I thought our patients might be interested in this story, since the Lasers used in the Air Force are the same as the ones used at our Yonge Eglinton Centre- DSR.
5/24/2007 - WASHINGTON (AFPN) – Air Force officials have changed the policy to allow people applying for aviation and aviation-related jobs to have had LASIK surgery. The change became effective May 21. The change also removes the altitude and high-performance aircraft restrictions for people who have had LASIK.
The decision to make these changes was based on studies that showed there was little to no effect on LASIK-treated eyes when subjected to the wind blast experienced during aircraft ejection or exposure to high altitude.
Due to stresses placed on the eyes during flight combined with the active lifestyle of military members, the recommended refractive surgeries are Wave Front Guided Photorefractive Keratectomy, or WFG-PRK, and Wave Front Guided Laser In-Situ Keratomileusis, know as WFG-LASIK, using the femtosecond laser. The eyes are more trauma resistant after surgery using one of these methods compared to other forms of refractive surgeries.
With all refractive surgeries, there is no guarantee of “perfect” sight after undergoing the procedures. Individuals must still meet the standards prescribed in AFI 48-123, Medical Examination and Standards, for entrance into the Air Force and aviation and special-duty positions.
Additional information and guidance can be found at the AF Knowledge Exchange by accessing the restricted “Dot Mil” site: https://kx.afms.mil/USAF-RS%20or%20public%20access or public access:
http://airforcemedicine.afms.mil/USAF-RS
I have a lot of patients asking me about intra-ocular lenses these days. Intra-ocular lenses are commonly called IOL’s. They put the eye into focus after cataract surgery. In the old days (30 years ago), cataract surgery was a major upset for people. They required a prolonged hospital stay and often had to lie still for many days. Then, after the banadages were removed, they would have to be fit with contact lenses or very thick glasses. The glasses were unsightly and caused all sorts of unwelcome distortions. The thick prescription glasses were needed because the cataract removal put the eye way out of focus. The cataract develops in the lens of the eye. The lens accounts for about 1/3 of the focusing power of the eye. Therefore, when it is removed, the eye is very much out of focus. Now, we replace the lens with a small plastic lens that stays in the eye permanently. The new lenses are very safe, in fact, a cataract operation is rarely done these days without one. One problem though, the lenses don’t completely correct distance vision and people need reading glasses.
That is where the multifocal lenses come in. These lenses give patients more normal vision, as they have a focus for up close (reading) and for distance as well. When combined with astigmatism surgery, people can be freed of glasses for 80% of all their activities. For long periods of reading, a small correction may be needed. The only downside of the multifocal lenses is that people will notice rings around lights at night due to the way the lenses are shaped. Most people get used to this, and the benefit of being able to function without glasses makes them more than happy.
Watch out for the MacLean’s magazine issue at the end of May, I think May 31st, 2007 issue. They were in to speak to us about our centre and about IntraLase and Customvue. The US Navy has done a very big study on the same technology we use here at YELC and have found it to be superior to other modes of Laser vision correction with the microkeratome (the blade) and other excimer lasers. That is one reason why we have the Visx Star S4 and IntraLase, as we want to use only the best and proven technology to acheive the greatest results for our patients.
What is an ICL? These are exciting devices to help correct very severe degrees of near-sightedness, farsightedness and astigmatism. They are a thin piece of soft plastic, much like a contact lens. But, unlike a contact lens, it can be inserted actually into the eye, and remains there. It has the lens correction built into it and never needs to be removed or cleaned. I have patients who are blind without glasses or contacts and now can see near 20/20 (normal) Imagine not being able to see anything clearly past the tip of your nose, and then leaving after a 20 minute operation and being able to see across the street. It is really quite amazing. The ICL is also for people with thin corneas that may not be eligible for laser vision correction.
At our centre, we have decided to concentrate on IntraLase for preparing the flap, and VisX CustomVue for the corneal shaping. Why? because there are now several good studies that show that this is the winning combination to give people the best results, closest to target, in the safest way possible. So we don’t want to offer anything else, even though decent results can be obtained with other methods. To us, decent is not good enough. IntraLase/CustomVue is giving us outstanding results, which is what it is all about. So we think we are offering tremendous value to our patients. High likelihood of no glasses, with the lowest chance of having a flap problem. In comparison, I once had to take my dog to the vet for an operation, and the bill was $2000. When I looked it over, it was totally reasonable. The doctor has a business to run, and has expenses we don’t even imagine. So too in the Laser vision correction area, there are expensive devices, insurance, staffing etc, that actually makes $2500 per eye sound like a very good value for a life changing experience.
We offer CustomVue, wavefront guided treatment to almost all our patients. The standard treatments, while good, represent older, less precise ways of reshaping the cornea. Without CustomVue, we cannot utilize the iris registration program, which allows us to precisely align the laser treatment and uniquely identify our patients by the laser. This alignment ensures a great result and takes into acount the shifting of the pupil when the pupil gets smaller. I can tell you, the smoothness of the surface after the laser is applied, is truly remarkable. While our older laser was good, the VisX Star S4 with iris registration is a quantum leap forward, so much so that we recommend it in most instances.
No, not at all. After the first day of using the IntraLase, I decided not to offer the treatment to patients. I felt the microkeratome, while a good device, has had its time in the sun, and it was appropriate to move on to better methods of creating the flap. And now there is lots of information and data out there to support the better outcomes that are available combining IntraLase with CustomVue (VisX) laser treatment. When I had my PRK and my wife had her LASIK (9 years ago), the IntraLase and CustomVue were not available, but if they were, we would have had it done that method.
Yes, sometimes they do. Most often on the day of surgery, less than 2% of the time. When this happens we will float the flap back into place and that takes care of the problem. In terms of late dislocations, this happens rarely. We have had 3 patients in the past 10 years that have had direct blows to the eye that have moved the flap. They were repaired promptly and all recovered excellent vision. Interestingly, we have not had a single flap dislocated since we switched to IntraLase, I think due to the stronger healing that occurs with the IntraLase.
People ask me: ”Why did you go this route, using the Intralase for the first step, flap creation in LASIK? Is it really necessary, I’ve heard that the blade technique has been around a long time”. At first I also thought that the microkeratome (blade) is so safe, complications so rare, it is worth the half a million dollars that it cost, plus the continued upkeep in order to switch to IntraLase? Well, I can honestly say, yes it is worth it. To my patients, it gives them the assurance they are getting the safest and best possible flap on their cornea. For me, it makes the surgery more exciting and relaxing at the same time. It is thrilling to watch the laser form millions of microscopic bubbles in the cornea so close together that a flap is created. Within 30 seconds, a perfect smooth layer has been made. We measure the flap thickness each time and it so close to what we predict, it is almost uncanny. That vertical edge on the flap, makes it like a man-hole cover on the street. In other words, it flips back into position and seals very securely. It is more relaxing, because there is not that moment where we hold our breath, as we did with the microkeratome, as the blade passes across the eye.
Getting back to the IntraLase, it is used for making the LASIK flap, but it doesn’t stop there. The company behind this machine has now made it possible to use the laser for therapeutic applications. This means that my patients with cornea problems that are fixable with a corneal transplant can now be operated on with a laser. The cornea is a very thin curved tissue on the front of the eye. It functions like a lens, and that is why we can reshape it with the laser and correct for the need to wear glasses. But, there are many unfortunate people out there with problems with the cornea that cannot be corrected with the laser. For these patients, a corneal transplant may correct their problem by putting a new clear window in place. This is great, but has its down side too. The healing is prolonged, and often there is much astigmatism after. This is where the IntraLase comes in and can help. The laser is so precise, that it can cut a perfect circle, give us alignment marks and even shape the edge, much as a carpenter does to shape a tongue-in-grove joint. This makes the cornea heal better and quicker. Truly science fiction. And we at Yonge Eglinton Laser Eye Centre, are the first in Canada, in fact one of the few places in the world to be able to offer this type of transplant. It is very exciting to be part of this revolution and can’t wait to see the further developments.
