When it Comes to Your Vision There Are No"Stupid Questions."
Are You In The 93%?
Despite all the advertising and media coverage, less than 7% of the people who could benefit from laser vision correction have chosen to reduce or eliminate their need for glasses or contacts. Surveys have shown the main reason for this is fear. LASIK is not as simple as a haircut. Most people simply don't know enough about vision correction technology and are uncertain about whom to trust with their precious vision. According to the American Society of Cataract and Refractive Surgery, patients who were well educated about laser vision correction were highly satisfied with their results (more so than those who were less informed). We strongly encourage our patients to ask questions to help them feel comfortable and understand laser vision correction.
On the next page we've listed the most common questions and answers; more information is available at www.washingtoneye.com. Please write down any questions you have after reading this information. When you come in for your complimentary, no-obligation consultation our staff and your surgeon will personally answer all your questions about your eyes and your visual goals.
- Does the procedure hurt and how long does it take?
- What happens if I blink or move my eyes during the procedure?
- How quickly will I see and what should I expect after LASIK?
- I have really bad vision. Can I still have laser vision correction?
- Are many people nervous about the procedure?
- Do you perform custom laser vision correction?
- How does custom/wavefront LASIK work?
- Does laser vision correction last? What about long term results?
- Where is the procedure done?
- When can I exercise or travel after laser vision correction?
- Should I have both eyes done at the same time?
- What are the risks?
- What about night vision?
- How important is my doctor's experience with laser vision correction?
- What if I have astigmatism?
- Who will perform my post-op examination?
- Should I wait for a better procedure? What's on the horizon?
- Is laser vision correction expensive?
- Do you offer interest-free financing?
Vision Correction over 40
- How can I see"20/20" and still need reading glasses?
- What is Monovision laser vision correction?
- How can I tell if I'd like Monovision?
- What about cataracts or glaucoma?
- What if I wear rigid or gas permeable contacts?
Does it hurt and how long does it take?
It only takes one anesthetic eye drop to numb your eyes so, to be absolutely certain, we use four drops. Some people feel a sensation of pressure around their eye for several seconds. After their LASIK most people have 3-6 hours of mild irritation (similar to the sensation of a dirty contact lens) and a single dose of Tylenol (if anything) is all most people need. PRK or Advanced Surface Ablation (laser procedures often recommended for patients who cannot have LASIK) can sometimes be more uncomfortable for a longer period of time (about 3-6 days for Epi-LASIK and 4-7 days for PRK). The LASIK procedure itself takes just a few minutes per eye. However, with check in, eye measurements and a brief post-op exam, you can expect to be in the laser center for between two and three hours on the day of your procedure.
What happens if I blink or move my eyes during the procedure?
Your eyes won't feel dry during the procedure because of the numbing drops and we help you keep your eye open with a small instrument to help prevent blinking while you relax your head in a soft, cushioned headrest. Your surgeon observes your eye through a microscope during the procedure and can detect the slightest movement before you can. We also use advanced lasers with tracking systems that track and adjust for the movement of your eye thousands of times per second. If you do look away, your surgeon can stop the laser treatment immediately and instruct you to look back at the flashing light. Once your eye is correctly positioned again, the treatment is restarted exactly where it left off.
During the laser part of your procedure, we will ask you to look at a green flashing fixation light. We will let you know when you may feel some pressure and your vision may dim for a few seconds at the beginning of the procedure. During the laser treatment you will also hear some ticking sounds, see red lights and notice an odor that's a bit like a hairdryer, although no significant heat is generated. Many of our patients worry they might not be able to hold their eyes steady for the seconds required for laser vision correction, but the overwhelming majority do so without any difficulty. Hearing about the experiences of other patients may help you feel more comfortable about deciding to have laser vision correction and can make the experience easier for you. Please feel free to ask the Washington Eye Physicians & Surgeons staff and surgeons who have had it done themselves about their personal experiences as well as checking our patient testimonials section at www.washingtoneye.com.
Just a few Washington Eye Physicians & Surgeons Employees who have had their Vision Corrected
Hundreds of doctors, including eye doctors, have chosen Washington Eye Physicians & Surgeons surgeons to perform their own laser vision correction. For a step-by-step interactive video tour of how LASIK works visit www.washingtoneye.com and click on LASIK Eye Surgery Tour on the middle left side of the home page.
How quickly will I see and what should I expect after LASIK?
Most of our patients return to work and driving in 1-2 days. In the first week or two, many people feel as though they're looking through a bit of Vaseline, fog or a dirty contact lens. Often they can see objects but the contrast or sharpness and clarity have not yet returned. This is completely normal. It usually takes a few weeks for your vision to reach its peak and, by three months, most patient's vision and eye prescriptions have stabilized.
It's common for one eye to be less comfortable than the other for the first few weeks and for one eye to see better more quickly than the other. This is normal, but usually doesn't interfere with driving or other daily activities. It's also common and completely normal for your vision to fluctuate somewhat from moment to moment or day to day because of dry eyes during this period. Even though your eyes may not feel particularly dry, please use the artificial tears in your kit or other similar tears from the pharmacy several times a day or as needed for the next few weeks. Avoid those with preservatives and check your post-op instructions for the brands we recommend.
As with any surgical procedure, to protect your eyes as they heal, it is critically important not to rub or get hit in the eye. Most people can swim and start exercising within about a week. Check with the eye doctor who examines you after surgery to see when you can return to your normal activities. At your first and second visit after surgery your eye doctor will also tell you whether you may need temporary glasses to improve your vision while your eyes are healing. This is not uncommon and generally does not suggest a problem. Red spots on the white of your eye are perfectly normal and will usually fade over about two weeks or so. Complications after laser vision correction surgery by expert surgeons are uncommon. There are a few symptoms that may indicate that something may need your doctor's attention.
- Discomfort that is getting worse, rather than better in the first week or so after surgery
- Significant reduction in your vision (not just mild fluctuations),
- Marked discharge or redness or swelling of your lids.
A Washington Eye Physicians & Surgeons doctor is always available to answer your questions. Just call 301-654-5114 or, if it's after hours, our answering service emergency number is 301-466-2625. Feel free to make a list of questions to ask the doctor at your post-op visits. The LASIK surgeons at Washington Eye Physicians & Surgeons - Dr. Marwa Adi and Dr. Neil Martin, thank you for trusting your precious vision and your only set of eyes to us.
I have really bad vision. Can I still have laser vision correction?
The overwhelming majority of patients (well over 95% of patients) can now have laser vision correction to improve their distance vision. We can often provide clear vision for those patients whose prescriptions are too high even for custom LASIK with procedures such as Epi-LASIK, ICL or advanced lens implants. More information about these vision correction procedures is available at www.washingtoneye.com.
Are many people nervous about the procedure?
Our eyes and vision are very precious. It's perfectly natural to be nervous, especially if you're not sure what to expect. Drs. Martin, Adi, Rubinfeld and their staff spend a great deal of time describing exactly what's involved in the procedure including the sounds and sights you will experience. We talk with you throughout the procedure to"walk you through the process" and ensure you are as comfortable as possible. We also usually prescribe a mild sedative prior to the procedure and play music you enjoy to help you feel more relaxed but you're still awake and able to follow instructions during the procedure. Although you can't actually see what is being done throughout most of the procedure, patients are still aware that someone is near their eyes and this can feel a bit awkward. We feel strongly that it's not enough to provide our patients with excellent vision. We want to make your experience as comfortable and reassuring as possible.
Do you perform custom laser vision correction?
Media coverage of custom or wavefront LASIK has drawn widespread attention to this important advance. Since the excimer laser was approved as safe and effective in 1995, several million Americans have had their vision corrected and have recommended LASIK to friends and family. However, concerns about nighttime glare, and reports of a very small percentage of problems have caused many people who would prefer not to wear glasses or contacts to postpone having their vision corrected.
Custom laser vision correction allows more people to have their vision corrected more safely than ever before. In fact, many patients who have had custom LASIK have found that their night vision after surgery is better than their night vision with glasses or contacts before surgery.
FDA Night Vision Resultsafter Custom or Wavefront LASIK
This is not to say that LASIK, as it's been performed since the early 1990s, is not a safe procedure. On the contrary, Washington Eye Physicians & Surgeons surgeons have performed well over twenty thousand LASIK procedures with excellent results. Custom LASIK now provides an extra measure of precision that allows many patients who've been"waiting for better technology" to now feel comfortable having their vision corrected.
How does custom/wavefront LASIK work?
Conventional LASIK is based upon the patient's eyeglass prescription. Custom LASIK takes into account not just the eyeglass prescription, but also other precise measurements of how each individual's eyes focus light. Two people can have the same eyeglass prescription but no two people have exactly the same wavefront or curvature maps of their eyes. With custom laser vision correction, these more sophisticated measurements and more refined treatments are used to achieve a more accurate correction, in many cases better than 20/20 vision with reduced risks. Also, many patients who were once told they could not have their vision corrected in the past because of large pupils or unusual prescriptions may now safely have vision correction with custom LASIK.
Above: In the middle is a typical eye prescription used for conventional laser vision correction. On the left and right are curvature and wavefront maps that can be used to more accurately customize laser vision treatment and results. Wavefront-optimized custom laser treatments the vision correction by taking into account measurements of the curvature of each individual eye.
Conventional laser treatments applied to the steeper side areas of the cornea are less effective since some of the cool laser pulses to these areas are reflected or spread out (see diagram below)
Wavefront-optimized treatments using Perfect Pulse™ technology add additional pulses to the steeper side areas of each cornea to achieve improved safety and precision. Many of our patients tell us that the quality of their vision actually improved after this form of custom laser treatment with better than 20/20 results.
Does laser vision correction last? What about long term results?
We have over four decades of experience with the precursor to LASIK known as myopic keratomileusis or automated lamellar keratectomy. Also, several studies have shown stable, good vision at 10, 12 and 14 years after laser vision correction (Ophthalmology 2004; 1813-1824, American Journal of Ophthalmology, Jan. 2008; British Journal of Ophthalmology, Feb. 2008).
We believe it is unlikely that you will require any additional laser vision correction to improve your distance vision once your vision is stable after the procedure (a recent analysis of our custom LASIK results showed that, on average, over 95% of our patients achieved excellent results with a single LASIK procedure). Occasionally, especially with high prescriptions, a second procedure may be desired to get your vision as clear as you desire. This does not mean that anything went wrong with your initial procedure. It's much like golf: the farther you are from the hole, the more likely you might need more than one stroke to get the ball in the hole.
With the Washington Eye Physicians & Surgeons Commitment of Care Program we will perform any necessary enhancements free of charge until your vision is satisfactory and stable, providing it is medically appropriate. In the unlikely event you do require an enhancement two years or more after your vision correction procedure, we will perform this procedure for a small nominal fee, if such a procedure is medically appropriate. For more information see our Commitment of Care Program.*
Where is the procedure done?
Washington Eye Physicians & Surgeons perform laser vision correction at their state of-the-art center one block from the Metro and one block from the DC line in Chevy Chase, MD. In some cases, we may perform procedures in Northern Virginia as well.
When can I exercise or travel after laser vision correction?
Most of our patients have returned to work within 1 or 2 days after LASIK. We generally recommend that you not fly for several days after the procedure -check with your doctor to be certain.
Each person's exercise routine is different. The key issue is avoiding the possibility of trauma to the eye, and when you do start exercising after LASIK, try to avoid perspiration in your eyes because you might then inadvertently rub them. Generally, patients can swim 1 week after vision correction, but should not participate in any exercise or sports that may involve injury to the eye unless they are wearing eye protection. Please ask us about your personal sports or exercise schedule.
Should I have both eyes done at the same time?
We perform laser vision correction on both eyes on the same day for the overwhelming majority of our patients. There are pros and cons to this approach but most people prefer to minimize any post-operative discomfort and time off from work. Also, if after the procedure, one eye is quite nearsighted and the other eye has been corrected, this can be somewhat disorienting.
In general, many potential problems which can occur in LASIK can be observed at the time of the procedure. This is why, in most cases, when LASIK of the first eye goes perfectly, we feel confident treating the second eye on the same day. If, however, the first eye proceeds less than perfectly, we generally wait until that eye heals and then treat the second eye on another day. Please don't hesitate to ask us about any concerns or questions you have about one eye or two eye treatments.
What are the risks?
Although LASIK is surgery and all surgery has risks, in our experience and in published studies most patients achieve excellent results. Serious complications are uncommon and we are not aware of any cases of blindness from laser vision correction in millions of procedures. Of course, nothing is without risk, including wearing contact lenses or walking across the street. We have, in fact, treated a number of patients who have experienced extremely serious complications simply from wearing their contact lenses. These complications are more common in patients who don't follow their eye doctor's contact lens care instructions.
The laser vision correction consent form can be very confusing and intimidating. While it is true that anything is possible, patients generally want to know the most common problems which might occur. We tell patients that in our experience, the most common potential"problem" involves the need for a second treatment in some people to get the best vision possible. If a second treatment is needed, it is usually performed several weeks to months after the first procedure. Also, eye dryness can be common after laser and generally is short lived.
Infections after laser vision correction are also possible, but Drs. Martin, and Adi have only seen a handful in their experience of tens of thousands of laser vision correction procedures. Occasionally, your surgeon may cancel your procedure if the flap is not adequate. Your LASIK can then be rescheduled once the eye heals. Another concern is trauma to the eye, especially while it is still healing after the procedure. Patients may inadvertently be hit in the eye after the procedure, which could move their flap and make it necessary to surgically reposition the flap. So take care to avoid anything striking the eye or rubbing the eyes for several months after the procedure. Occasionally, some epithelial (skin-like) cells on the surface of the eye can grow underneath the flap and cause problems especially after enhancement procedures. This can generally be resolved by lifting the flap, brushing away the cells, and replacing the flap.
What about night vision?
In the past, many patients experienced some increased halos around lights and some star-bursts or glare at night for several weeks to months after conventional laser vision correction. In general, these are noticeable but not debilitating (similar to the glare many patients have driving at night with their contact lenses) and usually resolve by 6 months after the procedure. Custom laser treatments have been shown to greatly reduce these issues.
How important is my doctor's experience with laser vision correction?
From published studies and our experience, it is clear that surgeon experience and skill are critical in laser vision correction and there is no truth to the myth that"the laser does all the work in LASIK." Risks of complications appear to be greatly reduced by the surgeon's experience, training and meticulous attention to detail. Washington Eye Physicians & Surgeons laser vision correction surgeons, Drs. Adi, Martin, and Rubinfeld are all fellowship-trained corneal specialists and laser vision correction is corneal surgery. Drs. Rubinfeld, Martin and Adi's experience and surgical skills are well known in the Washington area, nationally and internationally. They initially became involved in the treatment of excimer laser patients in 1991 and have dedicated much of their practice to vision correction for their patients. They have helped to train hundreds of LASIK surgeons and co-managing eye-doctors through proctoring, lectures and scientific articles and book chapters they have published. Because of their experience, hundreds of doctors, eye doctors, surgeons and other health care workers have trusted their eyes to our laser vision correction team.
What if I have astigmatism?
Many of our patients have heard that astigmatism can't be treated with the laser, however, treatment of astigmatism was FDA approved in 1997 and the results of our treatments of patients with astigmatism have been excellent, especially with custom LASIK.
Who will perform my post-op examination?
If you were referred to us by your regular eye doctor, he or she will generally continue to care for you after surgery. Please be sure to discuss this with us. All of the doctors in our office are experienced in caring for patients after LASIK. Of course, if any problem or question arises, your LASIK surgeon will be available to see you.
Should I wait for a better procedure? What's on the horizon?
For well over a decade, we have been involved in laser vision correction. Based on this experience and advances in vision correction, we believe there has never been a better time to have LASIK. Just ask the Washington Eye Physicians & Surgeons doctors and staff who have had it done themselves.
Is laser vision correction expensive?
The fee ranges between $2,250 and $3,000 per eye for LASIK and includes the preoperative evaluation, the procedure and all post-operative care for a year. Through Washington Eye Physicians & Surgeons Commitment of Care Program it may also include additional procedures, which you and your doctor feel might be appropriate to improve your distance vision (as medically possible) until your vision is stable and satisfactory. If you compare this to the cost of wearing soft contact lenses, especially those for astigmatism, laser vision correction can often cost less than wearing soft contacts for about 10 years. At the end of 10 years of contact lens wear, you're still back where you started with poor distance vision. In some ways, it's like"renting" instead of"owning" your clear vision.
Do you offer interest-free financing?
Insurance generally does not cover laser vision correction. Probably the best way to pay for laser vision correction is with a medical savings plan. If you have a medical savings plan through your work, you can place pre-tax dollars in the plan to be used for laser vision correction the following year. This can save a great deal of money in taxes and make laser vision correction even more affordable. For example, a person with an annual salary of $35,000 might save $1,480 on LASIK costing $5,000 using a flexible savings plan. More information on medical savings plans and financing and excellent payment plans with no interest for up to one year are also available.
Vision Correction over 40
How can I see"20/20" and still need reading glasses?
People with perfect vision who never needed glasses generally start to find reading difficult without reading glasses. This is due to natural changes in the flexibility and close up focusing power of the natural lenses inside your eyes which eye doctors call presbyopia.
The term"20/20" vision means that at 20 feet the patient can see what someone with"normal" vision can see at 20 feet. 20/200 means that the patient has to move up to 20 feet away from an object to see it as well as someone with normal vision can see it from 200 feet away. To accurately measure vision, it must be tested both at far distance and reading distance. Someone over 40 may have 20/20 distance vision but have very blurry 20/200 reading vision without reading glasses.
What is Monovision laser vision correction?
Monovision is a treatment to reduce the need for reading glasses in people over 40 that involves treating each eye a bit differently, with one seeing somewhat better for distance and one better for close up. Although it sounds like it might feel awkward, many people love monovision. Some don't. If you don't mind the idea of using reading glasses, you may want to choose clear distance vision in both eyes and use readers when you need them. Monovision may not be a good choice for very active people who want to play golf or tennis without glasses or contacts. Approximately 40% of our patients over 40 choose monovision and 60% choose to have the clearest possible distance vision in both eyes.
How can I tell if I'd like Monovision?
The best way to determine if this is a good choice for you is simply to try it in your eye doctor's office with either temporary glasses or contact lenses to see for yourself if it feels comfortable for you. Some people are right handed and others are left dominant. This is determined by the dominance patterns in your nervous system and monovision is much like this. Many people are very comfortable with a slight difference between their eyes and some are not. We often tell our patients that this decision is a bit like buying a suit or dress. Try it on. If it fits, you might want to choose it. If it doesn't feel right for you, don't. We will help you to be sure you won't make a bad choice. Another option for some people who don't like monovision is ReSTOR, ReZOOM or crystalens presbyopic lens implants.
What about cataracts or glaucoma?
In general, laser vision correction does not appear to cause cataracts or glaucoma. If someone who has had laser vision correction eventually develops cataracts, cataract surgery can still be successfully performed. Glaucoma is a disease involving pressure inside the eye that damages the optic nerve. If a patient does eventually develop glaucoma after laser vision correction, they may still be successfully treated.
Any patient who has had laser vision correction should inform their eye doctor so the doctor can take this into account when performing routine glaucoma testing. Also, patients who are quite nearsighted always have a higher risk of developing a retinal detachment in their lifetimes whether they have their vision corrected or not.
Laser vision correction may dramatically improve their vision, but these patients will still continue to have a higher risk of retinal detachment than those who were with normal eyes. To protect vision for a lifetime, all patients need to continue to be followed by an eye doctor and have regular eye examinations.
What if I wear rigid or gas permeable contacts?
Over time, hard and rigid gas-permeable contact lenses change the natural shape and therefore the prescription of your eyes. Once these lenses are discontinued, your vision may start to change rapidly as the cornea changes back to its natural shape. Before any procedure, the corneas of your eyes must return to their natural shape, so that you and your doctor can be assured that your vision correction procedure is not trying to correct a"moving target."
For this reason, if you wear hard or rigid, gas permeable contact lenses, you'll need to stop wearing them a minimum of 4 to 6 weeks prior to your surgery, or until your vision and corneal shape stabilize. It can take 6-10 weeks (and occasionally longer) if you've been wearing them regularly for many years. However, during that time you have the option of being fitted with soft daily wear contact lenses that will allow your cornea to regain its natural shape. Soft contact lenses should usually be discontinued 3-5 days before your procedure.
Your eye doctor will check your corneal shape and eye prescriptions about every 2-3 weeks to determine when they are stable. Once these are consistent, you will be ready for your procedure. Each person is different and it may take more or less time for your eyes to stabilize.
It is not critical that you stop wearing the lenses before your initial vision correction consultation, however, the sooner you discontinue wearing hard or rigid gas-permeable lenses the sooner you may schedule your vision correction procedure.