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Ophthalmology Associates of Mankato. Refractive Surgery Seminar: An Introduction to Laser Vision Correction. Emily Birkholz , MD John Hoines , MD. Our Plan:. Why do people need glasses or contact lenses? Nearsightedness, Farsightedness, Astigmatism

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Presentation Transcript
our plan
Our Plan:
  • Why do people need glasses or contact lenses?
    • Nearsightedness, Farsightedness, Astigmatism
  • What is refractive surgery/laser vision correction?
    • PRK vs. LASIK vsIntraLASIK
    • Custom treatment
  • Who is a good candidate?
  • What to expect with this procedure?
  • Questions
why do i need glasses contacts
Why Do I need Glasses/Contacts?
  • Nearsightedness (myopia)
  • Farsightedness (hyperopia)
  • Astigmatism
  • Presbyopia
  • Loss of accommodation with aging
how to correct refractive error
How to correct refractive error?
  • Glasses
  • Contact lens
  • Refractive Surgery
    • Laser vision correction
how does laser vision correction work
How Does Laser Vision Correction Work?
  • Laser energy applied to corneal tissue
  • Reshapes cornea to correct refractive error

Myopia – flattens cornea

  • Hyperopia – steepens cornea
laser vision correction
Laser Vision Correction:

Two Methods:

  • PRK (surface treatment)
  • LASIK (flap)
the excimer laser visx
The Excimer Laser (VISX)
  • Designed in the 1970’s
  • Removes 39 millionths of an inch of tissue in 12 billionths of a second
  • Typically a layer of tissue as slender as a human hair is removed
  • Average laser time is less than 1 minute

No adjacent tissue destruction

photorefractive keratectomy prk
Photorefractive Keratectomy (PRK)
  • Epithelium is removed
  • Laser treatment to anterior stroma
  • Corrects
    • Myopia
    • Hyperopia
    • Astigmatism
  • Advantages:
    • No Flap
    • Can be performed on thinner corneas
  • Disadvantages:
    • Pain
    • Longer time for vision to improve
    • Haze
laser assisted in situ keratomileusis lasik
Laser-Assisted in Situ Keratomileusis (LASIK)
  • Flap created and lifted
    • hinged, partial thickness
  • Laser treatment to deeper stroma
  • Flap repositioned
  • Corrects
    • Myopia
    • Hyperopia
    • Astigmatism
  • Advantages:
    • Minimal pain
    • Fast visual recovery
    • No haze
  • Disadvantages:
    • Flap complications
    • Dry eye
  • How is the flap created?
    • Laser – IntraLase
      • No blade
      • iLASIK, Bladeless LASIK, IntraLASIK
    • Microkeratome - Traditional
  • Femtosecond laser
    • Laserbeam creates tiny microbubbles at programmed depth, shape, and size
    • Precise depth (accurate within 10 microns)
advantages of intralasik
Advantages of IntraLASIK
  • More precise flap thickness
    • Less risk of a flap complication
    • Thinner flaps
    • Less Dry Eye
    • Ability to perform on more patients
      • Even those with thinner corneas who were not eligible for traditional LASIK
  • Less risk of infection or inflammation
    • No blade to sterilize
    • Vertical edge to flap
  • Low vacuum suction ring
    • compared to high vacuum ring with microkeratome
    • more comfortable
what is a custom treatment


What is a Custom treatment?
  • CustomVue system measures low and high order aberrations
    • Low order – myopia, hyperopia, astigmatism
    • High order – imperfections in system, linked to glare/halo
  • Wavefront represents all aberrations
    • Information obtained by a WaveScan
custom treatment
Custom treatment
  • A Custom treatment uses the information from the wavefront to reduce or eliminate all aberrations from the eye
advantages to custom treatment
Advantages to Custom Treatment
  • Improved visual quality
    • Reduced risk of glare/halos
  • Improved contrast sensitivity
    • Reduced risk of nighttime vision difficulties
  • Similar outcome as non-Custom for visual acuity
who is a good candidate
Who is a good candidate?
  • At least 21 years of age
  • Healthy eyes
  • Good health overall
  • Realistic expectations
who is a good candidate1
Who is a good candidate?
  • Nearsightedness from -1.00 to –12.00D
    • Astigmatism up to 4.00D
  • Farsightedness between 0 and +5.00D
    • Astigmatism up to 3.00D
  • Astigmatism between 1.0 and 5.0 D
who is not a good candidate
Who is not a good candidate?
  • Unrealistic expectations
  • Pregnant and nursing women
  • Ocular disease
  • Certain medical problems
    • History of autoimmune disease
      • Lupus
      • Rheumatoid Arthritis
when to choose prk vs lasik
When to choose PRK vs. LASIK?
  • PRK
    • Dry eye syndrome
    • Inadequate corneal thickness
    • Professions with potential for ocular injury
    • Faster visual recovery
    • Less post operative discomfort
what are the common risks
What are the common risks?
  • Under-correction
  • Over-correction
  • Night vision symptoms
    • Glare/halo
  • Worsening of dry eye symptoms (LASIK only)
what are the rare but serious risks
What are the rare but serious risks?
  • Loss of best spectacle corrected visual acuity
  • Minor loss of BSCVA: 1%
    • Usually due to haze/mild scarring or flap irregularities
  • Major loss of BSCVA: 0.1%
    • Usually due to infection
what can i expect after the procedure
What can I expect after the procedure?


  • Some discomfort for a few hours
  • Eye redness for 2-3 weeks
  • Back to work after 1-2 days
  • Good vision typically the next day
  • Excellent vision typically in 1 to 4 weeks


  • Some pain for 3-5 days
    • Bandage contact lens
  • Back to work after 3-5 days
  • Good vision typically in 1 week
  • Excellent vision typically in 4 to 8 weeks
what can i expect after the procedure1
What can I expect after the procedure?


  • Eye drops for about 1 month
  • Eye shields at bedtime for 2 weeks
  • Frequent artificial tears for the first 1-3 months


  • Bandage contact lens for the first week
  • Eye drops for 1-3 months
  • Eye shields at bedtime for 1 week
  • Frequent artificial tears for the first month
what is the follow up schedule
What is the follow-up schedule?
  • 1 day (LASIK only)
  • 1 week
  • 1 month
  • 3 months
  • 6 months
  • 12 months
what is an enhancement
What is an enhancement?
  • Repeat treatment
  • Usually performed after at least 3 months
is laser vision correction perfect
Is Laser Vision Correction Perfect?
  • Laser vision correction provides uncorrected visual acuity that closely approximates that which is currently achieved with glasses or contact lenses
  • Will not eliminate the need for reading glasses once you reach your 40’s and 50’s
near problems presbyopia
Near Problems (Presbyopia)
  • Difficulty with near focus is a function of progressive age and changes in the crystalline lens, not the basic refractive error
  • < 40 years of age: accommodation can be used to maintain clear images at all distances
  • >40 years of age: accommodation becomes progressively more difficult; first noticed for close work late in day and with poor light
solutions to presbyopia
Solutions to Presbyopia
  • Reading glasses
  • Monovision
    • Dominant eye corrected for distance
    • Non-dominant eye corrected for near
      • With contact lens or Laser Vision Correction
  • Cataract Surgery with implantation of Multifocal Intraocular Lens
how much does the procedure cost
How much does the procedure cost?

**Includes all postoperative visits for 1 year

**Wavescan cost $100

Custom PRK


Custom Traditional LASIK


Custom IntraLASIK


  • PRK
    • $1650
  • Traditional LASIK
    • $1650
  • IntraLASIK
    • $2200
what do i do if i am interested in lasik or prk
What do I do if I am interested inLASIK or PRK?
  • Call Ophthalmology Associates and set up free refractive surgery evaluation
    • 10% discount off surgical price if sign up after hearing this seminar