Measure Twice, Cut Once

Great results require great data.  When we reach the step of applying laser energy to the eye, we are on almost the last step of a checklist that has many steps preceding it.  To begin with we must take a careful history of the patient, their vision, and their eye and medical history.  We need to understand their visual needs, what they are currently wearing (contact lenses or glasses or nothing) and how effective these have been.  Then we want to understand what the patients expectations are with laser vision (ususally LASIK) correction, make sure that they are a suitable candidate mentally and physically for this procedure, and discuss alternatives and options that are available to them.  They need to decide whether to have one eye done at a time or both the same day.

Assuming that the basic measurements are favorable, we take more detailed measurements which involve a variety of scans of the eyes as well as a complete eye examination.  Some of this might be performed outside our offices by referring doctors, but all crucial measurements are taken or repeated here.  In fact some measurements will in some cases be repeated multiple times on the same or different days, depending on the individual situation.

We then need to discuss target, or where we want to leave the vision at the end of the healing process.  For most people this is no correction or plano, but sometimes we aim for monovision leaving one eye nearsighted, or rarely we want to target something other than plano (no residual correction).

This data is analyzed to determine which of the refractive procedures would best suit a particular patient.  Not only do we consider LASIK and PRK, but also other procedures such as phakic lenses or clear lens extraction.  Other specialized tests are sometimes performed including OCT to further measure thickness, and others.  Finally, a dilated eye examination needs to be done to again determine the refraction and to be sure that the internal structures of the eye are healthy.

After all of this evaluation we find that about 15% of prospective patients are not good candidates for laser vision correction.  For this reason, we provide this analysis at no charge.

The next step is patient counseling where all of this is discussed in detail and a surgical plan is developed.  This process usually takes about 90 minutes, but sometimes longer.  Of course there are questions presented by the patient which need to be answered and this can change the time estimates given.  We have two full time eye doctors on staff besides the surgeon who are able to help with much of this diagnostic work along with certified ophthalmic technicians.

All of this data is collected in the chart, and reviewed by the surgeon prior to the procedure, and it is entered into and verified as correct to the laser just prior to each treatment.  Importantly, the laser is calibrated just before every treatment, to be sure it is running in optimal condition.

The patient signs a consent for surgery, receives a mild sedative after allergy history is reviewed, and has the outer eye area cleaned.   All of the procedures are performed in our State of Colorado Certified surgery center.  While waiting in our comfortable patient lounge, they are given a series of eye drops, and a final visit by the surgeon to review again the surgical plan.

There are decisions to be made about both steps of the LASIK process.  First the flap must be designed as to the diameter, thickness, and side cut parameters, hinge angle, etc.  This step prepares the eye for the second step, the excimer laser treatment.  We have two flap creation or femtosecond lasers on premises, and two state of the art excimer lasers for the vision correction.  The surgeon must verify the data and properly align the patient and direct them throughout the treatment.  Fortunately this is mostly automated, quick , and essentially painless.

Once the procedure is done, there are more critical steps.  The patient who is usually happy and relieved to see so much better so quickly is examined at the slit lamp by the surgeon, and then is able to relax with their eyes closed while being checked for discharge.  Instructions which were previously given are reviewed, drops are instilled, and the patient is accompanied by their transportation person to home or hotel until checked the following morning.  If there are any problems we are available by phone and if necessary in person that evening.

The following day, vision and healing are checked, drops are reviewed, and questions answered.  Usually, there are several additional visits scheduled which are less frequent over time until healing is completed at 6 months to one year.  Sometimes, additional visits or treatments are needed and rarely, an additional laser enhancement or touch up must be scheduled.

Although the actual time in the operating room is only about 15 minutes, several hours of time are involved in the pre-operative and post operative care of every one of our patients.  We do quite a bit of measurement before proceeding with the laser treatment.