Mandel Vision Blog: Eyes on a Clearer World
The History of Laser Vision Correction Blog Series ~ Part Two
Keratomileusis and the Excimer Laser
Part 2 of a 4-Part Series
Although Radial Keratotomy was the more widely practiced refractive procedure in the United States, it was not the first. This accolade is instead reserved for keratomileusis. In keratomileusis, part of the cornea is removed and then the cornea is reshaped using a blade in order to correct refractive errors.
The process of keratomileusis was first developed in the 1950s, by a Spanish born ophthalmologist named Jose Ignacio Barraquer, M.D.[i] who later moved to Columbia.
As with R.K., keratomileusis was stumbled upon, as an incidental finding, when Dr. Barraquer performed a corneal transplant on a patient with keratoconus. Keratoconus is a degenerative corneal disease which is characterized by thinning and cone-shaped protrusion of the central cornea. Therefore, keratoconus-afflicted corneas are typically steep centrally. Since healthy corneal tissue is flatter, the corneal transplant flattened the cornea, which caused a reduction in myopia, or nearsightedness. Subsequent to this finding, Dr. Barraquer spent many years experimenting with different surgical techniques for the correction of myopia. He held his first course in Refractive Keratoplasty at the Barraquer Institute in Columbia in 1977. Seventeen of these courses were held at the institute until 1984.[ii]
In 1981, in the U.S., the physicist Rangaswamy Srinivasan 
discovered that the ultraviolet-light-based excimer laser could be applied in etching or drilling organic solids, including human tissue, without causing thermal damage to the surrounding area.[iii] In 1983, he began collaborating with ophthalmic surgeon Stephen Trokel, M.D. Together they developed the excimer laser used in refractive surgery today. This is a cold ultraviolet laser used to reshape the cornea. The laser uses UV light to remove microscopic amounts of corneal tissue. Its precision is at the level of a micron.
In 1985, Dr. Mandel was part of the first team, along with Dr. Trokel, proving that the excimer laser was effective in refractive surgery. Based on Dr Mandel’s work, he won the WIlliam Warner Hoppin Award from the New York Academy of Science and was recruited to Harvard’s Laser Laboratory to work on the next generation of research: large area ablation (PRK). Dr. Mandel's work, which was the first paper proving that the excimer laser works in current laser vision correction techniques, was presented in 1987 at the leading ophthalmologic research association (ARVO).
The first refractive procedure performed with the excimer laser was PRK (Photo-Refractive Keratomileusis), which was approved by the FDA in 1996 to treat nearsightedness[iv]. FDA approval for farsightedness and astigmatism soon followed.
In the PRK procedure, the epithelium is gently removed using a specialized epithelial brush. The cornea beneath is then reshaped using the excimer laser. A bandage soft contact lens is placed on the eye to allow the epithelium of the cornea to regenerate, which typically takes 72 hours. Although vision is functional and patients usually go back to work the next day, vision is slightly blurry and the visual recovery period for PRK is generally 7 to 10 days. Optimal vision then slowly returns over the next several months.
PRK is one of the technologies still utilized today for some patients who are not candidates for LASIK. These patients include those with both thin corneas and high levels of nearsightedness. The end results of PRK are just as good as LASIK. Thus, the determining factor for patients who are candidates for both procedures is convenience. In our world of immediate gratification, LASIK is the winner as optimal vision is achieved the morning after the procedure.
Next in this blog series: Bladed-LASIK Utilizing a Microkeratome
The History of Laser Vision Correction Blog Series ~ Part One
Radial Keratotomy
The First Blog in a 4-Part Series
Ever wonder about the origins of Laser Vision Correction? It’s actually a fascinating story, particularly because it was stumbled upon completely by accident. In the 1970’s, a Russian Ophthalmologist, Svyatoslav Fyodorov, removed glass splinters from the eye of a patient involved in an accident.[i] Prior to the accident, the patient was nearsighted and required glasses for distance vision. After the glass splinters were removed, the patient’s vision actually improved. That was the impetus for the development of the first refractive surgery procedure by Dr. Fyodorov, known as Radial Keratotomy (R.K.). R.K. was one of the very first refractive procedures.
To understand how this works, let’s review the functional anatomy of a normal sighted eye in comparison to a nearsighted (myopic) eye. In a normal sighted eye, light rays from an object come into focus directly on the retina.
A nearsighted (myopic) eye, however is anatomically longer than a normal sighted eye. Therefore, instead of light rays coming into focus directly on the retina, they come into focus in front of the retina, which creates a blurry image.
This condition can be improved by putting a concave lens in front of the eye with either eyeglasses or contact lenses. A concave lens is thinner in the middle and thicker around the edges and therefore, light rays that pass through this lens are refracted (bent) in a convergent manner which brings them into focus on the retina.
In order to accomplish this same effect with refractive procedures, since it’s not possible to shorten the eye, the cornea is flattened. In doing this, the light rays from an image have a shorter distance to travel, and can therefore come into focus directly on the retina, without the need for a corrective lens. In R.K., a diamond surgical blade, which could be calibrated to different corneal depths, was used to create radial incisions which flattened the cornea to correct nearsightedness (myopia). These incisions are likened to spokes on a bicycle tire.
Following the accidental finding, Dr. Fyodorov performed many R.K. procedures. From the post operative results of these procedures, he was able to fine tune the R.K. procedure and later predict the number of incisions required to correct different amounts of nearsightedness. Dr. Fyodorov's data then served as a template for other refractive surgeons. R.K. is one of the earliest, and most widely practiced, refractive techniques from which our current laser vision correction technology evolved. Both LASIK and PRK laser vision correction performed today employ the same concept as the original R.K. procedure: changing the shape of the cornea to correct different refractive errors. The advancement in technology over the years has improved the safety and efficacy of laser vision correction. It has also enabled refractive surgeons to correct not only nearsightedness (as with R.K.), but farsightedness (hyperopia), astigmatism and presbyopia (the need for reading glasses over age 40), as well.
Next in this blog series: Keratomileusis and the Excimer Laser
Soft Contact Lens Wear and Your Eye Health
There’s no question that contact lenses are a great, more aesthetically pleasing, alternative to eyeglasses. As long as you wear them responsibly, they are also a relatively safe alternative. Unfortunately, patients are not always educated about the proper use and care of their contact lenses. This is extremely important as unsafe practices can lead to vision threatening complications. With that in mind, here are some things you need to know about the cornea and contact lenses to keep your eyes safe during contact lens wear:
One size definitely does not fit all!
Although the correct prescription is important, it should not be the only concern when choosing a contact lens, as a proper fitting contact lens is the first step to safety. Contact lenses come in many different materials, curvatures and diameters so that ophthalmologists, as well as optometrists, can custom fit a contact lens to your specific cornea. Your cornea can naturally change shape over time. As your cornea changes shape, so can the fit. This is one of many reasons why annual contact lens evaluations are so important.
The cornea is avascular.
This means that the cornea is not nourished by blood vessels. Instead, the cornea gets its nourishment from your tear film and from oxygen. It is this reason that makes the proper fit of the contact lens so important. When you blink, your eyelid makes contact with the contact lens. A properly fitting contact lens should be well centered and should allow enough movement upon blinking to allow oxygen and the tear film to nourish the cornea. If a contact lens is too tight, movement of the contact lens on the cornea can be restricted, which doesn’t allow these nutrients to reach the cornea. Both movement and signs of lack of oxygen should be evaluated by a qualified eye doctor. If the contact lens is determined to be a well fitting lens, annual evaluations are recommended. If signs of malnourishment are detected, more frequent visits, to monitor changes, may be necessary.
You should NEVER sleep in your contact lenses!
When you sleep in contacts, the lenses do not move which means the cornea is deprived of oxygen and nourishment from the tear film during sleep. This can lead to blinding infections, which may not be reversible.
Lubrication when wearing contact lenses is a MUST!
Even with a properly fitting contact lens, if the cornea becomes dry, the lens can stick to the cornea, instead of resting on the tear film. When this happens, movement of the contact lens is restricted which prevents nourishment from reaching the cornea. Dryness can also lead to blinding infections. If dryness is severe enough, it can create dry spots on your cornea which can act as conduits into the eye for bacteria and fungi that can be present on your contact lenses. Therefore, all patients should use rewetting drops that are safe for contact lens wear, a minimum of 4 times daily, when wearing contact lenses. This will allow the contact lens to move on the eye, even in dry conditions, which still allows nourishment to reach the cornea. Additionally, when doing computer work, your blink rate decreases 60% which causes your eyes to get dry more quickly. This means the use of rewetting drops needs to be increased to once every ½ to 1 hour when on the computer. Click here to read more about this topic in our November 2012 blog entitled: Dr. Mandel's Reading and Computer Tips.
Listen to your body.
Although routine annual eye exams are the minimum recommendation, if you have a sudden decrease in vision, or if your eyes become red, light sensitive or irritated, these could be signs of an ocular emergency requiring immediate care.
Proper care of contact lenses is critical to safety.
Contact lenses are not sterile. They have the potential of becoming petri dishes of bacteria sitting on your corneas. Your best defense against this, and therefore against potentially blinding infections from contact lenses, is proper care. The most important component of this is proper hygiene. You should wash your hands before inserting AND removing your contact lenses. If your contact lenses are not daily disposable lenses, disinfecting lenses in a clean contact lens case is equally important. Be sure that your contact lens solution is kept clean and tightly capped to prevent dirt and bacteria from being introduced into the bottle. Lastly, the solution in your contact lens case should be changed daily and the case should be cleaned and allowed to air dry between insertion and removal, daily. Lastly, but most importantly, DO NOT clean or store your contact lenses in tap water, and DO NOT swim in your contact lenses. A particular amoeba, known as acanthamoeba, commonly found in fresh water as well as chlorinated pools and jacuzzi’s, can cause blinding infections.
Follow the recommended replacement schedule.
There are multiple types of contact lenses available, and they each have a specific, manufacturer recommended, replacement schedule which ranges from daily disposables to 1 year replacement lenses. This schedule is determined by factors such as lens material, oxygen permeability and water content. It’s important that you follow the replacement schedule closely to avoid degradation of the lens material, which could lead to corneal abrasions as well as serious, potentially blinding, infections.
Following the above recommendations can help keep your eyes healthy and in good shape for contact lens wear. Remember, you only have one pair of eyes – keep them safe!
Corneal Specialist, Eric R. Mandel, M.D., specializes in LASIK and PRK laser vision correction. Established in 1984, he also practices general ophthalmology which includes medical management of ocular disease and infection, as well as routine eye care, eyeglass prescriptions and contact lens fittings. Call us at Mandel Vision, at 888-866-3681, to schedule an appointment for ALL of your vision needs.
Click here to learn more about corneal surgeon and laser vision correction specialist, Eric R. Mandel, M.D.
Monovision Laser Vision Correction: An Alternative to Reading Glasses
One of the most common questions we hear from prospective patients over the age of 40 is: “Am I a candidate for LASIK or PRK laser vision correction if I only need reading glasses?” The answer may surprise you: It's yes! The common misconception is that laser vision correction is only for patients who are lifelong glasses or contact lens wearers. However, with the advantage of the monovision approach, patients who only wear reading glasses can also benefit from the procedure. Even better news: For those patients who truly have 20/20 distance vision in each eye without corrective lenses, the laser vision correction procedure is half the price, since only one eye is corrected.
Monovision is a tried and true approach to avoiding or minimizing the need for reading or computer glasses, and is a laser vision correction procedure in which one eye is optimized for distance vision and the other for near vision tasks. With monovision correction, although both eyes are still working together, one eye is relied upon much more for distance, while the other eye is relied upon for near, which is why it’s called monovision (from the term monocular, meaning one eye). Your brain has neuroplasticity, so you can train your brain to automatically, and seamlessly, switch between the eyes as you change your focus from near to distant objects, and vice versa. Monovision is also commonly used as a customized option in LASIK and PRK laser vision correction procedures for those patients who are either nearsighted or farsighted and over the age of 40 who have lost their ability to see clearly up close.
In order to understand monovision, you need to understand how the visual system works, as well as some key ophthalmic terms. When a patient reaches their mid 40’s and loses the ability to accommodate, (or adjust their focusing power for near vision) they need bifocals or reading glasses. This condition is called presbyopia, and the lenses used to correct this condition are plus powered lenses which enable the patient to see clearly for near vision tasks. In a normal sighted eye, light rays from distant objects are focused directly on the retina to produce a clear image without the need for corrective lenses. In a nearsighted (myopic) eye, the eye is anatomically longer than that of a normal sighted eye. Therefore, light rays from distant objects come into focus before they reach the retina. This condition results in an eye that cannot see clearly in the distance, but can see clearly up close (without the help of corrective lenses). This is the concept that is employed in monovision correction.
All patients have a dominant eye, which is the eye that is preferred for visual tasks. In the monovision approach, the non-dominant eye is purposely made slightly nearsighted to optimize reading vision. This means that vision in that eye will be clearer up close for near vision tasks, but blurry when viewing distant objects. The degree of correction chosen for reading correction will be customized for each patient’s visual needs. The factors considered in choosing the amount of correction for reading vision include the refractive error (prescription) of the eye, the patients’ age, profession and hobbies. The goal for the dominant eye is for it to see clearly in the distance. If a patient is nearsighted or farsighted, the dominant eye also requires laser vision correction treatment to correct that eye for distance vision. If a patient has a normal sighted dominant eye, that eye does not require treatment, so only the non-dominant eye is corrected for near vision.
Is it possible to train yourself to adjust to this different type of vision? YES. Monovision takes advantage of brain plasticity to help you learn to automatically see both near and far objects. How motivated you are to adapt to this customized vision and take advantage of your brains plasticity, is the best predictor of success with monovision.
Not everyone is an optimal candidate for this type of laser vision correction procedure. Therefore, a consultation, including a thorough medical eye exam, is necessary to determine whether monovision is the right choice for you. This type of correction can also be simulated with a contact lens so that patients can see what monovision is like prior to having this procedure. Monovision correction can also be achieved with contact lenses, but is usually not successful in eyeglasses.
There is a slight compromise with monovision, as two eyes working together typically give you better vision than one eye working alone. There is also a learning curve to adapt to monovision. However, after an adjustment period, the motivation to avoid bifocals or reading glasses is usually strong enough to overcome this. Depth perception can be affected slightly, but usually not enough to affect daily activities. At Mandel Vision, we do recommend driving glasses until you comfortably adapt to monovision. Once the brain adjusts to monovision, most patients are very happy with their customized procedure. Moreover, they are ecstatic that they no longer have to reach for their reading glasses every time they attempt to read a restaurant menu!
Click here to learn more about LASIK and PRK laser vision correction at Mandel Vision.
Call Mandel Vision® today, at 888-866-3681, for your free laser vision correction evaluation, with corneal surgeon, Eric R. Mandel, M.D., to see if you qualify for this exciting alternative to reading glasses.
The Customization of Laser Vision Correction
Recent WavePrint technology has afforded eye surgeons the benefit of customization in laser vision correction procedures. This is not a new concept to Eric R. Mandel, M.D., founder and medical director of Mandel Vision. Having researched refractive surgery since the mid 1980’s, he recognized very early in his surgical career the importance of getting to know his patients as individuals. The difference at Mandel Vision is that Dr. Mandel not only customizes each surgical procedure using the latest WavePrint technology, but he also calls on his years of experience to then personally customize the procedure based on the specific visual needs of each patient.
Surgical Customization
The WavePrint technology in the AMO WaveScan Wavefront System, utilized at Mandel Vision, leads the industry for outstanding wavefront acquisition and diagnostic capabilities.[i] The WavePrint Map is derived from technology that was first developed to correct distortions of light waves from space. This technology is now used as a diagnostic and therapeutic tool to enhance our abilities to measure the visual system with an accuracy that was previously unattainable.
The WaveScan™ captures the unique imperfections of each patient’s eye using all of the available Hartmann-Shack™ data points for more accurate wavefront error reconstruction.[ii] These data points then create a unique fingerprint of your cornea. This fingerprint is then programmed into the VISX Star S4Ò Laser for each eye of each patient, individually. This technology allows Dr. Mandel to correct for visual disturbances, such as spherical aberration, that cannot be corrected with glasses or contact lenses. This means it may be possible to achieve better vision following laser vision correction than was attainable with glasses or contact lenses before the procedure.
Individual Customization ~ Dr. Mandel’s Personal Touch
A researcher in refractive surgery since 1984, Dr. Mandel understands the importance of getting to know his patients, including their profession, their hobbies and their passions prior to performing laser vision correction surgery. Armed with this information, he’s able to customize their laser vision correction procedure. Although two patients may be the same age and have the same prescription for glasses, they may require different types of laser vision correction treatments. For instance, two 44-year-old patients with similar prescriptions may require completely different approaches to their surgical correction. A professional golfer, who will begin to lose focus on the logo of the ball which is used for aligning putts, will have different future visual requirements than a commercial pilot who spends the day monitoring multiple computer screens. Dr. Mandel and our vision correction team take the time to get to know each patient so that we can personalize their projected final outcome.
Here at Mandel Vision, we not only want you to be happy with your visual outcome now, we want you to be happy for life. Click here to learn more about LASIK and PRK laser vision correction at Mandel Vision.
[ii] Ibid.
Dr. Mandel’s Reading and Computer Tips
Did you know that when you are working on the computer or reading, you blink 60% less than at other times? This lack of blinking exacerbates dryness, fatigue and discomfort that are often associated with office work. Poor indoor environments, with low amounts of humidity, are another contributing factor. Think of your eyes as a car’s windshield. If you have poor windshield wipers, or no windshield wiper fluid, your windshield will be dirty and difficult to see through. Similarly, you must remember to blink frequently and lubricate your eyes with artificial tear drops, when you are working on the computer or reading, to keep your eyes moist and clear. This is especially true during the first year after laser vision correction.
Following the simple steps below will make you feel more comfortable so that you can spend more time doing close work without discomfort:
- For every half hour of reading or computer work, put a drop of artificial tears into your eyes and then close your eyes for 45 to 60 seconds. (Don’t just look away, but truly close your eyes.)
- Put a post-it note on your computer, or near your reading material, with the word "BLINK" written on it. This simple reminder to blink really works!
- Use good lighting for all near vision tasks. An incandescent light, with a rheostat to adjust illumination, is one of the best choices for comfortable reading.
- Try to get out of the habit of holding reading material too close or moving too close to your computer monitor. This can strain your eye muscles and cause fatigue.
Happy reading!
Click here to learn more about corneal specialist and laser vision correction surgeon, Eric R. Mandel, M.D.
How to Choose a LASIK Surgeon
Choosing a surgeon for any procedure can be a daunting task. This is especially true when choosing a surgeon for laser vision correction, as there are few things more precious than sight. LASIK is a surgeon dependant procedure. Akin to a master carpenter with master tools, a highly skilled surgeon and the most advanced technological equipment are required for an optimal result.
With that in mind, below are some important questions to consider when choosing your laser vision correction surgeon:
Were you told to discontinue the use of your contact lenses prior to your procedure?
Contact lenses, even the soft type, can distort the wavefront reading of your cornea for a week or two after the contact lens is removed. Because the treatment is so precise and contact lens wear can distort that reading, it’s recommended that patients discontinue their soft contact lenses for 1 to 2 weeks and toric and gas permeable contact lenses for 2 to 3 weeks prior to laser vision correction. This is to ensure that the most accurate measurements can be obtained. You want to be certain the measurements are obtained on the natural shape of your cornea and not a cornea molded to the shape of a contact lens. New wavefront analysis measurements should be taken on the day of your surgery.
Does the surgeon personally examine you during your evaluation, educate and answer your questions, and personally perform the procedure as well as your post-operative care?
LASIK should be a procedure that is customized to each patient’s individual needs. To achieve this, a surgeon needs to get to know the patient, their profession, hobbies and the specific goal they would like to accomplish with laser vision correction. Additionally, there are often adjustments that need to be made with post operative medications to achieve an optimal result, so it’s important that the surgeon follow the patient personally after laser vision correction.
Is the surgeon using the most advanced pre-screening equipment available?
Pentacam analysis is one of the most sophisticated screening technologies available. It is not necessary to perform on everyone, but a significant number of patients are turned away as less than optimal candidates because of findings that only this machine is able to uncover.
Is the surgeon using the most advanced technology to perform refractive surgery?
iLASIK is the latest technology and the only advanced all-laser procedure that NASA has approved for use on astronauts. This technology combines the VISX Wavescan mapping technology with iris registration, the all-laser method of flap creation with the IntraLase Femtosecond (FS) Laser and the CustomVue wavefront guided vision correction procedure with the VISX excimer laser.
Did you receive a thorough medical eye examination as a part of the laser vision consultation?
The evaluation process should consist of a comprehensive medical eye examination which includes an extremely precise refraction (measured both before and after dilation), a glaucoma screening, dilation, as well as extensive corneal curvature (topography) and corneal thickness (pachymetry) measurements. This exam should take a minimum of one hour to complete.
Is the surgeon a corneal specialist?
LASIK is a corneal procedure. The corneal flaps created in LASIK are thinner than a human hair. Surgeons who are cornea-fellowship trained are best equipped to perform LASIK, as they are specifically trained in microsurgical techniques of the cornea.
Is the surgeon Board Certified by the American Board of Ophthalmology (ABO)?
The ABO was the first medical specialty board founded in the U.S. and awards the only medical specialty certificate in ophthalmology recognized by both the American Board of Medical Specialties (ABMS) and the American Medical Association (AMA).[1] Board certification provides assurance to the public that a physician has successfully completed an evaluation designed to assess the knowledge, experience and skills requisite to the delivery of high standards of patient care in ophthalmology.[2]
In summary, it’s important to get to know your laser vision correction surgeon prior to undergoing this elective procedure. In the hands of a skilled corneal specialist, laser vision correction is a safe and very effective procedure.
About Dr. Mandel:
Dr. Mandel has been a true pioneer in laser vision correction research since 1984. Dr. Mandel has been board certified by the ABO, in good standing since 1988. Dr. Mandel is a Harvard trained corneal specialist and is the author of the ophthalmic textbook entitled: Atlas of Corneal Disease. Dr. Mandel has performed tens of thousands of refractive surgical procedures. At Mandel Vision, Dr. Mandel personally examines you before and after your procedure and will patiently answer all of your questions. Dr. Mandel is also the only exclusive laser vision surgeon in New York named in America’s Top Doctors by Castle Connolly, the most discriminating of the peer surveys, for twelve consecutive years.
Click here to learn more about corneal specialist and laser vision correction surgeon, Eric R. Mandel, M.D.
[1] http://abop.org/board-certification/
[2] Ibid
Flexible Spending Accounts and Laser Vision Correction
If you have a flexible spending account and are considering laser vision correction, now is the time to take advantage of it!
A flexible spending account (FSA) allows an employee to set aside pre-tax dollars to cover qualified out-of-pocket healthcare expenses. Qualified expenses include laser vision correction. These contributions are not subject to payroll taxes, which can result in substantial savings. Here’s how it works. Employees are either given an FSA debit card which they can use to pay directly for services using their FSA funds, or they pay out of pocket and then submit a receipt to their employer for reimbursement from their FSA account.
Currently, there is no legal limit to what employees can contribute to their FSA and 78% of large employers set it at $5,000 or higher.[i] Starting in 2013, when the Affordable Care Act kicks in, the maximum annual FSA contribution for each employee will be capped at $2,500.[ii] This cap goes into effect based on the calendar year of your particular plan. Here’s something else to think about: An earlier version of the Affordable Care Act plan called for eliminating FSA’s altogether, and this could come up again.[iii]
There is also a deadline for making contributions to an FSA plan. For most plans that deadline is between October and December for the following calendar year. This means you would have to contribute in 2012 in order to have access to the funds in 2013. Be sure to ask your plan’s administrator, which would typically be your human resources director, what the deadline is for your particular plan. Another important aspect of an FSA is the “use-it-or-lose-it” rule. This means unused money left in the account at the end of the calendar year for the plan is forfeited. This is especially important for those of you who are considering using flex spending dollars for laser vision correction. If you deposit money into your FSA account for LASIK or PRK, and are not a suitable candidate, you will either lose that money or be forced to find creative ways to spend it on healthcare. Therefore, it’s best to have a consultation to determine your candidacy for laser vision correction, or any elective procedure, before making a contribution to your FSA plan.
The good news is our consultations at Mandel Vision are FREE and extremely informative! So, you have nothing to lose by scheduling your laser vision correction consultation with Dr. Mandel. Better yet, you could save yourself a very costly mistake! Call our office at 212-734-0111 today to schedule your free consultation.
Click here to learn more about Mandel Vision.
Extreme LASIK: Taking the Fear Out of Laser Vision Correction
Fear is one of the most common barriers patients face when considering laser vision correction. Now, thanks to former Navy Captain and ophthalmologist, Steven Schallhorn, MD, patients can feel more secure. Dr. Schallhorn performed LASIK on military personnel from the Army, Airforce, Marine Corp., and Navy using the same advanced blade-free, Femtosecond and Wavefront guided technology used at Mandel Vision. In an effort to determine the safety and efficacy of LASIK, he then subjected these patients to some of the most extreme and harsh conditions possible including high altitude, extreme G forces, underwater pressures and blowing sand.
The results of the clinical trial were crystal clear. The visual results were excellent and the LASIK flaps were stable, even after being subjected to the most extreme environments. The LASIK flaps even proved to be stable in animal models that were exposed to forces equivalent to those produced during ejection from a plane traveling at 400 knots.[i] Another concern, particularly for Navy Seals who participate in many night maneuvers, is night vision following LASIK. Dr. Schallhorn found that night vision actually improved[ii], following LASIK with Femtosecond technology. This is critical, as many of these maneuvers put these soldiers in life and death situations. LASIK has enabled soldiers previously ineligible for special forces, due to the need for contact lenses and glasses, the opportunity to realize their full potential in the military.
Additionally, after careful review of Dr. Schallhorn’s data, NASA, which previously banned any laser corrective eye surgery, approved LASIK for its astronauts.[iii] This decision, made despite the physically demanding, extreme zero-gravity conditions that astronauts endure, was not taken lightly. Poor vision was the number one factor that previously disqualified many NASA applicants.[iv] LASIK, yet again, has opened the door to allow many more aspiring astronauts the opportunity to realize their dreams of space travel.
Patients can take comfort in the knowledge that LASIK is deemed safe in even the most extreme environments. AMO, one of the leading ophthalmic laser companies, says it best: “Consumers looking for proof that LASIK is safe, effective and advanced enough for them need look no further; LASIK has proven it has "The Right Stuff".[v]
Click on the links below to view the documentary, produced by Patient Education Concepts, entitled: LASIK on the Frontlines.
8 minute version: http://www.youtube.com/watch?v=4q-pbmLr46Q
28 minute version: http://www.youtube.com/watch?v=awBS2sxNCqU
Click here to learn more about LASIK and PRK laser vision correction with corneal specialist Eric R. Mandel, M.D.
[i] Tanzer, David J.Laser Vision Correction in the US Military. Cataract & Refractive Surgery Today. June 2008.
[ii] Ciccone, John. LASIK: On the Frontlines. ASCRS EyeWorld. February 2012.
[iii] Rundle, Rhonda L. Want to Work in Space? Squinters Can Now Apply. WSJ, Sept. 21, 2007, Vol. CCI, No. 69.
[iv]Ibid
[v] AMO, Inc., ©2007. NASA Approves Advanced LASIK for Use on Astronauts
Mandel Vision® Spring 2012 Health Tips
1. Hooray! Spring is here! Unfortunately, this means the dreaded Spring allergies are here as well.
With Spring here and all of the beautiful flowers that come with it, comes the promise of the dreaded Spring allergy season. Seasonal allergies are usually due to allergens that bind to mast cells in the eye, which then release histamine. The histamine causes most of the allergy symptoms. Allergic symptoms include itching, redness and tearing. Symptomatic relief can be obtained using antihistamine drops (Naphcon A, non steroidal anti- inflammatory drops (Acular) or steroid drops (Alrex). However, these deal solely with the symptoms, so they only offer temporary relief. To get to the root of the problem, we usually try to prescribe a mast cell stabilizer that prevents histamines from being released. Taken a week or two before the allergy season is in full swing, these drops can really make a difference between a truly annoying allergy season and one that is very tolerable. Combination drops like Patanol, Bepreve, Optivar, Elestat, Alaway or Zaditor all provide protection by acting as both an antihistamine and a mast cell stabilizer, together. Zaditor and Alaway are available over the counter, while the others require a prescription.
2. A Simple Way to Remember to Take Your Medication:
Remembering to take medication is not always easy, especially if you take more than one medication, and you take them several times a day. A patient shared something with me that can make the whole routine easier and, most importantly, can increase compliance for better results. If you have a smartphone or an iPad, you can download the App: RxMindMe.
3.Why do I need an annual eye exam?
This is a question I hear almost every day, which is typically followed by: "If I see so well, my eyes must be healthy." Even with excellent vision, you may still have undiagnosed medical issues with your eyes. Many conditions affecting your eyes are painless, and can only be found through a thorough medical eye exam. One example of a painless eye disease is glaucoma, which if untreated can be vision threatening.
Most patients who had a laser vision correction procedure were originally myopic (nearsighted). People who are myopic may have an eye that is anatomically elongated. Unrelated to your previous laser vision correction procedure, eyes that are elongated have a higher chance of retinal problems such as retinal tears, holes and detachments. If you ever experience flashes, floaters or shadows over your vision, go to your ophthalmologist immediately. Even if you do not experience any of these symptoms or they are unchanging, yearly exams may reveal a small retinal tear that could easily be treated, which could prevent the more serious complication of a retinal detachment.
A recent retrospective study confirmed that myopic or previously myopic patients have a higher incidence of open angle glaucoma. This is a painless condition that is easily treated if diagnosed early. Years may pass with undiagnosed glaucoma before a patient notices any visual symptoms. At this point, significant, irreversible damage may have already occurred.
First, don't panic! Most patients do not experience either of these conditions in their lifetimes. However, a simple, comprehensive eye exam is your best insurance against these conditions.
The eyes are really a window into your body. It is the only place where a doctor can actually visualize the tiniest blood vessels in your body, the arterioles and venules. This can reveal the first diagnosis of systemic medical conditions such as diabetes and hypertension.
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We hope you found this newsletter informative. Please contact us if you have any questions we can answer for you. You can reach us via email at: drericmandel@mandelvision.com or call us at 212-734-0111.
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