This information is collected from http://www.usaeyes.org/

USAEyes Certified Lasik Surgeon Medical Office Information

Garden City Nassau County Long Island	450 Endo Blvd Garden City, New York, 11530 Phone Jeanette Toll Free 1-888-55-SIGHT Map to Lasik Surgeons' Office
Hauppauge Suffolk County Long Island	200 Motor Parkway, # D25 Hauppauge, New York, 11788 Phone Jeanette Toll Free 1-888-55-SIGHT Map to Lasik Surgeons' Office
Manhattan	185 Madison Avenue New York, New York, 10016 Phone Jeanette Toll Free 1-888-55-SIGHT Map to Lasik Surgeons' Office

Nashville
Nashville 615/859-3937	Skyline Medical Plaza 3443 Dickerson Rd, Suite 140 Nashville Tennessee 37207 Phone 615/859-3937 Map to Lasik Surgeon James Loden's Nashville Office
Goodlettsville 615/859-3937	907 Rivergate Parkway, Suite C-2020 Goodlettsville Tennessee 37072 Phone 615/859-3937 Map to Lasik Surgeon James Loden's Goodlettsville Office
Brentwood 615/859-3937	3 Maryland Farms, Suite 3 Brentwood Tennessee 37027 Phone 615/859-3937 Map to Lasik Surgeon James Loden's Brentwood Office
Paris 731/642-5003	1024 Kelley Drive Paris Tennessee 38242 Phone 731/642-5003 Map to Lasik Surgeon James Loden's Paris Office
Gallatin 615/859-3937	323 Hancock Street Gallatin Tennessee 37066 Phone 615/859-3937 Map to Lasik Surgeon James Loden's Gallatin Office

Santa Rosa

Santa Rosa	3540 Mendocino Avenue, Suite 200 Santa Rosa CA 95430 Phone 707/522-6200 Map to Lasik Surgeon's Office
Walnut Creek	2033 N. Main #200 Walnut Creek CA 94596 Phone 925/947-2020 Map to Lasik Surgeon's Office
San Francisco	1700 California St #280 San Francisco CA 94109 Phone 415/346-5500 Map to Lasik Surgeon's Office
Mountain View	1174 Castro St. #112 Mountain View CA 94040 Phone 650/966-0900 Map to Lasik Surgeon's Office

St Petersburg

Scott Behler, MD
Behler Eye & Laser Center

2346 Drew
Clearwater FL 33765

Phone 727/712-2500

Map to Lasik Surgeon's Office

Kansas City

Daniel Durrie, MD
DurrieVision
Kansas City

5520 College Blvd #201
Overland Park, Kansas, 66211

Phone 913/491-3330

Map to Lasik Surgeon's Office

Boise

Metro Seattle 877/551-2020 900 SW 16th, Suite 200 Renton, Washington, 98055 Phone 877/551-2020 Map to Lasik Surgeon's Office Metro Portland 877/551-2020 1325 SE Tech Center Dr Vancouver WA 98683 Phone 877/551-2020 Map to Lasik Surgeon's Office Boise 877/551-2020 923 South Bridgeway Place Suite 150 Eagle Idaho 83616 Phone 877/551-2020 Map to Lasik Surgeon's Office Tri-Cities Washington 877/551-2020 8904 W Tucannon Ave Kennewick WA 99336 Phone 877/551-2020 Map to Lasik Surgeon's Office Vancouver, BC Canada 877/551-2020 1020-4710 Kingsway MetroTowers 1 Burnaby BC V5H 4M2 Canada Phone 877/551-2020 Map to Lasik Surgeon's Office Medford, Oregon 877/551-2020 1322 McAndrews Rd Medford OR 97504 Phone 877/551-2020 Map to Lasik Surgeon's Office Victoria, BC Canada 877/551-2020 201-3550 Saanich Road Victoria BC V8X 1X2 Canada Phone 877/551-2020 Map to Lasik Surgeon's Office Edmonton, AB Canada 877/551-2020 303-10060 Jasper Ave Edmonton AB T5J 3R8 Canada Phone 877/551-2020 Map to Lasik Surgeon's Office

Mesa Arizona

Mesa 480/833-0014	160 W University Dr Suite 1 Mesa, Arizona, 85201 Phone 480/833-0014 Map to Lasik Surgeon's Office
Phoenix 602/274-4992	2125 W Indian School Rd Phoenix, Arizona, 85015 Phone 602/274-4992 Map to Lasik Surgeon's Office
Glendale 602/274-4992	5620 W Thunderbird Rd Suite C-5 Glendale, Arizona, 85306 Phone 602/274-4992 Map to Lasik Surgeon's Office
Scottsdale 480/610-1252	10585 N Tatum Blvd Suite D-131 Scottsdale, Arizona, 85028 Phone 480/610-1252 Map to Lasik Surgeon's Office

San Gabriel Valley California

City of Industry	18725 E Gale Ave, Suite 140 City of Industry, California, 91748 Phone 626/854-2020 Map to Lasik Surgeon's Office
Los Angeles	266 S Harvard Blvd, Fourth Floor Los Angeles, California, 90004 Phone 213/251-7894 Map to Lasik Surgeon's Office
Westminster Orange County	8341 Westminster Blvd #202 Westminster, California, 92683 Phone 888/919-2020 Map to Lasik Surgeon's Office

Commnly Asked Questions About LASIK

What is wavefront-optimized LASIK?

Wavefront-optimized LASIK is the type of laser treatment available on the Wavelight laser. This treatment is also based on the patient's glasses prescription, but also takes into account corneal curvature and thickness, and applies laser energy in a unique fashion in the periphery of the cornea. This laser has been found to reduce the aforementioned complications such as glare, halos, and other nighttime visual aberrations that can occasionally occur with conventional treatments.

What is wavefront-guided LASIK?

Wave front-guided LASIK, also referred to as custom LASIK or wave front LASIK, is similar to conventional LASIK, except that in addition to treating a patient's basic refractive error, specific alterations in a patient's eye (high order aberrations) can also be treated. In wave front-guided LASIK, special mapping is performed prior to surgery to identify any small irregularities in the patient's optical system. When these irregularities are severe, they can affect vision quality, contrast sensitivity, and night vision. When significant irregularities in a patient's wave front mapping are found, wave front-guided LASIK can be used, and the treatment will be based on the wave front-map generated.

What is Epi Lasik?

EPI LASIK – it is a procedure, which combines the advantages of PRK and LASIK, Epi lasik involves the use of a microkeratome, similar to LASIK, however only the superficial epithelial layer of cornea is separated as in PRK and this flap is replaced following the reshaping of the cornea using the Excimer Laser.

Will my vision improve immediately?

You should be able to see reasonably well within a few days after your procedure. If you have had a SURFACE PRK procedure, your vision may fluctuate for the next 1 to 3 months and reading fine print may be difficult. If you have had a LASIK procedure, your vision is likely to stabilize around a month after the procedure.

What are the possible side effects of the procedure?

Early side effects of any corneal procedure include light sensitivity, glare and foreign body sensation in the eye. Both SURFACE PRK and LASIK can sometimes result in under correction or incomplete removal of the refractive error. Occasionally, an overcorrect ion eg., the correction of more myopia than intended, can also occur. A change in the clarity of the corneal tissues – termed corneal haze – can also occur in some patients.

How do I know if I am a good candidate for LASIK?

A large percentage of nearsighted, farsighted, and astigmatic patients are potential candidates for LASIK. Patients who are 18 years of age or older, have healthy eyes that are free from retinal problems, corneal scars, and any eye disease are suitable. Along with being medically suitable, the best candidates are people with a lifestyle or occupation in which they are dissatisfied with their contact lenses or glasses. By having an evaluation, examination, and consultation with you, the doctor will be able to determine if you are a good candidate.

How long does LASIK take?

In our practice, LASIK is performed as an office procedure in the comfort and convenience of an excimer laser suite. The entire treatment takes about 5 to 7 minutes per eye or approximately 15 minutes for both eyes.

Is the effect of LASIK permanent?

Yes. Following an initial healing period of two to three months, the effect of the treatment is lifelong.

Will I need reading glasses after the treatment?

Generally, patients under 40 years of age read well without glasses following the treatment. Patients over 40 may need magnification for reading fine print. Presbyopia is the term that refers to the natural weakening of the focusing muscles that occurs in our early to mid 40s, causing us to need the magnification that reading glasses provide. The LASIK treatment does not correct or prevent presbyopia. We also will be glad to discuss another option called monovision.

How many times do I need to be seen following the treatment?

Most patients are usually seen the day following the treatment and then atleast 1 month and 3 months following the treatment. Some patients require more visits. Remember, we are available 24 hours a day when you have any questions, concern or need attention.

How soon after the treatment can I bathe and take a shower?

Your physician will advise you as to the specific, however typically you can bathe the same day as the treatment but you should not shower for 2 days after the treatment. As always, avoid getting soap or water directly into your eyes. Avoid rubbing your eyes during the first month after surgery.

When can I drive after the treatment?

You should not drive the day of treatment. After that, you may drive when you feel confident that your visual acuity and eye comfort allow you to drive safely.

How soon can I use eye makeup?

You may resume wearing eye makeup starting 2 weeks after your treatment. We strongly recommend that you purchase new eye makeup, specifically mascara, to avoid potential infection following your treatment.

How soon after the treatment can I exercise?

Non-contact sports can be resumed as soon as you feel capable. Eye protection is always recommended for racquet sports or rough sports where there is a risk of being hit in the eye.

How soon can I swim?

You should stay out of swimming pools for two weeks after your treatment, and rivers, lakes and oceans for 3-4 weeks following your treatment.

What kind of Anesthesia is used during the treatment?

Numbing eye drops are used. Sometimes an oral medication is used to help with relaxation. Don't worry - no needle or intravenous drugs are used.

Can both eyes be treated at the same time?

In Lasik – Both eyes are performed same time, but SURFACE PRK and Epi LASIK is performed one eye at a time. The timing of treatment of the second eye is best decided in consultation with your ophthalmologist.

Does LASIK hurt?

The treatment itself is painless because we put a few numbing drops in your eyes to make you even more comfortable. You will feel pressure on and around the eye during treatment. With LASIK, some patients may experience a feeling of "something in the eye" for a day or so after treatment.

Can I see the treatment as it is being performed?

You will be "awake" but very relaxed. You will not be able to see any of the details of the treatment. You will see a number of lights, but the images will be blurred.

Will I experience pain after the treatment?

Some patients experience a feeling of burning or scratchiness. This feeling generally lasts from one to three hours following the treatment. Most people feel fine if they can take a nap soon after the treatment.

Will my eyes be patched?

No, but clear, protective eye shields will be placed over your treated eye(s) following the treatment, and will be removed in our office the next morning. You will continue to wear these eye shields at bedtime for 1 week for protection.

Will I need to wear spectacles or contact lenses after the procedure?

Both SURFACE PRK and LASIK are designed to allow you to discontinue the use of corrective lenses. In some patients with high refractive errors and in those over 40 years of age, corrective lenses may still be required. In some patients however, it may be possible to perform a second refractive procedure to correct a residual refractive error.

Will my vision improve immediately after Lasik?

You should be able to see reasonably well within a few days after your procedure. If you have had a SURFACE PRK procedure, your vision may fluctuate for the next 1 to 3 months and reading fine print may be difficult. If you have had a LASIK procedure, your vision is likely to stabilize around a month after the procedure.

Whether this LASIK procedure is covered by insurance?

LASIK (Corneal Refractive Surgery) is considered as elective/ cosmetic surgery and it is not covered by many health insurance plans. However you can contact our insurance section staff after your lasik consultation. You may also contact your concerned insurance agency for the same.

When can I resume my normal activities?

If you have had a SURFACE PRK, you will be able to return to work within three to four days of surgery. If you have had LASIK procedures, you can return to work on the following day. Eye medications should be continued during working hours as instructed by the surgeon. While most activities can be resumed after this time, the face should not be placed under water for at least one week following LASIK. Care should also be taken to avoid any trauma to the eye including rubbing of the eyes during this period.

Free E-Book on LASIK

Free Ebook -- LASIK and Advanced Surface Ablation can be Read at http://www.medrounds.org/LASIK/

Complete checklist

Know what makes you a poor candidate

Career impact - does your job prohibit refractive surgery?
Cost - can you really afford this procedure?
Medical conditions - e.g., do you have an autoimmune disease or other major illness? Do you have a chronic illness that might slow or alter healing?
Eye conditions - do you have or have you ever had any problems with your eyes other than needing glasses or contacts?
Medications - do you take steroids or other drugs that might prevent healing?
Stable refraction - has your prescription changed in the last year?
High or Low refractive error - do you use glasses/contacts only some of the time? Do you need an unusually strong prescription?
Pupil size - are your pupils extra large in dim conditions?
Corneal thickness - do you have thin corneas?
Tear production - do you have dry eyes?

Know all the risks and procedure limitations

Overtreatment or undertreatment - are you willing and able to have more than one surgery to get the desired result?
May still need reading glasses - do you have presbyopia?
Results may not be lasting - do you think this is the last correction you will ever need? Do you realize that long-term results are not known?
May permanently lose vision - do you know some patients may lose some vision or experience blindness?
Dry eyes – do you know that if you have dry eyes they could become worse, or if you don’t have dry eyes before you could develop chronic dry eyes as a result of surgery?
Development of visual symptoms - do you know about glare, halos, starbursts, etc. and that night driving might be difficult?
Contrast sensitivity - do you know your vision could be significantly reduced in dim light conditions?
Bilateral treatment - do you know the additional risks of having both eyes treated at the same time?
Patient information - have you read the patient information booklet about the laser being used for your procedure?

Know how to find the right doctor

Experienced - how many eyes has your doctor performed LASIK surgery on with the same laser?
Equipment - does your doctor use an FDA-approved laser for the procedure you need?
Informative - is your doctor willing to spend the time to answer all your questions?
Long-term Care - does your doctor encourage follow-up and management of you as a patient? Your preop and postop care may be provided by a doctor other than the surgeon.
Be Comfortable - do you feel you know your doctor and are comfortable with an equal exchange of information?

Know preoperative, operative, and postoperative expectations

No contact lenses prior to evaluation and surgery - can you go for an extended period of time without wearing contact lenses?
Have a thorough exam - have you arranged not to drive or work after the exam?
Read and understand the informed consent - has your doctor given you an informed consent form to take home and answered all your questions?
No makeup before surgery - can you go 24-36 hours without makeup prior to surgery?
Arrange for transportation - can someone drive you home after surgery?
Plan to take a few days to recover - can you take time off to take it easy for a couple of days if necessary?
Expect not to see clearly for a few days - do you know you will not see clearly immediately?
Know sights, smells, sounds of surgery - has your doctor made you feel comfortable with the actual steps of the procedure?
Be prepared to take drops/medications- are you willing and able to put drops in your eyes at regular intervals?
Be prepared to wear an eye shield - do you know you need to protect the eye for a period of time after surgery to avoid injury?
Expect some pain/discomfort - do you know how much pain to expect?
Know when to seek help - do you understand what problems could occur and when to seek medical intervention?
Know when to expect your vision to stop changing - are you aware that final results could take months?
Make sure your refraction is stable before any further surgery - if you don't get the desired result, do you know not to have an enhancement until the prescription stops changing?

Checklist - After surgery

After Lasik Surgery
Immediately after the lasik procedure, your eye may burn, itch, or feel like there is something in it. You may experience some discomfort, or in some cases, mild pain and your doctor may suggest you take a mild pain reliever. Both your eyes may tear or water. Your vision will probably be hazy or blurry. You will instinctively want to rub your eye, but don't! Rubbing your eye could dislodge the flap, requiring further treatment. In addition, you may experience sensitivity to light, glare, starbursts or haloes around lights, or the whites of your eye may look red or bloodshot. These symptoms should improve considerably within the first few days after surgery. You should plan on taking a few days off from work until these symptoms subside. You should contact your lasik doctor immediately and not wait for your scheduled visit, if you experience severe pain, or if your vision or other symptoms get worse instead of better.

You should see your lasik doctor within the first 24 to 48 hours after lasik surgery and at regular intervals after that for at least the first six months. At the first postoperative visit, your lasik doctor will remove the eye shield, test your vision, and examine your eye. Your lasik doctor may give you one or more types of eye drops to take at home to help prevent infection and/or inflammation. You may also be advised to use artificial tears to help lubricate the eye. Do not resume wearing a contact lens in the operated eye, even if your vision is blurry.

You should wait one to three days following lasik surgery before beginning any non-contact sports, depending on the amount of activity required, how you feel, and your lasik doctor's instructions.

To help prevent infection, you may need to wait for up to two weeks after lasik surgery or until your lasik doctor advises you otherwise before using lotions, creams, or make-up around the eye. Your lasik doctor may advise you to continue scrubbing your eyelashes for a period of time after surgery. You should also avoid swimming and using hot tubs or whirlpools for 1-2 months.

Strenuous contact sports such as boxing, football, karate, etc. should not be attempted for at least four weeks after lasik surgery. It is important to protect your eyes from anything that might get in them and from being hit or bumped.

During the first few months after lasik surgery, your vision may fluctuate.

• It may take up to three to six months for your vision to stabilize after lasik surgery.
• Glare, haloes, difficulty driving at night, and other visual symptoms may also persist during this stabilization period. If further correction or enhancement is necessary, you should wait until your eye measurements are consistent for two consecutive visits at least 3 months apart before re-operation.
• It is important to realize that although distance vision may improve after re-operation, it is unlikely that other visual symptoms such as glare or haloes will improve.
• It is also important to note that no laser company has presented enough evidence for the FDA to make conclusions about the safety or effectiveness of enhancement surgery.

Contact your lasik eye doctor immediately, if you develop any new, unusual or worsening symptoms at any point after lasik surgery. Such symptoms could signal a problem that, if not treated early enough, may lead to a loss of vision.

Cheecklist - During LASIK Surgery

During lasik surgery.
The lasik surgery. should take less than 30 minutes. You will lie on your back in a reclining chair in an exam room containing the laser system. The laser system includes a large machine with a microscope attached to it and a computer screen.

A numbing drop will be placed in your eye, the area around your eye will be cleaned, and an instrument called a lid speculum will be used to hold your eyelids open. A ring will be placed on your eye and very high pressures will be applied to create suction to the cornea. Your vision will dim while the suction ring is on and you may feel the pressure and experience some discomfort during this part of the procedure. The microkeratome, a cutting instrument, is attached to the suction ring. Your lasik doctor will use the blade of the microkeratome to cut a flap in your cornea.

The microkeratome and the suction ring are then removed. You will be able to see, but you will experience fluctuating degrees of blurred vision during the rest of the procedure. The lasik doctor will then lift the flap and fold it back on its hinge, and dry the exposed tissue.

The laser will be positioned over your eye and you will be asked to stare at a light. This is not the laser used to remove tissue from the cornea. This light is to help you keep your eye fixed on one spot once the laser comes on. NOTE: If you cannot stare at a fixed object for at least 60 seconds, you may not be a good candidate for this lasik surgery.

When your eye is in the correct position, your lasik doctor will start the laser. At this point in the lasik surgery., you may become aware of new sounds and smells. The pulse of the laser makes a ticking sound. As the laser removes corneal tissue, some people have reported a smell similar to burning hair. A computer controls the amount of laser energy delivered to your eye. Before the start of lasik surgery., your lasik doctor will have programmed the computer to vaporize a particular amount of tissue based on the measurements taken at your initial evaluation. After the pulses of laser energy vaporize the corneal tissue, the flap is put back into position.

A shield should be placed over your eye at the end of the procedure as protection, since no stitches are used to hold the flap in place. It is important for you to wear this shield to prevent you from rubbing your eye and putting pressure on your eye while you sleep, and to protect your eye from accidentally being hit or poked until the flap has healed.

Checklist-before LASIK surgery

What to expect before, during, and after lasik surgery will vary from lasik doctor to lasik doctor and patient to patient. This section is a compilation of patient information developed by manufacturers and healthcare professionals, but cannot replace the dialogue you should have with your lasik doctor. Read this information carefully and with the checklist, discuss your expectations with your lasik doctor.

Before lasik surgery
If you decide to go ahead with lasik surgery, you will need an initial or baseline evaluation by your eye lasik doctor to determine if you are a good candidate. This is what you need to know to prepare for the exam and what you should expect:

If you wear contact lenses, it is a good idea to stop wearing them before your baseline evaluation and switch to wearing your glasses full-time. Contact lenses change the shape of your cornea for up to several weeks after you have stopped using them depending on the type of contact lenses you wear. Not leaving your contact lenses out long enough for your cornea to assume its natural shape before lasik surgery can have negative consequences. These consequences include inaccurate measurements and a poor surgical plan, resulting in poor vision after lasik surgery. These measurements, which determine how much corneal tissue to remove, may need to be repeated at least a week after your initial evaluation and before lasik surgery to make sure they have not changed, especially if you wear RGP or hard lenses. If you wear:

• soft contact lenses, you should stop wearing them for 2 weeks before your initial evaluation.
• toric soft lenses or rigid gas permeable (RGP) lenses, you should stop wearing them for at least 3 weeks before your initial evaluation.
• hard lenses, you should stop wearing them for at least 4 weeks before your initial evaluation.

You should tell your lasik doctor:

• about your past and present medical and eye conditions
• about all the medications you are taking, including over-the-counter medications and any medications you may be allergic to

Your lasik doctor should perform a thorough eye exam and discuss:

• whether you are a good candidate
• what the risks, benefits, and alternatives of the lasik surgery are
• what you should expect before, during, and after lasik surgery
• what your responsibilities will be before, during, and after lasik surgery

You should have the opportunity to ask your lasik doctor questions during this discussion. Give yourself plenty of time to think about the risk/benefit discussion, to review any informational literature provided by your lasik doctor, and to have any additional questions answered by your lasik doctor before deciding to go through with lasik surgery and before signing the informed consent form.

You should not feel pressured by your lasik doctor, family, friends, or anyone else to make a decision about having lasik surgery. Carefully consider the pros and cons.

The day before lasik surgery, you should stop using:

• creams
• lotions
• makeup
• perfumes

These products as well as debris along the eyelashes may increase the risk of infection during and after lasik surgery. Your lasik doctor may ask you to scrub your eyelashes for a period of time before lasik surgery to get rid of residues and debris along the lashes.

Also before lasik surgery, arrange for transportation to and from your lasik surgery and your first follow-up visit. On the day of lasik surgery, your lasik doctor may give you some medicine to make you relax. Because this medicine impairs your ability to drive and because your vision may be blurry, even if you don't drive make sure someone can bring you home after lasik surgery.

Finding a right LASIK Doctor.

Finding the Right lasik doctor
If you are considering refractive lasik surgery, make sure you:

* Compare. The levels of risk and benefit vary slightly not only from procedure to procedure, but from device to device depending on the manufacturer, and from surgeon to surgeon depending on their level of experience with a particular procedure.
* Don't base your decision simply on cost and don't settle for the first eye center, lasik doctor, or procedure you investigate. Remember that the decisions you make about your eyes and refractive lasik surgery will affect you for the rest of your life.
* Be wary of eye centers that advertise, "20/20 vision or your money back" or "package deals." There are never any guarantees in medicine.
* Read. It is important for you to read the patient handbook provided to your lasik doctor by the manufacturer of the device used to perform the refractive procedure. Your lasik doctor should provide you with this handbook and be willing to discuss his/her outcomes (successes as well as complications) compared to the results of studies outlined in the handbook.

Even the best screened patients under the care of most skilled surgeons can experience serious complications.

* During lasik surgery. Malfunction of a device or other error, such as cutting a flap of cornea through and through instead of making a hinge during LASIK lasik surgery, may lead to discontinuation of the procedure or irreversible damage to the eye.
* After lasik surgery. Some complications, such as migration of the flap, inflammation or infection, may require another procedure and/or intensive treatment with drops. Even with aggressive therapy, such complications may lead to temporary loss of vision or even irreversible blindness.

Under the care of an experienced lasik doctor, carefully screened candidates with reasonable expectations and a clear understanding of the risks and alternatives are likely to be happy with the results of their refractive procedure.Advertising
Be cautious about "slick" advertising and/or deals that sound "too good to be true." Remember, they usually are. There is a lot of competition resulting in a great deal of advertising and bidding for your business. Do your homework.

Risks associated with LASIK

Most patients are very pleased with the results of their refractive lasik surgery. However, like any other medical procedure, there are risks involved. That's why it is important for you to understand the limitations and possible complications of refractive lasik surgery.

Before undergoing a refractive procedure, you should carefully weigh the risks and benefits based on your own personal value system, and try to avoid being influenced by friends that have had the procedure or lasik doctors encouraging you to do so.

* Some patients lose vision. Some patients lose lines of vision on the vision chart that cannot be corrected with glasses, contact lenses, or lasik surgery as a result of treatment.

* Some patients develop debilitating visual symptoms. Some patients develop glare, halos, and/or double vision that can seriously affect nighttime vision. Even with good vision on the vision chart, some patients do not see as well in situations of low contrast, such as at night or in fog, after treatment as compared to before treatment.

* You may be under treated or over treated. Only a certain percent of patients achieve 20/20 vision without glasses or contacts. You may require additional treatment, but additional treatment may not be possible. You may still need glasses or contact lenses after lasik surgery. This may be true even if you only required a very weak prescription before lasik surgery. If you used reading glasses before lasik surgery, you may still need reading glasses after lasik surgery.

* Some patients may develop severe dry eye syndrome. As a result of lasik surgery, your eye may not be able to produce enough tears to keep the eye moist and comfortable. Dry eye not only causes discomfort, but can reduce visual quality due to intermittent blurring and other visual symptoms. This condition may be permanent. Intensive drop therapy and use of plugs or other procedures may be required.

* Results are generally not as good in patients with very large refractive errors of any type. You should discuss your expectations with your lasik doctor and realize that you may still require glasses or contacts after the lasik surgery.

* For some farsighted patients, results may diminish with age. If you are farsighted, the level of improved vision you experience after lasik surgery may decrease with age. This can occur if your manifest refraction (a vision exam with lenses before dilating drops) is very different from your cycloplegic refraction (a vision exam with lenses after dilating drops).

* Long-term data is not available. LASIK is a relatively new technology. The first laser was approved for LASIK eye lasik surgery in 1998. Therefore, the long-term safety and effectiveness of LASIK lasik surgery is not known.

Additional Risks if you are Considering the Following:

* Monovision

Monovision is one clinical technique used to deal with the correction of presbyopia, the gradual loss of the ability of the eye to change focus for close-up tasks that progresses with age. The intent of monovision is for the presbyopic patient to use one eye for distance viewing and one eye for near viewing. This practice was first applied to fit contact lens wearers and more recently to LASIK and other refractive surgeries. With contact lenses, a presbyopic patient has one eye fit with a contact lens to correct distance vision, and the other eye fit with a contact lens to correct near vision. In the same way, with LASIK, a presbyopic patient has one eye operated on to correct the distance vision, and the other operated on to correct the near vision. In other words, the goal of the lasik surgery is for one eye to have vision worse than 20/20, the commonly referred to goal for LASIK surgical correction of distance vision. Since one eye is corrected for distance viewing and the other eye is corrected for near viewing, the two eyes no longer work together. This results in poorer quality vision and a decrease in depth perception. These effects of monovision are most noticeable in low lighting conditions and when performing tasks requiring very sharp vision. Therefore, you may need to wear glasses or contact lenses to fully correct both eyes for distance or near when performing visually demanding tasks, such as driving at night, operating dangerous equipment, or performing occupational tasks requiring very sharp close vision (e.g., reading small print for long periods of time).

Many patients cannot get used to having one eye blurred at all times. Therefore, if you are considering monovision with LASIK, make sure you go through a trial period with contact lenses to see if you can tolerate monovision, before having the lasik surgery performed on your eyes. Find out if you pass your state's driver's license requirements with monovision.

In addition, you should consider how much your presbyopia is expected to increase in the future. Ask your lasik doctor when you should expect the results of your monovision lasik surgery to no longer be enough for you to see near-by objects clearly without the aid of glasses or contacts, or when a second lasik surgery might be required to further correct your near vision.

* Bilateral Simultaneous Treatment

You may choose to have LASIK lasik surgery on both eyes at the same time or to have lasik surgery on one eye at a time. Although the convenience of having lasik surgery on both eyes on the same day is attractive, this practice is riskier than having two separate surgeries.

If you decide to have one eye done at a time, you and your lasik doctor will decide how long to wait before having lasik surgery on the other eye. If both eyes are treated at the same time or before one eye has a chance to fully heal, you and your lasik doctor do not have the advantage of being able to see how the first eye responds to lasik surgery before the second eye is treated.

Another disadvantage to having lasik surgery on both eyes at the same time is that the vision in both eyes may be blurred after lasik surgery until the initial healing process is over, rather than being able to rely on clear vision in at least one eye at all times.

When is Lasik not suitable?

You are probably NOT a good candidate for refractive lasik surgery if:

* You are not a risk taker. Certain complications are unavoidable in a percentage of patients, and there are no long-term data available for current procedures.

* It will jeopardize your career. Some jobs prohibit certain refractive procedures. Be sure to check with your employer/professional society/military service before undergoing any procedure.

* Cost is an issue. Most medical insurance will not pay for refractive lasik surgery. Although the cost is coming down, it is still significant.

* You required a change in your contact lens or glasses prescription in the past year. This is called refractive instability. Patients who are:

* In their early 20s or younger,
* Whose hormones are fluctuating due to disease such as diabetes,
* Who are pregnant or breastfeeding, or
* Who are taking medications that may cause fluctuations in vision,

are more likely to have refractive instability and should discuss the possible additional risks with their lasik doctor.

* You have a disease or are on medications that may affect wound healing. Certain conditions, such as autoimmune diseases (e.g., lupus, rheumatoid arthritis), immunodeficiency states (e.g., HIV) and diabetes, and some medications (e.g., retinoic acid and steroids) may prevent proper healing after a refractive procedure.

* You actively participate in contact sports. You participate in boxing, wrestling, martial arts or other activities in which blows to the face and eyes are a normal occurrence.

* You are not an adult. Currently, no lasers are approved for LASIK on persons under the age of 18.

Precautions
The safety and effectiveness of refractive procedures has not been determined in patients with some diseases. Discuss with your lasik doctor if you have a history of any of the following:

* Herpes simplex or Herpes zoster (shingles) involving the eye area.

* Glaucoma, glaucoma suspect, or ocular hypertension.

* Eye diseases, such as uveitis/iritis (inflammations of the eye)

* Eye injuries or previous eye surgeries.

* Keratoconus

Other Risk Factors
Your lasik doctor should screen you for the following conditions or indicators of risk:

* Blepharitis. Inflammation of the eyelids with crusting of the eyelashes, that may increase the risk of infection or inflammation of the cornea after LASIK.

* Large pupils. Make sure this evaluation is done in a dark room. Younger patients and patients on certain medications may be prone to having large pupils under dim lighting conditions. This can cause symptoms such as glare, halos, starbursts, and ghost images (double vision) after lasik surgery. In some patients these symptoms may be debilitating. For example, a patient may no longer be able to drive a car at night or in certain weather conditions, such as fog.

* Thin Corneas. The cornea is the thin clear covering of the eye that is over the iris, the colored part of the eye. Most refractive procedures change the eye’s focusing power by reshaping the cornea (for example, by removing tissue). Performing a refractive procedure on a cornea that is too thin may result in blinding complications.

* Previous refractive lasik surgery (e.g., RK, PRK, LASIK). Additional refractive lasik surgery may not be recommended. The decision to have additional refractive lasik surgery must be made in consultation with your lasik doctor after careful consideration of your unique situation.

* Dry Eyes. LASIK lasik surgery tends to aggravate this condition.

Alternatives for LASIK Surgery

Refractive Eye Surgery is any eye surgery used to improve the refractive state of the eye and decrease the need for glasses. The most common methods today use lasers to reshape the cornea.

Radial Keratotomy or RK and Photorefractive Keratectomy or PRK are other refractive surgeries used to reshape the cornea. In RK, a very sharp knife is used to cut slits in the cornea changing its shape. PRK was the first surgical procedure developed to reshape the cornea, by sculpting, using a laser. Later, LASIK was developed. The same type of laser is used for LASIK and PRK. Often the exact same laser is used for the two types of surgery. The major difference between the two surgeries is the way that the stroma, the middle layer of the cornea, is exposed before it is vaporized with the laser. In PRK, the top layer of the cornea, called the epithelium, is scraped away to expose the stromal layer underneath. In LASIK, a flap is cut in the stromal layer and the flap is folded back.

Another type of refractive surgery is thermokeratoplasty in which heat is used to reshape the cornea. The source of the heat can be a laser, but it is a different kind of laser than is used for LASIK and PRK. Other refractive devices include corneal ring segments that are inserted into the stroma and special contact lenses that temporarily reshape the cornea (orthokeratology).

Techniques

• RK uses spoke-shaped incisions (usually made with a diamond knife) to alter the shape of the cornea and reduce myopia; this technique has now been largely superseded by other methods.

• PRK is an outpatient procedure generally performed with local anesthetic eye drops. It is a type of refractive surgery which reshapes the cornea by destroying microscopic amounts of tissue from the outer surface with a cool, computer-controlled ultraviolet beam of light (an excimer laser).

• LASIK is a more difficult 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, opens the flap like a hinged door, removes the targeted tissue in the corneal stroma beneath it with the excimer laser, and then replaces the flap. Some variations don't use a microkeratome but cut the flap with a laser.

• LASEK is a procedure that permanently changes the shape of the cornea using an excimer laser to ablate a small amount of tissue from the front of the eye, just under the eye's skin or epithelium which is kept and replaced to act as a natural bandage.

• Thermal Keratoplasty is used to correct hyperopia by putting a ring of 8 or 16 small burns surrounding the pupil, and steepen the cornea with a ring of collagen contriction.

• Laser Thermal Keratoplasty (LTK) is a no-touch Thermal Keratoplasty performed with a Holmium Laser while Conductive Keratoplasty (CK) is Thermal Keratoplasty performed with a high-frequency electric probe. Thermal keratoplasty can also be used to improve presbyopia or reading vision after age 40.

• Lens implants can also be used inside the eye to change refractive error. Currently all refractive implants are under investigation by the Food and Drug Administration.

Risks

While refractive surgery is becoming more affordable and safe, it is not for everybody. People who are slow healers or who have ongoing medical conditions such as glaucoma or diabetes, uncontrolled vascular disease, autoimmune disease, pregnant women or people with certain eye diseases involving the cornea or retina, are not good candidates for refractive surgery. Furthermore, some people's eye shape may not permit effective refractive surgery without removing dangerous amounts of corneal tissue. It is important that those considering laser eye surgery have a full examination. Unfortunately, since some surgeons eager to find business may accept patients unsuited to such surgery, prospective patients should choose their surgeon with care.

Other risks even for healthy people may be:

• Infection and delayed healing: There is a less than 0.1 percent chance of the cornea becoming infected after PRK, and a somewhat smaller chance after LASIK. This is uncomfortable, but has no long-term effects after a period of four years.

• Undercorrection/Overcorrection: Predicting perfectly how your eye will respond to laser surgery is not yet possible. Therefore, you may still need corrective lenses after the procedure to obtain good vision. In some cases, a second procedure can be done to improve the result.

• Decrease in Best-Corrected Vision: After refractive surgery, a few patients find that their best obtainable vision with corrective lenses is worse than it was before the surgery. This may happen as a result of irregular tissue removal or the development of corneal haze.

• Excessive Corneal Haze: Corneal haze occurs as part of the normal healing process after PRK. In all but a few cases, it has no effect on the final vision and can only be seen by an eye doctor with a microscope. However, there are some cases of excessive haze that interferes with vision. As with undercorrections, this can often be dealt with by means of an additional laser treatment. The risk of significant haze is much less with LASIK than with PRK.

• Regression: In some patients the effect of refractive surgery is gradually lost over several months. This is like an undercorrection, and a re-treatment is often feasible. But, usually results are permanent.

• Halo Effect: The halo effect is an optical effect that is noticed in dim light. When the pupil enlarges to adapt to the dimmer light, a second faded image is produced by the untreated peripheral cornea. For some patients who have undergone PRK or LASIK, this can interfere with night driving.

• Flap Damage or Loss (LASIK only): Instead of creating a hinged flap of tissue on the central cornea, the entire flap could come loose. If this were to occur it could be replaced after the laser treatment. However, there is a risk that the flap could be damaged or lost.

• Distorted Flap (LASIK only): Irregular healing of the corneal flap could create a distorted corneal shape, which would decrease the best-corrected vision.

• Dry eye: Feeling of dryness, soreness, and discomfort in the eye.

• Altitude effects: Some refractive surgery patients have reported significant changes in vision with changes of altitude (perhaps because oxygen concentration can affect corneal swelling). A patient who achieves good vision at sea level may have poorer results in the mountains.

• Incomplete Procedure: Equipment malfunction may require the procedure to be stopped before completion. This is a more important factor in LASIK, due to its higher degree of complexity, than in PRK.

According to CRSQA (an industry body concerned with quality control of ocular surgery), a competent refractive surgeon will typically achieve results at the following levels:

• Around 90% of patients will receive 20/40 or better uncorrected visual acuity (and, thus, 10% will not).
• Around 50% will achieve 20/20 or better (and 50% will not); patients with high myopia, hyperopia, or astigmatism, have poorer chances of achieving 20/20.
• Around 10% of patients will need retreatment
• "Less than 3%" of patients will have unresolved complications six months after surgery.

FDA Regulations for LASIK

In the United States, the Food and Drug Administration (FDA) regulates the sale of medical devices such as the lasers used for LASIK. Before a medical device can be legally sold in the U.S., the person or company that wants to sell the device must seek approval from the FDA. To gain approval, they must present evidence that the device is reasonably safe and effective for a particular use, the "indication." Once the FDA has approved a medical device, a doctor may decide to use that device for other indications if the doctor feels it is in the best interest of a patient. The use of an approved device for other than its FDA-approved indication is called "off-label use." The FDA does not regulate off-label use or the practice of medicine.

The FDA does not have the authority to:

* Regulate a doctor's practice. In other words, FDA does not tell doctors what to do when running their business or what they can or cannot tell their patients.
* Set the amount a doctor can charge for LASIK eye surgery.
* "Insist" the patient information booklet from the laser manufacturer be provided to the potential patient.
* Make recommendations for individual doctors, clinics, or eye centers. FDA does not maintain nor have access to any such list of doctors performing LASIK eye surgery.
* Conduct or provide a rating system on any medical device it regulates.

The first refractive laser systems approved by FDA were excimer lasers for use in PRK to treat myopia and later to treat astigmatism. However, doctors began using these lasers for LASIK (not just PRK), and to treat other refractive errors (not just myopia). Over the last several years, LASIK has become the main surgery doctors use to treat myopia in the United States. More recently, some laser manufacturers have gained FDA approval for laser systems for LASIK to treat myopia, hyperopia and astigmatism and for PRK to treat hyperopia and astigmatism.

See the section on FDA-approved lasers for more details on which lasers have received FDA approval and the specific indications and treatment ranges for which they were approved.

The procedure of Lasik

The first step in the lasik procedure consists of mapping the corneal surface with a computer controlled scanning device to determine the exact shape. Then the appropriate amount of tissue which needs to be removed is calculated, such that upon replacing the flap there is no need (or less need) for corrective devices like spectacles and lenses. The ablation (or vaporization) is carried out by a computer controlled laser.

This lasik procedure is used for vision correction, i.e. the removal or reduction of dependence on corrective devices. The benefits of the lasik surgery are large and obvious - cosmetic, utilitarian and psychological. However, there is a small chance of complications like corneal infection, haziness, halo or glare, amongst others. The lasik procedure is irreversible.

Lasik technology is improving at a rapid pace, but a large body of conclusive evidence on the chances of long-term complications is not yet in place.

A 2004 Wake Forest University study found that Lasik results are affected by heat and humidity, both during the procedure and in the two weeks preceding surgery.

Why Lasik

The cornea is a part of the eye that helps focus light to create an image on the retina. It works in much the same way that the lens of a camera focuses light to create an image on film. The bending and focusing of light is also known as refraction. Usually the shape of the cornea and the eye are not perfect and the image on the retina is out-of-focus (blurred) or distorted. These imperfections in the focusing power of the eye are called refractive errors. There are three primary types of refractive errors: myopia, hyperopia and astigmatism. Persons with myopia, or nearsightedness, have more difficulty seeing distant objects as clearly as near objects. Persons with hyperopia, or farsightedness, have more difficulty seeing near objects as clearly as distant objects. Astigmatism is a distortion of the image on the retina caused by irregularities in the cornea or lens of the eye. Combinations of myopia and astigmatism or hyperopia and astigmatism are common. Glasses or contact lenses are designed to compensate for the eye's imperfections. Surgical procedures aimed at improving the focusing power of the eye are called refractive surgery. In Lasik surgery, precise and controlled removal of corneal tissue by a special laser reshapes the cornea changing its focusing power.

Brief about LASIK

LASIK - Overview of LASIK.

What Is It?

LASIK is an innovative form of eye surgery that uses a laser to reshape the cornea. LASIK stands for "laser in situ keratomileusis."

The cornea is the clear, round "window" of tissue that allows light to enter the front of the eye. By reshaping the cornea, the surgeon adjusts the focus of light on the retina (the layer at the back of the eye responsible for sight). As a result, vision often improves in people who have nearsightedness, farsightedness or certain other vision problems.

In LASIK, the eye surgeon first cuts a small, hinged flap of tissue from the front of the cornea with an instrument called a microkeratome. Once this flap is moved out of the way, a laser is used to reshape the underlying protein fibers (collagen) of the cornea. This reshaping is based on precise measurements made by the eye doctor during the presurgery exam. When the laser reshaping is done, the corneal flap is moved back into place. Because the cornea heals quickly, many people who have LASIK surgery notice dramatic improvements in vision almost immediately.

LASIK is an outpatient procedure, meaning there is no overnight stay in a hospital. It generally takes 10 to 15 minutes for each eye. Some surgeons work on both the right and left eyes at one sitting. Other surgeons do LASIK on only one eye first. Then, after achieving a good result with the first eye, they do LASIK on the second eye.

LASIK is the most common surgical treatment to correct nearsightedness in the United States. The technique has been used successfully in the United States since 1991, and hundreds of thousands of people have been satisfied with their results. However, because the procedure is still relatively new, the long-term effects of LASIK remain unknown. For this reason, people should have a clear understanding of the potential risks and complications of LASIK surgery.

Also, because most health insurance policies do not cover LASIK surgery, people must be willing to pay the entire cost of the procedure themselves. The cost varies depending on where you live, but it usually amounts to several thousand dollars per eye.

What It's Used For

LASIK can be used to treat the following vision problems:

• Nearsightedness (myopia), in which distant objects appear blurry
• Farsightedness (hyperopia), in which nearby objects appear blurry
• Astigmatism, in which blurred vision is caused by an irregularly shaped cornea

If you have one of the vision problems, your eye doctor can give you more information about whether LASIK surgery is appropriate for you. LASIK may not be an option for you if:

• You are less than 18 years old.
• Your eyeglass or contact lens prescription has changed in the past 12 months. (Pregnancy and breastfeeding can change your prescription temporarily.)
• Your career will be threatened. (Some employers and professional societies do not approve of LASIK surgery. Even the U.S. military has a very cautious view of LASIK, especially for service related to aviation or diving.)
• You have a chronic autoimmune disease (lupus, rheumatoid arthritis), uncontrolled diabetes or any illness that can alter wound healing.
• You are taking a medication that affects vision or slows wound healing. Examples include retinoic acid (Renova and other brand names), steroids and drugs that suppress the immune system.
• You play sports (boxing, martial arts, wrestling) in which eye impacts are common.
• You have had a serious eye inflammation, such as uveitis or iritis.
• You have had a herpes simplex or herpes zoster (shingles) eye infection.
• You have glaucoma or any other condition that changes the pressure inside your eye.
• You have an unusually thin cornea, or you have an eye disorder where the middle of the cornea thins and bulges outward (keratoconus).
• Your cornea has been damaged by trauma or altered by previous eye surgery.
• Your pupils are extraordinarily large.
• You have severely dry eyes.

Preparation

Once you decide to have LASIK eye surgery, your doctor will schedule an eye evaluation prior to surgery. If you wear contact lenses, you must switch to eyeglasses for a few weeks before this evaluation. This will allow your cornea to resume its natural shape.

At your presurgery eye evaluation, your eye doctor will review your medical history and eye history. To confirm that your vision is stable, he or she may ask to see your eye prescription records, so bring those with you to the examination. Also, make a list of any medications you take, including any over-the-counter drugs and herbal remedies. Your doctor will need to review this list.

After using eye drops to widen (dilate) your pupils, the doctor will examine your eyes thoroughly. This examination will include a test for glaucoma, an examination of your retina and a check of how well you can see. Your doctor will take precise measurements of your eyes, including measurements of the shape and thickness of your cornea.

After this eye examination is finished, your doctor will discuss LASIK as an option for you. This discussion should include your expectations, the potential risks and complications of surgery, other treatment options, and frank answers to your questions. At the end of this discussion, your doctor probably will ask to you sign an informed consent form giving the doctor permission to do the surgery.

How It's Done

Your doctor will ask you to stop wearing makeup, lotions and perfumes for a day or two before surgery. You will not be able to drive after your LASIK procedure, so make arrangements for someone to drive you home.

On the day of the procedure, your doctor may give you a mild sedative to help you relax. You will enter the operating room and lie down in a reclining chair. The area around your eye will be cleaned with an antiseptic solution. Next, numbing eye drops will be placed in your eye so that you will not feel pain or discomfort during the procedure. An instrument called a lid speculum will be inserted into your eye to keep your eyelids open, and the doctor will use special ink to mark the surgical area on your cornea.

Next, a ringlike suction device will be placed on the front of your eyes to hold your cornea in place during the procedure. This suction ring will cause a sensation of pressure, but no pain. Then, a delicate cutting instrument called a microkeratome will be used to slice a tiny, hinged flap of tissue from the front of your cornea. You will not see or feel the microkeratome cutting your cornea.

Once the cutting is done, the surgeon will remove the suction ring from your eye, and fold back the hinged flap of cornea. Next, the laser will be moved into position, and you will be asked to stare at a light. Staring fixes your gaze and keeps your eye from moving. Once your eye is steady, the doctor will use the laser to vaporize portions of your cornea. This vaporization is guided by a computer. It is based on precise eye measurements that were made during your presurgery examination. As the laser works, you will hear a clicking sound, and you may notice a smell similar to burning hair. These sounds and smells are normal.

When your laser treatment is finished, the doctor will reposition the hinged flap of cornea. Although no stitches are necessary, the doctor probably will cover your eye with an eye shield to protect the corneal flap as it heals.

After your surgery, you must be careful not to touch or press your eye. For a few hours, you may feel slight discomfort or a burning sensation in your eye. In most cases, you can relieve this with over-the-counter pain medication.

Follow-Up

Your first follow up visit probably will be scheduled for the day after surgery. At this visit, your doctor will remove the eye patch, examine your cornea and check your vision. He or she may prescribe antibiotic eye drops and "artificial tears."

Your doctor will tell you when it is safe for you to resume driving, wearing eye makeup, playing contact sports, and using a whirlpool or hot tub. To help protect your healing eye, you probably will need to wear the eye shield at night for about four weeks.

Your doctor may ask you to return for a second follow up visit seven days after surgery. Depending on your progress, a few more eye exams may be necessary in the next six months.

Risks

Potential risks and complications include:

• Malfunctions of the microkeratome, suction device or laser equipment, which can result in improper cutting of the corneal flap, or improper positioning of the laser beam
• Infection or scarring of the cornea
• Replacing the corneal flap in the wrong position after surgery
• Glare or decreased vision, especially at night. Some people also complain of seeing "star bursts" or "halos" around objects.
• Dry eye
• A decrease in vision after surgery. In some cases, even eyeglasses or contact lenses may not correct the problem completely.
• Persistent eye discomfort, blurry vision, glare or increased sensitivity to light
• Overcorrection, so that a nearsighted person is made farsighted or a farsighted person is made nearsighted

Surgical complications occur in about 1% to 2% of all LASIK patients. In addition, approximately 6% of people develop complications within the first three months after surgery. Between 5% to 15% of patients need to return for a second procedure to fine tune vision.

For the majority of people, however, LASIK treatment is successful and uncomplicated. More than 90% of nearsighted patients achieve vision that measures 20/40 or better after LASIK surgery. For farsighted patients, the percentage is somewhat lower � about 82%. In some cases, vision improves immediately. In others, improvement occurs gradually over three to six months.