LASIK

LASIK or "Laser assisted in situ keratomileusis" is a procedure which uses an excimer laser system to reshape the central corneal tissues underneath the outer epithelial layer.
During LASIK, a thin layer of the cornea is folded back from the outer surface of the cornea. An automated microsurgical device called a microkeratome is used to create a thin flap on the surface of the cornea. Alternatively, the Intralase laser can be used to create a flap.  The use of the Intralase laser is commonly referred to as an "all-laser" LASIK procedure.

As with PRK, an alternative FDA-approved method of laser vision correction, the excimer laser then reshapes the cornea. The flap is then gently folded back into its original position where natural suction forces in the cornea hold it in place.
Unlike PRK, the LASIK procedure preserves the outer epithelial layer of the cornea which is removed during the PRK procedure. Preservation of this surface epithelial layer avoids most of the discomfort associated with PRK. In addition, replacement of the smooth epithelial surface allows for rapid recovery of vision.
Healing after LASIK is fast and vision can improve within hours of the procedure. Most patients are able to drive and return to work the next day.

USC-Doheny Laser Center:

Patients have more choices than ever when it comes to LASIK. One of the important choices to be made apart from the surgeon is the technology used to treat your eyes.
There are several laser systems on the market today that have FDA approval. Dr Phillips has been working with these lasers for 15 years, and has performed LASIK surgeries with VISX, ALCON LADARVision, and NIDEK lasers.
The new VISX S4 with all the upgrades listed below is currently his laser of choice, largely because of the continual refinements that have been made over the years, culminating in the precision of the VISX Custom Vue system. The new eye tracker and smoother laser beam profile on these modern VISX lasers have set the standard for excellence in LASIK.
Not all VISX lasers in Los Angeles are equally advanced.
Upgrading a laser system is expensive and sometimes delayed at stand-alone Laser Centers. Review the steady technological enhancements of the VISX we use at USC to understand why our Center is truly state-of –the-art.

USC-Doheny Laser Vision Center: Evolution of Laser Technology

The excimer laser used in laser vision correction has a long history at USC. Dr Phillips has worked with all of these lasers.
1989 VISX 20/20 (a large modified industrial laser using Argon-Fluoride gas to produce a 193 nanometer output. This early laser featured simple constricting-diaphragm aperture and non-homogenous beam profile. This was largely a research laser that pre-dated the formation of the Laser Center at USC..

• 1996 VISX STAR S2 upgrade brought a entirely new design to the excimer laser used in Laser Vision correction. This machine was smaller and designed for clinical use with improved optics and maintenance.
• PRK receives FDA approval and pace of PRK procedures at USC increases.
  USC-Doheny Laser Center is formed.
• 1998 VISX STAR 2 Upgrade: Most important change is a smoother profile to the laser beam as it reached the patient’s cornea.
• 1999 1 Million procedures have been completed on VISX lasers worldwide by this time.
• 2001 VISX STAR 3 Upgrade: ActiveTrack upgrade which allowed for continuous eye tracking during the procedure.
• 2002 VISX STAR 4 Excimer Laser Upgrade : This important upgrade for VISX users that allowed the laser beam to follow the information obtained through WaveScan analysis ( link to Custom Vue page). More precise control of laser beam diameter and placement permits laser to follow the customized Wavescan paterns of an eye. Treatment time is also decreased due to faster laser application rate.
• 2003 Custom Vue Upgrade: Allowed for truly customized ablations for nearsighted and farsighted patients.
• 2006 Iris Registration Upgrade: This upgrade brought a higher level of control to the LASIK and PRK procedure. In addition to up and down decentration of the eye which was followed by the upgrade to ActiveTrack in 2001, the USC laser now has an infra-red camera device that can detect and compensate for torsional movements of the eye during the procedure. A small 5 to 10 degree rotation of the head or eye during the procedure can significantly reduce the correction of astigmatism during LASIK. This new upgrade adds another level of precision to the procedure as well as eliminating the need for the Phillips Axis Marker ( Rhein Incorporated) which Dr Phillips had been using up to this point.
• 2008 Intralase all-laser LASIK introduced at USC.
  

Who is a Candidate?

Laser Vision Correction is available to people who are nearsighted, farsighted, or who have astigmatism.

Depending upon your individual exam, the amount of each condition that can be treated varies, but in general the advanced VISX laser we employ can treat up to 10 diopters of nearsightedness, 5 diopters of farsightedness, and 4 diopters of astigmatism. The laser can also be used to add focusing power onto the surface of the cornea to restore near vision and reading. This condition is called presbyopia and is particularly troublesome for patients as they enter their forties and fifties.
To undergo laser vision correction patients should be at least 20 years of age and have healthy corneas and stable vision over the past year.

For extreme refractive errors there are also intraocular lenses that can be attached to the iris ( Verisyse implantable contact lens by AMO) or placed behind the iris just in front of the patients natural lens ( the Visian Implantable Collamer Lens by Staar Surgical).

For patients who are not suitable candidates for LASIK or CUSTOM LASIK due to farsightedness beyond 5 diopters, clear lens extraction is another option we offer. This surgery is essentially cataract surgery to remove a patient’s clear natural lens with a new intraocular lens that has the extra focusing power. While a more invasive surgery for significant farsightedness, it offers the distinct advantage of placing the extra focusing power needed by the eye in a position where it naturally belongs: right behind the iris where the original underpowered natural lens resided. At the time of surgery, either a conventional monofocal lens can be implanted or a multifocal lens implanted to reduce dependence on reading glasses.

PRICING: Same Technology, Lower prices

VISX, VISX CustomVue and Intrlase all-laser LASIK are all available at our Center. Fees will depend on the technology used to treat your refractive error and will be outlined during your evaluation. Our Center competes favorably with more expensive West-side LASIK Centers offering comparable technology but costing more.

Fees paid to our office include:
1) LASIK evaluation
2) LASIK Workup, including:

• Manifest refraction
• Cycloplegic refraction
• Corneal topography (pre-op and as needed post-op)
• Automated keratometry (measures the curvature of cornea)
• Corneal pachymetry ( measures the thickness of the cornea)
• Ocular dominance testing
• Tonometry (measure pressure within the eye)
• Dilated eye exam
• Any ancillary tests deemed necessary such as visual field testing or Stratus/OCT laser diagnostic imaging
• Counseling and discussion with Dr Phillips

3) LASIK procedural fee and post-operative eyedrops.
4) Post-LASIK exams for one year.
5) LASIK enhancements, if needed, for one year.

Fees paid to the USC laser center cover the costs of treatment and often the cost of re-treatment for CustomVue patients. There is a small fee for conventional LASIK re-treatments charged by the USC laser center. Our office, however, does not charge for re-treatments for the first year.

Our office offers financing through both CareCredit  and Unicorn Financial.  Please contact Jenny in our office for further details and to see if you qualify.

What to expect during your LASIK work-up and treatment

Before undergoing the LASIK procedure, it is important to have a full eye exam to make sure the eye is healthy to undergo an elective procedure such as LASIK. Dr Phillips performs all of these exams himself. If no contraindications for LASIK are found during the exam such as cataracts, glaucoma, or corneal diseases, you are a candidate for LASIK. The next step is a discussion of the risks and benefits of LASIK surgery with Dr Phillips to decide if you want to proceed with surgery. The whole process takes between an hour and an hour and a half. If you wear contact lenses please leave them out for five to seven days prior to your workup. Hard contact lenses are ideally left out for three to four weeks prior to the workup. If you have questions concerning your upcoming workup, please call Jenny, the LASIK coordinator in the office.

The LASIK treatment is performed at the USC Center. The day of surgery you will arrive and be greeted by the technicians. If you are undergoing Custom LASIK you will have your digital Wavescan taken.
You will be taken to the laser room and the procedure will be performed. Once completed, your vision will still be somewhat blurry but you should not feel any discomfort. You will be taken back to an examining room where Dr Phillips will personally go over post-operative instructions and examine the eye. You should have someone drive you home after LASIK. At home you should rest and use the drops as directed.
The pain is generally mild after LASIK and tends to resolve three to four hours after surgery. The vision also clears during this time, but clears most significantly after a night of rest.