Refractive Surgery Blog

I have been performing Intralasik or Ilasik for about a year and a half. A review of the results was just completed and they were impressive. To this point in time, of the first several hundred eyes operated on using this technology, there were no re-treatments needed. All patients had results that either hit or were very close to the target refraction. In addition, there were no flap or other complications.

To put this in perspective, using the "traditional" technology, microkeratome associated lasik flap complications occurred at a rate of about one percent. While this complication rate does not seem to be high, it can be inconvenient at best and cause the loss of best corrected vision at worst when it occurs. Traditionally performed lasik (when Customvue technology was not employed) had a re-treatment rate of nearly three percent. And, when the combination of the Intralase femtosecond laser and wavefront technology was used, it was better in almost every case - especially with night vision improvement.

I-lasik has been a real advancement in both the safety and visual results categories. While the improvements seem to be only incrementally better, we are continuing to strive for refractive visual perfection.

Labels: Ilasik

A patient I have followed over the past twenty years recently came in with an all too common problem - his vision had deteriorated gradually after having had radial keratotomy (RK) in the 1980s. Allan had a multiple cut RK along with an AK (astigmatic keratotomy) about twenty-five years ago when living in California. Through the years I have fit him with a variety of different contact lenses to improve his vision but even a rigid lens was difficult to fit as his cornea was so flat. The result was that his vision was inconsistent and he was never entirely happy with his compromised vision. Now, Allan's vision had become so abnormal due to the shifting of his cornea that he was no longer correctable with glasses or contact lenses. The question was: Now what?

RK was the first popular surgical approach used to correct both myopia and astigmatism. It was the rage in the 1980s and into the early 1990s before lasik became available in the United States. The way it worked was partial thickness radial cuts were made into the cornea. The effect was to weaken the peripheral cornea so that the normal intraocular pressure that was constantly pushing out, preferentially influenced the weakened area of the cornea that provided the least resistance. The result was the peripheral conea bulged and the central cornea flattend to give the desired effect. The problem was that over the years, the central cornea continued to gradually flatten and patients gradually became farsighted.

Over the past several years I have has success treating these refractive problems by performing either hyperoptic lasik under the RK cuts or PRK over the cuts in an attempt to even out the corneal curvature. In this case I recommended lasik to Allan with special emphasis on treating the large amount of astigmatism that had developed. Allan was nervous about this but decided to procede as he felt he had little to lose. The procedure went perfectly and Allan had 20/20 vision on the first post-operative day.

Post-RK refractive surgery works. If your having farsighted problems years after your RK, give us a call.

Labels: LASIK, PRK, RK

In addition to the upgraded IOLMaster discussed in my last blog entry, my practice has also acquired a Pentacam Comprehensive Eye Scanner. It is a rotating camera that photographs both the anterior and posterior surfaces of the cornea as well as other parts of the front of the eye. The main advantage to this technology is that this unique camera provides precise measurements of the central cornea better than any other instrument available.

The Pentacam has improved my ability to diagnose ocular conditions (especially keratoconus) more accurately than ever before. Equally important is that with this camera I have the confidence to rule out "false keratoconus positives" from traditional topographers and offer lasik and other refractive procedures to many patients who have been denied them in the past. The Pentacam is also extremely helpful in determining the intraocular lens(IOL) power for cataract patients who have previously had a refractive procedure. Finally, it is very helpful in understanding the positioning of phakic and piggyback IOLs.

With the the use of the IOLMaster and Pentacam both lasik and intraocular refractive procedures are safer and and more precise than ever before.

Labels: Pentacam

Happy New Year from the Cherry Creek Eye Physicians and Surgeons! Since 1982 when I entered into private practice, I have been commited to providing the very best options for treating our patients. That commitment began with the development of the Cherry Creek Eye Center in 1985 and has continued without interruption until today. The Cherry Creek Eye Center is now the most frequented eye only facility in East Denver and continues to grow in both numbers of patients and in the quality of care offered. We are trying to provide not just the community standard of care but rather the state-of-the-art.

An example of this commitment to excellence is the recent purchase of the IOLMaster, version 5 software. The IOLMaster is an optical device used to make multiple, critical measurements of the eye that can then be used to calculate the intraocular lens (IOL) power used when replacing the crystalline lens of the eye (cataract or clear lens replacement surgery). This instrument uses non-contact, optical methods to measure the length of the eye, the depth of the front chamber of the eye and the curvature of the cornea. The IOLMaster is accurate to +/- 0.02 mm or better giving an increase in accuracy of five fold over traditional measurement methods. While we have had the IOLMaster for years, the new software enhances both the accuracy and reproducibilty of measurements by analyzing them individually and as a series. And, with the new software, the IOLMaster can be used on an expanded population of patients who could not enjoy it's benifits in the past. The data obtained with this instrument takes us to the next level of precision in cataract and clear lens replacement surgery.

With the increasing technology of the newest replacement lenses available such as the multifocal IOLs (ReZoom and ReStor), precision measurements are more important than ever. Good vision is no longer good enough after cataract surgery - great vision is our interest and goal.

At the Cherry Creek Eye Center, we are invested in your visual results.

Labels: IOLMaster