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Q. What is laser eye surgery?

A. Laser eye surgery for refractive errors like nearsightedness, astigmatism and farsightedness has been approved in the United States since 1994, helping millions of people achieve better vision. The original, FDA-approved procedure is called photorefractive keratectomy, or PRK. This procedure was modified to be performed under a protective flap called laser in-situ assisted keratomileusis, or LASIK. Our doctors perform both procedures and will discuss your surgical options with you during your consultation. Both procedures have been very effective at reducing patients' need for glasses or contact lenses. Advances in laser eye surgery have made LASIK safer with the use of the Intralase to create the flap (IntraLASIK) and have made LASIK and PRK safer and more precise with wavefront-optimized laser vision correction.

Q. Who is a candidate for laser eye surgery?

A. Laser vision correction can be used to correct up to -10.00 diopters of myopia (nearsightedness) or up to +6.00 diopters of hyperopia (farsightedness) with up to 6.00 diopters of astigmatism. We can provide most patients over the age of 18 with a surgical option that will reduce their need for glasses or contact lenses. If the correction need is outside of this range, there may still be other options available such as phakic IOL (ICL) or clear lens extraction.

Q. What is the goal of laser eye surgery?

A. The goal of standard and wavefront laser procedures like LASIK or PRK is to improve patients' vision to a level that is stable, predictable, and long lasting. Results of standard laser eye surgery treatment show that LASIK and PRK can correct up to six diopters of astigmatism, as well as myopia and farsightedness. In addition, more than 99 percent of patients with less than -6.00 diopters of myopia achieve a legal driving vision of 20/40 or better after undergoing laser eye surgery. Despite such promising results, patients who decide to undergo refractive surgery should have realistic expectations about the success of the procedure. One can realistically expect a dramatic improvement in vision with the ability to participate in sports, drive or function in an emergency without glasses. However, if one defines success as achieving perfect 20/20 vision (without glasses) at all times, then they will be disappointed – not all patients achieve this level of vision. In our practice, the chance of achieving 20/20 vision for most patients in the mild-to-moderate nearsighted or farsighted range is typically between 90 and 96 percent. Results are slightly less predictable if the correction is significantly nearsighted or farsighted. Studies show that all patients can expect to achieve 20/40 vision over 95 percent of the time. Overall, the chances for visual success are even higher with wavefront laser eye surgery.

Q. What about reading glasses?

A. If over 40, there is another factor to be taken seriously in the decision to move forward with laser eye surgery, especially considering that most people of this age will develop or already have developed an eye condition called presbyopia. As we age, our eye's lens loses its ability to quickly focus from distance viewing to close-up viewing. This is called presbyopia. Presbyopia is the reason why people over 40 generally need reading glasses. If one has never needed glasses to see from far distances, then they likely will only need reading glasses when developing presbyopia. Presbyopia can be fixed with glasses, contact lenses or surgery. The glasses options include reading glasses, bifocals or progressive glasses. The contact lens options include monovision contact lenses or a multifocal lens. The surgical options include LASIK or PRK for monovision (see below), and refractive lens exchange with the Crystalens, Symfony, Restor, and Tecnis™ intraocular implant multifocal lens.

Q. What is monovision, and why might I want it?

A. Monovision is a very important concept for all patients over 40 to understand. If one is nearsighted than they are likely able to read without glasses; although if they are very nearsighted, they may have to hold objects rather close to see them. Patients who are over 40 and undergo laser vision correction will no longer be able to see objects close-up without reading glasses unless they elect to have monovision correction. If the patient is mildly nearsighted and loves to read without glasses, then laser eye surgery may not be the best option for this patient, unless they choose to have monovision. For many people, the ability to see clearly at a distance is worth the loss of uncorrected reading vision. If one is farsighted, then they already know that as they’ve gotten older, they need glasses to see clearly in the distance and even stronger glasses for reading. These patients can correct both eyes for distance and wear reading glasses or also consider monovision correction. Nonsurgical options are monovision with contact lenses, multifocal lens, reading glasses, bifocals or progressive lenses. People over 40 may need two separate glasses prescriptions to see clearly – one for distance and a different one for reading. In a monovision correction, the dominant eye is corrected for distance vision, and the non-dominant eye is corrected for reading or intermediate vision. Monovision does not work for everyone and it is always best to try it using contact lenses before doing it surgically. If it works, it generally allows patients to function without glasses for most distances, although some patients will want "night driving" glasses or “extended/smaller print reading” glasses, and many may eventually have to wear reading glasses as they continue to age.

Q. Does laser eye surgery hurt? What is involved in laser eye surgery?

A. We perform LASIK and PRK as outpatient procedures with the Allegretto laser or the CustomVue™ VISX® Smooth Scan laser. PRK and LASIK procedures take about 15 minutes, and the laser is turned on for less than 30 seconds. The actual surgeries are generally painless, although there can be some discomfort during recovery, which takes longer for PRK. Patients can take some comfort in the fact that our qualified eye doctors perform all procedures, and they do all follow-up examinations and preoperative care. We have performed thousands of laser eye treatments.

Q. What are the differences between PRK and LASIK?

A. PRK was the first laser procedure to use the excimer laser for reshaping the surface of the cornea. PRK was approved by the FDA in 1994 but has actually been used on the cornea since 1988. It is considered a stable and predictable procedure. After laser eye surgery with PRK, it usually takes three to seven days to heal the cornea. During this time, vision is not very good and the eye is somewhat uncomfortable (it may feel like a grain of sand). Modern variations, including cold application, better contact lenses, better medications and newer, smoother lasers have dramatically decreased the discomfort associated with PRK recovery. Still, healing time is about a week, with vision rapidly improving over the next few weeks. Patients may elect to do both eyes the same day or do one eye and wait two weeks before doing the second eye. LASIK is a newer laser eye procedure (1995) that involves lifting the protective flap of the cornea with a mechanical instrument called a microkeratome, or with a newer, femtosecond laser called IntraLase®. LASIK healing time is faster and more comfortable than with PRK. However, the process of making the flap adds a small surgical risk to LASIK that is not present with PRK.

Q. What are the risks and complications of PRK and LASIK?

A. Since both PRK and LASIK employ excimer laser technology, patients will face similar risks. The risks include overcorrection, under-correction, regression (all of which can be addressed with a retreatment or enhancement), irregular healing, glare, nighttime halos with possible increased difficulty driving at night (especially if there are large pupils or a high level of astigmatism or myopia). Although laser correction can improve every patient's vision, there is a range for how much each patient responds to the procedure. Results depend on the patient's prescription. Lower corrections with less than -6.00 diopters of myopia or +4.00 diopters of hyperopia, do very well, with over 99 percent achieving 20/40 or better vision without glasses using standard LASIK or PRK, and even better results with wavefront correction. PRK and LASIK appear to give the same results for overcorrection and under-correction. If the visual outcome is not as good as desired, patients can elect to have a retreatment to improve the vision. Today’s lasers have smoother treatments and larger treatment zones, making side effects like significant glare and halos less common. Wavefront-guided or wavefront optimized laser vision correction is often the best solution to lower the risk of glare and halos and can often be used as a retreatment for persistent glare and halo symptoms in those individuals who still develop symptoms. Infection is a risk that can occur with PRK or LASIK, but PRK infections are more common because they develop on the surface of the eye, while LASIK infection generally occurs in the deeper section of the cornea, making it difficult to treat and more likely to scar. Studies show that LASIK infections occur in fewer than one in 1,000 cases. PRK carries the additional primary risk of a longer recovery period and the development of a rare complication called haze. Haze occurs because the cornea surface is no longer crystal clear during healing, causing foggy vision with increased light sensitivity and glare. Haze has also been reported to develop up to a year later, especially if you are exposed to bright sunlight without protective, ultraviolet blocking sunglasses. Haze typically is mild and clears in two to six months. Though rare, more severe haze can significantly decrease vision and can take up to two years to clear, although retreatment is also a possibility. Fortunately, haze is now very rare thanks to smoother lasers and cold techniques used in modern PRK. Some evidence suggests that vitamin C taken before and after may lower the risk of haze. LASIK offers patients multiple benefits, including faster recovery of vision, less pain, and virtually no haze. There are additional risks with LASIK that are not seen with PRK. Complications can include incomplete flaps, irregular flaps, free flaps, flap buttonholes or bleeding around a flap. Newer technological advances have allowed us to make the corneal flap with a femtosecond laser (IntraLASIK using the IntraLase laser), which has significantly lowered the incidence of flap-related complications. Many LASIK patients experience an increase in symptoms of dry eyes in the weeks and months following LASIK, and usually need more lubricating drops for the first six to eight weeks. The most serious complications of LASIK such as progressive thinning of the cornea or severe scarring following infection, inflammation, or flap damage can usually be fixed with corneal transplant surgery. Corneal transplant surgery is highly successful. The chance of having a complication that could lead to corneal transplant is about one in every 20,000 surgeries. There are very rare reports of patients who have lost vision from severe infections following LASIK. The chance of this appears to be about one in a million.

Q. Which procedure is best for me, PRK or LASIK?

A. All patients have the option of either PRK or LASIK, and this will be discussed at the LASIK consultation with our eye doctors. Both PRK and LASIK share certain risks with the excimer laser, including overcorrection and under-correction. The primary differences between PRK and LASIK are related to the differences in risks, complications and recovery processes. Most patients select LASIK based on the more comfortable, faster recovery. If the correction is very nearsighted, ICL implantation may be the best choice; if the correction is very farsighted, refractive lens exchange may be the best choice.

Q. What occurs during the LASIK procedure and recuperation?

A. The different stages of a LASIK procedure can vary depending on which laser we use. Our eye doctors will discuss which laser is best recommended. It is important that prior to the preop/consultation visit, patients are out of soft contact lenses for about seven days and out soft toric or rigid gas permeable contact lenses for about three weeks. With either laser, patients should expect to arrive 30 minutes before the procedure. Patients will be offered a Xanax for anxiety, if necessary, before the procedure. Because we offer numerous LASIK options, the exact sequence of events on the day of the laser eye procedure may vary. The surgeon may put some marks on the patient’s eyes if they have astigmatism and take them to the excimer laser room. If the patient is having IntraLase laser (IntraLASIK) treatment, that portion of the procedure will take about five minutes. The patient will be instructed to lie down on a chair and look straight up into a fixation light. A gentle suction ring will be placed on the eye, and the laser will create the flap in about 20 seconds. During this portion of the laser procedure, there may be a mild pressure sensation and vision may fade to gray or disappear temporarily. After the flaps have been made, there will be a moment to wait for the bubbles that make the flap to clear. This usually takes about 10 minutes but can be longer. The doctor will then center the patient under the excimer laser and put anesthetic eye drops in the eye. The other eye will then be covered with a patch so the patient will only be able to see out of the operative eye. We will place sterile drapes and an instrument that prevents blinking. When the laser is activated, one can expect to hear a clicking sound and experience blurry vision, but no pain. After LASIK, we will reposition the flap and irrigate the eye. The doctor will then instill eye drops and clear goggles or a plastic shield to cover the eyes. It is very important to keep both eyes closed for the first three hours after LASIK. One should not expect vision to clear up until the next day.

Q. What occurs during the PRK procedure and recuperation?

A. As with LASIK, we advise patients to remove their soft contact lenses for approximately seven days before their preop visit, and their soft toric or rigid, gas permeable contact lenses for at least three weeks before their preop visit. On the day of the procedure, the patient should arrive at the laser center 30 minutes before the procedure. A Xanax pill will be offered to the patient to reduce anxiety and increase comfort. The doctor may place marks on the surface of the eye, then they will take the patient into the laser room where the patient will be centered under the laser. Anesthetic drops will be instilled and the nonoperative eye will be covered with a patch so that that patient will only be able to see out of the operative eye. After receiving a cold treatment, there will be an instrument gently placed on the eye such that the view of the fixation light will be momentarily blocked. When the laser is activated, expect to hear a clicking sound and experience blurry vision. The laser treatment will last between 15 and 90 seconds. There will be no pain from the laser. After laser eye surgery, the doctor will apply a cold treatment again and instill more eyedrops plus a thin bandage contact lens. The initial recuperation process usually lasts three to five days. Most patients describe the sensation as irritating like a grain of sand in the eye. They also report some light sensitivity and tearing. Generally, patients have mild discomfort, but with the help of eye drops and sunglasses are able to function although they cannot see very well. Most patients start to see adequately on the fifth to seventh day, with continued improvement over the next few weeks. Some patients use drops during the first six weeks after PRK and many do not require drops. All patients must wear UV blocking sunglasses for the health and protection of their eyes. Take Vitamin C 1000mg per day for one week prior to PRK surgery and continue for a month afterwards to reduce the risk of corneal haze.

Q. What LASIK results should you expect?

A. Our LASIK results compare very favorably with national averages published in scientific literature. Dr. Cornell has been performing laser eye surgery since it was approved by the FDA in 1994 and has done thousands of LASIK procedures. Dr. Stoll has been performing laser vision correction since 1999. Your specific LASIK results may vary and are not guaranteed.

Q. Why do you offer three different lasers?

A. Our doctors have the option of performing laser eye surgery using a number of different FDA-approved lasers, including the Allegretto laser and the VISX® Smooth Scan S4 system for LASIK and PRK. The Allegretto and the VISX® are excimer lasers, and each has advantages. As part of the LASIK consultation, the doctor will perform a thorough eye examination and recommend the best laser for the patient’s customized treatment. The VISX® Smooth Scan S4 with Active Tracker has been used to performed most of the LASIK procedures in the United States in the past few years. Our model is constantly upgraded with the newest software and maintained by Specialty Surgical Center. Our newest laser is the Allegretto, which offers a unique wavefront optimized treatment protocol with very low enhancement rates and blazing speed. The Intralase laser is used to create the corneal flap. All lasers have Wavefront-guided or wavefront optimized treatments available for most patients, depending on the correction required.

Q. Why IntraLase®?

A. Traditional LASIK is a very good procedure. While the risk of complication is quite minimal, all laser eye surgery carries some risk. Today’s advanced computer- controlled laser technology significantly reduces the risk of complications. It is known as the bladeless, all-laser LASIK treatment with the IntraLase® laser. The IntraLase® laser is uniquely safe, uniquely precise, and offers patients predictably better visual results. The advanced IntraLase® technology has given many patients more confidence when considering laser eye surgery. Our doctors use the IntraLase® FS laser because it provides micron level accuracy and significantly reduces the possibility of risk and unpredictable outcomes. We were one of the first in the country to use Intralase technology. The Intralase allows us to customize the flap to your eye’s needs. The Intralase is such a significant improvement over the mechanical blade microkeratome that the U.S. Navy approved Intralase LASIK procedures for Navy pilots in 2006.

Q. How is IntraLase® different from traditional LASIK?

A. With the IntraLase® laser, our doctors use the precision of a laser to create the corneal flap. This laser is 100 times more accurate than a blade and unparalleled by any other technology in eye surgery. This advanced technology allows the LASIK surgeon more control during the procedure, and customization of the corneal flap for every individual patient. Because of its consistent accuracy, IntraLase® now makes it possible to treat many patients who were dismissed as candidates for laser vision correction due to thin corneas.

Q. Is this the same as customized LASIK I have heard so much about?

A. Making the flap safely and predictably with the IntraLase® laser is the critical first step of the customized LASIK procedure. The second step is the wavefront guided or wavefront optimized excimer laser treatment to change the shape of the cornea. There has never been a combination of technologies that allowed for this type of personalized vision correction. In addition to getting the best results, we can do it all with unprecedented safety and precision. Every patient’s eyes are different and need to be evaluated independently and treated uniquely. Now, all steps of the laser eye surgery procedure may be customized to the individual from diagnosis through treatment.

Q. Is IntraLase® safer?

A. Many LASIK surgeons acknowledge that many safety issues in laser eye surgery are related to the use of the mechanical device used to create the corneal flap. Multiple studies, which compare complications with IntraLase® laser versus the old microkeratome device have shown a significant decrease in the events that adversely impact safety. The IntraLase® laser provides a unique level of safety during LASIK treatment because of its micron level precision. The assurance that the flap will be securely repositioned without incident gives you added peace of mind.

Q. Is traditional LASIK unsafe?

A. No, but IntraLase® reduces the risk of complications reported with traditional LASIK, and we feel that it is very important for all patients. Advanced IntraLase® technology has given many patients more confidence when considering laser eye surgery. LASIK surgeons recommend IntraLase® FS laser because it provides greater precision and may significantly reduce risk.

Q. How do visual outcomes with IntraLase® compare with traditional LASIK?

A. IntraLase® is rapidly becoming known as the key ingredient to optimizing results in laser eye surgery. Comparative clinical studies confirm that patients see better following LASIK with IntraLase® than with previous methods. We believe that IntraLase® is one essential ingredient of this strategy to obtain the best vision while maintaining the highest standards for safety and patient care.

Q. I have seen ads for "All-Laser LASIK." Is this IntraLase®?

A. All-laser LASIK means using a femtosecond laser to provide computer-controlled precision required for maximum predictability. Our eye doctors can explain the difference between other laser eye procedures that may be advertised as “all laser,” such as LASIK or PRK, which are surface ablations that do not require the creation of a corneal flap. These procedures generally require longer healing times and frequently involve more patient discomfort.

Q. Is IntraLase® more expensive?

A. Advanced technologies are usually more expensive for the surgeon to use. IntraLase® surgeons are often opinion leaders who continually evaluate advances in laser eye surgery technology. They have found that the IntraLase® computer-guided laser is the most sophisticated and accurate system available today. IntraLase® technology provides greater precision, safety, and predictability. Because of its unique safety profile, our LASIK surgeons have invested in the technology to maintain excellence in patient care. We are committed to only using the best technology available, and we only perform LASIK using the Intralase laser, except in very rare circumstances. As a result, there is no extra charge for using the Intralase laser to make the flap. Some vision insurance plans may provide some coverage for LASIK; please check with your insurance provider for more information.

Q. What surgical vision correction options are available?

A. Although vision imperfections can be corrected with glasses or contact lenses, many people choose to have laser eye surgery such as LASIK or PRK because they want to reduce their need for glasses or contact lenses. Astigmatic keratotomy is an option based on the older radial keratotomy procedure that involves making incisions to change the irregular shape of the cornea. Although most astigmatism today is corrected with the new bladeless laser techniques, astigmatic keratotomy is still a useful procedure, particularly when done in conjunction with laser-assisted cataract surgery.

Q. What is my next step?

A. If interested, call us at 310-274-9205 to schedule a laser vision correction screening. The consultation will include evaluation of corneal thickness, pupil size, corneal topography, and a thorough refraction. It will also include a complete, personalized discussion with one of the doctors about the options, risks and benefits.

Call us: (310) 274-9205
testimonials
IT WAS PERFECT! Three simple words that sum up the outcome of a remarkable experience. From the moment I was prepped for cataract surgery in November, from the time I was measured and examined by your wonderful staff, and from my first meeting with you, I knew I was in excellent hands from the surgical procedure you were going to perform on my eyes.
~ Vin Scully
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Is cataract surgery just a routine operation these days? I needed cataract surgery and Peter Cornell was very highly recommended, so I went to him. Modern technology has made this surgery almost routine, but eyes are highly individual, so be careful! Careful I was in choosing Dr. Cornell, and careful he was in treating my case.
~ Barry Barish
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450 North Bedford Dr. Suite 101, Beverly Hills, CA 90210
Phone (310) 274-9205, Fax (310) 274-7229
frontoffice@bheyes.com

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