Laser Vision Correction
Things to Consider on your iLASIK journey
There is a lot more to sight than simply achieving 20/20 vision on a Snellen chart in a doctor's office. 20/20 vision on a chart is a poor representation of real life quality of vision. It is but one aspect of vision that we measure when we assess the quality of your vision, including day and night vision.
As an example: To date, aero-medical professionals have been cautious of employing traditional LASIK procedures on military aviators like astronauts and jetfighter pilots, because in space, higher levels of vision precision is needed during flight and space walks requiring not just good sight, but exceptionally good sight
Dr. Schallhorn, himself a retired naval aviator, spearheaded the majority of the Defence Department's research in laser vision correction. It was only when the steel blade was totally eliminated from LASIK and LASIK became an all-laser procedure, that NASA approved it for use on pilots, mission and payload specialists in September 2007. The all-laser blade free procedure called iLASIK by AMO®, has also now been cleared for U.S. military personnel, including most recently Air Force pilots.
Why choose Bense Vision for your laser eye surgery?
- We are the only centre offering blade-free iLASIK in this province
- We have an excellent financing program that makes iLASIK very affordable
- We pioneered Laser Vision Correction and LASIK in Atlantic Canada
- Over 15 Years of Vision Correction Surgery Experience with over 20,000 successful vision correction procedures, including over 15,000 laser vision correction procedures
- Excellence in the Field of Ophthalmology
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Refractive Errors of the Eye
Your vision is a precious and essential part of your life, and your eyes are marvellous, complex instruments. In fact, your vision is made possible by the interaction of many components.
Myopia (Nearsightedness)
You may be familiar with the term myopia, also known as near-sightedness. Myopia is the result of an eyeball which is too long, or a cornea which is too curved. In both cases, light rays entering your eye fall short of the retina, and objects in the distance appear blurred. If you have this condition, you are not alone; more than 70 million people in North America have myopia.
Hyperopia (Farsightedness)
Hyperopia, or far-sightedness, is the opposite of myopia. Here, your eye is too short or your cornea is less curved. Consequently, light rays entering your eye fall behind the retina. This results in blurred vision which is worse at near distances than far distances.
Astigmatism
Astigmatism occurs when your cornea is shaped like a football, with two different curvatures. Images appear blurred or ghost-like because light rays are refracted unequally. In extreme cases, images both near and far appear blurred. Many people who have myopia also have astigmatism.
Presbyopia (Loss of Reading Ability)
Presbyopia is the term used for the loss of reading vision that everybody experiences after age 40. Typically, one wears reading glasses or bifocals to compensate for the loss of reading vision.
When laser vision correction is performed, patients can choose to preserve some of their near vision by having their non-dominant eye left mildly nearsighted. This is called mono-vision and is a very successful approach to providing patients with both distance and reading vision.
Co-management with Optometrists
Bense Vision has enjoyed a remarkable association with many optometrists in NL in a respectful and professional relationship.
Over 40 optometrists in this province many have participated in providing very valuable effective and insightful pre and post-operative exchanges of information between optometrists and Dr. Bense.
As a result of this co-management system that goes back over 15 years, it is not unusual for optometrists to refer a refractive patient to us. We refer them back promptly. We have a mentorship program for years and have offered free laser vision correction to any of them. Some of them have availed of this service to their great satisfaction
Am I really a good candidate?
Yes, if you are part of Generation i.
"Generation i" has been waiting years for the iLASIK procedure to come along!
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Generation Y (21-29) |
Generation X (30-39) |
Baby Boomer (40+) |
The ideal candidate for LASIK:
- Is normally 18-21 years or older
- With a stable prescription that has not changed significantly within the past 12 months
- Have generally healthy eyes and are generally healthy
- Have sensible, realistic expectations
Patients eligible for LASIK are eligible for iLASIK with IntraLase.
By offering the IntraLase Method™*, those patients who were reluctant to undergo LASIK for fear of a blade, may now have renewed interest with the availability of a 100% blade-free LASIK experience™—from start to finish.
And, with the architecturally sound and precise flap creation delivered by using IntraLase, we can now treat patients with:
- Higher refractive errors
- Thinner corneas
- Large pupils
- Moderate-to-high astigmatism
*Only the IntraLase FS laser can be used to perform the IntraLase Method.
Many people however still don't understand that not all LASIK surgery is the same.
They are generally amazed to learn that traditional LASIK is performed with an oscillating hand held razor type of steel blade housed in a micro-keratome. They seem surprised to hear that some surgeons still use a metal blade to cut the flap on the cornea.
The comfort of iLASIK, combined with the immediacy of its vision results and excellent results, predictability, stability, and safety, account for the great success that iLASIK is enjoying today. That is why Dr. Mike Bense, like so many ophthalmic teaching hospitals and other leaders in LASIK surgery across the continent have embraced iLASIK as the LASIK procedure of choice. Over 90% of patients that visit Bense Vision now choose blade free iLASIK as their chosen procedure.
But make no mistake about it, the most advanced technology in the world cannot compensate for lack of surgical experience and skill. When you choose Bense Vision for iLASIK you get both the most advanced technology available as well as a surgeon with over 15 years experience in laser eye surgery.
The reality is that most people who meet the age and general health criteria are in fact good candidates for the iLASIK procedure. With iLASIK, we can treat a broader range of patients who might otherwise have been rejected by other LASIK companies, especially those with thin corneas. Unfortunately many people whom we see have an incomplete understanding of LASIK and the antiquated view of who is a candidate. Let us make it simple; if you meet the basic criteria as listed below, chances you are a good candidate for the safest and best LASIK procedure on earth, the iLASIK procedure.
When is a patient a poor candidate for laser surgery? If you have:
- A collagen vascular disease
- An autoimmune or immunodeficiency disease
- Signs of keratoconus or an abnormal corneal topography
- If you are taking Accutane or Amiodarone hydrochloride (Cordarone)
- If you are pregnant or nursing
- If you have Advanced Diabetic Retinopathy or other devastating eye diseases.
What conditions does LASIK surgery not cure?
- Cataracts: Bense Vision treats developing cataract by RLE
- Lazy Eye (Amblyopia): No treatment. We do not treat an amblyopic eye unless you are at least able to see 20/50 in that eye
- Presbyopia: We have new solutions for loss of reading ability but presbyopia is a chronic progressive loss of the ability to see up close and LASIK does not cure this problem (see monovision LASIK later)
- Squints: this is a condition where an eye is turned inwards or outwards and requires the opinion of an ophthalmologist
Potential Complications of laser eye surgery (PRK, LASIK, iLASIK, LASEK)
Is a promise of "20/20 day vision or your money back" enough to convince you of the safety of a LASIK procedure?
NO! The key in iLASIK is its SAFETY, plus the Quality of your vision, day or night!!
- Everybody is afraid of a complication. Everybody wants maximum safety. iLASIK is the safest LASIK procedure because the ilASIK procedure does not lead to blade-associated intra-operative complications, like a mangled flap, lost or buttonholed flap, but just like blade LASIK, they also have a small risk of post-operative flap complications like flap wrinkles etc. I have personally not yet seen any flap complication when created with an IntraLase laser at Bense Vision.
- Surface procedures like PRK, LASEK, Epi-LASIK also do not lead to blade-associated intra-operative complications but they on the other hand, have a higher risk of haze, corneal scarring and postoperative pain.
20/20 but UNHAPPY: Poor quality of vision despite seeing 20/20 on a doctor's eye chart
20/20 is merely an indication that you can see quite well on a bright day or in your doctor's office under controlled lighting conditions. It actually reflects poorly on your near vision abilities (reading, computer work etc.), your ability to drive comfortably and safely at night without halos, night glare, double vision and the ability to detect objects in poorly- lit situations. These issues speak more clearly to the QUALITY and not quantity of your sight after LASIK.
Throughout this handout, we speak of iLASIK improving the quality of your sight, having fewer issues with night driving vision, improving contrast sensitivity vision. These are all the qualities of sight that NASA and other agencies like the TopGun jet school were seeking for their highly valued assets: their pilots and astronauts. It was not until the blade was 100% eliminated from the procedure and blade free iLASIK came along that NASA and other pilot agencies considered the procedure safe enough: it was not because they did not reach 20/20, but because the quality of their day and night vision was not assured with older LASIK techniques.
Flap Complications caused by a Blade
Examples of some Blade-LASIK Complications are:
- Buttonhole caused in corneal flap by a blade
- Night Glare and Halos
Creation of the corneal flap in all types of LASIK is a crucial element in the overall process. When using a blade instead of a blade-free laser in this step, blade flap complications can include small flaps, irregularly shaped flaps, very thin flaps, and very thick flaps, mutilated flaps, lost flaps, button-hole flaps and an irregular treatment surface. If the abnormality is serious enough, the case must be cancelled without performing the laser treatment. After a 3-6 month healing period, LASIK can again be attempted in some cases. Sometimes, LASIK has to be cancelled permanently. Using iLASIK at Bense Vision, I have seen no complications from using the IntraLase blade-free laser: no abrasions, no buttonholes, no disfigured flaps, no flap thickness surprises, no wrinkles, & no epithelia in-growth in primary cases. With a blade, I routinely would expect to see between 5-10% of cases get an epithelial abrasion. I have personally seen a significant improvement in safety in my own hands when using the IntraLase. Reported incidence: 0.7-11.8%
Inflammation (Sands of the Sahara): Diffuse Lamellar Keratitis (DLK)
Inflammation is a normal reaction in any surgery. Steroid and anti-inflammatory drops given post-operatively typically control this well. However, if the inflammation is more severe, it can require more aggressive therapy because it could affect the visual outcome. Reported incidence: 1%
Overcorrection of Results
This is usually an exaggerated response to treatment. Mild cases are typically visually insignificant and can often be remedied by simple measures. However, significant overcorrection can be bothersome and require a touch-up procedure to try and remedy the situation. Reported incidence: 1%
Epithelial In-growth
I have never seen this in my practise with iLASIK with a primary iLASIK case. It is not uncommon with traditional LASIK especially on touch-up procedures. This is a condition in which the microscopic surface epithelial cells manage to grow beneath the edge of the LASIK flap and invade the area known as the "interface". This is rare on primary cases and most commonly associated with re-treatment procedures. Mild cases are of no significance, but more aggressive intrusions can cause discomfort, a decrease in vision or threaten the health of the flap itself. In these more serious cases, it may be necessary to re-lift the flap and remove the cells by scraping the surface and or using 20% Ethanol to kill these cells. It may even be necessary on occasion to suture the cornea. Reported incidence: 1-15%
Corneal Infection
One of the most serious complications of any surgical procedure is infection. This can lead to serious loss of vision. Never before seen at Bense Vision. Reported incidence: 1/5,000 cases
Corneal Ectasia (Thinning)
This serious complication usually occurs 2-3 years after your procedure. It mimics a condition called keratoconus. Causes are obscure, debated and ill defined. It may require the use of RGP's (Rigid Gas Permeable contact lenses), INTACS surgery, or the use of collagen cross-linking. More likely to occur in situations where in Traditional LASIK, you accidentally cut a much thicker flap than you had wanted to, because of the blade.
Reported incidence: 1/2,500 cases
Corneal Perforation
This is only seen with bladed micro-keratome technologies used in "Old Technique LASIK". The blade was allowed to penetrate the eye, often leading to very serious consequences. Most of this technology has been replaced. Reported incidence: < 1/1,000
Courtesy of www.intralasefacts.com
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Better vision1 |
YES |
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Better safety |
YES |
— |
Highest degree of precision and predictability3 |
YES |
— |
Individualized flaps3 |
YES |
— |
Fewer retreatments4 |
YES |
— |
Ability to be used in more eligible patients2 |
YES |
— |
Patient preferred5* |
YES |
— |
*In a clinical survey of LASIK patients who had their corneal flaps created using a blade in one eye and the IntraLase Method in the other, the vision in the IntraLase-treated eye was preferred 3-to-1, among those who stated a preference.5
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Why is IntraLase in iLASIK safer than ordinary LASIK?
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INTRALASE |
BLADE LASIK |
Risk of abnormal flap |
0% |
Up to 1% |
Flap thickness complication |
0% |
1-2% |
Risk of a Corneal Abrasion |
0% |
5-10% |
Most people see 20/20 |
Yes |
No |
Can treat muchthinner corneas |
Yes |
No |
The vast majority of iLASIK patients will see 20/20 OR BETTER after surgery. That could be life changing!
Outcomes may vary from person to person. 98% of nearsighted patients participating in the Advanced CustomVue™ FDA clinical trials could see 20/20 or better one year after treatment.
The iLASIK procedure is not without risk, but wearing contacts comes with risks as well, as they require time and meticulous attention to ensure proper cleaning and to avoid infection. Infections with contacts do occur, so considering this risk, the hassle of contacts and the lifetime costs of wearing contacts, maybe it's time to consider the iLASIK procedure.
iLASIK is an elective procedure with other alternatives including eyeglasses, photorefractive keratectomy (PRK), conventional bladed LASIK, and other refractive surgeries. Only an eye care professional trained in laser vision correction can determine whether you are a suitable candidate.
As with any surgical procedure, there are risks associated with the treatment. It is important to discuss the risks associated with the procedure and any questions you may have about the procedure with your doctor. Before deciding whether to have the procedure, you should ask your doctor for and carefully review all the literature we will provide you with.
COMPARE the Keratome Blade to the Blade-Free IntraLase™ FS laser System!
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Vs. |
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Laser Results
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20/20 or better after 1 year |
20/40 or better after 1 year |
Lower Myopia |
96% |
100% |
Moderate Myopia |
92% |
100% |
High Myopia |
80% |
98% |
Hyperopia |
85% |
93% |
Mixed Astigmatism |
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94% |
Nearly four times as many participants were very satisfied with their night vision without glasses as they were with glasses before treatment.
Alternatives to LASIK/PRK for Myopia, Hyperopia and Astigmatism
- Continue to use glasses or contact lenses, and if you are over 40 you will automatically need reading glasses or bifocals.
- Excimer Laser PRK or Epi-K surface ablation
- Lensectomy with intraocular lens implant (RLE)
(The natural lens is removed and is replaced with an intraocular lens implant.) - Phakic IOL (Intraocular Lens) or ICL (Intraocular Contact Lens -- insertion of an artificial lens without removing the crystalline lens.)
- Intracorneal rings (INTACS)
Other Procedures:
- Astigmatic Keratotomy (AK)or LRI (Limbal Relaxing Incisions) with a diamond blade
- Myopic or hyperopic keratomileusis, or ALK (automated lamellar keratoplasty) without Excimer Laser. - AK, RK
- Holmium YAG laser surgery
- Myopic or hyperopic epikeratophakia
- Scelleral expansion implants (highly experimental)
- Newer forms of partial corneal transplantation
How will iLASIK improve my life?
Here are the benefits of having my vision corrected by iLASIK
- Reduced dependency on contact lenses and spectacles, often providing clear and natural vision of high quality, frequently better than 20/20: individual results vary however
- Reduced fears about breaking and losing spectacles/contacts: cost issues
- Expanded recreational activities
- Expanded career opportunities: police, RCMP, military, pilots, fire fighters
- More natural appearance
- Elimination of risks associated with contact lens wear: corneal warpage, worsening of keratoconus, infectious keratitis, vascularization of the corneas, and issues of contact lens overwear
My next step, now that I am ready to consider having the iLASIK procedure
Once you decide that you are ready to take the next step:
- Schedule a COMPLIMENTARY consultation to determine if you are a good candidate for the iLASIK procedure.
- Get comfortable with the procedure by getting to know the facts:
How to Schedule a Complimentary Consultation
100 Elizabeth Avenue, Elizabeth Towers
St. John's, NL, A1B 1S1 Canada
Tel: (709) 722-2020
email: eyecentre@bense.ca
Web: www.bense.ca
The Laser Vision Correction Consultation
This is a complimentary consultation. If you are nearsighted, farsighted, or astigmatic, you could be a candidate for this breakthrough procedure. Let Bense Vision help by providing you with the knowledge needed to help you make the most informed decision regarding your vision correction options.
I have decided on having iLASIK: Now what?
Remember: The Safety and Quality of your vision is our main concern, every step of the way.
Having laser vision correction at Bense Vision can be one of the most rewarding and exciting experiences of your life.
Once you arrive at Bense Vision, the staff at Bense Vision will answer any additional questions you may have. They will review a list of instructions with you as they prepare your eyes for the procedure. Your friends and family are invited to watch your iLASIK treatment in our viewing room. As you relax in a reclining chair, freezing eye drops will be placed in each eye so that your procedure is pain free.
Informed Consent: The Steps Involved
The Signing of the Consent Form Itself
You will be given ample opportunity to review our iLASIK info provided to you. We believe a patient who has researched the topic well will be a happy patient with reasonable expectations. From your very 1st contact with either us at Bense Vision or with your personal optometrist, you will repeatedly be told about the risks, potential benefits, alternatives and other such information about iLASIK and other vision enhancement procedure, that you will feel well informed about the risk/benefit ration involved in your situation.
Pre-operative Planning
Proper planning and care increases the success rate of any surgery. To save time there are many elements of the evaluation that should be clear to each prospective candidate. The elements of the final exam are also important for the proper surgical plan.
Preparing for your surgery
- You are required to stop wearing contact lenses prior to the surgery (see below) or until the cornea is stable
- A driver must accompany the patient or prior arrangement for transportation.
- Take your regular medications
- No perfume or any make-up
- Eat a light breakfast or lunch
- Wear loose comfortable clothing
- You must be accompanied by a responsible adult on the day of surgery
Contact lens rules are important!
- Disposable: out for 4-7 days
- Soft: out for 1-2 weeks
- Hard/Toric: out until topography is stable (up to 8 weeks)
- For iLASIK patients: For best results, CONTACTS SHOULD BE OUT A MINIMUM OF TWO WEEKS FOR SOFT LENSES, THREE WEEKS FOR GAS PERMEABLE LENSES
Day of Surgery
What to expect on iLASIK day!
- There are no restrictions on eating, drinking, or medications before the procedure.
- Wear comfortable clothing.
- On the day of your procedure, all traces of make-up should be removed prior to your arrival at Bense Vision.
- When you arrive at The Bense Eye Centre
- Please register with a patient services representative
- You will be given a consent form to read and sign.
- Should you have any further questions, the doctor will be happy to speak with you prior to your procedure.
- In the pre-operative patient preparation area:
- Your eye(s) may be re-measured with a WaveScan system and a Pentacam unit. In seconds, the system will determine the curve of your cornea, its thickness, and the size of your pupils and create a customized map of your eye(s).
- You will be given a mild sedative.
- The laser is calibrated and programmed with your prescription before you enter the laser room.
- Inside the laser Room:
- It will take a few minutes to position you properly under the blade free Laser
- Your fellow eye will be covered and eye drops will be placed in the operative eye
- These include aesthetic drops to numb the eye, antibiotic drops to prevent infection, and anti-inflammatory drops to reduce post-operative discomfort.
- 1st a blade free flap will be created in your left eye, then your right eye
- Then you will be positioned under the excimer microscope
- A simple device known as an eyelid speculum will prevent you from blinking. It is painless.
- You will be instructed to look at a flashing red target light. Your surgeon will monitor your eye through the microscope at all times.
- You will now hear a "clicking" sound as the excimer laser alters the refractive curvature of your eye. The actual laser time is usually less than 60 seconds.
- You will not experience any discomfort during your iLASIK procedure.
Once your procedure is completed
- You will be seated in our recovery lounge for 30 minutes. Thereafter Dr. Bense will re-examine your eyes. If all is well, you will be given a post-operative kit containing drops and medication to use for the next few days. Follow your surgeon's instructions.
- Your driver will then be able to take you home to rest.
- Please go directly home after your treatment. You will probably feel best if you rest for a few hours
- Avoid swimming, hot tubs, and gardening for one week.
- Do not wear make-up for the first four to five days following your procedure.
- It is important not to rub your eye at all, just dab gently underneath the eye.
- Showers and baths are fine, but avoid getting water into your eye.
- You may go back to work and return to your usual exercise routine the day after your treatment.
The Day after your Surgery
You will see Dr. Bense the following day for a brief eye examination to check on your eye health. Chances are that you will be quite happy with your progress. Though rare, as in any medical procedure, there may be some side effects associated your laser treatment.
Remember:
- Do not rub or squeeze your eyes for one week
- Please use your eye drops as instructed
- Wear a good pair of protective sunglasses
- Wear the eye shield for the first three nights after the surgery.
- No make-up for one week
- Avoid contaminated water, such as pools and hot tubs for one week
- No sports for one week
- Call the office if you have severe pain that cannot be controlled with over the counter pain medications
- It is important to keep up all your post-operative appointments
Symptoms during your recovery process:
Irritation:
It is not unusual to feel as if there is an eyelash in your eye. You will be given medication to take if you experience any discomfort.
Blurry Vision:
Your vision will be blurry for the first few hours after your iLASIK treatment. Within several hours you will notice significant improvement. Vision after PRK will remain blurry for several days. You must be prepared for this if PRK is the treatment of choice for you.
Night Glare:
This symptom is most apparent during the first several weeks of your recovery. Night glare usually resolves and returns to pre-procedure levels once both eyes have healed. Studies recently done at several North American laser centres have shown excellent results with the ability of the iLASIK method to improve night vision. Many patients treated with an Advanced CustomVue™ procedure had better night vision after treatment than they experienced with their glasses or contact lenses.
Reading Vision:
You may be slightly farsighted immediately following your procedure. This will temporarily affect your reading vision, especially if you are over 40.
Light Sensitivity:
You may experience increased sensitivity to light for the first few hours after your procedure. A good pair of sunglasses will help.
Infection:
There is a very slight risk of infection during the first one to two weeks after your procedure. As part of your treatment, you will receive antibiotic drops before and after your session. To minimize the risk of infection, we recommend that you avoid activities such as gardening or swimming for the first week.
Over correction:
You may experience some over correction during the healing process. Again, this is a normal part of your eye's healing. You'll find that your vision will stabilize within one to four weeks, depending on your initial level of myopia. In rare cases, the over correction may persist.
Regression:
Fifteen years of investigative trials with laser vision correction have demonstrated that vision almost always remains stable. Some individuals may experience a degree of regression or under correction, although this is usually minimal. It can be corrected with an additional procedure, or you can opt for a thin pair of glasses, or contact lenses. The overwhelming majority of individuals require only one procedure.
Post–op care
You will be given detailed instructions pertaining to your required care immediately after your surgery. Most times people will be able to drive the next day if your doctor gives you the green light. You will be seen again in 7 days by Dr. Bense or by your own optometrist.
You will soon forget that you ever had laser eye surgery.