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1 What......You Need to know about LASIK

2 Our Eyes Eyes are the windows to our world. They are so important to us that for many years we have looked for better ways to fix visual problems and improve our eyesight. To understand vision one needs to understand something about how the eye works. The eye is composed of several parts that work together to create sight. It is divided into two main parts, the Anterior anterior segment or front of the eye and the posterior segment or back of the eye. The main component of the posterior segment is the retina. This is what reacts to light coming into the eye and sends signals to the brain that are interpreted as sight. But if the light doesn't reach the retina properly, vision is affected. That brings us to the front of the eye. Its' two important parts are the cornea and lens. These are basically two lenses that focus the light coming into the eye so that it strikes the retina in the proper way for sharp vision. When one of these components changes, for whatever reason, the light no longer reaches the retina in focus and a visual problem results. This is called "refractive error" because it is the "refraction" or bending of light that is incorrect as it passes through the cornea and lens. When this occurs the light needs to be refocused by glasses, contact lenses or surgical treatments, so that it reaches the retina at the right point. Cornea Retina Posterior Optic Nerve Muscle controlling the shape of the lens. Lens Iris

3 Lets take a look at the most common types of refractive error. When near objects are clear and distant objects blurry, it is called Myopia or "nearsightedness": This term indicates that the eyes naturally focus light too quickly. Instead of focusing images on the retina, the image comes to focus in front of the retina. This results in blurred vision for distant objects. The shape of the eye and cornea is usually responsible. When distant objects are sharp and close objects blurry it is called, Hyperopia or "farsightedness": Eye Problems This term is used to describe the opposite of nearsightedness. The focus of the light is not quick enough due to lack of natural focusing power in the eye, leaving an unfocused image on the retina. There is another condition called presbyopia that is often confused with farsightedness. Presbyopia occurs when the lens in the eye becomes "stiff" and the muscle can no longer control it to focus the light properly between far and near objects. By about age 40 to 45, this focusing ability is significantly diminished and the eyes can no longer focus on close objects. This condition is directly related to aging and is not a refractive problem that can be corrected with LASIK. The last condition is called Astigmatism: This is different than the two conditions described above. This occurs when the surface of the cornea is not round in shape like a basketball. There is an uneven shape to the surface more like that of a football. The resulting view is distorted since there is not one sharp focal point in the eye.

4 Fixing Eyes Refractive Correction To correct these refractive errors we need to adjust the light coming into the eye so that after passing through cornea and lens, it is focused on the retina properly. For years glasses and contacts have been the most widely used solution to vision problems. But there are obvious and significant drawbacks to these solutions so other options were examined. Over the years, many attempts have been made to correct vision without glasses, some being more successful than others. One of the most promising avenues was to surgically alter the shape of the cornea or lens, thus refocusing the light. Since the light coming into the eye was refocused this was called refractive surgery. The first refractive procedure, done over 50 years ago, was actually cataract surgery done using implantable lenses placed in the eye. Later, in the early 70's a procedure called Radial Keratotomy or "RK" was developed. It involved making radial cuts in the cornea to change its' shape and was quite successful. However, due to advances in medical technology, it is now typically done only on select patients. As technology has evolved, lasers have been found to be useful in eye care due to their ability to accurately reshape tissue on the eye. Initially, photorefractive keratectomy, or "PRK" was done using the EXCIMER laser with fairly good results. This Radial Incisions on the Cornea for RK procedure was commonly done in the early 1990 s prior to LASIK (laser in-situ keratomileusis) becoming the refractive procedure of choice. Issues with PRK included slow healing time and increased pain in some patients. LASIK has evolved to the point that most eye doctors use it except in special circumstances. The lack of discomfort, the quick healing, and the accurate, stable outcomes have all contributed to LASIK s widespread acceptance by eye doctors and the general public.

5 So Why Do We Use LASER Light? Laser light is different than light from a light bulb. A light source like the sun or a lamp gives off light that is all colors (or wavelengths) mixed together at random and they travel in all directions. LASER light is all the same color and all the light waves move in the same direction. Using mirrors and special lenses, this light can be highly focused on a single point. With an Excimer LASER, at this exact spot and only at that spot, there is a controllable amount of energy generated. This makes it a great tool for medical procedures that require high precision, such as the eye. Another benefit to this technique, since there is no heat outside the target area, is the lack of damage to the surrounding tissues. Using this highly focused energy, the eye surgeon can reshape the cornea, helping correct nearsightedness, farsightedness and astigmatism. LASER Emitter Light that is all the same color and wavelength Focusing Lenses How I t Works The LASIK procedure: In PRK, the LASER is used on the outer surface of the eye so this surface tissue takes some time to heal. Because of this, vision is affected during the healing time and there can be some discomfort. LASIK improves on this procedure by lifting a small portion of the cornea away from the eye first. To do this, a small instrument called a "microkeratome" is used to painlessly create a flap of surface tissue. This round flap remains attached to the eye on one side and is folded back on this small "hinge". This creates a flat "bed" on the cornea and the laser is then used to reshape this part of the eye. Typically, the laser portion of the procedure takes less than a minute to complete. Then the flap is repositioned over the front of the eye, checked for stability (no sutures used) and then the other eye is done in similar fashion. The procedure itself generally takes approximately 5 to 6 minutes per eye and the patient can leave shortly afterwards. Patients can return to a normal lifestyle quickly and there are few restrictions during the healing period.

6 Who can have LASIK? Am I a candidate? Your eye doctor is highly trained and knowledgeable regarding LASIK and will be able to tell you if you are a candidate. A dilated examination which includes special tests generally not done in a regular examination will be performed by your doctor. This will allow the them to determine if there are any problems that would preclude you from surgery. If there any issues that relate to your eligibility for LASIK, your doctor will discuss these in detail. If you are a contact lens wearer, their removal prior to your evaluation will be necessary. Call your eye care provider to find out how long you should discontinue contact usage. This may vary depending on your doctor s recommendation. Some preliminary tests include corneal mapping and measurement of the corneal thickness. These may be done at your doctor s office or may be done prior to your procedure at the surgeon s office. Many factors need to be considered when deciding to have LASIK. When evaluating you for LASIK your eye doctor will consider your visual goals very seriously. Should these be largely achievable with the procedure, you are likely a candidate. Your doctor will question you about this in detail. Expectations need to be realistic as well. No surgeon can guarantee 20/20 vision. Studies indicate that 93% of all patients achieve 20/40 vision or better following LASIK which would allow you to pass a driver s test without glasses. The majority of patients do achieve 20/20 and are very happy. It is possible that some glasses or contact lens correction may be needed to provide the sharpest vision even after LASIK. This is necessary mainly in those who have such a slight residual refractive error that it may not be correctable by an enhancement. Finally, there are new diagnostic tools such as Wavescan and advanced Topography that help the surgeon determine the best treatment plan for each individual. The precision of these tools and the information they provide, vastly improve the chances of reaching your visual goals.

7 WHAT TO EXPECT... If you decide to have LASIK, an information packet will be given to you including an informed consent video, either at your optometrist s office or at Pacific ClearVision Institute. This packet contains instructions on what you should do prior to the surgery and instructions for the day of surgery itself. Make sure you go over this information carefully, it is important to the successful outcome of the proceedure. Upon arrival to Pacific ClearVision Institute, a few final tests will be administered. One more refractive check is done to confirm prior data. Your surgeon will also meet with you prior to the LASIK. This is the time to ask any questions you still may have. The doctor will be happy to discuss your questions on a personal basis and will take the time to make sure they are answered to your satisfaction. Prior to LASIK, if you become too nervous, the staff can provide some medication to help you relax. After the doctor examines your eyes and answers any questions, you will be taken to the laser room. You will be seated in a comfortable chair that will lie back, placing your eyes in position for treatment. The first eye to be treated is prepared using special drapes and a separator is used to keep the lids from blinking. In some people, especially those with small eyelid openings, this can be slightly uncomfortable. At this point, a special instrument is placed on the eye to cause it to become firm. During this time your vision will go dark and you will hear a humming sound of the microkeratome making the "flap". This takes only a few seconds. After the microkeratome is removed, the flap is lifted out of the way and the laser is applied to the exposed surface of the cornea. The laser has been calibrated carefully to deliver the exact treatment your eye needs. This is highly controlled to insure a precise outcome. Once the laser is finished, the flap is laid back down and adheres on its' own without stitches. This takes a couple of minutes. When the surgeon is sure the flap is properly seated, the other eye is treated in the same way. When the procedure is done, a careful examination of your eyes are done at the microscope. Your eyes may be covered with a clear shield and you are advised to keep them closed for 6 hours, except to put in your drops, eat and go to the bathroom. The LASIK Procedure

8 After LASIK What to do. The use of drops will be reviewed extensively with you at your LASIK appointment and you will receive a prescription for your medication. These drops are to prevent infection and to control the healing of your eyes during the first week. Typically there is no pain following the procedure. Your eyes may feel scratchy but generally nothing worse. Six hours after surgery you should see a significant improvement in vision. In 24 hours, 85-80% of the healing has occurred. Usually you will be able to drive yourself to the post-op visit without glasses or contacts. For a week or so, it is common for one eye to be clearer then the other. Generally over the course of a month they will become quite balanced. You may need reading glasses if you had bifocals or reading glasses over contacts prior to LASIK. After the procedure, your follow up visits will usually be with your referring eye doctor. These generally occur at one day, one to two weeks, one month and then as needed. Will I need an Enhancement? At approximately three months, most individuals' vision will have stabilized. In our experience a very low percentage of LASIK patients need enhancements. The greater the vision change, the more chance one will have of needing a second correction. Most enhancements are recognized and treated within approximately one year.

9 Changes to Expect As a rule, LASIK is a very stable procedure. However, the eyes do change over time and things unrelated to your LASIK procedure can occur. The most common is "presbyopia" or the inability of the eyes to close focus as we age. Those between 40 to 45 years of age or older notice that near vision may be more difficult and their eyes will not be able to adjust automatically. It is important to understand this as it will affect the way you use your eyes after LASIK if you are of this age. Typically glasses are only used for reading. In some people "monovision" can be done surgically, making one eye see better for reading and the other for distance. Ask your optometrist if this may work for you. After LASIK Some people may notice increased dryness of their eyes after LASIK. This is usually temporary and will diminish over time. Use of lubricating eye drops frequently helps alleviate the symptoms. Other changes in the eye over time can be cataracts, glaucoma, macular degeneration and other health-related problems. These can occur regardless of having had LASIK. Other specific questions about possible changes in vision should be addressed to your optometrist or to the staff at your surgeon s office.

10 Selecting A Surgeon What do I look for in a LASIK Surgeon? There are many claims about what LASIK can and cannot do. Not all of these claims are true and can lead to inaccurate expectations. Some believe that LASIK can be done to anyone and that they will immediately be able to hike, swim or exercise without restrictions. There are some that even believe their eyes will be perfect, never needing correction again. Many believe it is such a simple procedure that results will be the same no matter where they have it done. So when looking for a surgeon to perform LASIK, they look for price, even traveling long distances to save a few dollars. We want to remind you, this is a surgical procedure surgery to your eyes. Before having any other surgery, most of us would look for a surgeon who would give us the best RESULTS. Then we would consider other factors like price. Most people want the best possible outcome for their surgery regardless of cost. Good results form LASIK are based on several things; the surgeons skill and experience (outcomes), the type of equipment used and how that equipment has performed. Also important is the experience and training of the staff, what pre and postoperative care is offered and what type of screening for eligibility is done. But most important, does the LASIK center allow you to work with your personal eye care physician for your pre and post operative care. Your own eye doctor knows your eye health better than anyone else. They may not perform LASIK themselves, but they provide critical information about your eye health history. This "team" approach gives you the best chance for good LASIK results. Before surgery, a great deal of information needs to be gathered and checked. Your eye doctor can perform many of these tests and then provide the information to the surgeon, improving the ease with which he can perform your treatment. You should ask your doctor to recommend a surgeon whom they trust, work with regularly and has outstanding results. This cooperative care will increase your chances of a good outcome. This extends to the postoperative care. It is very important to closely monitor the outcome of any surgical procedure. This cooperative care between LASIK centers like Pacific ClearVision, and your personal eye care physician, makes the LASIK experience not only safer, but a much more enjoyable and positive experience for you.

11 Who is ClearVision? Pacific ClearVision is your source for specialized eye care needs. Since 1989, we have been a provider of quality Medical & Surgical eye care and we are continually looking for ways to improve that care. Our doctors and staff are highly trained in the latest techniques for eye diagnostics and correction. The medical doctors and optometric doctors at our office are focused on helping you achieve your visual goals in cooperation with your primary eye care physician. We provide a wide range of services dealing with both the front (cornea, lens and refractive portions), and back (retina) segments of the eye. We treat all major eye conditions and use a variety of medical and surgical techniques to address them. We work closely with your regular eye doctor or primary health care provider to give you the best in eye health. Our facility has the most advanced equipment possible and allows us to diagnose eye conditions in several ways, making it possible to tailor treatments very specifically to your individual needs. Find out more about us on the web: Or you can reach us by phone at: About ClearVision Eugene Office: Cottonwood Office : Toll Free:

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