LASIK St. Louis

Exactly how does laser vision correction eliminate my vision problems?

Nearsighted treatments share a common goal -- to flatten the center of the cornea in order to reduce or eliminate myopia. In contrast, procedures to correct farsightedness steepen the central cornea. Finally, treatment for astigmatism changes the contour of the cornea from football shaped to basketball shaped. Astigmatism treatment can be performed alone (if it is the only problem) or at the same time as treatment for nearsightedness or farsightedness. Using a cool-beam excimer laser, we are able to reshape the cornea to resolve these vision problems.

 

I've heard that different kinds of procedures are available to treat nearsightedness, farsightedness and astigmatism. What are the differences between LASIK, Flapless LASIK, Custom (Wavefront) LASIK and Multifocal IOLs?

LASIK is the procedure of choice both nationwide and internationally, for the treatment of mild to severe nearsightedness, farsightedness and astigmatism. Pepose Vision Institute was the first to perform LASIK in the bi-state region and remains the most experienced provider in the area. PVI was also the first to introduce Custom (wavefront) LASIK, the treatment of choice for patients with irregular corneas; and Flapless LASIK (LASEK), which is used when patients are not good LASIK candidates. Finally, Multifocal Intraocular Lens Implants, the latest FDA-approved non-laser technology for correcting nearsightedness or farsightedness, is specifically targeted for cataract patients requiring a lens extraction (for more information about cataract diagnosis and treatment, click here). All of these procedures are designed to treat nearsightedness, farsightedness, and astigmatism at the same time.

 

LASIK requires that a thin corneal flap be created, which acts as a natural bandage to promote healing. Once the flap is created, a pulsating, cool-beam laser is applied beneath the flap to gently reshape the cornea. The flap is then refloated to its original position and within a short time re-adheres to the cornea and is extremely difficult to disturb. LASIK offers rapid visual recovery and minimal postoperative pain. Most patients opt to have both eyes treated together, and even drive to their follow-up exam the very next day. The only difference between LASIK for nearsightedness and LASIK for farsightedness is the way in which the laser's beam is used to remove tissue from the cornea. During Hyperopic LASIK, the laser removes tissue from the periphery of the cornea, instead of from its center. This flattens the outer area and causes the center of the cornea to steepen, thereby reducing the patient's farsightedness.

 

At PVI, we use a wavefront analyzer to examine every patient's cornea, resulting in literally thousands of data points that your surgeon can use to improve your treatment plan. This is particularly important when a patient has significant corneal aberrations. These tiny aberrations cause some patients to complain that the letters on an eye chart appear "ghostly", that headlights at night have "tails" on them, and that streetlights have "halos," problems that are not easily corrected by contact lenses or glasses. Wavefront-Guided LASIK is clinically relevant for a small subset of patients who have large amounts of specific forms of wavefront aberration pre-operatively, sometimes associated with a larger pupil size, and who are not good candidates for standard LASIK surgery. Wavefront measurements are used in the programming of the laser to offset the eye's higher order wave aberrations, as it corrects for nearsightedness, farsightedness and astigmatism. This treatment is often referred to as Custom LASIK, because it actually customizes your laser treatment to the unique topography of your cornea.

 

FLAPLESS LASIK (LASEK) does not require the creation of a corneal flap. Instead, the outer skin of the cornea, called the epithelium, is treated with alcohol. This causes the outer skin to gel and adhere together. Using a special set of instruments, the outer corneal skin is delicately slid back as an intact sheet. The entire thickness of the underlying cornea is available for laser reshaping. The epithelial sheet is then gently floated back into its original position and a band-aid type contact lens is placed for 4 days of continuous wear. This allows the outer skin to quickly and completely heal. Flapless LASIK is ideal for individuals with thin corneas, deepset eyes, and those who are concerned about the creation of a flap. While flapless LASIK is associated with increased post-operative discomfort and a delay in achieving the full vision benefit of surgery, clinical studies have demonstrated that at 6 months post-op, patients who underwent LASIK and LASEK had the same improvements in vision. Because of its minimal discomfort and rapid visual recovery, LASIK remains the clinically preferred treatment for most patients.

 

Each and every vision correction procedure requires that a surgeon perform microsurgery on your cornea, using the laser and other instruments as tools to achieve your vision outcome. Each stage of the procedure requires surgeon input, whether it is to choose the appropriate laser, pre-program it for your precise vision treatment plan, create a corneal flap or epithelial sheet, or monitor the eye to avoid post-operative complications. Because all of these vision correction procedures are forms of corneal surgery, choosing a surgeon who is subspecialty trained in cornea will ensure the very best vision outcomes possible. At Pepose Vision Institute, your surgeon is cornea subspecialty trained and at the forefront of vision correction technologies and procedures.

 

Which laser vision correction treatments are FDA-approved?  

The FDA has approved laser vision correction performed using the VISX Star S4 Scanning Laser, PVI’s laser of choice. This approval is based on clinical data generated by the leading cornea subspecialist surgeons in the United States, including Dr. Jay Pepose. In fact, Dr. Pepose was one of the first eight investigators to participate in clinical trials of the excimer laser over 20 years ago. This laser has been used worldwide for decades, and has been found to have the highest level of performance in terms of vision outcomes and long-term stability.

 

While the FDA has approved this laser in terms of safety and efficacy, it does not guarantee that all surgeons using this technology will achieve the same vision outcomes. Pepose Vision Institute has tracked its vision outcomes since inception; these outcomes have been consistently superior to those reported to the FDA during the laser’s clinical trials. During your visit to PVI, ask to see its vision outcomes for patients with a pre-operative prescription just like yours.

 

Is there a minimum or maximum age to be a candidate for vision correction?

We have had patients as young as 18 and as old as 82 who have had outstanding vision correction outcomes. The most important determinant for young people is whether their eyesight has stabilized (no prescription change for at least one year). For older patients, it is critical that a thorough eye exam be performed to eliminate any other cause of vision loss, such as cataract formation. Because Pepose Vision Institute is a comprehensive eye care provider offering vision correction surgery as well as treatment for glaucoma and cataracts, it has the experience to diagnose and treat a wide variety of eye conditions that may be contributing to poor vision or may compromise an outstanding vision correction result.

 

How do I choose a skilled surgeon? Why should I trust my eyes to the surgeons at Pepose Vision?

At Pepose Vision Institute, our mission is clear: to protect, preserve and enhance your vision. If you are not well-suited for one of the many vision correction procedures we offer, we will NOT proceed with treatment. We have had a number of disappointed, but grateful, patients who have been turned down for surgery, or who have been diagnosed with other vision-compromising conditions that require treatment prior to, or in lieu of, laser vision correction. Because PVI provides treatment for glaucoma, cataracts and corneal problems in addition to vision correction, our patients can receive virtually all of their eye care services in one place, thereby assuring continuity and coordination of care. Having an experienced vision correction surgeon who is also experienced in other facets of eye care should be an important consideration when choosing your LASIK surgeon. For a list of questions to consider when choosing your LASIK surgeon, click here.

 

Can I have LASIK surgery if I'm pregnant?

You should not have LASIK or any other laser eye surgery if you are pregnant, nursing, or expect to become pregnant or nurse within six months of the procedure. If pregnant, wait at least two months beyond delivery or after nursing has ended to talk to your eye doctor about when it is optimal to have your laser eye surgery.

 

Hormones produced during pregnancy causes most women’s prescriptions to fluctuate dramatically, whether they are wearing glasses or contacts. The same occurs during the breastfeeding phase. This is because variability in hormonal levels causes fluctuations in the curvature of the cornea. As a result, having Lasik surgery performed during pregnancy or while still nursing increases the likelihood that a retreatment will be needed later, when a new mother’s vision stabilizes after delivery and the end of breastfeeding.

 

Is everyone a candidate? Which procedure is best?

If you are 18 years of age or older and have a stable prescription, you are likely to be a good candidate for one of the many vision correction procedures available today. We offer a free, personal consultation to determine whether your prescription is within the treatable range and whether you would be likely to benefit substantially from laser vision correction. Our 3+ hour comprehensive pre-operative exam enables us to evaluate the health of your eyes and to confirm that your vision problems are not caused by other factors such as cataracts or glaucoma. We use millions of data “points” derived from your pre-operative exam to create a customized treatment plan that will produce the very best vision outcome possible. At every stage in the evaluation process from personal consult to pre-operative exam the surgeons at PVI will assess the candidacy of each and every patient and, when necessary, defer surgery until an eye condition is resolved or a more appropriate technology is available. Because PVI is at the forefront of clinical trials and applications, and has longstanding relationships with the international leaders in eye technology, it knows what is coming “down the pike” and whether it will contribute to a better outcome for specific patients.

 

My glasses are thick as coke bottles and I've been told there is no laser vision correction treatment available for my high degree of nearsightedness. Is there anything on the horizon to reduce my dependence on glasses?

The wait is over! FDA-approved Verisyse Phakic IOLs are available for patients with very high degrees of nearsightedness, for whom laser vision correction is not an option. This intraocular lens is a micro lens placed behind the cornea that works alongside the natural lens. It is made out of PMMA, the same material used safely for the past 50 years in cataract surgery. The word “phakic” means that the natural lens is left in the eye (not removed as in cataract surgery). This is important because the natural lens helps the eye adjust between seeing objects near and far.

 

Because the Verisyse IOL is placed directly behind the cornea, it is important that this surgery be performed by a cornea subspecialist, who is trained to evaluate the cornea to ensure that you are an excellent candidate for the procedure. Pepose Vision Institute was one of the first centers in the nation to be certified in the use of Verisyse Phakic IOLs and has the most experience in the bi-state area in safely implanting these lenses.

 

My regular eye doctor recommended this procedure.  Can he be involved in my care?

Yes, provided that he has been trained and certified by PVI surgeons in the delivery of pre- and post-operative vision correction care. Outstanding vision outcomes require meticulous pre-operative screening and post-operative attention to detail. We routinely “co-manage” our patients with their PVI-certified optometrists and ophthalmologists, working together closely as a team to provide you with the very best vision outcome possible.

 

If I wear contact lenses, do I need to leave them out before my pre-operative exam?

Depending upon the type of contact lens you wear, and how long you have worn contacts, you will be asked to remove your contacts anywhere from 3 days to 6 weeks prior to your comprehensive pre-operative exam. Our surgeons will monitor your cornea’s curvature once your contacts are removed to ensure that any artificial reshaping of your cornea due to contact lens use is fully reversed prior to surgery. This may require more than one pre-operative visit; there is no additional fee charged in such situations.

 

After my pre-operative exam, how soon can I have my procedure done?

You may schedule your surgery so that it takes place as soon as the day after your preoperative visit, assuming that your surgeon concurs that this timetable is clinically optimal. Contact lenses wearers must have sufficient time out of their contacts to ensure that all corneal curvature induced by the contacts is gone prior to surgery. If you are a longtime contact wearer or wear hard lenses, we may schedule more than one pre-operative visit to check the curvature of your cornea.

 

Will I be able to have both eyes treated at the same time?

There is no difference in vision outcomes whether both eyes are treated on the same day or not. Consequently, virtually all of our vision correction patients choose to have both eyes treated the same day.

 

How long does the surgery take?

Vision Correction treatments are performed on an outpatient basis. You will arrive one-half hour before the scheduled surgery time, during which time you will be given eye drops to anesthetize the cornea and a mild sedative such as Valium to help you relax during the procedure. You should plan to be at the surgery center for approximately two (2) hours.

 

Is vision correction surgery painful?

Prior to your procedure you will be given a topical anesthetic (numbing eye drops) so that you will not feel any pain during surgery. If you have any discomfort after the procedure, you may take an over-the-counter pain medication such as Tylenol or Advil. We strongly recommend that you return home immediately and go to sleep so that your natural eye fluids can begin the process of soothing and promoting healing. You will be given eye drops that may be used should your eye feel scratchy or dry. Flapless LASIK patients should expect more scratchiness during the first week after surgery. These, too, can be remedied with eye drops and over-the-counter pain medications; in some cases, your surgeon will fit a bandage contact lens to promote healing during the first few days after surgery.

 

What if I blink or move during the procedure?

We use a lid holder to gently hold your eye open, making it impossible to blink during the procedure. Moreover, an infrared eye tracker follows eye movement and will automatically pause the laser if you look outside the treatment zone. We take the time to position you properly to ensure that your vision outcome is totally independent of any involuntary movements you may make.

 

How long will it take before I can see better?

Although everyone is a little different, most LASIK patients drive themselves to their one-day post-op exam the very next day! Flapless LASIK patients may take 4 or 5 days to achieve driving vision.

 

How soon can I get back to work?  What's the recovery time?

Visual recovery following LASIK is rapid. We strongly recommend that you rest immediately after your procedure. You can resume your normal activities as soon as the next day following surgery with a few exceptions. Patients should not wear eye makeup for at least one week following the procedure. Swimming, hot tubs and whirlpools should be avoided for two weeks, as should gardening and dusty, dirty environments. Also, it is a good idea to avoid smoking or smoky areas. While showering or bathing, keep your eyes closed to avoid soap or shampoo irritation.

 

How often will I come back for post-operative visits?  Are these included in the fee?

Pepose Vision Institute includes in its fee exactly the amount of post-operative care that it deems medically necessary to ensure the very best vision outcome possible. As part of this fee, you will be seen 1 day post-operatively, as well as approximately 1 week, 6 weeks, and 6 months post-operatively by our team of doctors. During this time, your vision outcome will be repeatedly evaluated to assure that it is stable and that it does not require any further (no-cost) “touchup.” In addition, our surgeons are available 24 hours a day, 7 days a week to address any postoperative concerns you may have.

 

What are the risks associated with laser vision correction?

As with any type of surgery, there are potential, but extremely rare, risks associated with vision correction surgery. These risks are reviewed in our “Informed Consent” materials that you will have ample opportunity to review prior to scheduling your treatment. To put these risks in context, it is important to recognize that the prolonged use of contact lenses to achieve improved vision has its own risks, including corneal infection and scarring, both of which may result in the need for a corneal transplant.

 

Numerous studies of laser vision correction outcomes have demonstrated that the best way to minimize the risk of any complication is to choose a cornea subspecialty trained surgeon who has lots of vision correction experience and provides a thorough pre-operative exam to confirm your candidacy for the procedure and create a detailed treatment plan for your unique eye anatomy. Patients who meet their surgeon on the very day of surgery are unable to take full advantage of the medical training and surgical experience that assures the very best vision outcome possible.

 

Is laser vision correction permanent? Can I have cataract surgery in the future should it be required?

Clinical data, gathered internationally from countries that have performed laser vision correction for decades, indicate that LASIK is a superior treatment in terms of long-term stability of vision. Studies of the first patients who had LASIK performed in 1991 indicate that they have maintained their corrected vision. Stability of vision is largely achieved within 3 months of surgery. For hyperopic patients, LASIK is the most stable treatment option available, remaining stable as long as the underlying causes of a patient’s farsightedness do not intensify.

 

All of the vision correction procedures offered by the Pepose Vision Institute will permit a patient to have cataract surgery should such surgery be warranted at some later date. However, once a patient has undergone laser vision correction, we strongly recommend that a highly experienced vision correction surgeon perform future cataract surgery; this will ensure that the intraocular lens replacement is measured precisely to reflect the earlier vision correction treatment.

In addition to being a leader in cataract surgery following laser vision correction, PVI surgeons have likewise performed vision correction surgery on patients who have already had cataract and other forms of eye surgery, thereby enhancing the clarity of their distance vision