Commonly Asked Questions about Lasik Laser Vision Correction: Details about LASIK in Virginia

Explanatory Note: The goal of this section is to answer many of the questions that patients commonly have about LASIK laser vision correction. It should be noted, however, that every patient is unique. In an individualized LASIK consultation, Dr. Dressler will analyze your LASIK needs and circumstances and will help you make an informed decision. The LASIK consultation is free of charge.

What Distinguishes Dr. Dressler From Other Laser Vision Providers?

The only Harvard Medical School graduate in the D.C. area performing LASIK laser vision correction, Dr. Dressler brings her intelligence, surgical skills and LASIK experience to make LASIK successful and comfortable for her patients. Her skills and dedication to patient welfare have resulted in her being named a D.C.-area "top ophthalmologist" in surveys in both Washingtonian Magazine and Washington Consumer Checkbook’s Guide to Top Doctors, wherein local family physicians recommend the specialists they trust best. Dr. Dressler is a highly experienced, VISX-, Allegretto-, LADAR- and Intralase-certified laser vision correction surgeon, having performed more than 1,200 LASIK procedures.

Unlike some impersonal, mass-market LASIK operations in which the LASIK surgeon spends little time with the patient (sometimes only seeing the patient for the surgery itself), at Dressler Ophthalmology, an ophthalmologist (an eye physician/surgeon medical doctor) performs your LASIK care, including the important patient counseling, refractive evaluations and post-op follow-ups, which all contribute to the success of your procedure. (In LASIK, a precise refraction is fundamental in determining how to program the laser, thus making the accuracy of the refraction critical in obtaining an excellent result without the need for an enhancement.) Dressler Ophthalmology's expertise and painstaking refractions have resulted in a notably low enhancement rate: fewer than 2% of Dr. Dressler’s LASIK procedures have required an enhancement*. In contrast, in mass-market LASIK practices, the ophthalmologist typically uses the pre-operative measurements of an optometrist in programming the excimer laser (and the optometrist follows the patient post-operatively). It is noteworthy that the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery have issued a joint position paper raising serious objections about such arrangements.**

Moreover, unlike most mass-market LASIK practices, Dr. Dressler’s LASIK patients can remain patients in her ophthalmology practice after their LASIK procedure, for any of their general eye care needs if they so choose. Dr. Dressler believes that the LASIK surgeon’s willingness to enter into a long-term relationship with the patient shows that the surgeon truly believes that LASIK is the right procedure for the patient long-term. Furthermore, Dr. Dressler believes that it is beneficial for LASIK patients to be followed by an ophthalmologist who knows their eyes well, since the LASIK procedure leads to falsely low intraocular pressure readings and thus can make the subsequent detection of glaucoma somewhat more difficult.Return to Top of List

What Sort of Laser is used in LASIK?

A special excimer laser is used in LASIK laser vision correction. The excimer is an ultraviolet laser, which creates a non-thermal (cool) beam of laser light which can painlessly and precisely vaporize minute amounts of tissue in a process commonly referred to as "photoablation." A simple way to imagine how the laser works is to think of it as placing the curvature from your glasses or contact lenses onto the front surface of your eye.

The excimer laser is remarkably precise. It is able to remove 0.25 microns of tissue in a single pulse, which is 1/200th of the width of a human hair or 39 millionths of an inch, in 12 billionths of a second! Return to Top of List

How Long Does the Procedure Take? Does it Hurt?

LASIK generally takes about 5 to 7 minutes per eye. Numbing eyedrops are the only anesthesia used, and the procedure itself is generally painless, although you will feel some eyelid pressure from the eyelid speculum which holds your eyelid open throughout your surgery. Additionally, the microkeratome or the Intralaser laser flapmaker produces a "pressure" sensation for about 30 seconds. After the LASIK procedure, most patients experience some irritation, light sensitivity and watering of their eyes for a few hours. Usually this irritation is not too bothersome because patients are medicated with Alleve and Valium which causes most patients to be sleepy enough to take a three to four hour nap. When the patient awakes, he or she typically can comfortably watch TV. The next day, most LASIK patients are very comfortable and can return to normal activities. Return to Top of List

Will I Have Perfect Vision After the Procedure? Will I Still Need my Glasses?

Experience has shown that LASIK has been overwhelmingly successful in reducing myopia, astigmatism and hyperopia. The substantial majority of patients achieve 20/20 vision following their laser procedure. An independent study by the U.S. Navy has found that 97% of patients treated with Custom LASIK acquired 20/20 vision, versus 88% with conventional LASIK. Due to differential healing patterns among people and other factors, some patients will not achieve 20/20 vision. Patients may receive a free second procedure (an enhancement) to further improve their results if desired by the patient (and medically advisable). Dr. Dressler’s expertise and painstaking approach have resulted in a notably low enhancement rate: fewer than 2% of her LASIK procedures have required an enhancement*. The chance of needing an enhancement is less in patients with mild myopia and greater in patients with extreme myopia or hyperopia. Return to Top of List

Can Anyone Have it Done? Am I a Candidate?

In general, candidates for laser vision correction must meet the following requirements:
-- be 21 years of age or older;
-- have stable vision for the year prior to the procedure;
-- be free of certain diseases of the eye and certain systemic diseases;
-- have realistic expectations about the outcome of the procedure;
-- understand that complications, as in any surgical procedure, while rare, can result.

Every patient’s situation is unique and requires a (free) pre-procedure consultation. Return to Top of List

I’m Very Nearsighted. Is it Still Possible for Me to Have Laser Vision Correction?

With the approval by the U.S. Food and Drug Administration (FDA) of high myopia treatment, the overwhelming majority of nearsighted patients (well over 98% of patients) can now have LASIK to improve their distance vision. Return to Top of List

What about Treating Astigmatism?

Many patients have heard that astigmatism can’t be treated with the laser. Years ago this was true in the United States. However, treatment of astigmatism with the excimer laser has been FDA approved and generally yields excellent results. Return to Top of List

What about Treating Farsightedness?

Farsightedness can be treated now also, having received FDA approval in late 1998. Many people confuse farsightedness (hyperopia) with presbyopia. The laser does not treat presbyopia, which is the aging process of the internal lens of the eye that causes one to need reading glasses over the age of 40. Farsightedness occurs when one’s eyeball is too short, resulting in blurred distance vision and even blurrier near vision. Despite some popular misconceptions, farsighted eyes need vision correction to see distance images clearly. Return to Top of List

What if I Look Away for a Moment or Can’t Hold my Eyes Still for the Procedure?

Some patients worry about this, but the overwhelming majority of people have no problems whatsoever in maintaining good eye alignment. The laser has an advanced eye tracking system to compensate for eye movements. The machine’s tracker will stop laser treatment if eye movement becomes extreme, and the laser will resume treatment at the right spot once proper eye alignment is regained. Blinking is not a problem, as an eyelid holder is inserted to prevent blinking and the topical anesthetic drops eliminate the urge to blink. Return to Top of List

How Much Time off from Work Will I Need after the LASIK procedure? Will I Have Any Restrictions?

Most patients need to take one day off from work. If you wear make-up, you should avoid eye make-up use for a few days prior to your laser and for about one week afterwards. You should avoid dusty, dirty and smoky environments, as well as swimming pools, hot tubs and saunas, for several weeks after your laser. Care should be taken not to have anything strike your eyes or to rub your eyes or squeeze your eyelids for the first week after the laser procedure. (Of course, it is best to continue to avoid such assaults on the eye indefinitely, but the first week is the most important period.) Return to Top of List

Can I Wear my Contacts up until my Surgery Date?

It is necessary to discontinue all contact lens wear prior to your procedure so that your cornea can resume its natural curvature. With soft contacts, depending on the type of soft contact lens worn, you may need to be out of the lenses between two weeks to two months prior to LASIK. With hard or rigid gas permeable lenses, more than two months out of your contacts is generally required. Return to Top of List

When Do I Return for Post-Op Visits?

You will be seen at our office the first day after your surgery. Patients are advised to avoid business or vacation plans that would require them to leave the area for the first week after LASIK. (In the unusual event that you have a post-op laser problem, most of these problems will be evident by the end of the first post-operative week.) After your first day post-op appointment, as long as you are healing properly, your next appointments will be at one week, one month, three months, six months and 12 months after your surgery. The costs for these visits are all included in your laser fee. Return to Top of List

Where Do You Perform the Procedure?

Dr. Dressler performs LASIK laser vision correction at the TLC Laser Eye Center facility in Tysons Corner. TLC is the largest provider of laser vision correction procedures in North America, with more than 90 centers throughout the United States and Canada. An advantage of getting your eyes lasered through TLC is TLC’s Lifetime Commitment to patients undergoing the procedure for myopia with or without astigmatism. The commitment is for free enhancements (as medically advisable) throughout your life if your post-op visual acuity is worse than 20/40 so long as you get an annual eye exam. (Only myopic patients with a pre-op prescription no worse than -10 diopters, with astigmatism no worse than -3 diopters, are eligible for the Lifetime Commitment program, but 99% of the myopic and/or astigmatic population falls into this group.)*** Return to Top of List

How Stable are the Results?

LASIK to correct myopia and hyperopia (with or without astigmatism) achieves very stable results after a healing phase (within a few months after the procedure). Return to Top of List

What are the Risks?

Most ophthalmologists and optometrists agree that laser vision correction is both safe and effective. More than 15 million LASIK procedures have been performed worldwide. At TLC centers alone, more than 4,000 doctors have had laser vision correction on themselves.

Experience has shown that most patients achieve excellent results without significant complications, but it is important that patients understand as much as possible about the risks associated with laser vision correction before surgery. Fortunately, for most of the problems that occur, there are good remedies, so that the patient still experiences a good clinical outcome. In general, there is a small risk in the range of 1-5% of experiencing a complication and a very small risk, much less than 1%, of a severe vision-threatening complication.

Common, but usually transitory and mild, complaints after LASIK include:

-	visual blurring and fluctuations for the first few days to several weeks after the procedure. These symptoms usually do not interfere with normal functioning, including nighttime driving.
-	halos or starbursts around lights or glare at night or reduced contrast sensitivity. These symptoms usually last a few days to several weeks after the procedure and typically do not interfere with normal functioning, including nighttime driving.
-	dry eyes. This symptom largely subsides by about a month or two and is ameliorated during this period with artificial tear drops.

Uncommon problems after LASIK include:

-	over and under corrections can occur. Typically by one to two months post-operatively, one can determine if there is sufficient residual refractive error present to warrant an enhancement, which, if needed, would typically occur between three to six months post-operatively.
-	regression can occur. Uncommonly, a patient who is 20/20 the first day post-op can heal and regress to poorer vision such as 20/50. If there is sufficient regression to warrant a re-treatment, this would occur between three to six months post-operatively.
-	loss of best corrected visual acuity. A small number of patients (about 1:100) experience a slight loss of sharpness following LASIK such that they lose the ability to read the bottom one to three lines of the eye chart. In some cases, improvement can occur over a period of 6 to 12 months. This means that after the procedure, in unusual cases, even with new glasses or contacts, the patient may not be able to see as clearly as prior to the procedure when the patient was wearing the best glasses or contacts possible.

Rare problems from LASIK include:

-	infection. This rare (about 1/5000 LASIK cases) complication usually responds very well to antibiotic eye drops.
-	epithelial in-growth. Epithelial (skin-like external) cells usually found only on the external eye surface can infrequently grow underneath the corneal flap (about 1:250). This problem can generally be resolved by lifting the flap, brushing away the cells, and replacing the flap. (Re-treatments are more prone to this problem.)
-	hazing or scarring. Serious hazing or scarring occurs in about 1/1000 LASIK procedures. There are various treatments to deal with this problem which are usually effective in reducing the hazing/scarring.
-	night glare. Even before laser vision correction, many people experience poor night vision or night glare (halos, starbursting) when wearing glasses or contact lenses. Night glare is common immediately following the procedure and will typically last for three or four months. Within six months, most night glare symptoms have lessened to the point of insignificance. Significant night glare past six months post op is very unusual.
-	flap making complications (flaps of inadequate size, thickness, centration, quality). In rare cases (about 1:500), the microkeratome does not produce a suitable flap to allow the procedure to go forward; usually the flap is able to be repositioned, and usually the patient can have the LASIK procedure at a later time; however, there can be loss of best corrected visual acuity and quality of vision problems if the flap has been damaged enough. (This risk is remarkably reduced with the Intralase laser-made flaps.)
-	eye rubbing or squeezing/ocular trauma in the early post-operative period can make it necessary to surgically reposition the LASIK flap. *Care should be taken not to rub your eyes or squeeze your eyelids or have anything strike your eyes for the first week after the procedure*. Of course, it is best to continue to avoid such assaults on the eye indefinitely, but the first week is the most important.

A complete discussion of the risks is not possible in this format, and all LASIK patients are required to read and sign the LASIK consent form. In reading the consent form, make notes about any questions you might have and be certain to ask Dr. Dressler any questions at all. Return to Top of List

What Type of Corneal Flapmaker Should I Choose -- the Intralase Laser Flapmaker or the Microkeratome Mechanical Flapmaker?

Dr. Dressler can use either technology to make the corneal flap. Both technologies are excellent and have different benefits and possible problems associated with them. The Intralase laser flapmaker is an additional $350 per eye if you choose this technology (which most patients do). At your consultation, Dr. Dressler will discuss your individual case to help you understand the differences and help you decide which technology is most appropriate for you. Return to Top of List

Should I Choose Classic LASIK, Custom LASIK or Wavefront-optimized LASIK?

Studies are consistently showing that the Custom and Wavefront-optimized LASIK programs produce better outcomes of sharper visual acuity and less nighttime glare than the classic LASIK procedure. Therefore, Dr. Dressler usually recommends Custom or Wavefront-optimized LASIK.

For example, a collaborative study recently released by the U.S. Army, Navy and Air Force demonstrates the superiority of Custom (wavefront) LASIK. Captain Steve Schallhorn, M.D., director of refractive surgery at the San Diego Naval Medical Center, said: "With wavefront-guided procedures we'e getting better quality of vision, better clarity, better night vision, and better contrast sensitivity than we did with conventional laser surgeries." Col. Robert Smith of the Air Force Warfighter Refractive Surgery Program agrees: "While conventional laser correction procedures are good, wavefront-guided vision correction is ratcheting up our expectations." Similarly, after review of extensive clinical data, NASA approved Bladeless (Intralase) Custom LASIK, finding that the combination of technologies provided superior safety and vision. Return to Top of List

When Can I Start Exercising After my Laser Vision Correction?

Each person’s exercise routine is different. The important issues that relate to exercise after laser vision correction involve the possibility of trauma to the eye. Generally, for six months after LASIK, patients should not participate in any exercise or sports that may involve injury to the eye unless they are wearing eye protection. Patients should ask Dr. Dressler about their sports activities or exercise schedule, but generally LASIK patients can resume their full exercise activities one week after the procedure. Return to Top of List

Should I Have Both Eyes Done at the Same Time?

Most people prefer to have LASIK on both eyes the same day. In the event that this cannot be done safely in a particular case, or if the patient prefers, one eye will be treated at a time.

If a patient’s second eye is treated at a later time than the first, one of the following three methods is used during the transition period between the procedures:

- the patient will wear a contact lens in the untreated eye during that period (until about two weeks prior to that eye’s LASIK procedure)

- the patient will wear his or her glasses with one lens covered or removed

- the patient will do nothing to the untreated eye

The solution that is best for you will be determined by discussion between you and Dr. Dressler.

This is an important question that must be answered individually with each patient knowing his or her needs. The objective of LASIK is to make you as independent of glasses or contact lenses as possible, but each person’s goals and time spent reading are different. The substantial majority of patients age 40 and older choose to have both of their eyes corrected for distance vision, and then they use reading glasses for near vision. (People who have naturally perfect distance vision likewise need reading glasses when they get into their 40’s.) Some patients choose to have "monovision" in which the dominant eye is corrected for distance and the non-dominant eye’s distance vision is intentionally undercorrected for distance, allowing some residual near-sightedness to be present which then compensates for the presbyopia problem and allows for better near vision in that eye. If the patient tolerates this lack of simultaneous focusing of the eyes, then he or she can function at both near and far distances without the need for glasses. However, a substantial percentage of patients have difficulty adjusting to monovision because this can cause significant binocular visual dysfunction, and thus a monovision trial with contacts or glasses can be done to educate the patient on what monovision would be like before monovision laser vision correction is performed . Patients over 40 years old should discuss the monovision question with Dr. Dressler to determine what is best for them individually. Return to Top of List

Can I Still Wear Contact Lenses after LASIK?

As stated in the previous paragraph, LASIK does not cure presbyopia, which causes middle-aged people to require reading glasses or bifocal contact lenses for near vision (though some LASIK patients can avoid reading glasses or bifocal contact lenses with monovision LASIK). If LASIK patients want to wear contact lenses to improve their close-up vision (or to fine tune their distance vision) after laser vision correction, they generally can do so. Return to Top of List

What’s on the Horizon? Should I Wait for a Better Procedure?

Dr. Dressler is professionally conservative (for example, she never advocated or performed the old manual radial keratotomy surgery for vision correction in light of its drawbacks). However, she is an enthusiastic proponent of LASIK for appropriate candidates. LASIK is very effective, and Dr. Dressler believes that LASIK will remain the main vision correction procedure for the next decade. With Custom and Wavefront-optimized lasers now available, the results are better than ever. Return to Top of List

What is the Cost of the LASIK procedure?

The cost for LASIK (on both eyes) varies from $4,200 to $5,300, depending on your type/degree of refractive error and whether you want classic vs. Custom vs. Wavefront-optimized LASIK and whether you choose the Intralase flapmaker. Most patients choose Custom LASIK with the Intralase flapmaker, which for most prescriptions costs $4,900 to treat both eyes.

This global fee includes:

- Personal consultation with the surgeon, not just with a patient counsellor or optometrist;

- Pre-operative evaluation, including corneal topographical eye mapping, corneal thickness measuring with an ultrasound machine, pupil measuring with infrared technology and, for Custom patients, waveprint analysis;

- LASIK surgical procedure (and any appropriate enhancements);

- All initial standard medications and eye drops;

- All post-operative visits for a period of 12 months; and

- Lifetime commitment of TLC (if applicable to you, depending on your type and degree of refractive error).

Patients, in comparing prices among LASIK surgeons, should beware of so-called "come on" pricing advertised by mass-market LASIK practices. The lowest prices advertised by such practices are often not available for most patients. (Not only are the lowest prices available (if at all) only for patients needing extremely little vision correction, but there can be additional fees for the initial consultation and follow-ups with the optometrist.)

Return to Top of List

Does my Insurance Cover Laser Vision Correction? Is Financing Available?

Insurance generally does not cover laser vision correction. For those patients who would need to pay off their laser vision correction slowly, TLC offers attractive financing plans for qualified patients. In addition, some people find significant tax savings on the cost by using "flexible spending accounts" or "medical savings accounts" available for health-related expenditures through some employers. Return to Top of List

* Data is as of March 31, 2008. "Enhancement" is defined here as an enhancement procedure on an eye whose vision was worse than 20/40 after the initial LASIK procedure.

** The Joint Position Paper states in part: "[T]he operating surgeon has the responsibility for the postoperative care and [we disapprove] if economic considerations drive the decision to transfer the care of a patient following surgery. Although this obligation may be ethically ceded to another healthcare provider, it is anticipated that this will be an exceptional, rather than a routine, occurrence. . . . If co-management of surgical patients is being considered, justifiable circumstances should exist such as:

+ The surgeon's unavailability (travel, illness, leave, itinerant surgery in a rural area, or surgery performed in a designated physician shortage area).
+ The patient cannot travel to the surgeon's office because of distance or the development of another illness.

. . . The ophthalmic surgeon has the primary responsibility for the preoperative assessment and postoperative care of his/her patients, regardless of the type of surgery performed. The decision to co-manage should be the result of a determination of what is best for the patient and not economic considerations. If the co-management of patients is done on a routine basis for predominantly financial reasons, it represents unethical behavior and may be illegal. Above all, patients' interests must never be compromised as a result of co-management." The Joint Position Paper may be read in full by clicking here.

*** Although hyperopic patients are not covered by the TLC Lifetime Commitment program, they are eligible for medically advisable enhancements at no charge within 12 months of their initial procedure. This is also true for patients with more than -10 diopters of myopia or -3 diopters of astigmatism.

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