laser eye surgery

laser eye surgery

LASIK & Laser Eye Surgery:
A Complete Consumer Guide

LASIK is one of several ways to correct your vision with surgery. Our articles cover:

What you should know about LASIK
Types of laser eye surgery
Alternative non-laser procedures

Start with the vision correction surgery basics article. Or choose from:

Free Online LASIK Evaluation
Are you a good candidate for LASIK? Our two-minute test creates a personalized report for you. Start now »

Custom LASIK Q&A
A prominent U.S. Navy eye surgeon explains why he favors custom LASIK.

Debate: Blade Vs. Bladeless LASIK
Two very experienced LASIK surgeons give us their opinions on a much-debated topic: Should the flap-cutting device in LASIK be a microkeratome blade or a second laser?

LASIK Surgeon Q&A
Read recent answers from our LASIK surgeon panel, then see our archives of Q&As About LASIK and Other Vision Correction Surgery.
What You Should Know About LASIK:

How LASIK Works: What happens before, during and after surgery.
How To Choose a Surgeon — with tough questions to ask the doctor.
LASIK Criteria for Success: How to know if LASIK or PRK is for you.
LASIK Eye Surgery Results: Are you likely to see 20/20 after LASIK?
LASIK Surgery Risks and Complications — and how to avoid them.
Dry Eyes and LASIK: You may still be a candidate.
LASIK Enhancement: Do you need an additional surgery? Will you in the future?
What Does LASIK Eye Surgery Cost? Check the current average LASIK prices.
LASIK Financing: Learn how you can afford LASIK surgery.
Which Laser Is Best? Read a review of all current LASIK lasers.
Contact Lenses After LASIK: Why some people need them.
When LASIK Goes Wrong: Some cautionary tales.

Types of LASIK and Other Laser Eye Surgery:

Corneal Onlays/Inlays blend with your eye's surface.
Custom Wavefront LASIK: What makes it "custom" LASIK?
Epi-LASIK uses a special cutting tool to remove the cornea's outer layer.
IntraLase "Bladeless" LASIK uses a second laser, not a blade.
LASEK is a no-flap procedure used mostly for thin corneas.
PresbyLASIK is a possible laser eye surgery for presbyopes.
PRK: Some surgeons prefer PRK, the original laser eye surgery.

SPONSORED SECTION: The iLASIK Procedure
Learn about this advanced laser vision correction procedure for nearsightedness, farsightedness and astigmatism.
Alternatives to Laser Eye Procedures:

Conductive Keratoplasty uses radio-frequency energy for corneal shaping.
Refractive Lens Exchange replaces your eye's natural lens.
Implantable Lenses (phakic IOLs) avoid removing corneal tissue.

Eye Surgery for Presbyopia
Want to toss your reading glasses or bifocals? Find out what you can do right now, as well as what investigational procedures might be available in the future.

Departments
Refractive Surgery News / LASIK & PRK FAQ / LASIK Quiz

LASIK Surgeon Directory Featured Markets
This week we're looking at California's Inland Empire, Milwaukee, Tulsa and Reno, Nevada.

About LASIK
LASIK is a surgical procedure that uses a laser to correct nearsightedness, farsightedness, and/or astigmatism. In LASIK, a thin flap in the cornea is created using either a microkeratome blade or a femtosecond laser. The surgeon folds back the flap, then removes some corneal tissue underneath using an excimer laser. The flap is then laid back in place, covering the area where the corneal tissue was removed.

With nearsighted people, the goal of LASIK is to flatten the too-steep cornea; with farsighted people, a steeper cornea is desired. LASIK can also correct astigmatism by smoothing an irregular cornea into a more normal shape.

If you are considering LASIK eye surgery, your first step is to choose a good LASIK surgeon who can evaluate whether LASIK is right for you. Your LASIK surgeon will examine your eyes to determine their health, what kind of vision correction you need, and how much laser ablation (corneal tissue removal) is required. The doctor will also ask about any health conditions that may disqualify you altogether for LASIK surgery.

If you are not a candidate for LASIK, you may qualify for another laser eye surgery such as PRK (similar to LASIK but without the flap), LASEK, or epi-LASIK. There are also non-laser vision correction procedures. Your prescription and eye structure will be considered to help determine which procedure is best for you.

LASIK is an outpatient procedure, so you don't have to stay at the surgery center overnight. The LASIK surgeon uses a computer to adjust the laser for your particular prescription. You will be asked to look at a target light for a short time while the laser sends pulses of light to painlessly reshape your cornea. The actual LASIK surgery usually takes less than five minutes.

LASIK is the most commonly performed refractive surgery procedure. You may hear people calling it "LASIX," but the correct name is LASIK, which is short for "laser-assisted in situ keratomileusis."

Why is it so popular? LASIK has advantages over other vision correction procedures, including a relative lack of pain afterward and the fact that good vision usually is achieved by the very next day.

An instrument called a microkeratome is used in LASIK eye surgery to create a thin, circular flap in the cornea. Another, newer way of making the flap is with a laser.

The surgeon folds the hinged flap back out of the way, then removes some corneal tissue underneath using an excimer laser. The excimer laser uses a cool ultraviolet light beam to precisely remove ("ablate") very tiny bits of tissue from the cornea to reshape it.

When the cornea is reshaped in the right way, it works better to focus light into the eye and onto the retina, providing clearer vision than before. The flap is then laid back in place, covering the area where the corneal tissue was removed.

Both nearsighted and farsighted people can benefit from the LASIK procedure. With nearsighted people, the goal is to flatten the too-steep cornea; with farsighted people, a steeper cornea is desired. Excimer lasers also can correct astigmatism by smoothing an irregular cornea into a more normal shape.
Before the LASIK Procedure

If you are considering LASIK eye surgery, your first step is to choose a LASIK surgeon.

To decide whether you're a good candidate for LASIK, your eye doctor will perform an eye exam to determine if your eyes are healthy enough for the procedure, what kind of vision correction you need and how much laser ablation is required.

Your doctor also will look for signs of dry eye disease, which must be treated and cleared up before LASIK can be performed. Even if your eyes have a normal tear film, your eye surgeon as a precaution may recommend treatment to reduce your risk of developing dry eyes after LASIK.

Also, a corneal topographer usually is used; this device measures the curvature of your eye and creates a kind of "map" of your cornea. With new wavefront technology associated with custom LASIK, you also are likely to undergo a wavefront analysis that sends light waves through the eye to provide an even more precise map of aberrations affecting your vision.

Finally, the doctor will ask you about any health problems you have or medications you take. Some health conditions will disqualify you altogether for LASIK, but others may just postpone the procedure until a later date.

[To learn more about whether you are a good candidate for LASIK, please read LASIK Criteria for Success or take our two-minute screening test.]
During LASIK Surgery

LASIK is an ambulatory procedure — you walk into the surgery center, have the procedure and walk out again. In fact, the actual surgery usually takes less than five minutes, and you're awake the whole time.
Please click here to watch a video about LASIK.
Want a visual? View our
LASIK slide show!

Occasionally, the surgeon will give you a mild oral sedative beforehand.

Even though the surgery is relatively quick, LASIK is a very delicate procedure and it's important to have it performed by a highly skilled surgeon with proper equipment. You also should have someone accompany you to the surgery center and drive you home afterward.

Before your LASIK begins, numbing eye drops will be applied to your eyes so you don't feel any discomfort during the procedure.

The doctor will have you lie down, then make sure your eye is positioned directly under the laser. (One eye is operated on at a time.) A kind of retainer is placed under your eyelids to keep them open — normally, this is not uncomfortable.

The surgeon will use an ink marker to mark the cornea before the flap is created. The flap is then created with either a microkeratome or a femtosecond laser. Whichever device is used, it is securely attached to your cornea with a suction ring to prevent eye movements or loss of contact that could affect flap quality. During the procedure you won't actually see the creation of the flap, which is very thin.
LASIK surgery
An ultra-thin flap is created on the eye's surface during LASIK corrective eye surgery. After laser energy is applied to reshape the eye, the flap is replaced to serve as a type of natural bandage.

The surgeon uses a computer to adjust the excimer laser for your particular prescription. You will be asked to look at a target light for a short time while he or she watches your eye through a microscope as the laser sends pulses of light to your cornea.

The laser light pulses painlessly reshape the cornea. You'll hear a steady clicking sound while the laser is operating. You also may smell a mild odor during the laser treatment; this is normal.

The higher your prescription, the more time the surgery will take. The surgeon has full control of the laser and can turn it off at any time.

After the procedure is finished, you will rest for a little while. If you're having both eyes done the same day, the surgeon typically will begin working on your second eye immediately after treatment of the first eye is finished. Some people choose to have their second eye done a week later.

Your surgeon may prescribe medication for any postoperative pain, but many people feel no more than mild discomfort after LASIK. That's one advantage of LASIK over PRK, which can cause significant eye discomfort for a few days.
After LASIK: Short-Term

As with any kind of surgery, it's important that you follow your doctor's instructions to the letter. Get proper rest, use all prescribed medications as directed and call your doctor immediately if you suspect a problem.
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Immediately after LASIK, the doctor will have you rest for a bit, then you can go home (someone else must drive). At home, you should relax for at least a few hours.

You may be able to go to work the next day, but many doctors advise a couple of days of rest instead. They also recommend no strenuous exercise for up to a week, since this can traumatize the eye and affect healing.

Avoid rubbing your eye, as there is a chance (though slim) of dislodging the corneal flap.
After LASIK: Longer Term

With LASIK surgery, most people's vision improves right away, but some find that their vision gradually improves even more over the next few days or even weeks.
Post-LASIK Quality of Life

In late 2009, the FDA announced it had launched a major LASIK quality of life survey in collaboration with the National Eye Institute (NEI) and the U.S. Department of Defense.

One survey objective is to assess LASIK outcomes from the patient's viewpoint. Any adverse LASIK events also will be identified and evaluated, with the idea of decreasing their frequency.

Three phases of the study include:

Design and implement a Web-based questionnaire for patients.
Evaluate quality of life and satisfaction in active duty personnel treated at the Navy Refractive Surgery Center.
Conduct a national multi-center clinical trial to assess outcomes of the LASIK procedure in a general patient population.

The study should be completed by the end of 2012. — M.H.

LASIK outcomes may vary. Most people achieve 20/20 or better vision with LASIK. Some may achieve only 20/40 or not quite as good. In fact, 20/40 is fairly good vision. In most states, the law considers it good enough for driving.

Some patients still need glasses or contact lenses following laser vision correction, though their prescription level typically will be much lower than before.

Postoperative LASIK complications can include infection or night glare (starbursts or halos that are most noticeable when you're viewing lights at night, such as while you're driving).

Rarely, people will experience clear vision after LASIK, then notice a gradual worsening of their eyesight over time (called "regression"). If this happens, discuss it with your surgeon to determine if more surgery (called an enhancement or "touch-up") will be necessary.

Even if you see perfectly after laser eye surgery, you may still need reading glasses or bifocal contact lenses once you hit your 40s. This is because of a condition called presbyopia, which is a normal, age-related loss of near vision. Your distance vision probably will remain crisp, but seeing up close will be more difficult.

Researchers are studying ways to correct presbyopia surgically. So it's possible that when you start needing reading glasses you could have one of these presbyopia-correcting procedures performed to restore your near vision, once they are FDA-approved.

These are important topics to discuss with your LASIK surgeon before deciding on the surgery.


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How To Choose a LASIK Surgeon

Choosing a surgeon for LASIK or PRK is not as difficult as it can be for many other kinds of surgery.

But a bad eye procedure outcome can affect your life almost as negatively as a bad heart operation outcome. That's why it is so important to choose the best surgeon available.

Indicators of a quality surgeon can include experience, great credentials and willingness to work with a patient to resolve possible problems following a procedure.
Finding a Good LASIK Surgeon

Factors to consider when you check qualifications and abilities of a refractive surgeon include:

Licensing. State licensing boards can validate a surgeon's credentials. You also can check a surgeon's credentials through the National Practitioner Data Bank.
Board certification. Ask if your surgeon is board certified beyond having a basic license to practice medicine. This means that an entity recognized by the American Board of Medical Specialties has certified the surgeon to practice in his or her specialty. The American Board of Ophthalmology is one such entity that requires board-certified physicians to complete specific training and continuing education related to the specialty.
American College of Surgeons (ACS) membership. The ACS upholds ethical standards of conduct for all members, who must be board certified.

"A lot of companies make LASIK sound like it's a flap-and-zap commodity. But the truth is, it's surgery," said Steve Updegraff, MD, a LASIK surgeon and medical director of Updegraff Vision in Tampa Bay, Fla. He recommends that you choose a doctor who is a Fellow of the ACS. "The credentialing process there is pretty steep; also, that group is diligent about advancing the field of surgery."

Surgeons who use the designation "FACS" after their names are Fellows of the ACS.
Advertisements. Many refractive surgery centers advertise in newspapers, on the radio and on TV. Some ads are more informative than others. Some tout extremely good pricing. But while this can be a starting point, an ad or a procedure price should not be your only criterion when choosing a doctor.
Referrals. Ask for a referral from your regular eye care practitioner, whether an optometrist or an ophthalmologist. Tell him or her that you want the LASIK surgeon in your area with the best reputation in the profession. Also, reputable LASIK surgeons themselves can be great sources of referrals. If you know of a refractive surgeon who is well respected in another state, call his or her office and ask for recommendations regarding good surgeons in your area.
Other resources. Visit the American Academy of Ophthalmology's website at [ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط] where you can use the "Find an Eye MD" feature. Be sure to specify "refractive surgery" under "specialty." The American Society of Cataract and Refractive Surgery (ASCRS) also maintains an online membership list and "Find a Surgeon" feature.

You might want to start your research by consulting the Yellow Pages and calling refractive surgery centers in your area to find answers to your questions. Also, most refractive surgery centers have Web sites that explain their specialties and list their doctors' credentials. Some surgical center sites even let you search for specific surgeons, if you have a name in mind.
What To Ask a Refractive Surgeon

After you find a surgeon, make an appointment for a consultation. This is an important meeting. To take full advantage of it, write down every single question you can think of, and ask every single one during your visit.

Some recommended questions are:

How many procedures have you done?
What is your complication rate, and how does this compare with national averages?
Do you perform procedures at your own center, or do you need to travel elsewhere?
What are your outcome statistics, and how do these compare with national averages?
Has the surgical center you use ever had an outbreak of serious eye infections? If so, what caused this?
If a complication does occur, what is your specific policy regarding follow-up?
Do you charge extra if an enhancement is required?
If you do charge extra for enhancements, what kind of a price break can be expected?
If you don't charge extra for enhancements, what is your cutoff date (one year, for example) for addressing problems after the initial procedure?
Does your billing department break out and explain all costs associated with a LASIK or other vision correction procedure?

You need to be confident that you have chosen the right person. So if you are not happy with answers to your questions, consult another surgeon.

In addition to the above concerns, you also need to consider the surgeon's versatility and competency in a variety of refractive procedures. LASIK isn't the only game in town, and it isn't the best procedure for every person.

Choose a surgeon who is comfortable and experienced with several procedures — such as LASIK, PRK, LASEK, CK and clear lens replacement (refractive lens exchange) — and the latest technology. If your doctor displays a thorough understanding of these different procedures, he or she can confidently choose the one that will be best to correct your particular vision problems.

If you're considering a surgeon who doesn't perform a particular procedure you're interested in, ask for an explanation of why, beyond "I don't do that."

It's also a good idea to know if a surgical center has had any unusual or ongoing outbreaks of eye infections, which potentially can be quite serious. With strains of antibiotic-resistant bacteria on the increase, it's essential that surgical center personnel observe impeccable standards regarding sterilizing instruments and equipment.

It's also appropriate to ask if the surgeon performs procedures from his or her own surgical center. Surgeons in this category likely have considerable experience because they perform enough procedures to support a center of their own. If a surgeon needs to travel to an outside surgical center or share a laser, then this may be evidence that fewer procedures are performed.

After a consultation, never feel that you are obligated to use that surgeon. You are completely free to talk to other surgeons as well. And don't feel that you are offending anyone. It has long been an accepted practice to seek a second opinion, and most doctors would urge patients with lingering doubts to do so.
The LASIK Surgeon's Office: "That Personal Touch"

While you might hear of a terrific surgeon who practices outside your area, it really is best and far more convenient to find someone close to home. If you do have a rare complication that requires ongoing attention, it will be much easier for you if you can avoid traveling long distances for appointments or even routine follow-up care.

"As with any relationship you have with someone in the medical profession, it has to be one of trust," said Penny Asbell, MD, ophthalmology professor at Mount Sinai School of Medicine and director of Cornea Service and Refractive Surgery Center in New York. "You have to feel that you trust the person and that they're personally interested in you."

She said it's normal to be concerned if you think you lack rapport with your eye surgeon.

"If everything goes well, you probably won't have to see that person too often, and that's the end of it," Dr. Asbell said. "But if for any reason you're not happy with the quality of the result, or there's any issue with healing that's going to require more attention, you want to know that you have someone who is personally connected to you and is working hard to address your concerns — someone who isn't just running a mill where they don't even remember who you are."

But to be fair, most good surgeons understandably have only a certain amount of time to spend with their patients when routine procedures are involved. So a good surgeon also recognizes that it's important to have friendly, competent staff available who also can assist with answering your questions and concerns.

The initial impression you receive at the "front desk" may be an important indicator of how comfortable you will be made to feel as you go through the remaining steps of scheduling and undergoing a surgical procedure.

Are staff members friendly or indifferent? Do they seem competent or disorganized? Are they willing to take the time to answer questions, particularly about costs and billing?

Assessing the presence of that "personal touch" may be an important step to take before you commit to any eye surgeon

LASIK Criteria for Success


While many people are good candidates for laser eye surgery, these procedures aren't for everyone. The six general guidelines below are a good start to help you determine if LASIK or PRK is for you.

You also may obtain a personalized evaluation of your candidacy for LASIK through our online LASIK screening.

Your eyes must be healthy. If you have any condition that can affect how your eyes respond to surgery or heal afterward, you must wait until that condition is resolved. Examples are chronic dry eyes, conjunctivitis and any injury. Your eye surgeon may want to prevent dry eyes after LASIK by giving you treatment such as prescription eye drops as a precaution.

Some conditions, such as cataracts that interfere with your vision, keratoconus and uncontrolled glaucoma, may disqualify you completely.
You must be an adult. By law, certain procedures require you to be 18; others, 21. Younger patients can be treated as an exception.
You must have stable vision for at least a year. Many young adults experience changes in their eyeglass and contact lens prescriptions in the teenage years. Vision stabilizes most often sometime in their 20s.

Usually it is nearsightedness that gradually becomes worse, but there may be other changes as well. Younger people are not good candidates until their eyes have "settled down" into one prescription. Your optometrist or ophthalmologist can tell you whether your prescription is stable.
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If you are pregnant, certain hormonal changes will cause fluid levels in your body to rise. This can change the shape of your corneas, leading to changes in your vision. Surgery should not be performed until your hormones and vision have "normalized" after pregnancy. This could take a few months.

Pregnant women often have dry eyes, which is another reason you may need to postpone LASIK until your eyes are healthier.

In addition, some medications that would normally be used before or after surgery to promote healing (such as antibiotics and steroids) may be risky for your baby, whether unborn or nursing.
Degenerative or autoimmune diseases may be disqualifiers, too. Some examples are Sjogren's syndrome, rheumatoid arthritis, type 1 diabetes, HIV, and AIDS.

Basically, if your body has any trouble with healing, your refractive surgery outcome may be unsatisfactory. Opinions vary among LASIK surgeons regarding which diseases are automatic disqualifiers and which ones might pose acceptable risks in certain cases.
Your prescription must be within certain limits. For example, very high amounts of myopia, which would require removal of too much corneal tissue, may preclude LASIK or make another type of refractive surgery a better option, such as insertion of artificial lenses known as phakic IOLs or implantable lenses.

For a more detailed and personalized evaluation of your candidacy for LASIK, please visit our online screening, Am I a LASIK Candidate?

LASIK Results: What To Expect

By Keith Croes, with updates by Diane Donofrio Angelucci;
contributions and review by Vance Thompson, MD

LASIK eye surgery results have continued to improve, along with supporting technology and surgeon skill, which should offer some reassurance to candidates who are unsure about what to expect.

Thanks to LASIK, millions of people throughout the world are less dependent on glasses or contact lenses. Still, the decision to have LASIK should be approached with caution. Because surgery is involved, some serious potential risks — though rare — are associated.

Because LASIK is an elective procedure, you will be contemplating surgery on an otherwise healthy eye. For that reason, always consider that you have the option of safe and effective nonsurgical alternatives, such as glasses and contact lenses.

When considering LASIK, do some homework and consult with your eye doctor to learn more about the procedure. Ask about potential LASIK complications as well as visual outcomes.

Inquire about the technology your LASIK surgeon uses for the procedure. In LASIK, an ultra-thin, hinged flap is lifted from the surface of your eye. After laser energy is applied to reshape the cornea, the flap is replaced to serve as a type of natural bandage.

Does your surgeon prefer a blade-created flap or a laser-created flap associated with the recent innovation of bladeless LASIK? Consider also that newly developed eye-tracking technology in an excimer laser helps make inadvertent eye movement less of a problem during a procedure.

Also, custom or wavefront-guided LASIK reduces the chance of nighttime visual problems such as glare and halos.

After you go through the education process to understand your best treatment options and the available technology, it is important to understand your surgeon's level of experience. After a balanced discussion about all these issues, you will be more prepared to make an educated decision, which will improve your chance of a good LASIK outcome.
Possible LASIK Complications

LASIK carries a slight risk of short- and long-term complications. Most people respond well to treatment, but some cases are more difficult. Very rarely, permanent problems can result.

According to guidelines from the Eye Surgery Education Council (ESEC) founded by members of the American Society of Cataract and Refractive Surgery, fewer than 1 percent of LASIK patients experience serious, vision-threatening problems.

LASIK complications can include:

More serious problems such as eye infection, chronic dry eye and LASIK flap problems.
Less serious complications that generally clear up on their own as the eye heals, including halos, haze and glare.

The ESEC says most LASIK complications can be treated and usually clear up within several months.

Studies consistently show that LASIK complications decline as surgeon experience increases. So you can increase your chance of a good outcome by choosing an experienced surgeon.

It's also important to remember that your general health and eye health both influence the risk of certain complications. For example, you may be at greater risk of LASIK complications if you have a disease such as diabetes that can interfere with your body's normal healing responses. Of course, you will need to discuss your general health with your eye doctor.

Also consider that, even under the most ideal circumstances with a technically flawless surgical procedure, each patient responds and heals differently after eye surgery.
LASIK Studies and Safety Standards

The eye care community sets high standards for LASIK success. For a LASIK laser to receive FDA approval, manufacturers are expected to have adverse event rates of less than 1 percent during clinical trials.
In certain situations, newer technologies such as wavefront-guided LASIK can produce better results.

The FDA definition of adverse event includes a list of specific problems such as corneal swelling, flap problems, uncontrolled intraocular pressure and a detached retina.

At this time, no central database of LASIK outcomes exists. At an April 2008 public hearing, the FDA announced intentions to clarify information about quality-of-life issues and details about what can go wrong in a LASIK procedure. The idea is to make more of these types of statistics available to the public.

Most of what is known about visual acuity outcomes after LASIK is based on various clinical studies, especially trials the FDA requires laser manufacturers to perform to obtain approval.

Most clinical studies of LASIK vision outcomes have a few elements in common. These include:

An assessment of how many people achieve 20/20 vision or better (so-called "perfect" vision) and how many achieve 20/40 vision or better (the minimum visual acuity required to obtain a driver's license in most states).
A discussion of how many people get to within one diopter or a half diopter of zero refractive error. (Myopia, hyperopia and astigmatism are all refractive errors. Zero refractive error is called emmetropia.)
Details about possible adverse events associated with LASIK.

To monitor vision changes during the LASIK recovery period, many studies measure visual outcomes immediately after surgery, several days later and at one, three and six months after the procedure.
Apples to Oranges: Comparing FDA Data on LASIK Lasers

The FDA has approved lasers for use in LASIK to treat myopia and hyperopia, with or without astigmatism. Best results generally have occurred in people with low to moderate myopia.
Heath problems such as diabetes may decrease your chance of a good visual outcome after LASIK.

When considering FDA studies, however, it is impossible to compare study results head-to-head. This is because people who enrolled in one study originally may have had different characteristics than those who had LASIK in a study for another company's laser.

Results from the same laser also can vary, depending on how people were selected for the study. Some studies may eliminate those with higher amounts of refractive error, for example, while others may need to assess results specifically for these types of vision problems.

Furthermore, later results with these lasers are probably better, as surgeons gain experience and many of the lasers are improved. In short, FDA results serve best to provide a general perspective of trends.

Our article on LASIK lasers provides more information about FDA-approved lasers for LASIK, including their approved treatment levels. For example, you can learn about the amount of myopia, hyperopia and/or astigmatism the lasers are approved to treat.

Just remember that, no matter the approved treatment level of the laser, you and your surgeon can choose to do whatever you think is appropriate and reasonable in your particular case.
Best-Corrected Vision After LASIK

The target values that the eye care community have established for LASIK vision outcomes say a lot about what you can expect from the procedure.

The most feared outcome of LASIK is a decrease in best possible vision, something doctors call best corrected visual acuity (BCVA), or sometimes best spectacle-corrected visual acuity (BSCVA).

In other words, if you can be corrected to 20/20 with glasses or contact lenses before undergoing LASIK, you'd like to be correctable to at least 20/20 after LASIK (if LASIK falls short of giving you 20/20 uncorrected vision).

For example, if you have 20/200 uncorrected vision before LASIK and see 20/20 with contact lenses or glasses, then see 20/40 uncorrected after LASIK but are correctable to only 20/25 with contacts or glasses, you have lost one line of BCVA (from 20/20 to 20/25) on a standard eye chart.

But even though you lost one line of best corrected visual acuity, you gained more than six lines of uncorrected vision (from 20/200 to 20/40).

The FDA expects laser manufacturers to show that no more than 5 percent of patients in clinical trials lose more than two lines of BCVA and that less than 1 percent of patients have BCVA worse than 20/40.
How Well Can You Expect To See After LASIK?

In a major report discussed on the American Academy of Ophthalmology website, 64 LASIK studies published since 2000 were reviewed with these results reported:

In a detailed analysis of all 64 studies, a median of 92 percent of eyes with myopia or myopic astigmatism achieved a correction within 2.0 diopters of target. Results were better for eyes with low or moderate myopia, compared with high myopia.
In 22 studies of outcomes involving people with low to high levels of myopia, a median of 94 percent of eyes achieved 20/40 or better vision after surgery and did not require correction with glasses or contact lenses (uncorrected visual acuity or UCVA). A median of 99 percent of people with low to moderate levels of myopia had 20/40 or better UCVA, and a median of 89 percent of people with high myopia had the same result.
In these same studies, outcomes for people with hyperopia also were examined. Results showed that a median of 88 percent of eyes with hyperopia and hyperopic astigmatism achieved correction within 1.0 diopter of target, resulting in at least 20/40 UCVA.

According to a major analysis of scientific literature by the American Society of Cataract and Refractive Surgery reported in 2008, worldwide satisfaction rates among LASIK patients is 95.4 percent.

Some studies, such as one reported in the October 2008 issue of Journal of Cataract and Refractive Surgery, continue to show a slight trend toward better LASIK outcomes if you don't require a high degree of correction — for example, if you are moderately nearsighted as opposed to extremely nearsighted.

More details about LASIK outcomes will be known after the FDA completes an ongoing Quality of Life study that involves detailed examination of the types of vision improvement people have, along with possible side effects that might not ordinarily be reported in clinical trials. In late March 2011, the FDA began selecting sites throughout the United States where people who have undergone LASIK will be surveyed to assess their satisfaction with their LASIK outcome and to document adverse visual symptoms or complications.

Most LASIK surgeons should be able to provide you with benchmarks, such as figures showing what percentage of their patients have achieved UCVA of 20/20 or better after LASIK.
LASIK Results and Your Eye Surgeon

LASIK is like many other surgical procedures. Where you start is an important predictor of where you end up. Results are affected by the health of your body in general, your eyes in particular and the status of your current vision.

And, as with all other surgical procedures, surgeon skill and experience are major factors that cannot be overlooked.

To best understand expected LASIK outcomes and potential complications for your particular situation, have a thorough pre-surgical consultation with an experienced refractive surgeon

LASIK Risks and Complications

If you are considering LASIK and are worried that something could go wrong, you might take comfort in knowing that sight-threatening complications from laser vision correction are rare. Also, many LASIK complications can be resolved with additional surgery or medical treatment.

Choosing the right eye surgeon probably is the single most important step you can take to decrease any risks associated with LASIK. An experienced, reputable surgeon will make sure you are properly screened and let you know up front if you aren't a good candidate for LASIK eye surgery.

Even if you are not qualified for LASIK, you still might be able to undergo vision correction surgery through other means such as PRK, LASEK, or implantable lenses. If you do decide to have LASIK, a responsible eye surgeon will work closely with you to resolve problems if they do develop. You can choose a LASIK surgeon by taking certain steps such as checking credentials.
How Common Are LASIK Complications?

Public confidence in LASIK has grown in recent years because of a solid success rate involving millions of successful procedures performed in the United States. With increasingly sophisticated technology being used for the procedure, most LASIK outcomes these days are very favorable.

The U.S. military also has adopted widespread use of refractive surgery including LASIK to decrease reliance of troops on corrective eyewear. This trend is particularly relevant because troops deployed for active duty are not allowed to wear contact lenses.

As of 2008, more than 224,000 military personnel had undergone laser vision correction. Since the procedure first was introduced in the military in 2000, researchers have conducted more than 45 studies regarding safety and effectiveness of LASIK and other procedures.

Outcomes have been overwhelmingly positive. Most soldiers see 20/20 or better after the procedure without corrective eyewear, and the rate of complications has been very low. According to one study, only one in 112,500 patients required medical disability retirement due to complications from laser vision correction during this eight-year period.

In a recent study of aviators from the U.S. Navy and U.S. Marine Corps who underwent wavefront-guided LASIK, all patients attained 20/20 uncorrected visual acuity (UCVA) within two weeks after surgery. When questioned about their satisfaction one month after surgery, 95 percent of the patients said the procedure was helpful to their effectiveness as an aviator, and 100 percent said they would recommend it to other aviators. Study results were presented at the 2008 annual meeting of the American Society of Cataract and Refractive Surgery (ASCRS).

Retired U.S. Navy Capt. Steven C. Schallhorn, MD, a former fighter pilot and the first U.S. Department of Defense eye surgeon to perform refractive surgery, says he favors wavefront-guided LASIK because of outcomes producing superior night vision vital to the performance of fighter pilots.
LASIK Complication Rates Are Decreasing

The safety and effectiveness of LASIK continue to improve. Complications generally were more common in the early years of LASIK, when studies in the late 1990s indicated that up to 5 percent of people undergoing laser vision correction experienced some type of problem.

Experienced LASIK surgeons now report that serious complication rates can be held well below 1 percent, but only if surgical candidates are selected very carefully. For example, you may be eliminated as a LASIK candidate if you have certain pre-existing conditions, such as diabetes, that may affect how well your eye heals.

It's very important that you mention any health conditions you have and any medicines you take during your LASIK pre-operative exam and consultation. Your eye surgeon needs to know this information to properly assess your suitability for laser vision correction and your risk for complications. It is especially important to discuss any health condition you have that might hamper your ability to heal; this is one of the standard LASIK criteria used for assessment.

Also, you might want to take AllAboutVision.com's online LASIK screening quiz to help you anticipate what kinds of questions you may be asked to determine if you are a good candidate.

Make sure you mention any problem with dry eyes, which is one of the most common reasons you may be eliminated as a candidate. However, many people with mild to moderate dry eyes can be treated before LASIK or other laser vision correction is performed.
The Truth About LASIK Risks

While LASIK outcomes overwhelmingly are favorable, remember that — as with any surgery — risks of complications still exist. Fewer than 1 percent of patients still experience serious and ongoing vision problems following LASIK, because no surgical procedure is ever risk-free.

Left: What someone with post-op starbursts might see at night. Right: Nighttime haloes.

Even people who have excellent uncorrected visual acuity after LASIK based on eye chart testing still can have bothersome side effects. For example, it is rare but possible that you may see 20/20 or better after LASIK but still have symptoms such as double vision, unresolved dry eyes or difficulty seeing at night because of glare or halos around lights.

When you sign the LASIK consent form provided by your eye surgeon prior to surgery, you should do so with a full understanding that, even in the best of circumstances, a slight chance exists that something unintended could occur.

Thankfully, most cases of undesired outcomes after LASIK can be corrected with additional surgery (called an enhancement) or with medical treatment, such as in the case of dry eyes.
Common LASIK Complications

When LASIK complications occur, they may be associated with the creation of a hinged flap in the clear front covering of the eye (cornea), which is lifted for laser re-shaping of the eye. The flap then is replaced to form a type of natural bandage.

If the LASIK flap is not made correctly, it may fail to adhere correctly to the eye's surface. The flap also might be cut too thinly or thickly. After the flap is placed back on the eye's surface, it might begin to wrinkle. These microscopic wrinkles in the flap are called corneal striae.

These flap complications can lead to an irregularly shaped eye surface. Most such problems can be resolved through re-treatment of the eye with enhancement surgery.

Studies indicate that flap complications occur in from 0.3 percent to 5.7 percent of LASIK procedures, according to the April 2006 issue of American Journal of Ophthalmology. But inexperienced surgeons definitely contribute to the higher rates of flap complications. Again, remember that you can reduce your risk of LASIK complications by choosing a reputable, experienced eye surgeon.

Some problems associated with LASIK flap complications include:

Irregular astigmatism can result from a less than smooth corneal surface. Irregular astigmatism also can occur from laser correction that is not centered properly on the eye. Resulting symptoms may include double vision (diplopia) or "ghost images." In these cases, the eye may need re-treatment or an enhancement.

Diffuse lamellar keratitis (DLK), nicknamed "Sands of the Sahara," is inflammation under the LASIK flap that may have several causes. Some inflammation of the cornea after LASIK surgery is normal. But if it is uncontrolled, as in DLK, it can interfere with healing and cause vision loss. If DLK occurs, it usually responds to therapies such as antibiotics and topical steroids. The flap also might need to be lifted and rinsed for removal of inflammatory cells and to prevent tissue damage.

Keratectasia or keratoconus is bulging of the eye's surface that can result from a flap that is cut too deeply, when too much tissue is removed from the cornea during LASIK or when the cornea initially was weakened as evidenced from cornea topography mapping prior to LASIK. Resulting distorted vision likely cannot be corrected with laser enhancement, and gas permeable contact lenses or corneal implants (Intacs) may be prescribed to hold the cornea in place.

A promising new treatment for keratectasia (also called "ectasia") is corneal collagen cross-linking (CXL). In one approach to this non-invasive procedure, eye drops containing riboflavin (vitamin B2) are placed on the cornea and then are activated with ultraviolet (UV) light. This strengthens the links between the collagen connective tissue fibers within the cornea to halt the bulging of the eye's surface.

In some cases, it may be possible to perform a laser enhancement of the eye after CXL to restore vision loss caused by post-LASIK ectasia or keratoconus.
LASIK Complications: How They Affect You, How They're Treated Complications Symptoms Treatments
Incomplete corrections (undercorrection, overcorrection, residual astigmatism) or regression of effect Blurry, less-than-perfect vision Glasses or contact lenses; eye drops; re-treatment with laser
Decentered ablations Visual aberrations* Eye drops; re-treatment with laser
Oversize pupils (pupils wider than treatment zone) Visual aberrations* Eye drops; re-treatment with laser
Haze Visual aberrations* Eye drops; re-treatment with laser
Irregular flap (folds, wrinkles, striae) Visual aberrations* Surgical correction; second laser procedure
Dry eye Dry, itchy or scratchy eyes, often with redness and sense of foreign object in eye, and sometimes pain Prescription dry eye medication; artificial tears; punctal occlusion (blockage of tear ducts in order to retain tear film on eye), oral flaxseed oil
Diffuse lamellar keratitis (eye inflammation) Visual aberrations* Eye drops; surgical rinsing of cells
Epithelial ingrowth Visual aberrations* Surgical removal of epithelium
Infection Redness, oozing of eyes, sometimes pain Eye drops; oral medications
*Visual aberrations include symptoms such as glare, double vision, ghosting, halos, starbursts, loss of contrast sensitivity, and problems with low-light or night vision. Not all patients experience all symptoms, and some patients with these complications experience no symptoms and require no treatment. [See also: Higher-Order Aberrations.] Chart created by Keith Croes and reviewed by Brian Boxer Wachler, MD.

Other, more commonly reported complications that can result from LASIK eye surgery include:

Dry eye after LASIK. Almost half of all patients reported problems with dry eyes after LASIK within the first six months, according to the April 2006 issue of American Journal of Ophthalmology. These complaints appear related to reduced sensitivity of the eye's surface immediately following the procedure. If you have this problem, temporary remedies such as artificial tears or prescription dry eye medication may be needed along with oral flaxseed oil capsules.

After about six months to a year, however, most dry eye complaints disappear when healing of the eye is complete. People who already have severe dry eye usually are eliminated as LASIK candidates.
Significant undercorrection, overcorrection or regression. This means that your outcome is less than optimal and makes it difficult to function in certain situations. There are various reasons for these problems. In many cases, the cause is simply that a patient's eyes did not respond to laser eye surgery in a predictable fashion. But it's also possible that results are related to an inaccurate diagnosis or incorrect settings programmed into software guiding the laser during eye surgery.

Regression from "over-healing" occurs when your eyesight is optimal at first, but then begins to deteriorate over time. In most cases, a significant undercorrection or regression can be treated with additional laser vision correction or other refractive surgery methods such as conductive keratoplasty, once it is certain that the refractive error is stable.
Eye infection or irritation. These problems are rare and may require treatment with eye drops containing antibiotics or anti-inflammatory medication such as steroids.

When bacterial infection occurs after LASIK, it appears to be related increasingly to an antibiotic-resistant form of Staphylococcus aureus. Survey results indicating a growing problem with this type of infection were reported at the 2008 annual meeting of ASCRS.

LASIK surgeons also reported that infections occurred more frequently with surface ablations such as PRK and when bladed instruments called microkeratomes are used to create the flap during LASIK surgery. ASCRS reports indicate that flaps that are lifted and replaced on the eye during LASIK, serving as a type of "natural" bandage, appear to create a more sterile surgical environment than PRK and other surface ablation procedures.

A Note About Presbyopia and Cataracts

If you are under age 40 when you undergo LASIK, remember that your reading vision naturally will change when you are older, due to presbyopia. Normal age-related changes in the flexibility of your eye's natural lens will cause you to slowly lose the ability to focus at closer distances. If you are nearsighted, you will lose your near vision when you wear your glasses but may be able to read comfortably by removing them.

Presbyopia is not caused by LASIK and will occur whether or not you have refractive surgery. You also might want to review options for eye surgery to correct presbyopia.

As you grow older, you also might develop cataracts. Again, this problem is unrelated to LASIK surgery. If you develop cataracts after LASIK, this is purely coincidental. Having LASIK will not limit your ability to have cataract surgery in the future, if that becomes necessary

Dry Eyes and LASIK

Dry eyes after LASIK are so common that they occur in about half of all LASIK patients. While the condition usually is temporary and mild, significant numbers of people continue to have dry eyes for months or even years after a procedure.*

But to keep the problem in perspective, many people who seek LASIK already have dry eyes. As an example, contact lens wearers who find their lenses uncomfortable because of dry eyes may investigate LASIK as an alternative because they do not want to wear eyeglasses.

Fortunately, screening for LASIK has led to advances in dry eye detection and treatment. Many people wanting laser vision correction now have the chance of actually solving their pre-existing dry eye problem if it is addressed in the LASIK consultation.
How Does LASIK Cause Dry Eyes?

In certain cases, LASIK and other vision correction procedures can cause dry eyes after they penetrate the eye's surface and reduce corneal nerve sensitivity. When your eye then fails to sense the need for lubrication, inadequate tear production results.

Dry eyes after LASIK can cause both discomfort and less than optimal visual outcomes. For this reason, many eye surgeons now recommend that you use lubricating eye drops or other therapies to help maintain eye moisture. As a precaution, you also may be given treatments to increase eye lubrication in advance of a LASIK procedure even if you don't have any sign of dry eyes.

In some cases where dry eyes are of extra concern, corrective vision procedures that do not involve creating a thin flap on the eye's surface — such as PRK — may be recommended instead of LASIK.
Dry Eye Screening for LASIK Patients

Both the quality and the quantity of tears you produce are factors in the development of dry eyes, which also can affect healing after eye surgery.

Because eye surgeons now increasingly recognize that the best LASIK outcomes may depend on controlling dry eyes, you probably will undergo screening in advance of a procedure.

Various tests for detecting dry eyes include:

Schirmer test: a thin strip of paper placed under the lower eyelid to measure tear production.
Tear breakup time: placement of a small amount of dye on the eye's surface to monitor how tears are distributed and when they "break up" on the eye's surface.
Imaging: keratometers or other instruments that provide a view of the tear film without touching the eye's surface.

While assessing you as a possible candidate for a LASIK procedure, your eye surgeon also may need to determine if you have an underlying condition that might be causing dry eyes.
Who Is Most at Risk of Having Dry Eyes After LASIK?

One Baylor College of Medicine study in Houston noted a significant risk of having dry eyes after LASIK particularly in people with higher degrees of myopia who required deeper removal of corneal tissue to reshape the eye.**

Researchers also found that LASIK generally carries significant risk for dry eyes in people who did not have the problem previously, and that dry eye symptoms persisted in about 25 percent of LASIK patients six months after surgery.

"Dry eye occurs commonly after laser-assisted in situ keratomileusis (LASIK) surgery in patients with no history of dry eye," the Houston investigators said. "The risk of developing dry eye is correlated with the degree of preoperative myopia and the depth of laser treatment. Patients should be counseled about the risk of developing dry eye after LASIK, particularly those with high myopia."

Other causes of dry eye syndrome before or after LASIK include:
Even if you already have dry eyes, you could still have LASIK if you receive treatments such as prescription eye drops.

Older age, particularly if you are female and have undergone menopause.
Allergy medications (antihistamines), certain blood pressure medications and anti-depressants that can decrease eye moisture.
Autoimmune diseases such as Sjogren's syndrome.
Unusually dry climates or environments, such as a room that is highly heated or air-conditioned.

Again, having dry eyes prior to a LASIK procedure will not automatically eliminate you as a candidate. But your eye surgeon will need to consider the severity of your condition and the possibility of effective treatment before recommending a procedure.
Treatment of Dry Eyes Before and After LASIK

Even if you do have a pre-existing dry eye condition, LASIK surgeons may consider treating you prior to LASIK or other procedures rather than eliminating you as a candidate.

Your eye surgeon also may treat you for dry eyes prior to a LASIK procedure as a precaution, even if your tear production ordinarily is normal.

You may be advised to take flaxseed oil or fish oil orally for several weeks before your vision correction surgery to improve your tear film. You also may need to use lubricating eye drops before and after a LASIK procedure.

Your eye surgeon may recommend prescription eye drops such as cyclosporine (Restasis) that help your body formulate tears. Cyclosporine actually has been found to quicken the recovery of corneal sensitivity after LASIK and thus return the eye to normal moisture.

Other common dry eye remedies include punctal plugs, which block tear drainage channels to increase moisture on the eye, and anti-inflammatory medications such as corticosteroids administered as eye drops.
Preventing Dry Eyes After LASIK

When meeting with your LASIK surgeon during your assessment as a candidate, make sure you mention any eye symptoms that could indicate a dry eye problem, such as a foreign body sensation or eye irritation. Even excessive tearing can indicate that you have dry eyes.
Older people, especially those who take medications such as anti-depressants, have a higher risk of dry eyes after LASIK.

Studies indicate that taking omega-3 fatty acid supplements and eating food containing these "good fats," such as salmon, can help maintain a healthy tear film. Drinking plenty of water also can help keep your body — and your eyes — properly hydrated.

Also, make sure you have a frank discussion with your LASIK surgeon about the possibility of developing dry eyes following a procedure. Ask what specific steps can be taken in case of dry eyes to restore the eye's tear film and comfort until healing is complete.

Again, keep in mind that many dry eye symptoms following a refractive surgery procedure usually are relatively mild and disappear in time. However, some LASIK patients have reported severe and ongoing problems with dry eyes

LASIK Enhancement:
When Additional Surgery Is Needed


A LASIK enhancement may be needed as a follow-up procedure if your first outcome is less than satisfactory or you have a complication following corrective eye surgery.

In most cases, you can expect a good result following a LASIK procedure even if an enhancement is done to help you achieve better vision.

A worldwide study by the American Society of Cataract and Refractive Surgery in findings published in 2008 showed that more than 95 percent of the 16 million people who had undergone LASIK surgery were pleased with their new vision.

But as your eye doctor will tell you before you have LASIK surgery, not everyone will achieve crystal-clear, 20/20 vision after just one procedure.

Each case has a unique combination of variables that can affect visual outcomes. So in some instances, you may need additional eye surgery — often in the form of a LASIK enhancement — to give you the sharpness of vision you desire.
Assessing Visual Satisfaction After LASIK

A number of factors affect your satisfaction after LASIK:

The characteristics and health of your corneas.
The type of refractive error you have, such as whether you are nearsighted or farsighted or have astigmatism.
The amount (strength) of your prescription needed to correct your vision problem.
The amount of tears you produce and their quality, which could be a factor in dry eyes after LASIK.
Your age.
Your expectations.

Although LASIK successfully corrects high degrees of nearsightedness, farsightedness and astigmatism, younger people with mild nearsightedness and astigmatism generally are the best candidates for a good outcome.

Your expectations before LASIK also may play a key role in how happy you are afterward. Remember, the goal of LASIK is to decrease your dependence on glasses and help you to see acceptably well without corrective lenses. Results vary from person to person.

Although many people who have had LASIK believe they see better than they did with eyeglasses or contact lenses before surgery, not everyone has the same experience. After LASIK, you can expect your vision to be slightly better or about the same as it was with glasses.

A small percentage of people may notice their vision is not quite as good as it was before with glasses. But you should be able to drive safely and perform other routine daily tasks without needing glasses or contact lenses.
When Is a LASIK Enhancement Needed?

When evaluating your vision after LASIK, it's important to be patient. Although you should be able to see much better without glasses the day after surgery, it's not unusual for vision to fluctuate for several weeks.

As part of your follow-up care after LASIK, your eye doctor will monitor your vision for several weeks.
If your vision still seems blurry three months after LASIK, you may need a LASIK enhancement.

Though not expected, it's possible that you may feel uncomfortable driving or performing other visual tasks after LASIK. If this occurs, be sure to tell your eye doctor. If necessary, he or she can prescribe new eyeglasses for you to wear part-time while your vision stabilizes.

If your vision is still noticeably blurred three months after LASIK, you may need an enhancement.

To determine whether you're a good candidate for a LASIK enhancement, your eye doctor will re-evaluate your corneas with the same methods used prior to your first LASIK procedure. Among other evaluations, your eye doctor will check to see whether you have enough corneal thickness for a second surgery.
How Does a LASIK Enhancement Differ From the Original Procedure?

A LASIK enhancement is nearly identical to a primary LASIK procedure, except for one aspect. Rather than using a microkeratome or laser to create a corneal flap, the surgeon performing a LASIK enhancement uses specialized tools.

These tools are manipulated to lift the flap that was created on your eye's surface during your primary LASIK surgery. Re-lifting the flap is painless and typically takes only one or two minutes. Then your surgeon uses an excimer laser to reshape your cornea.

Typically, only minimal corneal reshaping is necessary during an enhancement. So this laser treatment takes just a few seconds.

After the enhancement, you will receive the same post-operative instructions that were given after your primary LASIK procedure. Be sure to follow your doctor's instructions exactly, to reduce the risk of eye infection and facilitate a good visual outcome.

In most LASIK enhancement cases, only one procedure is necessary to restore vision to an acceptable level. However, in difficult cases, more than one enhancement may be required.
How Much Does a LASIK Enhancement Cost?

Many surgeons do not charge an additional fee for LASIK enhancements within one year of a primary LASIK procedure they performed themselves.

Others charge a fee only if the enhancement is needed within a specified period of time (usually a year or longer) after the primary LASIK procedure.

When choosing a LASIK surgeon, ask about policies and fees for enhancement procedures.
How Often Are LASIK Enhancements Required?

It's difficult to pinpoint a specific percentage of patients who will need an enhancement after LASIK. Studies show enhancement rates range from fewer than 5 percent to more than 15 percent, based on factors listed above and other variables.
Ask your surgeon if fees are charged for an enhancement. If so, you may want to shop around: many surgeons perform enhancements without charging extra.

Generally, enhancement rates are higher for people who are farsighted, have higher degrees of refractive error or are older than 50.

Regardless, a surgeon's LASIK enhancement rate is not a good indicator of surgical skill. Surgeon A may have a higher enhancement rate than Surgeon B because of more concern for achieving the best result possible.

Surgeon A may perform enhancements even for mild vision problems, while Surgeon B may perform enhancements only when vision problems are considered severe.

Also, surgeons who charge an extra fee for enhancements may have lower enhancement rates because of the financial disincentive for someone to undergo a second procedure.

So it's possible for a surgeon who performs LASIK enhancements more frequently to have good patient satisfaction ratings compared with a surgeon who doesn't perform as many enhancements.

As with any elective surgical procedure, it's important to choose a LASIK surgeon you trust. This means someone who will communicate with you well and show concern about your satisfaction.
Other LASIK Enhancement Options

LASIK enhancement surgeries can be performed to improve eyesight after refractive procedures other than LASIK, such as phakic IOL implantation and refractive lens exchange. In some cases, procedures other than LASIK can be used for enhancements.

For example, a refractive surgeon may prefer PRK rather than LASIK for an enhancement because he or she does not need to create or re-lift a flap for PRK.

LASIK and PRK enhancements also can be used after cataract surgery to eliminate residual refractive errors and sharpen vision.

If you have had LASIK or any other type of refractive eye surgery (including cataract surgery) and believe your vision isn't as sharp as it should be, visit your eye doctor to see whether an enhancement is right for you

Cost of LASIK Eye Surgery and
Other Corrective Procedures

LASIK eye surgery cost differs widely from one provider to another and depends on many factors. The only universal standard is that LASIK and other refractive surgery prices are quoted per eye (as we do in this article).

Remember that one LASIK procedure equals only one eye, even if both eyes are corrected on the same day. So the price quoted for a procedure doubles if you intend to have both eyes corrected.

LASIK surgeons also might add extra charges for new technologies, including wavefront analysis for extra-precise corrections (custom wavefront LASIK).

You also might be charged extra for all-laser or bladeless LASIK (IntraLase and other technologies), a LASIK procedure in which a laser is used instead of a bladed instrument to create the flap on the front of the eye. In LASIK, this thin flap is lifted so that laser energy can be applied to shape the eye, and then replaced to serve as a natural bandage.
Average LASIK Eye Surgery Costs

A price report commissioned by AllAboutVision.com from a leading industry analyst was based on results of a survey of refractive surgeons conducted during the first quarter of 2010. Average LASIK costs were:

$2,150 for all laser-based vision correction procedures (including LASIK) in which a single price is quoted.
$1,580 for non-customized LASIK using a bladed instrument (microkeratome) and excimer lasers that are not guided by wavefront analysis.
$2,170 for wavefront-guided LASIK using a laser-created flap.

Note that wide variation can exist in what an advertised price will include. Beware of advertising that, for example, promises "LASIK from $499 per eye." Look for the fine print. Typically, only a few select people are actually eligible for LASIK at prices that sound unusually low, because most eyes require more extensive correction or more follow-up after the surgery.

Average LASIK prices have not risen substantially in several years. That trend continued in 2010, no doubt because of the generally poor state of the U.S. economy. For now, many potential laser eye surgery candidates seem to be choosing more economical vision correction choices, such as eyeglasses and contact lenses, until the economy heats up again.

Average LASIK eye surgery prices in 2010 were about the same as or slightly less than in 2009. In fact, the average price for wavefront-guided LASIK using a laser-created flap on the eye dipped from $2,314 in 2009 to $2,170 in 2010.

Many more eye surgeons (54.1 percent) now quote a single price for LASIK or similar vision correction procedures than in 2009 (47.2 percent). And that percentage continues to grow each year.

This means new technologies such as customized wavefront procedures and laser-created flaps are not priced separately and charged as "extras," in addition to a basic fee for a laser vision correction procedure.

In previous years, you might have been able to find a few eye surgeons willing to charge less than $1,000 per eye for LASIK and other procedures. But the newest 2010 AllAboutVision.com report indicates that most eye surgeons have backed off entirely from charging prices that low.

But on the flip side of that trend, fewer eye surgeons are charging the highest prices in typical ranges quoted for vision correction surgery.

Non-customized procedures are performed with the less expensive options of bladed microkeratomes and excimer lasers that are not guided by wavefront analysis. Most customized wavefront procedures that also use laser-created flaps cost from $1,500 to $3,000 per eye (see charts).
LASIK Eye Surgery Cost and the U.S. Economy

The cost of LASIK and other vision correction surgery remained stable in 2010 because of the major economic downturn that began in late 2008.

As an example, LCA-Vision Inc. (Cincinnati) officials in June 2009 reported that procedure volumes at the company's 75 LASIKPlus vision correction surgery centers in the U.S. and Canada had declined by 45 percent compared with the previous year.

The downturn continued in 2010, but the decline in procedure volume was not quite as drastic as it was in 2009. LCA-Vision reports for the first quarter of 2010 showed that the 19,066 procedures performed at the company's remaining 62 vision correction surgery centers represented about a 32 percent decline from the same period in 2009 — when 27,959 procedures were performed.

TLCVision Corp. (St. Louis) also reported that fewer vision correction procedures were performed at the company's 62 majority-owned centers during 2010. In the first quarter of 2010, procedure volume was 19,300 — about a 10 percent decline from the 21,400 procedures performed during the same time period in 2009.

In the first quarter of 2009, TLCVision had reported a 38 percent decline in procedure volume.

TLCVision company reports say the continuing downturn is caused by a weak U.S. economy, less discretionary spending for consumers and fewer company expenditures devoted to marketing.

LCA-Vision Inc. company reports also mentioned that adverse weather conditions particularly affecting the East Coast during the first quarter of 2010 also impacted procedure volumes early in the year.

Many surgical centers hurt by low demand for LASIK and other procedures now are expanding cataract surgery offerings to help increase profitability.
Beware of "Bargain" Prices for LASIK

When you deal with centers and surgeons that advertise LASIK surgery at bargain prices far below what is mentioned above, you would be wise to ask plenty of questions about what a procedure actually costs beyond what is advertised. Be sure to ask for an estimate, in writing, that details exactly what you are getting for that low price.

As an example, in late 2005 Florida's attorney general announced a settlement with Lasik Vision Institute for allegedly misrepresenting the actual cost of eye surgeries as stated in the company's advertisements. One dispute in the case involved non-refundable deposits, even when an individual opted not to have surgery.

Based on these types of isolated incidents, make sure you know what the total cost of the procedure will or could be, including surgeon and facility fees and any other extras. One advertised price represented as a "bargain" might include those types of extra costs, while another might not.
How To Compare LASIK Eye Surgery Costs

Confused about what your eye surgeon charges for LASIK?

The charts on this page can help you compare the quote you received for a procedure with what some other eye surgeons typically charge.

Before making a final decision, ask yourself:

Does the quote fall within typical ranges — highlighted in yellow in the first chart — for the same procedure?
If the quote is significantly higher than usual, does your eye surgeon have exceptional credentials that help justify the extra price?
If the quote is significantly lower than usual, is your eye surgeon relatively inexperienced? And are you sure you are being quoted the full price?

Note that a small percentage of eye surgeons charge a premium price for LASIK that doesn't involve wavefront technology. If the price for basic LASIK is more than than $2,000 per eye, then you might consider a higher tech wavefront-guided procedure that may cost the same or only slightly more.

When a single price is quoted, ask your eye surgeon's billing representative these questions:

Will I receive a laser-created flap?
Will my procedure be wavefront-guided?

This information will help you compare the type of procedure you receive with the costs listed in the charts on this page.

Above all, listen carefully to what your eye surgeon recommends regarding the right procedure for your vision correction needs and budget.

If you don't like what you hear, get a second opinion. — M.H.

LASIK Prices

LASIK prices, after rising for several years, seemed to stabilize from 2006 to 2010, as shown by these average LASIK costs charged at a single price — meaning no extra charges were added on for new technologies:

2006: $1,950
2007: $2,099
2008: $2,105
2009: $2,140
2010: $2,150

In comparison, LASIK in 2002 cost $1,550-$1,600, and by October 2003 the price had risen to $1,710. At the end of 2004, the price was a little more than $1,800, and in 2005 it was $1,965. These averages take into account procedures performed at surgeon-owned laser centers, institutions and corporate laser centers.

Also, keep in mind that earlier prices do not reflect new technologies of wavefront analysis and laser-created flaps, which have been in widespread use only in recent years.

Following is a chart of average LASIK prices, per eye, as reported in 2010 by a leading industry analyst.
Average LASIK costs per eye, as reported in 2010

Average LASIK prices rose for several years early in the decade, partly because of demand and an increasing number of LASIK procedures. However, industry reports indicate that the number of LASIK procedures performed annually in the United States had stabilized in the past few years at around 1.4 million until a meltdown in the U.S. economy beginning in 2008.

Citing information from a leading industry analyst, company reports from LASIK providers note that 1 million LASIK procedures were performed in 2008, and about 760,000 procedures were performed in 2009.
New Technology Increases LASIK Eye Surgery Cost

You usually can expect higher LASIK prices when you add these two newer options:

"Custom" or "wavefront" LASIK, which is often more expensive than traditional LASIK.
Laser flap technology, which increases procedure cost (see charts).

LASIK with IntraLase and similar laser flap-making technologies, a procedure in which the surgeon creates the LASIK flap with a laser rather than a microkeratome, typically costs more than traditional LASIK. IntraLase reported in early 2007 that the average extra cost per eye added onto a LASIK procedure for use of IntraLase was $394.

Later in 2007, Advanced Medical Optics (now Abbott Medical Optics or AMO) acquired IntraLase and incorporated the technology into the company's wavefront-guided excimer laser platform. The total system now is marketed under one name, iLASIK.

AMO says on the company website that the cost of iLASIK procedures average about $5,000 per person, when both eyes are corrected.

Those surgeons who use laser-made flaps in LASIK cite studies that show patients have fewer flap complications, need fewer retreatments and have a greater likelihood of achieving 20/20 visual acuity or better.

Not all eye surgeons agree that laser-made flaps are superior, and the merits of blade versus bladeless LASIK continue to be debated.

Custom LASIK, which uses wavefront technology to measure and map the aberrations and vision problems that occur when the eye fails to focus light rays correctly, also usually costs more than traditional LASIK.

As noted above, many eye surgeons don't charge a separate fee for new technologies used in LASIK, and instead quote their price as a single fee.
Average LASIK prices, per eye

Prices for conventional LASIK with a bladed microkeratome, per eye

Prices for wavefront-guided LASIK with IntraLase, per eye


Prices for Other Types of Eye Surgery

Below are typical prices, per eye, for other types of refractive eye surgery. As with LASIK, the prices vary based on many factors, including your individual prescription, where you live and which surgeon you choose.

CK: $1,500 to $2,900
PRK, Epi-LASIK and LASEK: about the same as LASIK
Refractive Lens Exchange (RLE): $2,500 to $4,500 per eye or more, depending on extra costs such as facility fees

What Contributes to LASIK Eye Surgery Cost

One reason fees vary widely is that different providers perform varying levels of preoperative testing. Since proper screening can avoid problems, it's important to determine if appropriate testing is included in a quoted price.
Multiple charges are more likely for more advanced technologies used in LASIK and other laser-based refractive surgery.
If you are considering LASIK or other laser-based corrective eye surgery, you might encounter multiple charges reflecting different technologies used for your procedure.

These technologies can include a laser to create a flap on your eye's surface and wavefront analysis for guiding the way a laser reshapes your eye.

But about 54.1 percent of eye surgeons will charge you a single price that already incorporates use of these technologies.

Wide variation exists also in the cost of equipment used for testing and surgery. Technologies for eye tracking, tear film analysis and measurements of corneal thickness, corneal topography and pupil size, as well as the laser itself, are available at various price points and can be reflected in the procedure fee.

Refractive surgery fees cover a variety of costs, including:

Purchase or lease and maintenance of the laser, microkeratome and/or other devices used in the procedure.
A $100 to $150 per eye royalty fee to the excimer laser manufacturer, who must recoup the cost to develop the machine.
A $145 to $250 per eye royalty fee if it is a custom procedure, depending on the laser manufacturer.
Gowns, masks, gloves and other items for keeping the operation sterile.
Microkeratome blades, surgical solutions and medications used during the surgery.
With IntraLase, disposable equipment that includes a metal cone and glass lens connecting the laser to the treated eye.
Overhead for the surgery center, which includes office and surgical staff salaries and benefits, rent, office equipment and office administration.
Patient acquisition costs, which include advertising, seminars and fees paid to other eye care practitioners for comanagement.
Insurance.
And, especially, "the surgeon," who is the single most important part of any surgical procedure.

Also included in most fees are the pre-op evaluation meeting, comprehensive eye examination (including technician time and equipment costs), follow-up office visits and tests, plus any standard medications.

Many surgeons also offer free enhancement surgery if it is warranted. Often a team of doctors reviews your case to determine this, and their time is included in the fee.
Questions for Your Surgeon

When discussing fees with your surgeon, ask:
Click here for rebates and savings coupons

What is included?
What is not included?
What will I have to pay for if complications occur or enhancement surgery becomes necessary?
How much do prescription medications (such as anti-inflammatories or painkillers) cost?
If I require temporary contact lenses or glasses after the procedure, how much will they cost?
How many follow-up visits will I need to make, and at what cost?

Defraying Eye Surgery Cost: Insurance and Financing

Most vision insurance plans don't cover refractive surgery because they consider it cosmetic. However, some employers make arrangements with a given LASIK center (or refractive surgery center) for a special price. Also, you may qualify for a tax deduction for refractive surgery, so check with an accountant.

You may be tempted to choose a surgeon based only on the fee charged, but that may be unwise. It's better to choose the best surgeon you can find and then, if you need it, get the most affordable financing you can. Think of it this way: If you choose Surgeon A who charges $400 less than Surgeon B, but you know that Surgeon B has more experience, you are risking your vision for the sake of $1 per day over the course of 13 months. Is the higher risk really worth the monetary savings?

Financing is available for LASIK and other vision surgeries. Several financing companies specialize in elective procedures and offer plans with fixed rates and long-term payments. Most LASIK surgery centers and private medical practices work with one of these companies to offer a financing plan to their patients.

Note that some large employers offer subsidized health plans that cover at least part of LASIK costs. If you work for a major company, ask about possible benefits that might cover elective corrective eye surgery procedures.

Also, the U.S. military has been making LASIK and other corrective vision surgery options more available to troops. The procedures may be performed free of charge, depending on the nature of a soldier's duties



[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذه الصورة]

LASIK Financing:
How To Afford LASIK Surgery

With LASIK costing a few thousand dollars per eye, having laser eye surgery may sometimes seem more of a financial decision than a medical or lifestyle choice. However, financing options mean that cost need not be a reason to avoid LASIK.

With a little research, you may be able to find an affordable way to pay for the LASIK procedure even if you are concerned about cost. Payments typically range from $127 to $420 monthly, depending on the type of financing plan you choose.

Options for managing LASIK surgery costs include finding a healthcare financing company that suits your needs, financing the procedure through a LASIK surgeon or using a flexible spending account (FSA).

With these options, you can reduce the substantial upfront cost of LASIK into more affordable monthly payments.
Paying for LASIK Through Finance Companies

Today it's commonplace to arrange monthly payments for a variety of health-related procedures, ranging from gastric bypass to braces — or LASIK.

First you should make sure the LASIK surgeon you plan to use approves of the financing company. Because not all LASIK surgeons will work with all financing companies, you might consider asking for a list of approved financing companies before you apply for a loan.

Companies that provide LASIK financing offer a range of plans in which you can complete payments within three months, or extend monthly payments for as long as five years. Some companies allow you to spread out payments over time without incurring any extra cost.

Some short-term payment plans charge no interest at all. For longer term payments, interest rates can vary greatly and range as high as 22.99 percent. A deposit also may be required. Interest rates and deposits depend on personal credit ratings and the LASIK financing company used.

How To Apply for LASIK Financing

Applying for credit from a LASIK financing company usually is quick, easy and similar to obtaining other traditional loans. Many LASIK surgeons also offer LASIK financing through major companies, making the process simple for you.

Be sure you are prepared with the correct information when you take the following steps that may be needed to complete the application for financing:

You may not need to visit the financing office in person if you fill out paper applications that can be mailed or faxed in. You may be able to obtain application forms from your eye surgeon or by printing out forms displayed on financing company web sites.
A general credit check requires your full name, permanent address, social security and telephone numbers, and household income.
Some companies also may ask for a driver's license number.
You may be asked to submit the name of the eye surgeon you plan to use for your laser eye surgery, along with an estimated treatment fee amount.
Typically, no information about medical history or credit cards will be needed for financing LASIK.

Applying for LASIK Financing Online
Click here for rebates and savings coupons

Confidential and secure applications also may be directly available online, a method that tends to be easier for both you and the financing company if you have convenient computer access.

Qualified applicants usually can obtain financing within 24 hours of submitting the application. Some companies advertise that approval can take place within just a few minutes.

When entering your information online, be sure to check that the URL in the address bar begins with https, as opposed to http. This indicates you are on a secure server and that your personal information has been encrypted.
LASIK can be more affordable when you work out a plan of monthly payments.

Before submitting personal information online or via a paper application, you'll also want to make sure the company financing your loan is legitimate.

The easiest way of finding out would be to ask your LASIK surgeon or his/her staff member if the financing company is known and if it has a good track record.

Before you apply, obtaining a list of approved financing companies in advance from your eye surgeon probably is the best way to make sure you are dealing with a reputable organization.

You also can learn something about a financing company by determining its source of income. You can ask a company representative if the company provides financing in-house, or if it partners with a financial institution such as a bank.
Paying Off Your LASIK Loan

As with any loan, be sure to make your payments on time, or you will be subject to penalties and late fees. Each LASIK financing company has its own method of penalizing customers who default on a loan payment. However, general penalties can include:

Losing your low interest or no-interest rate
Incurring a substantial late fee
Having an adverse report on your credit record

On the other hand, most financing companies do not charge pre-payment penalties for paying off the loan in advance. If you think you might want to pay off the loan ahead of schedule, make sure you clarify policies regarding potential additional fees with your financing company.
Applying for a loan online? Make sure the finance company is legit before you supply personal information.
Financing Offered by LASIK Surgeons

Another way to finance LASIK is directly through the surgeon's office. Even though many LASIK surgeons use one of the major financing companies for arranging payments, they occasionally offer financing options through their own practices.

LASIK surgeons who provide their own financing generally do not charge interest. Again, this financing option allows you to spread out payments over several months or even a few years without incurring any extra costs. This is an option to consider as long as the surgeon is reputable and board-certified.
LASIK Financing Through Flexible Spending Accounts (FSAs)

Flexible spending accounts (FSAs) are a tax-free way to save for LASIK. With an FSA, you can use pre-tax income to pay for medical-related costs. You create an interest-free LASIK financing program for yourself by taking a portion of your salary each month and depositing it into a tax-free FSA account.

When you are ready for your LASIK procedure, the money is available for your use and you don't need to worry about paying interest on a loan. However, this option is available only through employer-sponsored

Which LASIK Laser Is Best?

Excimer lasers, designed for laser-assisted in situ keratomileusis (LASIK), are marvels of modern medicine.

Many potential LASIK recipients want to know more about subtle differences among currently approved instruments. But for most people, laser choice makes no significant difference.

Most experts agree that surgeon skill and experience and the quality of care before and after a corrective eye surgery procedure are far more critical factors affecting final LASIK outcomes.

Although all approved excimer lasers meet safety and effectiveness criteria established by the FDA, certain people may be better off with one type of laser over another.
Four Must-Knows About Comparing LASIK Laser Outcomes

When evaluating lasers, you may be drawn to information gathered during FDA clinical trials leading up to approval. But you should keep these points in mind when considering FDA data:

Today's results are often better than FDA data. By definition, FDA trials occur during the early period of a laser's life cycle. Manufacturers are allowed to and often do make technical improvements to the instruments, sometimes even while the lasers are still under investigation.

The surgeon's technique evolves as well, and usually becomes more advanced than the technique used in the FDA trials. This, together with increasing surgeon experience over time, means that results in actual clinical practice are often better than the initial FDA data.

FDA data in one study cannot fairly be compared with FDA data in another study. Manufacturers go to the FDA with various study designs, which often have differing endpoints and patient-enrollment criteria. Although all studies must answer certain basic questions regarding safety and effectiveness, they are not designed to be compared with one another.

A true comparison of Laser A and Laser B would require randomized clinical trials, in which patients would be randomly assigned to receive surgery by one laser or the other over the same time period by the same surgeons. FDA trials don't do that — although other, non-FDA studies sometimes do.

Studies don't cover every possibility. Even if your characteristic or condition appears to be eliminated from treatment because of how the approval for the excimer laser is worded, your eye surgeon still may consider you as a candidate.

Also, another laser with specific approval for your characteristic or condition may not necessarily do a better job.

Remember that studies have differing designs and people with your characteristic or condition may have been excluded. Even if they were included in the study, results may have been inconclusive because of factors such as too few people or insufficient data for determining statistical or clinical significance.
Visx Star S4 IR laser
Allegretto Wave Eye-Q laser
FDA-approved excimer lasers shown here are used in Abbott Medical Optical's iLASIK system with the Visx Star S4 IR (top) and Alcon's OptiLASIK system with the Allegretto Wave Eye-Q.

Once the FDA approves a laser, your surgeon can use it any way he or she deems appropriate. This is true of all FDA-approved drugs and devices. This is commonly referred to as "off-label" use of an FDA-approved drug, device or laser. It's called a physician's practice-of-medicine prerogative, and there's nothing inherently wrong with it.

In fact, most advances in medicine occur because of off label uses of devices or medications. So this type of use can be critical in modern medicine.

For example, without "off-label" use of aspirin, no one ever would have known that aspirin (originally FDA-approved for pain control) is vital for reducing risk of heart attacks.

Armed with this insight, the informed consumer can begin to compare the commercially available laser systems approved for LASIK (see chart).

Most discussion about these lasers surrounds the mechanisms they use to deliver the laser beam and track the eye during ablation.
Types of Modern Excimer Lasers Used for LASIK

Slit scanning lasers. Slit scanning lasers use relatively small beams linked to a rotational device with slit holes that enlarge. The laser beams scan across these holes during surgery, producing a gradually enlarging ablation zone. The approach provides a uniform beam and — potentially — smoother ablations than obsolete broad-beam lasers. The disadvantages include a slightly greater risk of decentration and overcorrection unless an eye-tracker is being used with the laser.

Spot scanning lasers. Spot scanning (or "flying-spot") lasers, which are the most common, use small-diameter laser beams (0.8 to 2 mm) scanned across the cornea to produce the ablation zone. This approach has the potential to produce the smoothest ablations, to more readily allow customized ablations and to better treat irregular astigmatism.

Wavefront-guided lasers. Many excimer lasers are connected to a device that detects and "maps" defects in the eye's optical system, based on how lightwaves travel through the eye. These wavefront devices individually guide the way the eye's cornea is reshaped to achieve a custom LASIK ablation. Both slit scanning and spot scanning lasers have the ability to be used for wavefront-guided treatments.
Excimer Lasers and Eye Tracking

Most modern excimer lasers have automated eye tracking systems to keep the laser beam on target. Studies have shown that eye trackers produce better outcomes and decrease LASIK complications compared with past lasers that did not use eye tracking systems.
Indications and Features of Excimer Lasers

In the following chart, OZ stands for optical zone, meaning the maximum size of the pupil allowing light to pass through the eye that can be targeted effectively for correction with a specific laser. TZ stands for the maximum treatment area, including a transition zone that can be used in an ablation to achieve vision correction in the targeted area.
Modern FDA-Approved Excimer Lasers Model Indication Type of Laser Beam Optical Zone (OZ) and Treatment Zone (TZ) FDA Approval Year
Alcon LADARVision 4000 & CustomCornea (laser plus wavefront device to guide laser) Myopia:
up to -8.00 D with or without astigmatism (up to -4.00 D)

Hyperopia and hyperopic astigmatism:
up to +5.00 D (near vision problems) and astigmatism causing distance vision problems up to -3.00 D Scanning spot
(0.8 mm) OZ:
5.5 mm

TZ:
7.5 mm 2002
myopia with or without astigmatism

2006
hyperopia and hyperopic astigmatism
Bausch + Lomb Technolas 217A and Technolas 217z Zyoptix (laser plus wavefront device to guide laser, approved 2003)

Advanced Control Eyetracking (ACE) (rotational eye tracking system approved 2009 for Technolas platforms)

(Technolas systems now are owned by Technolas Perfect Vision, a joint venture of Bausch + Lomb with 20/10 Perfect Vision.) Myopia:
up to -12.00 D with or without astigmatism (up to -3.00 D)

Hyperopia:
up to +4.00 D with or without astigmatism (up to +2.00 D) Scanning spot
(2.0 mm) OZ:
6.0 mm

TZ:
7.0 mm 2000
myopia from -1.00 to -7.00 D

2002
myopia up to -11.00 D

2003
hyperopia with or without mixed astigmatism
Carl Zeiss Meditec MEL 80 Myopia:
up to -7.00 D with or without astigmatism (up to -3.00 D) Scanning spot
(0.7 mm)

Gaussian profile with more energy applied centrally OZ:
6.0 to 7.0 mm

TZ:
7.7 to 8.9 mm 2006
myopia with or without astigmatism
Nidek EC-5000 Myopia:
-1.00 to -14.00 D with or without astigmatism (less than 4.00 D)

Hyperopia:
+0.50 to +5.00 D and up to +2.00 D astigmatism Scanning slit
(7.0 x
2.0 mm) OZ:
5.5 mm

TZ:
7.0 mm 2000
myopia from -1.00 to -14.00 D

2006
hyperopia and hyperopic astigmatism
Visx Star S4 & WaveScan WaveFront System (laser plus wavefront device to guide laser) Myopia:
up to -6.00 D with or without astigmatism (up to -3.00 D) Variable scanning spot beam
(0.65 mm
to 6.5 mm) OZ:
4.0 to 9.0 mm

TZ:
4.5 to 9.5 mm 2003
Visx Star S4 IR & CustomVue (laser plus wavefront device to guide laser) Myopia:
up to -6.00 D with or without astigmatism (up to -3.00 D)

Hyperopia:
up to +3.00 D and up to +2.00 D of astigmatism

Mixed astigmatism:
up to 5.00 D Same as S4 OZ:
6.0 mm

TZ:
9.0 mm 2005
WaveLight Allegretto Wave Myopia:
up to -12.00 D with or without astigmatism (up to -6.00 D)

Hyperopia:
up to +6.00 D with or without astigmatism (up to +5.00 D, not exceeding mean spherical equivalent or total refractive error of +6.00 D)

Mixed astigmatism:
up to 6.00 D Scanning spot beam (0.95 mm) with emphasis on applying more energy centrally (Gaussian profile) OZ:
4.5 to 8.0 mm

TZ:
5.2 to 8.7 mm for spherical treatments;
7.0 to 9.0 mm for cylindrical and spherico-cylindrical treatments 2003
myopia and hyperopia

2006
mixed astigmatism
WaveLight Allegretto Wave with Allegro Analyzer (laser plus wavefront device to guide laser) Myopia:
up to -7.00 D with or without astigmatism (up to 3.00 D)

Mixed astigmatism:
up to 6.00 D Same as Allegretto Wave OZ:
Same as Allegretto Wave

TZ:
Same as Allegretto Wave 2006

2007
mixed astigmatism
Notes: "D" is an abbreviation for "diopters." While FDA approval is based on studies with these levels of diopters, individual doctors are free to use their own discretion in deciding what is best for their patients. For example, a doctor may choose to use a laser for a patient whose vision falls outside the above ranges or may decide against using any laser on a patient with -13.50 D of myopia, even though some are approved for up to -14.00 D. It is important for you to discuss the risks and benefits with your doctor before surgery is performed.
Pupil Size, Ablation Speed and Patient Comfort

In recent years, increasing evidence has indicated that the zone where laser energy is applied to reshape the eye during LASIK may be too small to accommodate larger pupil sizes. If your pupil expands in low light beyond the zone where the eye was reshaped (ablated) for vision correction, you may have vision problems such as glare and halos at night.

Some surgeons believe the diameter of the zone where laser energy is used (ablation zone) should be at least as large as your pupil in dim light. If you have larger pupils, the type of excimer laser may be important in relation to how large an optical zone the machine is capable of creating. You should discuss this with your surgeon.

Ablation times also differ among lasers, ranging from 30 to 60 seconds or longer. You may consider that important in terms of your comfort as you undergo a procedure.

You also might want to ask whether your surgeon uses a laser or a bladed instrument (microkeratome) to create the flap used in LASIK eye surgery and how these two approaches might differ in terms of your comfort. Many surgeons take opposing sides in the blade vs. bladeless LASIK debate.

Again, no matter which laser is used, remember that ultimately your surgeon's skill and experience likely will be the most important factors affecting your LASIK outcome.

Contact Lenses After LASIK
or Other Refractive Surgery

If you have less-than-perfect results from LASIK or other refractive surgery, you may want to consider custom gas permeable (GP) or hybrid contact lenses to improve your vision — especially if a follow-up surgical procedure or enhancement is not possible.

The smooth, rigid surface of these lenses can correct optical imperfections that eyeglasses and soft contacts can't address, making gas permeable contact lenses or hybrids the best choice if you're looking for the sharpest vision possible.
Why Isn't My Vision Sharper After Refractive Surgery?

Despite high refractive surgery success rates, LASIK, PRK and other laser vision correction procedures don't produce perfect vision for everyone. Your results depend a great deal on the unique way your corneas respond to laser energy and how they heal after surgery.

Glare, halos and starbursts around headlights and street lights can sometimes be a problem after refractive surgery. LASIK and other procedures also can sometimes cause irregular astigmatism, with accompanying blurred and/or distorted vision.

For most people who have less-than-perfect vision after refractive surgery, problems are quite mild and usually tolerable. But for others, post-surgery vision problems can decrease overall quality of life with side effects such as eye strain, headaches and difficulty driving at night.
When Would I Need Post-Surgery Contact Lenses?

LASIK and other laser vision correction procedures reshape your eye's front surface by removing microscopic amounts of tissue from the cornea. Occasionally, this can cause irregularities in the shape of the cornea that can make your vision less distinct after surgery than it was when you wore glasses or contact lenses before the procedure.

These irregularities sometimes can be corrected with a follow-up laser procedure called an enhancement. But if your cornea is too thin for a second surgery, or other problems rule out an enhancement procedure, GP or hybrid contact lenses may be your best solution.
Post-Surgery Gas Permeable Contact Lenses

Because gas permeable contacts are rigid, they maintain their shape on the eye — unlike soft lenses that drape the cornea, losing their shape.

That's significant because the space between the cornea and the back surface of a GP lens is filled with tears. This "lake" of tears covers irregularities on the cornea's surface that cause aberrations. The smooth front surface of the GP lens then optically replaces the irregular corneal surface, eliminating blur and visual distortions.

In comparison, soft contact lenses are pliable and conform to the surface of the cornea. This means soft lenses can't achieve the same aberration-cancelling effect that GP lenses provide.

And conventional eyeglasses, which do nothing to change corneal irregularities, cannot correct the vision problems those irregularities cause. These glasses can correct only the basic refractive errors — nearsightedness, farsightedness, and regular astigmatism.
Special Contact Lens Designs for Post-Surgery Fittings

Because LASIK and other laser refractive surgery can significantly alter the shape of the cornea, fitting contact lenses on a post-surgery eye is more challenging than fitting lenses on a normally shaped cornea. Special gas permeable or hybrid lens designs usually are required in these circumstances.
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Modified GP lens designs may include a larger lens diameter, aspheric optics or a design where the center of the lens is significantly flatter than the periphery (called a reverse geometry design), similar to lens designs used for orthokeratology to correct nearsightedness without surgery.

Special computerized instruments (not needed for regular contact fitting) usually are required to obtain highly accurate, point-to-point measurements of the post-surgery corneal surface to obtain the best possible fit and vision correction. These instruments, called corneal topographers or aberrometers, use the same technology that measures the cornea before LASIK and other laser vision correction surgery.

Because of these added complexities, contact lens fittings after refractive surgery typically are more time-consuming and involve a higher fee than regular contact lens fittings. Also, if you've never worn GP lenses before, be aware that it takes longer to adapt to them than to soft contacts. You may have to wear the lenses at least part-time every day for several days before they feel completely comfortable.

Fitting GP contacts on an eye that has undergone refractive surgery requires special skills similar to those needed to fit lenses irregular-shaped corneas caused by keratoconus or a cornea transplant. Several lens modifications may be required to achieve the optimum fit, comfort and visual acuity. For best results, you may need to ask your eye doctor to refer you to a colleague who specializes in contacts for hard-to-fit-eyes.
New Technologies: Hybrid Contact Lenses and High-Definition Eyeglasses

Recently, two new eyewear technologies were introduced that offer an alternative to GP contact lenses for correcting irregular astigmatism and higher-order aberrations after eye surgery.
GP lenses
SynergEyes hybrid contact lenses have a rigid GP lens in the middle with a soft skirt for comfort.

Hybrid contact lenses are designed to offer the best of both worlds: aberration-correcting optics of a rigid GP lens and wearing comfort that is comparable with soft contact lenses.

Early reports suggest hybrid contact lenses are equally effective as gas permeable contacts in correcting aberrations after vision surgery, and may be easier to adapt to than GP lenses.

Currently, the only FDA-approved hybrid contacts sold in the United States are made by SynergEyes, Inc. (Carlsbad, Calif.).

New high-definition eyeglass lenses also may provide sharper vision after eye surgery than conventional eyeglasses.

One brand, called iZon High Resolution Lenses, uses LASIK-style wavefront measurements to create a custom lens design for each wearer. In addition to correcting common refractive errors like nearsightedness, iZon lenses also can correct some degree of irregular astigmatism and higher-order aberrations for improved night driving vision, according to the manufacturer.

Other types of high-definition eyeglass lenses created with ultra-precise "free-form" technology also are designed to reduce certain visual aberrations and provide sharper vision than conventional eyeglasses.

For more information about vision correction after eye surgery and to determine which method is best for you, ask your eye doctor.

When LASIK Goes Wrong

After considering testimony about unfavorable LASIK outcomes, an FDA panel in early 2008 declined to consider a moratorium on the procedure as some speakers had urged. Instead, FDA officials recommended clarifications in information presented on the organization's Web site and in patient disclosure forms that would make the risks of LASIK surgery clearer. The FDA also launched an ongoing LASIK Quality of Life project to collect detailed information about safety and patient satisfaction.

Although the vast majority of LASIK surgeries go well, some experiences with poor outcomes — presented at an April 2008 FDA hearing — provide cautionary tales.

By all accounts, Dominic Morgan should never have had LASIK. At birth, he had retinopathy of prematurity. This condition limited his vision to about 20/50 (not good enough to drive in most states), even with eyeglasses and before he ever underwent LASIK.

The surgeon who performed his LASIK procedure in 1998, in the early days of laser eye surgery, used an unapproved laser. Pressure from the eye suction ring used in the procedure effectively destroyed his fragile retinas, leaving him legally blind.

Morgan maintained that the surgeon illegally advertised the procedure and didn't give him the appropriate information before surgery. In retaliation, he founded his own Web site to share his experience with others.

Gerard Dorrian testified that his son, Colin, had LASIK surgery in 2001, when he was a law student at the University of Michigan. At the time, Colin couldn't wear his contact lenses — in fact, his eyes may have been too dry for him to have LASIK successfully.

In any case, Colin did have LASIK and ended up with poor quality vision and painfully dry eyes. Unable to cope, Colin took his own life, telling his family in a note that it was the only dignified choice.

Psychiatrist Jennifer Morse, MD, emphasized at the hearing that depression and suicide are complex and influenced by multiple factors, rather than caused by a single event.

Still, patients who have had a poor outcome from LASIK can easily fall into depression, said Terri Lynn F. Bankas, MD, who counsels a LASIK support group in Tampa, Fla. She explained that many of the people she has worked with suffer from sleep difficulties, loss of autonomy and self-anger.

She said they have experienced financial problems and estrangement from family and friends as their obsession with their vision intensified.

Some people with disabling outcomes from LASIK, like Dominic Morgan, were treated years ago with early lasers that are no longer on the market today. Modern lasers and other devices used in the LASIK procedure have generally produced very good outcomes. Nevertheless, there continues to be a small minority of cases in which, whether through bad surgery or just bad luck, the outcome is undesirable.

Joseph Schnell knows that all too well. He had LASIK in both eyes in 2007, partly because his union vision insurance covered a portion of the cost. Unfortunately, he was left with LASIK complications such as glare, halos, starbursts and generally poor vision at night.
People with a poor LASIK outcome can fall into depression; many have sleep difficulties and self-anger. [According to Terri Lynn F. Bankas, MD]

Schnell endured periods of depression, anxiety and physical ailments including nausea, which he believes were directly related to his visual problems. Although circumstances are better now, he told FDA officials that he regrets his decision to have LASIK.

Matt Kotsovolos had wavefront-guided LASIK in 2006 at an eye center where he was then the senior financial executive. Although he has 20/20 vision, he explained that he suffers from debilitating and unremitting eye pain from dry eyes.

Dry eye after LASIK is a common symptom that typically resolves in a matter of weeks or months and can usually be alleviated with artificial tears or other treatments. But for a minority of patients, like Kotsovolos, dry eye may be severe and longer lasting.

"Complications classified as 'symptoms' get buried in the medical literature," Kotsovolos told the panel of experts.
The Bigger Picture for When LASIK Goes Wrong

Although these patients had devastating outcomes, taken in context they represent a very small group — the worst possible outcomes in a largely favorable universe of LASIK results.
Of 224,000 laser vision surgeries done in the U.S. military, one person has gone on medical disability retirement as a result. [according to David Tanzer, MD, director, U.S. Navy Refractive Surgery Program]

A recent worldwide review of LASIK by the American Society of Cataract and Refractive Surgery (ASCRS) showed that more than 95 percent of patients who had the procedure were satisfied. The worldwide review examined the results of peer-reviewed studies in major scientific journals that comprise more than 32,000 patients treated in the past decade.

David J. Tanzer, MD, director of the U.S. Navy Refractive Surgery Program, reported to the FDA panel that, of 224,000 laser vision surgeries performed to date in the U.S. military, only one person has gone on medical disability retirement because of the procedure.

"If I did not believe in the safety of this procedure, I would certainly not be recommending it or performing it on naval aviators, let alone civilians," he said, noting that LASIK is overwhelmingly safe.

In a survey of Navy pilots, 95 percent said the procedure had made them more effective in their job; none said it hindered their effectiveness.
LASIK Safety Tips

These patients' stories are compelling reminders that with LASIK, like any other surgical procedure, the risks and benefits must be weighed. What can you do to stay on the right side of the statistics and avoid becoming one of the horror stories?

Read more about LASIK, including questions to ask your surgeon, at [ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط]
Get a second opinion before surgery.
Don't feel pressured to sign paperwork in a rush. Take it home, read it carefully and ask the surgeon or staff about any concerns or questions.
There are always risks in any surgical procedure. Carefully consider your own level of risk tolerance.

Ongoing LASIK Research
About 12 million people had LASIK during a 10-year period, but only 140 complaints were filed with the FDA.

FDA data showed that, although approximately 12 million people had LASIK in a 10-year period following initial approval in 1995, only 140 complaints were filed with the agency.

The FDA is partnering with the National Eye Institute and and U.S. Department of Defense on a large, multi-site prospective study on patient satisfaction and quality of life after LASIK.

Called the LASIK Quality of Life project, the study as of early 2011 included these phases:

Design of a Web-based questionnaire to assess patient satisfaction, created in part from interviews with those who have undergone LASIK.
Launch of a clinical study among U.S. military personnel who were to answer the questionnaire and provide self-reported outcomes after undergoing LASIK.
Expansion of the clinical study to include self-reported outcomes from people who have undergone LASIK at different U.S. surgical centers.

All phases of the LASIK Quality of Life project are expected to be completed in 2012. AllAboutVision com will provide updates as research continues.

Corneal inlays and onlays are made of biocompatible materials inserted into the eye that closely resemble the clear surface of the eye itself. And if current and future clinical trials prove successful, these devices may soon represent a new form of vision correction surgery.

In LASIK and PRK, vision correction is achieved when laser energy reshapes the cornea to alter the way light rays enter the eye.

Corneal inlays or onlays also alter the way light rays enter the eye, much like contact lenses. Unlike contact lenses, however, these devices never require regular removal or ongoing care. And they differ from surgically implanted lenses because they are not placed behind the cornea. Also, a corneal inlay or onlay is designed to seamlessly "merge" with the eye's surface.

Through use of inlays and onlays for vision correction, eye surgeons may avoid complications sometimes associated with procedures such as LASIK and PRK because no corneal tissue is removed. And these devices may have fewer risks than implantable lenses because the surgery takes place within the cornea, not inside the eye.
Kamra Corneal Inlay

While the technology is not yet FDA-approved, clinical trials began in early 2006 for one device created by AcuFocus (Irvine, Calif.), which has formed a business alliance with Bausch + Lomb (Rochester, N.Y.).

Previously called the ACI 7000 and now known as the Kamra, this corneal inlay is designed to correct near vision focusing problems caused by aging — a condition known as presbyopia. With this inlay, a thin flap is created on the eye's surface where the device is applied. The flap then is replaced over the inlay to hold it in place.
AcuFocus ACI 7000 corneal inlay
The Kamra corneal inlay (left) is used for presbyopia correction. Here it is shown next to a typical contact lens. (Image: AcuFocus)

The procedure takes less than 15 minutes and can be performed in the eye surgeon's office. Sutures are not required, and only topical anesthesia in the form of eye drops is used.

According to Bausch + Lomb, the Kamra is designed to block certain light rays reflecting from near objects that ordinarily would not be focused correctly by the presbyopic eye.

"Its optical principle is the pinhole phenomenon, which when used in photography (in terms of a small aperture), creates greater depth-of-focus and thus allows clear vision at all distances — near, intermediate and distance," said Vance Thompson, MD, who is participating in clinical trials for the device.

Thompson, a member of AllAboutVision.com's editorial board, said it's important to remember that the Kamra is still in investigational phases, but that early results are very promising.

"Having worked in the field of presbyopia correction for more than 18 years, I find it is such a pleasure to use a device like the AcuFocus corneal inlay," Thompson said. "It provides our patients who have needed reading glasses with good near vision, while still maintaining good distance vision."

Thompson said the Kamra is just 3.8 millimeters in diameter and only 10 microns thick (about 1/10th the thickness of a piece of paper). The device is made of an opaque biocompatible polymer called Kynar, a thermoplastic material that softens in heat and hardens in cooler conditions.
Vue+ (PresbyLens) Corneal Inlay

Researchers from Mexico presented promising early results from surgical implantation of the PresbyLens corneal inlay (ReVision Optics, Lake Forest, Calif.) during a 2009 American Society of Cataract and Refractive Surgery (ASCRS) conference.

The tiny (2-mm diameter) inlay, recently renamed Vue+, is placed under a thin flap or within a pocket to steepen the cornea's shape. The inlays appear to improve near and intermediate vision, as demonstrated by a study involving 38 people who received the PresbyLens implants in their non-dominant eyes:

All people enrolled in the study ranged in age from 45-56.
Six months after receiving the implant, most people could perform near vision tasks such as reading a newspaper without the need for eyeglasses.
Most subjects also did not require eyeglasses for intermediate tasks such as reading a computer screen.
All study participants had 20/25 or better distance vision in both eyes.
Only one adverse event was reported, when an inlay needed to be repositioned.

The Vue+ corneal inlay is placed within the cornea under a LASIK-style flap. When in position, the PresbyLens inlay changes the curvature of the cornea so the front of the eye acts much like a multifocal contact lens.

The inlay increases magnification power in the center of the cornea for near vision and allows the paracentral zones of the cornea to be used for intermediate and distance vision.

In September 2010, company officials announced they had filed for FDA clearance to expand a U.S. clinical trial by conducting a three-year evaluation of the Vue+ involving about 400 presbyopic participants implanted with the inlay.
Flexivue Microlens

The Flexivue Microlens (Presbia Coöperatief U.A., Amsterdam) uses a laser, which creates a tiny "pocket" just below the eye's surface. Eye surgeons use a specially developed instrument to then insert the microlens for correction of presbyopia. The pocket seals itself to hold the lens in place.

The lens is made of hydrophilic polymer, a highly wettable synthetic substance often used in intraocular lenses that permanently replace the eye's natural lens in cataract surgery. However, the Flexivue Microlens is permanent but can be easily removed and replaced if a stronger prescription is needed.

The tiny lens is 3 mm in diameter and only 20 microns thick at the edges — about a quarter of the width of a human hair.

This lens is being researched outside the U.S.
Corneal Onlays

W. Bruce Jackson, MD, University of Ottawa professor and chairman of ophthalmology, has helped pioneer another minimally invasive vision correction technology known as the corneal onlay. These devices are made of mostly liquid, genetically engineered collagen-like material.
Cornea onlay diagram
The corneal onlay is made up of artificially produced tissue similar to the eye's surface or cornea and can be used to reshape the eye. (Image provided by Dr. W. Bruce Jackson)

Corneal onlays do not require a thin flap, as occurs with inlays, but instead are placed in an artificially created pocket under the outer layer of the cornea (epithelium). This pocket then holds the onlay in place until the disturbed epithelial cells grow back to cover the device.

Jackson told AllAboutVision.com that laser energy ultimately might be applied to the onlay to sculpt it for vision correction, just as the eye's natural surface is now reshaped in LASIK and PRK.

The corneal onlay technology described by Jackson is still in experimental stages.

Other researchers are investigating techniques such as using biocompatible adhesives to attach an onlay temporarily to the outside of the cornea long enough to allow epithelial cells to grow over and secure the implant.

Reversibility is a major advantage of corneal inlays and onlays, which can be removed at any time

Custom LASIK surgery, also known as wavefront LASIK or wavefront-guided LASIK, uses 3-dimensional measurements of how your eye processes images to guide the laser in re-shaping the front part of the eye (cornea).

With a wavefront measurement system, some extremely precise, individualized vision correction outcomes may be achieved that would be impossible with traditional LASIK surgery, contact lenses or eyeglasses.

You should be qualified under FDA guidelines before custom wavefront LASIK is considered for your eye condition. Depending on the custom laser system used and other factors such as appropriate thickness of your cornea, you might be considered a candidate if you have mild to moderately high degrees of common vision defects such as myopia, hyperopia and astigmatism.

With custom LASIK, your eye's ability to focus light rays is measured, and a 3-D map used in wavefront technology is created that demonstrates irregularities in the way your eye processes images. Information contained in the map guides the laser in customizing the treatment to reshape your eye's corneal surface so that these irregularities can be corrected.

Standard prescriptions for glasses, contacts or traditional LASIK procedures can correct ordinary vision defects such as myopia, hyperopia, and astigmatism. But other irregularities associated with the eye's optical system could not be addressed until the advent of wavefront and related technology used in custom LASIK.
Potential Benefits of Wavefront-Guided Custom LASIK

Wavefront technology is groundbreaking because it has the potential to improve not only how much you can see, visual acuity measured by the standard 20/20 eye chart, but also how well you can see, in terms of contrast sensitivity and fine detail.

This translates into a reduced risk of post-LASIK complications, such as glare, halos and difficulty with night vision.

How much you see depends on vision defects known as lower-order aberrations associated with common refractive errors including myopia, hyperopia and astigmatism, which traditional LASIK can treat.

How well you see can depend on presence of the type and numbers of visual distortions known as higher-order aberrations, which are optical defects other than common refractive errors.

Higher-order aberrations can create problems such as decreased contrast sensitivity or night vision, glare, shadows and halos. However, higher-order aberrations do not always affect vision. Unlike traditional LASIK, custom LASIK treats both lower- and higher-order aberrations.

Custom LASIK's advantage lies in the area of quality of vision:

Greater chance of achieving 20/20 vision
Greater chance of achieving better than 20/20 vision
Reduced chance of losing best-corrected vision
Reduced chance of losing visual quality or contrast sensitivity
Reduced chance of night-vision disturbances and glare

Potential also exists for custom LASIK to treat people who have lost best-corrected vision from any past refractive surgery: LASIK, PRK, RK, etc.
LASIK surgery
Wavefront LASIK creates a highly individualized laser correction of your eye's surface, guided by precise analysis of vision errors that occur as light rays travel through your eye.

"Sometimes patients complain about vision quality problems, such as not being able to see in dim or low light. This is referred to as poor contrast sensitivity," said Roger Steinert, MD, vice chair of clinical ophthalmology and professor at University of California Irvine.

"Prior to the advent of wavefront measurements, there wasn't anything we could do to measure or treat higher-order aberrations," Steinert said. "With this technology breakthrough, we can now measure these disorders, show the patient what's going on in their eye, link that information to the laser, and actually correct higher-order aberrations that diminish contrast sensitivity. Wavefront technology enables the surgeon to improve overall vision quality better than in the past."

Not all refractive surgeons agree that wavefront-guided LASIK can treat higher order aberrations. In fact, studies show that both wavefront LASIK and conventional LASIK can sometimes cause these aberrations because of artificial changes made to the natural shape of the eye's surface.

However, wavefront-guided LASIK may be less likely to induce higher-order aberrations than conventional LASIK, according to discussion in the April 2005 issue of Ophthalmology Times.

Most refractive surgeons now use wavefront-guided LASIK in their practices, according to recent surveys such as those conducted by the American Society of Cataract and Refractive Surgery (ASCRS).
Wavefront-Guided LASIK & Contrast Sensitivity

While visual outcomes as noted on familiar eye charts can be similar for wavefront-guided and conventional LASIK, research has linked wavefront-guided procedures to better results in areas such as improved contrast sensitivity.

A study reported in June 2009* found that 84 percent of 324 eyes that underwent wavefront-guided LASIK procedures for myopia with or without astigmatism achieved 20/20 uncorrected vision or better. In specific tests measuring contrast sensitivity and night vision, significant improvement was noted. Custom LASIK was found to induce certain types of aberrations, which did not appear to affect good visual outcomes.

In certain cases, outcomes such as improved night vision with use of wavefront-guided LASIK appear to surpass results that can be achieved with conventional LASIK.

In August 2004, the U.S. Navy announced that patients at its refractive surgery center were achieving better distance vision and night vision after custom LASIK than after traditional LASIK.

In a small study, 88 percent of contrast sensitivity measurements improved after wavefront-guided LASIK, while only 40 percent improved after regular LASIK. This was one month after surgery.

Uncorrected visual acuity of 20/20 or better was achieved by similar numbers, however: 72 percent of the wavefront group and 70 percent of the regular LASIK group. The study was published in the March 2004 issue of Ophthalmology, the clinical journal of the American Academy of Ophthalmology. — L.S.


FDA-Approved Custom LASIK Systems Laser System and Manufacturer FDA-Approved Indications Features
LADARVision 4000 with CustomCornea (Alcon) Myopia: up to -8 D with or without myopic astigmatism up to -4 D

Hyperopia and hyperopic astigmatism: up to +5 D (near vision problems) and astigmatism causing distance vision problems up to -3 D Eye tracking, integrated wavefront, small spot system for precise laser application
Technolas 217z Zyoptix System (Bausch + Lomb) Myopia: up to -7 D with or without up to -3 D myopic astigmatism and total refractive error equal to or less than 7.5 D Integrated wavefront and "flying spot," meaning fast, uniform application of laser beam with each pulse for smooth corneal surface
Star S4 ActiveTrak with CustomVue (Visx, now owned by Abbott Medical Optics or AMO) Myopia: up to -6 D, with or without up to -3 D myopic astigmatism

Hyperopia: up to +3 D with or without up to +2 D for hyperopic astigmatism Eye tracking, integrated wavefront, no pupil dilation required, which speeds up procedure, unique wavefront analysis system known as Fourier for increased resolution
Star S4 IR with CustomVue (Visx, now owned by Abbott Medical Optics or AMO) Myopia: up to -6 D with or without up to -3 D of myopic astigmatism

Hyperopia: up to +3 D with or without up to +2 D of hyperopic astigmatism

Mixed astigmatism: up to 5 D Same as S4 Active Trak
Allegretto Wave with Allegro Analyzer (WaveLight, now owned by Alcon) Myopia: up to -7 D with or without up to 3 D of astigmatism Scanning spot system, eye tracking, integrated wavefront, algorithm (mathematical measurement) based on population studies that helps minimize possibility that a vision error known as spherical aberration might be induced during vision correction
Note: D refers to diopters.
How Custom LASIK Works

The process for determining a custom LASIK treatment begins with the use of a wavefront device to transmit a safe ray of light into your eye. The light is then reflected back off the retina, out through the pupil, and into the device, where the reflected wave of light is received and arranged into a unique pattern that captures your lower- and higher-order aberrations.

All of these visual irregularities are then displayed as a 3-D map, referred to as a wavefront map. This information is then electronically transferred to the laser (in wavefront-guided systems), and computer-matched to the eye's position, enabling the surgeon to customize the LASIK procedure laser treatment (or "ablation") to your unique visual requirements.
Getting Wavefront-Guided Custom LASIK

Numbers of LASIK procedures in general grew significantly in 2004 and 2005, with many leading LASIK surgeons reporting in publications such as EyeWorld (published by ASCRS) that most eligible patients were opting for more expensive custom LASIK.

However, deteriorating economic conditions in the United States and elsewhere during 2008 and 2009 caused demand for custom LASIK and similar elective vision correction procedures to plunge.

About 1.4 million LASIK procedures were performed annually in the U.S. in 2005, 2006 and 2007, according to a report filed in April 2009 by TLC Vision Corp., which operates laser surgery centers nationwide. The company report cites research from a leading industry analyst (MarketScope).

The report says the number of LASIK procedures dropped to 1 million in 2008. About 760,000 procedures were performed in the U.S. in 2009, representing almost a 50 percent decline from previous years.

Custom LASIK costs usually are significantly more than traditional LASIK, partly because surgeons pay a higher royalty fee to the device manufacturer for each procedure.

Research is continuing into expanding the degree of vision errors (such as high myopia) that can be corrected with custom LASIK. Investigations also are underway for use of custom LASIK to create multifocal corrections in a procedure known as PresbyLASIK, which would enable older eyes that have developed presbyopia to see at near, middle and distant ranges at the same time.

Investigators have reported early promising results of wavefront LASIK, combined with automated topographical measurements of the eye's surface during a procedure, to help reduce surgically induced aberrations and astigmatism. Early studies also indicate that night vision might be further improved with this approach.**

Like conventional LASIK, custom LASIK won't cure all vision-related problems, so it's important to discuss its applications with your eye doctor or surgeon to determine if you are a good candidate

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Articles On LASIK And Other Vision Surgery

Introduction
All Types of Vision Correction Surgery

LASIK:
Are You a Good Candidate for LASIK?
Ask the LASIK Surgeon (Read the Q&As)
Blade vs. Bladeless LASIK: Surgeons Debate
Custom Wavefront LASIK
Financing for LASIK
IntraLase
LASIK
LASIK Complications
LASIK Cost
LASIK Lasers
LASIK Results
LASIK Surgeon: How to Choose
LASIK Quiz

Other Refractive Surgery:
CK for Hyperopia
CK & Other Surgery for Presbyopia
Epi-LASIK
Implantable Lenses (Phakic IOLs)
LASEK
PRK
Refractive lens exchange (clear lens extraction)

FAQs, News, More:
Eye Doctor Q&A
LASIK & PRK FAQs
News on Refractive Eye Surgery
What's Better for You: 30-Day Contacts or LASIK?



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Information for Patients Seeking LASIK in Abu Dhabi

Professor Dan Z. Reinstein MD, MA, FRCSC, is a widely recognized expert in refractive surgery and the Medical Director of London Vision Clinic, a premier provider of LASIK and other laser vision correction procedures. Prof. Reinstein has helped more than 8,000 LASIK patients free themselves of the burden of wearing glasses or contact lenses. With his extensive experience, fellowship training in refractive surgery and board certification by ophthalmology boards in three countries (UK, U.S. and Canada), Prof. Reinstein is considered one of the Europe's top LASIK surgeons. As a result, many patients from the Middle East, including Abu Dhabi, have chosen London Vision Clinic for their vision correction needs. Prof. Reinstein and his skilled team work hard to ensure that every one of their patients achieves optimal vision.
London Vision Clinic Is a Top Facility in Europe

At London Vision Clinic, each patient undergoes a meticulous examination so that Prof. Reinstein can determine which treatment will result in the best vision. Prof. Reinstein has also developed special techniques to follow the progress of his patients after surgery.

Dr. Reinstein provides careful individualized treatment, ensuring the most precise customized results.

Professor Reinstein uses the state-of-the-art Carl Zeiss MEL-80 excimer laser when performing LASIK surgery. This advanced laser platform utilizes wavefront technology to chart the curvature of the patient's eye, producing a map of any irregularities, including higher order aberrations that traditional laser platforms are unable to spot. With this map in hand, Prof. Reinstein is able to customize each patient's treatment and produce better outcomes.

Patients who cannot have LASIK due to certain eye conditions have several other vision correction options. This includes phakic IOLs, LASEK and PRK, all of which can yield exceptional results. If you are interested in learning more about these options, contact Prof. Reinstein today.