LASIK Eye Surgery

How does LASIK correct poor vision?

LASIK (which stands for “Laser Assisted in Situ Keratomileusis) you can correct the focusing power of your eyes without wearing glasses or contacts via a very experienced surgeon and a highly specialized laser.

This dynamic duo properly reshapes the cornea so it can do a better job of focusing light more precisely onto the retina, which allows you to see more clearly. With the best LASIK surgeons, a patient’s vision often becomes even better than 20/20 and better than they could see with their glasses of contact lenses.

Does LASIK correct different types of vision problems?

Absolutely. There are a variety of FDA approved LASIK laser procedures designed to address different vision issues caused by variations in the shape and surface contour of the cornea. These variations cause one or more of the following refractive errors:

• Nearsightedness (where you can't see far objects clearly)
• Farsightedness (where you can't see near objects clearly)
• Astigmatism (in which everything is slightly blurry)

All LASIK procedures involve two important steps to reshape the cornea:

1. Step one is the creation of a thin flap from the outermost corneal layer. This flap is hinged (anchored) on one side so that it can be folded back to allow access to the underlying tissue (where the sculpting takes place).

2. The second step involves using laser energy to sculpt the newly exposed corneal tissue according to a treatment plan designed to improve its light refracting (focusing) ability.

LASIK laser eye surgery can often correct vision to 20/20 or even better. For those who have age-related eye conditions in addition to refractive errors, LASIK may still vastly improve their vision so that they only require glasses for distance or reading from time to time.

For example, some people need far vision correction and others need near vision correction that requires them to use reading glass. And then there are folks who need both far and near vision correction.

Are all LASIK Surgeries the same?

In short, no. Lasik was originally developed 30 years ago. AEI's own Dr. Kerry Assil was a pioneer in the early development of LASIK technology and continues to contribute to revolutionize the LASIK field today. Over the years there has been dozens of surgical techniques developed for performing LASIK. As expected, with the advancements in technology, many have been deprecated and no longer performed with new ones coming to the fore.

Today, there are no less than six significant surgical techniques, some were created strictly to be more cost-effective, which are found at the "chain style" LASIK businesses. Others were developed to create even better post-surgical vision and others to minimize the side-effects of LASIK. One in particular, EagleVision™ was created to offer the potential for most perfect individualized results possible, while further reducing the side-effects.

Besides for EagleVision™, other LASIK protocols include All Laser LASIK (also known as Bladeless LASIK) which AEI also performs and SMILE LASIK. Unfortunately, AEI and independent studies have not found SMILE’s results to match other protocols. Dr. Assil is involved in the development of an improved SMILE protocol with Johnson and Johnson that may be presented to the FDA for approval in the near future.

Learn more about today's common LASIK technologies.

Which type of LASIK Surgery is right for me?

This is probably the most important question each patient needs to answer while also choosing the best surgeon for themselves. At AEI, we pride ourselves in offering advanced surgical techniques and state-of-the-art LASIK technology to provide our patients with a safe, effective procedure designed to optimize their experience and visual outcomes.

At AEI, these technologies include the iLASIK Technology Suite combined with a protocol developed by Dr. Assil known as EagleVision™ (which stands for “Elliptical flap Aberrometry Guided Laser Enhanced Vision”).

EAGLE VISION™: What makes our LASIK surgery the gold standard?

At AEI, we combine leading edge technology with advanced surgical techniques developed by Dr. Assil to provide a unique approach to flap creation and corneal sculpting. This protocol enables us to safely correct nearsightedness, farsightedness, and astigmatism, while also improving night and reading vision, achieving excellent visual outcomes.

The EagleVision™ LASIK Procedure Advantages

With EagleVision™, AEI takes laser vision correction to the next level by customizing four key components of LASIK surgery:

1) Treatment Plan Customization

Treatment plan customization - we have created an algorithm to customize the software program guiding the laser that sculpts the cornea to provide highly tailored vision correction for each patient.

Your LASIK experience at AEI begins with a comprehensive eye exam to gather precise technical information about your eyes that will be used to guide your surgery.

For this step we use iDesign, a system that takes measurements that are 25 times more precise than other vision measuring systems available today.

The iDesign measures both inside and outside your eye to create a unique optical fingerprint that will be used to guide your surgery.

INSIDE EYE MEASUREMENTS

iDesign uses Wavefront technology developed by NASA for viewing deep space to capture and measure minute details of your vision. Specifically, iDesign measures how a wave of light is bent (refracted) as it travels through your eye (your refractive error). It does so by sub-dividing the eye's ¨seeing¨ surface into 1240 adjacent zones and uniquely measuring each segment's focusing capacity (known as refractive power).

OUTSIDE EYE MEASUREMENTS

Next, the iDesign scans your cornea's surface, measuring the dips and valleys of each of the 1240 zones in order to create a detailed 3-D map of your eye's surface (Corneal Topography).

The process for measuring your individually customized refractive error (Wavefront) and corneal topography is referred by us as Collective Aberrometry (iDesign), because it measures the aberrations (deviations) in your visual pathway and your corneal surface. The iDesign refraction and topography measurements are combined to create a detailed 3-D map of your eye’s focusing capability at each of the 1240 zones. This data is then used to create a unique program that guides the laser used to sculpt your cornea and correct your vision.

2) Aberrometry and Corneal Topograhy Algorithm Customization

The EagleVision™ approach further customizes the iDesign aberrometry and corneal topography programs using algorithms developed by Dr. Assil that adjust for patient age, lifestyle and eye shape. This allows us to optimize the laser's potential for reshaping your cornea in exquisite detail. Because each eye is as unique as a fingerprint, no two eyes receive the exact same treatment.

3) Corneal Flap Creation

The first step in a LASIK surgery involves creating a thin flap from the outer layer of your cornea that will be folded back for the sculpting work to be done on the tissue underneath.

Although some LASIK surgeons still use an actual blade or outdated lasers to create the corneal flap, AEI never does. Dr. Assil's extensive experience developing and using state-of-the-art LASIK laser technologies for more than two decades do not allow him or his team to ignore the vastly superior results the newer technologies offer patients.

Assil Eye Institute only uses the state-of-the-art VISX Star S4 Excimer Laser System (the only FDA approved Laser for individualized wavefront laser pulse delivery), coupled with the iFS (Femtosecond Laser) that sends microscopic laser pulses just under the corneal surface to create a flap with the thickness of a strand of hair. This has been proven to provide far greater safety and precision than blade or older lasers.

Learn more about the VISX Star S4 Eximer Laser System

4) Corneal Flap Shape Customization

Based on Dr. Assil's experience, we have re-designed the corneal flap to become what we believe to be far more ergonomic. Specifically, we've changed the flap shape from round to elliptical to align more with the eye's natural shape. Also, we've moved the flap's attachment point (we call it the hinge) from the 12 noon position to the temple region.

This new flap design has resulted in the following advantages over traditional LASIK surgery:

• • A larger working area that facilitates safer and more thorough corneal sculpting
  • A much wider flap hinge (anchor) that makes for a more stable and smooth flap surface
  • More reliable flap healing because the hinge position is compatible with firm lid squeezing forces (which travel in the ear to nose direction).
  • Greater corneal strength and stability, so the post-op eye is less vulnerable to injury
  • Fewer post-op dry eye side effects due to some preservation of delicate corneal nerves

Once the flap is created, your surgeon folds the flap back and uses gentle laser pulses to sculpt the exposed corneal tissue to correct your refractive error according to your personalized treatment plan. The actual laser vision correction typically takes less than 1 minute per eye.

Once the corneal re-shaping is complete, the flap is gently settled back into place over the treatment area where it serves as a natural bandage, allowing your eye to heal quickly. In most cases, you'll begin to see more clearly right away. And after one day, most people's vision is already at 20/20, and they can return to their normal routine, with further refined visual improvement in the following days and weeks.

LASIK Frequently Asked Questions

Q: What type of laser is used at AEI to perform LASIK?

Dr. Assil and AEI has had extensive experience using and developing LASIK laser technology for well over twenty years. This has included being involved with numerous clinical trials in addition to serving as a medical advisor for several laser manufacturers.

After working with many lasers, Dr. Assil has selected the VISX Star S4 Excimer Laser System to be his tool of choice for corneal sculpting. In fact, AEI is the only Los Angeles area ophthalmology practice with two LASIK surgical suites outfitted with a VISX Star S4 to offer the most advanced technology coupled with greatest reliability to our patients.

Advantages of the VISX Star S4 laser include:

• • • A safety feature called Iris Registration in which the laser takes photos of your iris (the colored part of your eye) that it uses to ensure that the laser remains properly aligned to your eye as it sculpts. This feature also ensures that there’s no possibility of treating the wrong eye or the wrong patient.

    • A second safety feature tracks eye movement during surgery, so that the laser's accuracy is not affected if you move or blink during your vision correction procedure.

Q: Is LASIK painful?

No. Lasik surgery is performed with numbing eye drops so that you don't feel discomfort.

We can also give you medication to help you relax while remaining awake throughout the process. The LASIK laser sculpting time is generally less than 60 seconds per eye and our patients are typically in the laser suite for less than 20 minutes. Our patients usually experience a couple of hours of mild eye irritation following surgery but are typically comfortable enough to return to easily work the next day.

Q: Am I a good candidate for LASIK?

Certain eye or general health conditions can make LASIK’s outcome less predictable. Our doctors may not recommend LASIK surgery if you have certain conditions including corneal stretching disorders, severe dry eye syndrome, deep corneal scars, untreated cataracts, progressive retinal disease and other conditions.

During your evaluation, we will ask the following questions to determine if you qualify for LASIK:

1) Has your vision prescription changed in the past year?

If your vision has changed greatly within the last 12 months, then it may be advisable to wait before undergoing LASIK surgery, because if your vision continues to change, you might have to repeat the procedure. We have found that after LASIK, our patients typically maintain stable vision for many years.

2) How high is your vision prescription?

If you are extremely nearsighted or farsighted (like if your prescription is -12 diopters or greater), you might not be a good candidate for LASIK. This does not mean that there aren't other vision correction options available. At AEI, we offer other effective solutions for such cases. After reviewing your particular circumstances, your LASIK surgeon and eye doctor can make specific recommendations tailored just for you.

3) Do you have any health conditions, eye disease or vision problems?

If you suffer from severe dry eye syndrome and are currently under treatment for it, you may not be a good candidate for LASIK. Occasionally LASIK can worsen dry eye symptoms.

If you currently have an eye infection, you must be treated for it and wait for the infection to clear before LASIK can be performed. Unstable vision due to medications, hormonal changes, pregnancy, or other health conditions can also increase side effects from LASIK.

4) Are you in good general health?

People with severe immune illnesses with ocular manifestations, such as type 1 diabetes with active retinal disease, are generally not suitable candidates for LASIK.

5) Do you have very thin corneas?

Corneal thickness is another important consideration because we wish to ensure a residual (post sculpting) Corneal thickness that will not then be prone to progressive shape changes. If you have been told that your corneas are very thin, you might be a more appropriate candidate for another vision correction procedure known as PRK or LASEK

Q: I was told years ago that I was not a LASIK candidate. Is that still true?

LASIK technology has evolved significantly over the years and many people who were considered ineligible for LASIK ten or twenty years ago, may easily qualify for it today.

If you are not considered a good LASIK candidate, the good news is that at AEI, our eye surgeons also perform a variety of other vision correction procedures, including;

• • • • Phakic IOL (ICL and Verisyse)
      • Refractive Lens Exchange (RLE)
      • LASEK (Laser Assisted Sub-Epithelial Keratectomy)
      • PRK (Photo-refractive Keratectomy)

      • Corneal Inlays

Ready to consider LASIK? Request your free LASIK consultation and AEI will tell you if you are a good candidate, explain how we perform LASIK and answer all of your questions.