do it yourself lasik

A friend of mine referred me to this site today. It's too bad I didn't find it before I had a professional surgeon do my lasik surgery. I could have done it at home in the kitchen.

Lasik at Home

When you go there, make sure you click on the tab that says "Four Easy Steps."

I Didn't Think I'd be Nervous

For the most part, thinking of having major surgery performed on my eyes didn't phase me. Through all the pre-surgery meetings and tests, I stayed pretty calm and could even joke about it. It wasn't until I entered the cold operating room and laid down on the table that I began to get a bit nervous. As I was waiting for Dr. Motwani to arrive, all these thoughts of "it's now or never", "what if I sneeze" ... all those crazy thoughts began to race in my mind and I started to shake a bit. I think I actually surprised myself.

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.

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!

Wavefront Technology

More from Wikipedia, this time about Wavefront technology. My Lasik surgeon, Dr. Motwani in San Diego, used wavefront technology on me.

Wavefront-guided LASIK is a variation of LASIK surgery where, rather than applying a simple correction of focusing power to the cornea (as in traditional LASIK), an ophthalmologist applies a spatially varying correction, guiding the computer-controlled excimer laser with measurements from a wavefront sensor. The goal is to achieve a more optically perfect eye, though the final result still depends on the physician's success at predicting changes which occur during healing. In older patients though, scattering from microscopic particles plays a major role and may exceed any benefit from wavefront correction. Hence, patients expecting so-called "super vision" from such procedures may be disappointed. However, while unproven, surgeons claim patients are generally more satisfied with this technique than with previous methods, particularly regarding lowered incidence of "halos", the visual artifact caused by spherical aberration induced in the eye by earlier methods.

http://en.wikipedia.org/wiki/Lasik#Wavefront-guided_LASIK

Lasik - The Technology

From Wikipedia ...

The LASIK technique was made possible by the Colombian-based Spanish ophthalmologist Jose Barraquer, who, around 1950 in his clinic in Bogotá, Colombia, developed the first microkeratome, used to cut thin flaps in the cornea and alter its shape, in a procedure called keratomileusis. He also provided the knowledge about how much of the cornea had to be left unaltered to provide a stable long-term result.

Later technical and procedural developments included the RK (radial keratotomy) started in the '70s in Russia by Svyatoslav Fyodorov and the development of PRK (photorefractive keratectomy) in the '80s in Germany by Theo Seiler.

In 1968, at the Northrup Corporation Research and Technology Center of the University of California, Mani Lal Bhaumik and a group of other scientists, while working on the development of a carbon-dioxide laser, would develop the Excimer laser, where molecules that do not normally exist come into being when xenon, argon or krypton gases are excited. This would form the cornerstone for LASIK eye surgery. Dr. Bhaumik announced his discovery in May of 1973 at a meeting of the Denver Optical Society of America in Denver, Colorado. He would later patent it. [1]

The introduction of Laser in this refractive procedure started with the developments in Laser technology by Rangaswamy Srinivasan. In 1980, Srinivasan, working at IBM Research Lab, discovered that an ultraviolet excimer laser could etch living tissue in a precise manner with no thermal damage to the surrounding area. He named the phenomenon Ablative Photodecomposition (APD).[2]. Dr. Stephen Trokel published a paper in the American Journal of Ophthalmology in 1983, outlining the potential of using the excimer laser in refractive surgeries.

The first patent for LASIK was granted by the US Patent Office to Gholam A. Peyman, MD on June 20, 1989, US Patent #4,840,175, "METHOD FOR MODIFYING CORNEAL CURVATURE", describing the surgical procedure in which a flap is cut in the cornea and pulled back to expose the corneal bed. This exposed surface is then ablated to the desired shape with an excimer laser, following which the flap is replaced.

Using these advances in laser technology and the technical and theoretical developments in refractive surgery made since the 50's, LASIK surgery was developed in 1990 by Lucio Buratto (Italy) and Ioannis Pallikaris (Greece) as a melding of two prior techniques, keratomileusis and photorefractive keratectomy. It quickly became popular because of its greater precision and lower frequency of complications in comparison with these former two techniques. Today, faster lasers, larger spot areas, bladeless flap incision, and wavefront-optimized and -guided techniques have significantly improved the reliability of the procedure as compared to that of 1991. Nonetheless, the fundamental limitations of excimer lasers and undesirable destruction of the eye's nerves have spawned research into many alternatives to "plain" LASIK, including all-femtosecond correction (Femtosecond Lenticule EXtraction, FLIVC), LASEK, Epi-LASIK, sub-Bowman’s Keratomileusis aka thin-flap LASIK, wavefront-guided PRK, and modern intraocular lenses.

My Lasik Experience

In the spirit of the Internet, where everyone shares something about everything, I've decided to open up a late-night blog to document my personal lasik experience. I'll have to update my profile picture -- it's so prescription challenged.

I'm now almost two months removed from when I had my lasik surgery done by Dr. Motwani at the Alpha Laser Center here in San Diego. It's been nothing short of a miracle!