1. Am I a good candidate for laser vision correction? Lasik effectively treats myopia (nearsightedness), hyperopia (farsightedness), and astigmatism (corneal irregularity). If you are presently wearing glasses or contact lenses there is an good chance that you are a candidate for laser vision correction.
There are however, correction limits, and various contraindications to Lasik, and thus, an evaluation by Dr. Ullman would be required to determine your suitability. As a courtesy, we provide a free consultation to determine whether Lasik is right for you.
Contraindications to Lasik include the following: If you are under the age of 18, because your refractive error may not have stabilized. If you have fluctuating vision or an unstable refraction within the six month prior to considering Lasik. If you are a female and are pregnant or nursing. If you have eye pathology such as cataracts or macular degeneration. Lastly, although our results are excellent with Lasik, if you are a perfectionist and have unreal expectations, Lasik may not be right for you. We will only perform Lasik on people who are good candidates. We turn away approximately 35% percent of those requesting the procedure because they are not ideal candidates. To insure the best results under the safest conditions, we are very discriminating about those we select for Lasik treatment.
2. What results can I expect from Lasik? Overall 97% to 99% of patients will see well enough to pass their drivers license exam (20/40 vision), without their glasses or contacts. Depending on the technology used, (see Wavefront guided Custom Cornea below), as high as 90% of patients may achieve 20/20 vision. As a rule the smaller the refractive error, the higher the percentage of 20/20 outcomes.
3. Will I be able to eliminate my glasses or contacts? The goal of all refractive surgery is to eliminate dependence on glasses or contact lenses. Virtually all of those patients that Dr. Ullman has performed Lasik on are able to drive and perform most other tasks without glasses or contacts. Those over the age of 40, who didn't choose "Monovision", (see below), usually will require reading glasses only. A few people may desire a small prescription for night driving, but this is the exception, not the rule.
4. Is the treatment painful? Will my eyes hurt afterwards? The Lasik treatment, which usually takes a few minutes per eye, is relatively painless. Anesthetic eye drops are used during the procedure to eliminate any discomfort. No further anesthesia or sedation is usually required. Afterwards, some patients may feel a foreign body sensation for one to two hours. Lubricating eye drops are given to alleviate this sensation. Rarely, does anyone complain of significant discomfort during or after the procedure.
5. How safe is the Lasik procedure? As with any surgical procedure, there are a few risks associated with Lasik, however, in the hands of a skilled and experienced surgeon like Dr. Ullman, the risks are very low. Careful patient screening, meticulous preoperative evaluation, planning on a case to case basis, and use of the best lasers with the latest technological advancements and safety features, further helps keep our risk of complications to a minimum. Potential risks include the following:
6. Are all excimer lasers the same? Do they all use the same technology? No. Lasers differ in the size of the treatment zone, eye tracking ability, and on whether they have modern Wavefront or CustomCornea® capability. The size of the treatment zone is very important when dealing with pupils that dilate widely. A common cause of halos or glare after Lasik, is when the pupil dilates beyond the treatment zone. An active eye tracker is important in neutralizing the small inherent movements the normal eye routinely makes. A laser with a good eye tracker will yield a smoother treatment. Wavefront computer analysis allows us to measure the higher order aberrations in the eye and transfer the data to the laser allowing a more individualized and precise treatment.
At our laser center we have both the LADARVision laser as well as the VISX laser. Worldwide, these two lasers are used more frequently than any others. Both of our lasers are equipped with advanced Wavefront technology. With Wavefront guided treatments we are seeing a higher percentage of 20/20 or better visual outcomes, and we are seeing less post operative glare or halos, and less difficulty with nighttime vision. In addition, both lasers exhibit sophisticated eye tracking devises to neutralize any small movements the eyes may make during the treatment, facilitating a smoother more precise ablation. For those candidates who have pupils that dilate widely, the LADARVision laser has an adjustable treatment zone, which can be enlarged to accommodate large pupils, further decreasing the risk of postoperative glare and nighttime vision problems.
Our laser center is also one of the few centers in southern California to have the new "All Laser Lasik" technology, IntraLase. Intralase is a revolutionary computer assisted laser that creates the Lasik flap using laser energy . This unique technology allows an unparalleled level of safety and precision when compared to the traditional method of cutting the flap using an automated steel blade.
7. Will I need reading glasses afterwards? As a rule, people over the age of forty begin to lose the ability to focus on near objects. This is called presbyopia. If you are older than forty, chances are you will need reading glasses after Lasik, unless you choose monovision (see below). If, however, you are under forty years of age, Lasik will usually provide excellent distance as well as reading vision.
8. What is monovision? Monovision is a refractive strategy for people in the presbyopia age where one eye is fully corrected to obtain excellent distance vision, while the other eye is under-corrected by a predetermined amount to allow for reading vision. If you are over the age of forty, we will give you a trial with contact lenses simulating monovision, to see if it is right for you.
9. Will my eyes look or feel any different after Lasik? Your eyes will look exactly the same after Lasik. You will have microscopic scars in the cornea outlining the edge of the flap. They can only be seen under the high magnification of the slit lamp. Over time many of these scars will become invisible. Your eyes should also feel no different after the procedure. Some people will experience dryness of the eyes in the first few days or weeks after Lasik, but in most cases it will be temporary, and easily treatable with artificial tears.
10. What are the long term results? Is the treatment permanent? The correction achieved with Lasik is permanent. In the majority of cases stability will be achieved by three month after the treatment. As you age the distance vision should remain clear.
11. What is "Wavefront-guided CustomCornea®" Wavefront technology is a computer assisted program that measures the higher order aberrations of the eye and transfers this information to the laser to provide a more precise and individualized Custom Treatment. Prior to Wavefront analysis, we could only measure the lower order aberrations of the eye, for example the refraction or prescription of the lenses in your glasses or contacts. With Wavefront measurements, we are able to correct all the aberrations in the complete optical system of the eye. This translates into a higher number of people getting 20/20 or better visual outcomes, and perhaps more importantly, less people having problems with halos and glare especially with nighttime vision.
12. What is "All Laser Lasik"? Intralase, is a new laser technology that allows the surgeon to create the Lasik flap using laser energy instead of a steel-bladed keratome. Creating the flap is the most delicate part of the procedure. With Intralase, computer-assisted technology allows us a higher level of precision and safety in creating the corneal flap. Complications with Lasik are often due to flap irregularities. With Intralase, flap irregularities are much less likely.
13. What if I close my eye or move during the procedure? A thin wire speculum is used to gently open the eye during Lasik, making eyelid closure impossible. Small eye movements are automatically neutralized by the active eye tracker technology of the laser. Larger movements are seen on the video screen which alerts the surgeon to lift his foot off the control pedal. Once the eye is re-centered the control pedal is reactivated and laser treatment resumes; no harm done. It is unlikely, however, to make large eye movements, because you will be continually focusing on a colored blinking light.