FAQs ABOUT LASER VISION CORRECTION

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1 revisionrubinfeld.com FAQs ABOUT LASER VISION CORRECTION The power of clarity According to the American Society of Cataract and Refractive Surgery, patients who were well educated about laser vision correction were highly satisfied with their results. At Re:Vision Roy Rubinfeld, MD, patient satisfaction is our top priority. To help inform you about laser vision correction, we have listed answers to the most frequently asked questions we receive. After reading these FAQs, we encourage you to make notes and bring them to your complimentary, no-obligation consultation. There, our staff and your surgeon will be happy to go over all of your questions and concerns about the procedure, your eyes and visual goals. How long does the procedure take? The LASIK procedure itself takes just a few minutes per eye but you can expect to be in the laser center for between two and three hours on the day of your procedure as we often carefully recheck many measurements. Is it normal to be nervous? Of course it is. Our eyes and vision are very precious. It s perfectly natural to be nervous, especially if you re not sure what to expect. However, Re:Vision Roy Rubinfeld, MD does all we can to ensure your comfort and relaxation before, during and after the procedure. Dr. Rubinfeld and his staff spend a great deal of time describing exactly what is involved in the procedure including the sounds and sights you will experience. We talk with you throughout the procedure to walk you through the process and ensure you are as comfortable as possible. Although you can t actually see what is being done throughout most of the procedure, patients are still aware that someone is near their eyes and this can feel a bit awkward. To foster comfort, we prescribe a mild sedative prior to the procedure and play music you enjoy. Please feel free to bring a digital music player or favorite CD. It is simply not enough to provide our patients with excellent vision. We want to make your experience as comfortable and reassuring as possible. On that note, if there is anything else we can do to make your procedure more enjoyable, please let us know.

2 FAQs, continued, page 2 What is the procedure like? What can I expect when it is happening? You will remain awake and relaxed during the procedure. We often prescribe a mild sedative that allows our patients to fully relax but still remain aware and responsive to instructions and information being shared by our staff and doctor. We will also give you numbing drops. It only takes one anesthetic eye drop to numb your eyes so, to be absolutely certain you are very comfortable, we use four anesthetic eye drops. Music of your choosing will be played during your procedure if you so desire as well. During the laser part of your procedure, we will ask you to look at a flashing fixation light pictured at right. We will let you know when you may feel some pressure and your vision may dim for a few seconds at the beginning of the procedure. During the laser treatment you will also hear some ticking sounds, see red lights and notice an odor that s a bit like a hairdryer, although no significant heat is generated. Hearing about the experiences of other patients may help you feel more comfortable about deciding to have laser vision correction and can make the experience easier for you. Please feel free to ask the Re:Vision Roy Rubinfeld, MD staff and surgeons who have had it done themselves about their personal experiences. What happens if I blink or move my eyes during the procedure? Many of our patients worry they might not be able to hold their eyes steady for the seconds required for laser vision correction, but the overwhelming majority does so without any difficulty. Just in case there is difficulty, however, we use certain precautions. Your eyes won t feel dry during the procedure because of the numbing drops and while you relax your head in a soft, cushioned headrest, we help you keep your eye open with a small instrument to help prevent blinking. Your surgeon observes your eye through a microscope during the procedure and can detect the slightest movement before you can. We also use advanced lasers with tracking systems that track and adjust for the movement of your eye thousands of times per second. If you do look away, your surgeon can stop the laser treatment immediately and instruct you to look back at the flashing light. Once your eye is correctly positioned again, the treatment is restarted exactly where it left off. How experienced is Dr. Rubinfeld in excimer laser treatments? Dr. Roy Rubinfeld was the first Washington area ophthalmologist to become involved in the care of laser vision correction patients in He has performed tens of thousands of LASIK, PRK and other vision correction procedures. He is considered a doctor s doctor, as hundreds of physicians, including ophthalmologists, have chosen him to perform laser vision correction on them. Please refer to the Meet Re:Vision Roy Rubinfeld, MD document for more information on Dr. Rubinfeld and his staff.

3 FAQs, continued, page 3 Does the procedure hurt? It only takes one anesthetic eye drop to numb your eyes so, to be absolutely certain you are very comfortable, we use four anesthetic eye drops. Some people feel a sensation of pressure around their eye for several seconds. After their LASIK, most people have 3-6 hours of mild irritation (similar to the sensation of a dirty contact lens) and a single dose of Tylenol (if anything) is all they need. PRK (a laser procedure often recommended for patients who cannot have LASIK) can sometimes be more uncomfortable for a longer period of time (4-7 days). How quickly will I see? Most of our patients return to work and driving in 1-2 days. In the first week or two, many people feel as though they re looking through a bit of Vaseline, fog or a dirty contact lens. Although they can see, contrast, sharpness and/or clarity have not yet returned. This is completely normal. It usually takes a few weeks for your vision to reach its peak and, by three months, most patients vision and eye prescriptions have stabilized. What should I expect after LASIK? It s common for one eye to be less comfortable than the other for the first few weeks and/ or one eye to see better more quickly than the other. This is normal, and usually doesn t interfere with driving or other daily activities. It is also common and completely normal for your vision to fluctuate somewhat from moment to moment or day to day because of dryness. Even though your eyes may not feel particularly dry, please use the artificial tears we supply you, or other similar tears from the pharmacy, several times a day or as needed for a few weeks after the procedure. Avoid those with preservatives and check your postop instructions for the brands we recommend. As with any surgical procedure, to protect your eyes as they heal, it is critically important not to rub or get hit in the eye. Most people can swim and start exercising within about a week. Check with the eye doctor who examines you after surgery to see when you can return to your normal activities. At your first and second visit after surgery your eye doctor will also tell you whether you may need temporary glasses to improve your vision while your eyes are healing. This is not uncommon and generally does not suggest a problem. Red spots on the whites of your eyes are perfectly normal and will usually fade over about two weeks or so. Can there be complications? Complications after laser vision correction surgery by expert surgeons are uncommon. There are a few symptoms that may indicate that something may need your doctor s attention. These include: Discomfort that is getting worse, rather than better in the first week or so after surgery. Significant reduction in your vision (not just mild fluctuations).

4 FAQs, continued, page 4 Marked discharge or redness or swelling of your lids. If you have questions after your vision correction procedure, call I have really bad vision. Can I still have laser vision correction? The overwhelming majority of patients (well over 95% of patients) can now have laser vision correction to improve their distance vision. We can often provide clear vision for those patients whose prescriptions are too high even for custom LASIK with procedures such as PRK, ICL or advanced lens implants. Your doctor will discuss the best options to correct your vision based on your particular eye characteristics like corneal thickness, corneal curvature and prescription. Re:Vision Roy Rubinfeld, MD is not only a LASIK center. Dr. Rubinfeld has extensive experience with many types of vision correction and access to the most advanced technology at several locations so we can select the best possible option to help you improve your visual freedom and see better without glasses or contacts. Do you perform custom laser vision correction? Yes, we do. Media coverage of custom or wavefront LASIK has drawn widespread attention to this important advance. Since the excimer laser was approved as safe and effective in 1996, several million Americans have had their vision corrected and have recommended LASIK to friends and family. However, concerns about nighttime glare, and reports of a very small percentage of problems have caused many people who would prefer not to wear glasses or contacts to postpone having their vision corrected. Custom laser vision correction allows more people to have their vision corrected more safely than ever before. In fact, many patients who have had custom LASIK have found that their night vision after surgery is better than their night vision with glasses or contacts before surgery. This is not to say that LASIK, as it has been performed since the early 1990s, is not a safe procedure. On the contrary, Dr. Rubinfeld has performed well over twenty thousand LASIK procedures with excellent results. Custom LASIK and other new advances now provide an extra measure of precision that allows many patients who want to see well without glasses or contacts but have been waiting for better technology to now feel comfortable having their vision corrected. How does custom/wavefront LASIK work? Conventional LASIK is based only upon the patient s eyeglass prescription. Custom LASIK takes into account not just eyeglass prescription, but other precise measurements such as eye shape and how eyes focus light. Two people can have the same eyeglass prescription but no two people have exactly the same wavefront or curvature maps of their eyes.

5 FAQs, continued, page 5 With custom laser vision correction, these more sophisticated measurements and more refined treatments are used to achieve a more accurate correction, in many cases better than 20/20 vision with reduced risks. Also, many patients who were once told they could not have their vision corrected in the past because of large pupils or unusual prescriptions, may now safely have vision correction with custom LASIK. The above diagram shows a typical eye prescription used for conventional laser vision correction (pictured in the middle). On the left and right are curvature and wavefront maps that can be used to more accurately customize laser vision treatment and results. Wavefront-optimized custom laser treats the vision correction by taking into account measurements of the curvature of each individual eye. Conventional laser treatments applied to the steeper side areas of the cornea are less effective because some of the cool laser pulses are reflected or spread out (see diagram at right). Wavefront-optimized treatments using Perfect Pulse technology add additional pulses to the steeper side areas of each cornea to achieve improved safety and precision. Many of our patients tell us that the quality of their vision actually improved after this form of custom laser treatment, with better than 20/20 results. Does laser vision correction last? What about long term results? We have over four decades of experience with the precursor to LASIK known as myopic keratomileusis or automated lamellar keratectomy. Also, several studies have shown stable, good vision at 10, 12, 14 years and longer after laser vision correction*. We believe it is unlikely that you will require any additional laser vision correction to improve your distance vision once your vision is stable after the procedure. A recent analysis of our custom LASIK results showed that, on average, over 95% of our patients achieved excellent results with a single LASIK procedure. Occasionally, especially with high prescriptions, a second procedure may be suggested to get your vision as clear as you desire. This does not mean that anything went wrong with your initial procedure. Much like golf, the farther you are from the hole, the more likely you are to need more than one stroke to get the ball in. With our Commitment of Care Program we will perform any necessary enhancements free of charge until your vision is satisfactory and stable, providing it is medically appropriate. In the unlikely event you do require an enhancement two years or more after your vision correction procedure, and it is medically appropriate, we will perform this procedure for a nominal fee. For more information see our Commitment of Care Program document. *Ophthalmology 2004; , American Journal of Ophthalmology, Jan. 2008; British Journal of Ophthalmology, Feb

6 FAQs, continued, page 6 Where is the procedure performed? Dr. Rubinfeld performs laser vision correction at two locations, both only minutes from the beltway in Rockville, Maryland and Fairfax, Virginia. Please be sure to note which office your appointment is located, and reference the Finding Us document for directions. Rockville Rockville Pike Suite 150 Rockville, MD Fairfax 8316 Arlington Blvd. Suite 235 Fairfax, VA When can I exercise or travel after laser vision correction? Most of our patients have returned to work within 1 or 2 days after LASIK. We generally recommend that you not fly for several days after the procedure. We advise you to check with your doctor to be certain. Each person s exercise routine is different. The key issue is avoiding trauma to the eye, and when you do start exercising after LASIK, try to avoid perspiration in your eyes because you might then inadvertently rub them. Generally, patients can swim 1 week after vision correction, but should not participate in any exercise or sports that may involve injury to the eye unless they are wearing eye protection. Please ask us about your personal sports or exercise schedule. Should I have both eyes done at the same time? We perform laser vision correction on both eyes on the same day for the overwhelming majority of our patients. There are pros and cons to this approach but most people prefer to minimize any postoperative discomfort and time off from work. Also, if after the procedure, one eye is quite nearsighted and the other eye has been corrected, this can be somewhat disorienting. In general, many potential problems that can occur in LASIK can be observed at the time of the procedure. This is why, in most cases, when LASIK of the first eye goes perfectly, we feel confident treating the second eye on the same day. If, however, the first eye proceeds less than perfectly, we generally wait until that eye heals and then treat the second eye on another day. Please don t hesitate to ask us about any concerns or questions you have about one eye or two eye treatments. What are the risks? Although LASIK is surgery and all surgery has risks, in our experience and in published studies, the overwhelming majority of patients achieve excellent results. Serious complications are uncommon and we are not aware of any cases of blindness from laser vision correction in millions of procedures. It is also worth noting that USA Today (2001) identified Dr. Rubinfeld as one of the leading surgeons to go to for complex cases and

7 FAQs, continued, page 7 cases for which complications arose. Because of this, we like to say our patients are in the best hands. Of course, nothing is without risk, including wearing contact lenses. There are medical papers that suggest that laser vision correction in the hands of a skilled, expert surgeon may be less risky than long term contact lens wear. We have treated a number of patients who have experienced extremely serious complications simply from wearing their contact lenses. These complications are more common in patients who don t follow their eye doctor s contact lens care instructions. The laser vision correction consent form can be very confusing and intimidating. While it is true that anything is possible, patients generally want to know the most common problems that might occur. We tell patients that in our experience, the most common potential issue involves the need for a second treatment to get the best vision possible. If a second treatment is needed, it is usually performed several weeks to months after the first procedure. Also, eye dryness can be common after laser and generally is short lived. Infections after laser vision correction are also possible, but Dr. Rubinfeld has only seen a handful in his experience of two decades and tens of thousands of laser vision correction procedures. Occasionally, your surgeon may cancel your procedure if the flap is not adequate. Your LASIK can then be rescheduled once the eye heals. Another concern is trauma to the eye, especially while it is still healing after the procedure. Patients may inadvertently be hit in the eye after the procedure, which could move their flap and make it necessary to surgically reposition it. For this reason, we caution our patients to avoid anything striking the eye, or rubbing eyes for several months after the procedure. Occasionally, some epithelial (skin-like) cells on the surface of the eye can grow underneath the flap and cause problems especially after enhancement procedures. Lifting the flap, brushing away the cells, and then reapplying the flap can generally resolve this issue.

8 FAQs, continued, page 8 What about night vision? In the past, many patients experienced some increased halos around lights and some starbursts or glare at night (see photographs below) for several weeks to months after conventional laser vision correction. They are similar to the glare many patients have while driving at night with their contact lenses. In general, these are noticeable but not debilitating and usually resolve by 6 months after the procedure. Custom laser treatments have been shown to greatly reduce these issues. How important is my surgeon s experience with laser vision correction? From published studies and our experience, it is clear that surgeon experience and skill are critical in laser vision correction. Risks of complications appear to be greatly reduced by the surgeon s experience, training and meticulous attention to detail. Dr. Rubinfeld is a fellowship-trained corneal specialist, and laser vision correction is corneal surgery. Dr. Rubinfeld s experience and surgical skills are well known in the Washington area, nationally and internationally. He initially became involved in the treatment of excimer laser patients in 1991 and has dedicated his practice to vision correction for his patients. He has trained hundreds of LASIK surgeons and co-managing eye doctors through proctoring, lectures, and published scientific articles and book chapters. Because of this experience, hundreds of doctors, eye doctors, surgeons and other health care workers have trusted their eyes to him. For more information about Dr. Rubinfeld and his career, please refer to our Meet Re:Vision Roy Rubinfeld, MD document.

9 FAQs, continued, page 9 What is PRK or advanced surface laser vision correction? Occasionally because a patient s corneas are too thin (or for another reason), LASIK is not the best procedure for them. In these cases, another good option to correct vision with the excimer laser is called PRK. In PRK, no flap is lifted and the laser is applied directly to the cornea after brushing away the corneal surface layer. Both LASIK and PRK achieve excellent (and similar) results but at different rates of speed. LASIK usually results in excellent vision within 1-2 days but, because the corneal surface cells need to regrow after PRK, it takes longer (usually about a week or more) for vision to start to improve. One way to think of the difference between LASIK and PRK is to consider LASIK the Ferrari of excimer laser vision correction and PRK to be the Dodge Stratus. They both get you to the same destination but one is much faster and more elegant. Your doctor will discuss PRK with you during your visit with us if LASIK is not your best option. What if I have astigmatism? The FDA approved the use of a laser for patients with astigmatism in 1997 and the results of our treatments for these patients have been excellent, especially with custom LASIK. Who will perform my eye examinations after my vision correction? If your regular eye doctor referred you to us, he or she will generally continue to care for you after your surgery. Please be sure to discuss this with us. All of the doctors in our office are experienced in caring for patients after LASIK. Of course, if any problem or question arises, your LASIK surgeon will be available to see you. Should I wait for a better procedure? What s on the horizon? For over two decades, we have been involved in laser vision correction. Based on this experience and advances in vision correction, we believe there has never been a better time to have LASIK. Just ask Dr. Rubinfeld, who has had it done himself. Is laser vision correction expensive? The fees range between $2,250 and $3,000 per eye for LASIK and include the preoperative evaluation, the procedure and all postoperative care for a year. Through our Commitment of Care Program it may also include additional procedures if they are needed. If you compare this to the cost of wearing soft contact lenses, especially those for astigmatism, laser vision correction can often cost less than wearing soft contacts for about 10 years.

10 FAQs, continued, page 10 At the end of 10 years of contact lens wear, however, a patient s vision is still not corrected. We liken laser vision correction to owning your clear vision versus renting it with contact lenses. Do you offer interest-free financing? Insurance generally does not cover laser vision correction. Probably the best way to pay for laser vision correction is with a medical savings plan. If you have a medical savings plan through your work, you can place pre-tax dollars in the plan to be used for laser vision correction the following year. This can save a great deal of money in taxes and make laser vision correction even more affordable. For example, a person with an annual salary of $35,000 might save $1,480 on LASIK costing $5,000 using a flexible savings plan. More information on medical savings plans or other financing options are available upon request. FAQs About Vision Correction over 40 For those of us over 40, laser vision correction can be a slightly different experience than for those younger. Because of this, we have prepared additional FAQs for our patients over 40. How can I see 20/20 and still need reading glasses? People with perfect vision who never needed glasses generally start to find reading difficult without reading glasses at around age 40. This is due to natural changes in the flexibility and close up focusing power of the natural lenses inside your eyes called presbyopia. The term 20/20 vision means that at 20 feet the patient can see what someone with normal vision can see at 20 feet. 20/200 means that the patient has to move up to 20 feet away from an object to see it as well as someone with normal vision can see it from 200 feet away. To accurately measure vision, it must be tested both at far distance and reading distance. Someone over 40 may have 20/20 distance vision but have very blurry 20/200 reading vision without reading glasses. What is Monovision laser vision correction? Monovision is a treatment to reduce the need for reading glasses in people over 40. The treatment involves treating each eye a bit differently, with one seeing somewhat better for distance and one better for close up. Although it sounds like it might feel awkward, many people love monovision. Some don t. If you don t mind the idea of using reading glasses, you may want to choose clear distance vision in both eyes and use readers when you need them. Monovision may not be a good choice for very active people who want to play golf or tennis without glasses or contacts and need the best possible distance vision depth perception. Approximately 45% of our patients over 40 choose monovision and 55% choose to have the clearest possible distance vision in both eyes.

11 FAQs, continued, page 11 How can I tell if I would like Monovision? The best way to determine if this is a good choice for you is simply to try it in your eye doctor s office with either temporary glasses or contact lenses to see for yourself if it feels comfortable for you. Some people are right handed and others are left dominant. This is determined by the dominance patterns in your nervous system and monovision is much like this. Many people are very comfortable with a slight difference between their eyes and some are not. We often tell our patients that this decision is a bit like buying a suit or dress. Try it on. If it fits, you might want to choose it. If it doesn t feel right for you, don t. We will help you to be sure you won t make a bad choice. Another option for some people who don t like monovision involves advanced lens implants. What about cataracts or glaucoma? In general, laser vision correction does not appear to cause cataracts or glaucoma. If someone who has had laser vision correction eventually develops cataracts, cataract surgery can still be successfully performed. Glaucoma is a disease involving pressure inside the eye that damages the optic nerve. If a laser vision correction patient eventually develops glaucoma, he or she may still be successfully treated. Any patient who has had laser vision correction should inform their eye doctor so the doctor can take this into account when performing routine glaucoma testing. Also, a patient who is quite nearsighted has a higher risk of developing a retinal detachment in his or her lifetime regardless of whether they had their vision corrected or not. Laser vision correction may dramatically improve their vision, but they are still at a higher risk for retinal detachment than those with normal eyes. To protect vision for a lifetime, all patients need to be followed by an eye doctor and have regular eye examinations. What if I wear rigid or gas permeable contacts? Over time, hard and rigid gas-permeable contact lenses change the natural shape and therefore the prescription of your eyes. Once these lenses are discontinued, your vision may start to change rapidly as the cornea reverts back to its natural shape. Before any procedure, the corneas of your eyes must return to their natural shape, so that you and your doctor can be assured that prescription is stable and your vision correction procedure is not trying to correct a moving target. For this reason, if you wear hard or rigid, gas permeable contact lenses, you ll need to stop wearing them a minimum of 4 to 6 weeks prior to your surgery, or until your vision and corneal shape stabilize. It can take 6-10 weeks (and occasionally longer) if you ve been wearing them regularly for many years. However, during that time you have the option of being fitted with soft daily wear contact lenses that will allow your cornea to regain its natural shape. Soft contact lenses should usually be discontinued 3-5 days before your procedure. Your eye doctor will check your corneal shape and eye prescriptions about every 2-3 weeks to determine when they are stable. Once these are consistent, you will be ready for your procedure. Each person is different and it may take more or less time for your eyes to stabilize. It is not critical that you stop wearing the lenses before your initial vision correction consultation, however, the sooner you discontinue wearing hard or rigid gaspermeable lenses, the sooner you may schedule your vision correction procedure.