Are You a Good LASIK Candidate?

The best way to determine if you are a good LASIK candidate is to schedule a consultation with a trusted physician. But even a good surgeon does not know you inside and out. Here are some good guidelines from the FDA at determining your LASIK candidacy.

You are probably NOT a good candidate for refractive surgery if:

• You are not a risk taker. Certain complications are unavoidable in a percentage of patients, and there are no long-term data available for current procedures.
  It will jeopardize your career. Some jobs prohibit certain refractive procedures. Be sure to check with your employer/professional society/military service before undergoing any procedure.
• Cost is an issue. Most medical insurance will not pay for refractive surgery. Although the cost is coming down, it is still significant.
• You required a change in your contact lens or glasses prescription in the past year. This is called refractive instability. Patients who are: In their early 20s or younger,
  Whose hormones are fluctuating due to disease such as diabetes, Who are pregnant or breastfeeding, or Who are taking medications that may cause fluctuations in vision, are more likely to have refractive instability and should discuss the possible additional risks with their doctor.
• You have a disease or are on medications that may affect wound healing. Certain conditions, such as autoimmune diseases (e.g., lupus, rheumatoid arthritis), immunodeficiency states (e.g., HIV) and diabetes, and some medications (e.g., retinoic acid and steroids) may prevent proper healing after a refractive procedure.
• You actively participate in contact sports. You participate in boxing, wrestling, martial arts or other activities in which blows to the face and eyes are a normal occurrence.
• You are not an adult. Currently, no lasers are approved for LASIK on persons under the age of 18.

Precautions:

The safety and effectiveness of refractive procedures has not been determined in patients with some diseases. Discuss with your doctor if you have a history of any of the following:

• Herpes simplex or Herpes zoster (shingles) involving the eye area.
• Glaucoma, glaucoma suspect, or ocular hypertension.
• Eye diseases, such as uveitis/iritis (inflammations of the eye)
• Eye injuries or previous eye surgeries.
• Keratoconus

Other Risk Factors

Your doctor should screen you for the following conditions or indicators of risk:

• Blepharitis. Inflammation of the eyelids with crusting of the eyelashes, that may increase the risk of infection or inflammation of the cornea after LASIK.
• Large pupils. Make sure this evaluation is done in a dark room. Although anyone may have large pupils, younger patients and patients on certain medications may be particularly prone to having large pupils under dim lighting conditions. This can cause symptoms such as glare, halos, starbursts, and ghost images (double vision) after surgery. In some patients these symptoms may be debilitating. For example, a patient may no longer be able to drive a car at night or in certain weather conditions, such as fog.
• Thin Corneas. The cornea is the thin clear covering of the eye that is over the iris, the colored part of the eye. Most refractive procedures change the eye’s focusing power by reshaping the cornea (for example, by removing tissue). Performing a refractive procedure on a cornea that is too thin may result in blinding complications.
• Previous refractive surgery (e.g., RK, PRK, LASIK). Additional refractive surgery may not be recommended. The decision to have additional refractive surgery must be made in consultation with your doctor after careful consideration of your unique situation.
  Dry Eyes. LASIK surgery tends to aggravate this condition.

Diabetes and Vision

Diabetes has serious effects on eye health, and rates of the disease are rising rapidly around the globe - in 2007 approximately 246 million people worldwide had the disease, and the International Diabetes Foundation estimates that number will jumpt to 324 million by 2025.

To make matters worse, there is a disturbing lack of awareness of the impact diabetes has on eye health and vision: In Transistions Optical's second annual Healthy Sight Survey, between one-third and two-thirds of respondents didn't identify vision problems as a side effect of diabetes.

Ocular Effects

Diabetes can lead to the development of eye diseases, including cataracts, diabetic retinopathy, age-related macular degeneration (AMD), and glaucoma.

Diabetic retinopathy may also lead to retinal cell phototoxicity, which is an extreme adverse reaction to UV light. In the U.S., 40.3 percent of diabetics over age 40 have diabetic retinopathy, and 8.2 percent have vision-threatening retinopathy.

In addition, diabetic retinopathy and cataracts have been associated with reduced contrast sensitivity and also increased susceptibility to glare.

If you are diabetic, it is crucial to have frequent dilated eye exams to monitor and prevent vision loss. If you have sudden vision changes, contact your eye care provider.

Are You Protecting Your Eyes?

A new survey conducted by the New England Eye Institute (Boston) and Transitions Optical (Pinellas Park, Fla.) has found that only 5% of consumers are aware that ultraviolet (UV) exposure can cause damage to their eyes, the two organizations reported jointly in a press release. The study also found that more than half (57%) of respondents said they do not wear protective eyewear when in the sun for extended periods. Those surveyed said they spend about 3.5 hours outdoors daily, which represents an average of 1,000 of unprotected UV exposure per year. A total of 80% of respondents were aware of the risk of skin cancer associated with UV exposure, the organizations said.

In an earlier post (Beyond Fashion, Why You Gotta Wear Shades) we gave more information regarding UV protection. Sun damage is serious and preventable. There is no such thing as overprotecting your eyes!

What the heck is monovision?

You may have heard the term monovision in your LASIK research. Monovision is a type of correction made in patients who need glasses for distance and, because of aging eyes, also need glasses for up close vision. Instead of correcting both eyes for distance vision, one eye is corrected to see far and the other is left slightly uncorrected in order to see up close. Sounds like a headache? Actually, its not. Once your brain adjusts to it, you can't tell that only one eye is getting you the clear picture. Both eyes seems to be giving you both distance and near vision.

LASIK monovision is a viable and increasingly accepted method for correcting presbyopic (near vision lost due to aging) and pre-presbyopic refractive surgery candidates, according to results from a recent study. In addition, crossed monovision, in which the dominant eye is corrected for near vision, may be applied successfully in suitable candidates.

“Although the overall success of monovision was good, patient selection is extremely important, as not every patient can adapt to monovision,” the study authors said. “Patients selecting monovision should also be aware that the reliance on one eye for distance vision makes an enhancement procedure more likely than if bilateral distance vision is chosen.”

Roger F. Steinert, MD, and colleagues retrospectively analyzed the preoperative characteristics and postoperative outcomes of 284 patients 45 years or older who elected to undergo LASIK to correct myopia or hyperopia. Subsequently, refractive success, functional success and patient enhancement rates were evaluated for patients treated with monovision correction. Of 284 total LASIK patients, 188 (67%) elected to undergo monovision correction and 96 (34%) chose bilateral distance correction.

Dr Drucker recommends Monovision if one can get adjusted. The only way to determine this before lasik is a trial with lenses prior to LASIK. Many of our patients elect to have monovision knowing that if they are not happy with it and do not accomodate they can have a retreat that will correct both eyes to see distance and then reading glasses can be used for near. People with certain personalities, occupations and lifestyles are better candidates than others. If you see ads for “getting rid of reading glasses”, monovision is what it’s all about. Dr. Drucker has monovision himself! (Dr. Drucker has one eye corrected for distance and the other for intermediate or computer distance. He wears his glasses for very close vision.)

PRK: The original laser eye surgery

It may be hard to believe these days, when everything is "LASIK this" and "LASIK that," but PRK (photorefractive keratectomy) used to be the most common refractive surgery procedure.

Both are grouped under the umbrella "laser eye surgery," but each is a little different when it comes to advantages and disadvantages.

LASIK patients have less discomfort and obtain good vision more quickly (with PRK improvement is gradual and over a few days or even months), but many surgeons prefer PRK for patients with larger pupils or thin corneas. Dr. Drucker is one of these surgeons, and, in fact, is a PRK specialist.

PRK was invented in the early 1980s. The first FDA approval of a laser for PRK was in 1995, but the procedure was practiced in other countries for years. In fact, many Americans had the surgery done in Canada before it was available in the United States.

PRK is performed with an excimer laser, which uses a cool ultraviolet light beam to precisely remove ("ablate") very tiny bits of tissue from the surface of the cornea in order to reshape it. When you reshape the cornea in the right way, it works better to focus light into the eye and onto the retina, providing clearer vision than before.

Both nearsighted and farsighted people can benefit from PRK. With nearsighted people, the goal is to flatten the too-steep cornea; with farsighted people, a steeper cornea is desired. Also, excimer lasers can correct astigmatism by smoothing an irregular cornea into a more normal shape.

IF YOU HAVE BEEN TOLD YOU WERE NOT A CANDIDATE FOR LASIK, YOU MAY WANT TO SEE IF YOU ARE A CANDIDATE FOR PRK. CHECK BACK NEXT WEEK FOR MORE ON THE PRK PROCEDURE.

Beyond Fashion: Why You Gotta Wear Shades

Cheap sunglasses may cost you less, but are they just as likely to protect against the effects of harmful UV rays as expensive sunglasses?

According to Dr. Donald J. D'Amico, chair of ophthalmology at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, there is no certain way for consumers to be sure they are getting ultraviolet or UV protection from their sunglasses -- even if they are labeled "UV absorbing" or "UV blocking." Cost is no indicator of UV protection. An expensive pair of sunglasses does not guarantee sufficient protection from the sun.

"There is no government regulating power for the classification of sunglasses," says Dr. D'Amico. As a result, company information may misrepresent how much protection their sunglasses offer; and, unfortunately, consumers sometimes assume all sunglasses have protection if they are dark in color.

Dr. Stephen Trokel, an ophthalmologist at NewYork-Presbyterian Hospital/Columbia University Medical Center, advises that consumers buy sunglasses from reputable companies to ensure that they block both UVA and UVB rays. Another tip is to pair sunglasses with a large-brimmed hat to protect the eyes from sunlight that may enter from above and from the sides of glasses. Wraparound sunglasses and those with large temples also provide important side protection.

Sunglasses are not just a fashion statement; their lenses block harmful UV rays that, in severe cases, can cause permanent damage to the eyes in the form of cataracts, pterygium and possibly retinal degeneration.

Dr. D'Amico and Dr. Trokel caution that consumers should be aware of the following:

- Persons with light-colored eyes, such as blue and green, are often more sensitive to bright sunlight than darker eye shades.
- Individuals who wear contact lenses are least likely to want to wear sunglasses; however, sunglasses are helpful from preventing the drying effect most contact lens wearers get from warm wind; UV protection in contact lenses are the most effective in blocking all UV entering the eye.
- While not always true, the darkness of sunglasses will indicate greater UV protection -- at least if they comply with the ANSI Z80.3 industry standard.
- Automobile window tints are not a replacement for sunglasses; however, windshields screen out and are very effective in absorbing both UVA and UVB rays (because of the internal shatter-proof laminate).

In addition, Dr. D'Amico and Dr. Trokel emphasize that you are never too young to protect your eyes from the sun's harmful rays. Parents should purchase UV-protected sunglasses for their children with wraparound design and keep infants' eyes shaded.

David Drucker Becomes First Ever "Honorary" Lion's Club Member

David Drucker, MD, PC was honored Tuesday as the first ever "Honorary Member" of Denver's Chapter of the Lion's Club for his work and contributions to the Lion's Club Eye Exams for the Needy Program. Our office has provided eye exams for the homeless and destitute through the Lion's Club for the past five years. The Lion's Club has taken the results of these exams and made glasses for these patients. This contribution has helped many needy people receive the glasses that allow them to function on a daily basis. Many of these patients are then able to find work and make a better life for themselves with their sight restored.

Along with providing exams for the Lion's Club, our office has also performed eye exams for the Stout Street Clinic. The Stout Street Clinic is a local organization that helps recovering alcoholics and drug addicts. Many of their members are also homeless and jobless and are very grateful for the services we provide at no charge to them.

Congratulations to Dr.David Drucker for being recognized for his contribution to this group of underserved Colorado residents.