McMann Eye Institute

Hawaii's Premier LASIK Surgery Practice

Filipino Chronicle – LASIK Article

LASIK eye surgery: Alternative to corrective lenses

 

 Q:  What does LASIK stand for?

A:  LASIK is the most commonly performed refractive surgery procedure.  You may hear people calling it “LASIX,” but the name is actually short for “laser-assisted in situ keratomileusis.”

Q:  What is LASIK and what does it do?

A:  LASIK can correct for nearsightedness, farsightedness and astigmatism.  LASIK vision correction is performed on the cornea which is the clear covering on the surface of your eye that overlies your pupil and colored part of the eye.  LASIK is a two step process.  First, a micro-thin flap of tissue is created on the outer layer of your cornea called a “corneal flap.”    In the second step, the cornea flap is flipped back and an excimer laser is used to reshape the cornea underneath the corneal flap.  When the cornea is reshaped in the right way, it works better to focus light into the eye, providing clearer vision than before.

Q:  How is this cornea flap created?

A:  Up until recently, the cornea flap was created using a very fancy blade mechanism called a microkeratome.  The microkeratome would affix itself to the surface of the eye by means of a suction ring and as the blade pierces the cornea to create the LASIK flap.

Fortunately, there is no longer a need for a metal blade in LASIKeye surgery.  There’s a relatively new laser called an Intralase that can very precisely create a corneal flap using laser energy instead of a metal blade.  You can have your vision corrected with two lasers instead of one.   First, the Intralase laser is used to create a precise corneal flap which is personalized just for you.   Then, this corneal flap is lifted and the excimer laser is used reshape your cornea.

In the last few years, Intralase “no-blade” LASIK has proven to be one of the safest and most effective refractive procedures available.  Complications are extremely rare.  The computer guided laser is 100% more accurate than the metal blade and is currently the best possible way to create the corneal flap.  The many advantages of Intralase include improved safety, better vision, reduced dry eye symptoms, higher predictability and precision, personalized flap, reduced night glare and halos, and allowing more patients to qualify for LASIK.  In fact, NASA added further confirmation to the superior safety and quality of vision using the Intralase laser by approving only “no-blade” LASIK for U.S. astronauts.

Q:  How long does the surgery take and how much time off work is necessary?

A:  LASIK takes about 20 minutes for both eyes and most people are in the laser center for 1-2 hours.  Immediately after the surgery, most people’s vision is like looking through frosted glass.  However, this foggy vision goes away after a good 6-8 hours of sleep.  Most people are able to work the very next day in a limited capacity and can be completely back to work just 2 days after their surgery.

Q:  Can I throw away my glasses after LASIK?

A:  The majority of people under the age of 40 who have LASIK done are indeed able to throw away their glasses or contact lenses.  However, for those people over the age of 40, they will very likely need reading glasses in order to see up close.  This is due to the natural aging process of the lens inside the eye which leads to the loss of focusing ability of our eye when we reach our 40’s.  This condition is called presbyopia.  LASIK is only done on the cornea of the eye and has no effect on this natural aging process of the lens.  There are some options if you’re in this age range and absolutely do not want to wear reading glasses.  One of these options is monovision LASIK where one eye is corrected for distance vision and the other eye is corrected for near vision.  Monovision is not for everybody as it does require some visual compromises, but there are a lot of people who absolutely love monovision and the freedom from glasses it provides.

Q:  Why is it so popular?

A:  LASIK has advantages over other procedures, including a relative lack of pain afterward and the fact that good vision is usually achieved by the very next day.

Q:  What are some potential complications?

A:  LASIK has over a 99% success rate.  However, it is a surgery and thus is not 100% guaranteed.  One potential complication is an infection.  In order to avoid this, good hygiene is strongly recommended and you’re put on antibiotic eye drops both before and after the surgery.  In the first weeks to several months after the surgery, the “corneal flap” is susceptible to trauma and possible rotation.  As such, eye protection is strongly recommended and it’s important not to rub your eyes.  However, if the flap does rotate, it’s usually easily treated by repositioning the flap as long as it’s addressed by your doctor in a timely manner.

Q:  Is LASIK covered by insurance?

A:  No.  It’s considered a cosmetic procedure since you can see perfectly fine with glasses or contact lenses and LASIK does not address decreased vision from other causes of decreased vision besides your refractive error.  There are some LASIK surgeons who are affiliated with some medical insurance plans who offer “discounts” to members of those insurance plans.  However, this is usually just a marketing ploy as the price that gets “discounted” is usually higher than average which brings the final cost of the surgery after the “discount” back down to the community average.

Q:  How much does LASIK cost?

A:  This ultimately depends on the type of LASIK you choose, but the average cost is usually just slightly above $2,000.00 per eye.  This is a lot of money, but the cost to perform the surgery for the surgeon is also quite high due to the very advanced and expensive technology necessary to perform the surgery.  Fortunately, there are many good financing options available.  With financing, you can reduce the total cost of the surgery to about $89 per month which if you think about it is less than the average cable or cell phone bill.

Q:  How do I know if I am a good candidate for LASIK?

A:  In order to decide whether you’re a good candidate for LASIK, the surgeon will examine your eyes to determine their health, what kind of vision correction you need, and how much laser ablation is required.

Q:  What’s important to look for in a LASIK surgeon?

A:  This is an important question because while many Ophthalmologists offer LASIK, very few have much experience with the surgery.  I have over 8 years of experience doing the surgery and have done well over 2000 eyes.  Even fewer LASIK refractive surgeons are cornea fellowship trained.  A cornea fellowship is extra specialized training a surgeon does after they’ve already completed their Ophthalmology training and are already full-fledged General Ophthalmologists.  There are only a few Ophthalmologists in the state that have completed this specialized Cornea Fellowship training.  In addition, I’m one of only 2 surgeons in the state of Hawai’i who is Fellowship Trained specifically in Refractive Surgery.

For more information on LASIK, please visit my website at  www.oahulasik.com  or better yet, come see me personally for a Free No Obligation LASIK Consultation.

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Dr. Michael A. McMann is a Board Certified Ophthalmologist and a Fellowship Trained Surgeon in Cornea, External Disease & Refractive Surgery.  His office is located in the Hawai’i Medical Center West – St Francis Medical Office Plaza in Ewa Beach.  He can be reached at 677-2733.

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DSEK Press Release

Leeward O’ahu Eye Surgeon Performs Breakthrough Corneal Transplant Procedure 
1/18/2008
Surgery Offers Less Risk, Rapid Vision Recovery

A large percentage of corneal transplant patients may face fewer risks and have their vision restored more quickly, thanks to a new less invasive procedure being performed at Hawaii Medical Center West (Formerly St. Francis West) by Michael A. McMann, M.D., the Medical Director of the McMann Eye Institute in leeward O’ahu.

Dr. Michael A. McMann

The procedure, known as DSEK, stands for Descemet’s Stripping Endothelial Keraplasty. The delicate surgery allows the abnormal back layer of the cornea, Descemet’s membrane, to be stripped away. Using highly specialized instrumentation, the back surface of a corneal transplant donor is prepared and through a small incision is placed into the front of the eye. It is secured with a large air bubble to properly position and maintains the delicate transplanted tissue. Within minutes of transplantation, the endothelium, or back surface cells which pump fluid from the cornea, start to function in the new host environment.

The incision is closed with three small sutures, leaving the surface of the cornea free of sutures. Most patients often experience visual improvement within days or weeks after the procedure. With a conventional corneal transplant, the full thickness of the patient’s cornea is completely removed, and a full thickness new donor cornea is sutured around the circumference of the cornea. These sutures can remain in the eye for more than a year and often cause the cornea to take on an irregular shape during the healing process that is difficult to correct with eyeglasses. While the success rate of corneal transplants for swollen corneas is in the range of 90 percent, according to Dr. McMann, the post-operative results are difficult to predict. “It may take up to one year or more for a patient to achieve full potential of vision after surgery,” he said.

“This surgical technique is one of the most important breakthroughs in modern corneal transplantation in 60 years,” said Dr. McMann, who is a former Army surgeon and who performed the first DSEK procedure at Tripler Army Medical Center in March 2008 as well as the first DSEK procedure at Hawaii Medical Center West on May 1st, 2009.  “The new approach requires minimal suturing and provides patients with less discomfort, more rapid visual restoration and a reduced risk of sight-threatening complications.”

The cornea is the clear window at the front of the eye that bends and helps focus light onto the back of the eye or retina. In order for vision to be clear, the cornea must be clear. There are multiple causes that can lead the cornea to become opaque or cloudy, preventing light from passing through it clearly. While corneal disease can occur anywhere on the cornea, the DSEK procedure only treats conditions that occur on the back of the cornea.  Each year, 30,000 corneal transplants are performed in the United States. As the DSEK technique evolves, patients who are carefully selected and meet the criteria for the procedure may have better outcomes than the conventional surgical approach.

Diabetes Information

Ophthalmology Corner

Diabetic Eye Care – Diseases of the Eye

Q&A with Michael A. McMann, MD.

Board Certified Ophthalmologist – Fellowship Trained Eye Surgeon

Q: What is Diabetic Retinopathy?

A: Diabetes is a very common disease here inHawai’i.  Diabetes is caused by high levels of sugar in the blood.  Diabetes affects blood vessels throughout the body, particularly vessels in the kidneys and eyes.  When the blood vessels in the eyes are affected, this is called diabetic retinopathy.

Q: What affect can it have on my eyesight?

A: The retina is a thin layer of cells that lines the back of the eye.  It acts much like film in a camera.  Blood vessels lie on the front portion of the retina.  When these blood vessels are damaged due to diabetes, they may leak fluid or blood and grow scar tissue.  This leads to retinal damage which may be permanent and just like bad camera film can ruin a picture, a damaged retina can lead to severe vision loss and blindness.

When diabetic retinopathy becomes advanced, new blood vessels grow in the retina.  These new blood vessels are the body’s attempt to overcome and replace the blood vessels that have been damaged by diabetes.  However, these new blood vessels are not normal.  They may bleed and cause the vision to become hazy, occasionally resulting in a complete loss of vision.

Q: What are the symptoms that I should be aware of?

A: There are usually no symptoms in the early stages of diabetic retinopathy.  Vision may not change until the disease becomes severe.  An eye exam by an Ophthalmologist is often the only way to diagnose changes in the vessels of your eyes.  An Ophthalmologist, unlike an Optometrist, is a Medical Doctor and Surgeon who receives advanced surgical and medical training in diseases of the eye such as diabetes.  Regular annual eye examinations for people with diabetes are extremely important.  People with diabetes should have an eye exam at least once a year and even more often as indicated by your Ophthalmologist.

 

 

Q: What other eye diseases should someone with diabetes be aware of?

A: The growth of abnormal blood vessels inside the eye can also lead to glaucoma.  Glaucoma results from high pressure in the eye which can cause damage to the optic nerve.  The optic nerve is like the cable connection from the eye to the brain.  Diabetes can also lead to the early development of cataracts.  Cataracts are a clouding of the natural lens inside the eye which leads to a decrease in vision.  Fortunately, cataracts are now easily treated with routine cataract surgery.

Q: How can I reduce the risk of diabetic eye disease?

A: Everyone who has diabetes is at risk for developing diabetic eye disease, but not everyone develops it.  Having poorly controlled blood sugar levels increases the risk.  Diabetic eye disease does not usually impair sight until the development of the abnormal new blood vessels that may bleed into the eye.

Q: How can diabetic eye disease be prevented?

A: You can reduce your chances of developing diabetic eye disease by keeping your blood sugar under control, monitoring your blood pressure, maintaining a healthy diet, exercising regularly, and getting an eye exam at least once a year.

If you have diabetes, it’s critical that you see your primary care physician regularly to help you manage this potentially very disabling and blinding disease.  It’s also critical that you get an eye exam at least once a year by an Ophthalmologist.