InSight LASIK & Refractive Group: 2013

Tuesday, October 8, 2013

Pregnancy, Breastfeeding, and LASIK

Many potential LASIK candidates inquire about the relationships between pregnancy, breastfeeding, and LASIK. In the most basic terms, LASIK is not an option for women who are pregnant, planning on becoming pregnant, or lactating.

One of the main reasons why LASIK is not suitable for pregnant or breastfeeding women is the fact that both pregnancy and lactation can cause eyesight changes. The hormonal fluctuations that women go through in these conditions cause the body to retain fluid, even in the eyes. When the eyes’ lenses swell, the way they bend or refract light changes, which causes vision to be slightly distorted.

In order to make eyesight clearer, LASIK changes the way the cornea refracts light. Prior to conducting a LASIK procedure, our certified LASIK surgeon carefully diagnoses each eye’s refractive error using Wavefront technology, which produces a 3-D map of the irregularities in each of the corneas. The LASIK procedure utilizes this information to determine the correction that needs to be done. If a diagnosis is made while the patient is experiencing fluctuations in their eyes as a result of pregnancy or lactation, their refractive error could be overcorrected or under corrected, resulting in unsatisfactory vision results.

Aside from the potential result of unsatisfactory results due to pregnancy or lactation, the medications associated with the LASIC procedure could be harmful. The antibiotic eye drops and inflammation reducing cortisone eye drops that are part of the necessary post-operative care for LASIK patients could harm a pregnant mother and her child if absorbed into the bloodstream, especially during the first trimester. Further, eye drops used to dilate the pupils have not been tested on pregnant women, and studies have not been done to discern whether or not any of these medications, if absorbed into the milk supply of a lactating mother, could harm the baby.

Lastly, dryness in the eyes, the predominant symptom of the LASIK procedure could cause problems for pregnant women as it is a symptom of both LASIK and pregnancy. Typically, the dryness resulting from LASIK is temporary, but in some cases, it can develop into Dry Eye Syndrome, which must be managed long-term. The combination of pregnancy and LASIK could cause particularly dry eyes post-surgery.

Because of these health factors and risks, if you are hoping to have the LASIK procedure but are also planning on becoming pregnant, you must have the baby, finish breastfeeding, and allow at least three months before going through with the operation.

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The Better Technology of the Wavefront

By Dan Zimmer

Today, many LASIK surgeons use outdated LASIK equipment for their procedures under the false assumption that they can create satisfactory results with old technology. Such suppositions, however, are vastly inaccurate due to the advancement in technology used in Wavefront guided laser treatments, the same treatments we use here at InSight LASIK and Refractive Group.

Wavefront laser vision correction provides vision clarity for people with nearsightedness, farsightedness, and astigmatism that the older equipment of traditional LASIK simply cannot achieve.

Most eyes experience blur, glare, or halo effects around lights, even with the best glasses and contact lenses. In the past, post-LASIK patients experienced exaggerated effects of these visual distortions. Such problems are caused by small irregularities, medically referred to as higher order aberrations, in the way that light is refracted, or bent, by the optical system. However, with the updated technology of the Wavefront guided laser treatment, such distortions can be significantly reduced or even eliminated completely.

The Wavefront makes these results possible by measuring all of the lower and higher aberrations of the eye which allows us to create a laser treatment plan that is unique to every individual. The Wavefront technology makes LASIK the ultimate in customized designer surgery, and as a result, many patients achieve vision even superior to normal 20/20 acuity.

With the wavefront guided treatments that we offer at InSight LASIK and Refractive Group, we can help you to achieve exceptionally clear vision without nighttime glare and halos, so that you can have the best sight possible.

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Understanding Common Focusing Errors

By Dan Zimmer

Focusing errors fall under four categories: Myopia, Astigmatism, Hyperopia, and Presbyopia. Below is a guide to understanding the characteristics of each of these optical conditions.

Myopia:

Myopia is the medical term for nearsightedness, a condition that affects more than 70 million people in North America. It occurs when the eye is too long for the curvature of the cornea. As a result, light rays that enter the eye do not come into sharp focus on the retina which is at the back of the eye, and instead they focus further forward. The result of this skewed focus is blurred vision.

The term ‘nearsighted’ means that one can see ‘near’ objects clearly without glasses or contact lenses, but objects that are further away are blurry. The condition occurs in varying degrees. The more myopic a person is, the blurrier the appearance of distant objects, the higher the eyeglass prescription, and the thicker the lenses.

Of all myopic people, about 90% have corrections that are less than -6.00 diopters. Below shows the categories of myopia severity:

Mild Myopia < -3.00 diopters

Moderate Myopia -3.00 to -6.00 diopters

Severe Myopia -6.00 to -9.00 diopters

Extreme Myopia > -9.00 diopters

Astigmatism:

Many myopic patients have a degree of astigmatism. In fact, it is the most common refractive condition. Astigmatism occurs when the eye is oval shaped instead of being a perfect sphere. As a result, patients with astigmatism experience distorted or tilted images as a result of the unequal bending of the light that enters the eye. Patients that have high degrees of astigmatism have blurred vision for both near and far objects.

Below is a list of the categories of severity of astigmatism:

Mild Astigmatism < 1.00 diopters

Moderate Astigmatism 1.00 to 2.00 diopters

Severe Astigmatism 2.00 to 3.00 diopters

Extreme Astigmatism > 3.00 diopters

Hyperopia:

Hyperopia is the medical term for ‘farsightedness’ and it occurs when the eye is too short for the corneal curvature. Light rays focus behind the retina, which produces a blurred image. Farsighted individuals can use their focusing muscles to move the image forward into the retina, but distant objects are seen more clearly than near objects. Laser technologies, like LASIK, can correct this condition.

Presbyopia:

Presbyopia is part of the normal aging process, where the lens of the eye loses some of its flexibility. The condition usually occurs between the ages of 40 and 50, and everyone experiences some degree of presbyopia. As a result, many nearsighted people begin wearing bifocals in the forties, and people who have never worn glasses may begin to need reading glasses.

An advantage of mild myopia is the ability to stop wearing glasses after age 40 as the myopia counteracts the presbyopia. The downfall of LASIK is that it causes patients to lose this ability. As LASIK produces normal sight in individuals, LASIK patients begin to need reading glasses like any other normally sighted person would, when they reach the age of 40 or 50.

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Understanding Optical Prescriptions

By Dan Zimmer

Most people know the numbers that signify the prescription of their eyes, but not everyone understands what they mean. To better understand your own eyes, here is a brief guide to reading optical prescriptions:

Visual refractive disorders such as myopia, astigmatism, hyperopia, and presbyopia are measured in units that are known as diopters. Diopters represent the amount of correction that is needed to achieve normal vision. The more nearsighted or farsighted a person is, the higher their prescription is in terms of dippers.

Prescriptions are written in three numbers.

As an example, -5.00 -1.50 x 180 represents a typical prescription.

The first digit signifies the degree of nearsightedness or farsightedness. The sign identifies whether the person is nearsighted (which is demonstrated by a - sign) or farsighted (which is demonstrated by a + sign). In the case of the example prescription above, the first number (-5.00) shows that the person is nearsighted to a degree of 5.00 diopters.

The second number identifies the degree of astigmatism. It can be written with either a + sign or a – sign. The example prescription shows that the patient has astigmatism of 1.50 diopters.

The third number is the axis, which indicates the direction of the astigmatism. In the example, an axis of 180 degrees means that the astigmatism is in the horizontal direction.

In terms of connecting these numbers to LASIK eligibility, most excimer laser studies have found that the average laser patient has a prescription between -3.00 and -4.00 diopters of myopia with less than 1.00 diopters of astigmatism.

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VISX STAR S4 Excimer Laser System at InSight Lasik and Refractive Group

Why we have chosen the VISX STAR S4 Excimer Laser System here at InSight Lasik and Refractive Group:

By Dan Zimmer

· The STAR 4 variable beam technology allows our surgeon to treat patients with different laser beam sizes and shapes that allow us to match each patient’s individual visual needs.

· The VISX Exclusive SmartBeam^TMtechnology adjusts beam size according to treatment, which helps us to minimize the amount of corneal tissue that needs to be removed.

· With ActiveTrak^TM3-D eye-tracking technology, the laser detects and compensated for small eye movements by guiding the laser beam to keep it centered precisely over the treatment area.

· VISX’s exclusive Active Trak^TMis the only system that allows surgeons to track eye movements in all three dimensions. With this technology, our surgeon is able keep the beam centered on the eye correctly at all times, which helps to ensure the most precise results.

· Unlike other lasers with eye-tracking technology, ActiveTrak does not require pupil dilation, which leads to even faster recovery time.

· VISX laser systems produce and extremely smooth surface on the cornea. Smoother ablations, or the sites where tissue is removed, promote faster healing and better visual outcomes.

· VISX laser systems achieve an optical zone that may result in reduced problems with night vision.

· VISX laser systems require a shorter procedure time than many lasers, which enhances patient comfort and may reduce the risk of postoperative complications.

Why Choose the VISX Star S4 IR?

Today’s laser vision correction treatments effortlessly free people from their dependence on glasses and contact lenses. The excimer lasers used to create this modern day miracle are some of the most sophisticated pieces of medical technology ever invented.

With over 10 million laser vision correction procedures having been performed worldwide, there is a strong competition amongst excimer laser manufacturers to establish a market position for their devices so as to maximize device sales and revenues from per procedure royalties. Such competition has inspired unprecedented advancement in excimer laser technology and numerous device enhancements that have served to improve procedure outcomes.

Unlike any other excimer laser manufacturer, VISX has been involved in the development of laser vision correction technology from the beginning. In many respects, it can be stated that VISX “invented” laser vision correction. Many of its founders conceived of, enhanced, or patented the core concepts of laser vision correction. The success of VISX, when compared to all other competing laser platforms, has been primarily founded upon an unparalleled commitment and investment in research and development efforts in the field of Laser Vision Correction technology. Today these efforts are represented by their achievement of the capacity for delivering the most sophisticated Custom Wavefront procedures in the world.

Their industry and scientific accomplishments include:

· The widest FDA approval of any laser system worldwide providing superior surgical options for more patients than any other laser platform

· The highest level of resolution of wavefront refractive error due to the use of Fourier algorithms

· Active 3-D eye tracking compensates for intraoperative eye movement in all dimensions. No other platform has these tracking capabilities

· Iris Registration (IR) – the only laser platform that centers and aligns the treatment while compensating for eye cyclorotation and physiologic pupil migration. VISX has the first and only fully FDA-approved, fully automated, non-contact method of aligning of the correct customized treatment to the corneal site

· The only system that compensates for pupil migration during physiologic pupil dilation resulting in more accurate laser pulse placement

· Variable Spot Scanning (VSS): The only platform that delivers variable beam sizes from as small as 0.65 mm up to 6.5 mm scanned over the treatment area thereby conserving tissue, optimizing treatment times, reducing corneal drying intra-operatively, and reducing adverse thermal load to the delicate corneal tissue

· Variable Repetition Rate (VRR): VRR delivers treatment at varying repetition rates, optimizing treatment time, and reducing the adverse effects of thermal loading of the delicate corneal tissue

· Conservative tissue removal, which is surgeon selectable leading to good residual corneal strength and less risk for corneal ectasia/weakening

· Rate of patients needing surgical re-treatment for residual refractive error is one of the lowest in the industry

· The VISX Star is the first choice for refractive surgeons. There are more VISX systems used in the United States than all other competing laser platforms combined. Such market dominance continues to increase as AMO-VISX continues to introduce additional advancements and technical innovations.

Wavefront Guided CustomVue: The CustomVue procedure from VISX tailors a distinct correction for each individual – in fact, each treatment is “designed” by the unique characteristics of the individuals’ eyes. WaveScan technology captures unique imperfections in each individual’s vision that could not have been measured before. The new level of measurement provides twenty-five times more precision than measurements using standard methods for glasses and contact lenses. WaveScan technology produces a detailed map of the eye – much like a fingerprint, no two are alike, and it translates this information into a set of CustomVue treatment instructions for the laser. WaveScan transfers these digital treatment instructions to the laser, providing a new level of precision and accuracy, which helps us to provide our patients with the best correction possible.

The WaveScan WaveFront System is an ophthalmic diagnostic instrument that measures the refractive error and wavefront aberrations of the human eye through the use of a Hartmann-Shack wavefront sensor. We use these measurements to determine regular (sphero-cylindrical) refractive errors and irregularities (aberrations) that cause decreases or blurry vision in the human eye. The WaveScan software uses the information to create a custom tailored correction map for the unique characteristics of each individual eye.

WaveScan technology was originally developed for use in high-powered telescopes to reduce distortions when viewing distant objects in space. This technology has been applied to laser vision correction, measuring imperfections in the eye never before measured using standard methods for glasses and contact lenses. WaveScan-based digital technology identifies and measures eye imperfections twenty-five times more precisely than standard methods. The powerful WaveScan software translates the information into a set of CustomVue treatment instructions for the laser. The digital treatment instructions that are created are then transferred to the laser, driving a new level of precision and accuracy.

Until now, optometrists were forced to practice one-size-fits-all vision. An off-the-shelf lens can correct your vision fairly well, but it is not uniquely tailored to your fingerprint of vision. Now, with the WaveScan technology that we utilize, our surgeon can custom tailor a correction for your own unique vision.

The WaveSvan WaveFront System provides:

· Fourier-based wavefront algorithms:

o Fourier delivers the highest resolution available for the wavefront error

o Uses more data points to derive the optimal shape

o Uses all data from any shape of pupil

o Accurately reconstructs all peripheral data

o Captures and treats higher and lower order aberrations up to 7 mm diameter pupil

· Acuity Maps®: Chart the optical aberrations of the eye

· Difference Maps: Track the changes of the eye for pre-op and post-op comparisons

· Point Spread Function (PSF): Demonstrates how a patient would see a point source of light

Beyond Glasses and Contact Lenses: Glasses and contacts are limited in their ability to correct unique imperfections in each individual’s vision. In fact, thousands of individuals have the exact same prescription. With the CustomVue procedure, no two “prescriptions” are identical. The precise level of measurement and treatment that this technology helps us to provide can enable individuals to achieve the full potential of their vision.

Clinical Study Results:

VISX’s FDA clinical study results were remarkable. Among other notable statistics:

· At one year after the VISX CustomVue Procedure*:

o 100% of the clinical study participants could pass a driving test without glasses or contacts

o 98% of the clinical study participants could see 20/20 or better without glasses or contacts

o 70% of the clinical study participants could see 20/16 or better without glasses or contacts

o Four times as many clinical study participants were very satisfied with their night vision after the VISX CustomVue procedure, compared to their night vision with glasses or contacts before the operation

* FDA clinical results for Low to Moderate Myopia, up to -6.0 D MRSE with or without astigmatism up to -3.0 DC

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