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Lasik

LASIK (laser-assisted in situ keratomileusis) is a safe, reliable and painless way to improve vision and reduce or eliminate the need to wear glasses or contact lenses. Lasik changes the way light is bent, or refracted, as it passes through the cornea so that it focuses properly on the retina and objects can be seen clearly.

During the procedure, a device called a microkeratome creates a thin flap on the surface of the cornea. Patients are given anesthesia so they can not feel the instruments. During the procedure, a femtosecond laser creates a thin flap on the surface of the cornea. The flap is then lifted and the excimer laser beam reshapes the cornea (steepened for far-sighted patients, flattened for near-sighted patients). The flap is then closed and heals around the edges within the first few hours.

The entire procedure takes only 5 minutes per eye, and patients are often ready to leave within an hour or two.


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LASIK FAQ

x How does LASIK work?

LASIK (an acronym that stands for LASer In-situ Keratomileusis). It is the most commonly performed type of laser vision correction.

During the procedure, a device called a microkeratome cuts a thin flap on the surface of the cornea. Patients are given anesthesia so they can't feel the instruments. The flap is then lifted and an excimer laser beam reshapes the cornea (steepened for far-sighted patients, flattened for near-sighted patients). The flap is then closed and heals around the edges within the first few hours.

The entire procedure takes only 5 minutes per eye, and patients are often ready to leave within an hour or two.

Antibiotic and steroid eye drops will be prescribed for a few days, along with any other post-operative instructions. Full recovery takes a few weeks.

x Why should I choose Dr. Palay for my surgery?

Dr. Palay is a nationally recognized expert in corneal surgery. He is the author of two textbooks of ophthalmology, Cornea Color Atlas, and Primary Care Ophthalmology. Cornea Color Atlas is regarded as the gold standard for corneal disease. He has been listed numerous times in the Best Doctors in America. He has been featured as one of the best ophthalmologists in Atlanta Magazine. Dr. Palay began performing LASIK surgery in 1996, and was part of the original LASIK trials, prior to FDA approval. He has performed thousands of LASIK procedures.

Dr. Palay takes a very personal approach to his LASIK patients. He is very conservative and will only recommend LASIK if he believes the patient is an ideal candidate for surgery. He is involved in every step of the LASIK process from the preoperative evaluation, to the surgery, to the postoperative care. He personally sees each patient for each visit and communicates with his LASIK patients frequently through e-mail to monitor their progress after surgery.

x Does LASIK correct nearsightedness, farsightedness and astigmatism?

LASIK is approved for nearsightedness from 0 to -10.0 diopters, farsightedness from 0 to +3.0 diopters and astigmatism up to +5.00 diopters.

x What steps are involved with the initial evaluation?

Dr. Palay will perform a thorough evaluation of each patient. The exam usually lasts 2 hours and you will be dilated with strong drops. Your eyes may remain dilated for several hours and occasionally into the next day. The dilation drops affect reading vision but your distance vision should remain close to normal. You may need sunglasses to help drive home. Contact lenses should be left out of the eyes for 7 full days if they are soft lenses and for 14 full days if they are hard or gas permeable lenses prior to both your evaluation day and surgery day.

x What is the schedule of follow-up visits?

Dr. Palay will see you one day after the procedure, one to two weeks after the procedure, 3 months after the procedure and 12 months after the procedure.

x Where is the LASIK surgery performed?

Dr. Palay performs his LASIK at Emory Vision, located at 5671 Peachtree Dunwoody Road, Suite 400, Atlanta, GA 30342, a short distance from Dr. Palay's office. Emory Vision is the only LASIK provider affiliated with Emory Healthcare.

x What is Wavefront Eye-Q LASIK?

The Allegretto Wave Eye-Q is the first new laser to receive FDA approval in the United States since 1999. Emory Vision purchased the first Allegretto Wave Eye-Q laser in Georgia in July 2004, and upgraded it in November of 2006.

It is the fastest laser system in the United States today, using PerfectPulse Technology to safely and accurately control every single laser pulse from start to finish. The system represents a new generation of refractive technology conducting High Performance Vision Correction. The Allegretto Wave Eye-Q offers a customized treatment that incorporates wavefront principles to patients with nearsightedness and even farsightedness.

The Allegretto Wave Eye-Q can preserve or improve quality of vision in regards to glare and night driving glare. The majority of myopia patients treated with the Allegretto Wave Eye-Q achieved 20/16 or better one year after LASIK. Allegretto Wave Eye-Q technology can be coupled witha cornea analysis using state-of-the-art wavefront technology to treat all of the conditions LASIK surgery has traditionally corrected, as well as a range of vision problems that could not be addressed before. These problems, called higher order aberrations, include problems with vision during low-light, glare and halos. This technology improves visual acuity and visual quality.

x How long does the procedure take?

The LASIK procedure takes approximately 5 minutes per eye. Patients can expect to remain at the laser center for about two hours on the day of the procedure.

x Do you do both eyes at the same time?

Yes. Most surgeons operate on both eyes on the same day. The advantage of doing both eyes on the same day is one of convenience. It allows the patient to only have to make arrangements for one set of appointments. It also restores your balanced vision as quickly as possible, especially if you are unable to wear a contact lens in the unoperated eye. If you prefer to have your eyes done separately, please discuss this with Dr. Palay.

x Does it hurt?

The procedure is painless. Most patients feel a pulling sensation on their eyelids and a pressure sensation on their eye. The eye may feel scratchy for the first 24 hours after the procedure.

x What type of anesthesia is used?

The only type of anesthesia used is anesthetic eye drops. These are very effective in making this a truly painless surgery.

x What if I am nervous?

It is normal to be nervous before eye surgery. Dr. Palay will prescribe a mild sedative to take by mouth before the procedure.

x What if I move my eye during surgery?

Dr. Palay will help position your head during the surgery. You will be asked to look at a blinking light during surgery to keep your eye still. The laser has a tracking device, so that small movements of your eye are compensated for by the laser.

x When can I return to work and when can I drive?

Most patients have 20/40 vision or better 24 hours after the surgery. 20/40 vision is the legal limit for driving in the state of Georgia. With LASIK surgery, the majority of patients can return to work the next day, although it is advisable to take 24 hours off following surgery on both eyes. While most patients can function normally at work the day after their LASIK procedure, we recommend that you not schedule any unbreakable appointments or meetings on that day. If your recovery is delayed slightly, you will still be able to accommodate the delay without any undue stress.

x What is an enhancement surgery?

In the event that you are undercorrected or overcorrected, it is possible to perform an additional treatment. Typically, retreatment with LASIK usually takes place three months after the original procedure. With LASIK, the corneal flap does not need to be recreated. Using specialized instruments, the surgeon can gently lift the pre-existing flap and perform additional laser work. Recovery time is similar to the original procedure. There is no charge for enhancement surgery if performed within the first year of the original surgery.

x What is monovision?

For patients in their mid-forties who are already experiencing difficulty with reading, it is possible to treat one eye for near vision and the other for distance vision, thus decreasing the necessity for both near and distance glasses. If you are considering this blended vision (monovision), it is advisable to try it out with contact lenses before proceeding directly to LASIK surgery. If you have already been successful with monovision in contact lenses, you will most likely enjoy this type of correction following LASIK. If you are over 40 and hope to avoid glasses altogether in your life, this is presently the only way to accomplish this. The disadvantage of monovision is that it decreases depth perception. Because of this, patients often choose to wear driving glasses for driving at night, to balance the distance vision in both eyes.

x Does having dry eyes effect my surgery?

Many patients seeking refractive surgery do so because they have dry eyes and are unable to wear contact lenses anymore. It is important that your dry eyes be treated. This usually involves the use of tear supplements and punctum plugs (tiny silicone plugs placed in the tear drainage openings of your eyelid) that delay the drainage of your own tears so your eyes will stay moist. After the procedure, your operated eye may feel temporarily drier because the corneal nerves are severed during LASIK surgery, causing the eye to make fewer tears. This condition is temporary and typically lasts three to six months. Dry eye symptoms can be particularly noticeable if you use the computer frequently, read for long periods of time, or drive extended distances. These types of activities exacerbate dry eyes because they cause you to stare and not blink as often. It is important to use ample lubrication, especially during the first few months after surgery.

x Can I wear contacts after surgery?

It is extremely rare for anyone to need contacts after LASIK surgery. Even though the corneal shape is altered, it is still possible to wear contacts, should the need arise.

x Who is not a good candidate for LASIK surgery?
  • Anyone whose prescription is actively changing a moderate degree over time.
  • Pregnant or nursing mothers.
  • Anyone who feels that he or she must absolutely gain 20/20 or "perfect" vision without glasses or contact lenses. It is impossible to guarantee 20/20 or "perfect" vision.
  • Anyone unwilling to accept the possible risks and complications of LASIK surgery.
  • Anyone with an uncontrolled or untreated eye disease. Certain corneal dystrophies or a history of a herpes infection in the eye may be relative contraindications, as are certain arthritic syndromes and other autoimmune disorders.
  • Anyone on certain medications (Accutane, etc.)
x Is LASIK covered by my insurance company?

Some insurance companies will provide an allowance for the procedure, but that is the exception rather than the rule. Many companies offer flex spending accounts which allow you to pay for the procedure with pre-tax dollars.

x What are the risks of LASIK surgery?

Every surgical procedure carries some risk. Fortunately, serious risks with LASIK are extremely rare. The two most serious risks of LASIK are infection and ectasia. Infection is a rare event after refractive surgery. Sterile procedures are meticulously followed and antibiotics are administered routinely after surgery. In spite of these measures, infections will occur occasionally. It has been estimated that the risk of infection is 1 in 20,000 procedures. Another serious complication is ectasia. Ectasia occurs when the cornea becomes excessively thin and structurally weak following LASIK surgery. It can also occur in eyes that have not undergone LASIK or other surgery. In these cases, it is termed keratoconus. With ectasia and keratoconus, the cornea has an abnormal tensile strength. The cornea can become progressively thin and this leads to nearsightedness and astigmatism. Mild cases can be treated with glasses. Moderate cases are treated with rigid gas permeable contact lenses. Severe cases may require a corneal transplant. Preoperative screening is aimed at excluding patients who are at risk to develop this condition. Unfortunately, screening is not 100% accurate and some patients can rarely develop this condition with normal pre-operative parameters. Although this is very rare, LASIK does increase the risk of this condition. It is estimated that the risk of ectasia is 1/5000 procedures.

The doctors at Atlanta Ophthalmology have collectively performed more than 20,000 cataract surgeries. Together, they have created a Cataract Center of Excellence.

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