Disorders

Introduction:

Dr. Skowron had LASIK in 1998 and is very happy he had it done. He says, "For anyone who has struggled with poor vision for a long time, it is a life-changing experience. Because I and some of the staff have had the procedure done, we feel we can do a better job in advising our patients regarding LASIK surgery."

Skowron Eye Care provides the pre- and postoperative care. The procedure itself is done by board-certified opthamologists who work closely with us.

A Surgical Option To Correct Vision



 
  Nearsightedness, farsightedness, and astigmatism are three types of refractive eye disorders. There are many options that you can choose to help correct these problems. A non-surgical option is corrective lenses such as glasses or contacts. Surgical options used today to correct these disorders are LASIK (laser assisted in-situ keratomileusis) and PRK (Photo refractive Keretetomy). If you suffer from moderate to high levels of nearsightedness, Lasik may be the choice for you.

WHAT ARE REFRACTIVE ERRORS?
If an individual has normal vision, light will enter the eye through the cornea and will be bent to a single point and focused on the retina at the back of the eye. If there is a refractive error, the light is not focused on the back of the eye.
The three most common types of refractive errors are:

Nearsighted: light is focused before the back of the eye  
     
Farsighted: light is focused behind the eye  
     
Astigmatism: light is split into 2 focus points  
 
What Is The LASIK Procedure Like?
  LASIK is a painless, outpatient procedure that usually takes less than 20 minutes to perform. During LASIK, the surgeon first creates a corneal flap which is lifted either with the microkeratome (blade) or with Intralase laser (bladeless) revealing the inner corneal tissue. Introduction of the laser to create the flap has make LASIK even safer. We exclusively use the Intralase Laser to create the flap.  

microkeratome
 
  Intralase laser
     
 
Surgical skill is the key component in the creation and re-positioning of the corneal flap, and the experience of our board-certified surgeons with this procedure is unsurpassed. Because the surface layer (epithelium) of the cornea is preserved, there is very little discomfort following LASIK surgery. .  
    Excimer Laser

WHAT ARE THE ADVANTAGES OF LASIK?

  • A quick, painless outpatient surgery
  • Less chance of infection
  • Rapid recovery, usually 1-2 days
  • Clear vision without corrective lenses, usually in a couple of days and sometimes within 24 hours
  • Greatly reduced chance for error due to the precision of computer-assisted lasers
  • Less chance of hazing
  • A thinner, more precise flap obtained with the development of Intralase laser
  • Few complications with the microkeratome, but even fewer with the Intralase laser
Potential glare from lasik

WHAT ARE THE DISADVANTAGES / RISKS OF LASIK?

  • Glare, halos around bright lights, or a haze may occur for a few months. A good clinical indication that you are may experience halos is you had them with your contact lenses.
  • Vision may become worse, or astigmatism may develop (usually within the first 3 months). If so, an enhancement procedure usually can be performed.
  • You may experience potential glare from LASIK.
  • Recovery can be uncomfortable, although this is uncommon.

These risks occur less frequently with new upgraded computer LASIK programs, the use of the Intralase laser to create the flap, and careful selection of candidates for the procedure. It is important to get a thorough evaluation to determine if you are a good candidate. We have a high success rate because we advise many (25%) patients against LASIK for various reasons.

Dr. Patadia advising a patient on Lasik surgery

HOW DO I KNOW IF I AM A GOOD CANDIDATE FOR LASIK?
A large percentage of nearsighted, farsighted, and astigmatic patients are potential candidates for LASIK. Patients who are 21 years of age or older and have healthy eyes that are free from retinal problems, corneal scars, and any eye disease are suitable. By having an evaluation, examination, and consultation with you, the doctor will be able to determine if you are a good candidate.

You could enjoy the benefits of LASIK if:

  • You have moderate to high levels of myopia or are nearsighted.
  • You have astigmatism or are farsighted.
  • Your eyes are generally healthy.
  • Your vision is stable.
  • Your corneas are thick enough.
  • You have adequate tears: do not suffer from excessive "dry eye."
  • Proper postoperative expectations are explained for YOUR particular case.

WHO IS A POOR OR RISKY CANDIDATE FOR LASIK

  • Thin corneas, usually less than 480 microns (1000 microns in 1 millimeter)
  • Eye prescription continually changing
  • Corneal disease
  • Very dry eyes
  • Amblyopia (lazy eye)
  • Pregnant or pregnancy planned within 6 months
  • Nursing mother
  • Lupus
  • Rheumatoid arthritis (usually very dry eye)
  • Collagen vascular disease
  • Healing problems (keloid formation)
  • Sjogren's syndrome
  • Diabetes
  • Keratoconus
  • Cataracts
  • Herpes zoster
  • Corneal scarring (trauma)
  • Large pupils
  • Certain medications

AT SKOWRON EYE CARE WE WILL TAKE THE EXTRA TIME AND CARE FOR YOU.

Dr. John discussing surgical options with patient

We establish life long relationships: Once you have the surgery, you are under our care. We take a conservative approach to LASIK because it's not worth the risk to have lifelong problems following an elective procedure.

In our consultation and examination, we will explain the entire LASIK procedure, show you a video, and demonstrate how your vision will be after LASIK surgery. This is especially important for those patients older than 40 who will soon need reading glasses. We will place contact lenses on your eye to demonstrate how your reading and distance vision will be following the procedure. You take these lenses home and see if you are happy with the results. Some patients return, and choose not to have the procedure. When that happens, we feel we have done our job.

CONTACT LENS PROTOCOL:
If you wear contact lenses, there are certain criteria that need to be met prior to LASIK.

  • Rigid Gas Permeable Contact Lenses
    Wearing gas permeable lenses must be discontinued so the cornea can stabilize. It usually takes from 2-8 months. Gas permeable lenses sometimes act like braces on your teeth. Following the removal of braces, teeth shift for a while. The same thing happens once you stop wearing gas permeable lenses. LASIK can not, and should not, be performed until we are as certain as can be that the eyes are stable.
  • Soft Lenses (including Disposables)
    These lenses need to be off the eye for 2 weeks prior to surgery if proceeding with custom LASIK surgery with Intralase (bladeless surgery).

SUMMARY OF TYPES OF LASIK SURGERY

1. CUSTOM LASIK:

  • A blade (microkeratome) is used to create the flap.
  • Most complications of LASIK occur when creating the flap.
  • An upgraded computer-driven program is used to reshape the eye.
  • Additional distortions are corrected.
  • The chance for halos is minimized.
  • Better than 20/20 vision can sometimes be obtained.

Note on the microkeratome:
The mickrokeratome has been used with great success over the past 15 years. It works on a principle similar to the manual credit card machine: The credit card is placed in a holder and swiped to make an imprint of your name and credit card number. The microkeratome stops ¾ of the way.

 

 


2. CUSTOM LASIK WITH INTRALASE LASER:

  • Uses completely bladeless surgery
  • Minimizes flap complications (safest)
  • Uses latest technology
  • Uses an upgraded computer driven program to reshape the eye.
  • Corrects for additional distortions
  • Minimizes chance for halos
  • Can sometimes obtain better than 20/20 vision


Note on the Intralase laser:
The Intralase laser is an entirely different laser than the one that is used to reshape your eye and correct your vision. This laser beam creates many gas bubbles at the inner layer of the cornea which can then be lifted. This flap is thinner and more consistent in thickness, which provides a much better outcome.

 

WHAT ARE THE ADVANTAGES OF PRK OVER LASIK?

  • No flap is created, so any minor chance of a flap complication is gone.

WHAT ARE THE DISADVNTAGES OF PRK OVER LASIK?

  • There is more discomfort in days after the procedure. The procedure itself is painless.
  • You need to wear a bandage contact lens, which in itself can cause problems.
  • Vision clarity takes days to weeks.
  • There is a greater chance of infection.
  • You will need more eye drops.
  • You will make more follow up visits.

WHY WOULD A DOCTOR RECOMMEND PRK?
PRK is done if your CORNEA IS TOO THIN to have LASIK performed. We measure that with a pachymeter. Creating the flap takes up a certain amount of cornea. If you cornea is too thin and LASIK is done, you may get corneal distortion, which could permanently impair your vision. In very rare cases, a corneal transplant would be needed to correct for the distortion. HOWEVER, NO ONE HAS EVER GONE BLIND FROM LASIK OR PRK.

DESCRIPTION OF PRK
PRK is a painless, outpatient procedure that usually takes about 10 minutes to perform. Just like LASIK, during PRK, computer-controlled pulses of cool laser light are applied to the surface of your cornea to delicately reshape your eye's curvature. Your cornea's new curvature is shaped to duplicate your contact lens or glasses prescription. This allows you to reduce or eliminate your dependence on glasses or contacts.

To effectively reshape your cornea, the laser surgeon will gently remove the protective surface layer (epithelium) from the eye. You essentially end up with a large corneal abrasion. This epithelial layer is regenerated within three to five days. In LASIK, a flap is created and positioned back on top after the procedure, that's why LASIK heals much faster.

The laser process is completed in approximately 30 to 60 seconds. A clear "bandage" contact lens will be placed on your eye, and you'll receive additional eye drops. The bandage lens is usually worn for three to five days and then removed by one of our doctors. After the PRK procedure, your eye WILL feel irritated -- a foreign body sensation -- for a few days, but this discomfort can usually be effectively managed with medication, if needed. Your vision will also be blurred for several days.

Dr. Skowron double checking the final measurements before a patient undergoes LASIK.
 

WHAT IS THE ROLE OF SKOWRON EYECARE?

  1. Pre-procedure evaluation, recommendation of which procedure, if any, and desired result for your specific case
  2. Post-procedure care, ensuring that the eye is healing properly and that you have obtained the results desired

Throughout these stages, two doctors will take care of you: the Laser surgeon who performs the procedure itself, and the doctors in our office who provide your pre- and post-operative care. We will:

  • Educate you about laser vision correction and other vision correction alternatives.
  • Perform your pre-procedure testing and evaluation.
  • Allow you to see and experience what the end result of LASIK or PRK would be.
  • Provide the surgeon with your eye history, accurate clinical findings, and precise target prescription.
  • Provide your post-procedure follow-up care and communicate with the surgeon on your progress.
  • Prescribe lenses for reading or night driving. Lenses may also be needed to cover any prescription that can't be treated or to use temporarily while waiting for an enhancement procedure.
  • Monitor the health of your eyes at your annual comprehensive eye exam

FREQUENTLY ASKED QUESTIONS

How do I prepare for my procedure?
There are no food, drink, or medication restrictions immediately prior to your procedure. However, you should avoid alcohol and medications that cause drowsiness.

Contact lenses change the shape of your cornea. Since this is the area that's treated, it's important to allow time for your cornea to return to its normal curvature.

Remove Contact Lenses:

  • Soft contact lenses should be removed at least 2 weeks before your procedure.
  • Hard or gas permeable contact lenses should be removed at least 4 to 6 weeks before your procedure.
  • Patients who have worn rigid contact lenses for over 20 years may need to remove them for up to 6 months or more until we determine that the vision has become stable.

It our responsibility at Skowron Eye Care to help you make this determination and even fit you with disposable contact lenses or glasses in the interim.

Will my vision be corrected forever?
People often ask how long the benefits of the procedure will last. Laser vision correction has been common in many countries around the world since the late 1980s. The first nearsighted patient's eye ever treated with laser vision correction was in the United States in 1987. That patient achieved 20/20 vision following treatment and is still 20/20 today.

In addition, many clinical studies have looked at the long-term effects of the excimer laser on the cornea. Today, most experts around the world agree that there are no long-term problems with laser vision correction. That is why laser vision correction has become the most commonly performed refractive procedure in the world

Following an initial healing period of two to three months, the effect of the treatment is life long. It is uncommon, but a regression of the nearsightedness may occur. This usually happens within the first 6 weeks of healing. It can be fully corrected with an enhancement procedure after 90 days.

What happens on the day of my procedure?
It's natural to feel a mixture of eager anticipation and nervousness before your procedure. On the day of your procedure, you should arrive at the Laser center as rested and relaxed as possible. Please allow approximately two to four hours for the entire process.

  • Wear comfortable clothing.
  • DO NOT wear eye makeup, perfume, hair spray.
  • DO NOT wear any jewelry or earrings.
  • Bring someone to drive you home, or make other arrangements for transportation.

The success of your laser procedure depends on our accuracy, the skill of the laser surgeon, and also the safety, accuracy and sophistication of the equipment. At Skowron Eye Care our primary objective is to provide you with the most advanced technology, best results, and greatest degree of safety. Automated, state-of-the-art equipment is used to test your vision, measure, and map your eye. Over 6,000 separate points on the eye are measured – creating a topographical map of your eye's shape. We will review your clinical findings and explain what you can expect during and after your procedure.

Immediately prior to your procedure, your eyelids and lashes will be cleaned. Antibiotic, anti-inflammatory, and anesthetic drops will be placed in your eyes. A mild sedative may be given. Once you are prepared for your procedure, you will be escorted to the laser suite for treatment.

The information from your eye exam is used to program the advanced computer software. The computer calculates the required corneal change and directs the laser to make this change. The surgeon programs and operates the laser, maintaining control throughout your entire procedure.

What's the actual LASIK procedure like?
You will enter the laser room and lie down on a reclining chair below a microscope that is part of the laser. When you look up into the laser, you will see a green or red light with a ring of lights around it. Your surgeon will ask you to look directly at this “fixation” light while the procedure is performed.

The LASIK procedure usually takes about 7 minutes per eye, and numbing eye drops will be used to make your entire procedure painless. You may be given some medicine to relax you. As each step is performed, your surgeon will explain exactly what is happening. First one eye will be treated; then the other. The eye which is not being treated will be temporarily covered. You can have one or both eyes treated on the same day.

An eyelid holder will be placed between your eyelids to prevent you from blinking. You will feel slight pressure but no discomfort. Some surgeons still prefer to use a microkeratome to create the flap; others prefer using the Intralase laser. As a perfectly normal part of this procedure, your vision will become dark for a few seconds. After the flap is created, you will be able to see the fixation light again.

   
Microkeratome   Intralase Laser (latest tech)   Folding back the corneal flap

The Corneal flap will be folded back, and the laser is applied to the cornea beneath the flap. Generally, the laser is used for less than one minute. The flap is re-positioned into place, where it adheres naturally and securely. At this point and for several weeks, you do not want to disrupt or wrinkle this perfectly placed flap by rubbing your eye.

What will my recovery be like?
Most patients notice dramatic visual results within the first few days following their procedure. However, the speed of visual recovery depends on personal healing patterns. Immediately after the surgery, your vision will still be somewhat blurred and smoky, almost like wearing very dirty contact lenses. LASIK patients usually see quite well the next day, but patients with higher prescriptions may recover more slowly from either procedure.

PRK patients are fitted with a bandage contact lens. This very thin, clear lens and eye drops reduce some of discomfort you may have. Don't be concerned if you've never used contact lenses before. We will insert and remove the lens for you. PRK patients usually experience irritation or discomfort for a few days. Sleep is strongly recommended shortly after your procedure.

LASIK patients do not receive a contact lens. They will receive clear eye goggles to protect the flap while sleeping during the first few days to prevent one from rubbing their eye during sleep. LASIK patients may experience some irritation or discomfort, but this usually lasts only for a few hours. Sleep is strongly recommended after the procedure, and most patients are quire comfortable after taking a short nap.

Will my activities be restricted?
Many patients return to work the next day, others a few days later. You will need to restrict the activities mentioned below. Otherwise, as long as you follow your doctor's instructions, you should be free to resume all your normal activities.

  • Wait one full day before taking a shower, and then be careful not to get soap or water in the eye.
  • Resume driving usually after one day, as your doctor advises.
  • Wear sunglasses for the first few days to keep debris from hitting your eye.
  • Read and watch TV in moderation the first few.
  • Do not wear eye makeup for one week.
  • Do not rub your eyes for up to 6 months. You can gently rub them after one month. If rubbing your eye causes a sensation, instill a drop of artificial tears.
  • Eliminate heavy exercise for one week (we don't want any perspiration getting in the eye).
  • Avoid swimming, hot tubs, and whirlpools for one week, rivers and lakes for one month. When swimming, don't open your eyes under water for at least 6 months. If swimming for exercise, wear goggles.
  • Avoid gardening and dusty environments for one week.
  • Avoid contact sports that could result in an eye injury for one month.

LASIK CAN GIVE A FALSE SENSE OF SECURITY BECAUSE YOU FEEL FINE AND SEE FINE, BUT THE FLAP IS STILL VERY FRAGILE THE FIRST MONTH AND CAN BE DISRUPTED. SO BE CAREFUL!!!! ERROR ON THE SIDE OF CAUTION. YOU COULD PERMANENTLY REVERSE ANY GREAT RESULTS BY BEING CARELESS!

What kind of follow-up care will I need?

We provide all the necessary follow-up care and recommend the needed eye medications to promote proper healing. Periodic examinations are required to ensure that your eye is healing as expected, to check for evidence of infection, and to measure your visual progress. The examinations are schedule for:

  • One day
  • One week
  • One month
  • Three months
  • Six months

Patients must use prescribed antibiotic and anti-inflammatory eye drops during recovery. LASIK patients use drops for four to seven days, and PRK patients continue drops for one to four months, depending on the prescription. PRK patients have the bandage contact lens removed on the third to fifth day. Each appointment takes about five to 15 minutes. Remember, we are available 24 hours a day if you have any questions or concerns or you need attention.

Eye exams are important. We strongly recommend that everyone, not only laser vision correction patients, have an eye exam performed every year. This is a proactive way to ensure that your eye is healthy and functioning properly. The retinal portion of the exam is especially important if you are highly nearsighted, since nearsighted eyes are at greater risk of retinal detachment.

Is this procedure covered by insurance or flexible benefits programs?
Most insurance companies do not cover LASIK and PRK, but we encourage you to check with your provider. While LASIK and PRK are often deemed elective and not covered, they may be tax deductible depending on your filing status. Please consult your accountant. In the U.S., if your company has a flexible benefits program you can usually include LASIK and PRK in it.

How soon after the treatment can I exercise?
Non-contact sports can be resumed as soon as you feel capable. No heavy exercise for one week. You don't want to risk getting perspiration into the eye. Eye protection is always recommended for racquet sports or rough sports where there is a risk of being hit in the eye.

How soon can I swim?
You should stay out of swimming pools for one week after your treatment, and rivers, lakes and oceans for 1 month following your treatment.

Can I see the treatment as it is being performed?
You will be "awake" but very relaxed. You will not be able to see any of the details of the treatment. You will see a number of lights, but the images will be blurred. You may be given a light sedative.

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Questions or Comments?
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(630) 834-6244

370 N. York Road
Elmhurst, IL 60126