iLASIK FAQ – Laser Vision Correction –
iLASIK & LASIK FAQ
WHY SHOULD I CHOOSE TO HAVE MY LASER VISION CORRECTION SURGERY PERFORMED BY DR. MITCHEL WONG, DR. SHANNON WONG OR DR. JOHN ODETTE?
Experience: We have treated thousands of patients from around the world with LASIK and iLASIK. We were the first practice to perform LASIK and iLASIK in Austin. We are first and most experienced ophthalmologists in Austin using Custom wavefront technology with IntraLase (aka Custom iLASIK).
Leading Edge Technology: We use only the most up-to-date technologies for our patients. Custom iLASIK outcomes are superior to the outcomes with standard LASIK. iLASIK patients are seeing 20/20 or better a greater percentage of the time with better quality of vision and less night time halo than our LASIK patients ever did. Additionally the enhanced safety of iLASIK greatly exceeds that of standard LASIK. iLASIK will appeal to patients who have been apprehensive in the past about having LASIK surgery. For more information bout iLASIK go to www.intralase.com.
Custom iLASIK is delivering the safest most accurate laser vision correction procedure available for our patients.
THE HIGHEST LEVEL OF PERSONAL SERVICE: We provide the best personal care for our patients who have iLASIK. As leading Austin LASIK surgery providers, Dr. Mitchel Wong, Dr. Shannon Wong or Dr. John Odette will personally perform the before and after surgery examinations in addition to performing your surgery – thus insuring the best results. There are other eye surgical practices that have the surgeon only do the surgery and only very limited or no pre or postoperative care… Each patient that has iLASIK at Austin Eye will have their exams before and after surgery by the surgeon doing your surgery. Additionally, all questions and answers will be explained by Dr. Mitchel Wong, Dr. Shannon Wong or Dr. John Odette. We want to spend time understanding the patients’ needs and obtaining the preoperative measurements personally… This is continuity of care… The results can only be better. We welcome our iLASIK patients to continue to stay with our practice for their long-term routine eye exams.
Each patient has direct access to our ophthalmologists via cell phone or email. We are available to you should questions or concerns arise before or after your procedure.
WHAT IS iLASIK AND HOW DOES IT WORK?
LASIK traditionally involves 2 main steps to reshape the cornea and improve vision: 1) creation of the corneal flap which is then folded back and 2) application of excimer laser pulses to reshape the middle surface of the cornea. It is a very popular and safe procedure. However like any surgical procedure it has risks. Creation of the corneal flap is the part of the LASIK procedure that has the least predictability and therefore the majority of the risk with LASIK. The LASIK flap is currently created with the use of a mechanical instrument – the microkeratome – which uses a surgical blade to create the flap.
iLASIK provides a safer and more accurate method to create the corneal flap. Using the Intralase femtosecond laser, a computer-guided infrared laser light is used to precisely create the corneal flap. The Intralase laser virtually eliminates the severe sight-threatening seen with the microkeratome, improving safety and precision while providing predictably better visual results for the patient. Intralase technology is reassuring to the patient and surgeon that the procedure will be the safest and most accurate possible.
WHAT IS iLASIK (aka Custom iLASIK)?
iLASIK and Custom iLASIK are synonymous terms. The iLASIK procedure involves a combination of technologies that have proven to be the safest and most accurate method for laser vision correction. For more information, please go to our custom iLASIK page.
IS iLASIK SAFER THAN LASIK?
Yes. iLASIK improves the safety, precision and visual results of LASIK, whether you choose to have a standard or custom procedure.
This is a result of the superior precision provided by the computer-guided IntraLase laser, as compared to that of a hand-held microkeratome, which houses a metal blade that cuts across the cornea to create the flap. In comparison, IntraLase uses the precision of a beam of light to create a laser flap without traveling across the cornea, virtually eliminating severe sight-threatening complications as a result.
Its precision is the source of its safety. Accuracy of flap thickness has been demonstrated at +/- 10 microns.* Precise flap thickness is critical to a successful LASIK outcome, and IntraLase flaps feature a consistent thickness from edge to edge. This degree of accuracy is unprecedented in flap creation technology to date.
Flap stability is also an important factor, as the consequences of flap slippage can be quite problematic. IntraLase flaps provide added assurance and peace of mind for many patients.
HOW DO THE VISUAL OUTCOMES USING iLASIK COMPARE WITH THOSE OF TRADITIONAL LASIK WITH A MICROKERATOME?
Clinical studies confirm that patients see better following iLASIK than with the hand-held microkeratome blade.
- More patients achieve 20/20 or better vision with IntraLase-initiated LASIK.
- Patients stating a preference preferred the post-operative vision of their IntraLase-treated eye 3 to 1 over their blade-treated eye.
- IntraLase creates fewer high and low order aberrations, frequently associated with glare and halos at night.
- IntraLase patients have a reduced incidence of post-operative dry eye symptoms.
- IntraLase patients required fewer enhancement procedures following LASIK.
- The precision of the IntraLase flap significantly reduces the incidence of post-operative induced astigmatism as compared with a microkeratome-created flap.
- Our retreatment rate decreased 50% when we transitioned from lasik to iLASIK.
WHY CUSTOM iLASIK RATHER THAN CUSTOM LASIK?
LASIK flaps created by a blade introduce more higher and lower-order aberrations to the eye. iLASIK flaps create far fewer aberrations than blade flaps. Custom wavefront guided surgery is designed to eliminate pre-existing aberrations. Logically, if the flap (LASIK) creates more new aberrations that are not treated, then part of the benefit of wavefront-guided Custom LASIK is lost. Custom iLASIK has advantages in that the laser created flap is more aberration neutral and therefore will lead to a better visual correction in terms of eliminating all possible aberrations after the wavefront-guided custom laser ablation.
IS THE SURGERY PAINFUL?
We use anesthetic eye drops which eliminate all pain during the iLASIK procedure. Additionally, we have each patient take a valium pill prior to surgery to help them relax and feel less nervous during surgery.
After surgery, most individuals will notice a stinging sensation, light sensitivity, and foggy vision for 3-4 hours. After this first 3-4 hours after surgery, there is minimal to no discomfort.
HOW SOON CAN I RETURN TO WORK AFTER SURGERY?
Most individuals report that their eyes feel and see normal by the first day after LASIK and iLASIK. Over 90% of individuals are capable of returning to work the day after iLASIK.
WHAT IS OUR SUCCESS RATE WITH THE CUSTOM iLASIK PROCEDURE?
Our overall success rate with Custom iLASIK is approximately 95-98%. (“Success” being defined as comfortable vision with both eyes. These patients see “normal” and are comfortable with their eyesight). The remaining 2-5% of patients will require an enhancement procedure to “fine-tune” their vision after their first procedure. Our experience with iLASIK and use of the latest most advanced technology allows us to provide the finest care to our patients.
The Global fee for Conventional iLASIK surgery to both eyes is $4550. This fee will cover the preoperative eye exam, surgery to both eyes, and follow-up visits. If a patient opts to have Custom iLASIK, the global fee for surgery to both eyes is $5050.
Monthly payment programs are available via Care Credit make the surgery more affordable. There is no prepayment for financing. To for financing, you may call CareCredit at 1-800-300-3046 or apply online at www.carecredit.com. We offer a 24 month no-interest plan, and extended payment plans of 2, 3, 4 and 5 years. We also accept visa and mastercard.
Cost is an important consideration, but surgeon experience with laser vision correction, personalized attention from the surgeon before and after your procedure, and the technology used are the most important factors in determining how well you see after surgery.
PAYMENT FOR LASER VISION CORRECTION.
We accept cash, check and Mastercard/Visa. Payment-in-full is required prior to surgery.
Most individuals who finance the surgery do so by using their credit cards. We also offer a competitive financing program for patients who would like to make the surgery more affordable (See the paragraph above on “How much does the surgery cost?”)
IS THERE A “GUARANTEE” FOR THE RESULTS OF LASIK SURGERY?
In life, there are no guarantees. No surgery is or will ever be 100% accurate, predictable or successful. Certainly with any type of surgery, there can be no true guarantee. Our iLASIK results are extremely accurate. However, no surgery is perfect because each individual eye will heal differently. Therefore, we have experienced an iLASIK laser enhancement (second surgery) rate of approximately 3-5%. For individuals who require a second procedure (aka “enhancement”) that uses the excimer laser, there will be an additional fee which helps to defray part of the cost of using the laser. For patients who wish to have a Customized enhancement, there are additional fees.
Surprisingly, iLASIK has reduced by 50% or more the number of retreatments that we used to do for our LASIK patients.
HOW SOON CAN I HAVE THE SURGERY PERFORMED?
“Call Today… See Tomorrow!” We perform iLASIK on Wednesdays and Thursdays each week in our on-site specially designed iLASIK surgery center on 11901 Jollyville Road. We can accommodate individual requests for surgery on other days of the week as well. Please consult with your surgeon to schedule your preferred day for surgery.
CAN I STILL WEAR CONTACT LENSES OR GLASSES AFTER SURGERY?
Most individuals do not wear glasses or contact lenses after LASIK or iLASIK. However for those who do need or want to wear glasses or contacts for some occasions (e.g. driving or reading), they can still use them.
PRIOR TO THE EXAM FOR LASIK SURGERY, DO I NEED TO REMOVE MY CONTACT LENSES?
Contact lenses can deform the shape of the cornea. Therefore, in order to obtain the most accurate measurement of your eyes prior to surgery, contact lenses need to be removed. Soft contact lenses should be removed at least 3-4 days prior to the exam. Rigid gas permeable lenses should be removed one month prior to the exam. Ideally, if a person has glasses that are useful, then they should be worn in preparation for the preoperative exam.
IS THE SURGERY PERMANENT?
Yes, the results of iLASIK and LASIK are permanent. They are however “adjustable” such that future correction of near-sightedness, far-sightedness or astigmatism can be performed to “touch-up” the original procedure. You and your eyes will continue to age normally after surgery.
WHAT IS THE RIGHT AGE TO HAVE LASER VISION CORRECTION? HOW LONG DOES MY VISION NEED TO BE STABLE BEFORE HAVING SURGERY?
There is no strict age requirement. However, most individuals by the age of 20-21 have reached a point at which their glasses prescription will remain relatively stable. The key to being a good candidate is that your glasses and/or contact lens prescription should be relatively stable. Your vision like all other aspects of your body will change very slowly as you age. iLASIK creates normal vision for your age. You will continue to age normally after your vision is corrected. We have treated patients 18-80+ years of age with LASIK and iLASIK.
WILL I STILL NEED TO USE READING GLASSES IF I’M 40 YEARS-OLD OR BETTER?
As we all age, we gradually lose our natural ability to readjust our focus. This normal unavoidable condition is called “Presbyopia.” For most individuals with presbyopia between 40 and 50 years of age, they begin to notice that reading small print up-close either requires additional effort, more light, reading glasses or bifocals, or if they are already “near-sighted,” they have to remove their glasses to read comfortably. iLASIK creates normal vision… Normal vision after age 40 involves presbyopia and some reliance on reading glasses to read small print comfortably.
I DON’T WANT TO HAVE TO USE READING GLASSES AFTER AGE 40 TO READ SMALL PRINT OR LOOK AT MY COMPUTER WHAT ARE THE OPTIONS WITH iLASIK?
Some patients with Presbyopia choose “Monovision.” Monovision involves making one eye (usually the dominant eye) see clearly for long-distance and the other eye see near or reading distance. It allows individuals to see near and far with minimal to no reliance on glasses or contact lenses even after age 40. We can simulate monovision with contact lenses before iLASIK. If the patient likes the monovision, then we can reproduce it with iLASIK. Monovision works well for approximately 50% of the patients who are motivated to make it work.
Lens replacement surgery with the Crystalens, ReSTOR, or Tecnis multifocal lens is another surgical option for patients who wish to obtain excellent far and near vision with minimal to no reliance on reading glasses or bifocals (click here for more information about presbyopia).
WHAT ARE THE LONG-TERM EFFECTS OF iLASIK, LASIK OR PRK?
The over 20 year follow-up of patients undergoing laser vision correction procedures (PRK and LASIK) is very stable…. Eyes that have undergone LASIK and/or iLASIK age normally. In fact the behavior of an eye that has had LASIK or iLASIK parallels the behavior of a normal eye that has not had surgery. LASIK has been performed since 1991. Based on what we have learned from performing eye surgery over time, we know that if an eye is “stable” in its vision at 2 years, then it should remain stable at 20 years and beyond. The eye behaves in a predictable manner. Since visual results from laser vision correction procedures have been stable for over 20 years, then they should remain stable over a lifetime. However as the patient ages, their eyes age with them and do develop normal age-related changes over a lifetime. Though iLASIK is newer technology, it uses the same surgical principals as LASIK. Therefore the long-term behavior of eyes that have had LASIK and iLASIK is the same.
Should your vision change with age, in most instances we can safely and easily restore your vision with additional laser or lens-based enhancement procedures.
DO WE TREAT PATIENTS COMING FROM OUT OF TOWN?
Upon your request, we have many individuals that we have treated who would be happy to share their iLASIK experience with you.
WHAT ARE THE COMPLICATIONS THAT CAN ARISE AFTER iLASIK?
Most individuals do very well after iLASIK. However, as with all surgical procedures, complications may arise. Our experience has taught us how to best prevent the complications of surgery. iLASIK allows us to dramatically decrease our complication rate. Still, should complications arise, our vast LASIK experience has made us experts in their management.
NEED FOR ADDITIONAL SURGERY: A retreatment aka “enhancement” procedure with the laser is a normal occurrence that arises arises approximately 3–5% of the time in our iLASIK practice. The need for an enhancement arises when the patient does not see as well as he/she would like because of residual near/far-sightedness or astigmatism. This is a correctable situation.
WHY ARE RETREATMENTS NECESSARY? BECAUSE ALL EYES HEAL DIFFERENTLY. The surgeon and laser may perform each surgical step perfectly with extremely precise and accurate laser and computer technology. But ultimately we rely on an individual’s healing characteristics. Enhancements occur because the cellular healing characteristics of each individual eye will vary within a narrow range. If an eye over or under-responds to iLASIK, then there will be a residual degree of near/farsightedness or astigmatism. Unlike a piece of plastic or silicone, there is variability between different eyes.
PERMANANENT BLURRED VISION: Approximately 0.2% of patients may experience a decrease (not a loss) of their best possible unaided vision after surgery. Most patients in this 0.2% still see quite well, are able to work and do most activities without glasses. However, they do not see as well after surgery as they did with their best glasses or contacts before surgery. For example if one’s best vision with glasses or contacts BEFORE iLASIK was 20/20 or better, and then AFTER iLASIK the best possible vision after surgery was only 20/30, then that eye would have had a “decrease of the best corrected visual acuity.” Again, this complication occurs in 0.2% or less of our patients.
GLARE AND HALOS AROUND LIGHTS: For the first days/weeks after surgery it is normal to see glare and haloes around lights at night because of early swelling after surgery. As your eyes heal, the swelling/inflammation will subside and your night vision will improve week-by-week. Patients with higher degrees of near/far sightedness and/or astigmatism, or patients with larger pupil sizes may experience long-term halos or glare around point sources of light in low light situations (eg nighttime). The overall risk of this occurrence is approximately 5% with Conventional iLASIK and 2–3% with Custom Cornea iLASIK.
Fortunately, those individuals who have this side-effect are still able perform their usual activities safely such as driving at night. Custom laser vision correction patients will have less glare or halo than patients treated with a standard laser ablation.
NIGHT VISION DIFFUCULTY (aka LOSS OF CONTRAST SENSITIVITY): Night vision difficulty is relatively common in normal individuals due to the different manner in which the eye sees through a dilated pupil. Patients after iLASIK can have a mild decrease in ability to see sharp contrast under low light conditions. In general, if an individual has difficulty seeing at night with their glasses or contacts, then they will continue to have that difficulty after LASIK or iLASIK.
This side-effect is very rare and generally does not impair one’s ability to work or drive at night. Custom iLASIK patients will have better night-time vision than patients treated with a conventional/standard laser ablation.
TEMPORARY DRY EYE: Most LASIK patients experience transient dry eye after surgery. This temporary problem is due to the fact that the corneal nerves which keep the cornea moist are cut during creation of the corneal flap. These nerves regenerate over a period of 1–12 months after LASIK or iLASIK. Once they regenerate, the eye will no longer be dry. Dry eye symptoms can account for temporary light sensitivity, glare or haloes around lights at night, and blurry vision in the first weeks after surgery.
Most iLASIK patients will use artificial tears (Eg. Refresh tears, Refresh Liquigel, Refresh Optive, Systane, Genteal tears, Bion tears, Celluvisc or Genteal Gel) to supplement the surface moisture on the cornea. The artificial tears are used for several weeks, then discontinued when the symptoms resolve.
Approximately 1–2% of patients will experience dry eyes that persist indefinitely. These individuals usually require placement of silicone plugs to block the passages that tears flow into before entering the nose. Use of silicone plugs usually helps to improve dry eyes by keeping the naturally produced tears on the eye surface rather than allowing them to flow into the nose via the lacrimal (tear) system in the eyelid.
Lastly, there are prescription eyedrops – restasis – that can be prescribed to you. These drops, used twice daily, help the eye to produce more tears and thus help to moisten dry eyes.
TEMPORARY VISION FLUCTUATION OR BLURRY VISION: Every surgical procedure, including LASIK or iLASIK, causes temporary swelling and inflammation. After LASIK and iLASIK, the swelling and inflammation of the cornea is microscopic but can lead to temporary fluctuation in the clarity of vision or a delay in the eye’s ability to see its clearest.
In general, younger individuals (less than 40 years of age) and individuals who have a higher prescription to start will need more time to allow their vision to stabilize and become its clearest.
FLAP IRREGULARITIES (STRIAE): Less than 0.2 % of patients may develop a flap problem such as a striation or wrinkle of the corneal flap during the first day after surgery. If striae should develop, they are correctable by various surgical techniques that we are experienced with. Patients with iLASIK flaps have a greatly reduced risk of flap striae. LASIK flaps tend to have a higher risk of flap striae than iLASIK flaps.
RECOVERY TIME AFTER LASIK/iLASIK – WHAT TO EXPECT, DOS AND DON’TS:
All patients immediately after LASIK and iLASIK will see blurry. In fact, for the first 3-4 hours after iLASIK normal symptoms include: blurred vision, light sensitivity, eye irritation (stinging and burning) and tearing. After the first 3–4 hours, these symptoms resolve.
All patients are instructed to use antibiotic and steroid eyedrops for about one week after surgery.
One cannot hurt the eye by using it after surgery. Therefore, watching TV, computer work, reading, etc will not affect the outcome of iLASIK.
Restrictions after iLASIK: no eye or eyelid rubbing or forceful eyelid closure (squeezing), no eyelid makeup for 4 days after surgery. No swimming for 1 week after surgery.
Normal activity that does not include pressure on the eye such as walking, jogging, routine work is allowed the day after iLASIK.
Potential high impact activities such as water-skiing, soccer, boxing, volleyball, contact sports should be avoided for 2 weeks after iLASIK.
WHAT SERVICES DOES YOUR PRACTICE OFFER?
WHAT IS AN “IMPLANTABLE CONTACT LENS (ICL)?” IS AN ICL BETTER THAN LASIK?
Implantable Contact Lenses (ICL) such as the Visian ICL are special lenses that can be placed inside the eye to correct vision. They are capable of correcting individuals with high amounts of near or far-sightedness beyond the range of LASIK (more than +6.00 diopters hyperopia and more than -15.00 diopters myopia). Additionally ICL’s can correct lower amounts of near/farsightedness for individuals who are not suitable candidates for corneal surgery. The first ICL’s received FDA approval in 2004.
Austin Eye is certified to use the Visian ICL.
ICL’s advantages compared with LASIK:
- Ability to treat extreme myopia or hyperopia (more than +6.00 diopters hyperopia and more than -15.00 diopters myopia).
- “Reversibility” since the lens can be removed from the eye if needed.
- Ability to correct near/farsightedness for individuals who are not safe candidates for laser vision correction.
ICL’s disadvantages compared with LASIK:
- Potential to cause premature cataract development during or after surgery.
- Increased risk for sight-threatening infection during or after surgery.