AUSTIN EYE CLINIC
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| IntraLase - Medical reports supporting the technology benefits over LASIK (PDF) |
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.
IntraLASIK 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.
IS INTRALASE SAFER THAN LASIK?Yes. IntraLase 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.
No, but IntraLASIK has proven in numerous published reports and clinical
studies to dramatically reduce the risk of complications reported
with traditional LASIK and we feel that is very important for our
patients.
No. Custom LASIK generally refers to an individualized visual diagnosis using technology called “wavefront,” which allows for customized treatment with the excimer laser. There has never been a combination of technologies that have allowed for this type of personalized vision correction. The most exciting part is that while the patient has the opportunity for an optimized visual result, it can be done with unprecedented safety and precision.
Every patient’s eyes are different and therefore need to be evaluated independently and treated uniquely. Now all steps of the laser vision correction procedure may be personalized to the individual: custom diagnosis with wavefront, personalized flap creation with IntraLase, and custom laser vision correction with custom ablation.
HOW DO THE VISUAL OUTCOMES USING INTRALASE
COMPARE WITH THOSE OF TRADITIONAL LASIK WITH A MICROKERATOME?Clinical studies confirm that patients see better following IntraLase-initiated LASIK than with the hand-held microkeratome blade.
Maybe. Contrary to popular belief, LASIK is not an “all-laser” procedure, due to the use of the microkeratome blade. Only LASIK procedures that use IntraLase can be considered “all-laser.”
Your doctor can explain the difference between other procedures that may be advertised as “all laser,” such as LASEK, PRK or epi-LASIK – all of which are surface ablation procedures. Because they are performed without creating a corneal flap, these procedures generally require longer healing time and frequently involve more discomfort and a delay in visual recovery.
Yes. Most patients agree that the added level of safety, assurance and predictably better vision offered by IntraLase is worth the incremental cost. IntraLase surgeons are leaders in the field of ophthalmology who continually evaluate advances in technology. They’ve determined that the IntraLase is the most sophisticated and accurate system available today for flap creation and have invested in the technology to sustain their leadership in patient care.
The INTRALASE™ FS Laser has been cleared by the FDA and became commercially available on a limited basis in 2001. The INTRALASE FS Laser is the only laser that provides IntraLASIK. To date, over One Million Intralase procedures in the USA have been completed with no significant complications reported. Dr. Mitchel Wong and Dr. Shannon Wong continually evaluate advanced technologies and adopt them into practice as soon as they become available. In order to provide the best possible care for you, we need the best and most accurate and safe technology – custom cornea with intralase.
Because we feel this is very compelling technology that significantly raises the standard for safety and accuracy in vision correction surgery, we are recommending IntraLASIK or Custom IntraLASIK for all of our patients. You should discuss your concerns directly with Dr. Mitchel Wong or Dr. Shannon Wong as certain vision disorders and corneal anatomy may be associated with a higher degree of risk.
LASIK flaps created by a blade introduce more higher and lower-order
aberrations to the eye. IntraLASIK 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 IntraLASIK 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.
There are two major models for laser vision correction surgery, “premium” in which the ophthalmologist provides continuity of care throughout the surgical process, and “corporate, comanaged or discounted LASIK” in which the ophthalmologist is less involved in the pre and postoperative process. The Austin Eye Clinic provides premium quality care for each patient for optimal continuity of care and patient benefit. When the ophthalmologist provides pre and postoperative care as well as the surgical procedure using the most advanced equipment, patients benefit. The differences are listed below:
We use anesthetic eyedrops which eliminate all pain during the IntraLASIK 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.
Most individuals report that their eyes feel and see normal by the first day after LASIK and IntraLASIK. Over 90% of individuals are capable of returning to work the day after IntraLASIK.
Our
overall
success rate with Custom IntraLASIK is approximately 95-97%. (“Success”
being defined as comfortable vision with both eyes. These patients
see “normal” and are comfortable with their eyesight).
The remaining 3-5% of patients will require an enhancement procedure
to “fine-tune” their vision after their first procedure.
Our experience with IntraLASIK and use of the latest most advanced
technology allows us to provide the finest care to our patients.
The Global fee for Conventional IntraLASIKsurgery to both eyes is $4005. This fee will cover the preoperative eye exam, surgery to both eyes, and follow-up visits. If a patient opts to have Custom Cornea Wavefront-guided Intralasik, the global fee for surgery to both eyes is $5005.
Two monthly payment programs – Care Credit and Bank of America Visa Platinum - are available to make the surgery more affordable. There is no prepayment for financing. To apply for financing from Care Credit, you may call CareCredit at 1-800-300-3046 or apply online at www.carecredit.com. We offer a 3 month no-interest, and extended payment plans of 2, 3, 4 and 5 years.
Bank of America Visa Platinum Credit Card offers 0% fixed introductory annual percentage rate (APR) on purchases and balance transfers (not cash advances) for 6 months. Click here to apply for the Bank of America Visa Platinum Credit Card.
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.
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?”)
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. Realistically, no honest physician can guarantee perfect results. Our IntraLASIK results are extremely accurate. However, no surgery is perfect because each individual eye will heal differently. Therefore, we have experienced an IntraLASIK 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 of $250-500/eye which helps to defray part of the cost of using the laser. For patients who wish to have a LADARVision Custom Cornea enhancement, there are additional fees.
Surprisingly, IntraLASIK has reduced by 50% or more the number of retreatments that we used to do for our LASIK patients.
"Call Today… See Tomorrow!" We perform IntraLASIK on Mondays, Tuesdays and Thursdays each week in our on-site specially designed IntraLASIK surgery center on 11901 Jollyville Road.
Most individuals do not wear glasses or contact lenses after LASIK or IntraLASIK. 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.
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 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.
Yes, the results of IntraLASIK 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.
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. Intralasik creates normal vision for your age. You will continue to age normally after your vision is corrected. We have treated patients 18-74 years of age with LASIK and IntraLASIK.
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. IntraLASIK creates normal vision…Normal vision after age 40 involves presbyopia and some reliance on reading glasses to read small print comfortably.
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 IntraLASIK. If the patient likes the monovision, then we can reproduce it with IntraLASIK. Monovision works well for approximately 50% of the patients who are motivated to make it work.
Lens replacement surgery with the crystalens, restor or rezoom implant 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 on surgical correction of presbyopia.
The 15 year follow-up of patients undergoing laser vision correction procedures (PRK and LASIK) is very stable….Eyes that have undergone LASIK and/or IntraLASIK age normally. In fact the behavior of an eye that has had LASIK or IntraLASIK 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 after 15 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 IntraLASIK is new technology, it uses the same surgical principals as LASIK. Therefore the long-term behavior of eyes that have had LASIK and IntraLASIK is the same.
Should your vision change with age, in most instances we can safely and easily restore your vision with additional laser enhancement procedures.
Yes. Many of our IntraLASIK patients come from out-of-town. We are conveniently located in Central and Northwest Austin, and are closely located near many excellent Austin Hotels.
Upon your request, we have many individuals that we have treated who would be happy to share their IntraLASIK experience with you.
Most individuals do very well after IntraLASIK. However, as with all surgical procedures, complications may arise. Our experience has taught us how to best prevent the complications of surgery. IntraLASIK 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: The most common complication is the need for a retreatment aka "enhancement" procedure with the laser. This need arises approximately 3-5% of the time in our IntraLASIK 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 IntraLASIK, 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 0.25% of patients may experience a decrease (not a loss) of their best possible unaided vision after surgery. Most patients in this 0.25% 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 intralasik was 20/20 or better, and then AFTER intralasik 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 0.25% or less of our patients.
GLARE AND HALOES 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 haloes or glare around point sources of light in low light situations (eg nighttime). The overall risk of this occurrence is approximately 5% with Conventional IntraLASIK and 2-3% with Custom Cornea IntraLASIK.
Fortunately, those individuals who have this side-effect are still able perform their usual activities safely such as driving at night. LADARVision Custom Cornea 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 IntraLASIK 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 IntraLASIK.
This side-effect is very rare and generally does not impair one's ability to work or drive at night. Custom Cornea IntraLASIK 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 IntraLASIK. 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 IntraLASIK patients will use artificial tears (Eg. Refresh tears, Refresh Liquigel, Refresh Endura, 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.
TEMPORARY VISION FLUCTUATION OR BLURRY VISION: Every surgical procedure, including LASIK or IntraLASIK, causes temporary swelling and inflammation. After LASIK and IntraLASIK, 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 IntraLASIK flaps have a greatly reduced risk of flap striae. LASIK flaps tend to have a higher risk of flap striae than intralasik flaps.
All patients immediately after LASIK and IntraLASIK will see blurry. In fact, for the first 3-4 hours after IntraLASIK 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 IntraLASIK.
Restrictions after IntraLASIK: 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 IntraLASIK.
Potential high impact activities such as water-skiing, soccer, boxing, volleyball, contact sports should be avoided for 2 weeks after IntraLASIK.
We practice comprehensive ophthalmology while specializing in laser vision correction (IntraLASIK), cataract and lens implant procedures. Our practice includes:
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 Clinic is certified to use the Visian ICL.
ICL's advantages compared with LASIK:
ICL's disadvantages compared with LASIK:
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