Procedures & Services
LASIK Details
LASIK stands for Laser Assisted In-situ Keratomileusis, Compared to the original
laser PRK , the surface of the cornea remains largely intact, so that LASIK
patients are more comfortable and see well more quickly.
Dr. Jacobs performs LASIK at Cincinnati Eye Institute's Eye Laser Center
at our Montgomery location, using the VISX Star Custom Vue™ excimer laser.
Please plan on being at the Center about 90 minutes total, although the actual
procedure takes about 10 minutes per eye.
Your eye will be anesthetized with eye drops. You may feel some pressure
or stretching sensation from the eyelid holder, but there should be no pain.
A sedative is offered to help you relax.
A fixation ring is applied to the eye to stabilize it and make it firm. During
this time you will feel pressure, and your vision will go dark for a few seconds.
The microkeratome then glides across the surface of the cornea to lift a flap
about 20% thickness. The flap is reflected back to expose the inner corneal
tissue.
INTRALASIK
Alternatively the corneal flap can be made with the Intralase Femtosecond Laser. This makes the Lasik completely "blade-free."
Your eye is precisely centered under the VISX laser, while you look into a blinking
laser fixation light. The laser is programmed for your correction. Repeated
pulses of the cool laser beam gently vaporize a programmed pattern of tissue
to reshape the cornea, neutralizing your refractive error. Your treatment
will consist of multiple Laser pulses over 15-60 seconds. The VISX infra-red
automatic 3-D eye tracker precisely follows your eye in three dimensions.
Minor movement of your eye is not a problem. (See Animation)
The flap is then returned to its exact original position.
It will stick in place without sutures in 2-5 minutes. The doctor will check
the flap again before you leave to confirm that the flap is exactly in place.
Eye shields are applied for protection.
Your vision will seem like you are under water for the first 12 hours or
so. You may have a mild foreign body sensation. We recommend you take Tylenol
when you arrive home and then take a nap.
Many people feel fine and see well enough to drive the next day, Older patients
with higher amounts of correction may take a little longer.
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LASEK
LASEK stands for Laser Assisted Epithelial Keratomileusis and combines features
of LASIK and PRK. The thick LASIK flap is avoided. First, the superficial
layer of epithelial cells is loosened. The epithelium is brushed back, rather
than completely removed as in PRK. After laser treatment, the epithelium is
repositioned, and a bandage contact lens is applied for a few days. LASIK
flap problems are avoided. The cornea is more stable than LASIK. Healing is
faster than PRK, though perhaps not as quick as LASIK.
Contact us today for your free consultation.
CustomVue™
Standard laser vision correction treats all corneas symmetrically, and treats
all people with the same prescription the same. This gives excellent results
for many people. However, everyone's visual system is unique with individualized
imperfections. The VISX laser system can now custom-tailor an individualized
treatment for your particular visual nuances. This is analogous to the fit
of a custom-made suit versus off-the-rack.
First the WavePrint™ takes a "fingerprint" of your visual
system, utilizing very precise wave scan technology originally developed for
space telescopes. If you are found to be a candidate for CustomVue™,
the doctor can design a customized treatment of your personal visual imperfections
and nuances. The computer then transfers this treatment plan to the laser. The Iris Registration feature rotates the treatment pattern to compensate for torsion of your eye.
While standard treatment gives excellent results for many, it may not correct
all imperfections. If you have certain types or amounts of visual abberations,
CustomVue™ may be better for you. For many people CustomVue™ gives
a better quality and crispness of vision. It can also improve night vision
and help minimize problems with glare and halos.
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NearVisionSM CK®
CK (Conductive Keratoplasty) is a low risk office procedure to improve near
vision in people over 40-45 who have good distance vision without glasses.
CK uses a radio frequency energy probe thinner than a human hair to shrink
corneal tissue and steepen the corneal curvature. No lasers or blades are
involved.
CK is done in the office using eye drop anesthesia. Under the operating
microscope a pattern of 1-3 rings of spots are marked on the cornea. The CK
probe applies energy to each spot to shrink and tighten tissue. Drops are
used for a few days afterwards.
NearVision CK is most often done in one eye (non-dominant) to achieve
"blended vision". This improves near vision without much diminution of
distance vision. As your eye ages, future treatment upgrades may be needed.
CK can turn back the clock but not stop it.
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About Intacs™
Intacs™ corneal ring segments are an option to correct mild myopia,
receiving FDA  approval in April, 1999. Intacs have the advantages of being
removable and of leaving the central visual axis of the cornea alone. They
are limited to the range of -I to -2.75 diopters with little or no astigmatism.
Intacs™ are also inserted as an outpatient procedure with anesthetic
eye drops and a mild sedative. The procedure takes about 15 minutes per eye.
First the corneal center and proper ring position are precisely
marked on the corneal surface. Corneal thickness is measured, and a micro-incision
is made in peripheral cornea. Corneal pockets are started at 2/3 of corneal
thickness. A fixation ring makes the eye firm while two circular spreaders
gently pass between the layers of corneal tissues to create pocket spaces
at the proper depth and position.
The two plastic semicircular Intacs™ rings are then
gently inserted into the pockets. This creates a microscopic bulge in the
peripheral cornea, which in turn flattens the central corneal curvature.
The thicker the rings, the more myopia is corrected.
Your vision should improve quickly. Some fluctuation in vision may last up
to a month before stabilization.
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Lens Implants
Since the mid-1970's Lens Implants have become the standard cataract correction,
restoring vision for millions of people worldwide. Now in addition to cataracts,
Lens Implants are being used for several other exciting vision correction
procedures to reduce the need for glasses and contacts. This now offers the
benefits of vision correction procedures to people who may have been told
they are poor laser vision candidates:
Cataract Replacement
As we grow older the natural clear lens of the eye becomes cloudy causing
a cataract. When the vision becomes blurry enough to interfere with daily
activities, the cataract is removed, and its focusing power is replaced with
an artificial plastic lens implant. The procedure, called phacoemulsification,
utilizes a small ultrasonic vibrating probe, which liquefies and vacuums out
the cloudy lens material. The artificial lens is then inserted into the capsule
which previously held the cataract.
Refractive Lens Exchange
Phacoemulsification and implants can also be used in the
absence of cataracts. Here the patient's clear lens is
replaced for the purpose of reducing the need for glasses
and contacts. (This does prevent future cataract formation.)
This is usually done in people with high degrees of near or
farsightedness beyond the range of Laser Vision Correction.
Standard or monofocal implants give a single focal distance,
either far or near but not both. If distance vision is perfect,
reading vision is not, and vice versa. Newer implants are available
to give a better range of vision. The CRYSTALENS® is an accommodative
implant which can give accommodation for distance, near and in between.
The lens actually moves forward inside the eye as up close focus is attempted.
The CRYSTALENS® works best for distance and intermediate (computer) vision.
The RESTOR® and ReZOOM® multi-focal implants are lenses with a pattern of rings giving simultaneous far and near images. The RESTOR® works best for distance
and close up reading vision. ReZoom® is better at intermediate vision.
VISIAN ICL™
This lens is for people who are too nearsighted or
whose cornea is too thin for Laser Vision Correction.
The VISIAN ICL TM can correct -5 to -20 diopters of
myopia. Patients are generally younger than for lens
exchange procedures, since they still have their natural
accommodation to shift from distance to near vision.
Here the lens is inserted into the eye without removing
the natural lens. This is called a "phakic" as opposed
to "aphakic" implant. The VISIAN™ lens floats above
the natural lens behind the colored iris.
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Setting
Lens implant procedures are done as an outpatient in the surgery center operating
room.
Anesthesia
In most cases topical eyedrop anesthesia is used, just as in LASIK. Mild IV
sedation is often added. There is minimal recovery time.
Incision
These procedures do require a tiny incision of one eighth of an inch. Sutures
are typically not needed. This allows rapid resumption of most reasonable
activities.
Implants
The artificial lenses are precision made of highly refined collagen-silicone
polymers or of acrylic. These materials have been used in the eye for many
years and are very well tolerated.
A complete eye exam is combined with additional implant calculation tests
to determine your candidacy for these life-enhancing procedures.
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Botox®
Since FDA approval to treat frown lines, Botox® has become a very popular
treatment to remove facial wrinkles. Both men and women are seeking the benefits
of Botox® to improve their appearance. The following are common treatment options:
- Frown Lines between the Eyebrows
- Crow's Feet at the corners of the eyes
- Forehead wrinkles
- Eyebrow Lift
- Lipstick Lines
- Corners of Mouth
- Neck
- Muscle Tension and Migrane Headaches
Removal of unwanted wrinkles gives your face a more youthful and relaxed
appearance. Removal of the frown lines between the brows can also eliminate
an unintended impression of being stern or unhappy. This can be a real benefit
for people dealing with the public. There may also be improvement in tension
and migraine headaches.
Botox® is a highly purified and diluted form of Botulinum Toxin Type
A. Although this is the toxin that causes Botulism food poisoning, the extremely
small doses used have been shown to be very safe. It works by blocking release
of acetylcholine in nerve endings, causing a very localized relaxation of
the facial muscles which cause the skin to wrinkle.
Botox® is administered in an office setting in a few minutes with a very
fine needle. There is no real pain, although some people may feel a mild stinging
for a few minutes afterward. This may be helped with ice packs. You can resume
all activities right away.
The effects of the treatment are not seen for a couple of days, with the
maximum effect coming at 7 -14 days. The effects of Botox® gradually fade,
and the treatments may need to be repeated every 4 months or so. After a year
or two the time between treatments may lengthen.
Dr. Jacobs will evaluate your candidacy for Botox®. Although most people
can be treated, it should be avoided in pregnant or nursing women, people
with neuromuscular diseases such as Myasthenia Gravis, or those taking certain
antibiotics. Side effects are minimal, although a few people may get temporary
bruising at the injection sites or drooping of the brow or eyelids.
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