Laser Vision Correction Surgery
The procedures offered at the Laser Vision Correction Center include:
- Femtosecond Laser Surgery
- LASIK (Laser Assisted In-Situ Keratomileusis)
- ASA (Advanced Surface Ablation)
- Phakic Intraocular Lenses
- Refractive/Clear Lens Exchange
- ICRS (Intracorneal Ring Segments)
- AK (Arcuate Keratotomy)
What is it?
Patients choosing cataract surgery at Massachusetts Eye and Ear may now elect to have laser-assisted cataract surgery with the femtosecond LensSx® Laser. The LensSx® Laser is an advanced technology, which enables surgeons to more precisely perform cataract surgery aided by a computer-controlled laser. It is also used to perform astigmatic keratotomy to help manage corneal astigmatism in patients. This technology requires both a physician and a technician to operate.
How does it work?
According to Alcon Surgical, the laser’s manufacturer, the LenSx® Laser offers a level of accuracy exceeding that of manual surgery methods. The surgeon uses the LenSx® Laser to first image the cornea and cataract in the eye to plan a procedure uniquely designed for the patient. The laser then dissects the cataract, creates the corneal incision and an opening to remove the cataract.
The femtosecond laser offers a level of precision not attainable with traditional surgical methods, and can be used, for example, to perform capsulotomy, one of the more challenging steps of cataract surgery. This procedure potentially reduces the risk of infection because the incision is more likely to self-seal. Additionally, femtosecond laser surgery requires less energy to break up the cataract and facilitates removal of the cataract. Mass. Eye and Ear is one of the few sites in New England to offer this advanced technology.
Mass. Eye and Ear’s Cornea Service and Comprehensive Ophthalmology and Cataract Consultation Service include 16 refractive and cataract surgery specialists who practice in Boston — at 243 Charles Street and at 800 Huntington Avenue in the Longwood Medical Area — as well as in Stoneham and Waltham. Femto-assisted cataract surgery is available at the 243 Charles Street location.
Medicare and private insurance typically cover some of the costs of laser-assisted cataract surgery. However, additional out-of-pocket expenses are involved, to cover the imaging and additional planning associated with the use of the laser as well as advanced technology lenses.
LASIK can correct varying degrees of nearsightedness (myopia), farsightedness (hyperopia), and astigmatism and is generally the treatment of choice for patients with high degrees of myopia or hyperopia. In LASIK surgery, the underlying surface of the cornea is reshaped with the laser, allowing light to be refocused and vision improved. LASIK surgery generally results in little or no post-operative pain and rapid recovery of vision.
a. Excimer Lasers, such as the ALLEGRETTO WAVE® or VISX CustomVue™, are used to produce beams of invisible ultraviolet light energy, and remove microscopic amounts of tissue in the eye; this process reshapes the curvature of the eye.
b. Femtosecond Lasers, such as the FS200 or the Intralase®, are an all laser approach to vision correction; they create thin flaps in the eye using short laser pulses. The flaps are then lifted from the eye's surface, and the curvature of the eye is corrected.
The convenience of LASIK (due to the quicker visual recovery and lack of post-operative pain) is what has made it a popular option for many patients. The need to create a corneal flap, however, adds a slightly increased risk to the surgery, and therefore some patients may be better served with PRK as opposed to LASIK.
There are a number of factors that doctors must evaluate before they can determine who is eligible for LASIK. Some doctors deem certain pre-existing conditions to be contraindications to the procedure and will not perform surgery if you possess them. Other conditions may complicate the surgery and increase your risk of having post-operative problems. Patients with these conditions need to have a thorough conversation with their doctors regarding eligibility and expectation levels.
LASIK improves the uncorrected vision -- one's visual capacity while not wearing corrective lenses -- in most patients who have the procedure. Over 90% of patients with low to moderate myopia achieve 20/40 or better vision (the level most states and provinces require for driving without glasses or contact lenses). Many patients can also expect to see better than 20/40 uncorrected. Some studies show that approximately 70% of patients may achieve 20/25, or better, uncorrected visual acuity following surgery. However, there are no guarantees that you will have perfect vision, and patients with high myopia (more than -7D) and high hyperopia (more than +4D) should have lower expectations. People who are most satisfied with the results of laser correction clearly understand the potential risks and complications of the surgery and possess realistic expectations of what their vision will be like following surgery.
The effects of LASIK are permanent and do not wear off over time. However, a person's eye can still change internally (even after refractive surgery) and this is why many surgeons recommend proceeding only if a stable prescription exists. For instance, LASIK is not recommended on children because their eyes change a great deal as they continue to grow. If the procedure is performed after the age of 18, the chance of long-term stable correction is more likely, although the eyes of patients over the age of 18 can still change. Patients should also note that while results are stable long-term, a mild regression of the laser effect may occur during the first few post-operative months. This occurs in approximately 10% of patients and if noted, may require an enhancement procedure if your doctor feels it to be appropriate.
ASA involves loosening skin cells in the eye and removing small amounts of eye tissue. The corneal surface is then treated with the laser.
a. PRK (Photorefractive Keratotomy) reshapes the cornea with an excimer laser beam that emits ultra violet light after removing the epithelial surface layers of the cornea.
b. LASEK (Laser Epithelial Keratomileusis) involves creating an epithelial sheet that is replaced after the PRK treatment. LASEK is a procedure that combines many of the advantages of LASIK and PRK in that there may be less discomfort than after PRK and it is indicated in situations where LASIK cannot be performed (such as thin cornea and irregular corneal contours by topography).
c. EpiLASIK uses a blunt blade to smoothly separate the epithelium from the cornea, creating a thin flap.
Phakic Intraocular Lenses are clear, implantable lenses that are surgically placed between the cornea and iris. The lenses allow light to focus on the retina, which causes clearer vision without glasses or contact lenses. The phakic intraocular lenses work from within the eye, unlike corrective lenses, which work from the surface of the eye.
a. Visian ICL™ intraocular lenses are made to remain in the eye for a lifetime. Visian ICL™ lenses are able to treat patients with thin corneas, dry eyes, and patients with extreme refractive errors.
Refractive/Clear Lens Exchange is typically performed on patients with high degrees of hyperopia (farsightedness). In this procedure, the eye's natural lens is replaced with an artificial, intraocular lens. This corrects refractive error and helps achieve sharper focus.
ICRS, also known as Intacs®, is currently only available to treat a specific low range of nearsightedness (myopia). Two, tiny crescents or arcs made of a transparent plastic material are placed in the outer periphery of the cornea. Once in place, the two arcs flatten the cornea so that light rays properly focus on the retina. Intacs® can be removed or replaced if vision changes.
AK reduces spherical error, and employs two arcuate incisions to reduce astigmatic error. Recovery is generally brief.
For more information on procedures and costs, please call 617-573-3234.