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LASIK Laser Eye Surgery Frequently Asked Questions
Provided by Dr. Ernest Kornmehl


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What is refractive surgery?


Refractive surgery is an outpatient procedure that corrects vision problems such as nearsightedness (myopia), farsightedness (hyperopia) and astigmatism The surgery restores the eye's normal curvature and its ability to bring images into focus.


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Who is a candidate?


Refractive surgery is typically for patients 21 years of age or older who have nearsightedness (myopia), farsightedness (hyperopia) or astigmatism, and who meet certain visual and medical requirements. The ideal patient has a healthy cornea and has not had a significant increase in his/her prescription in the last year. In addition, most candidates are individuals who are dissatisfied with their contact lenses or glasses (often due to occupational or lifestyle reasons) and are motivated to make a change.


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What is the excimer laser?


The excimer laser has provided significant advancement in surgical techniques, particularly in the field of eye care. Unlike traditional lasers,the excimer laser produces a "cool" or non-thermal light beam, minimizing the risk of thermal damage to surrounding tissue. Using an excimer laser to correct nearsightedness and astigmatism can eliminate or reduce a patient's need for corrective lenses. The laser is guided by an advanced computer as it precisely reshapes the cornea, producing a sharper image on the retina. Excimer laser surgery is now considered to be one of the safest and most accurate methods of correcting nearsightedness, farsightedness and astigmatism.


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Why do patients choose excimer laser surgery?


Many patients with nearsightedness, farsightedness, or astigmatism want to be free of the limitations of corrective lenses. Many patients enjoy swimming, diving, skiing and other athletic endeavors where wearing glasses or contacts is inconvenient or impossible. Some patients elect to have laser surgery for occupational reasons, while others feel visually and socially limited in their every day activities.


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Are there different types of refractive surgery procedures?


Patients have various options for refractive surgery. The two most popular options are PRK (Photorefractive Keratectomy) and Lasik (Laser-in-situ Keratomileusis).


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What is the difference between PRK and Lasik?


Both Lasik and PRK use the excimer laser to reshape the cornea and correct nearsightedness, farsightedness, or astigmatism. Developed during the 1980's, PRK is used to treat low to moderate amounts of nearsightedness, farsightedness, and astigmatism. In PRK, a thin layer of tissue is removed from the surface of the eye with a blade or laser prior to the shaping the cornea. Patients may experience discomfort for 1-3 days, and full healing and vision correction are achieved in about one to four weeks.

Lasik is the most advanced excimer laser procedure and requires more technical skill and training than PRK. The Lasik method offers next day visual recovery, minimal discomfort that may last up to two hours and a lower risk of scarring than PRK or other surgical options. Sometimes referred to as the "flap and zap" method, Lasik is an extremely effective outpatient procedure suitable for all levels of vision correction. During the surgery, a thin flap is made in the corneal tissue but not completely removed. Once the laser beam has been used to correct ("zap") the contour of the cornea, the flap is folded back in place and the procedure completed.


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Why choose Lasik?


The number of people considering refractive surgery is at an all time high and Lasik is currently considered to be the procedure of choice.

Specifically, Lasik surgery creates less trauma to the eye than PRK, enabling the cornea to heal more quickly and improving vision more rapidly. Some of the benefits of Lasik are:

1. brief recovery time
2. minimal postoperative discomfort
3. less post-operative medication
4. high degree of predictability
5. preservation of corneal surface
6. very low risk of scarring
7. low risk of complications
8. freedom or reduced dependence on glasses/contact lenses


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Can there be a problem with my eyes twenty years from now because I had LASIK?


This is very unlikely. LASIK is a form of lamellar refractive surgery, and lamellar refractive surgery (myopic keratomileusis) has been performed since 1949. Patients who have undergone these related but less accurate and more invasive procedures fifty years ago have not developed any unusual problems.


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How long does the Lasik procedure take?


The procedure lasts about 15 minutes and is performed on an outpatient basis.


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I have "dry eyes". Will this affect my LASIK surgery?


Many patients seeking refractive surgery do so because they have dry eyes and are unable to wear contact lenses anymore. It is important that your dry eyes be treated. This usually involves the use of tear supplements and punctum plugs (tiny silicone plugs placed in the tear drainage openings of your eyelid) that delay the drainage of your own tears so your eyes will stay moist.

After the procedure, your operated eye may feel temporarily drier because the corneal nerves are severed during LASIK surgery, causing the eye to make fewer tears. This condition is temporary and typically lasts three to six months.

Dry eye symptoms can be particularly noticeable if you use the computer frequently, read for long periods of time, or drive extended distances. These types of activities exacerbate dry eyes because they cause you to stare and not blink as often. It is important to use ample lubrication, especially during the first few months after surgery.


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If I need to, can I wear contact lenses after surgery?


If you have a residual refractive error and you choose not to have an enhancement procedure, you may elect to wear contact lenses. With PRK you may need to wait up to three months; with LASIK you may wear contact lenses within a few weeks. If you were a good contact lens wearer before LASIK, it is unlikely you will have problems afterward.


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Does the procedure hurt?


Anesthetic drops allow the procedure to be virtually painless, however, a pressure sensation is noted. Immediately following the procedure, some patients have tearing and burning while others have minimal discomfort. Whether or not tearing or burning is present has no bearing on the final result. Everyone feels much better after napping.


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Technology seems to be changing every day, is something better coming down the road?


Technology continues to change and move forward. Newer technology makes surgical techniques available to a greater number of surgeons. LASIK continues to be a surgeon dependent procedure, and final results are dependent upon the skill of the surgeon.


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How do I obtain more information?


Finding out more about the health of your eye and your vision correction needs is your first step toward better eyesight. Contact Dr. Kornmehl's office at 1-877-870-2010 for an appointment and personal consultation. If your vision's refractive error falls within the range for laser surgery, more tests can be performed to determine whether you are a candidate. This information will help you determine your best options for vision correction.


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What is Refractive Surgery?


Refractive surgery in Boston, as elsewhere, should be performed by a surgeon with comprehensive training and experience. Dr Kornmehl is a foremost expert in refractive surgery and laser vision correction. He explains on this webpage how refractive surgery improves vision and whether you should consider this surgery.

Refractive Eye Surgery

What is refractive eye surgery?

Most people are aware that there are new developments in eye surgery intended to reduce dependence on glasses and contact lenses.

Refractive surgery includes several surgical techniques designed to improve problems in focusing the eyes, also known as refractive problems. Until recently only glasses or contact lenses could correct refractive problems.

What are refractive problems?

Light is focused, or refracted, by the cornea, the clear front "window" of the eye. Your vision is clear if the cornea and lens combine to focus an image precisely on the retina. The retina is the inner layer of the eye that senses light and helps you to see.

Your vision is blurred if the cornea, lens and eye length place the image in front of the retina. This is known as myopia, or nearsightedness.

If the cornea is not round (like a basketball), but instead has unequal curves (like a football), the image is distorted. This is called astigmatism. An eye with astigmatism may have myopia as well.

Refractive solutions:

Refractive problems such as myopia and astigmatism are solved by helping the eye to focus light using glasses, contacts or refractive surgery. Refractive surgery techniques aim to change the eye's focus by changing the shape of the cornea.

The surgeon sculpts the cornea into a new shape by removing tissue using a laser without (Photorefractive Keratectomy (PRK) - and LASEK), or with a flap (LASIK).

How safe & effective is laser vision correction?

The Excimer laser is used to correct myopia, hyperopia and astigmatism. There are several thousand people in the United States who have had Excimer laser surgery through research studies that are authorized and reviewed by the Food and Drug Administration. The Excimer laser is now approved in the United States.

In a process called photorefractive keratectomy (PRK), the Excimer laser precisely sculpts the surface of the cornea using invisible, high-energy light. No surgical blades are used. The surgery takes about 15 minutes using eye drops to anesthetize the cornea. Complications during the procedure itself are very rare.

Following PRK for mild to moderate myopia, 95 percent of patients are 20/40 or better and can drive a car without corrective lenses.

A common but temporary problem after PRK is hazy vision. It usually improves after several months and, based on current clinical trials, rarely results in a permanent scarring of the cornea.

Over 70 percent of people report some haloes or glare after PRK, especially at night; these symptoms usually decrease over 3 to 6 months. However, most people are pleased with the improvement in eyesight unaided by glasses or contact lenses following PRK.

Should you consider refractive surgery?

You might consider laser vision correction if you:
  • Wish to decrease your dependence upon glasses or contact lenses;
  • Are free from eye disease;
  • Have the appropriate refractive error.
Refractive surgery offers an alternative to dependence upon glasses or contact lenses. But you may not be a good candidate for refractive surgery if you cannot accept the somewhat variable outcome of currently available procedures, and you are generally happy and comfortable with your glasses or contacts. After refractive surgery, some people still use glasses or contact lenses for some situations.

Laser surgery, contacts and glasses for the correction of refractive problems each have their benefits and drawbacks. The best method for correcting your vision should be decided after a thorough examination and discussion with Dr. Kornmehl.


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What is LASIK?


LASIK is performed by Dr Ernest Kornmehl, a laser vision correction specialist. Dr Kornmehl has extensive training and experience in LASIK laser eye surgery. He has spearheaded new developments in LASIK surgery, including the Kornmehl LASIK System. This webpage provides information about LASIK surgery and how it has improved the vision of many of his patients from Boston and around the United States.

LASIK or Laser in-Situ Keratornileusis treats refractive errors by removing corneal tissue beneath the surface of the cornea. This procedure combines the accuracy of the excimer laser with the benefits of Lamellar Keratoplasty (LK). LK has been performed on a limited basis since 1949 to correct higher levels of nearsightedness and moderate amounts of farsightedness. More recently, LK was refined by technological advancements of an instrument called a microkeratome that allows the surgeon to fold back a thin corneal layer of cornea (figure 1).A second pass of the microkeratome was required to remove tissue from the inner cornea. However, the quality and accuracy of this second pass could not always be achieved.

With LASIK instead of making a second pass with the microkeratome (as in LK), the excimer laser removes the proper amount of corneal tissue with much greater accuracy. How much tissue removed is controlled by the number of pulses and the size and shape of the laser beam. The thin flap of corneal tissue is then folded back into its original position where it bonds after only a few minutes of drying. No stitches or eye patches are required after the procedure.

Since only the edge around the corneal flap needs to heal, visual recovery is rapid and patients report little or no post-operative pain. Additionally, there may be less risk of scarring or developing corneal haze. There is also less need for post-operative medications with LASIK than PRK. LASIK treats low to very high levels of refractive errors. However, because of the microkeratome, LASIK carries additional surgical risks.


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What is IntraLase?


LASIK surgery has a well-documented history of safely and effectively eliminating a patient's dependency on glasses and contact lenses. The first step to a LASIK procedure is to create a corneal flap so the excimer laser can ablate the underlying corneal tissue. During conventional LASIK, the corneal flap is created using a hand-guided, oscillating blade (microkeratome). The IntraLase method, also known as all-laser or bladeless LASIK, uses a laser to create the corneal flap. Dr. Ernest Kornmehl provides both types of LASIK surgery in his Boston-area facilities.

The IntraLase method, using a femtosecond laser, was approved by the U.S. Food and Drug Administration in 2001 and has been used in more than 600,000 procedures. The laser used in the IntraLase method moves back and forth across the cornea's outer layers, emitting short, rapid bursts of laser light that create a series of minute bubbles at a determined depth. The tissue where the bubbles have formed is then gently separated, exposing the portion of cornea to be ablated.

Bladeless LASIK is one of several vision correction options offered by Dr. Kornmehl. He conducts a thorough examination of each patient to determine the best refractive procedure.


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What is PRK?


PRK is performed by Dr Ernest Kornmehl, a refractive surgery specialist. On this webpage, Dr Kornmehl provides information about PRK refractive surgery and how it has improved the vision of many of his patients. PRK or Photo-Refractive Keratectomy treats refractive errors by removing tissue from the surface of the cornea. First, your eye is numbed using a topical eye drop anesthesia. Then, the surgeon removes the epithelium, a thin layer of protective skin that covers the cornea. This may be done with either a blade, a brush or even the excimer laser. During the actual procedure, the patient stares at a fixation light. In less than a minute, the laser removes the proper amount of tissue while it reshapes the surface of the cornea.

After PRK, the eye is patched until the following morning. Because the epithelium was removed, patients may experience blurry vision for three to five days and a moderate amount of discomfort until the epithelium heals and covers the treated area. Eye drops, narcotics and possibly a contact lens are effective in reducing this post-operative discomfort. Final visual results may be fully realized anywhere from several days to a few months or more as the surface heals in accordance to each individual's healing tendencies. PRK is most often used to treat low to moderate amounts of nearsightedness and astigmatism.


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What is LASEK?


LASEK is performed in Boston by Ernest Kornmehl, MD. Dr Kornmehl is a refractive surgery specialist. Dr. Kornmehl provides information about LASEK eye surgery in Boston and about how this surgery has similarities and differences from LASIK. LASEK is performed exacly like PRK, except that the epithelium is put back over the cornea at the end of the procedure. 50% of patients have less discomfort than with PRK, however we still do not know if the risk of haze is reduced. The final refractive results mirror that of PRK.


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What is Conductive Keratoplasty?


Boston CK Surgery is performed by Dr Ernest Kornmehl, a refractive surgery specialist. Dr Kornmehl has extensive training and experience in the treatment of presbyopia. This webpage provides information about Conductive Keratoplasty Surgery and how it has improved the vision of many of his patients from Boston and around the United States.

Dr. Kornmehl is currently recommending conductive keratoplasty to treat presbyopia. CK for presbyopia works best in people:
  • Older than 45 years old
  • See well at distance
  • Would like to read magazine size print without reading glasses
Frequently Asked Questions

What is presbyopia?

People often confuse farsightedness with this condition, which occurs as the normal result of aging. Presbyopia affects most people by the age of 40 and everyone by the age of 51. This is because the aging process diminishes our natural ability to bring near objects into focus. This condition manifests when the lens inside the eye loses its flexibility, preventing accurate focus on objects in the near field of view, such as reading material.

How is CK performed?

CK uses radio waves, instead of a laser or scalpel, to reshape the cornea and bring near vision back into focus. CK is performed using a small probe, thinner than a strand of human hair, that releases radio waves. The probe is applied in a circular pattern on the outer cornea to shrink small areas of collagen. This circular shrinkage pattern creates a constrictive band (like the tightening of a belt), increasing overall curvature of the cornea. The procedure, which takes less than three minutes, is done in-office with only topical anesthesia (eye drops).

Will you be cutting the cornea?

No. CK is performed without the cutting or removal of tissue. It is a safe, minimally invasive procedure for baby boomers who struggle to read a newspaper, menu, alarm clock, or computer.

Who is a candidate?

Patients who are over 45 years old, and have poor reading vision with very good distance vision.

What will happen to my distance and reading vision in the treated eye?

Following the procedure, reading vision will improve immediately and distance vision when using both eyes will continue to be very good. Distance vision in the treated eye will temporarily decrease to 20/40 to 20/80 and may return to 20/20 or 20/25 after six or more months.

How long does improvement in reading vision last?

From 3 to 5 years. The effect of the treatment is not diminished, but the eye continues to age.

How often can I have the procedure?

Most patients can have two procedures.

Is the procedure painful?

The procedure is virtually painless. During the immediate post-operative period, one may experience some mild discomfort and tearing. A foreign body sensation may be present for 24 hours or more.

What type of anesthesia is used during the CK procedure?

A local anesthetic in the form of eye drops is used to numb the eye. Those patients who are nervous or have a high level of anxiety will be given a mild sedative to help them relax.

How soon can I return to work?

With CK, the majority of patients are able to return to work and other normal activities the day after their procedure. Although recovery is fairly quick, it is advisable to be careful with your eyes and to avoid any strain. Those whose jobs demand intense clarity of vision (such as dentistry, surgery, or computer work) may want to give their eyes some extra rest for several days following the procedure before going back to work.

What are the risks of CK?

Increased astigmatism. This can be corrected with additional treatment. There have been no reported cases of infection or loss of vision.

Are there restrictions after having CK?

As with any vision treatment procedure where the cornea is altered, certain precautions should be taken. After the CK procedure, patients should avoid getting contaminated water in their eyes for at least one week. This includes water from swimming pools, spas, lakes, and the ocean. When showering or taking baths, patients should keep their eyes closed in order to avoid getting soap and dirty water into their eyes. When exercising, sweat should be kept out of the eyes for at least a week after the procedure. Also, patients should avoid rubbing their eyes vigorously for two weeks following the procedure. Females should also avoid applying eye makeup for one week after the procedure.

Is CK reversible?

As with most vision treatment procedures, CK is not reversible. Once the procedure has been performed, it is not possible to "remove" its effects. This is an important factor for anyone thinking about undergoing a vision treatment procedure to carefully consider. To make sure CK is right for you, seek the advice of Dr. Kornmehl.

Can CK be performed on patients who have a pacemaker?

The CK equipment can produce interference that may adversely influence the operation of other electronic equipment. Therefore, CK is contraindicated for patients who are wearing a pacemaker.


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What is Wavefront?


Custom Wavefront LASIK uses the most advanced technology available to change the curvature of the cornea and correct vision. Boston Custom Wavefront LASIK is performed by Dr Ernest Kornmehl. Dr Kornmehl is a foremost Boston area specialist on custom LASIK and has corrected the vision of many patients using this advanced procedure. The web page below describes custom LASIK and how it corrects and it can improve vision for patients with nearsightedness, farsightedness and astigmatism.

Until now vision has been measured with lenses and categorized as nearsightedness, farsightedness and astigmatism. Technology has progressed to the point where fine distortions, called higher order aberrations can be measured and treated. Higher order aberrations are often the cause of night vision problems. Wavefront technology, using the advanced VISX Waveprint System, was approved in May 2003. Dr. Kornmehl has had the Waveprint System since October 2002. All patients examined for LASIK at Kornmehl Laser Eye Associates are evaluated for higher order aberrations whether or not they elect to have the data used in their treatment. With the data obtained using the Waveprint System, Dr. Kornmehl is better able to determine the appropriate course of treatment.

Recently completed FDA Trials have demonstrated that 70% of patients treated with wavefront technology by VISX had a reduction of glare and halos at night. 98% of patients treated were 20/20 or better at one year.


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What is Dry Eye?


Dry eye can be caused by a number of factors. On the page below, Dr Ernest Kornmehl, a Boston area LASIK pioneer, explains the various causes of dry eye and symptoms of dry eye. It is important to be properly evaluated for dry eye if you are considering LASIK eye surgery so that the refractive surgery can be properly tailored to your condition.

Dry Eye can result from decreased tear production, an unstable tear film, and rapid evaporation of tears.

Causes of Dry Eye:
  • Contact lenses
  • Age: As we mature, glands in the eyelids produce less oil. Oil keeps tears from evaporating off the eye. Decreased oil production allows tears to evaporate too quickly, leaving the eye dry.
  • Systemic diseases including Diabetes, Arthritis, Sjogren's, and Collagen Vascular Diseases
  • Hormonal changes, especially after menopause
  • Prescription medications as well as over the counter medications: these include some high blood pressure medications, antihistamines, diuretics, antidepressants, anti-anxiety medications, sedatives and pain medications.
The following can exacerbate Dry Eye:
  • Hot, dry, or windy conditions: High altitude, heat and air conditioning
  • Eye irritants such as cigarette smoke, chemical fumes
  • Reading, computer work, or watching TV
  • Eye surgery: Some types of eye surgery, including LASIK can exacerbate dry eye
Symptoms of Dry Eye
  • Foreign body sensation: the feeling there is sand in your eye
  • Blurring of vision after periods of reading, computer work, or watching TV
  • Eyes that itch, burn, or ache
  • Reflex tearing; excessive tearing
  • Red, irritated eyes
  • Mucus discharge
A comprehensive evaluation with Dr. Kornmehl will determine if you have Dry Eye. He will customize your treatment according to your specific condition.


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Ernest W. Kornmehl, MD, FACS
Laser Vision Correction

Office Address:

Wellesley Office
54 Washington Street
Wellesley, MA 02481

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The Brook House (Rt. 9)
Brookline, MA 02445
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