Q & A - San Jose and Mountain View LASIK and PRK Information
Peninsula Laser Eye Medical Group serves Mountain View, San Jose, and surrounding areas. Patients interested in LASIK, PRK, and other vision care treatments can review the information provided below to learn more about the advanced eye care options available at our center.
- What is the difference between myopia, hyperopia, astigmatism, and presbyopia?
- Is wavefront LASIK the best option for me?
- Is “all-laser” or IntraLASIK a safer or better form of LASIK?
- Why should I choose Dr. Beers or Dr. Volpicelli for my laser treatment?
- Is 20/20 vision guaranteed following my LASIK procedure?
- Am I a candidate for LASIK if I have a thin cornea?
- Is the laser vision procedure painful?
- What if I move my eye during the laser procedure?
- When can I resume normal activities following my procedure?
- Do I need medications following my procedure?
- What are the risks associated with laser vision correction?
- How long will laser vision correction last?
- Are all excimer lasers the same?
- Are there procedures besides laser vision correction that I should consider?
What is the difference between myopia, hyperopia, astigmatism, and presbyopia?
Myopic patients are near-sighted, meaning they are able to see well up close, but their distance vision is poor. In myopia, the cornea is too steep relative to the length of the eye.
Hyperopic patients have a cornea that is too flat relative to the length of the eye. These patients must use their own lens inside their eye to focus on objects in the distance. In order to read, hyperopic patients must bend the lens inside the eye to bring closer objects into focus because they are far-sighted.
As we age, the lens inside the eye becomes less flexible. Hyperopic patients often find reading difficult without glasses by their thirties. With time the lens gradually loses its elasticity and hyperopic patients develop blurred vision of distant objects as well. This process of lens stiffening is called presbyopia.
Astigmatism refers to a curvature of the cornea where one axis is steeper than another. Astigmatism causes blurring of vision for both near and distant objects.
We are now able to correct myopia, astigmatism, and hyperopia with laser vision correction. Unfortunately, we do not have a cure for presbyopia. Some patients over 40 years old choose to leave one eye slightly under corrected to help with reading. This option is called monovision. Many patients can try a monovision trial first with contact lenses and then decide how they would like their eyes treated with the laser.
Is wavefront LASIK the best option for me?
Wavefront™ technology refers to the most updated and sophisticated method to analyze and treat one’s refractive error. Wavefront™ technology was first introduced in 2003 and is now available for both low and high levels of myopia, farsightedness and astigmatism. The Wavefront™ guided laser treatment is a more customized and exact method of programming and applying the laser treatment pattern to the cornea. At Peninsula Laser Eye Medical Group, we have treated thousands of patients with Wavefront™ technology and we have found our Wavefront™ treated patients to have less nighttime glare or halo symptoms and a higher chance of seeing 20/20 that our patients receiving conventional LASIK treatment. Therefore, we currently recommend that nearly all patients who are candidates for Wavefront™ receive this technology. The Wavefront™ technology is slightly more expensive but we feel the excellent results are worth the extra price. A small pupil size or a thin cornea can prevent a patient from being a candidate for this technology.
Is “all-laser” or IntraLASIK a safer or better form of LASIK?
With IntraLASIK, the making of the flap is completed with a femtosecond laser rather than a mechanical microkeratome. This is a different type of laser than the excimer laser we use correct the refractive error. The IntraLase laser produces tiny microscopic gas bubbles into the interface of the collagen sheets of the cornea to cause separation of the cornea layers. The surgeon can then lift the corneal flap to prepare the eye to receive the excimer laser treatment to correct the refractive error. At PLEMG we have studied the final visual outcomes between patients that have received Intralase corneal flaps versus mechanical corneal flaps and we have found no statistical difference. IntraLase can be an important tool for some patient with thin corneas or those with a corneal epithelial dystrophy. IntraLase is a more expensive technology and at your consultation we discuss the various options of creating the protective flap of the cornea with each patient and decide on a case-by-case basis which method is best for each individual. With either method the risk of a less than perfect flap is very rare in our hands, less than one in 3000 cases. This high success rate allows us to confidently recommend either method of creating the protective flap for our patients.
Why should I choose Dr. Beers or Dr. Volpicelli for my laser treatment?
The LASIK eye surgeons at Peninsula Laser Eye Medical Group are board certified with extensive laser eye surgery experience. They have successfully completed thousands of laser vision correction procedures and have been FDA, VISX, and Norwood Abbey clinical investigators to evaluate leading edge laser vision technology. Both doctors are on the clinical staff at Stanford University and have been certified by CRSQA (The Council for Refractive Surgery Quality Assurance), an independent organization that assesses the quality of LASIK surgeons. Both doctors have also been the Chief of Ophthalmology at El Camino Hospital and have been the choice of physicians, surgeons and nurses in the Bay Area for laser vision correction. Our practice is built on personalized care and excellent visual results. Rather than advertise heavily and rely on professional athletes to market our practice we choose to concentrate on understanding our patient’s visual needs and then customize the treatment that is best suited for each patient. Our practice has grown and continues to grow based on our word of mouth referrals from happy and enthusiastic patients.
Realizing that LASIK is not the perfect procedure for each patient, we are also proud to offer alternatives to LASIK such as the Crystalens™, an intraocular lens procedure which helps one accommodate for near vision; state-of-the-art, “no stitch” cataract surgery; refractive lensectomy; and even corneal transplants. We are most interested in having our patients being satisfied and seeing their best with the procedure that is right for their eyes well into the future.
Our hallmark is an emphasis on personalized care, which means that each patient meets with their own surgeon so that all of their questions can be answered. Before and after your procedure, your surgeon will see you personally for all visits. We are most interested in having our patients being satisfied and seeing their best with the procedure that is best suited for their eyes.
Is 20/20 vision guaranteed following my LASIK procedure?
Though LASIK and other forms of laser vision correction yield excellent results, patients do not always achieve 20/20 vision. Generally our patients experience a 92 percent chance of seeing 20/20 or 2025 in each treated eye. With an enhancement procedure these percentages are even higher. Factors that determine your probability of achieving 20/20 vision involve the amount of pre-surgical refractive error, the best-corrected pre-operative vision, and corneal shape. Our surgeons achieve the high quality results that are necessary to be certified by the Council For Refractive Surgery Quality Assurance (CRSQA).
Am I a candidate for LASIK if I have a thin cornea?
If your cornea is thin then LASIK may not be an option. It is important to leave a certain amount of corneal thickness untouched so that the cornea retains its strength and stability. For some patients the cornea may not be thick enough for the surgeon to make a protective flap of the cornea. In these cases we perform an “advanced surface ablation” treatment. Forms of surface ablation treatment include PRK, LASEK, and epi-LASEK. These procedures involve the displacement of only the top superficial layer of the cornea, the epithelium. In PRK this layer is simply removed to prepare the cornea for the excimer laser. In LASEK a solution is placed to loosen the epithelial cells and the cells are remove in a thin sheet and then repositioned after the excimer laser treatment. With epi-LASEK, a mechanical plastic epithelial separator is used to separate the epithelium that is then repositioned after the excimer laser treatment, similar to replacing a bed-sheet over a mattress.
Surface ablation treatments yield excellent visual results like LASIK but the healing process often takes several days rather than one day as with LASIK. We find LASEK and epi-LASEK patients to be more comfortable and heal quicker than PRK patients so we are favoring these procedures over PRK. In 2005, we participated in a national multi-center study using epi-LASEK and found epi-LASEK to be a safe and effective method of laser vision correction when compared with standard PRK.
Is the laser vision procedure painful?
There is no pain during LASIK eye surgery, though mild foreign body sensation can occur post-operatively for the first several hours. During LASIK surgery, patients have reported a sensation of brief pressure when the corneal flap is being fashioned. PRK and surface ablation patients can experience a moderate foreign body sensation for 2-4 days following their procedure.
What if I move my eye during the laser procedure?
At our Mountain View and San Jose area LASIK and PRK, the laser eye surgeon uses a microscope to track and observe your eye movement during treatment. If the surgeon notices any major eye movements, he can immediately stop the laser. Your surgeon can safely resume the procedure once the eye is realigned. Additionally, at Peninsula Laser Eye Medical Group we use the VISX Star 4™ active pupil tracker to ensure our accuracy and your safety.
When can I resume normal activities following my procedure?
In most cases, patients are able to return to work the day after LASIK eye surgery and can return to their normal exercise routine a few days later. Following PRK, your vision will be blurred for the first few days making some activities, such as driving, difficult.
Do I need medications following my procedure?
You will require topical eye drop antibiotics and anti-inflammatory medication following your eye treatment. PRK patients may use anti-inflammatory eye drops for a few months in order to prevent the formation of corneal haze. LASIK patients only require eye drops for a week.
What are the risks associated with laser vision correction?
Complications associated with surface ablation and LASIK are uncommon. Some possible side effects associated with surface ablation include pain during the first two days and blurry or unfocused vision for the first week. Other possible surface ablation side effects include reduced night vision, a temporary elevation in eye pressure when taking eye drops, and in very rare cases, a decline in visual acuity following successful surgery. LASIK surgery shares some of the same risks as surface ablation, though with LASIK there is generally less discomfort, less risk of developing corneal haze, and a much shorter healing period. Forming the protective flap of the cornea, using the IntraLase laser or with a mechanical microkeratome, is very safe but if the flap is not perfect then the laser treatment cannot be completed on the same day. The procedure can be repeated again in three months once the corneal flap has healed. Fortunately, it is very rare (less than one in 1500 cases) for the corneal flap to be irregular in any way. At PLEMG, our attention to detail and surgical experience make our complication rate extremely low. During your preoperative appointment, your surgeon will address any concerns and answer any questions you may have about refractive surgery and your specific risk factors.
How long will laser vision correction last?
Following laser vision correction, the shape of the cornea is permanently altered. Although sometimes regression after successful laser vision correction can occur, especially in significantly high myopia. There is the possibility that your ability to see distant objects may fluctuate slightly in the years following laser eye surgery. If both of your eyes receive laser vision correction for distance correction, then reading glasses will likely be required by age 45-50 due to the effects of presbyopia (see FAQ question #1 for an explanation of presbyopia). We have performed laser vision correction since its FDA approval in 1995 and it is unlikely for a patient to need a second procedure, even ten years after the initial procedure.
Are all excimer lasers the same?
Not all excimer lasers are the same. At Peninsula Laser Eye Medical Group, our laser eye surgeons use the VISX Star 4 wavefront excimer laser with the latest software available to ensure our accuracy and your safety. Dr. Mark Volpicelli and Dr. Dan Beers treated each other with the VISX laser to correct their myopia and astigmatism.
Are there procedures besides laser vision correction that I should consider?
LASIK remains the safest and most accurate vision correction procedure for most patients. However, technology is always changing and there are new intraocular lenses that may be the best choice for certain patients. If we find an early cataract (a clouding of the eye’s natural lens) then a lens replacement procedure using the Crystalens or a multifocal intraocular lens may be the best choice for clear vision. In the near future an implantable contact lens may be available for those patients with severe refractive errors that are not candidates for LASIK. At PLEMG, we offer more than LASIK so we are able to offer each patient the procedure that is most appropriate for their visual needs and eye health.
Contact Peninsula Laser Eye Medical Group, serving San Jose and Mountain View, for more information on LASIK, PRK, and other vision care options.
