Until recently, if you were one of the millions of people with a refractive error, eyeglasses and contact lenses were the only options for correcting vision. But with the arrival of refractive surgery, some people with myopia (nearsightedness), hyperopia (farsightedness), or astigmatism (a cornea with unequal curves), may have their vision improved through surgery.

Laser assisted in situ keratomileusis, or LASIK, is a refractive procedure that uses an automated blade and a laser to permanently reshape the cornea. The reshaped cornea helps focus light directly onto the retina to produce clearer vision.

LASIK is usually performed as an office procedure using topical anesthesia with drops. The procedure itself generally takes about fifteen minutes. The surgeon creates a flap in the cornea with a microkeratome. The flap is lifted to the side and the cool beam of the excimer laser is used to remove a layer of corneal tissue. The flap is folded back to its normal position and sealed without sutures. The removal of corneal tissue permanently reshapes the cornea.

A shield protects the flap for the first day and night. Vision should be clear by the next day. Healing after surgery is often less painful than with other methods of refractive surgery since the laser removes tissue from the inside of the cornea and not the surface. If needed, eyedrops can be taken for pain and usually are only needed up to one week.

Some people experience poor night vision after LASIK. The surgery may result in undercorrection or overcorrection, which can often be improved with a second surgery. More rare and serious complications include a dislocated flap, epithelial ingrowth and inflammation underneath the flap. Most complications can be managed without any loss of vision. Permanent vision loss is very rare.

The ideal candidate for refractive surgery has a stable refractive error within the correctable range, is free of eye disease, is at least eighteen years old and is willing to accept the potential risks, complications and side effects of LASIK. LASIK is more dependent on surgical skill than PRK. Take this into account when selecting a surgeon.

Dr. Young performs LASIK, and other refractive procedures at the Tiffin Eye Center in a modern mobile surgery suite provided by For-Tec On Sight Inc. from Twinsburg, OH. He uses the VISX STAR S4 Smooth scan excimer laser. This laser is the industry leader, combining both broad beam and scanning technology. It has the broadest approval from the FDA to correct myopia, hyperopia, and astigmatism using the Wavescan aberrometer. This instrument takes a digital 'fingerprint' of the eye as an optical system measuring with unprecedented precision. The information is then used to plan a wave front-guided laser treatment customized for the patients correction. Dr. Young is a VISX-certified surgeon and has been performing refractive procedures since 1994.

The procedure costs $1500-2300 per eye. This includes:

• Workup
• Procedure
• Post-op visits - (for two years)
• Any Reoperations (for a two year period, as long as all post-op appointments are kept)

Phacoemulsification (Phaco)

Phacoemulsification is a surgical method used to remove a cataract, which is a clouding of the eye's naturally clear lens. A cloudy lens interferes with light passing through to the retina, the light-sensing layer of cells at the back of the eye. Having a cataract can be compared to looking at the world through a foggy window.

In Phacoemulsification, an ultrasonic oscillating probe is inserted into the eye. The probe breaks up the center of the lens. The fragments are suctioned from the eye at the same time. A small incision that often does not require sutures to close can be used since the cataract is removed in tiny pieces. Most of the lens capsule is left behind and a foldable intraocular lens implant, or IOL is placed permanently inside to help focus light onto the retina. Vision returns quickly and one can resume normal activities within a short period of time.

Dr. Young uses several special lens implants to help reduce dependence on glasses after cataract surgery. He is one of the few surgeons in the area to be approved to use the STAAR Toric implant that reduces astigmatism and the ARRAY Multifocal implant that reduces dependence on reading glasses after cataract surgery.

Posterior Capsulotomy

A posterior capsulotomy is a surgical laser procedure that may be necessary after cataract surgery.

During cataract surgery part of the front (anterior) capsule that holds the lens is removed. The clear back (posterior) capsule remains intact. As long as that capsule stays clear one has good vision. But in 10-30% of people, the posterior capsule loses its clarity. When this happens, an opening can be made in the capsule with a laser (posterior capsulotomy) to restore normal vision.

Before the laser procedure, the ophthalmologist does a thorough ophthalmic examination to make sure there is no other reason for vision loss.

A posterior capsulotomy is painless and takes five minutes. Eye pressure is taken a half hour after the operation to make sure it is not elevated and antibiotic drops are usually prescribed for three days following the procedure. Vision should improve within hours.

Potential but rare complications following laser posterior capsulotomy are increased intraocular pressure, retinal detachment, and lens dislocation.

At the Tiffin Eye Center, we perform posterior capsulotomies using our own YAG laser, avoiding a hospital outpatient charge.

Cataract

A cataract is a loss of transparency, or clouding, of the normally clear lens of the eye. As one ages, chemical changes occur in the lens that make it less transparent. The loss of transparency may be so mild vision is hardly affected or so severe that no shapes or movement are seen, only light and dark. When the lens gets cloudy enough to obstruct vision to any significant degree, it is called a cataract. Glasses or contact lenses cannot sharpen your vision if a cataract is present.

The most common cause of cataract is aging. Other causes include trauma, medications such as steroids, systemic diseases such as diabetes and prolonged exposure to ultraviolet light. Occasionally, babies are born with a cataract.

Reducing the amount of ultraviolet light exposure by wearing a wide-brim hat and sunglasses may reduce your risk for developing a cataract but once developed there is no cure except to have the cataract surgically removed. Outpatient surgical procedures can remove the cataract through either a small incision (phacoemulsification) or a large incision (extracapsular extraction). The time to have the surgical procedure is when your vision is bad enough that it interferes with your lifestyle.

Cataract surgery is a very successful operation. One and a half million people have this procedure every year and 95% have a successful result. As with any surgical procedure, complications can occur during or after surgery and some are severe enough to limit vision. But in most cases, vision, as well as quality of life, improves.