Insight Into LASIK Surgery

Interviewed by Rasa Fournier
Wednesday - February 02, 2011
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Where did you receive your schooling and training?

I trained at Jefferson Med School in Philadelphia, and then I did my ophthalmology training at Wills Eye Hospital in Philadelphia.

How long have you been practicing?

Since 1984 and I’ve been in Hawaii since 1989.

Weren’t you one of the first ophthalmologists to do LASIK surgery in Hawaii?

Yes, I was the first person to do laser in-situ keratomileusis or LASIK in Hawaii.

What is LASIK surgery?

With LASIK, you create a very thin flap of the cornea - which is the front surface of the eye - using a laser. The flap is folded back and underneath it, the actual front surface of the cornea is totally reshaped so that it makes the image focus correctly on the retina. The flap is then placed back. There is no need for stitches or anything for the flap to adhere. The reason LASIK is so popular is because of that flap the recovery is very fast. Most people are a little uncomfortable for about three or four hours and, if you look at the FDA studies, most patients are legal to drive the next day.

Who is the best candidate for LASIK?

There are various types of refractive surgery so there are many technologies used now to correct for glasses and contact lenses. The initial one was the Russian technique that happened back in the ‘60s and that was without lasers. With the advent of the excimer laser, LASIK and PRK (photorefractive keratectomy) were introduced in the United States in the mid 1990s. LASIK is a technology that can cover most refractive errors like nearsightedness, farsightedness and astigmatism. There are other technologies such as a Visian intraocular contact lens, intraocular lens implants and other modalities that have been introduced to correct refractive error. It’s important that someone who is interested in getting rid of their glasses goes to a surgeon who is versed in these different modalities. LASIK is an excellent choice for many, but may not be good for everyone. You need a surgeon who can discern this.

Is anyone who uses contacts or glasses a good candidate for LASIK?

Most of the time if you wear contacts or glasses, you are possibly a candidate for LASIK surgery, but there are many things we need to look at. For example, the shape of your cornea, the amount of prescription you have, your age, whether you have dry eyes or not. It’s a very successful surgery if you’re a good candidate. Do your research. And obviously, if there are any issues, this is elective surgery and best not to have it performed.

Can a person go through corrective surgery but have it not work, or is that a myth?

There’s a lot of negative press about LASIK surgery, but it’s actually one of the most commonly performed elective surgeries in the United States and it’s very successful. There are a few patients who still have to wear glasses or contacts afterwards. Most people are very happy with their results.

What is the most common condition LASIK is used for?

Nearsightedness and astigmatism comprise most of the refractive error that we see.

How many of those do you perform a month?

It varies. Initially when we were doing it, we were doing up to 300 cases a month and what’s happened is with the economy, that number has declined. More recently we do about 80 cases a month.

Dr. Tyrie Jenkins (right) performs a slit lamp exam on Beth Conlin

Are follow-up treatments needed or is the effect permanent?

With the advent of newer technologies the re-treatment rate has gone down. Initially our re-treatment rate was, even in the old days, up to 10 percent, but now our re-treatment rate is around 2 percent, and that varies depending on your prescription as well.

What advancements have been made since you started?

Two things have really changed a lot. First, the flap-making technology is all done with a laser. It’s gotten very precise to within microns, and now we also can customize flaps. So we can change the shape of it, we can change the bevel of the edge, we can change the thickness of it and we can customize it for each patient. How we make the flap has really progressed over the years. I’ve done everyone in my family and we used the old technology and they’re all still talking to me. The other thing that’s changed is the laser that’s used to reshape the cornea, and our treatments have gotten more accurate, and that’s one of the reasons that the re-treatment rate has gone down. Plus I think we have a lot of experience under our belts so we’ve gotten better at knowing who’s not a good candidate - who to treat and who not to treat.

What age group is the most appropriate for LASIK?

On the low end, the FDA has approved it from 21 on, but I don’t think it’s really a good idea until your eyes stop changing. So I recommend that usually you should wait until your mid 20s, unless you can document that your prescription is stable. I’ve done both of my daughters and I did their surgeries in their mid 20s. On the upper side, there’s really no limit. But when you get into the older patient base you really have to look out for things like dry eyes and also cataracts. If a patient has a cataract, then they really don’t need LASIK surgery because we can actually get rid of their glasses with lens implant technology.

Is there anything else about LASIK surgery the public should know?

LASIK has recently gotten some negative press because there are a very small percentage of patients unhappy with their procedure. They definitely should be listened to, but if you look at the number of people who have had it done, most people have been very happy. The thing that’s important is that a patient make sure that they have somebody that has enough experience to know when LASIK surgery is the right procedure.

Does LASIK surgery give a person perfect vision?

The goal for everyone of course is to get 20/20 vision. So when I see a patient and I look at the pre-op data, I spend a lot of time individually with the patient and find out what their expectations are. If their expectations are that they have to have 20/15 vision or they won’t have it, I’ll say, “You know what, I can’t guarantee that, so maybe you shouldn’t have this done.” For the most part, my goal is to make sure a patient has finished the procedure and they’re happy with their vision, and that can mean different things for different people.

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