It’s important to be well-informed about your vision. Here are the answers to some of the most commonly asked questions.
About Epi-LASEK and LASIK
What should I expect from PRK, Epi-LASEK and LASIK?
It is our goal to get you out of glasses or contact lenses for most of your activities. If you’re presbyopic, age 40 or older, you will still need glasses for reading. That would mean no corrective lenses to worry about when taking part in most of your favorite activities.
We are driven by the desire for excellent outcomes, and we are very careful in our patient selection.
We will exclude any patient we feel may not achieve acceptable results or those who would not be satisfied with the results we believe laser vision correction can deliver.
Are there problems that could occur with laser surgery?
Before the surgery, Dr. Snyder will explain to you the risks and possible complications, and potential side effects, including the pros and cons of LASIK, Epi-LASEK, and PRK and having one or both eyes done on the same day. This is the “informed consent” process. Some risks and possible complications include:
- Over- and under-correction. These problems can often be improved with glasses, contact lenses, and enhancements.
- Corneal scarring, irregular astigmatism (permanent warping of the cornea), and inability to wear contact lenses. These can cause visual disturbances such as blurred vision, glare, or halos.
- Corneal infection. This is rare (1/4,000 cases). Topical antibiotics are used to reduce the risk. Although rare, the scarring and tissue destruction can be devastating.
- “Loss of best corrected visual acuity” — that is, you would not be able to see as well after surgery, even with glasses or contacts, as you did with glasses or contacts before surgery.
- A decrease in contrast sensitivity. That means that even though you may have 20/20 vision, objects may be difficult to distinguish in low lighting conditions.
- Problems with night driving that may require glasses, contact lenses, re-treatment, or may not be fixable. Rarely patients say they no longer feel comfortable driving at night.
- With LASIK, there can be flap problems including irregular flaps, incomplete flaps, flaps cut off entirely, ingrowth of cells under the flap, and late dislocation of the flap from trauma. These do not occur with Epi-LASEK or PRK.
- Corneal ectasia is a condition where the cornea begins to bulge forward after surgery. The risks for this are usually, but not always, identified before surgery. This bulging and thinning of the cornea could require the use of a hard contact lenses or intracorneal rings, or in a more severe case, a corneal transplant to correct. This risk is greatly reduced with Epi-LASEK or PRK.
- With PRK or Epi-LASEK a small percentage of patients may develop corneal haze, resulting in glare or halos that could require a separate procedure and the use of anti-scarring agents such a Mitomycin applied topically. The risk of this is probably less than 1%.
The following side effects are possible, but usually disappear over time. In rare situations, they may be permanent.
- Discomfort or pain
- Hazy or blurry vision
- Halos or star bursts around lights
- Light sensitivity
- Small pink or red patches on the white of the eye
Remember, even if you see perfectly after vision correction surgery, you will eventually still need reading glasses or bifocal contact lenses to read or use a computer at some point after the age of 40. This is because your eyes will continue to change as you age, and no one can avoid presbyopia, which occurs when the crystalline lens in your eye becomes larger and stiffer with age. With presbyobia the patient loses the ability to focus the crystalline lens for close up objects.
Your distance vision will probably remain crisp, but seeing up close will become more difficult.
Why IntraLase versus the old mechanical keratome blade?
LASIK (Laser Assisted In-Situ Keratomileusis) has proven to be a very successful procedure, freeing millions of the daily dependence on glasses and contact lenses. Yet, while LASIK complications are rare, all surgery carries some degree of risk. Now, advances in laser technology have made it possible to significantly reduce the majority of LASIK complications. This advancement is known as IntraLase.
IntraLase is the first blade-free laser technology for performing the critical first step in the LASIK procedure: creating the corneal flap. Prior to IntraLase, this first step was done manually using a hand-held device with an oscillating metal razor blade, called a microkeratome.
IntraLase eliminates severe sight-threatening complications seen with the microkeratome, improving safety and precision while providing predictably better visual results for the patient. IntraLase is the most sophisticated and accurate technology for corneal flap creation available today and has given many patients greater confidence and assurance in choosing laser vision correction.
Are there different lasers?
We predominantly use the VISX S4 laser system. This system incorporates custom oblation and iris registration on what we believe is the most modern and user-friendly system.
Are PRK, Epi-LASEK and LASIK FDA approved?
Laser Vision Correction has been approved by the FDA. PRK was the first to be approved, in 1995. Epi-LASEK is an advanced form of PRK and the EPIVISION Keratome is approved for use in the United States.
Most recent FDA trials have been done with LASIK. With some lasers and treatment modalities PRK and Epi-LASEK were not studied but are commonly done “off-label.” This means they were not formally tested by the FDA but may be done under physician discretion.
In all cases where we do PRK or Epi-LASEK and custom ablation there is significant data to indicate this “off-label” use is safe and the procedures are effective procedures.
Is IntraLase safer than conventional LASIK?
Yes, we believe so. IntraLase improves the safety, precision and visual results of LASIK, whether you choose to have a standard or custom procedure.
This is a result of the superior precision provided by the computer-guided IntraLase laser, as compared to that of a hand-held microkeratome, which houses a metal razor blade that cuts across the cornea to create the flap. In comparison, IntraLase uses the precision of a beam of light to create a laser flap without traveling across the cornea, virtually eliminating severe sight-threatening complications as a result.
Its precision is the source of its safety. Accuracy of flap thickness has been demonstrated at +/- 10 microns.* Precise flap thickness is critical to a successful LASIK outcome, and IntraLase flaps feature a consistent thickness from edge to edge. This degree of accuracy is unprecedented in flap creation technology to date.
Flap stability is also an important factor, as the consequences of flap slippage can be quite problematic. IntraLase flaps provide added assurance and peace of mind for many patients.
*Data on file, IntraLase Corp.
Is IntraLase more expensive?
Yes. Most patients agree that the added level of safety, assurance and predictably better vision offered by IntraLase is worth the incremental cost. IntraLase surgeons are leaders in the field of ophthalmology who continually evaluate advances in technology. They’ve determined that the IntraLase is the most sophisticated and accurate system available today for flap creation and have invested in the technology to sustain their leadership in patient care.
I have seen several advertisements for “All Laser LASIK.” Is this IntraLase?
Maybe. Contrary to popular belief, LASIK is not an “all-laser” procedure, due to the use of the microkeratome blade. Only LASIK procedures that use IntraLase can be considered “all-laser.”
Dr. Snyder can explain the difference between other procedures that may be advertised as “all laser,” such as LASIK or PRK – all of which are surface ablation procedures. Because they are performed without creating a corneal flap, these procedures generally require longer healing time and frequently involve more discomfort and a delay in visual recovery.
Is traditional LASIK unsafe?
No, but IntraLase reduces the risk of complications reported with the microkeratome and has given many patients more confidence in choosing laser vision correction.
How do the visual outcomes using IntraLase compare with those of traditional LASIK with microkeratome?
- Clinical studies confirm that patients see better following IntraLase-initiated LASIK than with the hand-held microkeratome blade.
- More patients achieve 20/20 or better vision with IntraLase-initiated LASIK.
- Patients stating a preference preferred the post-operative vision of their IntraLase-treated eye 3-to-1 over their blade-treated eye.
- IntraLase creates fewer high- and low-order aberrations, thought to be associated with glare and halos at night.
- IntraLase patients have a reduced incidence of post-operative dry eye symptoms.
- IntraLase patients required fewer enhancement procedures following LASIK
- The precision of the IntraLase flap significantly reduces the incidence of post-operative induced astigmatism as compared with a microkeratome-created flap.
Is this “ILasik” the same as the customized procedure I have heard so much about?
No. Custom LASIK generally refers to individualized visual diagnosis with technology called “wavefront,” which allows for customized treatment with the excimer laser.
The most exciting part is that while the patient has the opportunity for an optimized visual result, it can be done with unprecedented safety and precision.
Every patient’s eyes are different and therefore need to be evaluated independently and treated uniquely. Now, all steps of the laser vision correction procedure may be personalized to the individual: custom diagnosis with wavefront, personalized flap creation with IntraLase, and custom laser vision correction with custom ablation.
How does IntraLase change the LASIK procedure?
LASIK is actually a two-step process. In the first step, the surgeon creates a flap of corneal tissue and folds it back to prepare the eye for the second step, where an excimer laser is used on the inner cornea to correct vision. This two-step process allows for rapid visual recovery with little or no patient discomfort.
Traditionally, the corneal flap was created with a hand-held microkeratome blade. While this method has worked well over the years, the performance of these devices can be unpredictable and are frequently the source of a majority of LASIK complications.
With IntraLase, the surgeon uses the precision of a computer-guided laser to create the corneal flap. IntraLase delivers micron-level accuracy over 100 times greater than that of a microkeratome (17,18), giving the surgeon more control during the procedure and the ability to establish precise dimensions and thickness of the corneal flap, factors which are critical to a successful LASIK outcome.
This level of precision is unparalleled by any other technology in vision correction surgery. IntraLase allows surgeons to tailor the corneal flap for each individual patient, and each individual eye. Because of its consistent accuracy, IntraLase may make LASIK a viable option even for patients who previously didn’t qualify, such as those with thin corneas.
How much time does it take?
The procedure, whether PRK, Epi-LASEK or LASIK, generally takes about 15 minutes per eye, or 30 minutes for both eyes. The screening evaluation is performed first, and includes a discussion of the procedures, your candidacy, and education about the process. This can be as brief as 10 minutes, or up to an hour, depending on the questions and the time the patient devotes toward looking at information.
If you are a candidate, we then arrange for a formal eye exam by Dr. Snyder, which involves a thorough examination with dilation of the health of your eye, including tear function, lids, lacrimal system, ocular surface, glaucoma, potential cataracts, and retinal disease. A determination is then made as to the relative risks and benefits, and whether the patient is a good candidate. This takes about 2 hours.
Once the procedure is completed, patients are seen by Dr. Snyder at day one, again within one week, one month, three months, and up to six months following surgery, or as necessary.
Will I have to wear an eye patch?
Patients are asked to wear eye shields at night after LASIK for one week after the procedure.
These are worn to prevent patients from rubbing their eyes while sleeping.
Will I have to limit my activities after the treatment? If so, for how long?
With PRK or Epi-LASEK, we recommend that patients avoid being in a dirty or dusty environment until the epithelium is completely healed, approximately four to five days, or until given clearance by Dr. Snyder.
We do not recommend swimming or hot tub use for at least two weeks.
With LASIK, the most important thing to remember following the surgery is to not rub your eyes! Patients will be given eye shields to wear at bedtime, and advised they must refrain from rubbing their eyes during the day.
Patients should avoid being in a dirty or dusty environment for a few days, as this might cause irritation.
In addition, we do not recommend scuba diving or swimming for the first two weeks. In general, there is minimal discomfort with LASIK. This discomfort is usually controlled with simple topical drops. Vision typically recovers within the first day, and most patients report a full recovery within the first week.
How fast can I return to work?
With PRK or Epi-LASEK, if surgery is performed in only one eye, and the other has a contact lens in place, a patient can return to work within a day or two. If both eyes are done, then the vision may not be adequate for four or five days. Generally, if surgery is done on Wednesday, our patients are functioning quite well at work Monday or Tuesday.
With LASIK and PRK, we suggest you have someone drive you on the day of surgery and to your first post-operative visit, since your vision will be slightly hazy following surgery.
After a good night’s rest, the majority of our patients may feel their vision is clear enough to drive and may do so once “cleared” by Dr. Snyder. Most patients return to work with confidence in four to five days.
What is the personal success rate?
These results are similar to those reported in national studies. The vast majority of patients can function quite well without glasses 95% of the time. Some patients may still require glasses for driving at night. If you are at the presbyopic age (over 40), you will definitely require glasses for reading.
Will I feel pain?
PRK or Epi-LASEK surgery is done with topical anesthesia that reduces or eliminates pain and discomfort during the procedure. We also prescribe analgesic and anti-inflammatory medications post-operatively to reduce discomfort.
The LASIK procedure is done with topical anesthesia, which is quite effective at eliminating pain and reducing discomfort. Patients may feel some pressure at the time of surgery.
How long do results last?
With most patients, the results are long-lasting.
LASIK has been FDA approved since 1999, and the general consensus is that it is a stable procedure. PRK (Epi-LASEK is a form of PRK) has been FDA approved since 1995, and may be more stable than LASIK.
Can I have additional treatment if I haven’t achieved the desired results?
Yes. If this is obvious within the first six months, we will provide this treatment for you if you have more than -0.75 diopters of uncorrected myopia or astigmatism, and we believe we can improve your vision.
In such cases, professional fees are waived. After six months, there will be an enhancement fee, which includes a professional fee of $700, as well as the facility fee, generally around $300-700 per eye.
Can you guarantee 20/20 vision?
No. As with any surgical procedure, there are variances in the patient’s healing and the corneal response.
Some patients may not have 20/20 vision. In order to achieve this, you may be required to wear contact lenses if you are one of the small percentage of patients who have some irregular-induced astigmatism, or visual aberrations. If your job requirements or your personality are such that this would be unacceptable to you, then laser vision correction is not for you.
However, if your goal is to get out of glasses for the majority of the time, for distance work and driving, and you are willing to wear reading glasses, if necessary, then this is a procedure you may want to continue to consider.
If you are one of the small percentage of patients who have some irregular-induced astigmatism, or visual aberrations, you may be required to wear contact lenses.
Will I still have to wear glasses or contact lenses?
At some point in your life, you will have to wear reading glasses for good near vision. A condition called presbyopia develops between age 40 and 45 in most patients. This is where the lens can no longer change shape, and if the eye is corrected for distance vision, in order to read up close you will need to have glasses for reading.
At present, there is no technology that is acceptable in circumventing this. Wearing glasses or contact lenses is inevitable for reading for most patients.
A small percentage of patients (less than 5%) will continue to wear glasses or contact lenses for night driving to have the best possible vision. However, the vast majority (over 95% of patients) do quite well without glasses, and can pursue their normal activities.
What does it cost?
The cost of laser vision correction may be reasonable if you compare it to your ongoing expense associated with wearing glasses or contact lenses.
However, it is an expensive technology, and the procedure may not be affordable for everyone. Our surgical fee with direct payment ranges from $1,765 for Custom Wavefront PRK per eye and $2,315 per eye for custom IntraLase LASIK.
We perform custom PRK or Epi-LASEK cornea surgery whenever we are able and will recommend what we believe is the best and safest procedure for each individual depending on your prescription. This fee includes the complimentary screening, comprehensive pre-operative evaluation as well as all pre-operative, and post-operative care for six (6) months. You will be followed closely by Dr. Snyder with an emphasis on the best outcomes possible.
There is a $199 non-refundable fee for the comprehensive pre-operative evaluation which is applied to the surgery fee where applicable. Dr. Snyder believes financial considerations should be carefully evaluated before obtaining Vision Correction. We are sensitive to the fact that different people have different needs in fulfilling their financial obligations. Our goal is to make Vision Correction affordable. We do have financing available but caution our patients that they should not put themselves in significant financial risk and should wait until they can afford the procedure and pay for it with “disposable income.”
You may choose any of the following payment options:
Cash or Check
Monthly Payment Plan with Care Credit
We offer a monthly payment plan through Care Credit. However, there is an additional service fee and payments must be made in a timely way to avoid additional finance charges, which can be high.
Apply now at www.carecredit.com or call toll-free 800-677-0718. The application process is fast, easy and confidential.
Can I use my Flexible Health Spending Account?
Most plans allow you to pay for Laser Vision Correction with pre-tax dollars from a flexible spending account. Please check with your account manager to be sure.
Does insurance cover PRK, Epi-LASEK and LASIK?
Some patients may have insurance plans that cover all or part of this elective procedure, or offer fee reductions. It is important that you discuss this with Dr. Snyder or our staff prior to your procedure.
What is mono-vision
Some nearsighted patients that are presbyopic, or nearing the age for presbyopia, may elect to have one eye set for a distance correction and the other eye set for a near correction. This is done by under correcting the near or reading eye.
Near vision allows you to read intermediate size print, such as with items in a grocery store or on a menu, but may not be adequate for fine print such as The Wall Street Journal.
Since only one eye is set for distance, the stereo vision and depth perception may be diminished, as is the overall quality of distance vision.
Thorough preoperative screening and trial of mono vision as simulated with contact lenses may identify patients at risk for a suboptimal outcome with mono vision.
How will I know if I am eligible for laser vision correction?
The only way to be sure that you are eligible for laser vision correction is to have a thorough screening and eye examination. People with severe dry eyes, corneal diseases, or other systemic diseases may not be candidates. We perform a complementary screening to determine if you are a candidate for this procedure.
What are Dr. Snyder’s credentials?
Dr. Robert Snyder is a fellowship-trained corneal specialist with over 20 years of corneal and refractive surgery procedures.
He has performed over 3,000 laser vision correction procedures. He has research experience in laser tissue interactions, Excimer laser, and refractive surgery. Until recently, he has been a Professor and Head of the Department of Ophthalmology at the University of Arizona, where he taught fellows and other surgeons how to perform LASK, Epi-LASEK and LASIK surgery. He is currently a volunteer faculty in Ophthalmology and a Tenured Professor of Biomedical Engineering.
How do I choose a surgeon?
We believe it is important to look for an experienced, Board-certified ophthalmologist. It is important to discuss the procedure, the surgeon’s experience, and complication rate with the surgeon directly.
It is also important that your surgeon will be available to provide care for you after surgery. We believe our team understands and recognizes the nuances of other potential predisposing factors, or unexpected problems that may arise, is an important asset in this type of process.
Should I bring in my glasses or glasses prescription?
The refractive error and the amount of refractive error are important in the decision-making process with respect to your being a candidate. If you do not have your glasses prescription, it can easily be obtained from your glasses by our “reading of the glasses prescription” when you arrive at the office.
If you wear contact lenses, it is very helpful for you to bring a contact lens box that has the prescription number on it, or call your optometrist, ophthalmologist, or dispensing optician and get a copy of the prescription before coming in for the screening examination.
Should I seek a discount surgical center?
As with just about anything, you tend to “get what you pay for.” Our pricing structure is based upon what we believe to be a fair return for investment of technology, personal time spent with you, post-operative care, and potential enhancements, if necessary. Some centers will advertise low prices which do not include additional costs for the entire process.
Our philosophy is to fully disclose the risks, benefits, and pricing to you and be up front in all aspects of your care.