LASIKblog

We have avoided performing LASIK during pregnancy or nursing. Some feel it is because the refractive error (that is, the glasses or contact lens prescription) can change when the body's endocrine system is altered. We have not been impressed with refractive changes during pregnancy, or nursing. The main reason we wait has to do with the use of eyedrops, or other drugs used after LASIK. Most of these drugs are eye drops, and probably very little would cross the placenta, or enters the mother's milk. But, why take a chance. After all, LASIK is elective surgery, and it can be performed before, or after, pregnancy and nursing. The same can be said of other medical procedures. It is preferable to clear up more serious conditions before performing LASIK.
Mitchell H. Friedlaender, M.D.
Director, Scripps Clinic Laser Vision Center
La Jolla, CA
JoyOfLASIK.com
ArtOfLASIK.com

Enhancements are another name for "touch-ups" after a LASIK procedure. If the vision is not full corrected by the initial procedure, an enhancement is usually recommended. Enhancements are rarely done sooner than three months after the initial procedure. In our practice, most enhancements are performed between the third and twelfth post operative month. During the first year, it is uaually easy to "lift" the LASIK flap, and add a few spots of laser treatment to the bed. After the first year, it becomes more difficult to lift the flap, especially when the flap was created with the IntraLase. IntraLase flaps adhere more tightly to the underlying cornea than microkeratome flaps. While many LASIK surgeons maintain they can lift a flap many years after the initial procedure, we would note that complicationns, such as tearing the flap, or epithelial ingrowth are more likely as time goes by. For this reason, we are big fans of PRK enhancments 18 months, or more, after the initial procedure. In our experience, flap lift enhancements work well for the first 18 months. After that, PRK enhancements offer greater safety and effectiveness. We are not enthusiastic about creating a second flap under any circumstances. The old flap edges may join up with the new, and create an undesirable "splintering" effect.

Mitchell Friedlaender, M.D.
Scripps Clinic Laser Vision Center
La Jolla, CA
ArtOfLASIK.com
JoyofLASIK.com

Many people are told they are not good candidates for LASIK, and indeed, some truly are not good candidates. Others may be good LASIK candidates but are simply told they are not. There may be many explanations for this. The eye doctor who discouraged them may not perform LASIK, and may not want to lose a patient. They may prefer to continue fitting the patient with glasses or contact lenses. Furthermore, someone who was not a LASIK candidate a few years ago may be a good candidate today because of improved technology. For example, people with thin corneas and high corrections may have been turned away in the past, but can now be treated with the IntraLase, or with PRK. People who had radial keratotomy (RK) years ago may have poor distance vision, but they can usually be improved dramatically with laser vision correction. Some patients who have poor vision after cataract surgery, or corneal transplantation, can also be improved with laser vision correction. So, even if you were told you are not a good LASIK candidate, get a second opinion. You may be pleasantly surprised.

Mitchell H. Friedlaender, M.D.
Scripps Clinic Laser Vision Center
La Jolla, CA
ArtOfLASIK.com
JoyOfLASIK.com

Correction of presbyopia (the need for reading glasses after age 42) has long been considered the "holy grail" of laser vision. We feel the most promising approach is multi-focal ablation, that is, creating a laser pattern in the cornea somewhat like a bifocal glasses lens. Some progress has been made, especially in Canadian studies, but the procedure has been slow in making its way to the U.S. This suggests that multifocal ablations are not quite ready for prime time, and we really don't know if presbyopic corrections are months, or years, away. Other approaches have been to implant synthetic lenses in the central cornea, or replace the crystalline lens inside the eye with a "focusing" intraocular lens. Both approaches seem more invasive than multi-focal ablations, and much more work needs to be done before they gain acceptance by most ophthalmologists. Those waiting for the perfect method to correct both distance and near vision may have a long wait. In the mean time, reading glasses, or monovision (one eye corrected for distance, and one for near), seem to be reasonable alternatives.

Mitchell Friedlaender, M.D.
Scripps Clinic Laser Vision Center
La Jolla, CA
ArtOfLASIK. com
JoyOfLASIK.com

Seeing postoperative patients Saturday morning reminded us that healing time, and visual recovery after LASIK, can vary depending on a number of factors. A 24 year old patient with a -5.00 correction in both eyes was 20/15 in both eyes 20 hours after "All-Laser LASIK". A 55 year old patient with a great deal of astigmatism was only 20/30 in one eye, and 20/40 in the other eye, 20 hours after "All-Laser LASIK". While we expect this lady to be 20/20 in both eyes when we see her next week, it reminds us that visual recovery can be slower due to age, astigmatism, or high amounts of nearsightedness, or farsightedness. No doubt the healing process is more complex when a patient's cornea is more complex. We feel that touch-ups, or enhancements, are also more common in these complex patients. Such observations teach us patience, and the importance of preparing certain patients for a slower visual recovery than they might expect. However, it is the end result that we are truly interested in, and when we achieve excellent vision, a few days here or there seems less important.

Mitchell H. Friedlaender, M.D.
Scripps Clinic Laser Vision Center
La Jolla, CA
ArtOfLASIK.com
JoyOfLASIK.com

There is some buzz (although, not much) about a new LASIK procedure, called EpiLASIK. The surface layer of corneal cells, the epithelium, is removed with an oscillating, plastic blade, and the uderlying cornea is treated with the excimer laser. This seems to be a variation on LASEK, an older, seldom-used procedure, but one which has its advocates. Some doctors replace the epithelial sheet, while others remove it permanently. The sheet is suppose to act like a bandage, but it eventually gets replaced by regenerating cells. We've always thought that LASEK and EpiLASIK are misguided approaches to LASIK. Both are associated with significant pain, and a slow visual recovery. The selling point of these procedures is their safety when the cornea is too thin to perform conventional LASIK. However, we are not convinced that EpiLASIK, or LASEK are as good as PRK, the direct laser treatment of the cornea. They are certainly more difficult for the surgeon to perform. And, increased complexity often leads to increased complications. Our advice is to stick with LASIK, preferably using the IntraLase femtosecond laser to make the flap. If the cornea is too thin, opt for PRK rather than EpiLASIK, or LASEK.

Mitchell Friedlaender, M.D.
La Jolla, CA
ArtOfLASIK.com
JoyOfLASIK.com

We've commented before about the beauty and symmetry of LASIK flaps created by the femtosecond laser, known by its brand name, IntraLase. The flaps are so precise and reproducible, that they seem to be perfect every time. Contrast this with the corneal flaps created by the cutting device, the microkeratome. Aside from varying in size, shape and thickness, microkeratome flaps can often be off center. While only about 30% of LASIKs are done with the IntraLase, so-called "All-Laser LASIK", we see no reason to perform LASIK with a microkeratome when a far more precise method of flap creation is available.

Mitchell Friedlaender, M.D.
La Jolla, CA
JoyOfLasik.com