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Welcome to the Cornea
Genetic Eye Medical Institute's Laservision (LASIK) correction home page. Learn how just about any refractive error can now be corrected by laser surface reshaping of your cornea and reduce your dependence or eliminate
your need for glasses or contact lenses for most activities. To learn about the appropriate procedure for your problem, merely click on your refractive problem.
The following additional information could be useful in helping you make a decision regarding Laservision (LASIK) Correction.
The Laser | The Microkeratome
| PRK vs. LASIK | The Surgeon | The Hospital If you would like any additional information regarding Laservision Correction, please call our refractive coordinator,
Aracelli Ortega at 310-423-9643 to RSVP for one of our seminars, receive a complimentary informational package, view an informational video or schedule a complimentary screening at our clinic. Patients who have myopia can usually see things close up, but objects in the distance remain blurry. Patients are myopic usually for one of three reasons: the
cornea is too steep, the lens is too thick (as in cataracts) or the eye is too long. Depending on the amount of myopia there are different options for surgical correction of refractive error. The amount of
myopia is usually measured in a unit called diopters (D). Myopia 4D or less – can be corrected with excimer laser PRK (photorefractive keratectomy) or RK (radial keratotomy) Myopia 4D-15D
– can be corrected with LASIK (laser in situ keratomileusis) Myopia 15D-25D
– can be corrected with phakic intraocular lens. Another procedure which is currently under investigative consideration in the United States is
the intracorneal ring, once the FDA studies in the US have been completed this will be offered by us as a treatment option. Photorefractive Keratectomy (PRK)
This procedure uses a cold laser beam to reshape the front surface of the cornea and typically takes 30 to 60 seconds depending on the patients refractive error.
Both nearsightedness and astigmatism can be corrected during the same sitting. Currently the VISX STAR excimer laser, the one used at our hospital, is approved by the FDA to correct up to 12D of myopia and 4D
of astigmatism. Typically the patient enters the laser room, a speculum is put in the eye to prevent the patient from blinking. The patient is then asked to fixate on a red light and the doctor helps the patient by
steadying their head. The top layer of the cornea is gently peeled off and the patient fixates at the red light while the ablation is being performed. The ablation is performed on the center of the eye and
flattens the cornea thus shortening the eye. Topical anesthetic is put in the eye so the procedure is totally pain free. At the end of the procedure the eye is washed out with cold water, an
antibiotic, an anti-inflammatory drop and a bandage contact lens is put on the eye. The patient is given pain medications in case they should be necessary and is seen by the doctor the following day. The first
day after the procedure, the eye feels a bit scratchy and is light sensitive. This improves rapidly and by the third to fourth day, the eye feels very comfortable and the bandage contact lens is removed.
Patients typically see improved vision immediately after the procedure, but for maximal vision to be achieved, it may take 2 to 8 weeks. The other eye is treated as soon as the patient feels he or she can
function with the treated eye. Laser-in-situ Keratomeliusis (LASIK)
This procedure is very similar to PRK, except the top layer of the cornea is modified with a microkeratome, a highly
sophisticated motorized device, which is applied to the cornea with suction under pressure. A very accurate thin flap is created and flipped to the side. Laser ablation is then
performed as in PRK. The flap is then put back in place and irrigated to remove debris from the interface. Antibiotics and anti-inflammatories are also given to the patient. No bandage
cotanct lens is placed to the patient is seen the next day. Typically the patient sees very well soon after surgery and has less discomfort than after PRK. Vision typically
stabilizes after two months. The second eye is also treated as soon as the patient is happy with the first eye. The advantages over PRK is that vision returns quicker,
there is less discomfort, it can correct higher degrees of nearsightedness and there is less chance of scarring. The disadvantages is that because a flap is created, there is a
greater risk of complications such as decreased best corrected vision, interface problems and flap problems causing astigmatism. This procedure is thus dependent on
surgeon experience. This procedure is also typically more expensive than PRK because additional equipment and blades have to be used. Patients who are hyperopic can see objects clearly in the distance but have problems seeing objects close up. This
usually happens because the eyeball is too short or the cornea is too flat. Depending on the amount of hyperopia there are different treatment options available, both of which
are currently under investigation. The amount of hyperopia is measured in units called diopters (D). Myopia 4D or less - Excimer laser PRK Myopia 5D or more - Phakic intraocular lens.
Hyperopic PRK
This procedure uses a cold laser beam to reshape the front surface of the cornea and typically takes 30 to 60 seconds
depending on the patients refractive error. Both farsightedness and astigmatism can be corrected during the same sitting. Currently the VISX STAR excimer laser, the
one used at our hospital, can correct to 4D of hyperopia. Typically the patient enters the laser room, a speculum is put in the eye to prevent the patient from blinking. The patient is
then asked to fixate on a red light and the doctor helps the patient by steadying his or her head. The top layer of the cornea is gently peeled off and the patient fixates at the red
light while the ablation is being performed. The ablation is performed on the periphery of the eye and steepens the cornea thus lengthening the eye. Topical anesthetic is put in
the eye so the procedure is totally pain free. At the end of the procedure the eye is washed out with cold water, an antibiotic, and anti-inflammatory drop and a
bandage contact lens is put on the eye. The patient is given pain medication in case they should be necessary and is seen by the doctor the following day. The first day after the
procedure, the eye feels a bit scratchy and is sensitive to light. Improvement is rapid, and by the third to fourth day, the eye feels very comfortable. The bandage contact lens is removed.
Patients typically see improved vision immediately after the procedure, but for maximal vision to be achieved it may take two to eight weeks. The other eye is treated as soon as the
patient feels he or she can function with the treated eye. Hyperopic Phakic IOL
This procedure is performed with patients who have 5D of hyperopia or more. During this procedure the patients natural
lens is removed through the small incision in the cornea with a highly sophisticated ultrasound device (phacoemulsification). The patients natural lens is then
replaced with a plastic lens to correct the refractive error. Astigmatism can be corrected during the same setting. This procedure is almost identical to cataract surgery except
higher power lenses or sometimes even two lenses may have to be used. Since this is an intraocular procedure, it is generally performed in the hospital as an outpatient
procedure. Vision can take several days to several weeks to be restored, but the quality of vision is usually excellent. Patients who have astigmatism see objects distorted both at near and in the distance. The reason for this is that their
eyes are shaped like a football. Different regions of curvature result in light not falling on the same spot on the retina as it does in a normal eye. Patients who have both astigmatism
and nearsightedness can usually be corrected with either Excimer Laser PRK (Photorefractive Keratectomy) or LASIK (Laser-in-situ Keratomeliusis).
Sometimes, depending on the patients refractive error, all that is needed to correct their astigmatism is an Astigmatic Keratotomy (AK). Astigmatic Keratotomy (AK) is extremely safe and simple
procedure to correct astigmatism and has been performed for over twenty years. This procedure involves making microscopic accurate cuts with a diamond blade under a high powered microscope in
the area of the astigmatism. It is extremely safe because the cuts are made outside of the visual axis, thus posing no threat for damaging the center of the cornea. The procedure
is done under topical anesthetic, is pain free, and is done in the doctor’s office typically taking five to ten minutes. The procedure may have to be repeated several times to
attain optimal vision (enhancement). Enhancements involve either adding additional cuts or deepening existing cuts. Improved vision is noted immediately, but for maximal vision
to be attained, may take from two to six weeks. The major risk of this procedure is perforation of the cornea with resultant infection. In experienced hands this rarely
occurs and even when it does occur, can be prevented if treated promptly. Presbyopia (reading glasses with age)
Presbyopia typically occurs when we reach our mid-forties requiring us to need glasses for reading. The reason this
occurs is because we have a muscle that allows us to accommodate (increase the curvature of our own lens) as we bring things close to the eye to read. As we get older,
this muscle becomes stiffer and we lose our ability to accommodate, thus see things close by and need glasses to help us to do this. For individuals who can tolerate monovision (and over 90%
of people can), there is an excellent solution to overcome this problem. This involves performing Hyperopic PRK on the non-dominant eye. This makes the non-dominant eye near
sighted by steepening the cornea. The nearsighted eye is then used for reading. The treated eye can still see well in the distance but not as good as the non-treated eye.
The brain then uses one eye for distance and one eye for reading, i.e., when you look into the distance, the brain sees the way the better eye sees, ignoring the nearsighted eye.
When you look close by, the brain sees the way the near eye sees and ignores the distance eye for reading. While this might seem confusing, surprisingly most patients cope very
well with this kind of correction. To determine whether this treatment is for you, you can come into our clinic for a screening and we will fit you with a
contact lens to simulate this type of correction. If after using the contact lens for two to four weeks and you feel you can cope quite well with this solution, you can then go ahead and
plan for permanent correction with the Excimer Laser.
Keratoconus or conical cornea is a condition in which the cornea progressively thins over time with age resulting in both nearsightedness and
irregular astigmatism. We do not know the cause of this problem but believe genetic factors may be involved. We are currently involved in one of the largest clinical studies in the world to determine Genetic Factors in Keratoconus . The best treatment for keratoconus are rigid
contact lenses which can confer high quality vision for many patients for many years at very little risk. For patients who are contact lens intolerant, cornea transplants are the best option. Because
the cornea is avascular, this procedure is highly successful (96-98% success rate) in keratoconus. Other incisional procedures are strongly contraindicated in keratoconus, these include
Radial Keratotomy (RK), Astigmatic Keratotomy (AK), Automated Keratomeliusis (ALK) and Laser-in-situ Kertomilcusis (LASIK). Disastrous results have been observed and reported in patients with keratoconus undergoing these
incisional procedures. We recommend all myopic patients considering PRK or LASIK undergo screening with corneal topography to rule out early forms of keratoconus, since they may be unhappy with the outcomes of
their surgery if these conditions go undetected. We are currently performing a small clinical trial to determine the efficacy of Excimer PRK in patients with "early keratoconus". To qualify for this study
you have to be over 40 years of age, have had no change in refractive error for 5 years, no slit-lamp signs of keratoconus, be contact lens intolerant, understand that you are at increased risk of
scarring, no guarantee of improved vision after surgery and may need a cornea transplant after surgery. To determine if you qualify call to schedule an appointment with our study
coordinator Diana Remba at 310-855-2438. This study is being performed based on preliminary results from Europe suggesting that this may be a reasonable treatment for patients
with "early keratoconus." Also our clinical studies suggest that it is unlikely though not guaranteed that keratoconus does not usually progress after age 40. There are definite increased risks
associated with this procedure and patients who are not prepared to assume these increased risks including the necessity of undergoing a cornea transplant should not enroll in this study. At Laser Eye
Associates, Cedars-Sinai Medical Center, Mark Goodson
Building we use the VisX Star Laser, which is the most modern and up to date Laser approved by the FDA in the United
States. Modules are present in this laser for correcting nearsightedness (myopia), astigmatism and farsightedness (hyperopia). For LASIK we have the most modern microkeratome, the Hansatome™ made by Chiron. This keratome is a big advance on previous
microkeratones in that there are less gears and it makes a superior flap thus significantly decreasing any potential for complications. Dr. Rabinowitz has undergone a special certification
course by Chiron to use this device, and was one of the first corneal surgeons in Southern California to perform LASIK with the new Hansatome. It is often a difficult choice for any patient to decide which is better, PRK or LASIK, each patient has different needs and depending on your needs
it is best to discuss the options with your surgeon and jointly decide which is best for you after he has explained the pros and cons of each procedure with you. We perform both procedures
routinely in our clinic and would be happy to discuss with you the best option for you. Dr. Rabinowitz
is a very experienced refractive and corneal surgeon. Having performed refractive surgery for the past eight years since completing his Refractive Surgery fellowship at USC in 1989.
For more information about Dr. Rabinowitz, click here.
Cedars-Sinai
has built its reputation on quality care and research and is now recognized both locally and internationally as one of the finest medical institutions in the world. The first
Laservision Correction procedures in the Western United States were performed at Cedars-Sinai in 1991 and physicians at Cedars have been lead investigators in steering these new laser
procedures through the rigorous process of FDA approval. The results have been excellent with over 96% of patients ending up with 20/40 vision or better in the VISX FDA sponsored studies. 20/40 vision is
the vision required to get a drivers license and perform most daily functions without the aid of glasses or contact lenses. Most people who are corrected for distance vision will need glasses for reading when they reach their mid-forties. Monovision is a solution to
overcome this problem so that you won’t need reading glasses when you get to this age. I recommend this to all my patients and 9 out of 10 people tolerate it very well. This involves
under-correcting the non-dominant eye and leaving it a little nearsighted, just good enough for reading while correcting the dominant eye fully for distance. The nearsighted eye is then
used for reading. This eye can still see well in the distance but not as good in the dominant eye. The brain then uses one eye for distance and one eye for reading, i.e., when you look into the
distance, the brain sees the way the better eye sees ignoring the nearsighted eye and when you look close by, the brain sees the way the near eye sees and ignores the distance eye for reading.
While this might seem confusing, surprisingly most patients cope very well with this kind of correction. To determine whether this type of treatment is for you, you can come into our clinic for a
complimentary screening and we will fit you with a contact lens to simulate this type of correction. If after using the contact lens, you feel you can cope quite well with this solution, you can then
go ahead and plan for permanent monovision correction with the Excimer Laser. We understand that for many people who want Laservision correction, money is a major obstacle since insurance does not cover this procedure.
While we do not discount our prices, we offer several attractive financing plans independent of your other credit to make this procedure affordable. Click here to read our Frequently Asked Questions
We have operated on many different types of athletes and have found individual needs different depending on the type of sport played.
For instance, tennis players prefer not to have monovision while policemen who shoot as a hobby tolerate monovision very well.
Email contact: rabinowitzy@cshs.org
Last modified: 04/22/99 11:12:12 PM
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