During some Lasik operations, surgeons cut a thin flap in the cornea and then fold it to the side. After that, a laser re-shapes the cornea underneath the flap. A newer form of Lasik bypasses the knife all together and relies solely on a laser.
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The first medical procedure that had millions throwing away their glasses was pioneered by a Soviet medical entrepreneur. He ran his clinics like medical factories.
Laser surgery revolutionized eyesight correction when it was introduced ten years ago. Originally, the procedure was used only to correct nearsightedness. Now, Lasik is used to correct most vision problems, including farsightedness and astigmatism. That's enticing more and more people to choose to have their corneas reshaped and their vision corrected. Every year, more than four million Americans make this choice.
Recently, Los Angeles resident Chet Lee, 30, had surgery at the UCLA Jules Stein Eye Institute, where he was able to take advantage of two of the newest techniques in Lasik: Wavefront-guided Lasik and all-laser Lasik.
Wavefront-guided Lasik, or "custom Lasik," uses a computer to diagnose and customize correction of the eye.
All-laser Lasik uses a laser rather than a blade to trim off the top of the cornea. Right now, that laser is only sold by the company IntraLase Corp. Surgeons think the new bladeless Lasik is more precise, easier to use, and reduces complications.
Dr. D. Rex Hamilton, Director of the UCLA Laser Refractive Center at the Jules Stein Eye Institute, says the new custom Lasik procedure helps make Lasik more exact. A camera takes pictures of how the eye actually reflects and filters light. The more dramatic the angles, the more Lasik correction is needed.
The new Wavefront-guided technology is more eye specific, Hamilton says.
"Everybody has optics of their eye that is unique. No two eyes are the same," Hamilton explains. "We can now measure those optics in a very detailed way and then use the laser to reshape the cornea for that particular optical fingerprint. It's like a detailed map of the optics."
With this detailed map, Hamilton says, the computer then figures out exactly how surgeons need to reshape the cornea to remove optical imperfections and correct vision.
For the patient, Hamilton says, "this translates into better nighttime vision, better quality, less halos, less glare of lights."
Before custom Lasik, decisions about how to reshape the eye were more subjective because doctors relied on a patient's prescription for glasses. And prescriptions are based on a patient's assessment of their own vision as they read the eye charts in doctor's offices.
With custom Lasik, decisions are more scientific, says Hamilton, because a computer measures how light is reflected in the eye. The pattern it produces tells doctors exactly how vision is impaired, and how to fix it.
"The computer figures out what I need to do to reshape the cornea to remove optical imperfections," Hamilton says.
Chet was nervous, but excited about the procedure's potential. He was hoping for 20/20 vision in both eyes, and eager to be done with contacts, which, at various times, had broken inside his eye, cut his cornea, fallen out of his eye or gotten lost.
The new "all-laser" Lasik was what finally brought Chet to UCLA. He'd been thinking about Lasik for about nine years but was squeamish about the surgery. During Lasik, surgeons cut a thin flap in the cornea and then use a laser to reshape the cornea underneath. Most surgeons use a blade, which automatically moves across the cornea to make the flap. But at UCLA, they've gotten rid of the blade and now use a laser to create the flap.
The laser more or less separates tissue, says Hamilton, "creating little bubbles of space that are right next to each other on a microscopic level that creates a plane that I can then lift with a blunt instrument."
In Chet Lee's surgery, it took only a few minutes for the laser to move across the cornea and separate the tissue to create a flap. Then Hamilton can work from a smooth, flat surface in order to create the new 'customized reshaped cornea." Lee is very nearsighted, so it takes a full two minutes on each eye for the laser to do its work.
At the end of surgery, Chet seems relieved. It wasn't as bad as expected, he says. On a follow-up visit the next day, his vision tests at nearly perfect: 20/20 in one eye, 20/25 in the other.
"Typical," says Dr. Hamilton.
Hamilton says that complications from Lasik are rare but include distortions, such as glare or halos, especially at night. The risk of that happening is greatly decreased, he says, because of the earlier computer measurements he took of the eye.
Although the computer measurements don't add a lot to the cost of Lasik, the new 'all-laser' procedure does. Conventional Lasik averages around $1,500 per eye. All-laser Lasik is more.
In Chet Lee's case, the cost was $3,050 per eye -- a total of $6,100. And for the most part, Lasik surgery is not covered by insurance.