1. What is LASIK?

LASIK stands for Laser In Situ Keratomileusis. The procedure reshapes the cornea with an excimer laser after a thin flap of cornea has been folded back to allow treatment of the inner cornea. The excimer laser is a computer-controlled device that emits a finely tuned ultraviolet (cold) laser beam capable of reshaping the corneal surface. Each pulse removes 0.25 microns of tissue.

a. An instrument called a microkerotome is used to create a thin-hinged flap of corneal tissue. This flap is folded back. Alternatively, a second laser (Intralase) is used to create the flap.

b. A predetermined amount of tissue is removed to reshape the inner cornea to correct the patent's refractive error.

c. The corneal flap is placed back into position. No stitches are needed.

2. How the Eye Works

The eye works much like a camera. The front of the eye has two focusing structures, the cornea and the lens. The cornea is the clear dome shaped structure that a contact lens rests upon. The lens is located directly behind the colored part of the eye (iris). Together the lens and cornea focus light on to the retina. The retina lines the inside of the eye and functions as the "film" of the camera. It changes light into nerve impulses.

3. What are nearsightedness, farsightedness, and astigmatism?

Myopia (nearsightedness) occurs when the cornea is too steeply curved or the eye is too long. This causes the light to focus in front of the retina. Distance vision is blurred.

Hyperopia (farsightedness) occurs when the cornea is too flat or the eye is too short. The light comes to focus behind the retina. Near vision is blurred. Distance vision may also be blurred depending on the age of the patient and the degree of hyperopia.

Astigmatism occurs when the cornea is more curved in one direction then the other, e.g. football curvature is different along the length and width. The two curvatures cause two focusing points that result in distorted vision.

4. Who is a LASIK candidate?

Characteristics of a good candidate include:

• Over age 18
• Has a stable refraction (vision is not changing)
• Healthy cornea
• Realistic expectations
• Glasses prescription within FDA approved ranges

5. Who is not a candidate?

Patients with the following characterteristics are not good candidates:

• Women who are pregnant or nursing
• Persons with unstable refractions (vision is changing)
• People younger than 18 years of age
• Unrealistic expectations
• Monocular (one-eyed) patients
• Prescriptions out of the FDA approved range
• Progressive cataracts
• Personalities demanding precise 20/20 vision
• Severe dry eye
• Autoimmune diseases or collagen vascular diseases
• Systemic vasculitis
• Ocular Herpes Simplex
• Ocular Herpes Zoster
• Poorly controlled diabetes
• Severe Amblyopia (lazy eye)
• Keratoconus or other corneal dystrophy
• Thin corneas

6. What pre-operative education process is required?

Dr. Allen wants his patients to be informed and comfortable with their decision to have laser vision correction. Patients will meet for a private consultation with our Refractive Coordinator. Dr. Allen will be performing your comprehensive examination, so you will be able to meet Dr. Allen and discuss any concerns.

7. What happens on the day of my procedure?

Have your driver bring you to our office one hour before your surgery time. This allows time for last minute questions and pre-operative eye drops in a relaxed atmosphere.

When you enter the laser suite, you will be comfortably positioned under the laser. Most patients choose to have both eyes treated the same day. The non-operative eye will be taped, allowing easier fixation with the operative eye. An eyelid holder will gently hold your eyelid open during the brief procedure. You will be instructed to fixate on a red light.

A ring will be applied to allow use of the microkerotome to create the corneal flap. You will feel a brief pressure sensation during creation of the flap. You will not see the creation of the flap, as the vision transiently blurs while the ring is in position. The thin flap is gently folded back.

You will be instructed to fixate on the red light. The laser will then make a snapping sound as it sends cool pulses of light to reshape the cornea.

Dr. Allen will talk to you throughout the procedure. Remember that the VISX Star4 is actually tracking any small eye movements that may occur. Dr. Allen is in full control of the laser and can stop treatment at anytime. Treatments usually last 15 - 45 seconds. The flap is repositioned without sutures.

After a one-minute wait, Dr. Allen will proceed to the second eye. Most patients spend less than ten minutes in the laser suite.

8. What will my vision be like immediately after my LASIK procedure?

Your vision immediately post-LASIK will be foggy, like looking through wax paper. Your eyes will water and you will experience a foreign body sensation. Dr. Allen recommends that you go home and sleep for the first several hours post-operatively. Do not rub your eyes. You will be provided eye drops to prevent infection and reduce inflammation.

9. What will I experience the day after my procedure?

Your vision will be improved but not crisp. Usually your eyes are comfortable.

10. What restrictions must I follow after LASIK?

On the day of surgery Dr. Allen recommends that you sleep the first several hours and limit your activity the rest of the day. Dr. Allen recommends:

• No swimming for two weeks.
• No make-up for the first week. After that make-up may be applied only if it is removed without rubbing the eye.
• No water in the eye for several weeks. Shower or wash your hair with your eyes closed.
• No rubbing the eye!
• You may resume normal exercise in 24 - 48 hours if you are healing normally.
• You may return to work in 24 - 48 hours, in most cases.

11. Are dry eyes a concern if I'm having LASIK?

Dry eye is a very common problem in the general patient population. Many patients are asymptomatic. LASIK surgery temporarily damages nerves that are important in the tearing process. This increased dryness usually resolves in six months. However, untreated dry eye patients are more likely to have poorer outcomes and more corneal surface complications. All patients use Restasis and artificial tears starting two weeks prior to surgery. These continue to be used for two months post-operatively. Restasis is a prescription medication that stimulates your own lacrimal gland to produce more tears. If dry eye still remains, soft punctal plugs are placed in the openings where the tears drain. This helps the eye retain more of it's own tears.

12. Will I meet Dr. Allen before the day of my LASIK surgery?

Yes. All patients will meet Dr. Allen during your pre-operative examination. You will have as much time as necessary to discuss your questions and concerns.

13. Who will perform my pre-operative LASIK evaluation?

Dr. Allen will personally perform your eye examination and refraction. He will also personally review all pre-operative tests.

14. Who will provide my post-operative care?

Dr. Allen will be providing your post-operative care. If you prefer that your family optometrist provide the post-operative care, Dr. Allen will co-manage with your doctor.

15. How many LASIK procedures has Dr. Allen performed?

Dr. Allen has performed over 20,000 LASIK procedures.

16. May I speak with any of Dr. Allen's previous LASIK patients?

Yes. We can provide phone numbers of patients of similar age and pre-operative prescriptions. We greatly appreciate those patients willing to share their LASIK experience with others.

17. May I observe a LASIK surgery?

Yes. Dr. Allen will have to obtain permission from the patient's having the LASIK procedure. However this should not be a problem. The procedure can be viewed on a video screen in the laser suite.

18. Will I see 20/20 after my LASIK?

Smaller prescriptions have a higher percentage of 20/20 vision. However no patient can be guaranteed 20/20 post-operative vision.

19. Can laser surgery be performed on both eyes on the same day?

Yes. Dr. Allen routinely operates on both eyes unless the patient reqeusts that only one eye be treated.

20. Is the procedure painful?

It is unusual for patients to experience pain during the procedure. You will receive anesthetic drops pre-operatively. You will feel an eyelid holder that helps keep your eyelids open. You will also experience pressure for approximately 20 seconds during creation of the flap. Most patients do not consider the procedure painful.

21. How long will the laser procedure take to complete?

You will be at the laser center for approximately one hour. However it will usually take less then 10 minutes to treat both eyes.

22. Do I need to have my contacts out before the procedure?

Yes. Soft lenses should be removed three days prior to your exam and surgery. Gas permeable lenses need to be removed a minimum of three weeks prior to the examination and surgery. The rigid lenses can mold the cornea. The time required to return to it's natural shape varies. In general each decade of continuous rigid contact lens wear many require one month without the contacts to normalize the cornea. Rigid contact lens wearers may switch to a soft lens while the cornea is normalizing.

23. Will I need reading glasses after LASIK?

As we age our focusing lens loses the flexibility to focus on near objects. This condition is called presbyopia. If your distance vision is fully corrected, that eye will eventually lose the ability to see up close. This usually occurs in the 40's and is inevitable. LASIK surgery does not alter this process. If your distance vision is maximized, you will need reading glasses at some point. One solution is monovision, where the patient corrects one eye for distance and the other is set to allow near vision. Remember that to do this, the reading eye must be left with some nearsightedness, thereby blurring the distance vision in that eye.

24. What is the risk of severe vision loss after LASIK?

Like any surgery, LASIK has risks. Fortunately severe complications are rare. The risk of vision threatening complications is estimated to be approximately one in 5,000 procedures.

25. How often do patients have glare and haloes after LASIK?

Fortunately most patients do not have problems with halos and glare at night. Many contact lens wearers as well as nearsighted patients have halos pre-operatively. Patients with large prescriptions are at a higher risk for nightime side effects. Use of larger optical zone laser treatments, such as those provided by the VISX Star4, have dramatically reduced the incidence of nighttime side effects.

26. What is the difference between standard and custom or wavefront LASIK?

Standard LASIK will treat your nearsightedness, farsightedness, or astigmatism. However it is the same treatment that someone with your same glasses prescription would also receive.

Custom laser surgery also treats minor imperfections that are unique to your eye. Custom LASIK therefore provides a unique treatment, providing a higher chance of 20/20 vision. Custom LASIK also reduces the chance of side effects like glare and haloes. Many patients feel that their night vision is improved after Custom LASIK, as opposed to before with contacts and glasses!

27. Does Dr. Allen only perform custom LASIK?

No. Some patients have pupils that are too small to allow acquisition of a good wavefront image. In that case we will perform standard LASIK.

28. What are the results after custom LASIK with the VISX Star 4 CustomVue laser?

A clinical study revealed the following results:

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

In this study, four times as many people were very satisfied with their night vision after the procedure, as compared to their night vision with contacts and glasses.

29. Is Dr. Allen the most experienced LASIK surgeon in Racine and Kenosha, Wisconsin?

Yes! Dr. Allen has performed more procedures (over 20,000 LASIK's) than other local doctors. He also began offering laser vision correction in 1994 (as part of the FDA monitored clinical trials for the Chiron Technolas laser). He was the first doctor in Racine and Kenosha, Wisconsin to perform laser vision correction (LASIK and PRK).

30. Does LASIK surgery experience improve outcomes and reduce LASIK complications?

Like most surgical procedures, LASIK surgery experience does correlate with better outcomes and lower complication rates.

31. What laser does Dr. Allen use in his Racine LASIK Center?

Dr. Allen uses the VISX Star 4 CustomVue laser. VISX is the industry leader in laser vision correction and it's Star 4 laser provides outstanding results.

32. What is intralase?

Intralase is a femtosecond laser used to create the LASIK flap. The current standard of care is to use a mechanical microkeratome for flap creation. Some doctors refer to LASIK using Intralase as all laser LASIK. Both techniques possess advantages. Dr. Allen will be happy to discuss your options during your evaluation.

33. Is LASIK the only laser technique to correct my vision?

Is LASIK the only laser vision correction technique? No. Photorefractive Keratectomy (PRK) is another laser vision correction technique. It was actually the first method developed and has a long record of success. During PRK corneal surface cells are brushed off prior to applying the laser directly to the front of the cornea. No flap is created.

Approximately 15% of all laser vision correction procedures are performed using the PRK technique. PRK is preferred in patients with thin corneas, flat corneas, steep corneas or those having had a previous surgery.

34. What if I'm too nearsighted for LASIK?

There are other vision correction techniques to reduce your dependence on glasses and contacts. If you are younger than age 40, we recommend special intraocular lenses called phakic intraocular lenses (IOL).

If you're over 40, we recommend refractive lens exchange. This procedure involves removing your natual lens material and placing an intraocular lens on the eye to correct your vision. Essentially we are performing cataract surgery before you have developed a cataract.

35. What if I'm too farsighted for LASIK?

Refractive lens exhange can help you. This procedure removes your natural lens material and replaces it with an introcular lens. Essentially we are performing cataract surgery before you have developed a cataract.

Dr. Allen will answer all your questions about this great procedure at your free evaluation.

36. Will my laser surgery by done in Racine?

Yes. Our Racine laser center opened in 2003. Racine's first local LASIK center.

37. Will my LASIK follow-up care be done in Racine?

Yes. Dr. Allen will see you personally in our Racine office. However if you are from a distant location, we can arrange co-managed follow-up care with a local optometrist.

38. What is involved in a LASIK evaluation?

First you will meet our refractive coordinator. She will interview you to determine your goals, what benefits you seek, what concerns you have, etc. Then a thorough testing and screening process as well as initial LASIK education will be provided. Then you will have your complete examination with me. There we will discuss if you are a candidate, and your likelihood of 20/20 vision. We will also cover potential risks, complications and side effects. We will discuss in detail what you will experience on the day of your procedure. You will have a chance to have all your questions, concerns, and fears addressed.