What is the difference between LASIK and PRK?
With LASIK, the middle portion of the cornea is treated by first using a machine called a microkeratome to lift up the surface of the cornea. The laser is then used to reshape the exposed corneal surface.

With PRK, or photorefractive keratectomy, the laser light is used to reshape the front surface of the eye. Both procedures can be used to correct near sightedness, farsightedness, and astigmatism. PRK has been performed in this country for about ten years, and LASIK for about eight years. Dr. Kawesch has been a clinical investigator for several FDA LASIK and PRK studies.

What are the goals of Laser Vision Correction surgery?
The goals of surgery are reduce or eliminate the need for glasses and contact lenses. By improving the uncorrected visual acuity in patients, LASIK and PRK are often able to allow patients to go about their daily routine without needing corrective lenses. These procedures may also be used to treat residual amounts of nearsightedness (undercorrections) or farsightedness (overcorrections) following other forms of refractive surgery, such as RK and LK.

How is LASIK surgery done?
Your eye is anesthetized with eye drops. A shaving is made with an instrument known as a microkeratome, to expose the inner layer of the cornea, creating a “flap.” The laser is then used to vaporize a very thin layer of corneal tissue, 0.2 microns at a time. The corneal flap is then reflected back to restore the corneal surface. Surgery takes only a few minutes. Typically, a protective eye shield is worn over the eye, for the first day.

What if LASIK is not the best procedure for me?

During your examination, we gather important information regarding the health of your eye, including various measurements regarding your prescription, your pupil size and the shape and thickness of your cornea. Our goal is to help you select the procedure which will have the highest chance of getting you to your goal of clear vision without glasses, while at the same time having the least risk possible of any complications.

Some patients have corneas that are thinner than average, and, depending on the amount of correction needed in these cases, a LASIK procedure could be riskier than in a patient with a cornea of normal thickness. With LASIK, a flap is created and lifted aside, and the laser is used to sculpt the exposed corneal bed, which is usually 130-180 microns deeper into the cornea from the surface.

The laser sculpts the cornea by vaporizing corneal tissue. So, the laser will make the cornea thinner than it was. If the thickness of the corneal bed is reduced too much with LASIK, a complication known as ectasia can occur, which is a destabilization of the cornea, causing high levels of nearsightedness, astigmatism and possibly cornea irregular curvatures to result. This is something which needs to be avoided. The amount of corneal tissue vaporized with the laser depends on the degree of correction being attempted, and the treatment zone diameter programmed into the laser. Bigger treatment zones are helpful in reducing nighttime side effects, but they do go deeper into the cornea.

Patients with thinner corneas might be better off with a procedure other than LASIK. A procedure which does not create a flap would give us more cornea to work with, to enable a more complete correction and/or a bigger treatment zone diameter. There are surface treatments available, known as LASEK or PRK. These techniques are extremely similar. They involve removing the very surface layer of the cornea, known as epithelium (usually about 50 microns thick), then lasering the exposed corneal bed. This way, the laser is not vaporizing tissue as deep in the cornea as with LASIK, and the risk of ectasia is lowered. With LASEK, a form of alcohol is applied to the cornea, which loosens (and kills) the surface epithelium. After the laser part of the procedure, the layer of dead and dying epithelial cells is replaced over the treated area to act as a bandage, and a contact lens is placed over that. Much of the healing involves the regeneration of new epithelium cells, over the course of a week. With PRK, no alcohol is used, and the surface epithelial cells are removed with a soft brush. After the laser treatment, as with LASEK, a disposable contact lens is placed on the eye, without replacing the damaged epithelial cells. New epithelium regenerates naturally, over two to three days. Both techniques are effective, however I have found that the alcohol used with LASEK causes significant inflammation and delayed recovery of vision. In other words, patients seem to see and recover more quickly with PRK, without trying to salvage the surface epithelium cells.
How is PRK surgery done?
Your eye is anesthetized with eye drops. The outermost layer of the cornea is removed with the laser, or mechanically with a special instrument. The laser is then used to vaporize a very thin layer of corneal tissue, 0.2 microns at a time. The amount of cornea removed depends on the amount of correction needed. The surgery takes less than 2 minutes. Following the procedure, a special contact lens may be applied, and is worn for 2-5 days.

Is there more than one type of excimer laser?
Yes. In the U.S., there are several approved machines: Visx, Summit, Nidek, Autonomous, and Bausch & Lomb are a few. There are many differences among them, which the doctor would be happy to discuss with you at your exam.

Is there any pain?
The surgery itself is generally painless. After the surgery, there may be some mild to moderate pain for one to three days (mostly with PRK, not with LASIK), which may be relieved by oral medications and topical eye drops.

Are both eyes done at the same time?
Usually, but they can be done separately. This is an issue that you may wish to discuss with the doctor.
What range of nearsightedness can be treated with Laser?
In the U.S., the excimer laser PRK procedure is approved for the treatment of nearsightedness within the range of -1.00 to -13.00 diopters, and astigmatism from 0.75 to 5.00 diopters. We generally only offer PRK as an option for lower levels of correction. LASIK is currently the best surgical option to treat low, moderate and high levels of nearsightedness. Dr. Kawesch has successfully treated up to 24 diopters with the laser.

What if I have astigmatism?
The excimer laser is approved to treat both near sightedness and astigmatism. Both LASIK and PRK are able to treat astigmatism right along with any nearsightedness. No additional procedures are necessary – it is all done at once.

What if I’m farsighted?
Dr. Kawesch has conducted FDA clinical studies to treat farsightedness up to 6 diopters with the laser (using PRK and LASIK) for several years.

In the fall of 1998, the FDA approved the treatment of farsightedness using the excimer laser. Results have generally been excellent.

Do I need to take time off from work?
With PRK, rarely will you want to return to work the next day. The visual results of PRK surgery are not quite instantaneous; it may take several days for the vision to become clear enough to drive. LASIK generally provides good vision the next day, enabling most patients to return to work immediately.

Can my vision return to its original level after surgery?
Some patients experience a regression of effect following surgery, but not to the preoperative level. Fine-tuning or enhancement surgery can often be done to further improve the vision if necessary.

What are the side effects of LASIK and PRK?
The most common side effects are light sensitivity, halos, and dryness. Undercorrection or overcorrection may occur, and glasses may be needed after surgery to restore perfect vision. In some instances, irregular corneal curvatures and/or haze might be created and glasses may not restore perfect vision. A more detailed discussion of these issues will take place during your Comprehensive Eye Examination.

Which is better, PRK or LASIK?
This question can be best answered by the doctor. Generally speaking, for low corrections, both LASIK and PRK can provide excellent results. LASIK offers the advantages of quicker healing, less pain, less regression of effect (more stable results), and lower incidence of corneal scarring. Additionally, retreatments are generally easier to perform with LASIK. Currently, most patients choose to have LASIK. PRK may be the preferred technique in certain special situations, such as patients with thin corneas.

How old do I have to be for PRK or LASIK surgery?
The doctor would prefer patients to be at least 18 years old, with a stable prescription. There is no upper age limit.
What if I am currently wearing contact lenses?
When you schedule a Comprehensive Eye Examination, it is important to note the following: if you are wearing hard or gas permeable contacts, they must be out of your eyes at least three weeks prior to your exam. Soft lenses must be out at least 72 hours. Also, bring in your glasses if available.

How do I get started if I am interested in Laser Vision Correction?
If you are reading this web page, you’re well on your way. We suggest you read everything in this web site. The next step is to call us for an appointment. A Comprehensive Eye Exam with our doctor will take about one and a half hours, and will specifically determine your chances for success with surgery. The eye exam consists of a thorough evaluation and analysis of your eyes and your visual system. You will have time to have all of your questions answered by the doctor.

Will my insurance company cover Laser surgery?
A few insurance companies do cover PRK and LASIK. This is not a “cosmetic” surgery, but rather the laser produces a functional change of vision. If covered, it is under major medical and not a vision plan. We will be happy to make a copy of your insurance card and check coverage for you. If there is no coverage, several medical finance companies that we work with can help you obtain financing should you need it. It is easy to apply and your payment schedule is flexible. Monthly payments are kept to a minimum. We can usually give you an answer within an hour whether or not you can qualify (ask to speak to one of our staff about the patient financing program). We also accept cash, personal checks, Visa and Mastercard.

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This computerized procedure increases the accuracy 100 times more than the hand held blades of the past. It also has a better success rate with four times as many people achieving 20/20 vision after surgery. The 100 % blade free method is preferred to the old fashion way of doing the surgery. Intralase also reduces the chance of scarring of the cornea which can impair vision.

The invention of Intralase has greatly reduced complications caused by LASIK surgery. The technique also helps patients recover faster after Lasik surgery. With the old way of doing things, 20% of patients experienced difficulties of some kind post surgery. The only major complication of this procedure is the sensitivity to light after surgery. This sensitivity is called photophobia. However this only happens in 1 % of patients. Photophobia, according to most doctors, is only temporary and can be treated with steroid eye drops for a few weeks.

How Intralase Works

A surgeon uses a computer to guide the laser over your eye. The computer guided laser makes three “bubble like” incisions in the middle layer of your cornea. The resulting flap is made at a specific depth and location that best suits your corrective needs as determined by your doctor. The doctor then folds back this flap to reshape your cornea to correct your vision and astigmatism if it exists.

The invention of Intralase has also brought back potential patients who chose not to undergo lasik in the past due to the high risks involved. Intralase is safer and more accurate than they lasik of the past. It is because of this that so many people have lost their phobias and have undergone the procedure. Lasik with Intralase now has minimal complications and higher success rates. That has made it more appealing to people today. The safety and accuracy is well worth the extra money to most people. If you are considering lasik, Intralase should be considered as well. It could mean the difference between seeing 20/20 again and never seeing again. The choice is yours. Be sure to make an educated decision. Learning all you can is the key to making the right choice.

With the innovation of Intralase, patients who were previously not able to have LASIK eye surgery may now be able to throw their glasses away forever. It has a wider range than the old hand held blade therefore making more people eligible for surgery. Nevertheless, you should consult your doctor to discuss whether LASIK is right for you.