LASIK Eye Surgery

Refractive surgery improves vision by permanently changing the shape of the cornea, the clear front window of the eye. When treating myopia, or nearsightedness, refractive surgery techniques reduce the curvature of the cornea to lessen the eye's focusing power. Images that focused in front of the retina, due to an elongated eye or steep corneal curve, are pushed closer to or directly onto the retina. When treating hyperopia, or farsightedness, refractive surgery techniques make the cornea steeper to increase the eye's focusing power. Images that focused beyond the retina, due to a short eye or thin cornea, are pulled closer to or directly onto the retina. Astigmatism occurs when the cornea is more curved in one direction than the other. If astigmatism is significant, light passing through the cornea is scattered. Images reaching the retina are distorted and vision is blurred. When treating astigmatism, refractive surgery techniques selectively reshape portions of the cornea to make it symmetrical and smooth, so that images focus clearly on the retina.

Common refractive surgery procedures include:

Laser-Assisted In Situ Keratomileusis (LASIK)

An instrument called microkeratome or an IntraLase femtosecond laser is used to create a 100 micron thick corneal tissue flap that is gently lifted back. The corneal tissue under the flap is reshaped with an excimer laser to correct the individual refractive error. The corneal flap is placed back in its original position and begins healing.
The advantage of LASIK is a fast recovery. Patient starts to see clearer in 24 to 48 hours.
The disadvantages of LASIK are:
• Microkeratome complication: there is up to an 8% complication rate with a microkeratome which are incomplete corneal flap, corneal epithelial defect, thin flap, hole in the flap and irregular tissue under the flap.
• Infection and inflammation (diffuse lamellar keratitis) and epithelial downgrowth under the corneal flap.
• Excessive thinning of corneal tissue under the flap that can lead to keratoconus and permanent damage of vision.
• Dry eye.
• Dislocation of the flap secondary to trauma even years after LASIK surgery.

Laser Epithelial Keratomileusis (LASEK)

In LASEK, a layer of cells with a thickness of 50 micron (corneal epithelium) is removed from the surface of the eye (cornea). A computerized laser is used to reshape the cornea and then the corneal epithelium is replaced back on the cornea. After LASEK, a bandage contact lens is placed on the eye (cornea), which will be removed four days later. The advantage of LASEK over LASIK is that LASEK is much safer than LASIK because no cut is made on the eye (cornea) by a machine (Microkeratom) and the cornea stays intact. The disadvantage of LASEK is that it takes 3-4 days to recover vision completely and the patient has to use eye drops for 6-8 weeks.

Lasik, Lasek and PRK correct Myopia (nearsightedness), hyperopia (farsightedness) and astigmatism.

Photorefractive Keratectomy (PRK)

PRK is a surgical procedure in which the surgeon uses a laser to remove micro-thin layers of tissue from the cornea. The tissue is removed in a controlled pattern programmed into the computer by the surgeon. When treating myopia, or nearsightedness, the surgeon uses the laser to flatten the corneal surface in a circular pattern. In comparison, when treating astigmatism, the laser is programmed to remove tissue in an elliptical pattern, selectively reshaping some portions of the cornea to form a smooth symmetrical surface. This procedure requires precise evaluation of the astigmatism so that the correct amounts of laser energy are delivered to the appropriate areas of the cornea.

Astigmatic Keratotomy (AK)

Astigmatic Keratotomy is a microsurgical procedure in which the surgeon makes deep curved incisions in the cornea (usually one or two) to flatten the areas of the cornea that are too steeply curved. AK is no longer the primary procedure longer the primary procedure to correct astigmatism.

Radial Keratotomy (RK)

Radial Keratotomy is an old surgical procedure to improve myopia by changing the curve of the cornea over the pupil. The surgeon maskes several deep incisions (Keratotomies) in the cornea in a radial, or spoke-like, pattern. The incisions flattern out the cornea and shorten the distance light rays must travel to the retina. RK procedure is no longer being used to correct myopia.

Cataract

A Cataract is a clouding of the normally clear natural lens of the eye. This clouding is usually due to the aging process but can also be caused by eye trauma, medications, and hereditary disease. Cataracts typically result in blurred vision, glare and light sensitivity. Human eye is like the old cameras that used film to take a picture. The lens of the camera focused light on the film. The lens of your eye focuses light which forms an image on the retina. The retina is the part of the eye that enables us to see the images. If the lens in the camera is dirty, then the picture will be hazy and blurred. A cataract causes the image focusing on the retina to be blurred in the same manner. Cataracts usually develop over several years. At the beginning Cataract may cause few problems, but as the cloudiness increases through the lens, you begin having difficulty seeing and have difficulty with activity of daily living like reading and driving.

Cataract Surgery

The best way to treat cataract is to remove the cloudy lens and replace it with a clear artificial lens. Cataract Surgery is one of the most successful surgeries performed each year in the United States. About 95 percent of all cataract surgeries result in an improvement in vision. At South Florida Laser Eye Center we use the latest techniques including Laser cataract surgery and small incision Phacoemulsification (Phaco) Surgery. The surgery is performed through 2.2 to 2.6 mm incision under topical anesthesia. Once the cataract is removed, a permanent artificial lens will be placed inside the eye. When your procedure is completed, you leave the operating room without a patch and are actually able to see. In time, your vision improves and you should be able to resume your daily activity within 24 hours.

Download surgery reminders (.doc)
Download informed consent for catarat surgery and/or implantation of intraocular lens (.doc)

Refractive Errors

What are refractive errors?

For our eyes to be able to see, light rays must be bent or "refracted" so they can focus on the retina, the nerve layer that lines the back of the eye. The cornea and the lens refract light rays. The retina receives the picture formed by these light rays and sends the image to the brain through the optic nerve. A refractive error means that the shape of your eye doesn't refract the light properly, so that the image you see is blurred. While refractive errors are called eye disorders, they are not diseases.

What are the different types of refractive errors?

Myopia (nearsightedness)

A myopic eye is longer than normal, so that the light rays focus in front of the retina. Close objects look clear but distant objects appear blurred. Myopia is inherited and is often discovered in children when they are eight to twelve years old. During the teenage years, when the body grows rapidly, myopia gets worse. Between the ages of 20 and 40, there is usually little change. If the myopia is mild, it is called low myopia. Severe myopia is known as high myopia. If you have high myopia, you have a higher risk of detached retina. It is important to have regular eye examinations by an ophthalmologist (medical eye doctor) to watch for any changes in the retina. If the retina does detach, a surgical operation is the only way to repair it.

Hyperopia (farsightedness)

A hyperopic eye is shorter than normal. Light from close objects, such as the page of a book focuses behind the retina. Like nearsightedness, farsightedness is usually inherited. Babies and young children tend to be slightly hyperopic. As the eye grows and becomes longer, hyperopia lessens.

Astigmatism (distorted vision)

The cornea is the clear front window of the eye. A normal cornea is round and smooth, like a basketball. When you have astigmatism, the cornea curves more in one direction than in the other, like a football. Astigmatism distorts or blurs vision for both near and far objects. It’s almost like looking into a funhouse mirror in which you appear too tall, too wide or too thin. You can have astigmatism in combination with myopia or hyperopia. Astigmatism can be corrected with glasses, contact lens, Laser vision correction, Laser cataract surgery or special implants(Toric lenses) during cataract surgery to provide the best vision potencial

Presbyopia (aging eyes)

When you are young, the lens in your eye is soft and flexible. The lens of the eye changes its shape easily, allowing you to focus on objects both close and far away. After the age of 40, the lens becomes more rigid. Because the lens can’t change shape as easily as it once did, it is more difficult to read at close range. This perfectly normal condition is called presbyopia. You can also have presbyopia in combination with myopia, hyperopia or astigmatism.

How are refractive errors corrected?

Eyeglasses or contact lenses are the most common methods of correcting refractive errors. They work by refocusing light rays on the retina, compensating for the shape of your eye. There is no scientific evidence that eye exercises, vitamins or pills can prevent or cure refractive errors.

Eyeglasses

Glasses are an easy method to correct refractive errors. They can also help protect your eyes from harmful light rays, such as ultraviolet (UV) light rays. A special coating that screens out UV light is available when you order your glasses. Bifocals are glasses that are used to correct presbyopia. They have a correction for reading on the bottom half of the lens and another for seeing distance on the top. No exercise or medication can reverse presbyopia. You will probably need to change your prescription from time to time between the ages of 40 and 60, because your lens will continue to lose flexibility.

Contact lenses

There are now a wide variety of contact lenses available. The type that is best for you depends on your refractive error and your lifestyle. If you want to wear contact lenses, discuss the various options with your eye care professional. You may have heard of a process called orthokeratology to treat myopia. It uses a series of hard contact lenses to gradually flatten the cornea and reduce the refractive error. Improvement of sight from orthokeratology is temporary. After the use of the lenses is discontinued, the cornea returns to its original shape and myopia returns.

Refractive surgery

Refractive surgery improves vision by permanently changing the shape of the cornea, the clear front window of the eye. Refractive surgery can correct myopia, (nearsightedness), hyperopia (farsightedness) and astigmatism.

Cornea Transplant

What is a Cornea? The Cornea is the clear window of the eye that covers the colored iris and round pupil. The Cornea and human lens focus the light on the retina that lines the back of the eye so we can see. If the cornea is damaged it may become scarred or swollen. The damaged Cornea scatters or distorts the light, resulting in blurred vision, glare and sometimes pain. Some of the conditions that affect the smoothness and clarity of the cornea require Corneal transplant include Keratoconus, a steep curving of the cornea and hereditary corneal disease like Fuchs' dystrophy.

Over 40,000 corneal transplants are performed in the United States each year. Corneal transplant is the most common and successful transplant surgery. Corneal transplant is the most common and sucessfull transplant surgery. The surgery is usually done on outpatient basis. The operation is painless and you will not see the surgery. Frequently local anesthesia is used. The eye lid is kept open with an speculum. The diseased or injured cornea is removed in a circular fashion. Other procedures, like cataract surgery, if indicated, are performed and then the clear donor cornea is sutured in the place of the diseased cornea. The eye is patched and patient is seen in the office the following day.

Like any other surgery, complications of corneal transplants include infection and bleeding. Corneal transplants are rejected 5 - 30 percent of the time. The rejected cornea swells and vision deteriorates. Warning signs of rejections are:

• Decrease vision
• Light sensitivity
• Redness

Most rejections can be reversed if treated promptly. A corneal transplant can be repeated. The rejection rates are higher in the repeated transplants than the first time. Vision may continue to improve up to a year after surgery. Sutures are usually removed one year after the surgery and the astigmatism is corrected if it is indicated. A successful corneal transplant requires the care and attention of both patient and physician.

Download request for corneal transplant (.doc)

Multifocal Lenses

Multifocal Lenses

A Breakthrough in Cataract Surgery Providing Freedom from glasses

The vast majority of patients who undergo cataract surgery today receive monofocal lenses, wich typically require them to use reading glasses or bifocals for near vision following surgery. Until now, conventional IOL's (Intraocular lens) used in cataract procedures provided good functional distance vision, but offered little benefit for a full range vision, making most patients dependant on glasses even after surgery.

Finally An Option - Freedom from Glasses

Multifocal lenses like Acrysoft as restore technology, giving patients a full range of vision, near through distance, and greatly reduces the reliance on reading glasses or bifocals.

What does this mean for me?

It means better quality of life, through visual freedom. Does this mean freedom from glasses? For many, yes. With the multifocal IOL like Acrysoft, is restore you may possibly be able to read the font on items such as prescription bottles, magazines and newspapers, while also having the ability to drive or go on sightseeing tours, all without using your glasses! In fact, FDA clinical studies have demostrated that 80 percent of patients never needed to wear glasses or bifocals again.

Am I a Candidate?

Not everyone is a candidate for multifocal IOL. You need to be evaluated prior to cataract surgery to see if you are a candidate for multifocal IOL