Am I a candidate for laser vision correction?
We are able to treat almost anyone who is in good health, wears glasses or contact lenses and has no eye disease such as glaucoma or cataracts. At the consultation with one of our physicians, we will confirm whether you are a good candidate, explain the procedure, and answer your questions. The doctor will also explain the results you can reasonably expect, and inform you of the risks. To schedule a free screening, please call (212) 342-3746.
Is the laser vision correction procedure painful?
Anesthetic eye drops are used just before surgery begins. Almost all patients describe no pain or discomfort during the actual surgery. Most LASIK patients describe the six hours following surgery as slightly uncomfortable as if there is a foreign body or irritation. PRK patients may experience discomfort for a couple of days.
When can I go back to work?
Most patients are able to return to work within three days of the procedure. There are very few restrictions on activity during the immediate post-operative period.
What kind of results can I expect?
Quality and safety are our primary concerns. Our commitment to use only the most modern equipment combined with our experience and expertise give you the best outcome possible. Better than 98% of our patients see well enough to drive without glasses after treatment. These results are better than the national clinical FDA trial data. Patients over age 40 may still need to wear reading glasses following surgery. At Columbia Vision Correction you will always be examined and treated by one of our board certified ophthalmologists.
What are the risks and how can I find the right doctor for me?
Most patients are very pleased with the results of their refractive surgery. However, like any other medical procedure, there are risks involved. That's why it is important for you to understand the limitations and possible complications of refractive surgery.
Before undergoing a refractive procedure, you should carefully weigh the risks and benefits based on your own personal value system, and try to avoid being influenced by friends that have had the procedure or doctors encouraging you to do so.
- Some patients lose vision. Some patients lose lines of vision on the vision chart that cannot be corrected with glasses, contact lenses, or surgery as a result of treatment.
- Some patients develop debilitating visual symptoms. Some patients develop glare, halos, and/or double vision that can seriously affect nighttime vision. Even with good vision on the vision chart, some patients do not see as well in situations of low contrast, such as at night or in fog, after treatment as compared to before treatment.
- You may be under treated or over treated. Only a certain percent of patients achieve 20/20 vision without glasses or contacts. You may require additional treatment, but additional treatment may not be possible. You may still need glasses or contact lenses after surgery. This may be true even if you only required a very weak prescription before surgery. If you used reading glasses before surgery, you may still need reading glasses after surgery.
- Some patients may develop severe dry eye syndrome. As a result of surgery, your eye may not be able to produce enough tears to keep the eye moist and comfortable. Dry eye not only causes discomfort, but can reduce visual quality due to intermittent blurring and other visual symptoms. This condition may be permanent. Intensive drop therapy and use of plugs or other procedures may be required.
- Results are generally not as good in patients with very large refractive errors of any type. You should discuss your expectations with your doctor and realize that you may still require glasses or contacts after the surgery.
- For some farsighted patients, results may diminish with age. If you are farsighted, the level of improved vision you experience after surgery may decrease with age. This can occur if your manifest refraction (a vision exam with lenses before dilating drops) is very different from your cycloplegic refraction (a vision exam with lenses after dilating drops).
- Long-term data are not available. LASIK is a relatively new technology. The first laser was approved for LASIK eye surgery in 1998. Therefore, the long-term safety and effectiveness of LASIK surgery is not known.
Additional Risks if you are Considering the Following:
Monovision is one clinical technique used to deal with the correction of presbyopia, the gradual loss of the ability of the eye to change focus for close-up tasks that progresses with age. The intent of monovision is for the presbyopic patient to use one eye for distance viewing and one eye for near viewing. This practice was first applied to fit contact lens wearers and more recently to LASIK and other refractive surgeries. With contact lenses, a presbyopic patient has the dominant eye fit with a contact lens to correct distance vision, and the non-dominant eye fit with a contact lens to correct near vision. In the same way, with LASIK, a presbyopic patient has the dominant eye operated on to correct the distance vision, and the other operated on to correct the near vision. In other words, the goal of the surgery is for the non-dominant eye to have some near-sightedness for near tasks and, as a result, the distance vision may not be 20/20. Although both eyes work together, there may be a decrease in depth perception, especially in low lighting conditions and when performing tasks requiring very sharp vision for near or distance. Therefore, you may need to wear glasses or contact lenses to fully correct both eyes for distance or near when performing visually demanding tasks, such as driving at night, operating dangerous equipment, or performing occupational tasks requiring very sharp close vision (e.g., reading small print for long periods of time).
Some patients cannot get used to having one eye blurred at all times. Therefore, if you are considering monovision with PRK or LASIK, your specialist may place you through a trial period with contact lenses to see if you can tolerate monovision, before having the surgery performed on your eyes. Find out if you pass your state's driver's license requirements with monovision.
In addition, you should consider how much your presbyopia is expected to increase in the future. Ask your doctor when you should expect the results of your monovision surgery to no longer be enough for you to see near-by objects clearly without the aid of glasses or contacts, or when a second surgery might be required to further correct your near vision.
Finding the Right Doctor
If you are considering refractive surgery, make sure you:
- Compare. The levels of risk and benefit vary slightly not only from procedure to procedure, but from device to device depending on the manufacturer, and from surgeon to surgeon depending on their level of experience with a particular procedure.
- Don't base your decision simply on cost and don't settle for the first eye center, doctor, or procedure you investigate. Remember that the decisions you make about your eyes and refractive surgery will affect you for the rest of your life.
- Be wary of eye centers that advertise, "20/20 vision or your money back" or "package deals." There are never any guarantees in medicine.
- Read. It is important for you to read the patient handbook provided to your doctor by the manufacturer of the device used to perform the refractive procedure. Your doctor should provide you with this handbook and be willing to discuss his/her outcomes (successes as well as complications) compared to the results of studies outlined in the handbook.
Even the best screened patients under the care of most skilled surgeons can experience serious complications.
- During surgery. Malfunction of a device or other error, such as cutting a flap of cornea through and through instead of making a hinge during LASIK surgery, may lead to discontinuation of the procedure or irreversible damage to the eye.
- After surgery. Some complications, such as migration of the flap, inflammation or infection, may require another procedure and/or intensive treatment with drops. Even with aggressive therapy, such complications may lead to temporary loss of vision or even irreversible blindness.
Under the care of an experienced doctor, carefully screened candidates with reasonable expectations and a clear understanding of the risks and alternatives are likely to be happy with the results of their refractive procedure.
Be cautious about "slick" advertising and/or deals that sound "too good to be true." Remember, they usually are. There is a lot of competition resulting in a great deal of advertising and bidding for your business. Do your homework.
Will insurance pay for my surgery?
Most insurance plans do not cover LASIK and PRK, as they are deemed elective surgeries. However, flexible benefits programs generally cover laser vision correction. You may choose from a variety of payment options. Payment by credit card is also accepted.
The Food and Drug Administration's advice about Laser Vision Correction
When is LASIK not for me? You are probably NOT a good candidate for refractive surgery if:
- You are not a risk taker. Certain complications are unavoidable in a percentage of patients, and there are no long-term data available for current procedures.
- It will jeopardize your career. Some jobs prohibit certain refractive procedures. Be sure to check with your employer/professional society/military service before undergoing any procedure.
- Cost is an issue. Most medical insurance will not pay for refractive surgery. Although the cost is coming down, it is still significant.
- You required a change in your contact lens or glasses prescription in the past year. This is called refractive instability. Patients who are:
- In their early 20s or younger,
- Whose hormones are fluctuating due to disease such as diabetes,
- Who are pregnant or breast feeding, or
- Who are taking medications that may cause fluctuations in vision, are more likely to have refractive instability and should discuss the possible additional risks with their doctor.
- You have a disease or are on medications that may affect wound healing. Certain conditions, such as autoimmune diseases (e.g., lupus, rheumatoid arthritis), immunodeficiency states (e.g., HIV) and diabetes, and some medications (e.g., retinoic acid and steroids) may prevent proper healing after a refractive procedure.
- You actively participate in contact sports. You participate in boxing, wrestling, martial arts or other activities in which blows to the face and eyes are a normal occurrence. PRK may be a better option for you as there is no risk of flap dislocations with facial/ocular injury.
- You are not an adult. Currently, no lasers are approved for LASIK on persons under the age of 18.
The safety and effectiveness of refractive procedures has not been determined in patients with some diseases. Discuss with your doctor if you have a history of any of the following:
- Herpes simplex or Herpes zoster (shingles) involving the eye area.
- Glaucoma, glaucoma suspect, or ocular hypertension.
- Eye diseases, such as uveitis/iritis (inflammations of the eye)
- Eye injuries or previous eye surgeries.
Other Risk Factors
Your doctor should screen you for the following conditions or indicators of risk:
- Blepharitis. Inflammation of the eyelids with crusting of the eyelashes, that may increase the risk of infection or inflammation of the cornea after LASIK.
- Large pupils. Make sure this evaluation is done in a dark room. Although anyone may have large pupils, younger patients and patients on certain medications may be particularly prone to having large pupils under dim lighting conditions. This can cause symptoms such as glare, halos, starbursts, and ghost images (double vision) after surgery. In some patients these symptoms may be debilitating. For example, a patient may no longer be able to drive a car at night or in certain weather conditions, such as fog.
- Thin Corneas. The cornea is the thin clear covering of the eye that is in front of the iris, the colored part of the eye. Most refractive procedures change the eye’s focusing power by reshaping the cornea (for example, by removing tissue). Performing a refractive procedure on a cornea that is too thin may result in blinding complications.
- Previous refractive surgery (e.g., radial keratotomy, PRK, LASIK). Additional refractive surgery may not be recommended. The decision to have additional refractive surgery must be made in consultation with your doctor after careful consideration of your unique situation.
- Dry Eyes. PRK and LASIK surgery may aggravate this condition.