Eye Surgery Information

Put Away Your Reading Glasses

2005-12-24T21:53:00.000-08:00

Put Away Your Reading Glasses

by Dr. Shobha Tandon

While LASIK and other eye surgeries have long been available for correcting nearsightedness and farsightedness, they are not suitable for treating presbyopia (the condition that makes reading difficult for middle agers). The solution is....

(PRWEB) July 2, 2005 -- Recently, the FDA approved a new, minimally invasive devise to correct (at least, temporarily) the stiffening of the eye lens that results in presbyopia. The new procedure, know as conductive keratoplasty (CK), involves anesthetizing the eye with drops and applying radio frequency radiation in a circular pattern to the non-dominant eye. The result is monovision, in which one eye sees better close up and the other retains it distance vision.At NeoVision Eye Center, we look forward to helping you understand your needs and providing information so you may make an informed decision regarding vision correction. Let us help you “see beyond your imagination” with state-of-art Lasik surgery http://www.neovisioneyecenter.com/laservision_correction.html. Our courteous staff is professional and well trained. Please call us to schedule your next eye examination. We are happy to answer all your questions and we will work with you to find the most convenient appointment. We possess high personal and professional standards, impeccable integrity, and exceptional knowledge in all facets of eye care.P.S When eyes are treated for monovision, the brain learns to adapt to the disparity and allows the patient to see both in the distance and up close without any hindrance.Shobha Tandon, MD, PhD, is an ophthalmologist and Medical Director of NeoVision Eye Center with offices at 2 Union Square in Union City, CA and at 2500 Hospital Drive, Bldg 11 in Mountain View, CA.

http://www.neovisioneyecenter.com/

Refractive Laser Eye Surgery – Will Insurance Pay?

2005-12-11T23:04:00.000-08:00

Refractive Laser Eye Surgery – Will Insurance Pay?

by Debbie Caldwell

Independent Review Organizations (IROs) Help Determine the Medical Necessity of “Cosmetic” Laser Eye (Lasik) Treatments
(PRWEB) June 29, 2005 -- Eye wear may be a fashion accessory, but when you depend upon it for seeing the world, it’s a lot more. Today, many people are turning to refractive laser eye surgery, such as Lasik surgery, to improve their vision. The cost of Lasik is high and is normally not paid for by insurance because it’s fails to meet the conservative therapy test and is classified as cosmetic surgery. According to Independent Review Organization (IRO), AllMed Healthcare Management (http://www.allmedmd.com), this trend is shifting. “We are seeing an increasingly number circumstances where refractive eye surgery is determined to be medically necessary and, therefore, payable by the insurance provider,” explains Dr. Skip Freedman, medical director at AllMed Healthcare Management. “For example, if conservative therapy treatments fail or if a patient is intolerant of contact lenses and cannot wear glasses because they might pose a risk in their job (e.g. police or firefighters), refractive eye surgery may be the most medically viable treatment option.” Photorefractive keratectomy (PRK) is a refractive laser surgical procedure that is often covered by a patient that suffers from recurrent corneal erosion (e.g. diabetics). With PRK, a surgeon uses a laser to remove corneal tissue to correct vision problems. Conservative therapy approaches, such as patching, epithelial debridement (mechanical removal of faulty tissue), and bandaged contact lens placement often don’t work. Stromal puncturing, a procedure involving the physician puncturing the anterior corneal stroma, can also be used but can fail or result in permanent visual loss. In such cases, PRK is the best alternative for removing the damaged cells (or membranes) and possibly correcting the vision problems. According to Freedman, physicians can help patients who are in medical need of laser eye surgery make a stronger case by initiating the following:Document a full medical history of the patient’s eye complaintsShow proof that the patient has not responded to conservative treatments and that the purpose of the laser eye surgery is for medical reasons other than simply improved eyesight Still, Freedman cautions, that even when the physician does this, each decision is taken on a case-by-case basis and is subject to the extenuating circumstances clearly noted in the patient’s medical record.Find more information about the medical necessity review services offered by IROs on AllMed’s web site at http://www.allmedmd.com.About AllMed Healthcare Management:Founded in 1995, AllMed is a URAC-accredited Independent Review Organization (IRO) serving insurance payers, providers, TPAs and claims managers nationwide. Reviews are conducted by board-certified physicians in active practice. AllMed's growing customer base includes premier organizations, such as Educator's Mutual Life, IMS Managed Care, Tenet Healthcare Corporation, HealthGuard, several Blue Cross Blue Shield organizations, TriWest Healthcare Alliance, Allianz and many other leading healthcare payers.

http://www.allmedmd.com/?eyepr

Extended Sun Exposure Increases Risk of Eye Pterygium - Florida Surgeon Treats Condition With State-of-the-Art Surgical Techniques

2005-11-25T20:44:00.000-08:00

Extended Sun Exposure Increases Risk of Eye Pterygium - Florida Surgeon Treats Condition With State-of-the-Art Surgical Techniques
by Stephanie Barker

Dr. Arun Gulani of the Gulani Vision Institute said increased sun exposure in tropical and sub-tropical climates can lead to an eye condition called pterygium. Pterygium can be surgically. Gulani has taken this surgery to a new level using human placental membrane and surgical glue.

Jacksonville, FL (PRWEB) March 24, 2005 -- As spring and summer approach, we are constantly warned about the dangers of increased sun exposure. Dermatologists caution us about melanoma. Doctors urge us to remain hydrated during outdoor activities. Now, a leading eye doctor is sounding the alarm about the harm the sun can do our eyes. Dr. Arun Gulani of the Gulani Vision Institute said increased sun exposure in tropical and sub-tropical climates can lead to an eye condition called pterygium, though its causes are not completely understood. Pterygium (pronounced ter ig¢ ee um) is a raised, wedge-shaped growth of the conjunctiva. Symptoms may include irritation, redness and tearing.“Pterygium is fairly common among sports and recreation enthusiasts, as well as outdoor workers,” Gulani said. “Although it often remains dormant with little or no reason for treatment, it can be a relentless disorder, growing across the cornea and adversely affecting vision.” As the pterygium develops, it may alter the shape of the cornea, causing astigmatism. It can be surgically removed, but surgery and stitches may, ironically, produce astigmatism. If the condition does develop, however, new surgical breakthroughs are making the residual effects of removing pterygiums less likely. Gulani, who educates doctors around the world on the latest eye surgery techniques, has been teaching what is referred to as the “iceberg” concept in treating pterygiums.“The part of the pterygium that you see is just the tip of the iceberg,” Gulani said. The actual growth may be much deeper.”Gulani said has applied this advanced surgical technique using human placental membranes grafted to the eye to promote healing after surgery. Recently, Gulani took the surgery to a new level: he was among the first to use surgical glue in eye surgery. In fact, Donnie Hammond, pro golfer and two-time PGA Tour winner, was the first in the North Florida area to undergo this glue technique instead of stitches. “The glue was used to graft a human placental membrane to the eye,” Gulani said. “The beauty is not putting stitches in the eye. There is no astigmatism, and it prevents fibrosis and bleeding. This relentless disorder is frequently seen in golfers and other outdoor enthusiasts.Now there is an elegant and successful procedure available to correct it. Glue is definitely the future in promoting better recovery after eye surgery.”Of course, Gulani said prevention is still the best medicine. Since pterygiums are most commonly caused by sun exposure, protecting the eyes from sun, dust and wind is recommended, including wearing good sunglasses with UV protection.

http://www.gulani.com

What To Do With Dry Eye After Lasik

2005-11-14T19:24:00.000-08:00

I know of people who have experienced dry eyes following Lasik Surgery. It was not severe but annoying. The following article addresses what you can do to avoid this problem. Enjoy

What To Do With Dry Eye After Lasik
by Bob Hett

Lasik eye surgery is for people who are nearsighted or farsighted and have astigmatism. This surgery changes the curvature of the cornea, which is the outermost part of the eye. This allows the person to see without the need for glasses or contacts.
Most people have no trouble with their vision correction surgery. Less than 1% of people who have this type of surgery done actually experience any side effects. It is done on an outpatient basis and most people can return to work and to their usual activities the day after surgery. As with any surgery, there is always the risk of side effects. One of the possible Lasik complications is having chronic dry eyes after Lasik surgery. This is the most common complaint of patients who have had eye surgery. The reason for this is that vision correction surgery reduces the amount of lubrication that a patients eyes normally receive.
Dry eye problems can run the spectrum from less serious to more serious. A patient can experience itching, redness, and even pain after vision correction surgery. For some the problem is minor and can be solved with artificial teardrops or other types of drops or topical treatments for the eyes. Other people find that taking flax seed oil caplets helps, and that using a humidifier in their home also relieves that dry, scratchy feeling. For many patients, their eyes return to their normal or near normal lubrication levels in the weeks and months following their eye surgery.
If the dry eye problem is more serious, a tiny plug can be inserted that prevents tears from going to the nose and therefore allows for more lubrication in the eye. This plug can be removed in the future if the dry eye problem is resolved.
The best way to avoid any Lasik complications or side effects is to choose your ophthalmologist wisely. Make sure that they have the proper credentials and have done a large number of successful vision correction surgeries. Do not be swayed by discount offers on Lasik that seem too good to be true. You should always have a consultation with your surgeon prior to having any kind of surgery. A good surgeon will be able to tell you if you are a good candidate for this type of surgery, and will let you know if you would not benefit from Lasik. An experienced ophthalmologist will also be able to help you if you do experience dry eyes after Lasik surgery, they will be able to help you deal with the problem and lessen your discomfort until the problem is resolved. To get quality vision correction surgery, you need to be willing to pay a competitive price for it and do your homework when choosing a doctor.

Bob Hett offers great tips and advice regarding all aspects of Lasik Eye Surgery Get the information you are seeking now by visiting http://www.eyesurgeryreview.info

Ready to Lose Your Glasses? Ten tips to choosing a LASIK or Laser Vision Correction Center

2005-11-01T03:22:00.000-08:00

Tired of your glasses? Are you ready to lose dependance on your reading glasses? Then read on.

Ready to Lose Your Glasses? Ten tips to choosing a LASIK or Laser Vision Correction Center
by: Robert K. Maloney

Ready To Lose Your Glasses? Ten Tips To Choosing A LASIK or Laser Vision Correction Center

The world of ophthalmology is one of the fastest evolving fields of medicine. Never before have so many new techniques and scientific breakthroughs emerged in such a short period of time. LASIK surgery, which uses an excimer laser to reshape the cornea, offers millions of people the opportunity to reduce or eliminate their need for glasses or contacts.

Television and radio ads are filled with amazing stories about LASIK surgery as the fast and painless way to correct vision, but stories are also appearing about people for whom it was less than successful. Before you opt to go under the beam, what can you do to help ensure that you will be happy with your results?

The key to safe surgery in any field of medicine is an informed patient. Take a little time and research the LASIK center you are considering for laser eye surgery. Dr. Robert K. Maloney, voted by his peers as one of America’s Top Ten vision correction surgeons in a national survey by Ophthalmology Times, offers the following guidelines to quality care and treatment.

1. Find a doctor by getting referrals from other doctors or from patients who have had LASIK or laser vision correction.

2. Don't be fooled by fancy advertisements about a particular laser center. Choose the doctor, not the laser center. Find out who will actually do your procedure, then ask about that doctor’s qualifications (e.g., board certification, special training).

3. Choose a doctor who has done at least 5,000 LASIK or eye laser surgeries. What a doctor doesn’t know can hurt you.

4. Ask for information on your doctor’s LASIK eye surgery complication rates. If your doctor won’t tell you, find another one. For top surgeons, the figure is under 3 in 1,000.

5. Ask what measures are taken to prevent infection. Look for a center with a sterile or dust-free operating room. Make sure that disposable parts are not reused. Insist that your eye be thoroughly sterilized, and insist that the surgical instruments be sterilized before your eye laser surgery to eliminate the risk of transmission of HIV or hepatitis.

6. Beware of advertisements pushing “low cost” LASIK surgery. Discount surgery is as good as a discount parachute. The potential savings are not worth the risk of receiving less than expert care!

7. Expect to see very well after LASIK, but don't expect to see perfectly. Each patient gets a slightly different result. The best surgeon in the world can’t guarantee 20/20 vision. As with any eye laser surgery, results are as individual as each patient. Beware of any doctor who promises 20/20 vision.

8. If you feel like you're getting a hard sell, you probably are. Go elsewhere. You're not buying a car; this is real LASIK eye surgery.

9. If your level of nearsightedness is more than -11 or so, implantable lenses will probably offer better vision than LASIK. Consider waiting until the new lenses are available. Ask your doctor about them and other recent advances.

10. While you investigate, don't lose sight of the benefits: for most people a lifetime of bad vision can be cured in 5 minutes. LASIK eye surgery has improved the eyesight of millions of people around the world.

About The Author

Robert K. Maloney

Dr. Maloney is director of the Maloney Vision Institute, located at 10921 Wilshire Boulevard, Suite 900, Los Angeles, California 90024, 1-877-EYESIGHT. For more information about LASIK surgery, visit www.maloneyvision.com.

A Day in the Life of a LASIK Procedure

2005-10-30T23:54:00.000-08:00

Here is an interesting article that will prove to be helpful for anyone considering Lasik surgery. It follows a patients journey as he undergoes a Lasik procedure.

A Day in the Life of a LASIK Procedure
By Jay Stockman Platinum Quality Author

It is 9:00am, I must get up, I have been waiting for this day my entire life. As far as I can remember I have needed glasses, not the kind that would flatter a person, the kind that would bring pity to the faces of strangers who looked at me. I mean, my glasses where thick! . This is the day I am going to have LASIK. LASIK is an acronym for laser assisted in situ keratomileusis, which refers to creating a flap in the cornea with a microkeratome and using a laser to reshape the underlying cornea. I have done the research, I have met with the surgeon, there is no turning back, its almost show time.

On my way to the doctor’s office, my mind is racing, am I making the right decision? Will I experience the debilitating side effects that others have warned me about? My journey originally began at my eye doctor’s office, who does not perform LASIK. I asked him for a referral, and he suggested a local Ophthalmologist. An Ophthalmologist is a Medical Doctor who is licensed to perform LASIK procedures, after additional LASIK-specific training. After an extensive checking of his credentials, and experience, this was going to be my LASIK doctor.

I finally arrive, and a very friendly, and helpful staff greets me, and assures me that this procedure will be painless, and quick. Easy for them to say, they all probably have perfect vision. My name is called; I proceed to a cold, large room, which looks like a scene from the movie Independence Day. My hour of reckoning is here, I think about going blind, what I would miss most. I have to start thinking positive thoughts. I briefly meet with the Surgical Counselor who explains to me the different steps I am about to go through. He asks me if I require a sedative, I tell him a Bombay Sapphire Martini would do just fine. He reminds me it is 10:00 am in the morning. I opt out of taking any sedative; I want to be awake for the entire procedure. With this, in walks his royal highness, THE LASIK SURGEON.

I lay down on what is referred to as the treatment bed, a bit hard, but totally acceptable. The surgeon places drops in both of my eyes, within seconds my eyes feel very heavy, and numb. He assures me this is normal, and will not affect my brain. He starts on the right eye first, he places clamps under my eyelids to keep them wide open. My heart is racing; I want to cry out for my mommy. Next he places a contraption on my eye, that he calls a keratome, the instrument that will be used to create the cornea “flap”. At this point, I only feel some pressure on my eye, absolutely no pain. His assistant is constantly pouring artificial tears in my eyes to keep them wet since I cannot blink. I am now directed to focus on a red fixation light, which I do obediently. The surgeon activates the keratome, I hear a noise my cornea is being sliced like a bologna, and I still feel no pain. Next the laser is activated, I smell something like burning hair, again no pain, just pressure. Within minutes the surgeon is finished with the right eye, on to the left. The entire procedure lasted about 20 minutes. That is it!

My procedure is over, and I am in recovery. I am almost in tears, I open my eyes, and for the first time in my life I have VISION, a bit cloudy, but vision nonetheless. I am overwhelmed at this point. The LASIK surgeon walks in, checks me briefly, and informs me everything went well. I wanted to hug and kiss him, however there is a time and place for everything. I am given some drops, and instructions, and within 24 hours of surgery I am back at work. Absolutely amazing, how quick the recovery period was. My vision at this point is cloudy, and I am told this is normal, since the cornea is still swollen.

Six weeks have passed, and I am doing great. The vision in my right eye is 20/20, my left is 20/25 all with no glasses, or correction. The cloudiness is completely eliminated, I still have a noticeable glare at night, but far from debilitating. There is no dryness in my eyes at all, and I rarely use lubricating drops. I am completely satisfied with my entire experience, and highly recommend it to any potential candidate.

Jay B Stockman is a contributing editor for The Contact Lens Resource Visit http://1contactlenses.com/ for more information.

Article Source: http://EzineArticles.com/

LASIK FAQS

2005-10-25T16:42:00.000-07:00

LASIK FAQS
Q: Can you refer me to a good LASIK surgeon in my area? A: Refer to the Other Resources section of this site. You may want to contact the organizations listed there for additional information. While FDA regulates medical devices and drugs, FDA does not regulate the practice of medicine and does not have a registry of doctors. FDA does not know of any government agency that can provide a referral for any medical procedure. You may want to go to your library and see if there is a local community services magazine that may provide comparison information of services for doctors in your area. Q: How do I report a bad experience or who do I notify about a 'bad' doctor? A: If you had a bad experience or sustained an injury, you should file a voluntary MedWatch report (1-800-FDA-1088) to the FDA. Also, you could contact your state medical licensing board and file a complaint with them. In addition, you could contact your state health department or consumer complaint organization (e.g., Better Business Bureau). Q: How much does LASIK cost? A: The FDA regulates the safety and effectiveness of medical devices for their intended use. The FDA does not regulate the marketing of or any fees associated with the use of that product. Again, you may want to go to your library and see if there is a local community services magazine that may provide comparison information of services for doctors in your area. Q: How can I find out if a particular laser has been approved to treat my refractive error (nearsightedness, farsightedness and/or astigmastism)? A: You can find approved devices, their approval date, and a synopsis of the approved indications on the FDA-APPROVED LASERS page. Q: If the laser I am interested in has not yet been approved for a particular indication, how can I find out when it will be approved? A: Confidentiality restrictions prohibit FDA from commenting on the status of a device under regulatory review, but you can try asking the laser company for this information. Q: Which laser is the best for treating my refractive error? A: FDA does not provide comparisons between refractive lasers. FDA approves the safety and effectiveness of a device independent of any other product. However, you are encouraged to review the approval documents to assess the capabilities of specific laser systems and make your own comparisons. The approval number for each laser on the FDA-APPROVED LASERS page is linked to these documents, which provide additional, detailed information about the clinical trial results and indications for use. Discuss any concerns you may have with your doctor.
Q: How does wavefront LASIK compare to conventional LASIK? A: Wavefront adds an automatic measurement of more subtle distortions (called higher order aberrations) than just nearsightedness, farsightedness, and astigmatism corrected by conventional LASIK. However, these “higher order aberrations” account for only a small amount (probably no more than 10%) of the total refractive error of the average person’s eye. Conventional LASIK increases higher order aberrations. Although wavefront-guided treatments attempt to eliminate higher order aberrations, results from the clinical studies have shown that the average aberrations still increase, but less than they do after conventional LASIK. In a few studies comparing wavefront-guided LASIK to conventional LASIK, a slightly larger percentage of subjects treated with wavefront LASIK achieved 20/20 vision without glasses or contact lenses compared to subjects treated with conventional LASIK. Patient selection (“When is LASIK not for me?”) and the experience and competence of the surgeon are still the most important considerations. Q: What percentage of patients attain 20/20 vision or better without glasses or contacts? A: Data in the Approval Orders and related documents summarizes the outcomes from the clinical trials submitted to the FDA for each approved device. Links to these documents are included on the FDA-APPROVED LASERS page. Q: Can you send me more information or respond to my concern? A: No. The most current information we have about LASIK is on this website and we update it routinely. We do not have the resources to respond directly to patient concerns or questions. We encourage you to discuss these matters with your doctor. Q: Can I use information from the FDA LASIK website? A: Yes. Information on this website can be used freely by the public. Any use on other websites or in publications should be properly cited.
Source: fda.gov

LASIK Laser Eye Surgery

2005-10-24T02:10:00.000-07:00

LASIK is eye surgery done with a laser to help you see better. The laser makes tiny cuts that change the shape of the clear cover over the eye, the cornea. If done right, it can reduce a person's need for glasses or contact lenses.
Most patients are very pleased with the results. But there are risks, as with all surgery.
Is LASIK right for me?
Things to think about ...
• Find the right doctor.
• Cost -- Most medical insurance will not pay for this surgery.
• LASIK won't work well if your sight changes often. Have you needed a change in your contact lenses or glasses in the past year? Vision changes are more likely if you are:
o In your early 20s
o Diabetic or have certain other diseases
o Pregnant or breast-feeding
o Taking medicines that cause vision changes, such as steroids
• Laser eye surgery is not a good choice for people who do contact sports. Examples: boxing, wrestling, martial arts
• Laser surgery is not approved for anyone under age 18.
• Some jobs do not allow workers to have certain kinds of eye surgery. Check with your boss to make sure.
Things Your Doctor Must Look for Before Surgery
Your doctor needs to find out if you have any of these conditions:
• Past or current eye diseases, such as glaucoma and ocular hypertension.
• Eye injuries or other laser eye surgery.
• Large pupils, thin corneas, or dry eyes.
If You Choose LASIK
Before surgery:
• Your doctor should give you an informed consent form. Read and understand
• it. Get answers to all your questions.
• Have a detailed eye exam.
• Plan not to drive or work right after the surgery.
After surgery:
• Take at least two days off work to rest and get better.
• You will have some pain for a few days.
• You will not be able to see clearly for a few days. Final results could take months.
To Report a Problem
The FDA controls the sale of the lasers used for LASIK. If you have a problem with LASIK eye surgery, first speak with your doctor. Then report the problem to FDA's MedWatch program at 1-800-332-1088. Or visit www.fda.gov and click on "MedWatch" (Medical Product Reporting/Safety Information.)
Finding the Right Doctor is Very Important
Ask these questions before choosing a doctor:
Experience: How many LASIK eye surgeries has this doctor done with the same laser?
Equipment: Does this doctor use an FDA-approved laser?
Information: Does this doctor take the time to answer all your questions? Do you feel at ease giving and getting information with this doctor?
To Learn More
Call the FDA Center for Devices and Radiological Health web site at 1-888-463-6332.
Or visit www.fda.gov/cdrh/lasik.
U.S. Food and Drug Administration
Office of Women's Health
October 2003

Types of Eye Procedures

2005-10-24T02:00:00.000-07:00

Radial Keratotomy (RK)/Astygmatic Keratotomy (AK) reshapes the cornea by creating linear incisions in the peripheral cornea with a surgical knife. These incisions relax the peripheral wall of the cornea, resulting in a secondary change which flattens the curvature of the central cornea.

Photorefractive keratectomy (PRK) is one of two FDA approved procedures for reshaping the cornea. An excimer laser uses an ultraviolet wavelength to deliver pulses of energy that remove a small disc shaped sliver of the central cornea. To accomplish this treatment, the surface layer of the cornea must be also be removed, but it grows back in place within a few days after the surgery.

Laser In-situ Keratomileusis (LASIK) is a procedure almost identical to PRK, in that the same small sliver of the central cornea is removed using the identical excimer laser. LASIK differs from PRK in what is done with the surface layer of the cornea. Instead of removing it, a special surgical blade is used to create a flap that can be lifted up to expose the part of the cornea that will be treated with the laser. After the laser treatment has been performed, the flap is laid back down on the cornea, thereby eliminating the need for the surface layer to grow back in place.

Clear lens extraction/Intraocular contact lenses are procedures that either; 1) remove the patient?s native lens and replace it with one an artificial lens of different refractive power, or 2) add an artificial lens within the eye altering the overall refractive power of the eye.

Intracorneal rings are surgical implants that can be inserted into the peripheral cornea in order to change its shape.

What is refractive surgery?

2005-10-24T01:57:00.000-07:00

Corneal refractive surgical procedures change the shape of the cornea to correct myopia (near sightedness), hyperopia (far sightedness), and most forms of astigmatism (irregular curvature of the cornea).The various types of procedures differ in how they actually change the shape of the cornea. Laser refractive surgery uses the excimer laser to reshape the cornea. Incisional refractive surgery is performed by placing incisions in the cornea with a blade or knife. For the most part, Laser refractive surgery has supplanted incisional surgeries due to improved outcomes and safety. These procedures offer the potential to reduce or eliminate the need for glasses and contact lens. It should be noted that in most cases these procedures do not correct presbyopia, which is the need to wear glasses for reading after middle age."

Laser Eye Surgery: Is It Worth Looking Into?

2005-10-24T01:54:00.000-07:00

Laser Eye Surgery: Is It Worth Looking Into?

by Carol Lewis

For Jeri Goldstein everything was a blur. Without her contact lenses she couldn't distinguish people, the scenes on television, the stars at night, and, generally, the world at large. Then, in March 1998, the 49-year-old California resident had eye surgery, and all that changed.

"After wearing contact lenses for 35 years, you can't imagine the freedom I felt," says Goldstein.

Goldstein underwent refractive eye surgery, an elective procedure intended to correct common eye disorders, known as refractive errors, such as myopia (nearsightedness), hyperopia (farsightedness), and astigmatism (distorted vision). Although there are several types of surgical techniques being performed today to correct refractive errors, laser refractive correction is fast becoming the most technologically advanced method available, according to the American Academy of Ophthalmology in San Francisco. Doctors say it allows for an unparalleled degree of precision and predictability.

"Laser surgery is the most exciting advancement in ophthalmology," says James J. Salz, M.D., clinical professor of ophthalmology at the University of Southern California in Los Angeles and the doctor who performed Goldstein's surgery. But surprisingly, he says, despite its sudden popularity, "only 20 percent of ophthalmologists in the United States today are trained in its operation."

The Food and Drug Administration first approved the excimer laser in October 1995 for correcting mild to moderate nearsightedness. With that approval, the agency also restricted use of the laser to practitioners trained both in laser refractive surgery and in the calibration and operation of the laser. Currently, the excimer laser is only approved for use in a procedure called photorefractive keratectomy (PRK).

Precision Surgery

PRK is an outpatient procedure generally performed with local anesthetic eye drops. This type of refractive surgery gently reshapes the cornea by removing microscopic amounts of tissue from the outer surface with a cool, computer-controlled ultraviolet beam of light. The beam is so precise it can cut notches in a strand of human hair without breaking it, and each pulse can remove 39 millionths of an inch of tissue in 12 billionths of a second. The procedure itself takes only a few minutes, and patients are typically back to daily routines in one to three days.

Before the procedure begins, the patient's eye is measured to determine the degree of visual problem, and a map of the eye's surface is constructed. The required corneal change is calculated based on this information, and then entered into the laser's computer.

Since 1995, two laser systems have been approved by FDA to treat mild to moderate nearsightedness and mild to moderate astigmatism with PRK: The SVX Apex excimer laser, manufactured by Summit Technology of Waltham, Mass., and the VISX excimer laser, manufactured by VISX Inc., of Santa Clara, Calif. FDA also has approved the VISX system to treat high myopia.

According to FDA's Center for Devices and Radiological Health, clinical studies showed that about 5 percent of patients continued to always need glasses following PRK for distance, and up to 15 percent needed glasses occasionally, such as when driving. In addition, many patients experienced mild corneal haze following surgery, which is part of the normal healing process. The haze appeared to have little or no effect on final vision, and could only be seen by a doctor with a microscope. Some patients experienced glare and halos around lights. These conditions, however, diminished or disappeared in most patients in six months. For about 5 percent of patients, however, best-corrected vision without corrective lenses was slightly worse after surgery than before. In view of these findings, FDA and the Federal Trade Commission (which oversees advertising) issued a letter to the eye-care community in May 1996 warning that unrealistic advertising claims, such as "throw away your eyeglasses," and unsubstantiated claims about success rates could be misleading to consumers.

What About LASIK?

A more complex procedure than PRK is laser in-situ keratomileusis, or LASIK. Performed for all degrees of nearsightedness, it is still in clinical trials and not yet approved by FDA. The surgeon uses a knife called a microkeratome to cut a flap of corneal tissue, removes the targeted tissue beneath it with the laser, and then replaces the flap.

"With LASIK, the skill of the surgeon is important because he'll be making an incision," says Stephen Crawford, O.D., an optometrist practicing in Virginia, "compared to the PRK method where the machine does more of the work." Crawford urges people to find qualified, experienced doctors to perform this surgery. "You'll want someone who's done a number of LASIK procedures since this is a surgeon-dependent operation," he said.

According to Ken Taylor, O.D., vice president of Arthur D. Little, Inc., a technology and management consultant firm in Cambridge, Mass., "Last year, across the country, 40 to 45 percent of refractive surgeries performed by physicians were LASIK, which equates to approximately 80,000 procedures." Doctors not participating in clinical trials may choose to use the approved laser to perform LASIK procedures at their discretion, says Morris Waxler, Ph.D., chief of FDA's diagnostic and surgical devices section. But such uses are considered "off label" and are not regulated by FDA.

Ralph A. Rosenthal, M.D., director of FDA's division of ophthalmic devices, says, "The agency has ruled that individual physicians can perform LASIK under the general 'practice of medicine,' if it's in the patient's best interest."

Advantages of LASIK

Some doctors believe that LASIK is a suitable procedure for correcting the most severe refractive errors. They also say that there is generally a faster recovery time after LASIK than after PRK. In addition, LASIK patients can see well enough to drive immediately and have good vision within a week.

After studying the options, Goldstein first decided on the LASIK procedure, but was surprised to learn that her doctor advised against it.

"Initially, I wanted the quick recovery that LASIK offers," Goldstein says, "but the bottom line was, which surgery will give me the best results, and after considering everything, eventually we agreed on PRK."

James Salz is currently involved in an FDA-sanctioned clinical trial at Cedars-Sinai Medical Center in Los Angeles, which is now studying the laser system specifically for farsightedness (hyperopia) with astigmatism. Although routinely performing laser eye surgery, he still encourages a small percentage of his low to moderately nearsighted patients to undergo radial keratotomy, or RK, an earlier refractive correction procedure that does not require the excimer laser.

With RK, incisions are made in a "radial" pattern along the outer portion of the cornea using a hand-held blade. These incisions are designed to help flatten the curvature of the cornea, thereby allowing light rays entering the eye to properly focus on the retina. The number and length of the incisions determines the degree of correction attained.

"Typically, this is still a practiced procedure for select people with very small corrections of myopia," Salz says.

Conversely, Crawford says that although he will mention RK as an option to his patients considering eye surgery, he is not in favor of this method. He says studies indicate that incisions made during this procedure, which penetrate approximately 90 percent of the cornea, appear to weaken the structure of the eye. Also, once you've had RK done you can't repeat it or have PRK done.

"I think that patients should understand and consider all available options for correcting refractive errors," Crawford says, "but I would never recommend RK to anyone."

Is Laser Surgery for You?

For some, like Goldstein, laser surgery has been the ultimate freedom from the everyday hassles of contact lenses, and a second chance at having normal eyesight. But can everyone expect such dramatic results?

"The answer is no," says Rosenthal. "It's not a foolproof procedure and people need to know that some can end up with worse eyesight than before they went in."

Mary Ann Duke, M.D., a general ophthalmologist practicing in Potomac, Md., adds that there are other reasons why the expectations for laser surgery vary from person to person.

"People who are slow healers or who have ongoing medical conditions [such as glaucoma or diabetes] are not good candidates for laser surgery," she says. "That's why it's so important for patients to undergo a thorough examination with their doctor."

Poor candidates for this surgery also include those with uncontrolled vascular disease, autoimmune disease, or people with certain eye diseases involving the cornea or retina. Pregnant women should not have refractive surgery of any kind because the refraction of the eye may change during pregnancy.

Looking Ahead

At present, a number of other lasers for eye surgery are currently being tested in FDA-sanctioned studies to determine their safety and effectiveness. Investigational Device Exemptions (IDEs) filed with FDA allow for clinical studies involving the excimer laser and the correction of farsightedness. The IDE process is designed to investigate the safety and effectiveness of a device, or a new procedure with an already approved device, either to obtain information for publication or to generate the data needed to obtain marketing approval from FDA. Currently, neither the Summit nor the VISX lasers have been approved for correcting farsightedness.

"If the refractive surgery center says the laser is approved by FDA, it probably is," Waxler concludes. "Still, it is wise for consumers to check that the device being used for their surgery is FDA-approved," he says, or that they make sure they are being treated with a laser that is under study in an FDA-sanctioned clinical trial.

During the first few weeks immediately following laser surgery, Goldstein says, "Every week I kept thinking, 'this is as good as it gets'?" Then, she discovered by the sixth week, as predicted by her surgeon, that her eyesight was noticeably better and eventually stabilized.

"I would tell others to be patient about their expected outcome," she advises. "Even though with LASIK you can expect quicker results, I'm happy with the choice of PRK."

Carol Lewis is a staff writer for FDA Consumer.

Are You a Candidate for Laser Eye Surgery?

You may be a good candidate for laser eye surgery if you:

* are at least 21 years of age for a Summit laser or 18 years of age for a VISX laser, since the eyes are still growing to this point
* have healthy eyes that are free from retinal problems, corneal scars, and any eye disease (refractive errors are considered eye disorders, not diseases)
* have mild to moderate myopia (nearsightedness) within the range of treatment (see your doctor to determine your range)
* have a way to pay for the treatment since laser procedures are costly and probably not covered by health insurance policies
* are fully informed about the risks and benefits of laser surgery compared with other available treatments.

--C.L.

Frequently Asked Questions About Laser Eye Surgery

Is it painful?
There is little if any discomfort during surgery because the cornea and eye are anesthetized by drops. Some patients experience a "scratchy feeling." After the anesthetic wears off, the amount of discomfort varies with each individual, but any irritation is minor and usually disappears within a few hours. You may be sensitive to light for a few days.
When will I be able to return to work?
Most people can return to work one to three days following surgery, but a rule of thumb is to wait until you feel up to it. Most return to normal activities as soon as the day after surgery.
What are the side effects and risks?
The most common side effects are a halo effect and some glare at night around lights.
(See "What Are the Risks of Laser Surgery?")
How long does the treatment take?
Laser treatment itself takes only about 15 to 40 seconds, based on the degree of correction necessary. Recovery is minimal, and usually the patient is able to be driven home after about 30 minutes. Typically, you will notice improved sight in 3 to 5 days following treatment.
Is the treatment permanent?
According to the results of the U.S. clinical trials and results reported internationally, the treatment appears to be permanent. As people age, however, their eyes change and re-treatment may be necessary.
Are there any activity restrictions following surgery?
Following surgery, do not rub your eyes. Other than that, patients can do whatever they feel up to as long as they follow their doctors' instructions.
What if I move my head during surgery?
This is the number one question that patients ask when undergoing laser treatment. The surgeon is skilled in the technique of removing his foot from the pedal that controls the ultraviolet beam as soon as a patient moves his or her head. This allows him to realign the beam with the corneal "target" and proceed with the surgery.

--C.L.

The Insight on Eyesight
diagram of the eye

In order to decide whether laser vision correction is a viable option for you, it is important to first understand how the eye works and why people need glasses or contact lenses to see well.

The eye works much like a camera; its primary function is to focus light. For the eye to see, light rays must be bent or "refracted" to meet at a single point through the cornea, the clear window at the front of the eye that provides most of the focusing power. Light then travels through the lens, where it is fine-tuned to focus properly on the retina, the nerve layer that lines the back of the eye and connects to the brain. The retina acts like the film in a camera, and clear vision is achieved only if light from an object is precisely focused onto it. If the light focuses either in front of or behind the retina, the image you see is blurred. A refractive error means that the shape of eye structures does not properly bend the light for focusing.

Having 20/20 vision means seeing at 20 feet what a normal person sees at 20 feet. However, if vision is measured at 20/40, it means a person has to walk up to 20 feet to see the same size letter that someone with 20/20 vision could see at 40 feet. And so on. People whose best-corrected visual acuity (what they see using glasses or contact lenses) is less than 20/200 in the better eye are considered legally blind, even though they still have enough vision to get around. Prior to laser surgery, Jeri Goldstein's visual acuity without her contact lenses was measured at 20/400 in her right eye and 20/200 in the left eye. Following surgery, her eyesight without contacts stands at 20/25 and 20/20, respectively.

--C.L.

What Are the Risks of Laser Surgery?

The risks outlined below apply to both PRK and LASIK procedures. The chances of having a serious vision-threatening complication are minimal, and there have been no reported cases of blindness following either PRK or LASIK, says James Salz, M.D., clinical professor of ophthalmology. However, FDA is aware of a few instances of severe eye injury requiring corneal transplant.

Infection and delayed healing: There is about a 0.1 percent chance of the cornea becoming infected after PRK, and a somewhat smaller chance after LASIK. Generally, this means added discomfort and a delay in healing, with no long-term effects within a period of four years.

Undercorrection/Overcorrection: It is not possible to predict perfectly how your eye will respond to laser surgery. As a result, you may still need corrective lenses after the procedure to obtain good vision. In some cases, a second procedure can be done to improve the result.

Decrease in Best-Corrected Vision: After refractive surgery, some patients find that their best obtainable vision with corrective lenses is worse than it was before the surgery. This can occur as a result of irregular tissue removal or the development of corneal haze.

Excessive Corneal Haze: Corneal haze occurs as part of the normal healing process after PRK. In most cases, it has little or no effect on the final vision and can only be seen by an eye doctor with a microscope. However, there are some cases of excessive haze that interferes with vision. As with undercorrections, this can often be dealt with by means of an additional laser treatment. The risk of significant haze is much less with LASIK than with PRK.

Regression: In some patients the effect of refractive surgery is gradually lost over several months. This is like an undercorrection, and a re-treatment is often feasible.

Halo Effect: The halo effect is an optical effect that is noticed in dim light. As the pupil enlarges, a second faded image is produced by the untreated peripheral cornea. For some patients who have undergone PRK or LASIK, this effect can interfere with night driving.

Flap Damage or Loss (LASIK only): Instead of creating a hinged flap of tissue on the central cornea, the entire flap could come off. If this were to occur it could be replaced after the laser treatment. However, there is a risk that the flap could be damaged or lost.

Distorted Flap (LASIK only): Irregular healing of the corneal flap could create a distorted corneal shape, resulting in a decrease of best-corrected vision.

Incomplete Procedure: Equipment malfunction may require the procedure to be stopped before completion. This is a more significant factor in LASIK, with its higher degree of complexity, than in PRK.

Problems with a Perfect Procedure: Even when everything goes perfectly, there are effects that might cause some dissatisfaction. Older patients should be aware that they can't have both good distance vision and good near vision in the same eye without corrective lenses. Some myopic patients rely on their myopia (by taking off their glasses, or by wearing a weaker prescription) to allow them to read. Such a patient may need reading glasses after the myopia is surgically corrected. Another consideration is the delay between eye treatments. If one eye is being done at a time, then the eyes may not work well together during the time between treatments. If a contact lens is not tolerated on the unoperated eye, work and driving may be awkward or impossible until the second eye has been treated.

--C.L.

source: FDA Consumer magazine (July-August 1998)

Basik Lasik: Tips on Lasik Eye Surgery

2005-10-24T01:52:00.000-07:00

If you're tired of wearing glasses or contact lenses, you may be considering Lasik eye surgery — one of the newest procedures to correct vision problems. Before you sign up for the surgery, get a clear picture of what you can expect.
The Facts
• Lasik is surgery to a very delicate part of the eye.
• Hundreds of thousands of people have had Lasik, most very successfully.
• As with any surgery, there are risks and possible complications.
• Lasik may not give you perfect vision. The American Academy of Ophthalmology (AAO) reports that seven out of 10 patients achieve 20/20 vision, but 20/20 does not always mean perfect vision.
• If you have Lasik to correct your distance vision, you'll still need reading glasses around age 45.
• Lasik surgery is too new to know if there are any long-term ill effects beyond five years after surgery.
• Lasik surgery cannot be reversed.
• Most insurance does not cover the surgery.
• You may need additional surgery — called "enhancements" — to get the best possible vision after Lasik.

Understanding Your Eyes
To see clearly, the cornea and the lens must bend — or refract — light rays so they focus on the retina — a layer of light-sensing cells that line the back of the eye. The retina converts the light rays into impulses that are sent to the brain, where they are recognized as images. If the light rays don't focus on the retina, the image you see is blurry. This is called a refractive error. Glasses, contacts and refractive surgery attempt to reduce these errors by making light rays focus on the retina.
Refractive errors are caused by an imperfectly shaped eyeball, cornea or lens, and are of three basic types:
• myopia — nearsightedness; only nearby objects are clear.
• hyperopia — farsightedness; only objects far away are clear.
• astigmatism — images are blurred at a distance and near.
There's also presbyopia — "aging eye." The condition usually occurs between ages 40 and 50, and can be corrected with bifocals or reading glasses.
Are You a Good Candidate for Lasik?
Lasik is not for everyone.
• You should be at least 18 years old (21 for some lasers), since the vision of people younger than 18 usually continues to change.
• You should not be pregnant or nursing as these conditions might change the measured refraction of the eye.
• You should not be taking certain prescription drugs, such as Accutane or oral prednisone.
• Your eyes must be healthy and your prescription stable. If you're myopic, you should postpone Lasik until your refraction has stabilized, as myopia may continue to increase in some patients until their mid- to late 20s.
• You should be in good general health. Lasik may not be recommended for patients with diabetes, rheumatoid arthritis, lupus, glaucoma, herpes infections of the eye, or cataracts. You should discuss this with your surgeon.
• Weigh the risks and rewards. If you're happy wearing contacts or glasses, you may want to forego the surgery.
• Understand your expectations from the surgery. Are they realistic?
• Ask your doctor if you're a candidate for monovision — correcting one eye for distance vision and the other eye for near vision. Lasik cannot correct presbyopia so that one eye can see at both distance and near. However, Lasik can be used to correct one eye for distance and the other for near. If you can adjust to this correction, it may eliminate or reduce your need for reading glasses. In some instances, surgery on only one eye is required. If your doctor thinks you're a candidate, ask about the pros and cons.
Finding a Surgeon
Only ophthalmologists (Eye MDs) are permitted to perform Lasik. Ask your Eye MD or optometrist for a referral to an Eye MD who performs Lasik. The American Academy of Ophthalmology website (www.eyenet.org) feature "Find an Eye MD" can provide you with a list of their members who perform Lasik. Ninety-five percent of all ophthalmologists (Eye MDs) are Academy members. Also, the International Society of Refractive Surgery website (www.LocateAnEyeDoc.com) will provide you with names of refractive surgeons.
Ask your surgeon the following questions:
1. How long have you been doing Lasik surgery?
2. How much experience do you have with the Lasik procedure?
3. How do you define success? What's your success rate? What is the chance for me (with my correction) to achieve 20/20? How many of your patients have achieved 20/20 or 20/40 vision? How many patients return for enhancements? In general 5-15% return.
4. What laser will you be using for my surgery? Make sure your surgeon is using a laser approved by the U.S. Food and Drug Administration (FDA). As of this publication's printing, the FDA has approved five lasers for Lasik; they are manufactured by VISX, Summit, Bausch and Lomb, Nidek and ATC. Contact the FDA for updates.
5. What's involved in after-surgery care?
6. Who will handle after-surgery care? Who will be responsible?
7. What about risks and possible complications?
Risks and Possible Complications
Before the surgery, your surgeon should explain to you the risks and possible complications, and potential side effects, including the pros and cons of having one or both eyes done on the same day. This is the "informed consent" process. Some risks and possible complications include:
• Over- or under-correction. These problems can often be improved with glasses, contact lenses and enhancements.
• Corneal scarring, irregular astigmatism (permanent warping of the cornea), and an inability to wear contact lenses.
• Corneal infection.
• "Loss of best corrected visual acuity" — that is, you would not be able to see as well after surgery, even with glasses or contacts, as you did with glasses or contacts before surgery.
• A decrease in contrast sensitivity, "crispness," or sharpness. That means that even though you may have 20/20 vision, objects may appear fuzzy or grayish.
• Problems with night driving that may require glasses.
• Flap problems, including: irregular flaps, incomplete flaps, flaps cut off entirely, and ingrowth of cells under the flap.
The following side effects are possible, but usually disappear over time. In rare situations, they may be permanent.
• Discomfort or pain
• Hazy or blurry vision
• Scratchiness
• Dryness
• Glare
• Haloes or starbursts around lights
• Light sensitivity
• Small pink or red patches on the white of the eye
Surgery: What to Expect Before, During and After
Before: You'll need a complete eye examination by your refractive surgeon. A preliminary eye exam may be performed by a referring doctor (Eye MD or optometrist). Take your eye prescription records with you to the exams. Your doctor should:
• Dilate your pupils to fine-tune your prescription.
• Examine your eyes to make sure they're healthy. This includes a glaucoma test and a retina exam.
• Take the following measurements:
o The curvature of your cornea and your pupils. You may be rejected if your pupils are too large.
o The topography of your eyes to make sure you don't have an irregular astigmatism or a cone-shaped cornea — a condition called Keratoconus.
o The pachymetry — or thickness — of your cornea. You need to have enough tissue left after your corneas have been cut and reshaped.
• Ask you to sign an informed consent form after a thorough discussion of the risks, benefits, alternative options and possible complications. Review the form carefully. Don't sign until you understand everything in the form.
• If your doctor doesn't think Lasik is right for you, you might consider getting a second opinion; however, if the opinion is the same, believe it.
If you qualify for surgery, your doctor may tell you to stop wearing your contact lenses for a while before the surgery is scheduled because contacts can temporarily change the shape of the cornea. Your cornea should be in its natural shape the day of surgery. Your doctor also may tell you to stop wearing makeup, lotions or perfume for a few days before surgery. These products can interfere with the laser treatment or increase the risk of infection after surgery.
During: Lasik is an outpatient surgical procedure. The only anesthetic is an eye drop that numbs the surface of the eye. The surgery takes 10 to15 minutes for each eye. Sometimes, both eyes are done during the same procedure; but sometimes, surgeons wait to see the result of the first eye before doing the second eye.
The Surgical Procedure: A special device cuts a hinged flap of thin corneal tissue off the outer layer of the eyeball (cornea) and the flap is lifted out of the way. The laser reshapes the underlying corneal tissue, and the surgeon replaces the flap, which quickly adheres to the eyeball. There are no stitches. A shield — either clear plastic or perforated metal — is placed over the eye to protect the flap.
After: Healing is relatively fast, but you may want to take a few days off after the surgery. Be aware that:
• You may experience a mild burning or sensation for a few hours after surgery. Do not rub your eye(s). Your doctor can prescribe a painkiller, if necessary, to ease the discomfort.
• Your vision probably will be blurry the day of surgery, but it will improve considerably by the next day when you return for a follow-up exam.
• If you experience aggravating or unusual side effects, report them to your doctor immediately.
• Do not drive until your vision has improved enough to safely do so.
• Avoid swimming, hot tubs and whirlpools for two weeks after surgery.
Alternatives to Lasik
You may want to discuss some surgical alternatives to Lasik with your eye doctor:
• Photorefractive keratectomy (PRK) is a laser procedure used to reduce myopia, hyperopia and astigmatism without creating a corneal flap.
• Astigmatic keratotomy (AK) is an incisional procedure to reduce astigmatism.
• Intrastromal corneal rings are clear, thin, polymer inlays placed on the eye to correct low myopia only.
For More Information
For more information about vision correction procedures, contact:
American Academy of Ophthalmology, P.O. Box 7424, San Francisco, CA 94120-7424; www.eyenet.org
The AAO works to advance the lifelong learning and professional interests of ophthalmologists to ensure that the public can obtain the best possible eye care.
American Society of Cataract and Refractive Surgery, 4000 Legato Road, Suite 850, Fairfax, VA 22033; www.ascrs.org
The ASCRS works to raise the standards and skills of anterior segment surgeons through clinical and practice management education. The Society also works with patients, government and the medical community to promote delivery of quality eye care.
International Society of Refractive Surgery, 1180 Springs Centre So. Blvd. #116, Altamonte Springs, FL; www.LocateAnEyeDoc.com
The ISRS provides scientific research, knowledge and information to all individuals who are interested in refractive surgery.
National Eye Institute, 31 Center Drive MSC 2510, Bethesda, MD 20892-2510; 301-496-5248; www.nei.nih.gov
The NEI conducts and supports research on eye diseases and vision disorders, and offers free publications for the general public and patients.
Food and Drug Administration, 5600 Fishers Lane (HFE-88), Rockville, MD 20852; 1-888-463-6332; (301) 827-4420; www.fda.gov
The FDA oversees the safety of food, cosmetics, medicines, medical devices, and radiation- emitting products and provides information on contact lenses, intraocular lenses, refractive surgery, and corneal implants for myopia.

Learning About LASIK

2005-10-24T01:38:00.000-07:00

Learning About LASIK
LASIK is a surgical procedure intended to reduce a person's dependency on glasses or contact lenses. The goal of this Web site is to provide objective information to the public about LASIK surgery. See other sections of this site to learn about what you should know before surgery, what will happen during the surgery, and what you should expect after surgery. There is a glossary of terms and a checklist of issues for you to consider, practices to follow, and questions to ask your doctor before undergoing LASIK surgery.
LASIK stands for Laser-Assisted In Situ Keratomileusis and is a procedure that permanently changes the shape of the cornea, the clear covering of the front of the eye, using an excimer laser. A knife, called a microkeratome, is used to cut a flap in the cornea. A hinge is left at one end of this flap. The flap is folded back revealing the stroma, the middlesection of the cornea. Pulses from a computer-controlled laser vaporize a portion of the stroma and the flap is replaced. There are other techniques and many new terms related to LASIK that you may hear about.