What Is a Refractive Error?

This is the term used to denote an error in eye focusing that produces blurred vision. If the combination of eye focusing elements (the 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 it’s focusing. With the advent of laser vision correction and ICL implants, we can now obtain the same corrective effect by modifying the shape of the cornea.

What Is the Cornea?

The cornea is the clear focusing lens at the front of the eye that provides the greatest percentage image resolution, upwards of 70%. Working in conjunction with the eye’s internal focusing element, the 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 cornea’s inherent low water content that allows for its optical clarity. The shape of the cornea is modified when we treat errors in eye focusing (aka refractive errors) with the excimer laser. The central cornea is flattened to address myopic and astigmatic errors and steepened to correct hyperopic errors.

What Is Myopia?

Myopia is a family of focusing problems in which the visual image is focused in front of the retina. This can result from an optical system (cornea and crystalline lens) that is too 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 that reduce the optical power of the focusing system (minus or concave lenses i.e. -3.00) or by altering the optical characteristics of the cornea through the use of excimer laser technology which can modify the shape of the cornea, reducing its power and thus allowing it to focus more efficiently with refractive surgery. ICL implant surgery can also treat myopia through the implantation of a biocompatible lens, which provides the eye with additional focusing power necessary to provide clear vision.

What Is Astigmatism?

Astigmatism is a focusing anomaly resulting from problems with the curvature of the eye-focusing elements (the cornea and the internal crystalline lens). If either is not spherical (round), the eye becomes incapable of producing a clearly focused image on the retina. An aspheric surface is much like the back of a spoon or the shape of a football with one steep meridian curve and another a flat 90 degrees away. In laser 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.

What is 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.

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 ophthalmology offering 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 eye’s 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.

What Is An 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 to treat 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, derived from 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.

Where Does Dr. Fox Perorm His Lasik Surgery?

Laser vision correction procedures are performed in New York at the TLC Laser Center as well as at the Clarity/TLC Center in West Orange where Dr. Fox is Medical Director. ICL, Keratoconus and Laser Corneal Transplant procedures are also performed at the Clarity/TLC Center.

Do I Have To Be Out of Contact Lenses Before Surgery?

In order to assure accuracy and excellence in outcomes it will be advisable that soft contact lens wear should be avoided for a period of ten days prior to surgical measurements and for 2-3 weeks for hard contact lens users.

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.

How Long Does the Procedure Take?

Bilateral Laser Vision Correction typically takes 20 minutes to perform. The actual laser treatment to correct your vision is always under 60 seconds.

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 post-operative 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. Visit our After Surgery page for more information.

Will the Laser Completely Correct My Vision and Will My Correction Last Forever?

Custom laser vision correction is associated with great accuracy and precision and Wavescan derived laser treatments will address all characteristics of your refractive error. In 1-2% of cases patients may slightly under respond or over respond to the calculated treatments. Such responses may require a custom laser enhancement treatment after vision stabilizes over 2-3 months. Such enhancements are safe and associated with excellent outcomes. In the course of the normal aging process vision can change years after the original laser surgery. This is not suggestive of loss of the effect of your procedure but rather the effect that aging has on the eye. Such patients may have enhancement treatments after a full evaluation and can expect equally successful outcomes.

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 presbyopia, 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 patient’s 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 varieties of eye procedures with minimal risk of serious vision-threatening complications. 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. The vast majority of these problems can be treated with good results.

Am I A Good Candidate For Laser Vision Correction?

The process of determining candidacy for Refractive Surgery can only be determined through a no-charge office consultation with Dr. Fox either at his New York office or at the Clarity center in New Jersey. A thorough review of your ocular history and examination will be conducted to determine whether Laser Vision Correction or one of the other procedures might best serve your situation. In general, good candidates for Laser Vision Correction enjoy a 99% chance of successful outcomes and: Are over the age of 18 Are free of any active eye disease Have myopia of no greater than -9.00 diopters with less than -3.50 diopters of astigmatism Have hyperopia of no more than +3.50 diopters Please contact us for more information.

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 1% 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 within the first year.

What is Laser Corneal Transplantation?

When the cornea is damaged due to a variety of disease processes, the best refractive surgical option is corneal transplantation. Dr. Fox makes use of Femtosecond laser technology to assure increased safety and rapid recovery of excellent vision.

When Is An ICL Lens Indicated To Correct Vision?

If your level of myopia is greater than -9.00 or your consultation results indicate that your cornea is too thin or it is dry or structurally compromised, an ICL procedure is the best choice for vision correction. The ICL can be used to treat prescriptions from -3.00 to -20.00.

Should I be Fearful of Laser Vision Correction?

Many patients who wish to have Laser Vision correction performed are kept away because of Fear. Much of what generates this anxiety is founded on a perception that the technology might be dangerous. Nothing could be further from the truth as modern techniques have reached a point where we can predict that fully 99% of patients who are good candidates will be pleased with their results.

And What About the 1%?

Approximately 1% of patients can heal with minimal corneal irregularity. The path of light passing through these pockets of irregularity can be affected in a way that can occasionally produce quality of vision issues such as problems with night vision with subjective complaints of halo and glare. The good news is that even patients in this small group can have their issues corrected making use of the same WaveScan technology that was used to calculate the original custom laser treatment to correct these microscopic irregularities. Using this approach, fully 90% of the 1% of those individuals with quality of vision issues will have their concerns corrected in this manner.

Can I Go Blind from Laser Vision Correction?

Modern improvements in Laser Vision technology have made these procedures among the safest that exist in medicine. Patients can expect a level of safety and predictability making such concerns about visual loss following LASIK a thing of the past. The art and science of LVC has progressed to a point that in our comprehensive evaluations leading up to surgery any potential concerns that might result in post op problems are identified and addressed. We know which prescriptions will do as well as those that will require other procedures in order to provide safe and successful vision correction.

What if My Eye Moves During Surgery?

One of the greatest advances in Laser Vision correction has been the addition of eye tracking technology. Prior to your laser treatment pupil tracking technology locks on to anatomical landmarks of your eye. The iLASIK tracking technology adjusts 60X per second to assure that each pulse of the laser is delivered precisely where it was designed to be placed. If your head moves excessively the treatment is immediately interrupted.

What if I Blink?

A gentle eyelid holder will be placed prior to your treatment along with anesthetic drops. These numbing drops will eliminate the urge to blink and of course the lid holder prevents any lid movement from becoming an issue.

What is the Most Common Side Effect of Laser Vision Correction?

The most common complaint after surgery is dryness and almost every patient will notice this intermittently for the first several months. The dry sensation is much akin to that which contact lens wearers notice commonly. We anticipate this issue by providing lubricating drops and other medications to keep you comfortable throughout the recovery period. Because of our comprehensive screening process, individuals with pre-existing tear film issues are identified and treated. Less than 1% of patients will have long term dry eye problems, most of which are easily treated.

Can I Drive Following the Day of Surgery?

The overwhelming majority of our patients are able to drive and work on the day following surgery.


345 East 37th Street, Suite 210
Midtown East

New York, NY 10016
Phone: 646-499-2352
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