LASIK Center

Please select a section to learn about the LASIK procedures performed by Dr. Silk:

•What is LASIK?
• The Eye and Vision Errors
• How is LASIK Performed?
• CustomVue
• IntraLase Blade-Free LASIK
• iLASIK
• LASEK & PRK
• When is LASIK not for me?

What is LASIK?

LASIK stands for Laser-Assisted In Situ Keratomileusis and is a laser vision correction procedure that permanently changes the shape of the cornea, or the clear covering of the front of the eye, by using an excimer laser. A mechanical microkeratome (a blade device) or a laser keratome (a laser device) 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 middle section of the cornea. Pulses from a computer-controlled laser vaporize a portion of the stroma and the flap is replaced.

The Eye and Vision Errors

The cornea is a part of the eye that helps focus light to create an image on the retina. It works in much the same way that the lens of a camera focuses light to create an image on film. The bending and focusing of light is also known as refraction. Usually the shape of the cornea and the eye are not perfect and the image on the retina is out-of-focus (blurred) or distorted. These imperfections in the focusing power of the eye are called refractive errors. There are three primary types of refractive errors: myopia, hyperopia and astigmatism. Persons with myopia, or nearsightedness, have more difficulty seeing distant objects as clearly as near objects. Persons with hyperopia, or farsightedness,have more difficulty seeing near objects as clearly as distant objects. Astigmatism is a distortion of the image on the retina caused by irregularities in the cornea or lens of the eye. Combinations of myopia and astigmatism or hyperopia and astigmatism are common. Glasses or contact lenses are designed to compensate for the eye's imperfections. Surgical procedures aimed at improving the focusing power of the eye are called refractive surgery. In LASIK surgery, precise and controlled removal of corneal tissue by a special laser reshapes the cornea changing its focusing power.

How is LASIK Performed?

During LASIK, a thin layer of corneal tissue is created with either a microkeratome or laser and folded back from the surface of the cornea. After the laser reshapes the cornea, the tissue is folded back into place, where it bonds quickly. At the Silk Vision and Surgical Center, we use a state-of-the-art, VISX S4 eye-tracking laser-flying spot laser that produces an exceptionally smooth treatment. This three-minute procedure requires no needles and no stitches.

LASIK can be used to treat nearsightedness, farsightedness and astigmatism.

Healing for most patients is so fast that vision can improve within hours of the procedure, and many patients return to work the next day.

CustomVue

With CustomVue™ or Wavefront Guided laser vision correction, a new standard is established, providing a precise level of measurement and correction never before possible.

Using WaveScan® based digital technology, originally developed for use in high-powered telescopes to reduce distortions when viewing distant objects in space, we can now identify, measure and correct imperfections in an individual's eyes 25 times more precisely than with standard methods used for glasses and contact lenses. This information is transferred to the laser, providing a new level of precision and accuracy.

The pattern of visual imperfections in your eye is as unique to you as your fingerprint. Before these recent advancements in technology, doctors were only able to use standard measurements to correct vision, meaning that prescriptions could only provide a certain level of correction regardless of an individual's needs.

CustomVue™ allows us to measure these visual imperfections at 200 individual points. We can treat each of the 200 points individually to create a personalized vision correction that is ideal for you. This treatment can potentially provide vision better than you have ever experienced with glasses or contact lenses.

One year after the CustomVue™ procedure, patients in a clinical study reported these great results without glasses or contact lenses:

• 100% could pass a driving test
• 98% could see 20/20 or better
• 70% could see 20/16 or better

In the clinical study, four times as many people were very satisfied with their night vision after the procedure as compared to their night vision before with glasses or contact lenses.

IntraLase Blade-Free LASIK

With the IntraLase method, pulses of laser light create your corneal flap, which is then lifted so the next step of LASIK - the reshaping of your cornea - can be performed. When your LASIK treatment is over, the flap is securely repositioned into place.

Our commitment is to provide you with the ultimate in comfort, safety, and outstanding vision. LASIK with IntraLase can help you achieve all of this - while it delivers the added assurance of knowing you're being treated with the most advanced technology there is.

How the IntraLase Method WorksIntraLase technology is uniquely able to program the dimensions of your flap based on what's best for your eye. Then the IntraLase laser creates your flap from below the surface of the cornea - without ever cutting it.

1. Ultra - fast pulses of laser light position microscopic bubbles at a precise predetermined depth.
2. The laser light passes harmlessly through your cornea. Then the laser creates rows of these bubbles just beneath your corneal surface as it moves back and forth across your eye in a uniform plane.
3. Next, the IntraLase laser stacks bubbles around your corneal diameter to create the edges of your flap. These bubbles are stacked at an angle that is determined by your doctor and is individualized to the way your eye is shaped.
4. The process takes only about 30 seconds from start to finish - it's quiet and it's comfortable.

Dr. Silk then gently lifts the flap to allow for the second step of your LASIK treatment. When treatment is complete, the flap easily "locks" back into position and rapidly begins to heal

iLASIK

iLASIK is a combination of the most advanced FDA-approved technologies so clinically beneficial that it has become the preferred method of performing LASIK surgery. The complete package of iLASIK technologies includes:

• VISX Wavescan WaveFront™ Diagnostics
• IntraLase™ Femtosecond Laser
• VISX Star S4 Iris Registration™ Excimer Laser
• VISX Advanced CustomVue™ Treatment

What is iLASIK and how does it work?

The very best things in life are custom-fit, and that includes vision correction at Silk Vision and Surgical Center. One size does not fit all when it comes to your eyes. Just like the tailoring of a fine suit or designer dress, your iLASIK procedure is 100% tailor-made for you.

iLASIK is the combination of Wavescan diagnostic eye-mapping, Iris Registration technologies, IntraLase flap creation and CustomVue LASIK treatment.

It allows unprecedented customization and accuracy making it possible for the actual laser treatment to be fully customized to the unique characteristics of each of your eyes. This precise level of measurement and treatment can enable you to achieve the full potential of your personal best vision. Here's how it works:

iLASIK Step One:

iLASIK addresses the uniqueness of your eyes, from the individual curvature of your corneas to the microscopic nuances of your anatomy. Wavescan 3D mapping creates a blueprint of your eye and Iris Registration reads the specific characteristics of your iris to accurately align the Wavefront treatment.

iLASIK Step Two:

The IntraLase FS laser is a computer-guided, ultra-fast laser that is used to create the thin corneal flap for the iLASIK procedure. The IntraLase FS creates an optimal surface below the flap, allowing better visual outcomes. In clinical studies, more patients achieved 20/20 vision or better with procedures that incorporate the IntraLase technique.

iLASIK Step Three:

Silk Vision and Surgical Center utilizes the VISX Star S4 excimer laser to perform your laser treatment. The Advanced CustomVue procedure provides the most precise, accurate form of laser vision correction available today. 3D eye tracking ensures that even if your eye moves, your treatment remains exact and specific to your customized iLASIK procedure.

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LASEK & PRK

These procedures are similar to LASIK, except that a tissue flap is not created. The laser treatment is done on the surface of the eye after removing the outer layer of cells. LASEK and PRK are suitable for people whose corneas are too thin or too curved to be good candidates for standard LASIK. With LASEK and PRK, healing time is slightly longer than with LASIK, and good vision is achieved in four to seven days.

In general, the conditions we're able to treat include nearsightedness (myopia), farsightedness (hyperopia) and astigmatism.

We like our patients to be at least 18 years of age, have healthy corneas, and to have had stable vision over the past year.

What should I expect before, during, and after surgery?

What to expect before, during, and after surgery will vary from patient to patient, the following is a compilation of patient information to inform you about what to expect. Dr. Silk will be able to explain the process in greater detail during your LASIK evaulation.

Before Surgery

If you decide to go ahead with LASIK surgery, you will need an initial or baseline evaluation by your eye doctor to determine if you are a good candidate. This is what you need to know to prepare for the exam and what you should expect.

If you wear contact lenses, it is a good idea to stop wearing them before your baseline evaluation and switch to wearing your glasses full-time. Contact lenses change the shape of your cornea for up to several weeks after you have stopped using them depending on the type of contact lenses you wear. Not leaving your contact lenses out long enough for your cornea to assume its natural shape before surgery can have negative consequences. These consequences include inaccurate measurements and a poor surgical plan, resulting in poor vision after surgery. These measurements, which determine how much corneal tissue to remove, may need to be repeated at least a week after your initial evaluation and before surgery to make sure they have not changed, especially if you wear RGP or hard lenses. If you wear:

• Soft contact lenses, you should stop wearing them for 2 weeks before your initial evaluation.
• Toric soft lenses or rigid gas permeable (RGP) lenses, you should stop wearing them for at least 3 weeks before your initial evaluation.
• Hard lenses, you should stop wearing them for at least 4 weeks before your initial evaluation.

Tell your doctor:

• About your past and present medical and eye conditions
• About all the medications you are taking, including over-the-counter medications and any medications you may be allergic to

Your doctor should perform a thorough eye exam and discuss:

• If you are a good candidate
• What the risks, benefits, and alternatives of the surgery are
• What you should expect before, during, and after surgery
• What your responsibilities will be before, during, and after surgery

You should have the opportunity to ask your doctor questions during this discussion. Give yourself plenty of time to think about the risk/benefit discussion, to review any informational literature provided by your doctor, and to have any additional questions answered by your doctor before deciding to go through with surgery and before signing the informed consent form.

You should not feel pressured by your doctor, family, friends, or anyone else to make a decision about having surgery. Carefully consider the pros and cons.

The day before surgery, you should stop using:

• Creams
• Lotions
• Makeup
• Perfumes

These products as well as debris along the eyelashes may increase the risk of infection during and after surgery. Your doctor may ask you to scrub your eyelashes for a period of time before surgery to get rid of residues and debris along the lashes.

Also before surgery, arrange for transportation to and from your surgery and your first follow-up visit. On the day of surgery, your doctor may give you some medicine to make you relax. Because this medicine impairs your ability to drive and because your vision may be blurry, even if you don't drive make sure someone can bring you home after surgery

During Surgery

During SurgeryThe surgery should take less than 30 minutes. You will lie on your back in a reclining chair in an exam room containing the laser system. The laser system includes a large machine with a microscope attached to it and a computer screen.

A numbing drop will be placed in your eye, the area around your eye will be cleaned, and an instrument called a lid speculum will be used to hold your eyelids open.

Your doctor may use a mechanical microkeratome (a blade device) to cut a flap in the cornea.

If a mechanical microkeratome is used, a ring will be placed on your eye and very high pressures will be applied to create suction to the cornea. Your vision will dim while the suction ring is on and you may feel the pressure and experience some discomfort during this part of the procedure. The microkeratome, a cutting instrument, is attached to the suction ring. Your doctor will use the blade of the microkeratome to cut a flap in your cornea. Microkeratome blades are meant to be used only once and then thrown out. The microkeratome and the suction ring are then removed.

Your doctor may use a laser, instead of a mechanical microkeratome, to cut a flap on the cornea.

If a laser keratome is used, the cornea is flattened with a clear plastic plate. Your vision will dim and you may feel the pressure and experience some discomfort during this part of the procedure. Laser energy is focused inside the cornea tissue, creating thousands of small bubbles of gas and water that expand and connect to separate the tissue underneath the cornea surface, creating a flap. The plate is then removed.

You will be able to see, but you will experience fluctuating degrees of blurred vision during the rest of the procedure. The doctor will then lift the flap and fold it back on its hinge, and dry the exposed tissue.

The laser will be positioned over your eye and you will be asked to stare at a light. This is not the laser used to remove tissue from the cornea. This light is to help you keep your eye fixed on one spot once the laser comes on.

When your eye is in the correct position, your doctor will start the laser. At this point in the surgery, you may become aware of new sounds and smells. The pulse of the laser makes a ticking sound. As the laser removes corneal tissue, some people have reported a smell similar to burning hair. A computer controls the amount of laser energy delivered to your eye. Before the start of surgery, your doctor will have programmed the computer to vaporize a particular amount of tissue based on the measurements taken at your initial evaluation. After the pulses of laser energy vaporize the corneal tissue, the flap is put back into position.

A shield should be placed over your eye at the end of the procedure as protection, since no stitches are used to hold the flap in place. It is important for you to wear this shield to prevent you from rubbing your eye and putting pressure on your eye while you sleep, and to protect your eye from accidentally being hit or poked until the flap has healed.

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After Surgery

Immediately after the procedure, your eye may burn, itch, or feel like there is something in it. You may experience some discomfort, or in some cases, mild pain and your doctor may suggest you take a mild pain reliever. Both your eyes may tear or water. Your vision will probably be hazy or blurry. You will instinctively want to rub your eye, but don't! Rubbing your eye could dislodge the flap, requiring further treatment. In addition, you may experience sensitivity to light, glare, starbursts or haloes around lights, or the whites of your eye may look red or bloodshot. These symptoms should improve considerably within the first few days after surgery. You should plan on taking a few days off from work until these symptoms subside. You should contact your doctor immediately and not wait for your scheduled visit, if you experience severe pain, or if your vision or other symptoms get worse instead of better.

You should see your doctor within the first 24 to 48 hours after surgery and at regular intervals after that for at least the first six months. At the first postoperative visit, your doctor will remove the eye shield, test your vision, and examine your eye. Your doctor may give you one or more types of eye drops to take at home to help prevent infection and/or inflammation. You may also be advised to use artificial tears to help lubricate the eye. Do not resume wearing a contact lens in the operated eye, even if your vision is blurry.

You should wait one to three days following surgery before beginning any non-contact sports, depending on the amount of activity required, how you feel, and your doctor's instructions.

To help prevent infection, you may need to wait for up to two weeks after surgery or until your doctor advises you otherwise before using lotions, creams, or make-up around the eye. Your doctor may advise you to continue scrubbing your eyelashes for a period of time after surgery. You should also avoid swimming and using hot tubs or whirlpools for 1-2 months.Strenuous contact sports such as boxing, football, karate, etc. should not be attempted for at least four weeks after surgery. It is important to protect your eyes from anything that might get in them and from being hit or bumped.

During the first few months after surgery, your vision may fluctuate.

• It may take up to three to six months for your vision to stabilize after surgery.
• Glare, haloes, difficulty driving at night, and other visual symptoms may also persist during this stabilization period. If further correction or enhancement is necessary, you should wait until your eye measurements are consistent for two consecutive visits at least 3 months apart before re-operation.
• It is important to realize that although distance vision may improve after re-operation, it is unlikely that other visual symptoms such as glare or haloes will improve.
• It is also important to note that no laser company has presented enough evidence for the FDA to make conclusions about the safety or effectiveness of enhancement surgery.

Contact your eye doctor immediately, if you develop any new, unusual or worsening symptoms at any point after surgery. Such symptoms could signal a problem that, if not treated early enough, may lead to a loss of vision.

When is LASIK not for me?

You are probably NOT a good candidate for refractive surgery if:

• You are not a risk taker. Certain complications are unavoidable in a percentage of patients, and there are no long-term data available for current procedures.
• It will jeopardize your career. Some jobs prohibit certain refractive procedures. Be sure to check with your employer/professional society/military service before undergoing any procedure.
• Cost is an issue. Most medical insurance will not pay for refractive surgery. Although the cost is coming down, it is still significant.
• You required a change in your contact lens or glasses prescription in the past year. This is called refractive instability. Patients who are:
  • In their early 20s or younger
  • Whose hormones are fluctuating due to disease such as diabetes
  • Who are pregnant or breastfeeding
  • Who are taking medications that may cause fluctuations in vision
  • Are more likely to have refractive instability and should discuss the possible additional risks with their doctor
• You have a disease or are on medications that may affect wound healing. Certain conditions, such as autoimmune diseases (e.g., lupus, rheumatoid arthritis), immunodeficiency states (e.g., HIV) and diabetes, and some medications (e.g., retinoic acid and steroids) may prevent proper healing after a refractive procedure.
• You actively participate in contact sports. You participate in boxing, wrestling, martial arts or other activities in which blows to the face and eyes are a normal occurrence.
• You are not an adult. Currently, no lasers are approved for LASIK on persons under the age of 18.

Precautions

The safety and effectiveness of refractive procedures has not been determined in patients with some diseases. Discuss with your doctor if you have a history of any of the following:

• Herpes simplex or Herpes zoster (shingles) involving the eye area.
• Glaucoma, glaucoma suspect, or ocular hypertension.
• Eye diseases, such as uveitis/iritis (inflammations of the eye)
• Eye injuries or previous eye surgeries.
• Keratoconus

Other Risk Factors

Your doctor should screen you for the following conditions or indicators of risk:

• Blepharitis. Inflammation of the eyelids with crusting of the eyelashes, that may increase the risk of infection or inflammation of the cornea after LASIK.
• Large pupils. Make sure this evaluation is done in a dark room. Although anyone may have large pupils, younger patients and patients on certain medications may be particularly prone to having large pupils under dim lighting conditions. This can cause symptoms such as glare, halos, starbursts, and ghost images (double vision) after surgery. In some patients these symptoms may be debilitating. For example, a patient may no longer be able to drive a car at night or in certain weather conditions, such as fog.
• Thin Corneas. The cornea is the thin clear covering of the eye that is over the iris, the colored part of the eye. Most refractive procedures change the eye’s focusing power by reshaping the cornea (for example, by removing tissue). Performing a refractive procedure on a cornea that is too thin may result in blinding complications.
• Previous refractive surgery (e.g., RK, PRK, LASIK). Additional refractive surgery may not be recommended. The decision to have additional refractive surgery must be made in consultation with your doctor after careful consideration of your unique situation.
• Dry Eyes. LASIK surgery tends to aggravate this condition.

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