought, Keratectomy, Laser Eye Surgery, Laser vision correction, LASIK, Optometry, Photorefractive, PRK, Refractive Surgery, Surgeon | No Comments

There has been a lot of talk recently about the “Bionic Lens” which has been invented by an optometrist from British Columbia.  CBC news recently ran a story about the new lens implant.  According to this news story, “Pending clinical trials on animals and then blind human eyes, the Bionic Lens could be available in Canada and elsewhere in about two years, depending on regulatory processes in various countries.”  If there are problems in the back of the eye involving the retina, such as macular degeneration, this lens would not be able to correct the poor vision.  So vision improvement using this lens would be helpful to people who can correct their vision with glasses or contact lenses.  At this time vision correction surgeries are able to allow people to see as well without glasses or contact lenses as they do with their eyewear – for most people they would not be expected to see better than their best corrected vision.

The photographs of the lens looks similar to some of the designs currently available for intraocular lens implants used most frequently in cataract surgery.  It is not clear from the news reports what makes this lens design so revolutionary.  There do not appear to be reports yet in the peer reviewed literature which would fit with the reports that animal and blind human eye trials have not been done yet.  These steps are needed to prove that the lens is safe before proceeding to sighted human eye studies.  In people younger than 45 years old, lens replacement surgery is not usually recommended due to the fact that reading glasses may be required unless a multifocal lens is used or unless one eye is left near-sighted for reading (monovision).

The most common treatment for reducing dependence on glasses in this age range is laser vision correction.  The original photorefractive keratectomy (PRK) techniques were developed in the 1980’s and have been refined over the following decades.  This is still a reliable way to improve uncorrected vision in people who meet the safety criteria including thick enough corneas, prescriptions that are within the range of correction, healthy eyes, and no health problems that might cause problems in healing or risk of infection (such as immunosuppression).  For people younger than 45 but with high corrections outside the range of laser vision correction the implantable contact lens is usually the next option.

Will the Ocumetrics Bionic Lens replace laser vision correction and standard lens implants used for cataract surgery?  The reports are optimistic according to the news stories, but the proof will be coming in the next few years as preliminary studies and then sighted human eye studies are done.  There is a lot of excitement about this new lens implant and if it lives up to expectations it is possible that it may become a common option for vision correction in the future.  For now though, laser vision correction is the first option to consider as a way to reduce the need for glasses or contact lenses.

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

Should you have laser eye surgery (PRK or LASIK)? Answer these three questions.

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

1. Do the benefits outweigh the risks (low but not zero)?

The vast majority of people who have laser vision correction (PRK or LASIK) are satisfied with the outcome, and in a large FDA study of LASIK (PROWL 1&2) <1% of people experienced “a lot of” difficulties following surgery.  The most common side effects at 3 months in that study were dry eye and some increase in halo at night; these side effects may improve in some people beyond 3 months.  If this sounds like a reasonable risk versus benefit then read on; if you need a 100% guarantee of the outcome of PRK or LASIK then laser eye surgery may not be a good choice for you.  If you would like to have laser vision correction and are looking for the lowest risk then PRK may be your best choice.  This no-flap treatment avoids cutting into the cornea to create a LASIK flap.  Eliminating the need for a LASIK flap will avoid any complications that could happen when cutting the flap and also will eliminate the risk of a LASIK flap shift in the future if you suffer an eye injury even months or years after surgery.  For some people with high risk occupations PRK is a better choice.  Surface PRK also does not disturb the cornea as deeply and may be a better alternative in thinner corneas.  Surface PRK does involve a longer recovery (7-10 days) before returning to usual activities, but provides equally good results without the need to cut a corneal flap.

2. Do you have the right expectations?

The goal of laser vision correction is for you to function as well without glasses or contact lenses as you do now with your corrective lenses.  PRK or LASIK will not be expected to make your vision better than it is with your glasses or contacts.  If you already need reading glasses over contact lenses or a bifocal in your glasses, then laser eye surgery can correct for distance but you will still need reading glasses.  For people that have PRK or LASIK at a younger age, they will need reading glasses in their mid-forties as the focusing declines naturally with age.  This is called presbyopia and there is no treatment available for this natural age change that has been shown to be effective at this time.  In most people their night vision will be similar to what it was with glasses or contact lenses before surgery, but it does take longer (up to 6 months or longer for some people) to improve than vision during the day or in bright light.  For most people if they have dry eye with glasses and contact lenses this means their eyes will be dry after surgery.  Dry eye can also be worse for the first three to six months and generally returns to baseline – PRK and LASIK do not cure dry eye (some people think that if they can get rid of the contact lenses then the dry eye will be solved, but this is usually not the case).  There are a number of treatments for dry eye, so if this is a problem then working with your eye care provider to improve your comfort is recommended before considering PRK or LASIK.

3. How do you find out if you qualify for laser eye surgery?

There are some eye conditions and also systemic conditions that may disqualify you from PRK or LASIK.  An assessment with specialized corneal mapping and other testing is the next step if you answered yes to the first two questions.  During the assessment a medical history is also taken.  If your testing shows that you are a good candidate then there will be an opportunity to discuss any questions and to learn more about laser eye surgery.  At Western Laser Eye Associates Dr. Anderson Penno will examine your eyes at the assessment and answer any questions that you may have about laser eye surgery.  Once you have all the information you can make the choice that is right for 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.

 

Is PRK / Advanced Surface Ablation better than LASIK?

By | Customvue, Laser vision correction, LASIK, PRK, Refractive Surgery, Surgeon, VISX | No Comments

PRK (photorefractive keratectomy) was the first laser vision correction used to eliminate glasses and contact lenses. The first PRK was done in North America in the 1980’s and PRK has remained an excellent way to eliminate nearsightedness, farsightedness, and astigmatism.

PRK involves removing just the surface layer of cells on the surface of the cornea (the clear winshield-like structure on the front of the eye) and then reshaping the surface using the excimer laser.  A contact lens is placed on the surface for three to five days as the surface cells grow back to cover the cornea.  Most people are back to usual activities in 7 to 10 days.

LASIK (laser in situ keratomileusis) was developed in the 1990’s as a way to speed up the recovery from laser vision correction.  Also called “Flap &  Zap”, LASIK involves cutting a flap from the cornea, folding it back out of the way to reshape the surface underneath with the excimer laser, and then replacing the flap to it’s original position.  This allows people to be back to usual activities within a day or two but does carry higher risks;  the LASIK flap is more complicated to create, the flap can be shifted even months or weeks later, and the cornea is weakened more from the LASIK flap.

For over twenty-five years surgeons have preferred to use PRK for people with thin corneas or other factors that may make LASIK too risky.  With the newer excimer lasers a customized wavefront laser pattern can be used.  This custom wavefront treatment uses a map of the patients vision system to create an individualized laser treatment pattern – much like a fingerprint that is customized to each individual eye.  Some surgeons believe that a customized treatment is more effective with PRK because the LASIK flap will cover up the finely customized wavefront treatment.

Many surgeons around the world are choosing PRK as their preferred way to do laser vision correction due to the excellent results and safety.  Although the risks are low with LASIK, they are lower with PRK and most complications of PRK are easier to treat than a complicated LASIK flap.

For people who are looking for safe and effective laser vision correction the combination of PRK/Advanced Surface Ablation with customized wavefront laser treatment is an excellent choice.

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

Ebola, Influenza: what is your risk?

By | LASIK | No Comments

Ebola is one of the least likely diseases that you might catch in North America, but it has raised awareness of the risks of infectious diseases.

The top 10 causes of death in high income countries like Canada and the US according the the World Health Organization WHO:

1. Coronary Heart Disease

2. Stroke

3. Lung and Other Respiratory Cancers

4. Lower Respiratory Infections

5. Chronic Obstructive Pulmonary Disease

6. Colon and Rectal Cancer

7. Alzheimer and Other Dementia

8. Diabetes

9.  Breast Cancer

10. Stomach Cancer

HIV/AIDS, perinatal (deaths in childbirth), accidents, and malaria make the top ten in lower income countries.

According to the Huffington Post there are 5 more scarier infections to worry about.  Rabies kills about 55,000 people in Africa every year and is one of the deadliest viruses.  Hiv/AIDS has killed over 36 million people and can be treated but not cured.  More than 600,000 people are killed worldwide by mosquito spread disease like malaria, dengue fever, yellow fever, and West Nile – every year.  Rotavirus is a particular problem for children under the age of 5 in developing countries.

In the top 5 viral diseases scarier than Ebola is Influenza which kills between 3,000 and 49,000 in the US each year.  Worldwide between 250,000 and 500,000 people die each year from influenza.

Ebola has been around for decades but has more recently become epidemic in some areas of Western Africa.  There have been approximately 4,000 deaths so far from Ebola according the Centers for Disease Control and Prevention/ CDC.

You are more likely to become ill or die from the far more common influenza virus, but with any infectious disease there are common sense steps you can take to protect yourself:

1. Get vaccinated if a vaccine is available.  Influenza vaccines are available with the latest strains every year and there may be an Ebola vaccine available in the future.

2. Wash your hands & take other universal precautions

3. Stay home if you are sick and in particular if you have a fever.

4. Be aware of recommended precautions when you travel.

5. Don’t forget about common sense heart health including not smoking, exercise and watching your weight, and having proper screening for common diseases like colon cancer and breast cancer that are more likely to be treatable if found early.

Ebola is scary because it is new, but in developed countries sensible precautions are likely to prevent the devastating outbreaks that have been seen in African countries.  Everyone can do their part to slow down the transmission of all infections by common sense measures like hand washing, covering your mouth when coughing or sneezing, and staying home when you are sick or feverish.

Ebola is one of the least likely diseases that you may catch in North American but it is a good reminder to take common sense steps to avoid both the rare Ebola and the more common Influenza.

Blepharitis & PRK/LASIK

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

If you are thinking about having PRK or LASIK laser refractive surgery you should be familiar with the common conditions that can cause problems after surgery.  Most people who have PRK or LASIK are very satisfied.  For the small percentage of people who have problems following laser vision correction, dry eye is one of the most common complaint.

Dry eye can be a complicated problem, called “ocular surface disease” by eye care professionals.  Dry eye is not as simple as not enough tears.  A normal tear film is like oil and vinegar salad dressing – the oil, mucous, and water components need to be in the proper proportions and also mixed properly to form an emulsion.  An emulsion is what happens when you shake your oil and vinegar salad dressing.

Blepharitis is a condition that causes plugging of the oil glands that have openings just inside the upper and lower eye lashes.  Blepharitis can also cause redness and inflammation along the eye lashes and mattering of the lashes.  Without the proper oils the tear film does not wet the eye surface as well.  The mattering of the lids can also lead to a poor quality tear film which causes dry eye symptoms.

Blepharitis treatment is like treating dry skin or any other chronic condition.  Treatment of blepharitis means a change in habits – the treatments need to be done as part of your daily routine on an ongoing basis.  Daily warm compress with mild pressure on closed lids with a warm wet cloth for 3 to 5 minutes twice per day is the most important treatment.  The warmth will encourage the oils to flow, the mild pressure can soften and lift off matter, and the moist cloth will help lift off debris.  Other treatment are gently washing the lids with dilute baby shampoo 1:10 or with a lid care pad available at pharmacies.

The link between blepharitis and PRK or LASIK is that after surgery, without glasses or contact lenses, the eye is more exposed to wind and evaporation.  If you wear glasses you know that there moist air trapped between your eye and your glasses because when you go out in the cold the glasses fog up.  Even contact lenses can provide a barrier from evaporation.  Once the surface is exposed on a daily basis, people with blepharitis might find their eyes feel more dry than before PRK or LASIK.

Before you have laser vision correction your eye care provider will assess pre-existing conditions like blepharitis and give you advice about treatment of these conditions.

If you have questions about laser vision correction or wish to book a complimentary evaluation, 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.

Exercise & Eye Health

By | LASIK, Ophthalmologist, Ophthalmology, PRK, Refractive Surgery | No Comments

A long term study of thousands of adults shows that regular exercise lowers risk of vision loss over 20 years.  The Beaver Dam Eye Study started in 1987 and continued to follow approximately 5,000 adults over 20 years.  Vision loss was reported in 5.4% of the population overall.

People who were physically active had a 58% lower risk of vision loss according to this study.  Heart healthy practices like exercise, not smoking, healthy weight, and regular check-ups to monitor blood pressure have been shown to reduce the risk of eye diseases like macular degeneration and glaucoma.

Whether you are considering laser vision correction like LASIK or PRK or not, a heart healthy lifestyle including exercise can keep help to keep your vision safe.  Regular eye health checks with your optometrist or ophthalmologist are also very important to find and treat eye conditions.  For many eye problems early treatment is important in preventing serious vision loss and can often be found before you have symptoms.

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