I AM UNHAPPY WITH MY VISION, IS THERE ANYTHING THAT CAN BE DONE?

Our doctors specialize in LASEK, lensectomy, cataract surgery, astigmatism treatments, glasses, contact lenses, and orthokeratology. By offering a variety of surgical and non-surgical treatments we can individualize a plan to meet the vision needs of most patients. The same vision treatment will not work for everyone because everyone is unique. A visit to our practice can allow us customize a plan that is best for you!

WHAT IS LASEK SURGERY?

Excimer lasers are used worldwide to modify the shape of the cornea in an attempt to correct nearsightedness, farsightedness, and astigmatism. Here at Eyesight Associates, we offer a form of laser vision correction called LASEK. LASEK is an acronym that stands for Laser-Assisted Sub-Epithelial Keratectomy and was first developed in Italy in 1999. LASEK is a variation of the traditional PRK procedure. PRK has been the preferred laser vision treatment for military personnel since its development. PRK has a proven record of safety for over 20 years. Our LASEK procedure uses no blades and is performed on the surface of the cornea to make sure our patients have the safest laser vision correction available. This technology offers hope for improved sight with less dependence on corrective eyewear. LASEK is performed with an excimer laser, which uses a light beam to precisely ablate very tiny bits of tissue from the surface of the cornea in order to reshape it. Using this technique, you are reshaping the cornea to better focus light into the eye and onto the retina, providing clearer vision than before. People who are nearsighted, farsighted or have astigmatism can benefit from LASEK. With nearsighted people, the goal of the excimer laser is to flatten the too-steep cornea and with farsighted people, the goal is to steepen a too-flat cornea. When correcting astigmatism the excimer laser smoothes the warped cornea into a more normal shape.

WHAT IS THE DIFFERENCE BETWEEN LASEK AND PRK?

Photorefractive keratectomy (PRK) and LASEK are surface laser eye surgeries intended to correct a person’s vision, and reduce dependency on glasses or contact lenses.
LASEK is a refractive surgery technique that is a variation of the previous traditional surface treatment PRK. Both procedures are surface treatments that do not have the potential complications of the LASIK flap. In PRK the surface cells are discarded rather than swept back into place like in LASEK. Some studies show that LASEK has less pain post operatively, faster vision recovery, less corneal haze, better visual acuity, and faster healing compared to PRK.

I HEAR A LOT ABOUT LASEK, LASIK, AND INTRALASE? IS THERE A DIFFERENCE?

Yes, there is a difference! We performed LASIK several years ago when it first became popular. However, we stopped performing LASIK because of the inherent risks with the corneal flap. In LASIK, a keratome blade is used to cut a flap deep into the middle layer of the cornea. In Intralase an additional laser is used to cut a flap. This flap is then lifted and the laser applied to internal central layer of the cornea. The flap is then smoothed back into place. Once this flap is cut and loosened it never completely heals back into place. It may become water tight, but any type of trauma around the eye may cause it to move or even come off. Since the nerves are severed, the cornea loses its feeling. After LASIK the eye frequently can not feel itself drying out which can result in severe dryness. The dryness is complicated further with age. This flap itself can produce ghost images, halos, distortion, farsightedness, astigmatism, and weakening of the cornea. We adopted LASEK as our preferred method when it comes to laser vision correction. By eliminating the flap created by LASIK or IntraLase we are avoiding potential problems.

HOW DOES LASEK WORK? HOW IS THE SURGERY DONE?

The actual surgery only takes about 8 minutes per eye but we do require you to come in earlier to prep you and your eyes for surgery. When you come in on the day of surgery you will be given a series of numbing drops to prep you for surgery. We have oral medications that can be given to most patients prior to surgery to help you relax and ease anxiety. In the operating room, a small device, called a speculum is inserted to help keep the eye open. Instead of cutting a flap into the corneal tissue as in the procedure LASIK, a very thin layer of surface cells are gently removed using a weak alcohol solution. Because they are skin cells, they will grow back. The weak alcohol solution is applied to the corneal surface for approximately 30 seconds. This softens the cells allowing them to be gently swept aside. The laser then treats the cornea for a few seconds to around a minute depending on how much treatment you need. A contact lens is placed over the cornea to act as a bandage for about 5-7 days. You may sleep in this contact lens, and you do not have to worry about changing it. We will put the contact lens in and take it out on one of your post op appointments. An eye patch will not be needed after surgery. We do require that you wear your sunglasses while outside for at least 6 months post operatively.

IS LASEK PAINFUL AND WHAT IS RECOVERY LIKE?

LASEK is a healing procedure. The actual surgery is very comfortable. The healing process is mild to moderately uncomfortable. Most people have the most discomfort around day two and day three after surgery. Pain medications and pain drops are given to assist you through these first few days. The primary benefit to surface treatment is that your eyes do heal. Patience is required, your comfort and vision will gradually improve. Studies indicate that long-term comfort and safety are better with surface treatments. During the healing process we want you to rest as much as possible so we recommend that you take one week off of work to focus on your healing. No outdoor activities are recommended for the first week after surgery. We do not want any debris getting under your bandage contact lens causing any infections or irritation. You will be using eye drops frequently during the first couple of weeks to assist you while you are healing. Most people can pass a driving test one week after surgery and feel comfortable driving at night after two weeks. Most people have stable vision at one month, but there is a six month healing process and your vision may fluctuate throughout the entire healing process.

WHAT ARE THE LONG TERM RESULTS OF LASEK? WHAT CAN I EXPECT MY RESULTS TO BE?

The clinical results of LASEK are very stable. Studies have shown that the current LASEK or PRK techniques are most effective in the treatment of nearsightedness from one to seven diopters. There is no guarantee that you will end up with 20/20 vision. Some people are unable to correct to 20/20 with glasses or contact lenses. The goal is to achieve 20/happy, a level of vision that is comfortable and functional for you. Your cornea is permanently changed with LASEK surgery. However as a person gets older, other visual disturbances may occur such as cataracts. A study that was posted in Ophthalmology, October 2004 showed that after 15 years, people who had LASEK/PRK still had stable vision. Other studies have also demonstrated that approximately 80% percent of eyes will see 20/20 one year after LASEK or PRK. 95% to 98% of eyes will see 20/40 or better — this is the level of vision required to drive without glasses in most states. Although complications may occur with any surgical procedure, LASEK and PRK have been shown to be safe and effective in the appropriate patients. According to the distributor of our laser, the Allegretto Wavelight, clinical studies have found that 93% of patients see at least 20/20 or better following the procedure and that 97% of patients would recommend the procedure to their friends.

WILL I NEED LASEK AGAIN IN THE FUTURE?

LASEK provides stable vision for most patients. In fact clinical studies show that the enhancement rate following LASEK is approximately 3%, whereas the enhancement rate with LASIK is 20-30%. Patients who need a larger treatment are more likely to need an enhancement to fine-tune their vision. Enhancements, if needed, can be done 6 months or longer after surgery and will be done at no additional charge.

WHAT ARE GLARE AND HALOS?

A few LASEK patients have complained of glare, halos, and starbursts post operatively. This may be the result of postoperative corneal haze that may develop during the healing process. Modern lasers have made this quite rare after six months, but it has been reported symptoms have occasionally lingered longer than a year in some cases. Studies have shown that LASEK induces fewer night vision effects than LASIK. Nearsighted patients typically have a longer eye than average. Consequently they are more likely to have glare and halos whether they are wearing glasses, contacts, have laser vision correction or cataract surgery.

WHAT ARE SOME POSSIBLE COMPLICATIONS OF LASEK?

You should be informed about LASEK surgery, including the risks associated with the treatment and alternatives to it. After your exam, you will meet with a surgical counselor to discuss the risks and benefits associated with the procedure. A copy of our LASEK consent can be obtained at any time. LASEK and PRK are the safest forms of laser vision correction available on the market today. However, there are risks with any type of surgery. Some of the risks associated with LASEK are corneal haze, infection, glare, under correction, or over correction. Following all instructions given to you and using all of the medications as prescribed will minimize the risk of complications.

WHY DO I SEE SOME ADVERTISEMENTS FOR LASIK/LASEK AT UNBELIEVABLY LOW PRICES?

Some current LASIK ads can be very misleading. One of the most common misleading ads is the extremely low priced ad. These advertised $399 LASIK ads are used to get patients into the doctor’s office. This $399 price can quickly escalate over $3000 with the consultation, pre operative exam, surgery, and postoperative evaluations, medications, and any enhancements.

Another popular advertising scheme is the 20/20 guarantee. This type of “guarantee” sounds too good to be true and usually is deceptive. Remember that any type of medicine or surgery cannot be guaranteed by anyone anywhere.

Some LASIK discount centers also employ surgeons who only come in one day and perform surgery. Most of the time the surgeons can only be met on the day of surgery and do not provide any pre or post op care. In order to do this, the center employs others to do measurements and delegates your care to doctors who may not be as qualified. Some discount centers are also used for training purposes. This means inexperienced doctors may be used to actually perform the procedures.

Some LASIK centers also use commissioned salesmen instead of ophthalmic professionals to promote LASIK. If someone is being paid a commission then they may mislead or disguise potential complications or risks that may apply to you so that they can get a larger paycheck.

Here at Eyesight Associates, we offer the same pricing for everyone and we will tell you the fees up front.

MY INSURANCE SAYS IT COVERS PART OF MY LASIK/ LASEK OR IT GIVES ME A LARGE DISCOUNT OFF MY LASIK/ LASEK?

Laser vision correction is considered a cosmetic procedure; therefore, it is not covered by insurance. However, there are some insurance companies that say they can get you a deal on laser vision correction by going through one of their providers. These providers are often large discount LASIK centers that rely on older technologies. If you needed heart surgery, would you go to the cheapest heart surgeon or try to find a discount heart center? No, you probably would not. Your eyes are one of your most prized and valued organs. Overall, laser vision correction is less invasive than other kinds of surgery, but poor vision can affect your life almost as negatively as a bad heart. That’s why it is so important to choose an experienced surgeon who uses the latest technology and equipment.

WHAT IS MONOVISION?

Monovision is a condition where one eye is set to see better at a distance and the other eye is set to see better up close. The eye that is set to see better up close will not see well at a distance and the distance eye will not see at near. You and your doctor will discuss which eye should be done for distance vision. This varies from patient to patient and will be discussed during the refractive exam.

WHY WOULD SOMEONE NEED OR DESIRE TO HAVE MONOVISION?

Around age 40, most people start to have difficulty seeing up close. This is the time when they begin to wear bifocals or reading glasses. This is because the focusing lens inside our eyes is no longer able to bend enough to bring close objects in to focus. Monovision allows a person to see using one eye primarily for distance, and one eye primarily for near. This results in a decreased need to wear glasses for near and distance vision.

WHAT ARE THE DISADVANTAGES OF MONOVISION?

One eye at a distance is not as good as two eyes at a distance. Consequently some people find their vision slightly fuzzier than what they experienced when they had both eyes in focus at the same distance. Few people see as well only one eye at a time as they do with both eyes together. Some people have difficulty in reading fine print especially if the lighting is dim. Night driving is another activity that many people have difficulty with. These problems may be alleviated by wearing a pair of glasses that focus both eyes together when necessary.

CAN MONOVISION BE GUARANTEED TO WORK FOR ME?

Medicine is not an exact science, so honestly no guarantee is possible. There is an adjustment period while your brain learns to prefer your distance eye while driving, and your near eye while reading. However, most people happily adjust and enjoy less dependence on glasses as a result of choosing monovision. Please be realistic. Most people over the age of 40 will be more comfortable visually wearing glasses at some point in time. Two eyes at a distance are better than one eye at a distance, but you will not be able to focus at near. Monovision is a compromise that gives you more freedom from glasses. It does not always eliminate the need for glasses.

WHAT IF I GET MONOVISION AND I DON’T LIKE IT?

You have several options. You can wear glasses to balance both of the eyes. In most cases, an enhancement can be done to change the focus of the near eye to a distance. Keep in mind that if both eyes are focused better at distance and you are presbyopic or pseudophakic then your near vision will be blurry. You will need reading glasses to do close up activities. You may also choose to wear a contact lens on the near eye to focus your vision better at a distance when needed.

HOW DO I GET STARTED?

We offer free screenings for anyone who would like to come in and discuss their options with one of our refractive counselors. Your counselor can frequently tell if you are probably a good candidate for the surgery during your discussion. A pair of your glasses, contact lens boxes, or your most recent eyeglasses prescription is helpful for this appointment. Before surgery, we will have you come in for an extensive exam. If you are a contact lenses wearer you will need to remove them for a few days to a couple of weeks prior to the exam. This depends on the type of contact lenses you wear. Even wearing contacts temporarily changes the shape of your cornea and can alter your measurements. The examination is very thorough and takes about 2 hours. We do several undilated and dilated measurements during this exam. If you cannot drive while you are dilated please bring someone with you. During your examination you will meet with Dr. Gayton, so he can discuss your results and give you his professional recommendation. He will also check your eyes for any signs of cataract, glaucoma, or macula disease that may compromise the results of the surgery. You will then speak with one of our surgical counselors to further discuss and possibly schedule surgery.

WHAT IF I AM NOT A CANDIDATE?

It is estimated that around 80% of contact lens wearers are candidates for LASEK. However, there are a few reasons that could exclude you that can only be found by our doctors during your refractive exam. If you are not a candidate for LASEK, we will explain why, and tell you if there are any other procedures that could help your vision. It is possible that you may be a candidate for more than one procedure. If this is the case, the doctor and his staff will assist you to help you make the best decision for you. Many of our age 40 and above patients may be better candidates for another excellent procedure called Lensectomy. We will cover that information in this brochure as well.

WHAT IS A LENSECTOMY?

As we age, the lens inside our eye loses its ability to focus both near and far. This is called presbyopia. Most vision correction procedures attempt to change the focusing power of the cornea. A lensectomy can correct nearsightedness and farsightedness by replacing the eye’s natural lens with an artificially lens specifically selected to provide the patient with better vision. Advancements in lens technology have made it possible to treat astigmatism and presbyopia as well. Lensectomy is a surgical procedure that uses the same successful techniques of modern cataract surgery. These surgical techniques have evolved and improved dramatically over the last 20 years. Cataract removal is one of the most common, safest and most effective operations performed in medicine today. Cataracts are a part of the aging process, and if a person lives long enough chances are they will develop cataracts. People who have lensectomy now, will not have to have cataract surgery in the future. The main difference between standard cataract surgery and refractive lensectomy is that cataract surgery is primarily performed to remove a lens opacity which is obstructing and clouding vision. A lensectomy is performed to reduce a person’s dependence on glasses or contact lenses.

HOW DOES IT WORK?

Our lensectomy procedures are done in our surgery center conveniently located next to our Warner Robins office. You will be given several numbing drops, and you will be offered IV sedation. Once you are relaxed, Dr. Gayton will create a tiny incision on the side of the cornea. A small ultrasonic hand piece will then be used to emulsify the natural lens. After the natural lens is removed, it is replaced by an artificial lens. We have several different types of artificial lenses to choose from. Your surgeon will discuss which one may be the best for you. You will not feel the new lens inside your eye, and it doesn’t require any extra care. The entire procedure takes about ten minutes and usually doesn’t require any sutures.

WHAT IS THE RECOVERY TIME FOR A LENSECTOMY?

Because of the anesthesia you are not allowed to drive or make any major decisions within 24 hours after surgery. To perform the surgery your eye will be dilated. Dilation drops make ones vision blurry until the effects wear off. Other than that, most people have functional vision the day of surgery.

WHAT ARE THE LONG TERM RESULTS FOR A LENSECTOMY?

One of the best things about the lensectomy procedure is how stable your vision is following surgery. Before surgery, the natural crystalline lens inside the eye changes, which is the primary reason someone would need to change their glasses prescription later in life. Since the changing natural lens is removed, a lensectomy typically provides long lasting, stable vision. However, some patients who have the lensectomy surgery will need fine-tuning with our LASEK procedure to get their maximum uncorrected vision. Regardless of whether you have surgery or not, as we age, we are more likely to develop other eye related conditions unrelated to the lensectomy. If you were to develop diabetes, glaucoma, macular conditions, dry eye, or any of other diseases your vision can be affected whether or not you have had eye surgery.

WHAT ARE SOME POSSIBLE COMPLICATIONS OF LENSECTOMY?

As with any surgery, there are some possible complications to a refractive lensectomy. Since the lensectomy surgery is an intraocular procedure, it carries the same risks as standard cataract surgery. The risks could include possibility of retinal detachment, inner eye surgery complications, and corneal problems. The risks and benefits will be discussed by a surgical counselor prior to your surgery. A consent form explaining the possible risks will also be made available to you.

WHAT TYPE OF IOLS DOES EYESIGHT ASSOCIATES OFFER?

We offer several different types of lens implants to treat a wide variety of patients. The same lens will not work for everyone. During your exam, your surgeon will review your measurements and your lifestyle to customize a lens to meet your needs. The surgeon and surgical counselors will discuss the lens choice available for you in detail. Please see our educational insert on lens options for a summary of different types. You may also call our office and view our website for information on the various lenses.

DOES INSURANCE COVER A LENSECTOMY?

Lensectomy is considered a cosmetic procedure; therefore it is not covered by insurance. Flexible spending account funds can generally be used for lensectomy. If you have cataracts that visually impair you then your insurance may cover most of the surgery.

I AM NOT READY FOR SURGERY. ARE THERE ANY ALTERNATIVES?

Yes, we have several optometrists that specialize in glasses and contact lenses. We also have our own optical department making Eyesight Associates a one stop shop for most of your visually needs. We also offer Orthokeratology for those who desire better-uncorrected vision without surgery.

WHAT IS ORTHOKERATOLOGY?

Orthokeratology is a procedure for decreasing nearsightedness using specially designed rigid contact lenses. The lenses correct vision while they are being worn, and the correction is maintained after the lenses are removed. Orthokeratology is limited to low and low-moderate degrees of nearsightedness, but it is as effective as surgery for these amounts of nearsightedness. The lenses are fitted flat against the cornea, which causes the cornea on the front of the eyeball to flatten. This decreases nearsightedness much like LASEK. Orthokeratology has been around since the early 1960’s. It has been thoroughly researched. Many studies have been published in professional journals indicating its safety and effectiveness. Most people never require adjustments to their orthokeratology lenses. The lenses are very durable, lasting up to 3 years or more in many instances.

Modern orthokeratology is known as accelerated orthokeratology. The majority of change takes place in the first one to four weeks of lens wear. Smaller, slower changes may occur up to several weeks thereafter. The original method of performing orthokeratology used standard contact lenses, was very limited in the amount of nearsightedness it could eliminate, and took up to 2 years to work. This outdated method of orthokeratology should not be confused with today’s modern procedure that utilizes highly technical, computer-generated, special contact lens designs.

IS ORTHOKERATOLOGY COMFORTABLE?

Yes, even people who have never worn contact lenses are amazed at how comfortable the orthokeratology lenses are. The lenses are slightly scratchy in the beginning. This is because the lenses are not fit to your eye – we’re making your eye fit the lenses. Once the shape of your cornea begins to change, usually within the first 2 to 3 days, your eye fits the lens better which results in increased comfort. How often the lenses must be worn varies from person to person. Some people only need to wear their lenses 3 to 4 nights a week to maintain optimum vision. Others must wear their lenses every night to maintain clear vision the following day. The orthokeratology contact lenses will provide proper vision correction just like standard contact lenses while they are being worn.

IS ORTHOKERATOLOGY PERMANENT?

No. Orthokeratology is a reversible procedure. The contact lenses used to perform orthokeratology must be worn a limited number of hours every day (or at least several days each week) to maintain the improved vision. If the lenses are discontinued, the eyes will return to their pre-orthokeratology status over time.

IF IT IS NOT PERMANENT THAN WHY WOULD I CHOOSE ORTHOKERATALOGY?

There are many reasons:
1. If you are under 18 years of age, you are too young to undergo refractive surgery. Orthokeratology may be able to provide you with vision that is independent of glasses or contact lenses until you are old enough to undergo refractive surgery.
2. If you have an extremely low degree of nearsightedness, refractive surgery may overcorrect your vision, making you farsighted rather than nearsighted.
3. If you are concerned about having eye surgery, orthokeratology offers the only non-surgical method of reducing nearsightedness.
4. If you would like to reduce your dependence on glasses or contact lenses, but having refractive surgery would disqualify you from your job, orthokeratology offers the only non-surgical method of nearsightedness reduction.
5. If you are a preteen or teenager whose glasses are getting stronger each year, orthokeratology offers a way for you to stop the progression of your nearsightedness, reduce it, and perhaps eliminate the need for glasses or contact lenses altogether.

ARE THERE ANY RISKS ASSOCIATED WITH ORTHOKERATOLOGY?

As with any contact lens, there is a slightly greater risk of having an eye infection such as “pink eye.” Also, if proper care is not taken to follow the doctor’s instructions, or if follow-up appointments are not kept, the lenses could flatten the cornea off center. If the cornea is flattened off-center, your orthokeratology may be less effective and your eyes may develop temporary astigmatism. If it is impossible to get the orthokeratology lenses to center on your eyes, your doctor will tell you are not a good candidate for the procedure.

HOW DO I FIND OUT IF I AM A CANDIDATE FOR ORTHOKERATOLOGY?

Dr. Schlesinger offers free consultations in which he will evaluate your eyes and tell you if you would be a good candidate. He will gladly answer any questions or concerns you have about Orthokeratology.