Laser vision correction

Refractive error, or a need for corrective lenses, comes in many forms. There are two components of the eye that focus light rays on the retina, the cornea and the lens. These two components together can be thought of as analogous to the lens of a camera which focuses light rays on the film. In this analogy the retina of the eye can be thought of as the film in the camera. If light rays are focused sharply by the camera lens on the film, the photograph is clear and sharp. If not, the image is blurred. The same is true in the eye where light rays must be focused sharply on the retina or the image will be perceived by the brain as blurred.

Myopia, commonly referred to as near-sightedness, is a condition in which people see clearly at near but blurred at distance. Most commonly this occurs because the eye is longer than needed for the power of the cornea and lens causing light rays to come into focus in front of the retina. Hyperopia, commonly called far-sightedness, is the opposite problem where light rays are focused at a hypothetical point behind the retina. Astigmatism occurs when the cornea is shaped more like a cylinder (such as the shape of a football) than a sphere (such as the shape of a basketball) which leads to multiple images being cast on the retina. Finally, presbyopia begins to occur in most patients around the age of 40 when the lens begins to lose the ability to change its shape to focus on images at near.

All of the above conditions can be treated well with glasses or contact lenses. Some patients, however, feel that glasses or contact lenses are inconvenient for various reasons and they choose to be evaluated for refractive surgery.

» LASIK
» PRK
» Refractive Surgery using Wave-Front Technology
» VISX CustomVue Advantage
» INTACTS

LASIK
LASIK is one of a number of alternatives for correcting nearsightedness (myopia), farsightedness (hyperopia) and astigmatism. In LASIK, a device called a microkeratome is used to shave the cornea to create a flap. In order to do this accurately, the pressure inside the eye needs to be raised to a high level. The flap then is opened like the page of a book to expose tissue just below the cornea's surface. Next, the excimer laser is used to remove ultra thin layers from the cornea, to reshape it to reduce nearsightedness, farsightedness, and astigmatism. Finally, the flap is returned to its original position, without sutures. There are several advantages and disadvantages to LASIK which can be discussed at length during your consultation.

PRK
PRK is similar to LASIK in many ways. Much like LASIK, the excimer laser is used to precisely reshape the cornea according to your prescription or custom wavefront imaging map. In PRK, however, the microkeratome is not used to make a flap in the cornea. Instead the epithelium, the most superficial layer of the cornea is removed and the laser performed on a more superficial part of the cornea. The laser used in PRK is identical to that used in LASIK and the visual results are comparable. After the procedure a contact lens is placed on the eye and the epithelium is allowed to regrow over the next 3-5 days, after which the contact lens is removed. The advantages and disadvantages of PRK can be discussed at length during your consultation. There may be reasons why you are a better candidate for PRK or possibly only a candidate for PRK and this will also be discussed.

Refractive Surgery Using Wave-Front Technology
Wave front technology represents a new advance in refractive surgery in which a highly advanced diagnostic wave scan is taken of the eye. This scan can be thought of as a fingerprint of the eye’s visual system. This information is then input into the laser where it can be directly translated onto the surface of the eye providing an individualized pattern of laser correction. This technology is not good for every individual but can be a significant advance in surgical outcomes when used correctly. All patients are assessed for custom LASIK using wave front technology during their refractive consultation.

VISX CustomVue Advantage
The Fingerprint of Your Vision
Your vision is unique - as personal as your fingerprint or your DNA. WaveScan technology provides your eye doctor with a map of your eye.

WaveScan Technology

Initially you will meet with Dr. Schwartz for a complete medical evaluation and eye history to determine whether you are a good candidate for the CustomVue procedure. Your doctor will discuss the benefits and risks of the procedure with you. A corneal topographic measurement will be taken to map the unique characteristics of your eye. With this map, your doctor will be able to:

Accurately assess whether you're a good candidate for laser vision correction.
Along with the other diagnostic tests that your doctor performs, an individualized treatment plan can then be developed to address your unique vision needs.

Once it is confirmed that you are a good candidate, your doctor will schedule you for a CustomVue procedure. Your doctor will provide details to you on how to prepare for the day of the procedure.

The CustomVue Procedure

On procedure day, you will be seated in a reclined position. Anesthetic drops will be placed in your eyes and a flap will be created on your cornea. Your individualized treatment information is transferred from the WaveScan to the laser in order to drive the CustomVue procedure. The actual laser procedure typically takes several seconds. Most individuals feel no pain during the procedure.

After CustomVue, you will notice results immediately, and your vision will continue to improve over the next few days. Typically, you will be scheduled for a follow-up visit the next day, again in about a week, and again around a month after the initial procedure.

Please review the important information contained in the CustomVue Patient Information Booklet and Patient Information Sheet.

STAR S4 Laser
The VISX STAR S4 Excimer Laser System

The VISX STAR platform's heritage of dependability and performance is well known. The STAR S4 from VISX has taken that reputation to an even higher level. Our latest excimer laser system represents the most advanced laser technology platform available today. Integrating data collected by the WaveScan WaveFront System, the STAR S4 utilizes these exclusive VISX technologies to deliver precision custom ablations:

Iris Registration (IR): The first FDA-approved, fully automated, non-contact method of alignment of the correct CustomVue treatment to the corneal site
Variable Spot Scanning (VSS): Variable beam sizes from as small as 0.65 mm up to 6.5 mm scanned over the treatment area, conserving tissue and optimizing treatment times
Variable Repetition Rate (VRR): VRR delivers treatment at varying repetition rates, optimizing treatment time
ActiveTrak 3-D Active Eye Tracking: Captures all 3 dimensions of intra-operative eye movements—no dilation required
ActiveTrak Automatic Centering: Locates, and then automatically sets the treatment center to the center of the pupil.

Click the following link to see an overview of the customVue procedure:
http://www.visx.com/candidates/customvue_advantage/customvue_procedure.php

INTACTS
Intacts are thin plastic corneal implants that when inserted into the cornea change the shape and therefore refractive power of the eye. They can be useful in select patients to treat both myopia (near-sightedness) and certain types of corneal disease. Dr. Schwartz has researched this area extensively and authored some of the longest term peer reviewed studies in the literature in this area.