LASIK and Options For Presbyopia By Wasif

Many medical conditions are associated with aging. Just as your bones and joints show wear and tear or aging signs as you start to age, so will your eyes. Presbyopia is one of the most common aging-related problems that affect the eyes. The word Presbyopia literally translates to “old person” in Greek. The condition is characterized by the eye’s inability to focus on both near and far objects.

Speculators and theorists alike suggest many causes of Presbyopia, yet no certain explanation can explain the condition’s cause. Research however not so long ago indicated that the condition Presbyopia may be caused from a loss of elasticity in the crystalline lens while other experts think it is actually changes in the curvature of the lens from continued growth and loss of strength in the Ciliary muscles, which the weakness hinders the eye’s ability to help the lens to hold its shape.

Naturally, aging causes various eye conditions to develop for many people. Some people believe that those who are at risk of Presbyopia do not have preventive tactics they can use to slow or stop the aging disease. This is not true. (Learn about exercise and healthy eating to reduce risks of all diseases)

LASIK comes with risks and benefits and any patient should learn about these benefits and risks before going to surgery. Some of the patients (With hidden symptoms of Presbyopia) who have had LASIK surgery had experienced vision problems to the point their vision began to deteriorate.

While there is no sure cure for Presbyopia, doctors will use standard eye corrective treatment to help correct the eye problems. Eyewear is commonly used, which doctors will recommend reading glasses for those with mild cases of Presbyopia, and will recommend bifocals or progressive lens for those with more serious case of Presbyopia. Reading glasses are used as sort of magnifying glasses to help a person read smaller print. Progressive lens and bifocals are used to treat certain Presbyopia conditions, which the doctor must provide two different prescriptions. One of the prescriptions is used to treat nearsightedness while the other prescription treats farsightedness. The doctor will clearly separate the prescriptions for bifocal lens, while the progressive lens are prescribed and tend to blend with the other.

Thanks to advances in eyewear, people with Presbyopia can also choose three types of contacts. Now patients have a choice of monovision contact lenses, bifocal contact lenses, and multifocal contact lenses. Monovision lenses, as their name suggests, targets one eye at a time. In other words, the dominant eye lens is adjusted so the patient can see at greater distance while the non-dominant eye lens is used for near or close vision.

Initially, patients who are prescribed monovision lens may find it difficult at first to wear the lens. In many instances doctors will need to adjust the lens to fit the patient’s needs. The eyes and the brain must also adjust to the lens however.

Bifocal contact lenses work in a similar ways to bifocal glasses. The doctor will give the patient two different prescriptions. Two different prescriptions are also given to patients who are prescribed multifocal lens. The lens gives the eye the ability to see at multiple focus points while viewing near or far objects.

LASIK surgery has provided great results for millions of patients. As the procedure improves or advances, there are now methods available for patients with conditions like myopia, hyperopia, and astigmatism. Unfortunately, traditional LASIK is still not a good option for patients diagnosed with Presbyopia.

What puts a Presbyopia patient at risk of LASIK is the fact that because the symptoms are often hidden, doctors usually do not diagnose the patient in time. This means the patient may seek corrective eye care from LASIK and not even know they have Presbyopia.

Because of the commonness of the disorder, much research is being done on Presbyopia, and surgeons are looking for alternative treatments. Some options are already available. Today, some surgeons are combining Conductive Keratoplasty and LASIK Monovision to correct near and distant vision problems in two separate operations. Doctors also consider Presbyopia Reversal with Sclera Expansion bands, Laser Presbyopia Reversal, and Anterior Ciliary Sclerotomy to correct eye problems. Surgeries such as Crystalens, ReZoom Multifocal Intraocular Lenses, and ReSTOR intraocular lenses replace LASIK surgery and are often used to enhance the eye’s lens by using Crystalens.

At this time there is no known LASIK procedure capable of repairing damaged caused from Presbyopia. Sciences however are working hard each day to find other alternatives for Presbyopia patients.

Surgery for Presbyopia By Wasif

Even if you undergo LASIK or PRK as a young person and achieve perfect vision, you still will develop a condition called presbyopia typically beginning between the ages of 40 and 50. Presbyopia is the inability of the eye to focus at all distances, usually noticed when fine print starts to blur.

Some eye doctors disagree about what causes presbyopia. Most believe stiffening of the eye's lens contributes to the condition. Other theories suggest that presbyopia also could be related to continued growth of the lens or atrophy of the muscles controlling the lens.
In the past, the usual remedy was to wear reading glasses or special multifocal lenses (bifocal or progressive) for presbyopia. But in modern times, surgical remedies for presbyopia also are available for qualified candidates.
One of the first effective surgical options for presbyopia correction involved producing what is known as "monovision" during LASIK. But other surgical procedures such as conductive keratoplasty or CK (see below) also have been approved by the FDA, which gives eye surgeons additional options for correcting this common vision problem.
Several other experimental devices and procedures also are under investigation, but not yet FDA-approved. Here is a rundown.

Monovision and LASIK

Producing monovision is one way eye care professionals deal with presbyopia. Normally, both your eyes work together equally when you look at an object, to produce what's called binocular vision. However, you probably have a dominant eye that your brain tends to favor for "sighting" (most right-handed people are right-eye dominant, for example).
Contact lens fitters often take advantage of this "one-eye dominance" to produce monovision, where typically the dominant eye is prescribed a contact lens power for optimum distance vision and the other eye is fit with a contact lens that has a modified power to provide good near vision. To a large extent, binocular vision is preserved in monovision — so you have adequate depth perception for driving, for instance. But one eye sees more clearly in the distance, and the other eye sees better up close.
Some LASIK surgeons will produce monovision in their presbyopic patients by purposely leaving the non-dominant eye slightly nearsighted so that these patients can see up close without glasses. Other surgeons are wary of the technique because not everyone can become accustomed to monovision. It's a good idea to try monovision with contact lenses or trial lenses in the doctor's office first to be sure you can adapt to it before you opt for monovision LASIK.
Monovision LASIK initially was used off label, meaning that it had not received official FDA approval as an approach to correcting presbyopia. But in July 2007, the FDA announced approval of the Abbott Medical Optics (AMO, formerly Advanced Medical Optics) and Visx CustomVue excimer laser for performing the monovision procedure.

A surgeon performing CK first numbs the eye with drops. A circular treatment pattern then is imprinted in ink on the cornea. This pattern helps guide a tiny probe as radio waves are applied to shrink collagen. The treatment works like a belt to tighten and steepen the curvature of the cornea, resulting in better near vision. (Drawings provided by Refractec.)

Monovision and Conductive Keratoplasty (CK)

Conductive keratoplasty uses low-level, controlled radio-frequency energy to shrink collagen fibers in the periphery of the cornea. This steepens the central cornea, in effect lengthening a too-short eyeball.
CK was FDA-approved in 2002 for the temporary reduction of farsightedness, then received approval in April 2004 for the temporary improvement of near vision in people with presbyopia.
In a monovision technique called NearVision CK (Refractec, Irvine, Calif.), conductive keratoplasty is performed on one eye only — usually the non-dominant eye — to correct presbyopia in a person who can see well in the distance without glasses or contact lenses, but who needs help with near vision.
Again, it's a good idea to try monovision with contact lenses or a trial lens in the doctor's office before undergoing NearVision CK, to make sure you'll adapt to it. After the three-minute procedure you'll likely notice improvement in your reading vision, but it can take a few weeks before you reach the final level of vision correction.
One attractive feature of CK is that it is minimally invasive. Some people experience tearing, foreign-body sensation and/or vision fluctuation, but this is normally temporary.

IntraCor

Intrastromal correction of presbyopia, known as IntraCor (Technolas Perfect Vision), has shown promising results outside the United States. The procedure uses a femtosecond laser to create precisely placed gas bubbles, which then reshape the interior of the cornea without penetrating the outer surface. This means less chance of infection, inflammation or other complications.
Researchers so far report significant improvement in near vision, as long as ample light is provided for tasks such as reading fine print. The technology, backed by Bausch & Lomb (Rochester, N.Y.) and 20/10 Perfect Vision AG (Heidelberg, Germany), is approved in Europe for presbyopia correction in people with farsightedness.

Artificial Lenses (Refractive Lens Exchange or RLE)

One currently available option for presbyopia correction involves removing the eye's natural lens and inserting an artificial one in a procedure identical to cataract surgery. While this surgical procedure is not FDA-approved specifically for presbyopia correction, it may be available off label for qualified candidates.
The surgical procedure, known as refractive lens exchange (RLE) or clear lens extraction, is becoming more popular because of the recent availability of four FDA-approved multifocal or accommodating artificial lenses capable of correcting presbyopia.

Multifocal LASIK (PresbyLASIK)

Different zones in a multifocal artificial lens correct vision at near, intermediate and far ranges. In an investigational procedure known as multifocal LASIK or presbyLASIK, similar zones are created on the eye's clear front surface (cornea) with an excimer laser to correct presbyopia. PresbyLASIK is an investigational procedure, which is not yet FDA-approved. U.S. clinical trials investigating the effectiveness and safety of the procedure currently are being conducted.

Corneal Inlays & Onlays

Corneal inlays and onlays are inserts placed just beneath your eye's clear surface (cornea). Because the inserts alter the way light enters your eye, near vision is improved.
One insert currently undergoing FDA clinical trials is the ACI 7000 (AcuFocus and Bausch & Lomb), which uses principles similar to how a camera works. In a camera, the aperture opens or closes to control exposure to light and refine focus. When the aperture is small, greater depth of focus is achieved. In the same way, the ACI 7000 corneal inlay corrects presbyopia by controlling the amount of light that enters your eye and increasing the range of what you see in focus.
Other corneal inlays under investigation include:

• InVue intracorneal microlens (Biovision, Brügg, Switzerland), which is placed in a tiny tunnel in the center of the cornea.
• PresbyLens (ReVision Optics, Lake Forest, Calif.), an ultra-thin lens implanted in the cornea.
• Presbia Flexivue System (Presbia Coöperatief U.A., Amsterdam), which uses a femtosecond laser to create a tiny "pocket" into which a micro-lens is inserted.

Corneal onlays use genetically engineered, collagen-like lens material placed in a pocket under the outer layer of the cornea to achieve better focus. In the future, lasers also may be used to reshape this material to refine focus without altering the eye itself.

Recovering from LASIK eye surgery

For the first few days after having LASIK eye surgery, you should:

have baths rather than showers
keep soap and shampoo out of your eyes (it's sensible not to wash your hair for the first few days)
try not to touch or rub your eyes, or screw your eyes up
try not to get anything in your eyes - wearing sunglasses may help
not wear eye make-up
not play contact sports, swim or play racket sports, such as squash or tennis, for at least four weeks after the procedure
You should be able to return to work after two to three days. If you have questions about what you can and can't do, such as when you can drive, ask your surgeon or nurse for advice.

If you experience more than mild pain, or you have a loss of vision or increasing redness of your eye, you should contact your clinic or hospital for advice.

If you need them, you can take painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

What are the risks?
LASIK is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

There is little evidence of the long-term effects of this procedure as the treatment is relatively new.

Side-effects
These are the unwanted, but mostly temporary effects of a successful treatment.

After LASIK eye surgery you may have:

dryness of your eye(s) for up to a year after the procedure
glare around bright lights, causing a "halo" or "starburst" effect that makes night-time driving difficult - this shouldn't last more than six weeks
a drooping eyelid - but this should stop within a few weeks
Complications
This is when problems occur during or after the operation. Most people aren't affected. The possible complications of any operation include an unexpected reaction to the anaesthetic or excessive bleeding.

Very rarely, complications can lead to reduced vision or blindness.

Specific complications of LASIK are rare but can include:

mild or moderate haziness or scarring of your cornea
slight over- or under-correction of short-sightedness
some return of short-sightedness
accidental damage to your cornea - if this happens, you might need stitches
problems with the flap that is made in your cornea
your vision getting worse - but this is rare
The amount of improvement in your eyesight depends on how well your eyes heal - it can't be absolutely guaranteed. If the operation doesn't achieve the result you hoped for, you may need further LASIK treatment.

The exact risks are specific to you and will differ for every person, so we haven't included statistics here. Ask your surgeon to explain how these risks apply to you.

Laser Eye Surgery: Is It Worth Looking Into?

For Jeri Goldstein everything was a blur. Without her contact lenses she couldn't distinguish people, the scenes on television, the stars at night, and, generally, the world at large. Then, in March 1998, the 49-year-old California resident had eye surgery, and all that changed.

"After wearing contact lenses for 35 years, you can't imagine the freedom I felt," says Goldstein.

Goldstein underwent refractive eye surgery, an elective procedure intended to correct common eye disorders, known as refractive errors, such as myopia (nearsightedness), hyperopia (farsightedness), and astigmatism (distorted vision). Although there are several types of surgical techniques being performed today to correct refractive errors, laser refractive correction is fast becoming the most technologically advanced method available, according to the American Academy of Ophthalmology in San Francisco. Doctors say it allows for an unparalleled degree of precision and predictability.

"Laser surgery is the most exciting advancement in ophthalmology," says James J. Salz, M.D., clinical professor of ophthalmology at the University of Southern California in Los Angeles and the doctor who performed Goldstein's surgery. But surprisingly, he says, despite its sudden popularity, "only 20 percent of ophthalmologists in the United States today are trained in its operation."

The Food and Drug Administration first approved the excimer laser in October 1995 for correcting mild to moderate nearsightedness. With that approval, the agency also restricted use of the laser to practitioners trained both in laser refractive surgery and in the calibration and operation of the laser. Currently, the excimer laser has been approved for use in a procedure called photorefractive keratectomy (PRK), and, as of November 1998, for a procedure called laser in situ Keratomileusis (LASIK).

Precision Surgery

PRK is an outpatient procedure generally performed with local anesthetic eye drops. This type of refractive surgery gently reshapes the cornea by removing microscopic amounts of tissue from the outer surface with a cool, computer-controlled ultraviolet beam of light. The beam is so precise it can cut notches in a strand of human hair without breaking it, and each pulse can remove 39 millionths of an inch of tissue in 12 billionths of a second. The procedure itself takes only a few minutes, and patients are typically back to daily routines in one to three days.

Before the procedure begins, the patient's eye is measured to determine the degree of visual problem, and a map of the eye's surface is constructed. The required corneal change is calculated based on this information, and then entered into the laser's computer.

Since 1995, a limited number of laser systems has been approved by FDA to treat various refractive errors, both with PRK and LASIK.

According to FDA's Center for Devices and Radiological Health, clinical studies showed that about 5 percent of patients continued to always need glasses following PRK for distance, and up to 15 percent needed glasses occasionally, such as when driving. In addition, many patients experienced mild corneal haze following surgery, which is part of the normal healing process. The haze appeared to have little or no effect on final vision, and could only be seen by a doctor with a microscope. Some patients experienced glare and halos around lights. These conditions, however, diminished or disappeared in most patients in six months. For about 5 percent of patients, however, best-corrected vision without corrective lenses was slightly worse after surgery than before. In view of these findings, FDA and the Federal Trade Commission (which oversees advertising) issued a letter to the eye-care community in May 1996 warning that unrealistic advertising claims, such as "throw away your eyeglasses," and unsubstantiated claims about success rates could be misleading to consumers.

LASIK

LASIK is a more complex procedure than PRK. It is performed for all degrees of nearsightedness. The surgeon uses a knife called a microkeratome to cut a flap of corneal tissue, removes the targeted tissue beneath it with the laser, and then replaces the flap.

"With LASIK, the skill of the surgeon is important because he'll be making an incision," says Stephen Crawford, O.D., an optometrist practicing in Virginia, "compared to the PRK method where the machine does more of the work." Crawford urges people to find qualified, experienced doctors to perform this surgery. "You'll want someone who's done a number of LASIK procedures since this is a surgeon-dependent operation," he said.

According to Ken Taylor, O.D., vice president of Arthur D. Little, Inc., a technology and management consultant firm in Cambridge, Mass., "Last year, across the country, 40 to 45 percent of refractive surgeries performed by physicians were LASIK, which equates to approximately 80,000 procedures." Doctors not participating in clinical trials may choose to use the approved laser to perform LASIK procedures at their discretion, says Morris Waxler, Ph.D., chief of FDA's diagnostic and surgical devices section. But most uses are considered "off label" and are not regulated by FDA.

Ralph A. Rosenthal, M.D., director of FDA's division of ophthalmic devices, says, "The agency has ruled that individual physicians can perform LASIK under the general 'practice of medicine,' if it's in the patient's best interest."

Advantages of LASIK

Some doctors believe that LASIK is a suitable procedure for correcting the most severe refractive errors. They also say that there is generally a faster recovery time after LASIK than after PRK. In addition, LASIK patients can see well enough to drive immediately and have good vision within a week.

After studying the options, Goldstein first decided on the LASIK procedure, but was surprised to learn that her doctor advised against it.

"Initially, I wanted the quick recovery that LASIK offers," Goldstein says, "but the bottom line was, which surgery will give me the best results, and after considering everything, eventually we agreed on PRK."

James Salz is currently involved in an FDA-sanctioned clinical trial at Cedars-Sinai Medical Center in Los Angeles, which is now studying the laser system specifically for farsightedness (hyperopia) with astigmatism. Although routinely performing laser eye surgery, he still encourages a small percentage of his low to moderately nearsighted patients to undergo radial keratotomy, or RK, an earlier refractive correction procedure that does not require the excimer laser.

With RK, incisions are made in a "radial" pattern along the outer portion of the cornea using a hand-held blade. These incisions are designed to help flatten the curvature of the cornea, thereby allowing light rays entering the eye to properly focus on the retina. The number and length of the incisions determines the degree of correction attained.

"Typically, this is still a practiced procedure for select people with very small corrections of myopia," Salz says.

Conversely, Crawford says that although he will mention RK as an option to his patients considering eye surgery, he is not in favor of this method. He says studies indicate that incisions made during this procedure, which penetrate approximately 90 percent of the cornea, appear to weaken the structure of the eye. Also, once you've had RK done you can't repeat it or have PRK done.

"I think that patients should understand and consider all available options for correcting refractive errors," Crawford says, "but I would never recommend RK to anyone."

Is Laser Surgery for You?

For some, like Goldstein, laser surgery has been the ultimate freedom from the everyday hassles of contact lenses, and a second chance at having normal eyesight. But can everyone expect such dramatic results?

"The answer is no," says Rosenthal. "It's not a foolproof procedure and people need to know that some can end up with worse eyesight than before they went in."

Mary Ann Duke, M.D., a general ophthalmologist practicing in Potomac, Md., adds that there are other reasons why the expectations for laser surgery vary from person to person.

"People who are slow healers or who have ongoing medical conditions [such as glaucoma or diabetes] are not good candidates for laser surgery," she says. "That's why it's so important for patients to undergo a thorough examination with their doctor."

Poor candidates for this surgery also include those with uncontrolled vascular disease, autoimmune disease, or people with certain eye diseases involving the cornea or retina. Pregnant women should not have refractive surgery of any kind because the refraction of the eye may change during pregnancy.

Looking Ahead

At present, a number of other lasers for eye surgery are currently being tested in FDA-sanctioned studies to determine their safety and effectiveness. Investigational Device Exemptions (IDEs) filed with FDA allow for clinical studies involving the excimer laser and the correction of farsightedness. The IDE process is designed to investigate the safety and effectiveness of a device, or a new procedure with an already approved device, either to obtain information for publication or to generate the data needed to obtain marketing approval from FDA.

"If the refractive surgery center says the laser is approved by FDA, it probably is," Waxler concludes. "Still, it is wise for consumers to check that the device being used for their surgery is FDA-approved," he says, or that they make sure they are being treated with a laser that is under study in an FDA-sanctioned clinical trial.

During the first few weeks immediately following laser surgery, Goldstein says, "Every week I kept thinking, 'this is as good as it gets'?" Then, she discovered by the sixth week, as predicted by her surgeon, that her eyesight was noticeably better and eventually stabilized.

"I would tell others to be patient about their expected outcome," she advises. "Even though with LASIK you can expect quicker results, I'm happy with the choice of PRK."

Carol Lewis is a staff writer for FDA Consumer.


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Are You a Candidate for Laser Eye Surgery?
You may be a good candidate for laser eye surgery if you:
are at least 21 years of age for a Summit laser or 18 years of age for a VISX laser, since the eyes are still growing to this point
have healthy eyes that are free from retinal problems, corneal scars, and any eye disease (refractive errors are considered eye disorders, not diseases)
have mild to moderate myopia (nearsightedness) within the range of treatment (see your doctor to determine your range)
have a way to pay for the treatment since laser procedures are costly and probably not covered by health insurance policies
are fully informed about the risks and benefits of laser surgery compared with other available treatments.

Surgeons offer eyesight tailored to an individual’s life and career

There are sportswear firms offering bespoke trainers and funeral companies that sell personalised coffins, but this latest extension of Savile Row principles may shock even the staunchest devotees of mass customisation.

Laser eye surgeons are now offering tailor-made corneas. Two decades after the first laser eye treatment in Britain, in November 1989, the quest for perfect vision has been replaced, in many cases, by eyesight tailored to an individual’s life and career.

Would sir like night vision? Does he require the eyes of a hawk? Or one eye customised to see into the distance, the other for reading? Such questions are now the stuff of client consultations in leading eye clinics.

Now one of the three most common surgical treatments in Britain, an estimated 100,000 people undergo the procedure each year, about 20 million have had it worldwide, and an increasing number have their corneas tailored to meet specific demands.

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Julian Stevens, of Moorfields Eye Hospital, is an expert on laser refractive surgery. He has, in the past, offered tailored treatment for members of the special forces. “They require 1,000-metre vision at night,” he said. “It is the same for fighter pilots.”

Increasingly, though, he offers to reshape corneas to cope with the more mundane work/life demands of office workers and lorry drivers.

The refractive power of a lens is measured in diopters. “Vision changes by about 0.3 diopters at night,” he said. “If you are a sniper that’s critical. It is also important for long-distance lorry drivers, who need excellent night-time distance vision.”

Professor Stephen Trokel, who was the first to demonstrate the application of the excimer laser (then used for carving microchips) to the field of eye surgery in 1983, recently operated on a leading soprano in his New York clinic. She requested that her eyesight be corrected so that she could see the front row of the orchestra and read the music.“I also had a catcher for the New York Yankees whose vision was terrible and who needed to be able to see a ball coming out of the light at night,” he said.

Laser refractive surgery alters the shape of the cornea to correct myopia (short-sightedness) or hyperopia (longsightedness), but technological advances have now made more specific alterations possible. Wavefront technology, originally developed by Nasa to aid the focus of the Hubble Space Telescope on distant stars, measures up to 250 spots in the pupil to provide a precise map of the cornea and iris. This offers the potential to correct problems not addressed by glasses, such as halos around lights at night or glare.

If it seems peculiar that many patients do not simply require 20:20 vision, Professor Trokel’s explanation is that perfect vision is defined by the person’s needs and age. The eye’s ability to focus on close objects declines with age, and older patients given laser eye surgery to correct myopia, for example, may soon find that they require reading glasses and have simply swapped one set of glasses for another.

To compensate, it may become common practice for office workers over 40 seeking eye correction in the future to be made mildly short-sighted.

Another group of middle-aged professionals favours a stranger alteration called “monovision”: one eye designed for distance vision, the other for reading. Professor Marguerite McDonald, who performed the world’s first excimer laser treatment in New Orleans in 1987, said she had received several requests from US presidential candidates: “They never wanted to look helpless on the campaign trail because they couldn’t read their notes. They wanted to send a message that they were young.”

In this brave new world of customised corneas, a radical change of lifestyle or career may soon precipitate a decision to have one’s eyeballs resculpted. Mr Stevens offers an example. “One of my patients led an active life and had high-quality distance vision. When he became paralysed from the neck down, his world became smaller — reading and television. Spectacles on your nose become painful if you can’t shift them.” The solution? Mr Stevens made him slightly short-sighted.

PRK Laser Types

Current PRK lasers are best classified by laser source (either Argon-Fluoride excimer lasers or solid state) and beam type (broad beam or scanning beam). Laser technology and computer control software has evolved significantly since the first normally sighted eyes were treated in 1987. Initial PRK treatments used 3.5 and 4mm optical zones so as to minimize the depth of ablation. Since many pupils dilate to 5mm it is not surprising that edge glare and light sensitivity were common complications. Ablation diameter increase with edge smoothing has been implemented to solve many edge glare problems. Wide or broad beam machines initially had problems caused by the use of nitrogen flow to disperse vaporized tissue and with the occurrence of unvaporized central islands. Stoppage of nitrogen flow and modification of computer generated treatment regimes has largely eliminated these problems.
The US Food & Drug Administration (FDA) has been cautious, rigid, and slow to approve PRK for widespread use within the USA. There has been speculation that the reason for the current caution is embarrassment over a previous premature approved of the surgical procedure of radial keratotomy (RK). Many observers have feared that the apparent bureaucratic rigidity might impede the implementation of future needed changes to equipment or procedures prior to long and inflexible testing schedules. However, recently the FDA surprised its critics when, with the final approval of the Summit Laser, they insisted upon increasing the size of the optical zone from that tested in the preapproval trials. In the US a number of other laser manufacturers are progressing or almost through FDA trials. In contrast, most other jurisdictions including Europe and Canada, have, without the "benefit" of as vigorous an approval process, had the freedom to amend and improve equipment and treatment regimes as improvements presented themselves. There is now worldwide a large and expanding experience with many varied laser machines and evolving technical improvements.

Laser Eye Surgery for Vision Correction

The Issue
Thousands of Canadians are turning to laser eye surgery to correct their vision and eliminate their dependency on glasses or contact lenses. Like all medical procedures, laser eye surgery provides benefits, but poses risks.

Background
Laser eye surgery is the most commonly practiced procedure to correct vision problems caused by refractive errors, including myopia (near-sightedness), hyperopia (far-sightedness) and astigmatism (distorted vision when looking at objects at any distance).

More recently, laser eye surgery has also been used to correct presbyopia (the inability to focus on nearby objects), which is part of normal aging and can be corrected by using reading glasses.

All of these conditions are caused by problems with the way the eye focuses an image on the retina, which is the light-sensitive layer at the back of the eye. A large part of the eye's ability to focus depends on the shape of the cornea, the clear front surface of the eye.

During laser eye surgery, a surgeon uses a laser device to make permanent changes to the shape of the cornea. The laser used most often is the Excimer laser, which produces a beam of ultraviolet light to vaporize tissue. Surgically altering the shape of the cornea can correct mild to moderate refractive errors in most people.

Common Laser Procedures
The two types of Excimer laser surgery performed commonly in Canada are PRK (Photo-Refractive Keractectomy), first introduced in the early nineties, and LASIK (Laser Assisted in situ Keratomileusis), introduced in the mid-nineties. There are also more recent procedures called LASEK (Laser Epithelial Keratomileusis) and Epi-LASIK.

PRK: The surgeon removes the outer layer of the cornea (epithelium) with a surgical blade or blunt instrument. The laser beam, guided by a computer, is then used to vaporize tiny amounts of tissue under the surface of the cornea. The procedure removes just enough tissue to reshape the cornea in a way that corrects vision. The initial healing process is complete in about a week.

LASIK: This surgery is more complicated. The surgeon first cuts a flap in the cornea with a very sharp blade or laser, and then lifts it and uses a computer-guided laser to remove calculated amounts of tissue from the inside layers of the cornea. Afterwards, the flap is put back and the eye heals more quickly than with PRK.

A recent advance in LASIK surgery is the use of Wavefront technology, which creates a detailed map of the eye. This helps the surgeon make even more precise correction to vision. Your eye surgeon can advise whether this is an option for you.

LASEK: This is a variation of PRK and LASIK. The surgeon cuts the outer layer of the cornea (epithelium) with a fine blade, and uses alcohol to loosen and lift it in a single layer. The laser beam is then directed at tissue under the epithelium, as with PRK. When the laser procedure is finished, the epithelium is put back in place. LASEK is best suited to vision problems that require minor correction. The healing process takes about two weeks.

Epi-LASIK: This is a modified LASEK in which the outer layer of the cornea is removed with a mechanical device using a blunt, rather than a sharp blade.

Benefits and Risks of Laser Eye Surgery
Laser eye surgery is performed by highly trained specialists, and in most cases, the results are satisfactory. Some patients feel their lives are vastly improved when their dependence on prescription glasses or contact lenses is reduced or eliminated. However, laser eye surgery also poses certain risks.

With PRK, the risks include:

•pain, ranging from moderate to severe, for the first few days;
•hazy vision during the healing process, which usually clears up within the first week after surgery; and
•regression, which in some cases can cause the eye to regress to its previous refractive error within about six months. If this happens, the patient may need a second operation (called an "enhancement") or may need to start wearing glasses or contacts again.
With LASIK, there is less post-operative pain. However, since this procedure involves cutting into the cornea, there is a greater risk of complications, including the following:

•dry eyes, which can range from mild to significant and can affect vision;
•poor quality of night vision due to halos and glare, which could affect your ability to drive at night; and
•a serious condition called corneal ectasia, which is a weakening and bulging of the cornea. Severe cases may need to be treated with a corneal transplant or implant.
A serious complication that may occur with both PRK and LASIK is corneal infection (infectious keratitis), which may result in significant loss of vision.

The more recent LASEK surgery shares some of the problems associated with both PRK (pain, haze and regression) and LASIK. However, the LASEK procedure reduces the risk of some of the complications associated with cutting a flap in the cornea, such as weakening of the eye and dry eyes.

The risks of laser eye surgery go up significantly for people with certain conditions or lifestyles. When weighing the risks, you should have a detailed talk with the surgeon about the following:

•your medical condition (including family history) - especially regarding such conditions as lupus, diabetes and keloid formation, as well as any eye diseases (e.g., herpes simplex, glaucoma, dry eyes, eyelid infections or previous eye surgery);
•whether or not you play sports where you are likely to be hit in the face - after LASIK, there is a risk for years that the flap could dislocate; and
•your career plans - some occupations (e.g., police officer, pilot) have specific vision requirements that can be achieved with laser eye surgery. Still, it is a good idea to discuss your plans for surgery with current or future employers, as well as your surgeon, to make sure your plans do not affect your prospects for employment.
This article cannot cover potential risks for every conceivable situation. If you are considering laser eye surgery, you must have a thorough talk with your eye surgeon about your options and your individual suitability for different types of procedures. Keep in mind that the long-term effects of laser eye surgery are still unknown.

Other Considerations
It is important to have realistic expectations. If you are over the age of 40, you will probably need reading glasses after laser eye surgery. Also, your eyes will continue to change as you grow older, and you may need prescription glasses or contacts again at some point. There is also a chance that you may need a second surgery if you do not get the right amount of correction the first time.

Cost is also a factor, as most health insurance plans do not cover laser eye surgery for vision correction.

Minimizing Your Risk
Health Canada advises you are more likely to have a successful outcome with laser eye surgery if you:

•Choose your eye surgeon carefully. The traditional approach is to get a referral from your own eye care professional.
•Discuss the risks, benefits and your expectations with the surgeon. Read the "informed consent" form thoroughly. Ask questions. Make sure you are a suitable candidate for surgery before you decide to go ahead.
Also, ask your surgeon for a copy of your pre-operative report, which should include information about your pre-operative vision, refraction readings and the shape of your cornea. Keep the report in a safe place for future reference.

After surgery, you can reduce your risk of complications by participating fully in the follow-up care recommended by your eye surgeon.

Health Canada's Role
Health Canada regulates the safety, effectiveness and quality of medical devices imported and sold in Canada, including devices used in laser eye surgery. This is achieved through a combination of a pre-market review prior to licensing, and post-market surveillance of adverse events after licensing. As part of this work, Health Canada monitors complaints about medical devices sold in Canada, and communicates safety information about medical devices to health care professionals and the public.

Have no fear of Lasik eye surgery!

Thinking about eye surgery using a Lasik procedure is a big step, and many people are a little hesitant to ask the questions that they have. The Lasik procedure, though widely talked about, is not discussed in detail, and people tend to fear the unknown. This report addresses some of the more commonly held fears, and talks about the experience for the vast majority of people that undergo a Lasik procedure.

A most common fear when thinking about a Lasik procedure, or really thinking about any surgery in general, is the possibility of pain during or after the operation. Since the Lasik surgeon works on patients that are conscious, this is a widely held apprehension. In every operation the Lasik surgeon applies numbing drops into the eyes before the procedure starts, and the patient is also given a mild sedative to relax them and make sure that they are comfortable. Though a small pressure to the eye may be felt during the Lasik procedure, the process itself is relatively pain free.

The surgeon does use a laser in the eye to help reshape the cornea during the Lasik procedure. Many folks are worried about the laser being shone directly into the eye, or that they might look away and, due to this, develop a serious complication with their eyes and the Lasik laser beam effects. In actuality, the laser is only active for ten to fifteen seconds for each eye, and the Lasik machine has a tracking system that allows the beam to be on only when the eye is in the correct position.

Another general fear for people contemplating a medical procedure is fear of “the scalpel”. Any Lasik procedure uses only a very small microkeratome blade to approach the eye, or some more recent Lasik innovations have the laser itself created the flap and avoid using any hard surface at all. There is no reason to be concerned about a scalpel, for the Lasik physician does not use one.

Many wonder about the horror stories they hear about this or any other operation, and wonder about serious consequences like going blind. According the government statistics taken by the FDA, there are no reported cases of blindness due to a Lasik operation. Actually, the risk of a serious permanent complication due to the Lasik procedure is less than 1 percent, and the risk of any permanent complications even if not serious (such as light halos) is 3 percent or less. It is extremely rare for a patient to not have improved vision after a Lasik procedure.

If the thought of being awake and having your eyes open during the Lasik procedure bothers you, remember that you will be given a mild sedative for the procedure, and that your eyes will have numbing drops administered to them. If the thought of actually seeing the Lasik physician’s hand approaching your eye is bothersome, be comforted that the surgeon applies drops to the eye that blacks out the vision in that eye for ten to fifteen seconds, which is long enough for the procedure to be done for that eye.

This introduction has hopefully addressed the most common fears about the Lasik procedure. For anyone that might gain a better life quality with improved vision, please visit your local Lasik eye surgery clinic and discuss the procedure in detail with the professionals there.

Lasik Surgery Fears

You have probably seen the news stories over the last couple of days about the FDA and Lasik eye surgery. As a lifelong contact lens and glasses wearer I thought that it would be important to look at why this is important and what you should think about when considering any corrective eye surgery.

Criticism of FDA policy
First of all the FDA does have a site dedicated to Lasik surgery and the benefits as well as the risks of the quick and easy surgery. One of the criticisms by consumer groups was that the FDA was not stressing hard enough the bad side effects that are possible with Lasik surgery.

Another issue that is often overlooked is regular aging of people and of eyesite. Any reputable ophthalmologist will agree that most men begin losing near sitedness in their 40s so the idea that Lasic or any other corrective surgery will get rid of glasses for life is not very realistic.
What the FDA did Say
The U.S. Food and Drug Administration should take more steps to advise LASIK patients about potential risks of the laser eye surgery, an advisory panel said on Friday, following pleas from those who suffered from glare, dry eye and even suicidal tendencies.

“I think we need better screening, better information and in some cases better doctors,” said panel chairwoman Jayne Weiss, a Kresge Eye Institute ophthalmologist in Detroit.

The panel’s recommendation followed hours of testimony by some LASIK patients who said that blurriness, double-vision and other problems led to depression and in some cases suicidal tendencies.

Panelists agreed with the FDA that LASIK is safe and effective, but said the agency could offer clearer information about side effects. They also suggested the FDA provide photos on its website to give patients a better idea of what halos and other visual complications look like.

How common is Lasik surgery
Millions of Americans have successfully undergone LASIK, or laser-assisted in-situ keratomileusis, which cuts a flap in the eye then uses a laser to reshape the cornea, making people less dependent on glasses or contact lenses.

Roughly 700,000 Americans have had LASIK since it was approved in 1998, according to industry estimates.

Still, the FDA is taking another look at the procedure after a 2006 internal review concluded that while available data did not point to widespread problems, there was not enough information on rare but serious complications.
The agency also is set to begin a LASIK study on patient satisfaction next year along with the National Eye Institute and two groups: the American Society of Cataract and Refractive Surgery and the American Academy of Ophthalmology.
The panel urged the FDA to take more action upon the study’s conclusion, although some patients pointed to the medical groups’ involvement as a conflict of interest.

Common Fears Associated with LASIK Surgery

Common Fears Associated with LASIK Surgery
Many people fear the unknown. This is a particularly common fear among people who are contemplating LASIK surgery and do not know what to expect from the procedure. Prospective LASIK patients may be apprehensive about the possibility of LASIK pain, the risk of losing their eyesight, and the fact that they will have to be awake during the procedure. For some, such fears may be enough to prevent them from seriously considering LASIK surgery; however, gaining a solid understanding the LASIK process has helped many others to overcome their phobias. The sections below discuss some of the most common LASIK fears.

DocShop can help you find an eye care specialist in your area today.

Fear of Pain
One of the most common fears about the surgery is LASIK pain. Many prospective LASIK patients are afraid they will experience some kind of discomfort since the procedure is performed while they are fully conscious. However, a mild sedative is given to patients to ensure that they remain comfortable, and numbing drops are applied to the eyes before the surgery begins. Although patients may feel some pressure, these steps help to make the LASIK process relatively pain free.

Fear of Laser Contact
Aside from LASIK pain, many prospective patients are also afraid of having a laser beam shine directly into their eyes during the procedure. While LASIK surgery does involve the use of a laser to remove tissue from the cornea, the laser only comes in contact with each eye for about 10-to-15 seconds. Some patients are concerned they might blink or look away during surgery and fear that this might result in serious complications. However, the laser used during LASIK has an eye tracking system which follows eye movement, and laser pulses are matched to that movement during treatment.

Fear of "the Scalpel"
Some patients are also afraid that a scalpel will be used to make a flap in the cornea during LASIK surgery. However, the LASIK process does not incorporate the use of a scalpel. Instead, a microkeratome blade or an IntraLase® laser is used during the procedure to create the corneal flap.

Fear of Going Blind as a Result of LASIK Surgery
In addition to LASIK pain, another common fear patients have is that they might go blind after LASIK surgery. But according to the FDA, there have been no reported cases of a patient going blind due to LASIK. In fact, the risk of facing serious complications after surgery is less than 1 percent, and the risk of suffering from less serious complications is 3 percent. It is also very rare for a patient’s vision to become worse after LASIK surgery. Should that occur, your surgeon will perform a second procedure to correct the problem.

Fear of Being Awake During the Procedure
Prospective LASIK patients may also be worried about having to be awake during surgery. Although patients must be awake during the LASIK procedure, they are given a mild sedative beforehand to help them relax.

Fear of the Eyes Being Open During the Procedure
Even though a sedative is administered to help patients calm down before surgery, some patients are still fearful of having to watch the entire LASIK procedure. However, the surgeon applies drops to the eyes during LASIK surgery, which allows the patient’s vision to black out for about ten seconds. Because of this, the patient will not be able to see the entire procedure.

Discuss Your Fears with a Surgeon in Your Area
The more you know the LASIK process, the more comfortable you will feel about undergoing the surgery. It is best to talk with a qualified surgeon about any fears of LASIK pain or other fears you may have about the procedure. The DocShop directory has a list of experienced LASIK surgeons in your area who can address all your questions and concerns.

Bad lasik eye surgery

Bad Lasik Eye Surgery




Bad lasik eye surgery is not commonly known, but it is a risk that can cause terrible side effects for the patient. A variety of lasik complications may occur, both during and after the surgery. These complications can be dependent on a variety of factors, from the doctors inexperience to faulty equipment. Surgical disasters are things that seem to be hidden from the public for various reasons. Because of the severity of side effects that can occur, it is very important for an individual to research and understand the procedure and problems that can occur from surgical eye correction that is either not successful or performed incorrectly. There are many ways to find information and determine if the risks of the procedure are enough to outweigh the decision to go through with it.

A thorough investigation or study of surgical vision correction, including records of any bad lasik eye surgery, should be completed before making the decision to choose to have the surgery done. Many studies have been completed and the results can be found from a variety of sources. Health organizations are a great place to begin a search for information on these procedures and any lasik complications that may be a risk to the individual. Many websites will provide information from these health organizations on the risks and rewards of the surgery. Personal websites may also provide some insight. Using a search engine can help in the search of individuals with stories to share on both positive and negative experiences. While the positive stories are usually very positive, the negative stories may be enough to keep an individual from even thinking about the procedure. Trust may be a major issue when viewing information from websites that are either for or against the procedure. It may be hard to accept what some people say, especially with no clear evidence that they are telling the truth. One of the most effective ways to seek information on the procedure and lasik complications is to speak with friends or relatives that have undergone surgical eye correction. They will often be more than happy to tell of any problems or success experienced. Consulting with many doctors may be helpful as well. While some doctors may be into the procedure for the money, many feel a sense of duty to be open and honest with patients.

Experiencing a surgical disaster can be devastating. If the risk is taken and the surgery is not a success, there can be serious consequences to face. Lasik complications can be very difficult to live with. One of the most serious is loss of eye sight. This loss can come from a variety of reasons. With faulty equipment, wrong moves may be made by the doctor, leading to loss of vision. Also, infections from equipment that is not sterile or from other factors can also lead to the loss of eyesight. Another serious complication that can result from bad lasik eye surgery is the change in shape of the corneas. The shape of the cornea is a very important part of receiving and wearing contact lenses. If the cornea is odd shaped due to surgery, the individual may have trouble finding contacts that will fit. Sometimes, these contact lenses will need to be specially made, making them much more expensive than the average lens. Constant burning and irritation to the eye can also result from an unsuccessful surgical vision correction. Certain problems that occur during the process can lead to this problem. The only relief may be the frequent use of eye drops to stop the pain or itching from occurring. Other problems like double vision and emotional problems can also arise from a bad lasik eye surgery.

The choice to have this procedure should be well thought out before being made. It's important to pray about the decision. "In the day when I cried thou answeredst me, and strengthenedst me with strength in my soul" (Psalm 138:3). Many problems can occur, leading to serious issues for the individual. With the use of health organizations, friends, and doctors, many answers can be received on the safety and helpfulness of the procedure. Surgical eye correction is widely used and can be beneficial if it is successful. However, complications can be devastating to the individual, especially if the loss of vision or eyesight becomes a problem. Research should be thoroughly done before choosing between lasik surgery and living with having to wear corrective lenses.


For more information: http://www.christianet.com/lasiksurgery

LASIK: Before-During and After Lasik Eye Surgery

LASIK eye surgery, otherwise known as Laser-Assisted In Situ Keratomileusis, is a surgery, which changes the shape of the cornea in order to correct vision problems. LASIK eye surgery has been changing over the past ten years, and some potential patients are confused as to exactly what LASIK is. In order to clear up your LASIK concerns and questions, here are some important facts about what happens before, during, and after LASIK surgery.

Before you can undergo LASIK surgery, you must have your eyes evaluated. It is advised that you stop wearing contacts and switch to glasses before your first evaluation; contact lenses change the shape of your cornea and may interfere with an accurate evaluation. If you wear contact lenses you need to stop wearing them for at least 2 weeks, those wearing toric or gas permeable lenses need to stop wearing them for at least 3 weeks, and those wearing hard lenses need to stop wearing them for at least 4 weeks before the first evaluation.

During the evaluation, the doctor will determine whether or not you are a good candidate for LASIK surgery; you will need to be honest about your medical history and any medications you are currently taking in addition to medications you are allergic to. The first evaluation should also be a time when you discuss the risks of the LASIK surgery and what you should expect. It is important to take some time to review everything you discussed with your doctor before you commit to a decision; LASIK is an elective surgical procedure, and the decision to undergo this type of procedure should never be made on an impulse.

Once you have decided to have the LASIK procedure performed, it is important to understand your responsibilities and what to expect. The day before the surgery is to take place you will need to stop using creams, lotions, makeup and perfumes; you will also need to arrange reliable transport to and from the surgery location for the surgery and for prearranged post-op visits. The LASIK surgery itself, depending on the type of LASIK you are having, is usually less than 30 minutes. You will be asked to lie in a reclining chair, and then numbing drops will be placed in your eyes.

After the drops are placed in your eyes the area around your eyes will be cleaned, and a lid speculum instrument will hold your eyelids open. Once your eyelids are held open, the first cut into the cornea will be made. During this procedure you will probably feel pressure and discomfort, but it will be mild; you vision will also dim and start to blur. You will then need to stare at a light while the cornea is reshaped; the light is used to keep your cornea in a fixed spot while the laser reshapes it.

After the surgery is over, a shield will be placed over your eyes to protect them and let them heal. Most patients experience watery eyes, burning and itching sensations, and mild pain. Vision immediately following LASIK is often hazy and blurry. The symptoms will gradually disappear, usually within a week, and you will need to see your doctor for regular appointments for the first 6 months following the surgery; expect to see the doctor again in the first 24 – 48 hours after your surgery as well. Patients with especially irritated eyes will be given eye drops. Vision will usually stabilize in 3 – 6 months following the surgery.



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.What Happens After the Lasik Procedure?

After you are fully prepared, the Lasik procedure takes less than fifteen minutes to complete for both eyes. This will seem a remarkably short time to have a permanent change to your vision, and in this regard Lasik seems almost too good to be true. In addition, most Lasik patients notice improved vision immediately or within a few hours after the Lasik procedure has been performed.

This does not mean that you should expect to walk out of the Lasik clinic with perfect vision and without any need to treat your eyes carefully for the next several days. It also means that some Lasik patients will need more time to see the total results for the Lasik procedure, sometimes as much as six months for their vision to stabilize permanently. Anticipate good vision, and take the time and care for the operation to produce its best result.

Usually the Lasik physician will give the post-procedure patient a protective shield for their eyes. This should be worn as long as the physician specifies, and usually only at night for one or two nights. He may also recommend sunglasses during the day if you experience sensitivity to light after the Lasik procedure is done. Discuss these options in detail at the Lasik center before the operation, so you know how to best take care of your eyes.

Many patients at the Lasik centers often get eye drops to keep their eyes moist for some time after the Lasik procedure is done. Again, this varies by patient and by physician, so ask about your particular situation, especially if you are prone to eye dryness on an occasional basis even before the Lasik procedure. Also, it might be helpful to keep any ceiling fans or other air circulation devices off in the household for the first few days.

Most clients can return to work and normal daily activities the day after the Lasik procedure is done, and do not require any extra assistance from other friends or family members. There is usually little to no post-operative discomfort after Lasik has been performed. It is recommended that patients go to sleep as quickly as possible after the Lasik surgery in order to minimize any post-operative discomfort. Upon waking, improved vision from the Lasik corrections should already start to be visible.

This improved vision may not be the final product of the Lasik procedure. The improvement to nearsightedness after Lasik is usually quick and dramatic, though there may be some problems in reading easily for the first few days after the Lasik operation. This is perfectly normal, and should clear up before the week is out.
Patients that use Lasik to improve their farsightedness usually find a dramatic improvement the day after the Lasik surgery. It might be that there is a temporary blurring of objects in the distance, but this will resolve itself. If this condition remains for more than a few days, the Lasik physician can recommend and prescribe temporary glasses until vision is stabilized.

These are all typical post-operative recommends for a Lasik patient, in order to feel comfortable with what to expect after the Lasik procedure. As with any medical treatment, get all of your questions answered by the staff of your Lasik center for your individual case.

Why LASIK?

LASIK can reduce your dependence on the hassle and inconvenience of contact lenses and eyeglasses. You can enjoy recreational activities especially water and contact sports without being limited by corrective lenses. Improved appearance and self-confidence that follows will also improve your life and career opportunities.

Note: LASIK is a surgical procedure for correcting the problems of nearsightedness, inborn farsightedness, and astigmatism, but cannot correct presbyopia, or age-related near focusing problems. This is because presbyopia is the result of muscle slackening, and LASIK does not improve muscle tone in any way, but instead changes the curvature of the cornea.

Advantages of LASIK

LASIK makes permanent changes to correct refractive errors
Quick surgery and rapid recovery
Minimal and temporary side effects
Quick return of usable vision
No injections, no sutures, only numbing eye drops
LASIK and the improvement in your quality of life

LASIK can reduce your dependence on eyeglasses and contact lenses.
LASIK can eliminate risks associated with long term contact lenses usage
LASIK can make you more eligible for certain professions.
LASIK can increase convenience in everyday life.
LASIK can increase your performances in activities such as hobbies and sports, especially water sports, and other outdoor sports.
LASIK can improve your personalities and self-confidence
Side Effects and Complications of LASIK

These are adverse effects that may occur after LASIK. Although the risks of these side effects and complications are very small in LASIK, they have to be thoroughly understood and accepted by the patient before undergoing the surgery. During the preoperative evaluation by your surgeon, the relative risks of these problems can be discussed on an individual basis.

Infection

Infections are very rare in LASIK, but they can damage the cornea if not resolved with early treatment. They are usually identified early and effectively treated with medications.

Under and Over Correction

Very uncommon, but corrections to fine-tune the vision can be carried out in appropriate cases, which must be agreed upon by the patient and the surgeon in charge. In the event where corrections by the same method cannot be carried out, most patients can return to using spectacles or contact lenses again.

Glare and haloes

May be experienced, especially at nighttime. This condition may happen in the early stages after treatment, but will gradually diminish. Nevertheless, some cases may experience more severe glare and haloes than others, and some permanently (with a probability of less than 1%). People with high corrections and large pupils are more prone to get this problem.

Fluctuation of vision

More prevalent in the early stages after treatment, this will also slowly improve.

Dry eyes

As a result of surgery, a patient may not be able to produce enough tears to keep the eyes moist and comfortable. This condition may stay for during the first few months or may be permanent. Intensive drop therapy may be required.

Did You Know You Can Use Flexible Spending for LASIK?

Flexible Spending Accounts Can Be Used for Your LasikPlus Surgery!
Depending on your tax bracket, using an FSA to pay for Laser Eye Surgery could save you significantly.


Check with your benefits manager at work to find out if Flexible Spending Accounts or Health Spending Accounts are offered by your company.


Planning & Your FSA
It will be important to decide how much of your salary you want deducted from each paycheck - this money is exempt from federal, state, and Social Security taxes. This money will be deposited in your Health Care FSA. Most companies allow you to spend the money any time during the year, even when it has not fully accumulated in your account. We suggest taking advantage of the Free LASIK Exam; this way you will know how much to invest in your FSA. FSA funds that are not used, get forfeited at the end of the year.

To print a summary about FSAs, click here.

Surgical and Postoperative Complications of LASIK, LASEK, PRK

The following charts taken from two scientific review articles contain all surgical and postoperative complications associated with LASIK. Surface procedures like PRK, LASEK, Epi-LASIK do not lead to microkeratome-associated intraoperative complications but they have a higher risk of haze, scarring and postoperative pain. The IntraLASIK or so-called "All Laser LASIK" with femtosecond laser flap creation also doesn't lead to microkeratome-associated intraoperative complications but, like standard LASIK, they have a risk of postoperative flap complications. IntraLASIK is associated with a higher risk of Diffuse Lamellar Keratitis (DLK) and Transient Lightsensitivity Syndrome (TLS).


Keratome and flap complications
Intraoperative complications (0.3 to 5.7%)
Ectasia
Flap striae (up to 10%)
Flap dislocation (up to 2%)
Laser complications
Misinformation / improper ablation
Decentered or improperly registered ablation
Reduced qualtity of vision
Complications of healing / infection / inflammation
Recurrent corneal erosions
Infectious keratitis (0.03%)
Epithelial ingrowth (1%)
Diffuse lamellar keratitis (DLK)
Post-LASIK dry eye (48% during the first six months)
Other complications of LASIK
Intraocular pressure management after LASIK
Optic neuropathy and glaucoma
Schallhorn SC, Amesbury EC, Tanzer DJ. Avoidance, Recognition, and Management of LASIK Complications. A, J Ophthalmol 2006;141:733-739.




1. Inadequate alignment with astigmatism axis
2. Irregular flap cuts
Partial Flaps
Thin Flaps
Donut-shaped flaps
Decentered flaps
Free caps
3. Complications due to improper microkeratome assembly or defective blades
4. Intraoperative bleeding
5. Intersecting microkeratome cuts
6. Excimer laser ablation-related complications
Input errors
Decentered ablations
Central Islands and peninsulas
7. Microkeratome-induced epithelial defects
8. Postoperative pain
9. Postoperative flap complications
Striae
Flap displacement
10. Epithelial growth within the interface
11. Interface debris
12. Regular astigmatism
13. Irregular astigmatism; glare, halos, poor visual quality
14. Overcorrection
15. Undercorrection and regression
16. Corneal ectasia
17. LASIK-induced neurotrophic epitheliopathy
18. Diffuse lamellar keratitis (DLK)
19. Infection
20. Retinal complications

Laser Vision Correction Surgery FAQs

Here are answers for frequently asked questions (FAQs) about laser vision correction surgery. Read the sections below to learn more about the safety of LASIK, how to find qualified LASIK surgeons, and LASIK surgery cost estimates.

DocShop can help you find an eye care specialist in your area today.

Is LASIK Safe?
LASIK is usually safe, provided you are a good candidate. The success rate for LASIK averages above 95 percent for most experienced LASIK surgeons. Do your research to see if you are a good LASIK candidate prior to receiving laser vision correction surgery.

What Are The Risks Associated With LASIK?
As with any refractive surgery, there are risks of LASIK complications. Common side effects of this laser vision correction surgery include:

Starbursts
Difficulty with glare and night vision
Foreign body sensation
Most of these side effects are temporary and should pass within a few days or weeks of the surgery. Approximately 1 to 2 percent of patients will have permanent side effects. Talk to one or more LASIK surgeons to find out if you could be prone to LASIK complications, or to learn about safer methods, including IntraLASIK and custom LASIK.

Is LASIK Painful?
Because of the minimal amount of tissue affected, the LASIK procedure is typically near-painless. Most patients complain of mild discomfort, but this usually can be controlled with medication.

What Results Should I Expect?
It is very common to see doctors advertising claims of 20/20 vision in all of their LASIK patients. However, LASIK statistics show that 20/20 vision does not occur with every surgery. You should expect to have improved vision and reduced dependency on your glasses and contacts.

How Much Does LASIK Surgery Cost?
LASIK costs have declined as the procedure has become more common. The average LASIK surgery costs $499 to $2,500 per eye. However, the American Academy of Ophthalmology (AAO) cautions patients not to choose their doctor based on the LASIK surgery cost. Instead, the AAO encourages people to choose their doctor based on experience level. Most insurance companies do not cover LASIK costs.

How Can I Pay For My Surgery?
Patients may pay for LASIK costs with cash, check, or credit card. Many doctors also offer LASIK financing to help cover the LASIK surgery cost.

How Do I Find Qualified LASIK Surgeons?
DocShop provides a directory of skilled LASIK surgeons practicing laser vision correction surgery throughout the United States. Find qualified LASIK surgeons today to learn more about laser vision correction and LASIK surgery costs.

Considering LASIK Surgery?

It's been a little over a year since Joseph Schnell, an elevator construction worker from Philadelphia, had LASIK eye surgery to correct his nearsighted vision. Rather than becoming clearer and sharper, though, Schnell's vision soon was plagued by near-constant glare, halos, starbursts, and double images. The results, he says, have affected his mood--he became depressed shortly after--and he rarely sleeps through the night because of eye pain.

In response to a Food and Drug Administration public forum on LASIK last week, where Schnell and other people shared their experiences with life-altering complications following the procedure, an FDA advisory panel has recommended ways to make warnings of the risks more clear. The panel suggests that photos depicting what people with visual impairment actually see be made available to those considering the surgery, as well as information on conditions such as large pupils and severe nearsightedness, which would disqualify a person from the procedure, and statistics on side effects. The FDA and a number of organizations, including the National Eye Institute and the American Academy of Ophthalmology, have formed a task force to study quality of life post-LASIK and figure out how to minimize problems.

Experts emphasize that serious complication rates are quite rare. Patient satisfaction hovers around 95 percent, according to a worldwide analysis released in March by another task-force member, the American Society of Cataract and Refractive Surgery. Among those remaining, many are simply dissatisfied that LASIK didn't measure up to their expectations--their vision isn't quite 20/20, and they still need reading glasses, for example. According to the FDA, only about 1 percent of patients report worse vision and have permanent side effects like eye pain, dry eye, and poor night vision. (Lots of people experience temporary effects like dry eye, glare, and halos.)

Still, "we want people to understand that not everyone is a candidate for LASIK," says Kerry Solomon, cochair of the task force and a professor of ophthalmology at the Medical University of South Carolina. "The quality-of-life investigation will provide us with additional knowledge on how to select the best candidates."

Meantime, there are steps you can take to minimize the chances of being among the dissatisfied patients.

Pre-Surgery:

--If you're predisposed to dry-eye syndrome, LASIK can exacerbate the condition, says Marguerite McDonald, a spokesperson for the American Academy of Ophthalmology and a clinical professor of ophthalmology at New York University School of Medicine. Treatment of dry eye is essential before surgery and is usually successful with eyedrops, prescription medication, or tear duct plugs.

--Any pre-existing conditions like blepharitis (an inflammation of the eyelids), keratoconus (which causes a curvature of the cornea), or severe seasonal allergies can increase the risk of infection and may decrease the success of surgery. Make sure your doctor tests for these and treats them effectively before going ahead with the surgery.

--Contact lenses can distort the shape of the cornea, according to McDonald, making it harder for surgeons to take accurate measures of the eye's refractive power. The FDA recommends patients who wear soft contact lenses switch to glasses full time two weeks before the first preop evaluation. That would be three weeks for toric soft lenses for astigmatism and four weeks for hard lenses.

Post-Surgery:

--Accidentally bumping or rubbing your eyes, even while asleep, can disturb the thin flap of cornea the doctor cuts in order to reshape the cornea beneath. If a flap has wrinkles, the patient may be more susceptible to visual impairment and will likely require corrective surgery, which is typically included in the cost of the original procedure.

--Halos, ghosting images, nighttime glare, and starbursts can interfere with vision after LASIK and may be caused by naturally larger pupils or under- or over-treatment with the laser. For the vast majority of patients, these side effects improve after a few months. If they remain, however, consult a doctor who may suggest eyedrops or retreatment.

Lasix side effects?

Questions and Answers
can u please tell me how can get rid off from the side effects of lasix?

My dad is taking lasix 40mg and urispas 2 times a day since 1 and a half month (He had 2nd time heart attack on 31st dec. 2007, he has high blood sugar and low blood pressure too). But from 1 week he is suffering from some sort of mental confusions... Is this occurred from the side effects or over doges of those medicines?

mental confusion in his case could be due to various reasons and one of them can be due to electrolyte disturbance due to lasix which causes loss of potassium leading to hypokalemia and hypernatremia which can cause mental confusion. his sugar levels may be low i.e. hypoglycemia or his kidney functions may be deranged even a low cardiac output may cause this. it is a matter that requires immediate medical evaluation by a doctor.

What are some of the possible side-effects that can occur when a persons prescription of Lasix is doubled?

Also, being an extremely strong diuretic, will a person with one kidney be more likely to have adverse side effects to this?

If the Lasix was doubled, it was probably apparent to the doctor that it was needed either by increased blood pressure, increased weight gain or swollen ankles, etc. He knows your health history and would not have increased your lasix if it would cause any problems with your remaining kidney. Low potassium, occasional leg cramps and mild dehydration are side effects of lasix use. People can take very large amounts of this medication without any side effects.

Is there is any side effect of having eye lasix at the age of 24 and does it cures your eye sight or not?

do u feel pain while ur being operated......is there is any chance that you could get blind while doing operation....

No side effects due to age. You do have to have a stable RX for a few years before you can be considered. Also, they only correct for one vision problem. So if your corrected for distance, you may need reading glasses. You don't feel pain while being operated, but afterward you will be light sensitive.

Will lasix 10 mg help me loose weight?

I have been prescribed 10mg lasix for water retention in my feet and fingers, i also take celexa though, i noticed some of the side effects of lasix were dizziness and lightheadedness, has anyone experienced that while taking lasix, and will it help me lose weight?

Those are common side effects.
Lasix will help you lose water weight.

Anyone who took or is taking LASIX (furosemide) - please inform me.?

I have much edema in my legs after a severe trauma & surgery on my tibia to repair. I also have left ventricle heart dysfunction. I might consider to try LASIX to expel excessive water from my tissues. But I fear the dangerous side-effects. I read that Kidney functions can get deranged, frequent testing is needed, and that one must take potassium chloride if taking Lasix. I don't believe that any MDs will divulge the frightful toxicity of this drug. They will prescribe it for me - but I fear what it may do. I reviewed the info on it and it is deadly toxic. I have a clean body with no Rx drugs in my system. I just don't want to get sicker than I am.already.

So please- if you are on Lasix or were on it - inform me what really happened and your side-effects and how well did it eliminate tissue edema? did it make you sick? What is your warning to me.??

I always use natural herbs, and avoid chemical Rx drugs for all my life. Thank you for answering. Please help.

Lasix helps your body flush out excess fluids that surgery or disease makes your body retain. You take the potassium because of the flushing action of the lasix. Talk with your doctor. My physician lets me monitor the effectiveness of the lasix. When the edema abates I can stop taking the meds. When it comes back I can start up with the meds. The lasix was not for my heart, but it did lower my blood pressure a little bit (it was a good thing).

I personally had no side effects from the Lasix and I am one of those people who darn near react to 90% of my meds! But I did the same thing you are doing, researching the medication, that's a good thing. My doctors are good at letting me call day or night about my meds and reactions to them. Two years and counting and no diabetes. You will develop diabetes only if you already have a propensity for it. I've had some really bad meds - Lasix was not one of them. Good Luck.

Wondering about Lasix...?

I'm considering Lasix but have some misgivings. I'd love to hear from professionals who use the system and from people who have first-hand knowledge of how it works, side-effects, etc. Please let me know the pros and cons of this procedure, based on your personal experience.

Thank you!
Tia

Hi Tia, I have used Lasix for many years because I have right heart failure. Lasix helps eliminate the excess fluid from my body. However, if you use lasix you must pay attention to your potassium levels because it is washed out of your body with lasix. Some of the side effects I have personally experience are leg cramps and being thirsty very often. The lasix keep my limbs from swelling with fluid. Consult your doctor, the pills saved my life. Good luck!

what side effect of tablet furosemide?

furosemide is a generic name of lasix tab.

"WARNING: This is a very potent medication. Using too much of this drug can lead to serious water and mineral loss. Therefore, it is important that you are closely monitored by your doctor. Tell your doctor immediately if you become very thirsty or confused, or develop muscle cramps/weakness while taking this medication."

"SIDE EFFECTS: Dizziness, lightheadedness, headache, blurred vision, loss of appetite, stomach upset, diarrhea, or constipation may occur as your body adjusts to the medication. If any of these effects persist or worsen, notify your doctor or pharmacist promptly. This medication may lead to excessive loss of body water and minerals (including potassium). Tell your doctor immediately if you have any of these unlikely but serious symptoms of dehydration or mineral loss: muscle cramps or weakness, confusion, severe dizziness, drowsiness, unusual dry mouth or thirst, nausea or vomiting, fast/irregular heartbeat, unusual decrease in the amount of urine, fainting, seizures. Tell your doctor immediately if any of these unlikely but serious side effects occur: numbness/tingling of the arms/legs, ringing in the ears, hearing loss. Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: signs of infection (e.g., fever, persistent sore throat), easy bleeding or bruising, stomach/abdominal pain, persistent nausea/vomiting, yellowing of eyes/skin. A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching, swelling, severe dizziness, trouble breathing."

I want advice only from those who used Lasix long-term or use it now.?

Let me explain. I am mid-age guy with severe edema in my lower body. this is only 2 months old. I have no diabetes, normal blood chemistries,
Last year a car ran me over badly. Upon admission, I had heavy blood loss from internal bleeding & had a MASSIVE heart attack, from the NEUROGENIC & cardiac SHOCK to my nervous system

Prior, I lived with some blocked arteries. But cardiologists said I had very good COLLATERALS ARTERIES formed within me & they compensated a lot. I had no ankle edema, no angina, no chest pain, no blatant heart discomfort. I walked quite freely, carried things, managed well.
but since the Massive MI - I now have severe left ventricular dysfunction & also in right.side. I gasp & strain with every breath & effort. Cardiologists said they cannot remedy the dead heart muscle. I have no arrythmias. When you take lasix, how bad are toxic effects? I am scared of Lasix. It may not take the edema out after all. So tell me exactly what it did for you ??

i've have been on Lasix for years, it never really helped my lower edema.......recently i'm on edmadex, which turns out to be a much better water pill but still barely touchs my edema, i think mine is more diet, mostly salt......as a cardiac tech, i think yours probably is due to your heart muscle damage........they recently ordered me a leg pump that pushs the edema up, which i can't afford the first months rent of $425!!!! but it seems to work in the hospital........also i have in my bloodwork, very low sodium, & my body sees it, & thinks it needs to retain water(great), so you might have them check that out???? i think mine was due to massive amounts of a memory herb and/or i had a wimple 2 yrs ago, which removed my spleen, & small parts of my stomach & a cyst on my panceus(ms)..............but really any water pill that i've tried is simply not working with my legs, & other than a couple of good pees.................the more veggies/less meat i eat seems to help...............good luck!

A panting cat?

When my cat (7 months old) plays really hard he seems to be out of breath. I even caught him panting once or twice. I talked to my friend who is studying to be a vet tech, and she said this was never normal and is usually because the cat has congestive heart failure. I am going to take him to the vet monday... but I just wondered if there was anything else it could be. Can cats be asthmatic or have allergies? And if it is CHF, she said they treat it with Lasix. I am a nursing student, so I know how Lasix works, but I'm just wondering what kind of side effects he might have and what the monthly cost is going to be. Do cats with CHF live a normal life span? I will ask the vet about all this too, but I am really worried about him... I love him dearly and don't want him to be sick. Also, are there any special considerations I should be aware of? Like limiting play time, or special diet? He lives to play.... I would feel bad if I had to limit his play time. Thanks so much

it is probably asthma. that's how I figured out that one of my cats has asthma. I have to give him abuterol twice a day (liquid form) and it's been a year or more since we have had any major issues with it, from time to time he may get a little winded and we give him a time out till he calms down some

Side Effects of Furosemide

An Overview of Side Effects of Furosemide
As with any medicine, side effects can occur with furosemide (Lasix®). However, not everyone who takes the medication will have problems. In fact, most people tolerate it well. If side effects do occur, in most cases, they are minor and either require no treatment or can be easily treated by you or your healthcare provider.

(This article covers many, but not all, of the possible side effects with furosemide. Your healthcare provider can discuss a more complete list of side effects with you.)

Furosemide Side Effects to Report
Some side effects with this drug are potentially serious and should be reported immediately to your healthcare provider. These include but are not limited to:

•Dizziness, lightheadedness, or fainting spells
•Signs of dehydration or low electrolytes, such as:

◦Dry mouth
◦Thirst
◦Weakness
◦Lethargy
◦Drowsiness
◦Restlessness
◦Muscle pain or muscle cramps
◦Low blood pressure (hypotension)
◦Decreased urination
◦A rapid heart rate (tachycardia) or irregular heart rhythm (arrhythmia)
◦Nausea or vomiting

•Yellowing of the skin or the whites of the eyes (jaundice)
•Ringing in the ears (tinnitus) or hearing problems
•High blood sugar (hyperglycemia)
•Signs of an allergic reaction, including:

◦An unexplained rash
◦Hives
◦Itching
◦Unexplained swelling
◦Wheezing
◦Difficulty breathing or swallowing.


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