QUESTION AND ANSWER

WHAT IS LASER VISION CORRECTION?
Laser vision correction is a phrase used to describe a number of treatments that physicians can perform with a laser to reshape the cornea and to help restore vision compromised by nearsightedness, farsightedness or astigmatism. The results are rapid and permanent. Over 1.7 million procedures have been performed throughout the world, and the number is growing daily.

WHAT IS LASIK?
Lasik is Laser-Assisted In-Situ Keratomileusis. LASIK was first performed in 1989 by an ophthalmologist in Greece and was introduced to American surgeons in 1990.

WHAT IS AN EXCIMER LASER?
The Excimer Laser produces a very intense, yet gentle beam of light of one wavelength. The excimer uses a mixture of gasses to produce a narrow beam of invisible ultraviolet light energy, which when focused through a lens system, results in the removal of a thin microscopic layer of tissue.

HOW DOES LASIK WORK?
LASIK corrects vision problems like nearsightedness, farsightedness, and astigmatism by changing the shape of the outer layer of your eye (the cornea). Changing the shape of the cornea allows light entering the eye to be properly focused so that you see more clearly.

Including prep time, you will only spend about an hour in our office on the day of your LASIK laser eye surgery. If you are nervous, we may give you a sedative medicine to help put you at ease. Your eye is then numbed with anesthetic eye drops, and a special device called a speculum is used to hold your eye open. A suction ring is then placed over your eye.

To begin your LASIK laser eye surgery, we then use a special instrument called a microkeratome to create a thin flap in your cornea. After the flap is made, the suction ring is taken off your eye and you are asked to stare at one place while the laser works. The laser removes tissue from beneath the flap so that the shape of the eye is changed. Once your cornea achieves the proper curvature, the flap is laid carefully back over your eye. It heals there without stitches. We will give you an eye shield and allow you to go home. After your LASIK laser eye surgery you will return for a check-up within twenty-four hours and at prescribed intervals thereafter.

WHAT ARE THE PREREQUISITES FOR LASIK?
DIOPTER RANGES
Here are the diopter ranges that LASIK can treat:

Myopia (-0.75 to -10.00)
Hyperopia (+0.75 to +4.00)
Astigmatism (+/- 0.75 to +/- 6.00)

CORNEA THICKNESS
Corneal thickness is an important factor in determining candidacy for laser vision correction. During your examination we will conduct tests which allow us to identify the physiological characteristics of your cornea. Based on information gathered with specialized ORBSCAN technology, we will determine the vision correction solution that is best suited to your needs.

PUPIL DIAMETER
The diameter of the pupil ideally should be no more than 6.5 mm. However, advances in the laser technology can now work with diameters up to 8.5 mm.

COMPLICATIONS
In addition to the list above, certain conditions are considered too risky and can keep a person from being an ideal candidate:

Pregnancy - You are pregnant or attempting to become pregnant
Severe heart problems - Particularly if you must wear a pacemaker
Certain diseases - Auto-immune diseases (rheumatoid arthritis, lupus), vascular disease, eye diseases (severe glaucoma, cataracts, ocular herpes simplex), severe diabetes
Certain drugs - Acutane (acne), Imitrex (migraines), immune-system medications
Kerataconus - Condition characterized by a thinning of the cornea

It is very important that you meet the requirements for an ideal candidate. Otherwise, you greatly increase the chance for complications or poor results.

WHAT IS PACHYMETRY?
A test performed to measure the corneal thickness. Part of our free examination.

WHAT KEEPS THE FLAP IN PLACE AFTER LASIK SURGERY?
The flap created in LASIK eye surgery stays in position after surgery without stitches. It protects the treated areas of the eye and enhances healing. The flap does not need stitches because of action of specific cells within the eye. First, endothelial cells, which line the deepest surface of the cornea, create suction as they funnel fluid from the exterior to the interior of the eye. This suction helps to hold the flap onto the eye. In addition, the cells of the epithelium, the outer layer of the cornea, are able to rapidly heal and bond to the cornea.

WHAT IF LASIK IS NOT RIGHT FOR ME?
LASIK is not right for everyone, but that doesn't mean that people who shouldn't have LASIK are out of options. Another procedure, photorefractive keratectomy (PRK), may be a good choice for people whose corneas are too thin to have LASIK. PRK was actually the first laser refractive surgery procedure. Whereas in LASIK, a thin flap is made in the cornea in order to access the tissue below, in PRK the outer layer of cells (called the epithelium) is removed. The laser then reshapes the cornea as in LASIK. Both LASIK and PRK can treat nearsightedness, farsightedness, and astigmatism. There is slightly more discomfort and downtime with PRK. If you are not a good candidate for LASIK, however, PRK can help you achieve similar results overall. Note: while some doctors offer a newer procedure called LASEK in lieu of PRK, we have found PRK to be more comfortable and reliable for our patients.

WHAT IS PHOTOREFRACTIVE KERATOTOMY (PRK)?
The precursor to LASIK, PRK first appeared in 1987. Like LASIK, PRK uses an Excimer laser to reshape the cornea. However, PRK works directly on the outer surface of the cornea. PRK can correct myopia, astigmatism and, to a lesser degree, hyperopia.

HOW SOON AFTER LASIK WILL VISION IMPROVE?
Most patients will see 20/20 within 1-2 days and are able to drive and work the day following.

CAN I WEAR CONTACT LENSES AFTER LASIK?
LASIK improves most patients' vision to the point where glasses or contacts are not necessary after surgery. Some patients may still need prescription lens correction for tasks such as night driving or prolonged periods of reading, but most people would simply opt to slip on a pair of glasses in those situations. If you still need your contacts to see well after surgery, we may be able to do a second LASIK procedure to further improve your results. If for some reason you still want to wear contacts after your surgery, you will most likely be able to do so if you were comfortable wearing them before.

WHAT ARE THE RISKS AND POSSIBLE COMPLICATIONS OF LASIK?
LASIK is generally considered to be safe, but -- as in all surgical procedures — there are some risks and possible complications to consider. The incidence of most problems is low.
Free caps occur in probably less than 1 in 6000 patients. If the microkeratome creates a free cap instead of a flap it is simply laid back in place after the cornea is treated with the laser.
Another risk is the creation of an imperfect flap (i.e. flap is too short, thin, or uneven) — which happens in about 1 in 1000 cases. If this occurs, the laser portion of the treatment in not done. The flap is put back in place to heal. Surgery can be tried again in a few months.

Striations or wrinkles in the flap occur in 1 out of about every 1000 patients. Striations can cause astigmatism. The most likely causes are rubbing your eyes before they are fully healed or the surgeon not properly lining the flap back up after your surgery. If the wrinkles are causing astigmatism, a second procedure can be done to relift and smooth out the flap. If they are not bothersome, they can be left untreated.

Another risk of LASIK is the development of a condition called dry eye. Most patients experience some temporary dryness after LASIK, but in some people the condition is lasting. Eye drops can help provide relief. Probably about 5% of patients have lasting dry eye symptoms.

Postsurgical astigmatism tends to occur in about three of every thousand cases. Glasses cannot fix this type of astigmatism but contacts usually can. Although postsurgical astigmatism can occur even in perfect surgeries, an inexperienced surgeon or sub par equipment increases the odds. People who had very high refractive errors before surgery also have a higher risk.

Glare and halos are probably the most common and most feared side effect of LASIK. In fact, most patients experience some level of glare and halos at first, but over time they resolve themselves (generally in a few weeks to a few months). Those who do have lasting effects usually only experience symptoms at night and most say they are not debilitating. Approximately 5 to 10% of patients have lasting problems with glare and halos.

HOW LONG WILL THE RESULTS OF LASIK LAST?
Because LASIK has only been performed for a little more than eleven years, there are no results available beyond this time frame. So far most patients' corrected vision has remained relatively stable. It should be noted, however, that vision can change with age. In fact, after the age of forty, most people develop a condition called presbyopia that affects near vision. LASIK does not prevent this age-related condition from developing. If you simply develop an additional refractive error over time, retreatment is usually possible.

CAN THE CORNEAL FLAP BE LOST?
By definition, the flap created in LASIK remains attached to the cornea by a hinge. As long as the flap has a hinge, it cannot be lost. If you rub your eyes too soon after having LASIK, you might shift, or displace, the flap, but it will remain attached. Displaced flaps can usually be put back into position with a second procedure. In order to avoid this, we give you a protective eye shield to wear for the first day after LASIK eye surgery.

It is important to know, however, that is rare cases (less than one in six thousand), the microkeratome used to create the flap may cut too far and completely free the top layer of the cornea from the tissue below. The result is called a "free cap" rather than a flap. This is not necessarily a problem. In most cases, the free cap can simply be placed back over the cornea after the procedure, and it will heal there without complication. In fact, LASIK was originally done using free caps rather than flaps. A free cap could become lost, however, if you rub your eyes soon after surgery. A lost free cap will not necessarily cause problems with your vision, but it is, of course, better not to lose it. If a free cap is created during your procedure, we will be sure to let you know what extra precautions and care you should take.

SHOULD I HAVE BOTH EYES DONE AT THE SAME TIME?
Whether you have both eyes done at the same time or not is a personal choice. Some people opt to have each eye done separately, because they hope to avoid any possible complications (such as infection) affecting both eyes. Fortunately, the risk of complications like infection affecting both eyes are so rare that the reduction in risk is extremely small. On the other hand, having both eyes done at once offers the benefit of only have to be on medication one time around. Because medications can also sometimes produce side effects, limiting medication use can also lower an already low risk. The point is that whether you have your eye done separately or at the same time, your risk of complication is very small. Most of our patients opt to have both eyes done at the same time, but if you would prefer to have them treated separately, we make that option available to you. Please feel free to discuss your thoughts and concerns on the subject with us.

WHAT CAUSES GLARE AND HALOS AND HOW CAN THEY BE TREATED?
Although LASIK has a low occurrence of side effects overall, problems with night vision like glare and halos are among the most common. There are a few possible causes of glare and halos.
The first is that the shape of your eye may not have been changed enough during your first LASIK procedure, meaning that you are still slightly nearsighted, farsighted, or still have a slight astigmatism. If this is the case, you may be able to remedy the problem by having a second LASIK "touch-up" procedure, or by wearing glasses at night.

Another cause of glare and halos has to do with pupil size. If a patient's pupils dilate beyond the area of the cornea that is treated during LASIK, the discrepancy can cause the appearance of glare and halos in low light conditions (when the pupil is fully dilated). The best method is prevention. By measuring your dilated pupil size before surgery, we can determine whether or not we can effectively treat a large enough area of your cornea with the laser. If not, you may not be a good candidate for LASIK.

WHAT ARE YOUR PAYMENT OPTIONS?
We offer financing through CARECREDIT. It is based on a credit approval and is interest free for a year. You can get additional info at www.carecredit.com

We also offer FLEX SPENDING. Save up to 30%! Let your tax free dollars reduce the cost of your laser vision correction at I-Surgeons.

Flexible Spending Accounts are one of the most versatile yet underutilized benefits offered to employees. Now is time to start planning to use this benefit.

By using tax-free Flex Spending money to reimburse you for eligible medical expenses like LASIK, a Flexible Spending Account can reduce your out of pocket costs by hundreds, even thousands of dollars.

FSA enrollment periods are brief and yours may open soon - for details on how to set up an FSA, see your Employee Benefits representative.

Flexible Medical Spending Accounts have a deadline of December 31.

Can I use my Flexible Spending Account for Conventional LASIK or CustomLASIK?
Yes, Conventional LASIK and CustomLASIK have been approved by the federal government as eligible medical expenses under Flexible Spending Accounts.

How do I know if I have a Flexible Spending Account?
Check with your human resources manager. Be sure to ask if there is a maximum contribution amount and when are the open enrollment dates.

What if I have money left over from my Flexible Spending Account this year?
Depending on the amount, you may want to consider having one eye treated this year and one eye treated next year.

How can I be sure the money I put aside towards Conventional LASIK or CustomLASIK in my Flexible Spending Account will be used?
Before committing any money to a Flexible Spending Account for Conventional LASIK or CustomLASIK, we recommend you come in to have a full evaluation to ensure you are a candidate. Then, you can confidently set aside your FSA funds and schedule your surgery during the planned Flexible Spending Account year.

How do I pay for Conventional LASIK or CustomLASIK if I am using a Flexible Spending Account for Conventional LASIK or CustomLASIK?
We will give you an itemized receipt, which you should submit to your Flexible Spending Account administrator. They will reimburse you directly from the amount you have budgeted for in your FSA account.

How long does it take to get reimbursed?
Most Flexible Spending Account management companies process claim payments on a frequent basis. However, please check with your human resources manager or the FSA Administrator to determine your company’s payment schedule.

Are there any additional costs to me for using/planning to participate in a Flexible Spending Account?
No, Flexible Spending Accounts are voluntary programs sponsored by employers as a benefit to their employees.