When it Comes to Your Vision There Are No “Stupid Questions.”

According to the American Society of Cataract and Refractive Surgery, patients who were well educated about laser vision correction procedures were highly satisfied with their results (more so than those who were less informed) . We strongly encourage our patients to ask questions. This helps them feel more comfortable and understand any risks associated with laser vision correction. We have provided some common questions and answers here. More information is available at www.washingtoneye.com.

Are You in the 93%?

You may find it interesting that in spite of all the advertising and media coverage, less than 7%* of the people who could benefit from vision correction have had a procedure to reduce or eliminate their need for glasses or contacts. Surveys have shown that the main reason for this is fear. Most people simply don’t know enough about technology and their options, and are uncertain about whom to trust with their precious vision.

Please review the information in this folder and write down any questions you have. When you come in for your free, no-obligation consultation with your Washington Eye surgeon, we will make sure to address all your questions, focusing on how they relate to your eyes, your visual needs and vision correction goals.
* Source David Harmon Marketscope.com

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I have really bad vision. Is it still possible for me to have laser vision correction?

With the approval of high myopia, astigmatism and other treatments, the overwhelming majority of patients (well over 90% of patients) can now have laser vision correction to improve their distance vision.

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Does it hurt?

Numbing eye drops are the only anesthesia we use and the procedure itself is generally painless. Most people have 3-6 hours of mild irritation after their LASIK (similar to the sensation of a dirty contact lens). One dose of Tylenol is all most people need. PRK or Epi-LASIK (laser procedures often recommended for patients who cannot have LASIK) can sometimes be more uncomfortable for a longer period of time (about 3 days for epi-LASIK and 3-6 days for PRK).

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How long does the procedure take?

The LASIK procedure takes just a few minutes per eye. You can expect to be in the laser center for between two and three hours on your procedure day.

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Are many people nervous about the procedure?

Although the LASIK procedure is virtually painless and takes only minutes, many patients have told us they felt nervous when they thought about correcting their vision. Our eyes and vision are very precious. It’s perfectly natural to be nervous about having the procedure. Much of this comes from fear of the unknown. 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 will talk with you throughout the procedure to “walk you through the process” and ensure that you are as comfortable as possible. We usually prescribe a mild sedative prior to the procedure and play music of your choice to help you feel more relaxed but still awake and able to follow instructions during the procedure. A recent New York Times article described how music had a calming effect in other types of surgery.

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, which can feel a bit awkward. LASIK is not as simple as a haircut and most people realize this. Nonetheless, hundreds of doctors, including eye doctors, have chosen WEPS surgeons to perform their own laser vision correction.

At Washington Eye we feel strongly that it’s not enough to provide our patients with excellent visual results. We want to make what might be a potentially anxiety-provoking procedure as comfortable and reassuring as possible for each and every patient.

Many patients ask us ‘What happens if I blink or move my eyes during the procedure?’ It is important to understand that we numb your eyes with anesthetic eye drops which means you won’t have the sensation of ‘needing’ to blink, nor will your eyes feel dry during the procedure. Your eye will be gently held open with a small instrument to help prevent you from blinking and we secure your head comfortably in a headrest similar to a pillow. In addition, the surgeon is watching your eye through a microscope during the procedure and can detect the slightest movement before you will. Your surgeon can always pause the laser should you move your eye, reposition you, remind you to look at the light and simply activate the laser to pick up where the treatment left off.

In addition, we use lasers with tracking systems that track the movement of your eye thousands of times per second and adjust accordingly for movement of your eye.

Talking with patients who’ve had the procedure and asking questions about what to expect may help make you more comfortable about the decision to have laser vision correction and can make the experience easier for you. Hundreds of our patients have volunteered to talk about their laser correction experiences with anyone considering having the procedure. Just let us know if you would like to receive a list of names and phone numbers of people with eyes like yours, and/or if you'd like to add your name to this list after your procedure. Please feel free to ask the WEPS staff and surgeons who have had it done themselves about their personal experiences as well.


Just a Few Washington Eye Employees who have had their Vision Corrected

Hundreds of doctors, including eye doctors, have chosen WEPS surgeons to perform their own laser vision correction.

For a step-by-step, interactive video tour of how LASIK works click on Laser Eye Surgery Tour below.

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I’ve heard about custom wavefront or wavefront-optimized LASIK. What is this?

Recent media coverage of custom or wavefront LASIK has drawn widespread attention to this new development in laser vision correction surgery. 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 put off having their vision corrected.

Based on clinical research submitted to the FDA, most eye doctors feel that custom wavefront ablation will enable more people to have their vision corrected more safely than ever before. In fact, many patients who have had wavefront LASIK have found that their night vision after surgery is better than their night vision with glasses or contacts before surgery.

 

FDA Night Vision Results After Custom or Wavefront LASIK


This is not to say that LASIK, as it's been performed since 1994, is not a safe procedure. On the contrary, our practice has performed well over twenty thousand LASIK procedures with excellent results. Custom LASIK 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.

Here's how custom/wavefront LASIK works: Conventional LASIK is based upon the patient's eyeglass prescription. Wavefront-guided LASIK takes into account not just the eyeglass prescription, but also subtle irregularities in the way each individual’s eyes focus light. Two people can have the same eyeglass prescription but no two people have the same wavefront map. In other words, more sophisticated measurements and treatment designs are used and a more precise correction is obtained to achieve in many cases, better than 20/20 vision with, we believe, reduced risks.

Custom LASIK wavefront-guided ablation is not the best option for every patient. This development is most valuable for those people with greater than average irregularities in their prescription. Only an eye doctor very experienced in LASIK can determine the value of custom LASIK for each individual person. Contrary to the old myth that "the laser does all the work in LASIK," adding the more advanced technology of wavefront analysis requires even more surgical expertise and judgment than conventional LASIK.

Now that custom LASIK is a reality, 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 reduce or eliminate their need for glasses or contacts.

Above: On the left are a typical eyeglass prescription formula and eye map used for vision correction in conventional LASIK. On the right, a wavefront eye map and measurement of the same patient’s eye to be used in wavefront-guided LASIK. Wavefront analysis allows for more sophisticated and precise measurements of how each person's eye focuses light .

Another recent state-of-the-art advance is known as wavefront-optimized LASIK. Like wavefront LASIK, its results are superior to conventional LASIK. Wavefront-optimized laser treatments customize the vision correction by taking into account measurements of the curvature of each eye. Laser treatments of 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 (Link to Wavelight materials in web version) 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 was actually improved by having custom LASIK.

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Does laser vision correction last? What about long term results?

We have approximately four decades of experience with the precursor to LASIK known as myopic keratomileusis or automated lamellar keratectomy. Also, studies have shown stable vision at 12 years after laser vision correction (Ophthalmology 2004; 1813-1824). 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 Commitment of Care Program we will perform any necessary enhancements for free 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, will perform this procedure for a nominal fee, if such a procedure is medically appropriate.

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What if I look away for a moment or can’t hold my eyes still for the procedure?

During the laser part of your procedure, you will be instructed to look at a flashing fixation light which is either red or green/blue. Many of our patients worry they might not be able to hold their eyes steady for the minute or so required for laser vision correction. Actually, the overwhelming majority of patients do so without any difficulty at all. The surgeon is carefully monitoring your procedure through a microscope and your eye movements are being tracked at thousands of times per second. If you do look away, the surgeon can stop the laser treatment immediately and then 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.

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Why might some of my friends and family be skeptical about laser vision correction?

It’s wise not to rush into something you know very little about, especially when it comes to something as important as your vision. Your friends and family care about you and may not know very much about the scientific information or medical background of laser vision correction. We encourage you to bring friends or family members with you to your laser vision evaluation so that we can educate them, as well as you, and answer any questions they might have. We can even demonstrate to them what it is like to have your vision. Many people who don’t need glasses cannot imagine what it it’s like to depend on glasses or contact lenses to function.

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Where is the procedure done?

Our surgeons perform laser vision correction at various locations in the Washington, DC area. We work closely with a large network of doctors who are extensively trained in evaluating potential laser correction patients and monitoring patients after their procedures.

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When can I start exercising or fly in an airplane after my laser vision correction?

Most of our patients have returned to work within 1 or 2 days of having LASIK surgery. 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. 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 or 2 weeks after the procedure, 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 sports activities or exercise schedule.

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Should I have both eyes done at the same time?

We perform laser vision correction on both eyes on the same day in the overwhelming majority of our patients. There are pros and cons to this approach, but most people prefer to minimize any postoperative 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, however, many of the potential problems which can occur in LASIK can be observed at the time of the procedure. Therefore, we believe that in most cases if LASIK of the first eye goes perfectly, we feel confident performing 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.

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What are the risks?

Although LASIK is surgery and all surgery has risks, in our experience and in recent published studies (Ophthalmology, August, 2005) most patients achieve excellent results without complications. Serious complications are rare, 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.

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 likely 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.

Infections after laser vision correction are also possible, but Drs. Martin, Adi and Rubinfeld 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 realistic concern is trauma to the eye after the procedure, while the eye is still healing. Patients may inadvertently be hit in the eye after the procedure, which can move their flap and make it necessary to surgically reposition the flap. Care should be taken not to have anything strike the eye or to rub 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. This can generally be resolved by lifting the flap, brushing away the cells, and replacing the flap.

Most patients experience some halos around lights and some starbursts 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. Wavefront-guided and wavefront-optimized custom laser treatments have been shown to greatly reduce these issues.

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How important is my doctor’s experience with laser vision correction?

From our experience and published studies, it is clear that surgeon experience is critical in LASIK. Complications appear to be greatly reduced by the surgeon’s experience, training and meticulous attention to detail. Drs. Adi, Martin, and Rubinfeld are all fellowship-trained corneal specialists. Our practice initially became involved in the treatment of excimer laser patients in 1991, and we’ve dedicated much of our practice to vision correction for our patients. Our doctors have helped to train hundreds of LASIK surgeons and co-managing doctors through proctoring, lectures and scientific articles we have published.

Because of our experience, hundreds of doctors, eye doctors, surgeons and other health care workers have trusted their eyes to our laser vision correction team.

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I am 42 years old. Should I plan to have good distance vision in both eyes and wear reading glasses or should I have monovision laser?

This is an important question that is best answered by understanding your particular needs. The objective of laser vision correction is to make you as independent of glasses or contact lenses as possible, but each person’s desires are different.

Please consult the section in our website or information packet on Monovision and be sure to ask us this question if you are over 40 years old. If you don’t mind the idea of using reading glasses, you may want to choose clear distance vision in both eyes and use the readers when you need them. Monovision is usually not a good choice for very active people who want to play golf or tennis without glasses or contacts. About 40 percent of our patients over 40 choose monovision and about 60 percent choose to have the clearest possible distance vision in both eyes. Most of the people who choose monovision have been happy before surgery with monovision contacts or a monovision trial before their procedure. Less than 10 percent of the people who chose monovision treatment decide later to change to full distance vision in both eyes.

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How can I tell if I would like monovision?

Although it sounds like it might feel awkward, many people love monovision. Some don’t. 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 with contact lenses. This is the best way to determine whether monovision would be comfortable for you. Some people are right handed and others are left dominant. This is determined by the dominance patterns in your nervous system. Monovision is much like this. Some 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. One option for some people who don’t like monovision is the crystalens® or ReSTOR®.

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Is laser vision correction expensive?

The fee ranges between $1,800 and $2,950 per eye for LASIK and includes the preoperative evaluation, the procedure and all postoperative care for a year. Through Washington Eye’s 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 generally costs less than wearing soft lenses over the course of 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" compared with "owning" your clear vision.

The technology of laser vision correction is very expensive. The laser itself costs over half a million dollars. Every time the laser is used fees are paid to various licensing agencies. The microkeratome and other equipment are also very expensive. Remember also that your postoperative care and the Commitment of Care are included in this fee.

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Is financing available?

Probably the best way to pay for laser vision correction is the use of a medical savings plan. INSURANCE GENERALLY DOES NOT COVER LASER VISION CORRECTION. 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 saves a great deal of money in taxes and makes 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 saving plan. More information on medical savings plans and financing is available. Excellent payment plans with no interest for one year are also available.

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What about astigmatism?

Many of our patients have heard that astigmatism can’t be treated with the laser. Prior to 1997, this was true in the U.S. However, treatment of astigmatism was approved by the FDA in 1997, and the results of our treatments of patients with astigmatism have been excellent with custom or wavefront LASIK, permitting even some cases of irregular astigmatism to be corrected.

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What about laser treatment of farsightedness?

Treating farsightedness was FDA approved in 1999 and has now become a routine procedure similar to treating nearsightedness. Farsightedness (or hyperopic) patients under 40 can generally achieve both excellent distant and near vision after laser. For those farsighted patients over 40, we can usually give them excellent distance vision and greatly improved reading vision, but they will still need reading glasses for some activities as they get older. In other words, the excimer laser cannot make you younger. One option for both farsighted and nearsighted patients over 40 who want to reduce their dependence on reading glasses is monovision.

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Why is farsightedness so confusing?

There are really two types of “farsightedness.” Eye doctors use the term hyperopia for people who need reading glasses (and occasionally distance glasses) before the age of about 40 years old. This type of “farsightedness” can be treated with the laser to give most patients excellent distance and reading vision without glasses.

Most people, however, use the term “farsightedness” to describe the natural aging change that occurs when people start to need reading glasses over the age of about 40 years old. For this natural aging problem (which eye doctors call presbyopia), excimer laser treatment cannot eliminate the need for reading glasses without making one eye nearsighted to improve its reading ability, which blurs the distance vision in that eye. We call this option monovision.

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How will laser vision correction affect the development of cataracts or glaucoma?

In general, there is no evidence that laser vision correction causes 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, he or she 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 that of normal eyes. To protect their vision for a lifetime, all patients need to continue to be followed by an eye doctor and have regular eye examinations.

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How can I see “20/20” and still need reading glasses?

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 at reading distance. Someone over 40 may have 20/20 distance vision but very blurry 20/200 reading vision without glasses.

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What’s on the horizon? Should I wait until next year for a better procedure?

For 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 your Washington Eye surgeons and staff who have had it done themselves.

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Does it matter who performs your laser vision correction?

Drs. Rubinfeld, Martin and Adi’s experience, meticulous attention to detail, and surgical skills are well known in the Washington area, nationally and internationally. We believe that we owe our patients much more than surgical skill and expertise. With laser vision correction (or any procedure), our task is to be sure that we are communicating clearly to each patient what to expect during their laser experience, and what their results are likely to be. We work hard to make a potentially frightening experience as comfortable and positive as possible by guiding you through the entire process. We pledge to you, always, our best efforts and complete dedication.

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Who will perform my post-op examination?

If you were referred to us by your regular eye doctor, he or she can continue to care for you after surgery. All of the doctors in our office are experienced in caring for patients after LASIK. Please be sure to discuss this with us. Of course, if any problem or question arises, your LASIK surgeon will be available to see you.

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What should I expect to experience after my LASIK procedure?

Our practice has performed over 20,000 LASIK procedures and, in listening to our patients, we know that questions and concerns often come up soon after LASIK.

First, 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. It takes several weeks and often a few months for your vision to improve and stabilize. In the first week or two, most people feel as though they're looking through Vaseline, a 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, for most people, their vision and eye prescriptions have stabilized.

It's also common and completely normal for your vision to fluctuate from moment to moment or day to day during this period. Even though your eyes may not feel particularly dry, please use the artificial tears we provided 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 consult your post-op information sheet for the brands we recommend.

In order to protect your eyes as they heal, just like after any surgical procedure, it is critically important not to rub your eyes 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 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 LASIK surgery by expert surgeons are uncommon. There are a few symptoms that may indicate that there may be something that needs your doctor's attention. These include: discomfort that is getting worse rather than better in the first week or so following surgery, a significant reduction in your vision (not just mild fluctuations), a lot of discharge or redness or swelling of your lids.

A Washington Eye 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, Dr. Marwa Adi, Dr. Neil Martin and Dr. Roy Rubinfeld, thank you for trusting your precious vision and your only set of eyes to us.

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MOZART AS A SEDATIVE

Care for a little Brahms with your sedative? Or are you more partial to Led Zeppelin? Either way, a study reports, patients who are allowed to hear music they enjoy during surgery that does not require general anesthesia need less sedation than ordinary. Writing in the journal Anesthesia & Analgesia, researchers from Yale and the American University of Beirut Medical Center described an experiment involving prostate surgery patients who were invited to take their favorite CDs to the hospital. Some heard the music over headphones. Others heard "white noise" intended to drown out the sounds of the operating room. A third group heard neither, The 80 patients in the study, operated on in New Haven, Connecticut, or in Beirut, Lebanon, were given a device commonly used in such surgery allowing them to control their sedation level The devices also let the researchers see how much sedative was used. Previous studies have shown that patients who listened to music over earphones need less sedation, but it was not clear whether the benefit was from the music or the fact that it blocked out the noises of the operating room. This study, the researchers said, shows that it is the music that has the calming effect. And the type of music, Kain said, did not seem to matter, as long as the patient liked it. The New York Times, June 2005
Updated: 9/24/05

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Washington Eye Physicians & Surgeons
5454 Wisconsin Ave
Suite 950
Chevy Chase, Maryland 20815

Ph. 301-654-5114
Fax .301-654-9132

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This form is intended for general questions and eye care inquiries. It is not intended for medical advice or care. For immediate assistance or to address a medical question please call us at 301.654.5114. Please note that this is not a secure email transmission site. We are concerned with protecting your privacy as per federal HIPAA guidelines.