The Procedure

LASIK is the most popular of the refractive laser procedures. LASIK involves the creation of a thin flap of corneal tissue which has a small hinge area to aid flap realignment. This flap is hinged aside and the laser treatment applied to the exposed cornea. When the flap is replaced, it tightly adheres to the corneal surface without sutures. The flap speeds healing and visual recovery.

Traditional LASIK involves the precise measurement of the refractive correction and the input of this data into the laser. Options are available to the surgeon to vary the amount of treatment, the diameter of the treated area and to use blend zone to smooth the edge of the treatment area.

Traditional LASIK offers the advantage of greater flexibility in altering the amount of treatment performed, being able to treat corrections that fall outside the current WaveScan approval range, and not having to remove as much corneal tissue. The ability to correct a patient's vision with less removal of tissue is important for patients with thinner corneas. It is exciting that the WaveScan measurements have helped us refine our accuracy with traditional LASIK.

WaveScan Custom Cornea Technology

The FDA approved Visx S4 variable spot scanning excimer laser is an exciting new advancement in refractive surgery. A key component is a device which measures the optical imperfections of the eye in a very precise manner. A customized program for correction of your eye is created and downloaded into the laser's computer to perform a treatment pattern which is individualized. The treatment zone is large and with custom peripheral blending, tends to provide improved night vision and better vision under low light conditions. Patients who have optical imperfections which spectacles do not correct are greatly benefited by the custom approach. Those who have unusual corneal shape maps can also be ideal candidates for WaveScan treatment.

Our facility offers:

• WaveScan Wavefront Analysis: A new technology which provides a detailed evaluation of the optics of each patient's eye.
• Orbsan Topography: This device creates a detailed topographic map of the shape and thickness of the cornea. This information helps the doctor choose the safest procedure to correct your vision.
• Visx S4 3D Active Tracking Excimer Laser: Through wave scan custom cornea technology, and an advanced infrared tracking system which follows the movement of the eye, we can now deliver a more precise laser treatment.
• Iris Registration: A new level of precision in treatment alignment is now available at the WVU Eye Institute. The iris registration system identifies multiple iris reference points when the Wavescan is acquired. These reference points are used to align your custom laser treatment with a level of accuracy which is unprecedented.
• Updated "State of the Art" Software for Custom View Treatments: Software upgrades and recent FDA approvals have expanded our ability to treat patients with the custom laser technology. Higher degrees of nearsightedness (-6.0 D to -11.0 D with astigmatism to -3.0 D), farsightedness (+3.0 D with astigmatism to 2.0 D) and mixed astigmatism are now available with the custom view format. To learn more about the custom view advantage go to www.visx.com.

The Lasik Team

We have developed a team approach to refractive surgery which we feel delivers a personalized care and the best outcomes. The technicians and doctor that perform your initial evaluation are also involved with your treatment and follow up. We feel this consistency of care is important for patient confidence and satisfaction. Involvement of the physicians and staff at every step of the refractive surgical process is our most important quality control measure. Your postop care is not delegated to an uninvolved party.

The laser treatment can be applied to the surface of the cornea after gently removing the layer of surface cells which covers it. Termed PRK, this was the first type of refractive surgery performed in the US with the excimer laser. Still an excellent option for lower degrees of treatment or for those with thin corneas who cannot spare the tissue for flap creation, PRK offers the advantage of no potential for flap complications as no flap is created. Preferred by the military for resistence to trauma, advances in laser technology have also optimized PRK outcomes. The disadvantage to PRK has always been slower recovery as vision remains blurry until the surface cells heal and smooth, usually within several weeks.

A variation on the PRK technique called LASEK utilizes a dilute solution of alcohol to loosen the surface cells as a sheet which can then be replaced under a bandage contact lens to speed healing.

Another advance which is pushing the frontiers of PRK is the use of an antiscaring medication called mitomycin, which allows higher degrees of correction without inducing a scarring response.

Advantages

No Flap: The procedure eliminates the surgical step of flap creation and thus eliminates the possibility of flap complications. Recent reports have documented that flap creation induces a small amount of optical irregularity which is of course avoided with PRK.

Better for some facial and eyelid configurations which will make the microkeratome difficult to use.

Greater Trauma Resistance: PRK may be preferable for those with occupations or avocations in which trauma to the eye is a possibility such as law officers, military personnel, martial artists, etc. For those who suffer form recurrent breakdown of the corneal surface, PRK is a better procedure.

Better for thin corneas: If too much corneal tissue is removed, the cornea may become structurally weakened and bow forward (ectasia). By not creating a flap, more tissue is preserved for laser treatment thus not weakening the cornea.

LASEK (Laser-Assisted Subepithelial Keratectomy)

A variant on the PRK procedure, this technique loosens the surface cells with a dilute alcohol solution allowing the sheet of cells to be displaced then repositioned over the treatment site. This method can reduce the time required for the surface cells to heal. A bandage contact lens is still used as in PRK.

Studies have verified that a substantial percentage of surface cells remain viable in the flap of epithelial tissue. It remains to be determined whether there is any less superficial haze or regression for patients with higher myopic corrections. Until more information is available, we prefer to select candidates for LASEK according to the same criteria as the PRK procedure.

Below are some commonly asked questions regarding the LASIK procedure. If your question is not listed here, please do not hesitate to contact Krista Felton at 304-598-4494.

How do I know if I am a candidate for laser vision correction?

Currently, the FDA has approved laser vision correction for nearsightedness, astigmatism and farsightedness. Not everyone is a candidate. There are several factors to consider. Patients with high nearsightedness, astigmatism and farsightedness are not good candidates. There are certain eye and medical conditions which makes a patient not suitable for LASIK surgery. To get the process started, we recommend you call for a phone consultation with our patient counselor. If you have your eyeglass or contact lens prescription available, we can tell you if you are potential candidate for laser refractive surgery.

What will my vision be like following laser vision correction?

Laser vision correction has been shown to reduce dependence on glasses and contacts. Over 95% of our patients undergoing laser vision correction achieve 20/40 vision or better. This will enable you to pass a driver's license exam without glasses. We will be happy to review the potential benefits and risks of laser vision correction with you.

What is the difference between Conventional LASIK and Custom LASIK?

Custom LASIK uses a tool called the wavefront analyzer to accurately measure the way light travels through your eye. The resulting map of your eye is then programmed into the laser, and the laser treats your eye based upon that personalized 3D map. CustomLASIK helps to treat "higher order" aberrations, which are tiny imperfections in the eye that can have a significant impact on one's quality of vision. In fact, higher order aberrations have been linked to visual glare and halos. Higher order aberrations have not been previously treatable with contacts, glasses or Conventional LASIK.

What is CustomLASIK?

CustomLASIK is a procedure that involves the use of a wavefront analyzer and enables your surgeon to customize the Conventional LASIK procedure to your individual eyes. This customized procedure can result in patients seeing clearer and sharper than ever before.

Is the actual part performed the same way? Or is CustomLASIK a completely different procedure?

The actual LASIK procedure is performed in exactly the same way in both Conventional LASIK and CustomLASIK. The pre-op testing for Conventional LASIK and CustomLASIK differ greatly. The wavefront analyzer used with CustomLASIK brings a whole new level of knowledge and accuracy to the surgeon.

Are expensive places better?

LASIK is a professional service with variable quality. It is not a product with consistency from one place to another. Top surgeons have professional fees consummate with their expertise. Often, less-skilled doctors charge less in order to attract more patients. Many of the discount centers work like assembly lines where patient-doctor relationships are minimal. Often, discount centers do not allow you to choose your surgeon or the doctor that performs your pre- and post-operative care. For most people, refractive surgery isn't the most appropriate place to try getting a "good deal." You can throw away and replace bad glasses or contact lenses, but you can't do that with bad refractive surgery. Look for quality, service, and commitment.

How long will the procedure actually take?

You will be at the Eye Institute approximately 1-½ hours. The time in the surgery suite with the surgeon is 15-20 minutes. The actual laser treatment time is approximately one minute per eye.

Is LASIK really painless?

For many patients, LASIK is indeed painless. However, some patients experience some discomfort after the procedure usually less than 24 hours. The eyes may feel scratchy, gritty or watery. These are temporary symptoms and are not a problem for most patients. Keeping the eyes closed and using the medication drops as instructed minimize discomfort. Discomfort during the procedure, if any, usually happens when the suction ring of the microkeratome (the flap maker) is seated on the eyes. The suction can give the eye a pressure sensation.

Why must I discontinue contact lens wear before my preoperative exam?

Contact lenses can change the shape of the cornea similar to how a watchband can make a skin imprint on your wrist. If you have your eyes examined too soon after taking out your contact lenses, some of the eye tests could give inaccurate results. You should discontinue wearing soft contact lenses 2 weeks prior to the pre-operative measurements and surgery. Rigid gas permeable (RGP) contact lens wearers should discontinue wearing lenses 4 weeks prior to pre-operative measurements. Our doctors will advise you if they suspect your corneas have not returned to their natural shape after removing your contact lenses.

What kind of vision can I expect after surgery?

Many patients notice improved vision immediately after the procedure, although it is normal to be somewhat blurred immediately after an operation. The next day, most patients have excellent vision and do not need any glasses or contacts. Patients continue to see gradual increase in their visual acuity during the first five to seven days after the surgery.

Do the results last?

Refractive surgery is considered to be a permanent procedure. However, refractive surgery will not prevent any age-related conditions such as presbyopia (the need for reading glasses) , or cataracts. In a small number of cases, eyes do change over time and develop a new prescription, but the effect of the laser on the pre-operative prescription is permanent.

Does insurance cover refractive surgery?

Most insurance companies consider refractive surgery an elective surgery and it is not usually a covered benefit. However, it is certainly worth checking with your insurance company and we encourage you to call them.

How much work will I miss?

Most patients return to their normal activities the day after the procedure. The doctor can give your more details on what you can expect when you come in for an evaluation.

Can both eyes be done at the same time?

Because of the advanced technology associated with laser vision correction, both eyes are most often done at the same time.

What are the risks of refractive surgery?

While enjoying a very high success rate, refractive surgery is still surgery and like all surgery there is some risk associated with it. Our most important goal is your safety. Some potential complications include conditions such as dryness, complications in making the surgical flap, night glare, over or under-correction, infection and loss of best-corrected vision. Your surgeon will go over the potential risks with refractive surgery and measures taken to avoid them. Be sure to have all your questions are answered before having surgery.