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Frequently Asked Questions
WHAT IS REFRACTIVE SURGERY? Refractive surgery is a term that refers to a family of new procedures designed to help the eye focus with less dependence upon glasses or contact lenses. For near-sighted, far-sighted and astigmatic individuals this field is one of the most exciting in modern ophthalmologyÑoffering the realistic prospect for safe effective and significant visual improvement. Historically, ophthalmologists have long performed refractive surgery. Cataract and corneal transplant surgery, for instance, impact upon the eyeÕs natural focusing elements and are designed to improve their function. Other procedures designed to improve the focusing efficiency of the eye have been studied intensively over the last 40 years. EXCIMER LASER In October of 1995, after a period of exhaustive study and scrutiny The United States Food and Drug Administration gave pre-market approval for the use of the excimer laser for the use of mild to moderate myopia. This historic development was a landmark in the development of modern surgical correction of refractive errors, the use of laser light to remove corneal tissue precisely. The Excimer Laser is a technology that produces a cool intense beam of ultraviolet light which when focused upon the cornea will vaporize its collagen fibers by breaking their molecular bonds at a microscopic level. The light is produced when a pulse of high voltage electricity excites a mixture of gases (Argon, Fluorine and Helium). The electricity causes the atoms of Argon and Fluorine to temporarily bind together into a chemical structure known as a dimer (hence the name EXCIMER=Excited Dimer ). The newly formed molecules of Argon and Fluorine break apart releasing packets of light energy with a coherent wavelength of 192 nanometers in a continuous stream. When directed upon the cornea, the stream of ultraviolet excimer light delicately ablates or vaporizes tissue at a rate of 0.25 microns per pulse. Tissue is removed with a precision never dreamed of before in modern medicine. ABOUT DR. FOX'S PROCEDURES Where does Dr Fox perform his LASIK surgery? Dr. Fox is a medical director with TLC, an organization that is the largest provider of laser vision correction in North America and Canada. As such its devotion to excellence in surgical outcomes is beyond compare to any other similar center in the metropolitan area. All LASIK, PRK and INTACS procedures are therefore performed at either the Manhattan or North Jersey centers. For further information on TLC and its philosophy of excellence look them up at www.tlcvision.com. Will I be awake for my procedure? Yes. All laser and refractive procedures are done under topical anesthesia alone. Occasionally, light sedation is also offered as necessary. Laser refractive surgery is a painless experience and Dr. Fox will endeavor to make your experience pleasant and stress free. Are both eyes done at the same sitting? Yes. It is recommended that both procedures be done at the same appointed day. We believe that bilateral surgery is safe, predictable and effective. Be aware, however, that if there is any suggestion of difficulty with the initial procedure, Dr. Fox will not proceed with the second portion. Is there any pain associated with LASIK surgery? Most patients find that there is a short period of mild postoperative discomfort limited to a stinging and burning sensation that can last for several hours. Light painkillers such as Tylenol or Advil may be taken in anticipation of this brief period of post-operative irritation. What should I do in the immediate period after LASIK surgery to make my recovery as smooth as possible? All post LASIK patients should spend a period of two to three hours after surgery with eyes closed. This will help to keep the surface of the eye moist and will help the LASIK flap to settle in a good position. After this period of rest topical drops may be initiated including artificial tears, topical steroids and antibiotics. Will I have perfect vision after my procedure? Will I still need glasses? Experience has shown that laser vision correction is overwhelmingly successful in reducing myopia, hyperopia and astigmatism. While the intension of our treatment is to completely eliminate all of your refractive error in one treatment, it is the healing response to surgery that ultimately determines outcomes. The vast majority of patients achieve 20/20 acuity following surgery, however, approximately 3% may require a second enhancement treatment to achieve visual goals. The need for enhancement therapy in no way implies a complication in treatment, rather it speaks for the individual healing pattern of the patient. Enhancement treatments are offered free of charge to our patients. Will I need reading glasses after surgery? While patients under the age of 45 years need not worry about an alteration of their reading ability after Lasik surgery, those over that age may have early signs of prebyopia, an aging change in the eye which can make near visual tasks difficult to perform. For these individuals, reading tasks will remain problematic after vision correction. In this case a mono-vision therapeutic approach can be of great benefit. Here the patientÕs non-dominant eye is deliberately left mildly under-corrected to allow for improved reading function. These are decisions that our staff will help you make prior to your surgery. What are the risks of Laser vision correction? It is important that you understand as much as possible about the risks of surgery in your decision making process. The LASIK procedure remains perhaps one of the safest variety of eye procedures with the risk of serious vision threatening complications less than 0.1% Side effects of surgery can include under-correction and over-correction ( both of which are correctable with enhancement procedures), infection, healing haze, night glare, loss of best spectacle corrected acuity, flap slippage and contact lens intolerance. Most of these less serious problems can be treated with good results. Am I a good candidate for Laser Vision Correction ? The process of determining candidacy for surgery can only be determined through in office consultation to assure that there are no contra-indications. These consults are performed free of charge by Dr. Fox at his Madison Avenue office or at one of the TLC centers in Manhattan and North Jersey. In general good candidates must :
GLOSSARY REFRACTIVE ERROR This is the term used to denote an error in eye focusing that produces blurred vision. If the combination of eye focusing elementsÑthe cornea and internal crystalline lens, do not focus the visual image precisely upon the retina the result is poor vision. Up to now we could only compensate for these errors in focusing by prescribing glasses or contact lenses to assist the eye in its focusing. With the advent of laser vision correction, we can now obtain the same corrective effect by modifying the shape of the cornea. MYOPIA Myopia is a family of focusing problems in which the visual image is focused in front of the cornea. This can result from an optical system (Cornea and Crystalline lens) that is to strong in its effect (simple myopia) or from a situation in which the overall length of the eye is too long for the existing optical system (axial myopia). Myopia can be corrected by lenses which reduce the optical power of the focusing system (minus or concave lenses i.e. Ð3.00) or by flattening the shape of the cornea and hence reducing its power with refractive surgery. HYPEROPIA Hyperopia refers to those focusing errors, which cause the visual image to focus behind the plane of the retina. These are caused by situations in which the optical system of the eye is too weak or the length of the eye is too short. Hyperopic errors can also be approached with contact lenses, glasses or with refractive surgical procedures designed to steepen the cornea. Steepening the cornea will increase its refractive power allowing for the visual image to fall upon the retinal plane. ASTIGMATISM Astigmatism is that focusing anomaly resulting from problems with the curvature of the eyeÕs focusing elements; the cornea and the internal crystalline lens. If either is not spherical (round), the eye becomes incapable of producing a point focus on the retina. An aspheric surface is much like the back of a spoon or the shape of a football with one steep meridian of curve and another flat 90 degrees away. In refractive surgical procedures we can address this focusing anomaly by either steepening the flat corneal meridian or (more commonly) by flattening the steep corneal meridian. CORNEA The cornea is the clear focusing lens at the front of the eye that provides the greatest percentage image resolution Ðupwards of 70%. Working in conjunction with the eyeÕs internal focusing elementÑthe crystalline lens, the cornea allows for the placement of a clear visual image upon the retina. Visual elements within the retina will then process the image and send it on to the brain for interpretation. The cornea is made up of orderly layers of collagen strands known as lamellae. These lamellae are arranged in arrays that are precisely separated by a chemical family of ground substance known as glycosoaminoglycans. It is this orderly arrangement of fibers, in conjunction with the corneaÕs inherent low water content that allows for its optical clarity. The shape of the cornea is modified when we treat errors in eye focusing( refractive errors). The central cornea is flattened to address myopic and astigmatic errors and steepened to correct hyperopic errors. |