Corneal Associates, PC
840 Walnut Street
Philadelphia, PA 19107-5109
To be considered a good candidate for refractive surgery you must meet a few conditions. First, you must be at least 18 years old and preferably over 21. You should have healthy eyes and vision that has been stable for several years. You cannot be pregnant or nursing, and you must not have certain medical conditions (such as autoimmune disorders) that can decrease the success of the surgery. Lastly, you must have a good understanding of the surgery and realistic expectations for your result.
Certain anatomical features of your eyes, such as your corneal thickness, can also factor into which refractive procedure is best suited to your case. At Wills Eye Institute, we have the most advanced diagnostic instruments to assess your situation, and experienced LASIK surgeons skilled at counseling patients on which refractive procedure, if any, is right for them.
Dr. Rapuano is the Chief of the Cornea Service and the co-director of the refractive department at Wills Eye and has been performing refractive surgery since 1992. At that time, he was instrumental in reintroducing radial keratotomy (RK) to Wills Eye. That year he also began performing PRK as part of the VISX FDA trials at Wills. He has been performing LASIK since 1997.
Drs. Rapuano has extensive experience in many forms of refractive surgery and can advise patients as to their best options. Dr. Nagra trained here at Wills under Dr Rapuano and has performing corneal and refractive surgery for 8 years.
Above all, Drs. Rapuano and Nagra are compassionate physicians. They will personally discuss your particular refractive surgery options with you prior to surgery; after surgery, they will spend time examining you and discussing the results of your procedure.
LASIK and other refractive procedures, such as ASA and RK/AK, are safe and effective refractive surgery procedures. ASA (advanced surface ablation) has a longer track record than LASIK, as it is an older procedure. ASA is a more straightforward procedure as it does not involve creating a corneal flap. LASIK is a newer procedure, but it is developing an excellent track record. LASIK does offer some benefits over ASA, including less discomfort during healing, more rapid recovery of vision, and less chance of corneal haze/scar after surgery. Medication is used for a shorter period of time, and there are fewer post-operative visits after LASIK than after ASA.
However, complications from the use of the microkeratome can occur after LASIK, including thin flaps, partial flaps, dislodged flaps, and cell growth or infection under the flap. Many of these problems can be easily fixed, but some can result in loss of vision.
The long-term visual results are similar for ASA and LASIK, but in the short-term, LASIK patients see better and are much more comfortable. Talking to our LASIK surgeons is the best way to determine which procedure is best for you.
Wavefront™ technology is simply a different method of collecting data about the eye’s refractive abilities. The Wavefront™ machine sends multiple rays of light into the eye, and then records how they exit the eye — giving refractive data over a large area of the cornea. That information can be transmitted to the laser to reshape the cornea.
While the end result of Wavefront™-guided LASIK, or custom LASIK, is similar to standard LASIK, it has the potential to give a more individualized ablation, ideally yielding better visual results. It is FDA approved for mild to moderate myopia with mild to moderate degrees of astigmatism. The cost for Wavefront™-guided LASIK is slightly higher that standard LASIK, and the procedure involves additional testing.
After preparation of the eyes with drops, an eyelid holder is placed so you cannot close the eye. A suction ring is placed on your eye to increase the eye pressure. You will feel a pressure sensation and your vision will dim. The microkeratome is used to create the flap. Then the pressure ring is removed and your vision returns, but will be fuzzy. The flap is lifted, the laser treatment performed, and the flap is replaced. The interface is irrigated and the flap adheres for several minutes. After the surgery, your vision will be moderately blurred for several hours, and it is recommended that you go home and take a nap to allow for optimal healing of the flap.
There is minimal discomfort during the LASIK procedure because the eye is numbed with anesthetic drops. The eyelid holder can cause mild irritation when it is opened wide. When the suction ring is placed on your eye, you will feel a pressure sensation, but no real pain. After the surgery, the eye often has a sandy or gritty feeling for four to six hours. Usually, the eye will feel back to normal by the next day.
Most patients elect to have both eyes treated the same day, although it is up to you. Advantages of having surgery on both eyes on the same day include convenience (fewer trips for surgery, fewer post-operative visits), fewer days off from work, and minimal imbalance between the two eyes. Disadvantages include safety issues such as infection or severe inflammation, which could occur in both eyes if they are treated on the same day, or rare cases of decreased vision from corneal scarring or irregularity.
On the day of surgery, vision is often moderately blurred. By the next day, vision generally improves greatly, although it is often not perfect. Most patients experience glare and halos, especially in dim illumination, after LASIK. These symptoms typically last a few weeks but in rare cases can last longer. The chances of achieving 20/40 uncorrected vision is around 95 to 98 percent. The chance of reaching 20/20 uncorrected vision is about 60 to 70 percent. Your individual results will depend on your initial degree of nearsightedness or farsightedness and astigmatism.
LASIK has an excellent safety record. The chance of complications is approximately 1 to 2 percent, including significant undercorrection, overcorrection, flap problems, and, rarely, infection. Most of these complications do not cause a loss of final best-corrected vision.
When a significant undercorrection or overcorrection occurs, it is often (but not always) possible to lift the LASIK flap and repeat laser treatment. The "enhancement" rate is 5 to 15 percent, depending on the original refraction. Higher corrections correspond to a more frequent need for enhancement. When you undergo refractive surgery at Wills Eye Institute, there is no additional cost for enhancements done during the first year after your initial procedure.
Insurance rarely covers refractive procedures like LASIK. However, we do accept cash, checks, and major credit cards such as Visa and MasterCard. If necessary, you can arrange a payment plan with us to finance your LASIK surgery.
We are happy to send you an information packet regarding refractive surgery. Please call our office at 215-928-3174 to request this information, or contact us by email through our website.
If you are interested in scheduling a refractive surgery evaluation at Corneal Associates, please contact us by email or call our office at 215-928-3174.
Please note that you should stop wearing soft contact lenses at least two weeks prior to your evaluation, and rigid contact lenses for at least three. This complete ophthalmic examination, which includes dilation, takes about one and a half to two hours and costs $250. If you have additional questions, please feel free to call and speak to our refractive surgery coordinator or one of our surgeons.