REFRACTIVE SURGERY
OVERVIEW | LASIK | ASA | RLE | Presbyopia

NOTE: Because of the growth in Refractive Lens Exchange and Presbyopia treatment, both Dr. Decker and Dr. Yang have decided to focus their refractive practice exclusively in these two areas and are no longer performing Laser Refractive Surgery at this time. The information below regarding Laser Refractive Surgery is for information purposes only.

Overview
An increasing number of patients are inquiring about refractive surgery to reduce their dependency on glasses or contact lenses. We are experienced in all aspects of refractive surgery, including laser as well as non-laser procedures. We are determined to provide excellence in patient care, ensuring the well-being of our patients and the health of their eyes. We are highly selective as to which refractive surgery is best suited for each patient. Some patients are excellent candidates for Laser Vision Correction, such as LASIK or ASA. Others are better suited for non-laser refractive surgical techniques, such as refractive cataract surgery, piggyback IOL's, and ICL's. Patients with presbyopia who require bifocals and desire independence from their reading glasses, may be candidates for lens exchange procedures. These procedures involve removing the natural lens in the patient's eye and replacing it with a multi-focal intraocular lens. Those who are not candidates for current procedures are placed on waiting lists and called when other, new and proven techniques become available.
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LASIK
LASIK refers to Laser Assisted in Situ Keratomileusis. It is a laser procedure that can be performed on patients with myopia, myopia with astigmatism, hyperopia, and hyperopia with astigmatism.

With either a special instrument called a microkeratome or a special femtosecond laser called IntraLase, a hinged flap of corneal tissue is created. This LASIK flap is raised to expose the deeper tissue of the cornea, which is then treated with an excimer laser. This excimer laser reduces a patient's refractive error by ablating and reshaping this exposed corneal surface. This laser produces a powerful beam of light, which is directed at the cornea in extremely brief, intense pulses. Each pulse, lasting only a few billionths of a second, removes a microscopic amount of tissue by breaking the molecular bonds between cells. The laser produces very little heat and leaves the underlying tissue intact. The laser changes the shape of the cornea to create the desired optical effect. Once the shape of the cornea is changed, the protective LASIK flap is then replaced in its original position.

With LASIK, the patient's vision improves quickly with relatively little discomfort. Both eyes can be operated on at the same time and most patients can return to work 24 hours later.
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ASA
ASA refers to Advanced Surface Ablation. It is used for patients with myopia and myopia with astigmatism. Many patients undergoing ASA have corneas that are too thin for LASIK or have superficial corneal disease.

Just as in LASIK, an excimer laser is used to reshape the cornea. However, with ASA, a corneal flap is not created. A very thin layer of the corneal surface is first removed, exposing the underlying tissue bed. It is this tissue bed that is then treated with the laser. The surface subsequently grows back to protect the corneal bed.
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RLE
RLE refers to Refractive Lens Exchange. Patients with any refractive error (myopia, hyperopia, astigmatism) and are presbyopic are candidates.

Just as in cataract surgery, the patient's natural lens is removed and a new intraocular lens in used which is a combination of both the patient's natural lens power and the refractive error that the patient has. This intraocular lens comes in a large range of powers and can treat almost any refractive error. In fact, many patients outside the limits of Laser Vision Correction may still be candidates for Refractive Lens Exchange. Because the cornea is not altered in shape, the quality of vision is also typically better than with Laser Vision Correction.

As a general rule, patients with cataracts (regardless of whether the cataract is mild or dense) are not ideal patient's for Laser Vision Correction for three reasons: (1) The laser treatment cannot improve any vision lost because of the presence of the cataract. (2) Following Laser Vision Correction, the vision will most likely decline as the cataract develops. (3) With the current technology, it is much more difficult to predict the refractive outcome of cataract surgery if the patient has had a prior history of Laser Vision Correction.
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Presbyopia
Presbyopia refers to the loss of the ability to read and the need for bifocal glasses as one ages. There are multiple techniques that can be utilized to correct Presbyopia. The most common include: (1) the creation of monovision using Laser Vision Correction, (2) the use of Refractive Lens Exchange to achieve monovision and (3) the use of Refractive Lens Exchange and the use of a multifocal lens instead of a standard monofocal lens. Monovision refers to having one eye treated to see distance and one eye treated to see near. It works well for most patients, but not everyone can tolerate monovision. The use of multifocal lenses are discussed in the Refractive Cataract Surgery section.
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