LASIK SERVICES in Dearborn, MI

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Overview

Laser in-situ keratomileusis (LASIK) is a method of vision correction which uses the excimer laser to precisely remove corneal tissue from beneath a protective corneal flap. By removing this tissue, the curvature of the cornea, and therefore its focusing power, is changed. Myopia or nearsightedness, hyperopia or farsightedness, and astigmatism can be corrected with LASIK.

Procedure

  1. The corneal flap or cap is flipped open like the cover of a book.
  2. While the patient looks at a blinking target light, the laser is pulsed onto the bare surface of the cornea (under the flap). For someone who is nearsighted, more corneal tissue is removed from the center than from the sides (peripheral cornea). This flattens the cornea and corrects the nearsightedness. Imagine making a mountain top flatter.
  3. For someone who is farsighted, more corneal tissue is removed from the sides (peripheral cornea) than from the center. This is like removing a “doughnut” of corneal tissue, making the cornea steeper, and thus correcting the farsightedness.
  4. The protective corneal flap is then flipped back into place, like closing the cover of a book.
Laser Skin Solutions is a distributor of Newport Cosmeceuticals.
  • The Laser
  • Post-Op Recovery
  • Risks 
The Laser

Dearborn, MI Quality Eye Care

The Laser

The excimer laser is the laser used in LASIK and PRK surgery. This particular laser is very precise, removing as little as 0.25 microns of corneal tissue with a single pulse. 0.25 microns is the same as one quarter of one millionths of a meter.

Put it another way, this is a fraction of the thickness of a human hair, (pictured here) The average treatment removes only about the thickness of a human hair. The fact that this laser can remove so little tissue without causing significant damage to surrounding tissue, makes it ideal for corneal surgery such as LASIK. The laser energy originates from a gas mixture of argon and fluorine. The laser light itself is ultraviolet, and thus invisible to the naked eye.

The laser is controlled by a computer, into which the surgeon enters the desired prescription correction for a patient’s eye. The number the surgeon programs into the computer is the patient’s refraction (the measurement of the prescription of the eye), usually modified (by the surgeon, based on the results of his lasik cases) to adjust for patient age, the amount of correction, the environment of the laser room (temperature and humidity), the surgeon’s specific technique, and other factors. The focusing of the laser, performed by the surgeon, is extremely important.

The laser beam produced by the laser is very complex. The energy or power of the beam must be very carefully monitored by what is termed “fluence testing”. The laser should also be calibrated so that whatever the laser is programmed to correct, will be delivered; this is usually done by treating a plastic plate and reading the result much like one does when measuring the prescription of a pair of glasses. In general, calibration should be performed before every third eye that is treated by the laser (after treatment of both eyes of a single patient, before the next patient).

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If you understand the above points, two things become very clear:

(1) Laser maintenance is critical to a good outcome. This is not a machine that you just turn on. The optics or focusing lenses that modify the laser beam must be replaced at regular intervals. The humidity and temperature should be kept as constant as possible, otherwise the results of surgery may not be predictable. Trained technicians are a must for laser maintenance.

(2) The surgeon plays a major role in the surgery and outcome. There has been a great deal of emphasis on the high-tech equipment, but the role of the surgeon cannot be minimized. The laser is just a tool which depends on a skilled surgeon to be used correctly. The actual numbers put into the laser are surgeon and laser-dependent. Depending on who does the surgery and which laser is used, the results can be quite different.

While all the current lasers can theoretically treat all types of prescriptions including astigmatism, not all the lasers are FDA-approved to treat all of these types of prescriptions. Treatments not FDA-approved for a given laser can sometimes be done with that laser, in a roundabout fashion, but such use is called “off-label”. To add to the confusion, some lasers that are FDA-approved to treat certain types of prescriptions are only approved to do so using the PRK technique. When these lasers are used to treat these types of prescriptions using the LASIK technique, such treatment is also called “off-label”. “Off-label” does not necessarily mean that this is unsafe, only that the FDA has not examined the data to draw any conclusions. The FDA is not in the business of telling doctors how to practice medicine. This is why, for example, some prescription medications are routinely used for reasons other than the original indications.

Ask your doctor whether your prescription can be treated with the laser he or she uses, and whether it will need to be treated off-label.

Post-Op Recovery

LASIK services in Dearborn, MI

Post-Op Recovery

While most of the visual recovery occurs within the first few days, there may be some fluctuation in vision during the first 1-3 months. Most people see well enough to pass the driver’s test by the day after Lasik.

Post-operative discomfort is minimal. Most of this presents as a foreign body sensation, a scratchy feeling, that can be treated with artificial teardrops. The postoperative eyedrops consist of antibiotic and steroid eyedrops, each four times a day (usually for 1 week), and frequent artificial tear drops (usually preservative-free) for as long as 2-4 weeks. Dry eye is very common after Lasik, and is usually temporary.

Risks 

Experienced Ophtalmolodist in Dearborn, MI

Risks

LASIK is very safe, assuming the patient meets the physical requirements and has a skilled surgeon. LASIK, however, is real surgery, and as such, involves some risk. The main risks of LASIK are primarily related to the corneal flap, in its creation and post-operatively. However, it is the corneal flap which makes LASIK so appealing: the lack of pain and the very quick visual recovery are possible because of the flap. Some of the risks include infection (which is rare), corneal abrasions, a poor quality flap, wrinkles, dislocated or dislodged flap, interface inflammation (“Sands of the Sahara” or diffuse lamellar keratitis), epithelial ingrowth (surface cells growing under the flap), and night vision difficulties such as glare and halos.

The risk of losing some vision is very small, perhaps 1% or less.

Choosing a qualified surgeon is one way of making LASIK safer.


Why have LASIK with Dr. Yu?

  • Experience
  • Individual Patient Care
  • Free Screening 
  • Knowledge of Treatment
  • Dr. Yu has had LASIK
  • Accessibility & Excellence
  • Our Ultimate Goal...
Experience
Dr. Yu has extensive experience in eye microsurgery.

He has been honored as a Top Doc in Hour magazine. He has over 25 years experience in refractive surgery. He has performed thousands of refractive procedures. He counts as patients, many physicians who could have gone to anyone, but chose him as their surgeon.

Individual Patient Care
Dr. Yu is personally involved in every step of your Lasik experience.

Dr. Yu is with you through the initial screening, the preoperative exam, the surgery, and the post-operative visits. This degree of hands-on involvement assures you of the best possible care and quality results. Dr. Yu does not delegate the responsibility of determining who is a good candidate for Lasik. Remember, there is no easy formula that applies to all patients. Even if a candidate meets the basic physical requirements, there are medical history issues that need to be addressed. There are occupational and non-work related factors (such as hobbies, sports interests, etc.) that must be considered in deciding whether someone would be happy with Lasik surgery; these same factors also direct the choice of the end result (the desired end result may not always be clear distance vision in both eyes; some patients over 40 years of age may want some reading vision in one eye, without the aid of reading glasses).

 

Dr. Yu personally measures the eye prescription that will be the basis of the numbers that will be programmed into the computer of the laser (this step is still done even in patients who elect Custom treatment). The results of surgery depend, in large part, on the accuracy of these measurements. The measurements are not like blood tests, in that they depend on the subjective or verbal responses of the patient to the question “Which is better, 1 or 2?”, as the patient views the eye chart. The responses of a patient cannot be second-guessed and analyzed real-time, after the numbers have been measured and recorded by someone else. Put yourself in the surgeon’s shoes: Would you perform surgery based on numbers measured by someone else, especially if the patient’s vision depended on it? This situation is quite different from getting measured for a pair of glasses, where the lenses can be changed if the measurement is found not to be correct.

 

Dr. Yu performs the surgery himself. Dr. Yu personally examines all of his Lasik patients after their surgeries. Despite what some might imagine, the care after surgery is very important. Potential problems, identified early, can help to ensure an optimal result. While problems after Lasik are uncommon, they can occur. Most of the problems that occur can be treated, with excellent results, but they require prompt diagnosis and treatment. Patients should insist on being examined post-operatively by the operating surgeon. Only the surgeon knows the specifics of a patient’s surgery, and so-informed, can be on the lookout for potential problems; patients and their surgeries are not all the same. Most medical societies consider postoperative care to be an ethical issue; with some exceptions, the operating surgeon has a responsibility to see his or her patients after surgery. Dr. Yu takes his responsibility and obligation to patients seriously, and does not co-manage or share the care of his Lasik patients.

 

Free Screening 

Eye screenings

The screening exam or consultation at Quality Eye Care is completely free, without strings attached.

At Quality Eye Care, we feel you should be able to learn about Lasik surgery, but not feel pressured into having surgery.

While the initial consultation at Quality Eye Care is free, the testing is very thorough. Our screening exam does not stop with measuring your old glasses prescription, as it does with some offices. Corneal thickness measurements (pachymetry), corneal mapping (topography and more advanced tomography), pupil size measurements, eye dominance, and intraocular pressure measurements are standard. When you leave our office, you will truly know whether you are a so-so, good, or excellent candidate for Lasik surgery (or maybe not a candidate). Without the above measurements, it may be difficult to make a truly informed decision about whether Lasik surgery is right for you.

Your decision to have Lasik surgery with a specific doctor should at least be partially influenced by how much quality time the staff and doctor spend with you at the screening exam. It should inform you of the level of commitment the practice is willing to make to you.

Knowledge of Treatment
Dr. Yu has extensive knowledge of the lasers used and the different types of procedures.

Dr. Yu does not want the appearance of a conflict of interest. If he feels that a patient is a borderline or not even a candidate, he will so inform that patient. If a patient is best served by a procedure other than Lasik, that recommendation will be made. “Lasik centers” oftentimes are only set up to do Lasik; non-Lasik surgery means lost business.”

 

Not being tied to a particular laser has its advantages. It means that Dr. Yu can offer individualized care to his patients. Some patients may be better treated using a different brand of laser. Again, patients are not all cast from the same mold, and therefore, may require different kinds of treatments. Beyond his expertise in laser vision correction, Dr. Yu is also skilled in other types of refractive surgery.

Dr. Yu has had LASIK
Dr. Yu knows first-hand what this feels like; he had LASIK in January, 1999!

While a great deal of a person’s energy is directed at the “nuts-and-bolts” of the surgery and making the decision to go ahead with surgery, it is not always easy to follow through. Oftentimes, what holds patients back from taking the next step is anxiety. Only by first-hand experience can someone truly understand what someone else is going through.

 

Dr. Yu and his staff are experts at “hand-holding”. While we at Quality Eye Care take great pains to educate our patients so that they can make an informed decision about the surgery, we then take the anxiety out of the procedure.

 

Dr. Yu wants patients walking into surgery not having second thoughts about their decision. Reducing the level of anxiety for a patient is no small matter; the patient is involved in the surgery, and being calm and focused contributes to a good outcome. What we hear from patients over-and-over again at Quality Eye Care, after surgery, is that the only regret they have is that they wish they would have had the surgery sooner.

Accessibility & Excellence
Accessibility and Excellent Service.

All of Dr. Yu’s Lasik patients are given his contact information before surgery, so they can contact him for any reason, at any time. There is ultimately one person responsible and accountable to the patients. Our service and commitment to your satisfaction does not end with the surgery. Your importance to us as a patient does not diminish after surgery. Your needs are given the same priority as those patients who have not yet had surgery.

We want to be more than a “pit-stop” to you; you will get to know our office staff by name and ask for them when you call. Unlike some faceless Lasik chain outlet (some of which have gone out of business, despite their “lifetime” warranties), Quality Eye Care and Dr. Yu will always be available to take care of their patients.

Our Ultimate Goal...
While all of the above are important, they all contribute to the ultimate goal: a happy patient.

While all of the above are important, they all contribute to the ultimate goal: a happy patient. Quality Eye Care is committed to the best possible results for its patients. Dr. Yu is an experienced Lasik surgeon who is forever refining his technique as new information and technology unfold. Medicine is not a static, unchanging field of endeavor, so it is important to change to give patients the best.

We invite you to talk to our Lasik graduates to find out first-hand about the kind of results our patients enjoy.


FAQ'S

What conditions can LASIK treat? +

LASIK can treat myopia (nearsightedness), hyperopia (farsightedness), and astigmatism.

Is there any pain during the LASIK procedure? +

Your eyes will be anesthetized with eyedrops so that you will not feel any pain. Occasionally, patients will feel some pressure-sensation during surgery.

Is there any pain after the procedure? +

Some patients will have dryness or a foreign-body sensation for the first few days, but nothing that would generally be described as painful.

How much time will I need to take off work? +

Most patients see well enough the first day after LASIK to resume work. If it is possible, patients are encouraged to avoid prolonged reading, television, or computer work for the the first 24-48 hours to encourage quick healing.

How soon after LASIK can I drive? +

Most patients see well enough to drive the day after LASIK. Visual recovery is usually rapid, but vision sufficient for safe driving can take a variable amount of time to develop.

What kind of restrictions will I have to observe after LASIK? +

Protective goggles will need to be worn while you sleep for the first week, and you will need to avoid activities which could potentially cause infection or trauma.

How long does the procedure take, and will I need someone to drive me home? +

The LASIK procedure itself only takes a few minutes per eye; however, you will need to be at the surgery center about 1 hour prior to your procedure, and stay about 15-20 minutes afterward. Your vision may be blurry in the first few hours after the LASIK procedure, and because you will be given a mild oral sedative prior to surgery, you will need someone to drive you home.

Will my eye(s) be patched after LASIK? Will I need medications? +

No eye patching is required. You will be given protective eye goggles to wear home after the procedure. You will be on eyedrops for the first week after LASIK.

How many follow-up visits are routinely scheduled? +

At a minimum, visits are scheduled one day, one week, one month, and 3 months after LASIK.

Will the vision I get from LASIK be long-lasting? +

As long as your eyes are not changing (this usually stops by the late 20s), and as long as you do not develop any vision- decreasing eye disease such as cataract, macular degeneration, or glaucoma, you can expect to enjoy the vision you get from LASIK well into the future.

Why is corneal thickness important when laser vision correction is being considered? +

When lasik is being performed, a corneal flap is first created. After the flap is lifted out of the way, much like opening the cover of a book, the underlying corneal tissue is exposed. The laser then precisely removes the amount of tissue necessary to correct your prescription. The corneal flap is then replaced, much like closing the cover of a book. Surgeons who perform lasik want to make sure that the strength of the cornea is not weakened too much after the lasik procedure. This means making sure there is enough corneal tissue left after the laser treatment is finished.

The average cornea is about 550 microns thick (that’s about 1/2 millimeter). The thickness of the corneal flap can be planned in advance. Dr. Yu typically makes a flap 100-160 microns in thickness. Using the example of the average cornea, if you subtract 160 from 550, you’re left with 390. This is the thickness of the cornea that’s exposed or remaining after the flap is lifted out of the way. The laser can now remove the amount of tissue necessary to correct your prescription; this can be calculated before the procedure.

For a given treatment size, the stronger the prescription, the more tissue that needs to be removed (and the deeper you go). Let’s say that 100 microns of tissue needs to be removed to make you see clearly. Subtracting 100 from 390 leaves you with 290 microns. This 290 microns represents what is called the residual bed. The standard of care, of sorts, has been to leave at least 250 microns in the residual bed. Some surgeons like to leave a 300 micron residual bed for more safety. When your surgeon counsels you during your lasik screening, he or she should be doing the kind of calculations you did above, but using numbers from your own eyes.

Is pupil size important? +

The pupil of the eye is the round hole or aperture located in the middle of the iris or colored part of the eye. The pupil is generally round, and changes size depending on the amount of light to which the eye is exposed; when lighting is bright, the pupil constricts or becomes smaller; when lighting is poor, the pupil dilates or becomes larger. In theory, it is desirable to have the size of the treatment zone (made by the laser on the cornea) at least as large as the pupil becomes under dim lighting.The cornea is the clear dome-like structure that arches over and covers the front of the eye. The pupil and iris are behind the cornea, “under glass”, so to speak. The human cornea is about 11-12 mm in diameter. However, the corneal flap is typically smaller than the size of the cornea, as large as 9.5 mm.

To an extent, the diameter or size of the corneal flap can be specified before the procedure. A given flap maker is labeled as to how thick and large a flap it can make. Once the flap is lifted out of the way, the underlying corneal tissue has the same diameter as that of the flap, in this case, 9.5 mm. Theoretically, a surgeon could plan a laser treatment which corrects your prescription, in any diameter size he or she wishes. The treatment zone could be smaller or as large as the 9.5 mm which is exposed. If the treatment size is too small relative to the size of the pupil, it would be as if you’re looking through a tunnel. Essentially, you would be looking through part of the cornea that is now corrected for your prescription, but around this treated area, there would be a ring of your “old” cornea which has been untreated. This is why it might be desirable to have a treatment zone which is larger than the size of your pupil, especially the pupil size under dim lighting. The physics of laser vision correction dictate that the larger the treatment zone, the more corneal tissue you have to use (and the deeper you go). The converse is true, in that the smaller the treatment zone, the less corneal tissue that needs to be removed.

Your corneal thickness (and the strength of your prescription) places a limit on how large the treatment can be and how much tissue can be safely removed (read about corneal thickness in previous question). Your doctor will measure your corneal thickness using an ultrasound device called a pachymeter. This instrument uses sound waves to determine the thickness of your corneas, in a painless fashion.

In practice, the treatment zone size does not always have to be as large or larger than the pupil size under dim lighting conditions. There are a number of factors which influence the desired treatment zone size. One is the strength of the prescription. If the prescription is not too strong, a treatment size smaller than the pupil size at night may not cause any difficulty. If the prescription is very strong, and the treatment zone size is smaller than the pupil size at night, there may be increased risk of night vision difficulty (glare, ghosting, and halos). There are natural optical effects that counteract the need for a treatment zone size as large or larger than the pupil size at night. In one study of 32,000 eyes which underwent LASIK, no relationship between pupil size and night vision problems was determined. Your ophthalmologist is the one best suited to tell you how large a treatment zone size you need. The Visx Star S4 laser with Variable Spot Scanning technology, using CustomVue (see Custom LASIK) allows the surgeon to expand the treatment zone, within the limits imposed by your corneal thickness and prescription.

PRK


Overview

Laser Skin Solutions is a distributor of Newport Cosmeceuticals.

PRK is a method of vision correction which uses the excimer laser to remove corneal tissue directly from the surface, without the benefit of a protective corneal flap or cap. PRK can be used to treat nearsightedness, farsightedness, and astigmatism.


  • PRK Procedure 
  • PRK Drawbacks
PRK Procedure 

PRK Procedure

  • In PRK, the excimer laser is directly applied to the surface of the cornea, without making a corneal flap. For someone who is nearsighted, more corneal tissue is removed from the center than from the sides (peripheral cornea). This flattens the cornea and corrects the nearsightedness.
  • For someone who is farsighted, more corneal tissue is removed from the sides (peripheral cornea) than from the center. This is like removing a “doughnut” of corneal tissue, making the cornea steeper, and thus correcting the farsightedness. The amount of prescription correction that can be safely treated with PRK is debatable. Most surgeons feel treating up to 6-8 diopters of nearsightedness is safe with PRK. There is a risk of developing corneal haze when treating large amounts of prescription with PRK. This corneal haze is almost like scar formation; usually it fades over time, but can cause loss of best-corrected vision. The use of anti-fibrotic agent, mitomycin C, can reduce the risk of haze formation.
PRK Drawbacks

PRK Drawbacks

The drawbacks of PRK as compared to LASIK are, in fact, healing issues. At the completion of PRK, a large part of the cornea is abraded. More healing is necessary. It may take several days to get back useful vision, and there can be some degree of discomfort until the surface heals, usually 1-3 days, but sometimes longer. A “bandage” soft contact lens is inserted into the operated eye to make it more comfortable; it is removed after the abrasion heals. Weak anesthetic eyedrops can be used to numb the eye until it heals. Analgesic medications can be taken as needed. Steroid eyedrops may used for a much longer time than with LASIK, up to 4 months.

Despite what sounds like a long list of disadvantages, PRK is sometimes an excellent option for those patients who are not candidates for LASIK. Because no corneal flap needs to be made, PRK is arguably safer than LASIK. Patients, appropriately chosen and treated, can have excellent visual outcomes with PRK (visual results are as good as LASIK).

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