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Laser Vision Correction

For the very best results, we refer our patients to surgeons who use "CustomVue" (VISX Star 4) utilizing the latest technology in LASIK treatment.

 

 

LASIK

Laser Assisted In-Situ Keratomileusis

Three steps are involved in LASIK:

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Step 1

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Step 2

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Step 3

In the LASIK procedure, a thin layer of the cornea is gently lifted to reveal the stroma of the cornea (step 1).  The laser is then applied to the stroma (step 2).  The thin layer of the cornea is returned to its original place (step 3).  Because the epithelium of the cornea is not disturbed during this procedure, healing is much faster, usually within 24 hours.

FOR YOUR OWN PERSONAL COMPLIMENTARY EVALUATION

Aniemail.gif (7085 bytes) drespinosa@earthlink.net

(800) 914-2020

(323) 261-3098

    Laser Vision Surgery is a very safe procedure which has grown in popularity because of the high patient satisfaction with the procedure.  Now the surgeons we use are performing "CustomLASIK" which utilizes wavefront analysis, the most precise technology possible to date.  This custom treatment may give you the best possibility for exceptional natural vision.  

    Here are some of the most frequently asked questions about the procedures.  If you can't find the answer to your specific question, email us.   We'll answer you right away.

    Is there any pain?

    The surgery itself is painless.  After the surgery there may be some mild discomfort for a few hours which may be relieved by oral medications and/or topical eye drops.


    How much pain should I expect following laser vision surgery?

    The afternoon following surgery most patients experience mild to moderate discomfort.  You will be given eye drops that are very effective in alleviating discomfort.  We recommend that you go home and try to sleep for several hours following surgery.  This will help make you comfortable and facilitate healing.   For a few days following surgery, your eyes may be light sensitive, scratchy and watery.  These symptoms are much less pronounced with the LASIK procedure than with PRK.

    How long will I need eye drops after surgery?

    You may use eye drops from one to several weeks following your surgery.  The type of eye drop and the frequency of drops will be determined by us based on the postoperative refraction and the healing response.

    Will I be able to see right away?

    Yes.  The improvement in your distance vision will be almost immediately apparent, especially with larger prescriptions, and will improve rapidly over the first week.

    How much time will I need to take off work?

    Most patients are back to work within 1-3 days after treatment.   The final visual results of surgery are not instantaneous; it may take several days or even a week for your vision to become clear enough to drive.  With LASIK, recovery is often fast enough to drive within 24 hours.  This is why LASIK has become the procedure of choice.  However, your individual healing properties will dictate when you should resume your normal activities.

    What range of nearsightedness, farsightedness and astigmatism can be treated with the laser?

    The currently approved FDA lasers in the United States can correct up to -12.00 diopters of nearsightedness with 6.00 diopters of astigmatism and up to +6.00 diopters of farsightedness.  The best way to find out what can be done for you is to come into our office for a complimentary evaluation.  We will discuss and recommend the best procedure for your specific needs in detail.

    There are special procedures for people whose refractive error falls outside this range.  Please refer to the other refractive surgical procedures page for more information.  

    Will I ever have to wear glasses again?

    Usually not for distance vision, although some patients may desire glasses for certain activities such as driving at night and for reading when you're past 40 years of age ("presbyopia") which is natural.  Nearly all patients, as they enter their early 40's, require reading glasses or bifocals.  This is also true for patients who have had refractive surgery (unless you choose the "monovision" option).

    What is "monovision"?

    Monovision is a method of correcting your vision so that one eye is corrected for distance and the other for near vision in presbyopic patients (patients over 40 years of age).  This potentially can eliminate the need for reading glasses and distance glasses.  You need to discuss this with us to find out if you are a good candidate.

    How long after surgery do I need to wait before I can take a bath or shower?

    You can bathe or shower the same day of your surgery; however, you should avoid getting soap or water directly in your eyes.

    When can I drive following surgery?

    You should not drive for 24 hours following your surgery.   After that, you may drive when you feel confident that your vision and eye comfort allow you to drive safely.

    How long after surgery before I can wear eye makeup?

    You may wear eye makeup as soon as you are comfortable applying it.   It is a good idea to use all new eye makeup, including mascara, to avoid potential infections following surgery.  For many years Dr. Espinosa has recommended Clinique™ hypoallergenic makeup purchased at some of the finer department stores.

    When can I exercise after surgery?

    Heavy weight lifting should be avoided for two to four weeks, but other non-contact sports can be resumed as soon as you wish.

    When can I swim following surgery?

    You should stay out of swimming pools for one to two weeks, and avoid hot tubs, lakes, ponds and oceans for one month following your surgery.

    Can I snorkel or scuba dive following refractive surgery?

    Yes.  Beginning one month after surgery you may snorkel or scuba dive.

    Can I fly in an airplane following refractive surgery?

    Yes.  You may fly any time following surgery.

    What services does your refractive surgical fee cover?

    Our global fee covers a thorough preoperative eye exam, including refraction and a dilated exam, computerized mapping of your corneal surface, the surgeon's fee, the operating room fee, full postoperative examinations for twelve months and, if needed, most enhancement surgery within one year following your refractive surgery.

    What is an "enhancement"?

    An enhancement is additional surgery performed at least one to three months after the original procedure.  Enhancements are reserved for those patients who fall short of the expected results of surgery.

    Does insurance cover refractive surgery?

    Select insurance companies and some union plan insurance programs will sometimes cover refractive surgery.  You should check with your insurance carrier or employer prior to consultation.  Our staff is available as well to help you with the details of your coverage.

    Can I make payments on my surgical fee?

    Unless other financial arrangements have been made, we require payment in full or a written authorization of insurance coverage prior to surgery.   Surgery charges may be paid with credit cards such as MasterCard™, Discover™ or Visa™.  Convenient payment plans are also available for patients with good credit.

    Can someone look at my eyes and tell that I have had refractive surgery?

    No.  Only by examining your eyes under high magnification can an eye doctor see that you have had refractive surgery.

    What should I expect on the day of surgery?

    Plan to be at the surgeon's office for about two hours.   When you arrive you will meet with the coordinator of refractive surgery patient care.  They will discuss any final questions you might have.  They will also take you, step by step, through the details of the procedure.

    You will then walk into the preoperative room for corneal measurements including topography (eye mapping) and pachymetry (measuring corneal thickness).  After this, you will walk into the refractive surgery suite.  Your eye will be anesthetized with topical eye drops so the experience will be painless.  While the actual surgery only takes a few minutes, you will be in the surgery suite for about 15 to 20 minutes.  Your eye(s) will be covered with a clear plastic shield through which you can see.  You can go home immediately after surgery.  Please arrange to have someone to drive you home after your surgery.

    Follow-up care:  You will be seen at the surgeon's office the next morning.  We will monitor your progress in our office at one week, one month, three months, six months and twelve months intervals.  The surgeon will receive and review reports from these exams and communication with your doctors will be ongoing.

    You may experience some mild discomfort when the anesthetic wears off.   Use your eye drops as instructed.  Most people return to work and other normal activities within two to four days.

Principals of Refractive Surgery

    How does refractive surgery make me less nearsighted?

    All corneal refractive surgery is based on the same principal.   The cornea is reshaped to change the focus of images on the retina.   Refractive surgery began by making radial incisions to flatten the central cornea in the case of nearsightedness.  The techniques have improved dramatically since the inception of the excimer laser.  Now the central cornea is reshaped much more precisely.

    The excimer laser produces a high energy cold laser ultraviolet light beam (193 nanometer wavelength).  This unique laser is actually able to break the bonds between molecules in tissue cells.  It is so precise that it can remove tissue 1/5th of a micron at a time (one micron is 1/25,000th of an inch).  This gently and precisely vaporizes and removes microscopic layers of tissue to reshape the corneal surface.

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    Will the excimer laser help my astigmatism?

    Yes.  With the excimer laser, astigmatic refractive errors are very effectively reduced or eliminated.

    Can the excimer laser correct for farsightedness or hyperopia?

    Yes.  Advances are being achieved frequently to correct almost all refractive errors accurately.  LASIK is the procedure of choice for low amounts of farsightedness, up to +6.00.  For more information on other procedures, please go to the other surgeries page.

    How long has laser surgery been performed?

    Excimer laser PRK was developed in the United States in 1983.   The first Excimer laser photorefractive keratectomy procedure was performed in 1987 in Berlin, Germany.  Since then, several million have been performed in more than forty countries worldwide.

    Is excimer laser PRK considered experimental?

    No.  The FDA approved the procedure for use in the United States in 1995.  Millions of procedures have been performed in Europe, Asia, Canada, Mexico, Colombia and the United States.  The excimer laser computers are programmed utilizing data from vast experience gathered from around the world and in the United States.

    How long does the excimer laser take?

    The laser itself takes ten seconds to ninety seconds.  The total time in the operating suite depends on the type of surgical procedure performed.   The LASIK procedure takes about 15-20 minutes with an experienced surgeon.

    What is the difference between LASIK and PRK?

    In PRK the laser removes the corneal epithelium, a layer called Bowman's membrane (which lies directly below the epithelium) and cells in the stroma or the "bed" of the cornea.  It is the cells removed in the stroma that causes the correction of the refractive error of the eye.

    In the LASIK procedure a thin layer of the cornea is gently lifted as an instrument called a "microkeratome" glides across the cornea.  This allows the laser direct access to the stroma of the cornea without affecting the epithelium or Bowman's membrane.  As a result, healing is faster and more comfortable with LASIK than with PRK.  LASIK is quickly becoming the procedure of choice and is expected to soon replace PRK as the refractive surgical procedure in the United States.

    What kind of anesthesia is used for laser surgery?

    A combination of oral medication (to help with relaxation) and anesthetic eye drops is used.  Patients are generally very comfortable throughout the surgical procedure.

    Can I see the operation as it is performed on me?

    You will not be able to see any of the details of surgery.  You will see a number of bright lights, experience no pain, and have an easy and comfortable surgical experience.

    Will I be awake?

    You will be awake and able to understand everything the doctor will be saying to you; however, you will be very relaxed if you are given a mild sedative before the operation.

    Do you perform laser vision surgery on both eyes at the same time?

    Yes.  It has become usual and customary to perform LASIK and PRK on both eyes at the same time (sequentially).  However, if you prefer to have one eye at a time, our surgeon will be pleased to accommodate you.

    Will my vision fluctuate following laser vision surgery?

    No.  Once the eye has completely healed, your vision will be stable throughout the day.

    Can I have excimer laser surgery following radial keratotomy surgery?

    Existing forms of laser surgery are all compatible with radial keratotomy.  Excimer laser vision surgery can be used to correct residual refractive errors following radial keratotomy in most patients.

    What are the risks of excimer laser surgery?

    The risks associated with excimer laser surgery are minimal.  A review of the informed consent will outline the risks associated with PRK and LASIK.   Potential risks include:

bulletInitial overcorrection (farsightedness).  The eye generally stabilizes to near predicted results within three months; however, some patients may remain overcorrected.
bulletUndercorrection.  Significant undercorrection may need an enhancement procedure or corrective lenses full or part-time for sharp vision.
bulletLight sensitivity.  Most eyes are sensitive to light postoperatively.  This usually diminishes with time and disappears in almost all cases.  Some patients experience a halo effect around bright lights at night, similar to wearing contact lenses.
bulletPersistent corneal haze.  This rarely occurs following the normal postoperative healing period.  It occurs more frequently in PRK and in eyes requiring a large amount of correction.  The haze usually reduces with time and disappears.  If it persists, an enhancement procedure may be required to eliminate or reduce it.
Decreased best-corrected visual acuity.  This rarely occurs.  It can usually be corrected with an enhancement surgery or contact lenses, although fitting and wearing contact lenses may be more difficult following refractive surgery.
bulletInfection.  This rarely occurs, and it can usually be treated with antibiotic drops.  In the rare event that the infection results in corneal scarring, an enhancement procedure is usually needed.  In extreme cases a corneal transplant may be required.

    What is the success rate of excimer laser vision surgery?

    More than 90% of all patients having excimer laser surgery become independent of contact lenses and glasses for most, if not all, of their activities.   This success rate is even higher with lesser degrees of myopia.  In fact, up to 96% of those with lower degrees of myopia can expect not to need glasses or contacts for most, if not all, of their activities.

For Your Own Personal Complimentary Evaluation

Aniemail.gif (7085 bytes) drespinosa@earthlink.net

(800) 914-2020

(323) 261-3098

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