Laser Vision Correction

by Donald L. McCormack, M.D.

Extraordinary advances in the correction of refractive errors (nearsightedness, farsightedness and astigmatism) have been made possible by improvements in laser technology. The eximer laser is a cool-beam, incredibly precise tool which has allowed literally millions of people to reduce their dependence on glasses and contact lenses.

Donald McCormack, MD, is a board-certified ophthalmologist who has been with the Boulder Medical Center since 1993. He offers an individual approach to patients wishing to have refractive surgery. Unlike the highly advertised centers where you see the doctor only during surgery, Dr. McCormack performs all of the needed preoperative measurements, surgeries, and postoperative exams himself. A full year of postoperative care is provided with each surgery. Dr. McCormack's patients enjoy excellent visual results.

The following information is intended to familiarize you with refractive surgery and to anticipate and answer your questions. If you would like to know more, please call (303) 440-3065 and Dr. McCormack will personally return your call.

The eximer laser

The eximer laser was approved by the FDA in 1995 for the correction of refractive errors. This laser can precisely sculpt the surface of the eye by creating an invisible beam of energy pulses. Very different from older, less reliable surgeries which required spoke-like cuts into the cornea, each burst of the eximer laser breaks microscopic chemical bonds, vaporizing a tiny amount of corneal tissue - the equivalent of 1/300th of a human hair in thickness. Programming the laser with Dr. McCormack's measurements of your eye allows an exact and customized correction.

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What is refractive error?

When the shape or length of your eye is abnormal, light entering the cornea at the front of the eye is not perfectly focused on the retina at the back. Myopia (nearsightedness) occurs when the corneal curvature is too steep relative to the length of the eyeball. This causes blurring in the distance. Hyperopia (farsightedness) occurs when the cornea is too flat relative to the length of the eyeball, causing blurring up close, and often in the distance as well. Astigmatism is caused by a cornea that is more steeply curved in one direction and more gently curved in another, like the back of a spoon. This causes distortion both up close and far away. Presbyopia is caused by a stiffening of the flexible lens inside the eye. This happens with aging, so that most people older than forty require reading glasses or bifocals to see objects up close.

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Would the surgery be right for my eyes?

The best candidates for laser vision correction:

• are at least 18 years of age
• have had a stable glasses prescription for one year
• have no active eye disease
• have a prescription that falls within the limits of the procedure
• are not pregnant or nursing
• have corneas that are thick enough to tolerate the procedure
• have no restrictions mandated by their employer
• have no systemic disease which can affect the immune system

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LASIK or PRK?

The eximer laser is used for both of these procedures to reshape the cornea. In PRK (photorefractive keratectomy) some surface cells are remove before the laser is used. In LASIK (laser assisted intrastromal keratomileusis) a thin, partial-thickness flap is made with an instrument called a keratome. This is folded back so that the laser can sculpt the inner layers of the cornea. The flap is then returned to its original position and adheres in minutes without stitches. Dr. McCormack can discuss the relative advantages of each procedure as they relate to your eyes.

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Can I "throw away my glasses forever"?

Laser vision correction is a great way to reduce your dependence on glasses or contact lenses. But some patients may need to use supplemental glasses with a mild prescription to get the crispest vision possible after surgery for activities such as driving at night. Patients over forty will probably need reading glasses for seeing objects up close. While some people can have one eye corrected for distance viewing and the other for seeing objects up close (monovision), this is not an option that works for everyone. Dr. McCormack will give you a good sense of what outcome you may expect from laser vision correction during your examination.

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Where is the surgery performed?

Dr. McCormack operates at the Boulder Community Hospital Foothills Campus at 4745 Arapahoe Road in Boulder. Clear Vision, an independent laser company, owns and maintains a state-of-the-art eximer laser made by VISX. They have highly trained and experienced full-time technicians who assist Dr. McCormack during surgery.

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Expectations

If your goal is to significantly reduce you dependence on glasses or contact lenses, but you understand that perfect vision can not be guaranteed, then you are probably a good candidate for laser vision correction. Ninety-eight percent of people will see well enough to pass a driver's test without glasses. You will also be able to:

• see at the swimming pool
• care for the baby in the middle of the night without searching for glasses
• see the alarm clock in the morning
• see the mountains on a hike

You may need supplemental glasses with a mild prescription for activities requiring extremely precise vision or for seeing objects up close.

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Can I afford it?

The price of laser vision correction in Dr. McCormack's office, $1800.00 per eye, includes all preoperative measurements, surgery and a full year of postoperative care. If you need a complete vision exam beforehand, most insurance companies will cover this. Measurements to make certain you are a candidate for surgery cost an additional $110.00. If you elect to have surgery, a $225.00 consultation fee is waived. At this time most insurance companies do not cover the costs for this elective surgery. There is no additional charge if an enhancement procedure is needed after your surgery within the first year.

Payment can be made by credit card (VISA, MasterCard, Discover, or American Express), personal check, cash or money order. Vision Fee Plan (1-877-837-2272) offers financing for refractive surgeries; payments may be lower than $100.00 per month.

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Why does the price of the procedure vary?

Some companies charge less for refractive surgeries. But usually the surgeon is not involved in preoperative evaluations or in caring for you after the procedure. You may not even meet the surgeon or find out who is doing your surgery until the day of your operation. You may never see the doctor again after surgery; postoperative care is usually done by technicians. Consistency of results is sacrificed. You may need to pay more if you have astigmatism, require any special testing, or need an enhancement procedure.

At the Boulder Medical Center, Dr. McCormack, not a technician, personally performs all needed measurements which will be entered into the laser's computer system. He does all surgeries and postoperative care himself. All equipment he uses is FDA approved. Because of this one-on-one approach, his result are consistent and significantly better than national averages. While occasionally a surgery needs to be enhanced with a touchup procedure, this happens far less after Dr. McCormack's surgeries than in most centers.

When considering surgery on your eyes, please take time to inform yourself of all your options. Levels of service and quality of care vary tremendously - seek out the safest and most reputable healthcare providers. When investing in this permanent surgical procedure, look for the best value, not the lowest price.

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Frequently asked question:

• Does it hurt?
  • PRK and LASIK are painless procedures done with numbing drops in the eye. No shots are needed. On the day of LASIK there may be some discomfort comparable to an eyelash in the eye. After PRK, patients sometimes require an oral pain killer for the first day or two.
• How much time off work will it require?
  • Dr. McCormack performs refractive surgeries on Wednesdays. Most patients can return to work Thursday afternoon or Friday morning following a post-operative checkup with Dr. McCormack.
• What are the risks?
  • Laser vision correction is a surgical procedure and like any surgery, carries some risks. Temporary side effects are common during the first days to a few weeks after surgery and may include:
    • mild discomfort (like an eyelash in your eye)
    • dryness
    • halos, or glare
  • Under / over-correction can result from variations in how eyes heal. Mild cases do not usually affect the visual outcome, however if needed, an enhancement procedure can be done at no additional charge. Infection is very rare with today's surgical techniques. Returning for all follow-up appointments, following postoperative instructions, and keeping the doctor informed of redness, pain or decreased vision will assist in clearing an infection quickly if one occurs. The risk of serious vision-threatening complication is far less than 1%. Since LASIK and PRK are relatively new procedures, there may be some long term effects that have not yet been recognized. At this time, there is no evidence that these procedures are likely to adversely affect the eyes in the future.
• What if I blink during the procedure?
  • Many patients are worried about blinking or losing focus during surgery. Anesthetic drops eliminate the urge to blink and a small lid holder will keep your eyelids open during the procedure. Eye movements are constantly monitored by the laser's computer during surgery so if you move inadvertently or look away from the light during surgery, the laser will automatically shut off and can be restarted once you are repositioned. The laser does not cause burning so there is no risk to tissue that is not meant to be treated.
• Can I have both eyes treated at the same time?
  • Dr. McCormack will discuss this with you during your consultation. Most patients do have both eyes treated the same day, but some prefer to wait between eyes.

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Next Steps...

Once you've decided that you would like to pursue laser vision correction, contact Dr. McCormack at (303) 440-3065. He will help you schedule the following three visits:

• Eye exam: If you haven't had a complete eye examination at the Boulder Medical Center, that is the first step. This will allow Dr. McCormack to see if your vision is stable and to check the health of your eyes. Tests which measure the thickness and contour of your cornea will also be performed and analyzed by Dr. McCormack. He will also discuss the benefits and possible side effects of the surgery with you. If you are not a good candidate for the surgery, he will be happy to explain vision-correcting alternatives with you. If you wear contact lenses, it is best to leave them out for one or two weeks before this visit. Many patients have insurance that will cover the charges for this exam.
  
  
• Consultation: A consultation with Dr. McCormack is a 45 minute appointment which allows the doctor to answer any questions you may have and to recheck all measurements before and after dilating your pupils. You will see a video presentation explaining the procedure and will review and sign a medical consent form. The dilating drops used during this exam may make it difficult for you to see objects up close that evening. The $225.00 charge for this visit is waived if you elect to have the surgery.

What happens the day of the surgery?

Surgeries are scheduled on Wednesdays. You should arrive at the Boulder Medical Center Foothills Campus, 4745 Arapahoe Road, at least 45 minutes prior to your procedure time. Please check in and make your payment on the second floor of the Medical Office Building. While you may shower in the morning, you and anyone accompanying you should avoid smoking or wearing hairsprays, perfumes or scented lotions, as the eximer laser is sensitive to vapors.

Dr. McCormack's assistant will prepare your eye for surgery. After putting an anesthetic drop in your eye, the area around your eye will be cleaned to ensure sterility. Postoperative instructions will be reviewed.

The surgery is done on the first floor of the office building with you lying in a reclining chair. After more anesthetic drops, a sterile plastic drape will be placed around the eye and a small lid holder will be inserted to help keep your eye from blinking. The drops eliminate the urge to blink. The procedure takes about five minutes per eye and is completely painless. You will be asked to focus on a red flashing light above you, but at times your vision may be temporarily become dark or blurry, and you may feel some vibration. The doctor and his assistants will guide you through each step of the surgery.

After the surgery, clear plastic shields will be placed over your eyes, to be worn that day and at bedtime for seven days. You will need to arrange to have someone else drive you home.

There is usually no pain after LASIK, but some patients experience a temporary discomfort comparable to having an eyelash in the eye. It is best to rest your eyes for the first 12 hours and to not rub or touch your eyes. Your vision will gradually improve throughout the day.

...And after the surgery?

You will have an appointment with Dr. McCormack the day after your surgery. He will examine your eyes and instruct you on the use of your medications. For the first week following surgery, you should be careful to avoid getting any chemicals in your eyes, such as shampoo, hairspray, makeup, etc. It is best to avoid swimming, contact sports and unprotected sun exposure for two weeks after your procedure.

Most LASIK patients see well after 24-48 hours. There may be continued improvement over time. During the first few weeks after surgery, you may experience these normal side effects:

• fluctuations in your vision
• occasional tearing
• increase glare

It is important to keep all follow-up appointments with Dr. McCormack. A full year of postoperative visits is included with each surgery.

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Contact:

Electing to have laser vision correction is an important decision. The potential benefit is permanently clear vision without glasses or contacts. You should ask questions to help you learn about this exciting procedure and carefully consider which healthcare provider to trust with your eyesight. Dr. McCormack will take time to discuss your options and will personally care for you from start to finish, allowing you to feel informed and confident throughout the process.

Call (303) 440-3049 to schedule a visit or (303) 440-3065 if you have questions.

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