LASIK in Monterey

LASIK or Laser In-Situ Keratomileusis reshapes the cornea by removing tissue beneath the surface of the cornea. LASIK combines the accuracy of the Excimer Laser with the benefits of Lamellar Keratoplasty (LK).

First, a device called a microkeratome lifts a thin layer of the cornea. This instrument creates a precise layer by working very much like a carpenter's plane. This layer, or flap, is then folded back. Next, a cool beam of light gently reshapes the outer surface of the cornea. The laser treatment typically takes less than one minute, and the flap is replaced in its original position.

LASIK is performed on an outpatient basis and takes only a few minutes. You will remain awake during the procedure and the only anesthetic you will need is eye drops. Anticipate being in our office about one hour on the day of the procedure. Most patients experience improved vision the same day and are able to return to work the very next day. You will take an antibiotic drop a few times a day for less than a week following your procedure.

Some of the advantages of LASIK are little or no postoperative discomfort, vision usually improves within 24 hours, vision usually stabilizes in 1-2 months, infection is rare, and eye drops are used for less than a week.

While serious problems are rare, possible risks may include an incomplete flap due to microkeratome malfunction or poor suction, irregular astigmatism or loss of best corrected vision, epithelium ingrowth under the corneal cap, under/overcorrection, or infection.

For more information about LASIK Treatment, please click here »

LASEK

LASEK, or Laser Assisted Subepithelial Keratomileusis, is a modification of the LASIK procedure for patients with very thin or very flat corneas. First, the outer layer of the cornea (the epithelium) is cut with a trephine. The trephine has a much finer blade than the microkeratome used in LASIK. Next, the eye is bathed in a special alcohol solution that loosens the edges of the epithelial flap. The flap is lifted so the central cornea may be exposed and treated with an excimer laser. After treatment the flap is replaced and allowed to heal. A contact lens may be worn for a few days until recovery is complete.

For more information about LASEK Treatment, please click here »

PRK in Pacific Grove

PRK or Photo-Refractive Keratectomy treats refractive errors by removing tissue from the surface of the cornea. First, the epithelium, a thin layer of protective skin on the front of the cornea will be removed. Next the Excimer Laser, usually in less than a minute, will remove the proper amount of tissue thus reshaping the surface of the cornea. A bandage contact lens is then placed on the eye for 2 to 3 days until the epithelium heals.

Patients often experience discomfort and a watery eye for the first 24-72 hours after their procedure. Vision may take up to three months to stabilize.

Possible risks and complications include infection (very rare and usually treated with eye drops), over or under correction, glare, or post-operative haze.

LASIK has mainly been used to treat nearsightedness. By adjusting the laser beam, however, it is now possible to treat moderate levels of farsightedness (Hyperopia) and astigmatism by using the LASIK technique. Multiple studies have shown excellent results with hyperopia up to +6.00 diopters.

For more information about PRK Treatment, please click here »

PRK vs. LASIK

As can be seen from the above, many patients must decide between LASIK and PRK. There is excellent data from U.S. studies that show PRK works well for the myopic group from -1.00 to -3.00 diopters, and comparative studies in this range show similar results to LASIK at one year post-op. Above -3.00, however, LASIK has a significantly decreased risk of corneal haze, and much less dependence on post-op steroid eye drops. In all patients, LASIK is more comfortable, with more rapid return of vision post-op, and less tendency for regression of effect. In addition, a membrane of the cornea, called Bowman's membrane, is not removed in LASIK, as it is in PRK. These advantages must be weighed against the possible complications of the microkeratome, the instrument used in making the corneal flap. As we have become more experienced with this instrument, however, this has become less of a concern. A final advantage of LASIK is that, in many patients, we can do both eyes at the same time, because vision is usually clear enough to function the next day.

Epi-LASIK

Epi-LASIK is the most advanced form of surface laser treatment (ablation). Surface ablation differs from true LASIK in that there is no flap made, either by a mechanical keratome or by laser. Because there is no flap, there can be no flap complications (e.g. dislocation, wrinkles, perforation). Flap complications are, however, not common.

To prepare the eye for this advanced surface laser treatment, the top cells (epithelium) is removed by a special instrument called an epi-keratome. Dr. Friedman uses the Moria instrument (www.moria-surgical.com), as this one has the best results and has the most number of published studies. Our experience with this technique has been excellent.

Patients chose epi-LASIK over LASIK if:

• They are found to be unsuitable for LASIK (e.g. thin cornea)
• Want to avoid any possibility of flap complications
• Have a low correction

The vision recovery is slower with epi-LASIK than conventional LASIK, but the end results are similar. Most of our patients are 20/30 the day after laser treatment, but take two to three weeks to reach stable 20/20 vision.

Your consultation with Dr. Friedman will determine if you are a candidate for Epi-LASIK.

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Phakic Implants (ICL)

A new vision correction procedure is now available for patients with moderate to severe nearsightedness. A phakic implant (ICL) is a lens that is implanted in the eye while the healthy natural lens remains in place. This can be an alternative for patients who do not qualify for laser vision correction due to high levels of nearsightedness or very thin corneas.

The surgical procedure to implant the lens is performed on an outpatient basis under local anesthesia and takes approximately 15-30 minutes. The surgeon makes an incision in the eye, through which the ICL is inserted. After the lens is fixed into place, sutures are used to close the incision. Patients are free to return home the same day. While everyone heals at a different rate, most patients return to their normal lifestyle in a day or two, and achieve their best vision in about six weeks, after healing is complete.

Dr. Friedman is currently implanting the Visian™ lens, which is the first FDA approved lens for treatment of moderate to severe nearsightedness.

For more information about Phakic Implants, please click here »

Bifocal and Astigmatic Lens Implants

For the right candidate, patients now have another option to reduce their need for reading glasses. With the development of bifocal or multifocal intraocular lenses, an intraocular surgery similar to cataract surgery can be performed. These lens implants offer both good distance and good reading vision reducing the need to use reading glasses more than 80% of the time.

The natural, clear lens is removed using phacoemulsification ("phaco") surgery which is a minimally invasive, no-stitch cataract surgery. First, the eye is numbed with topical anesthesia in an outpatient surgery setting. Then a tiny incision is made in the eye to make room for a small ultrasonic probe. This probe breaks up, or emulsifies, the clear lens and then is suctioned out. After the natural lens has been removed, the multifocal artificial lens is implanted in the eye through the same small incision from the phaco procedure. The next day the patient can enjoy the remarkable change in vision both at distance and at near.

For more information about Biofocal Implants, please click here »