Vision Correction Procedures

There are now several highly effective surgical vision correction procedures to treat the common vision problems known collectively as "refractive errors."

Distance & Reading Vision	Reading Vision Only	Restorative
Custom LASIK or Wavefront Guided LASIK	CK (Conductive Keratoplasty)	Complication Repairs
Thin Flap LASIK	LTK (Laser Thermal Keratoplasty)	Cataract Surgery w/ RESTOR Lens
Intralase "All Laser LASIK"	Crystalens IOL	Cataract Surgery w/ ReZoom Lens
LASEK and PRK	Tetraflex IOL
Staar Visian ICL	ReZoom IOL
Artisan Verisyse ICL
RESTOR lens

Common Refractive Errors

Refractive errors are caused by the eye's inability to refract, or bend, light as necessary in order to create a clear, focused image. Vision begins when light rays pass through the cornea (i.e., the clear window in the front of the eye) and lens. When all of the rays focus uniformly and strike the retina at the back of the eyeball, the result is called perfect vision or 20/20 vision.

Vision becomes impaired when the light rays focus at some point in front of or behind the retina. This occurs due to an imbalance between the shape of the cornea and the length of the eye. All of us will at some point experience one or more of the following refractive errors.

Corrective Procedures

Each of the above vision problems can be corrected with refractive surgery. The advent of the excimer laser, which uses cool ultraviolet light to sculpt eye tissue, has revolutionized the refractive surgery field. Approved by the FDA in 1995, the laser is used to perform LASIK - the most popular elective medical procedure in the U.S. New refinements such as custom cornea mapping are making LASIK a great option for even more people. Other innovations such as Phakic Intraocular Lenses (the ICL or Verisyse) and various Intraocular Lenses (IOLs) achieve excellent results for patients who are not good candidates for laser vision correction.
Which procedure is right for you depends on several factors, beginning with the source and degree of your refractive error, as well as your age.

LASIK (Laser In-Situ Keratomileusis)

Uses a highly concentrated beam of cool light generated from an excimer laser to permanently change the shape of the cornea. The first step of the procedure involves creating a flap in the cornea. This flap is gently lifted and folded back so the inner layer of the cornea can be reshaped with the laser. After reshaping, the flap is carefully replaced so the natural bonding qualities of the cornea allow it to heal without the need for stitches. The entire procedure lasts about three minutes per eye, and can be used to treat nearsightedness, farsightedness and astigmatism.

Custom ("Wavefront Guided") LASIK

A further refinement of the LASIK procedure that facilitates more precise eye measurement and correction. It measures each patient's unique visual imperfections at hundreds of individual points. This enables the surgeon to customize the treatment, not just for the patient's overall prescription, but for each individual point that is measured on the eye. The result is vision that may be better than the best vision attainable with glasses or contact lenses. Not every patient may qualify for custom treatment. Custom LASIK tends to result in better nighttime and low light vision than traditional LASIK.

Thin Flap LASIK

Uses an ultra-thin 130 microkearatome blade to create the flap that is lifted during LASIK surgery. This allows the surgeon to retain more of the patient's corneal tissue upon which to apply the laser. The Thin Flap LASIK technique is especially advantageous for people with high degrees of nearsightedness and/or thin corneas, who otherwise would not be considered suitable candidates for LASIK. Dr. Dougherty is an authority on the development and practice of Thin Flap LASIK. His Thin Flap LASIK research study has been published extensively in leading peer reviewed medical journals.

Intralase All-Laser LASIK

With IntraLase, a special laser is used instead of a blade to create the flap. Then the usual excimer laser does the ablation. So in the IntraLase procedure, two different lasers are used, which is why it is sometimes promoted as "bladeless" or "all-laser" LASIK. As in typical LASIK, the flap then is replaced to serve as a type of natural "bandage" for healing.

Phakic Intraocular Lens Implants

(IOLs) are essentially contact lenses placed inside the eye on top of the natural crystalline lens, or attached to the iris (colored part of the eye). Because no cornea tissue is removed (as is done with LASIK), a Phakic IOL can correct extreme levels of nearsightedness and farsightedness. Another benefit is that it can be removed, and its effects potentially reversed.

Dougherty Laser Vision offers two types of Phakic IOLs:

Staar Visian Implantable Contact Lens (ICL) - approved by the FDA in 2005 for treating farsightedness
Verisyse (Artisan) ICL - approved by the FDA in 2004 for treating nearsightedness

Refractive Lensectomy

Involves removing the natural lens of the eye with ultrasonic energy and replacing it with an intraocular lens (IOL) implant to treat high levels of nearsightedness, farsightedness and astigmatism. This surgery is typically reserved for patients over age 50 whose lens has stiffened and lost the ability to focus. These patients are also likely to begin to develop early cataracts that can cloud vision. Refractive lensectomy is essentially cataract surgery with an intraocular lens implant to decrease dependence on glasses and contacts. LASIK is often used after lensectomy to fine tune the results obtained with the IOL. Patients who have lensectomy will never need cataract surgery. The lens that is placed in the eye is typically well tolerated and will outlive the patient.

Several different types of IOLs may be used in this procedure:

Traditional IOLs treat a wide range of vision problems from high nearsightedness to high farsightedness. These lenses do not correct astigmatism or accommodate to restore partial reading vision.
Toric IOLs treat a wide range of vision problems from high nearsightedness to high farsightedness, but also have the benefit of treating astigmatism at the same time.
Accomodating and Multifocal IOLs are designed to provide clear near, intermediate and far vision to help people with presbyopia (i.e., age-related loss of zooming power) become less dependent on bifocal eyeglasses. Approved by the FDA in 2003, the Crystalens is an accomodating IOL equipped with tiny hinges that allow it to move back and forth, or "accommodate," in a design intended to provide seamless clear vision. Approved in 2005, the ReZoom lens is a multifocal lens with five distinct focusing zones intended to provide clear vision at wide range of distance.

Which Procedure is Right for You?

Dr. Dougherty will evaluate your vision thoroughly to determine if you are a candidate for the above mentioned refractive surgery options. The comprehensive exam includes a corneal map to measure the curvature and thickness of your cornea, as well as a dilated assessment to obtain precise measurements of your prescription. Once all of the necessary information is gathered, he will help you decide which procedure is best for you based not only on your vision impairment, but also your overall health, age and lifestyle.