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Multifocal and Toric lens implants for Cataract Surgery
Children’s Eye Care and Strabismus Surgery
How to help your child wear an eye patch to treat amblyopia
Glaucoma Diagnosis and Treatment
REFRACTIVE EYE SURGERY PAGE
LASIK / ZYOPTIX / PRK / Intraocular Contact Lens
Epi-LASIK / Refractive Lens Exchange
Below is an explanation of the refractive surgical procedures, such as LASIK, offered by Costello Eye Physicians and Surgeons. A brief history of refractive eye surgery, conditions treated, and a description of the procedures is provided below. See the included links and our main links section for more detailed information.
If you wish to read about these procedures at the USFDA’s website, click here: http://www.fda.gov/cdrh/lasik/
There are several options when it comes to refractive surgery for your eyes. Before hastily scheduling a procedure that can profoundly impact the rest of your life, you should get all of the facts about the procedures and your surgeon. A thorough one on one discussion of the benefits, risks, and alternatives of the surgery should take place between you and your surgeon.
Some patients are not candidates for certain types of procedures, such as LASIK, but may have other options to be free of spectacles and contact lenses. Many new procedures have become available. Certain risky and less predictable procedures from the past are no longer available and technology is always changing.
A refractive surgery timeline is shown below:
1936 Tsutomu Sato observes flattening
of the cornea after traumatic eye injury
1948 Jose Barraquer begins using surgical
techniques to reshape the cornea by removing a portion, freezing
it, reshaping it with a lath, and then stitching back into the
eye. The portion removed is approximately proportionate to
today's LASIK flap.
1960's radial keratotomy (RK) is developed
by Russian Svyatoslav Fyodorov.
1975-79 development of excimer laser
technology
1983 Stephen Trokel describes use
of excimer laser to remove corneal tissue
1987 Theo Seiler performs first excimer
treatment on human eye
1991 Stephen Brint performs first
LASIK Procedure
1995 FDA Approves excimer laser for
refractive surgery (PRK) to correct myopia (nearsightedness) with
or without astigmatism
1999 first excimer lasers approved
for LASIK surgery
2000 FDA approves excimer laser for
LASIK to correct hyperopia (farsightedness)
2002 Wavefront guided LASIK approved
for custom correction (Zyoptix)
Costello Eye Physicians and Surgeons have performed the most LASIK surgery in the Mohawk Valley. Dr. John Costello is currently the only doctor certified to perform the Intraocular Contact Lens (ICL) surgery here in the Mohawk Valley. This unique lens can be inserted into the front of the eye to correct vistion in patients who may not be a candidate for LASIK or PRK.
What conditions can be corrected by refractive surgery?
Nearsightedness (myopia). For a nearsighted person, close objects are clear, but distant objects-such as a school blackboard, a street sign, or a face across a room-are blurred and difficult to distinguish. Over 25% of adults worldwide are nearsighted. This occurs in an eye that is unusually long. This causes light to be focused in front of the retina instead of on it. It is usually discovered between the ages of 8-12 years. It tends to be stable between the ages of 20-40 years. People who are severely nearsighted have an increased risk of retinal detachment.
Farsightedness (hyperopia). Technically known as hyperopia, people who are farsighted have blurred vision at all distances unless the make a constant effort to focus, which can lead to strain, headaches, and eye fatigue. Farsightedness occurs when the eye is shorter than normal. This shape causes light to be focused behind the retina rather than on it. This condition is often inherited.
Astigmatism. For people with astigmatism, all objects both near and far are distorted. Images are blurred because some of the light rays are focused and others are not. A normal cornea is round and smooth like a basketball. With astigmatism, the cornea curves more severely like a football. Astigmatism is inherited, and can occur in combination with nearsightedness or farsightnedness.
What procedures are offered by Costello Eye Physicians and Surgeons?
PRK (Photorefractive Keratectomy)
PRK, the forerunner to LASIK, was the most common refractive surgery procedure for several years in the United States before LASIK was developed and became more popular. Over time, the results of the two procedures are relatively similar. The primary difference is that PRK patients tend to have more pain and foreign body sensation over the first 3-5 days. It typically takes PRK patients more time to recover their vision than LASIK patients, although this is not always true. PRK is approved for myopia, hyperopia, and astigmatism.
During PRK surgery, the excimer laser ablates the most superficial layers of the cornea to reshape the cornea’s corrective power. When the laser is completed, a bandage contact lens is placed over the eye and the patient goes home on drops. Until the ulcerated area on the cornea heals, the patient will have a scratchy burning sensation. This is the worst on the first day and typically gets better each day for 3-5 days. PRK patients can sometimes have a haze in the cornea for a few months after surgery. This haze typically goes away over time, but may require an extended period of eyedrops for up to 6 months.
PRK
for Myopia
LASIK (Laser-Assisted in Situ Keratomileusis)
LASIK surgery applies the very same laser used for PRK, the excimer laser. The difference is that LASIK is a two stage procedure. In the first stage, the eye is made firm and a very thin surface slice of cornea is made to form a flap with a cutting blade. The flap is reflected to the side while the second stage of the procedure is performed with the cornea sculpting laser. Once the laser is finished, the surgeon places the flap back in its original position on the cornea.
The advantage to this procedure is that the patient recovers vision much quicker and pain and foreign body sensation are typically minimal and short in duration. The quick recovery has made this a more popular procedure, but some patients may not be a candidate for LASIK because the cornea is not thick enough to allow the creation of a flap and a healthy residual cornea bed. LASIK is approved for myopia, hyperopia, and astigmatism.
LASIK
flap lifted
Both PRK and LASIK have risks unique risks and benefits that you can discuss with your doctor. Both types of surgery enjoy wide success.
Epi-LASIK
Epi-LASIK is sort of a combination of PRK and LASIK. Much like LASIK, a ring is placed on the eye, but instead of cutting a flap, a plastic blade will simply peel off the skin of the cornea and the laser will be applied to the most superficial parts of the cornea. This procedure can also have the haze commonly seen with PRK patients, but this procedure is believed to have a less painful recovery than PRK.
Epi-LASIK
ZYOPTIX (Custom Laser Ablation)
ZYOPTIX laser can be used with PRK, LASIK, or Epi-LASIK. Zyoptix will correct for irregular astigmatism that may cause optical aberrations in many patients. The Zywave scanner will scan a patients cornea much like a satellite scans the earth’s topography. Small peaks and valleys that cause irregular astigmatism are mapped and the this software is used to control the amount of laser placed at each part of the cornea. Patients who underwent this procedure in one eye and standard LASIK in the other reported better contrast sensitivity in the eye that underwent ZYOPTIX custom ablation. A Zywave scan print out and the Technolas 217A laser unit are shown below.
Visian ICL
The Visian ICL (Implantable Collamer Lens) is a lens that is permanently
implanted in the eye behind the iris and in front of the natural lens. The
lens is intended to correct moderate to severe nearsightedness. This
type of lens is called a phakic IOL because the patient still has their
own natural lens. It works by bending (refracting) light rays to
allow them to focus on the retina. For a throrough description of
FDA approval site: http://www.fda.gov/cdrh/mda/docs/p030016.html
Patient information site: http://www.visianinfo.com/
Visian
ICL
Refractive Lensectomy
This involves cataract surgery or removal of the patient’s natural lens and replacing it with a lens which corrects the patients nearsightedness, farsightedness, or astigmatism. In some very farsighted patients, this may be the only refractive surgery option. This is a very effective and permanent way to correct this condition.
CK (Conductive Keratoplasty)
We do NOT offer CK (Conductive Keratoplasty) for Presbyopia, or to replace your reading glasses. This procedure has not been shown to provide long term results and outcomes are very unpredictable. This procedure has also been shown to cause astigmatism.
Who is not a candidate for laser eye surgery?
Several pre-existing eye conditions may exclude you from candidacy for one or several procedures discussed above. Many conditions, not limited to the following can cause patients to be eliminated as candidatesL Keratoconus, Connective Tissue Diseases, Multiple Sclerosis, Uncontrolled glaucoma, Diabetic Eye Disease, Cataracts, Unstable Spectacle Correction, Thin Cornea, and many other conditions.