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LASIK Laser Eye Surgery Frequently Asked Questions
Provided by Dr. Jamie Monroe


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Why Do LASIK Costs Vary So Widely?


There are different types of LASIK from which you can choose. Like selecting options on a new car or home, you have several alternatives for your LASIK procedure. There is 1) conventional LASIK, 2) CustomVue LASIK, 3) conventional IntraLASIK, or 4) CustomVue IntraLASIK.


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Why Are There Different Kinds of LASIK?


When conventional LASIK was first developed in the 1990's, it was capable of delivering good enough vision for most people to pass a driver's exam without corrective lenses (20/40). Many of these people were fortunate enough to get an exceptional result of 20/20, but the baseline expectation was 20/40. Technological advances in wavefront guided LASIK and femtosecond laser flap creation have raised the bar so that 20/20 is now the baseline expectation and 20/16 or better is the goal.


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What Is Conventional LASIK?


It is a surgical procedure in which a microkeratome with a metal blade is used to cut a thin flap on the cornea (the outer window of the eye). The flap is folded back so that an excimer laser can reshape the underlying corneal tissue. This reshaping of the cornea can correct simple prescriptions (nearsightedness, farsightedness, or astigmatism). The corneal flap is then returned to its original position.


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How Good Is Conventional LASIK?


It is good enough to have served millions of people very well over the years. If expectations are realistic, conventional LASIK can provide good enough vision for people to enjoy a more active lifestyle without corrective lenses. Driving a car, watching television, swimming and hiking are a few of the activities conventional LASIK can provide without the hassle of corrective eye wear.


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What Are The Advantages of Conventional LASIK?


Conventional LASIK can correct a wide range of simple prescriptions. It is less expensive than other types of LASIK, especially if it is performed on certain types of lasers which have a limited FDA-approved treatment range. Unfortunately, these lasers may not be able to enhance, touch up, or fine tune a less than optimal result.


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What Are The Disadvantages of Conventional LASIK?


While conventional LASIK corrects simple prescriptions, it induces complex prescriptions (spherical aberration, coma, trefoil, etc.). These are unique imperfections in the cornea which can reduce visual sharpness postoperatively. Although 20/40 is the baseline expectation, even when 20/20 vision is attained, the quality of vision may not be satisfactory. Halos, glare, or night vision problems could result. Both the microkeratome flap creation and conventional laser treatment have been found to cause these unique imperfections and there is no way to predict who may experience symptoms or how severe they may be.


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Can Conventional LASIK Be Retreated For Improvement After I Have Had It Done?


If there remains a simple prescription after conventional LASIK, it may be retreated with a conventional LASIK enhancement or touch up. If the problem is unique imperfections, then vision may not be fully correctable with conventional LASIK, glasses, or soft contact lenses. However, it may be corrected with hard or rigid (gas permeable) contact lenses or an upgrade to CustomVue LASIK.


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What Is CustomVue LASIK?


It is a surgical procedure in which a microkeratome metal blade is used to cut a thin flap on the cornea (the outer window of the eye). The flap is folded back so that an excimer laser can reshape the underlying tissue for correction of both simple prescriptions and unique imperfections. The corneal flap is then returned to its original position.


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How Does CustomVue LASIK Correct Complex Prescriptions That Conventional LASIK Does Not?


Wavefront technology has been borrowed from astronomy. It analyzes the entire human optical system and is 25 times more accurate than the usual method of measuring vision. It is capable of measuring both simple prescriptions and complex imperfections, making a "fingerprint of the eye." This data is transmitted directly to the excimer laser for individualized treatment on a given individual. The WaveScan analysis is so unique that no two treatments are exactly the same. Hence, CustomVue LASIK is personalized just for you. New VISX Fourier Analysis uses 100% of your wavefront data for your laser vision treatment compared to only 16% of wavefront data points used by LADARVision and Technolas Lasers and 0% used by Wavelingt Allegretto Lasers.


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Can WaveScan Analyze Everybody's Eyes?


Almost everybody's. The VISX WaveScan, which is the first FDA approved WaveScan in the United States, is capable of analyzing the eyes of most people. The small percentage of eyes that cannot be captured on the WaveScan generally have a condition that makes LASIK undesirable. For example, cataract may be treated with cataract surgery, corneal warpage with IntraINTACS, etc.


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How Much Better Is CustomVue LASIK Than Conventional LASIK?


In the FDA trials, CustomVue LASIK 12 month results showed 100% of patients with vision good enough to pass a driver's license without glasses (20/40). 98% were at least 20/20, and 70% were able to see as well or better after CustomVue LASIK as they could with their glasses or contact lenses before their CustomVue LASIK procedure. Also, 4 times as many patients expressed "very satisfied" nighttime vision after CustomVue LASIK as they had expressed preoperatively with their glasses or contact lenses. No retreatments were performed in the FDA studies. Retreatment is less likely after CustomVue LASIK than conventional LASIK.Wavefront technology has been borrowed from astronomy. It analyzes the entire human optical system and is 25 times more accurate than the usual method of measuring vision. It is capable of measuring both simple prescriptions and complex imperfections, making a "fingerprint of the eye." This data is transmitted directly to the excimer laser for individualized treatment on a given individual. The WaveScan analysis is so unique that no two treatments are exactly the same. Hence, CustomVue LASIK is personalized just for you. New VISX Fourier Analysis uses 100% of your wavefront data for your laser vision treatment.


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Are There Any Disadvantages to CustomVue LASIK?


CustomVue LASIK is more expensive than conventional LASIK. Moreover, it is currently not yet available for all prescriptions. Although CustomVue LASIK can treat unique imperfections that are either pre-existing or induced by conventional LASIK, it doesn't correct unique imperfections induced by a microkeratome blade that is used at the same time as the LASIK procedure. However, it may be possible to treat microkeratome induced unique imperfections at a later date with CustomVue laser vision correction.


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Is CustomVue LASIK Available On All Excimer Lasers?


No. It is only available on the VISX Star S4 laser system.


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Are There Any Other Lasers Deside VISX That Have FDA Approval for Wavefront Guided LASIK?


Yes, the Alcon LADARVision laser offers CustomCornea and the Bausch & Lomb Technolas laser offers Zyoptix. The Wavelight Allegretto laser is not FDA approved for wavefront-guided laser vision correction but it imitates a wavefront treatment by removing more peripheral corneal tissue. It does not, however, address an individual's specific wavefront pattern. VISX is the only laser FDA approved for wavefront-guided far-sighted and mixed astigmatism prescriptions.


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What Are Some Considerations in Choosing Between a VISX, LADARVision, Technolas, or Allegretto LaserVision Treatment?


VISX is preferred 2:1 by laser vision surgeons in the U.S. over all other lasers combined. Some reasons for this include:

1) VISX has variable spot (rather than fixed spot) scanning capabilities allowing for faster treatment times and greater tissue preservation.

2) VISX has both active and passive 3-D eye tracking capabilities. ActiveTrak follows eye movements, and if the eye moves out of the safe zone (1 1/2 millimeters), the passive tracker pauses the laser and resumes treatment as soon as the eye is properly aligned.

It also is the only laser to have iris registration which tracks the cyclotorsional movements of the eye and makes sure your custom treatment is properly aligned for best results. The eye may rotate up to 15 degrees between the wavefront exam and your lying down for the laser treatment--especially if the eye is dilated when the wavefront is taken as is the case in some non-VISX lasers. Iris registration takes a picture of the unique landmarks of your iris and then rotates your treatment on the VISX Laser to align the landmarks. Better alignment means better results.

3) Only VISIX lasers use Fourier analysis instead of Zernike Polynomial analysis to address the unique slope of your cornea. 100% of your wavefront data is used for your laser vision treatment by VISX lasers compared to only 16% of wavefront data points used by LADARVision and Technolas Lasers and 0% used by Wavelight Allegretto Lasers.
4) VISX Lasers are the only FDA approved lasers for wavefront-guided farsighted or mixed astigmatism prescriptions. This may be important for your prescription or for enhancement or fine tuning a less than optimal result from a previous treatment.

5) Custom wavefront laser treatment requires precise registration from your wavefront exam to your laser treatment. If your pupils require dilation for your wavefront exam or laser vision treatment (LADARVision & Technolas Lasers), you may experience a 15 degree or more eye rotation error from sitting at the wavescan to lying down at the laser. VISX Lasers do not require pupil dilation which reduces eye rotation to about 2 degrees. Moreover, VISX has the only FDA approved automated iris registration for precision tracking.

6) While other lasers require the surgeon to ink mark the edge of the cornea or to identify a blood vessel or other external landmark to align the laser treatment with the wavefront exam, only some VISX lasers can read your iris landmarks from the wavefront analysis and automatically rotate your laser treatment to within 1/10th of a degree of eye rotation accuracy (a $400 value).


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What is Conventional IntraLASIK?


It is an all laser procedure in which an IntraLase femtosecond laser makes the corneal flap instead of a microkeratome metal blade. Then, the excimer laser reshapes the underlying corneal tissue for a simple prescription after which the flap is returned to its original position.


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What Are The Advantages of a Laser Corneal Flap Over a Microkeratome Blade Flap?


There are MANY:

1) Similar to the excimer laser that reshapes the cornea, the laser corneal flap is under computerized laser control. Flap position, size, shape, depth and hinge location and width can be programmed with unprecedented accuracy and safety.

2) Flap thickness is reproducible to within 10-15 microns with laser generated flaps versus 30-40 microns or more with microkeratomes. This is critical in some patients with thin corneas.

3) Flap created with a femtosecond laser.

4) Laser flap formation is more comfortable and predictable. Patients with corneas that are too small, flat, steep, or thin for conventional LASIK with a metal blade microkeratome may be candidates for IntraLASIK with the femtosecond laser.

5) Laser flaps are planar shaped (same thickness throughout) whereas metal blade flaps are meniscus shaped (thicker at the edges and thinner in the center). Planar flaps are tighter fitting and are less likely to shift, develop wrinkles or incur surface tissue (epithelial) ingrowth.

6) One study has shown no significant induced unique imperfections with a laser flap. Mechanical-blade microkeratomes are well known to induce unique imperfections.

7) Another study found retreatment rates went down by 64% for those receiving femtosecond laser flaps.

8) A third study showed that laser flap patients had 73% less dry eye symptoms postoperatively.


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What Are The Disadvantages of Conventional IntraLASIK?


A laser flap takes a minute or more to create, compared to just a few seconds for a microkeratome flap. The cost for the laser generated flap is $400 more per eye. Although the flap doesn't introduce any significant unique imperfections, the excimer laser treatment may, especially if it is conventional LASIK instead of CustomVue (wavefront guided) LASIK.


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What Is CustomVue IntraLASIK With Iris Registration?


CustomVue IntraLASIK with Iris Registration is the ULTIMATE LASIK. It is an all laser procedure which combines the safety and accuracy of the femtosecond laser flap creation with the unique precision of an iris-registered wavefront-guided excimer laser treatment. Now you can better understand why there are different LASIK prices. LASIK is not like shopping for the cheapest airplane ticket to get you to a given destination. It's like hiring an expert to develop your voice or body, so that you can attain your personal best potential. You want your eyes to obtain their personal best vision.


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Where Can I Receive CustomVue IntraLASIK With Iris Registration?


The Cataract & Lasik Center of Utah is the first center in Utah, Idaho, Montana or Wyoming to offer CustomVue IntraLASIK with iris registration (IR). When you compare prices, be sure that you are comparing CustomVue IR IntraLASIK prices (Iris Registration Fourier wavefront guided + laser flap). This is laser vision correction at its very best. CustomVue IntraLASIK with iris registration typically costs between $2,500 and $3,000 per eye. Our fee is only $2250 per eye which includes all pre and post operative care for one year.


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Jamie M. Monroe, MD
Cataract & Lasik Center of Utah

Office Address:

175 North 400 West
Orem, UT 84057
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