All the Tests

To determine if I was a prime candidate for Lasik surgery, Dr. Motwani and his staff ran me through several different exams and tests. Not only did they test my prescription (which I knew was way high), they also tested to see how much tissue I could afford to lose and what the topography of my eye looked like.

One of my favorite tests was the Wavelength test and having to focus on the hot air balloon. Then the lights flashed red and it felt like a flashback to the 1960s. Of course, I only lived for about eight weeks during the 1960s but you get my point :-)

Prolate Ablations

The original corneal shape is prolate, i.e. a dome like the side of a ball. When you re-shape a cornea for myopia, you create a bucket or divot like shape in the cornea, causing it to become oblate. This creates a completely different light entrance pattern at the periphery, causing night glare/halos and contrast sensitivity loss. Even if a wavefront laser pattern perfectly smooths the center cornea, the oblate overall shape of the ablation can still lead to contrast sensitivity losses and night glare/halo issues. A prolate ablation much more closely resembles the dome like shape of the natural cornea, especially in the area of pupil dilation, and therefore acts much like the normal eye with the additional advantage of corneal smoothening by the excimer laser. That is what accounts for the high 20/15 rate of this procedure. Further advantages are less central tissue removal, and excellent overall regression rates.

Source: Dr. Motwani San Diego Lasik Surgeon

Custom Ablations

These are various forms of laser ablation patterns that allow for a higher degree of 20/20 visual results, and a higher amount of better than 20/20 results (usually measured as 20/15 vision rates). Many of these use wavefront analysis to determine how to shape the cornea. Since 2002, Dr. Motwani has pioneered a custom system that allows for more prolate cornea, Aspheric Ablation. This was originally intended to decrease night glare and halos, and to decrease losses in contrast sensitivity, but this procedure also gave some of the highest 20/15 rates from any custom excimer laser system. Since then, a 68% 20/15 rate has been achieved for single eye visual acuity, a more rigorous test than bilateral visual acuity. Most other custom systems have 30-40% 20/15 rates.

Source: Alpha Laser Eye Center, San Diego Lasik.

Laser vs. Blade Microkeratomes

The micro-keratome is a device used to make a flap in he cornea. Over the past few years, a laser micro-keratome, the Intralase, has been introduced and heavily marketed as “All Laser LASIK.” The Intralase still makes a flap, usually has longer healing times (as much as 24 hours of discomfort vs. 3-6 hours), and longer visual rehabilitation (as much as 48 hours instead of overnight), and is also more expensive. Furthermore, the Intralase does not make a smooth cut, but actually makes multiple perforations in the flap, and the flap has to be raised forcefully with a forceps.

For the past several years Dr. Motwani has been using what he considers the most advanced blade micro-keratome, the Moria M2. This device makes very smooth, quick, reliable, corneal flaps with a flap complication rate of 1-2 flaps per year. Because of the extreme reliability of this device, the extremely smooth flap beds, and the faster rehabilitation times, Dr. Motwani continues to recommend blade over laser micro-keratomes until such day as the discomfort and rehabilition times can be brought on par with the Moria M2.

Source: San Diego's Alpha Laser Center.

Laser vs. Blade Microkeratomes

The micro-keratome is a device used to make a flap in he cornea. Over the past few years, a laser micro-keratome, the Intralase, has been introduced and heavily marketed as “All Laser LASIK.” The Intralase still makes a flap, usually has longer healing times (as much as 24 hours of discomfort vs. 3-6 hours), and longer visual rehabilitation (as much as 48 hours instead of overnight), and is also more expensive. Furthermore, the Intralase does not make a smooth cut, but actually makes multiple perforations in the flap, and the flap has to be raised forcefully with a forceps.

For the past several years Dr. Motwani has been using what he considers the most advanced blade micro-keratome, the Moria M2. This device makes very smooth, quick, reliable, corneal flaps with a flap complication rate of 1-2 flaps per year. Because of the extreme reliability of this device, the extremely smooth flap beds, and the faster rehabilitation times, Dr. Motwani continues to recommend blade over laser micro-keratomes until such day as the discomfort and rehabilition times can be brought on par with the Moria M2.

Source: San Diego's Alpha Laser Center.

E-LASIK or Epi-LASIK

E-LASIK or Epi-LASIK. This is a newer, advanced procedure in which a special micro-keratome is used to make a flap of only the clear outer skin layer (the epithelium). This exposes the stroma, the excimer laser is used to re-shape the cornea, and the epithelial flap is replaced and a contact lens is placed as a bandage. This procedure is used wherever a LASIK flap is not appropriate or desired, such as with thin corneas, corneal dystrophies, or where the patient does not want a LASIK flap. It has also been used very successfully by Dr. Motwani in cases of high prescriptions, which require high amounts of tissue for re-shaping. Since the entire stromal depth is available for the re-shaping, it creates a higher margin of safety also.

Source: Dr. Motwani.

LASEK

LASEK. This is a procedure where the outer clear skin layer (epithelium) is weakened with alcohol, and removed carefully in whole form to expose the stroma. The excimer laser is used to re-shape the cornea, and the loosened epithelium is replaced with a contact lens as a bandage. This procedure usually takes 5-6 days to heal, has a significant amount of epithelium loss due to alcohol being toxic to epithelium, and has been largely supplanted with Epi-LASIK.

Source: Dr. Motwani, San Diego Lasik Surgery.

PRK - Photo Refractive Keratectomy

PRK- Photo Refractive Keratectomy. This is the original laser procedure where the outer clear skin layer of the cornea is scraped away and the cornea is re-shaped using the excimer laser. The amount of skin scraped away depends on the type of re-shaping being done, and usually takes about 2-4 days to heal. A contact lens is used as a bandage lens to aid healing and decrease discomfort. Modern PRK post-op care limits pain to mostly the day of the procedure, with little to no pain after day one. PRK is used in cases where a LASIK flap is not appropriate or not desired.

Source: Dr. Motwani's Alpha Laser Center in San Diego.

Different Types of Laser Eye Surgery

There are many different types of laser eye surgery. I thought I'd post a few definitions (borrowed from Dr. Motwani's website -- the San Diego lasik surgeon who performed my surgery).

LASIK- Laser Assisted In Situ Keratamileusis. This is a procedure where a corneal flap is made consisting of the outer clear skin layer (epithelium) and a small layer of the stroma of the cornea. This allows the stroma to be exposed, and the excimer laser is used to re-shape the cornea. With hyperopia, the laser removes tissue from the outer part of the cornea, with myopia, it is removed in the inner part of the cornea, and with astigmatism tissue is removed preferentially along one axis of the cornea. With Dr. Motwani’s techniques, discomfort and visual rehabilitation take 3-6 hours after surgery.

My First Visit to Doctor Motwani

My first visit to Dr. Motwani was to see if I qualified for lasik surgery. His staff ran me through the same types of tests that I had undergone previously at Dr. Kawesch's office. Though both seemed professional, I felt much more comfortable with Dr. Motwani than I did with the other office. During my consultation, I had a chance to visit with Dr. Motwani -- I never even saw Dr. Kawesch the day I went into his office. In fact, I was never told that it was a different Dr. Kawesch who was now running the clinic. I only found out when I noticed that the picture on the folder didn't match the picture on the website. From there Google took over ...

What I enjoyed the most about Dr. Motwani was that he was both professional and personable. When you're considering having laser surgery peformed on your eyeballs, it's important to feel that the person is competent; it's also nice to have a good feeling about them. I was fortunate in that I had both.

Learning New Things

Now that I'm on the post-side of Lasik surgery, I'm having to learn things that people with good eyesight have known all along. Case in point: Never leave your black sunglasses in the car when it's 100 degrees outside and then put them on!