Customized Wavefront PRK (or “flapless LASIK”) has already established itself as a superb techology and has been used by both the US Air Force and the US Navy for their most elite fighter pilots. A next generation wavefront technology was recently introduced and the FDA data show amazing results. This new, groundbreaking technology is the technology we now use at the Shapiro Laser Eye Center for customized wavefront PRK and customized wavefront LASIK.

What is PRK?

PRK, or photorefractive keratecomy, is LASIK without a flap. Instead of creating a flap and applying the laser beam to the interior of the cornea and replacing the flap, the same laser is simply applied to the surface of the cornea without a flap. Recovery times are longer for PRK than for LASIK but PRK has advantages over LASIK in other ways.

What is Customized Wavefront Technology?

Customized wavefront laser technology is different from convenetional laser technology in that the optics of the eye are measured differently so there is different information used to program the laser treating the eye for PRK or LASIK. With conventional laser technology, the surgery is simply based on the “which is better, one or two” test that is used to make glasses or contact lenses. Whatever answer the patient gives to the doctor goes into the laser and then onto the eye. With customized wavefront technology, instead of using the “which is better, one or two” test to measure the eye, an invisible infra-red laser beam is shined into the eye to measure the optics of the eye by seeing how the eye affects the optical pathway of the laser as it bounces off the back of the eye and returns to exit the eye. A map is made of how the wavefront of returning light has been distorted by the eye. This map is unique to each eye and is called the “optical fingerprint” of the eye. This is far more accurate than using conventional measurements and also is not based on the patient’s opinion — it is an objective measurement taken with lasers. In this way, each treatment is customized to the unique optical properties, or optical fingerprint, of each patient’s eye.

How is the Next Generation Customized Wavefront Technology Different?

Customized wavefront technology was invented by NASA for use in astrophysics. The original customized wavefront measurement devices used for LASIK incorporated NASA’s methods of analyzing the optical measurements. This original wavefront technology is still in use in many places in the United States today and produces excellent results. The next generation customized wavefront technology that we are now using at the Shapiro Laser Eye Center has 50 times the resolution of these systems originally introduced by NASA. This introduces a new era of “ultra high resolultion” customized wavefront technology. In addition to the extremely high resolution meaurements, the next generation wavefront measurements also incorporate a topographical map of the surface of the cornea and integrates that data into the customized wavefront data, something no previous customized wavefront treatments did.

What Does the FDA Data Show?

The FDA data for using this next generation wavefront technology in the format of PRK is the best data I have seen for any laser platform and technique. In the FDA clinical trials (PMA data) for nearsighhtedness with or without astigmatism for adults 18 years or older, 322 cases were studied. 100% of cases could pass a driver’s test (20/40 or better vision), 99% of cases achieved 20/20 vision, and 92% of cases had better than 20/20 vision (20/16 or better vision).  In terms of night vision, there was a 64% increase in patients who said they could drive at night with no difficulty when compared to using their glasses or contacts for driving at night before surgery. This data is consistent with the results we are seeing at the Shapiro Laser Eye Center with this technology and similar to the results of a groundbreaking joing US Air Force, US Navy, US Army study of this advanced technology. (PMA P930016/S057 Summary of Safety and Effectiveness Data)

How Does this FDA Data Compare to Other Modern Laser Platforms?

This FDA data for next generation ultra-high resolution customized wavefront PRK is the best FDA data I have seen to date for laser vision correction and this is the technolgoy I prefer. For comparison, the FDA data for the Alcon Allegretto (lower resolution) Wavefront Guided LASIK showed 93% of patients achieving 20/20 vision, while Alcon Allegretto Contura (topographically guided) and Alcon Allegretto Wavefront Optimized (a version of conventional surgery) also each showed 93% of patients achieving 20/20 vision. SMILE (small incision lenticular extraction — a different laser techniqe than either LASIK or PRK) showed 84% of patients achieving 20/20 vision. Alcon Allegretto Contura topographically guided LASIK shows improved results if an additional software called Phorcides is incorporated. (Lobanoff M, Understanding the Eye’s “Fingerprint”, Ophthalmology Management, June 2021, p. 22).

The answer is: yes! LASIK and PRK (“flapless LASIK”) are laser vision correction eye surgeries which can correct astigmatism with extremely high accuracy and precision. Even high degrees of astigmatism can be corrected with superb results.

What Is Astigmatism?

Astigmatism is an out of roundess of the cornea. The cornea focuses light because it is curved. If the optics of the cornea are very good, all the light rays that pass through the cornea will be focused to the same point. Think of holding a magnifying glass over a sidewalk to focus the sun’s light to a single pinpoint on the concrete. Since curvature causes focus, the best optics are when the curvature is the same throuhouot the cornea so all the light rays are focused with the same power and to the same point. With astigmatims, the cornea has different curvatures in different places. The best way to visualize astigmatism is to think of a football. If you hold a football tip to tip, the horizontal curvature is more gentle and the vertical curvature is steeper. Because these are different curvatures from each other, the football has astigmatism. With a basketball, by contrast, the curvature is the same no matter where you run your hand. So, while the football has astigmatism, the basketball does not have astigmatism.

How Does LASIK Correct Astigmatism/

LASIK uses a laser beam to very precisely reshape the cornea. In correcting astigmatism, the laser essentially rounds the football into a basketball. Once the cornea shape has been perfected, the astigmatism is gone. Its completely about shape.

Has LASIK Always Been Able to Correct Astigmatism?

No. LASIK originally could not correct astigmatism, but this was a very long time ago. LASIK has been able to effectively correct astigmatism for approximately 20 years, but somehow the myth that LASIK cannot correct astigmatism still lingers.

What Advances Have Occurred in Astigmatism Correction With LASIK?

The biggest breakthrough in astigmatism correction has been the introduction of customized wavefront LASIK technology. With this NASA-derived technology, the entire optics of the eye — including all the eye’s astigmatism — is measure by infrared lasers and a customized analysis of each person’s optical system is created called the “optical fingerprint”.  The optical fingerprint is uploaded into the laser to give a customized treatment which correccts the entirity of the patient’s optical errors, including all of the patient’s astigmatism.

In an effort to curb the spread of the SARS-CoV-2 virus, governments around the world have instigated lockdown measures, including school closures for children with remote learning. There has been much discussion of the difficulty this has brought on families and on school children themselves, but now researchers find there may be one more thing to worry about for children forced to stay at home to learn: increasing rates of myopia (nearsightedness).

SCHOOL CLOSURES AND AT-HOME LEARNING

Researchers have worried that at-home learning has forced children to spend even more time on digital devices, compounding an already existing problem of too much screen time for kids. Pediatric ophthalmologist Jordana M. Smith, MD notes that many schools were doing hour and a half long courses all day long with only a 5 minute break between courses. She said other schools had less direct screen time, combining screen lectures with at home work sheets. She said none of the at-home school programs she was aware of had scheduled outdoor time or physical activity time. A Canadian study showed that only 4.8% of children 5 – 11 years of age and only 0.6% of children age 12 – 17 had sufficient physical activity during COVID lockdown in Canada while 8 year olds in the study spent an average of 5.14 hours per day of screen time on digital devices during lockdown.

STUDY SHOWS MOST SIGNIFICANT EFFECT ON SIX TO EIGHT YEAR OLDS

A massive study by Wang et al of 123,535 children in China age 6 – 13 years old showed an increase in myopia during home confinement for COVID in 6 – 8 year olds, but not in children in the study. The authors of the study hypothesize that younger children are more susceptible to environmental factors than the older children in the group.

WHAT CAN BE DONE TO HELP?

Part of the problem is that children already spent too much time on digital devices even before COVID. A Common Sense Media report from October of 2019 showed that even before COVID, 8-12 year olds in the United States spent an average of five hours a day of screen time! Already screen time has been linked to an increased risk for developing or increasing nearsightedness in children. The addition burden of COVID lockdown at-home learning only massively compounds the problem. Parents should make efforts to minimize unnecessary screen time outside of required school screen time if possible. Other studies have shown that outdoor time can help prevent the development of myopia, so parents should make efforts to let their children outdoors during at-home learning as much as possible. The good news, of course, is that once children grow up, we have outstanding solutions for correcting their nearsightedness with LASIK or PRK laser eye surgery!

This time of year we receive many inquiries about patients using their FSA (Flexible Spending Account) to help pay for their LASIK or PRK laser eye surgery.

FSA Allows You to Use Pre-Tax Dollars to Pay for LASIK or PRK Laser Vision Correction!

A Flexible Spending Account, or FSA, allows you to use pre-tax dollars to pay for your laser vision correction surgery, including both LASIK and PRK. An FSA is also sometimes referred to as a Flex Plan, a Reimbursement Account, Flex 125 Plan, Tax Saving Plan, Medical Spending Account, or a Section 125 account. It is a type of “Cafeteria Plan” that is set up with your employer and conforms to Section 125 of the Internal Revenue Code, hence the name “Flex 125 Plan”.

An FSA account is different from an HSA, or Health Savings, Account, which also can be used for helping to pay for laser vision correction.

Why Patients Think About Their FSA So Much This Time of Year

The FSA account is set up by your employer. Money put in an FSA can be used only for “qualified expenses,” which include LASIK and PRK laser eye surgery. Funds put into an FSA account need to be used by the end of the year they are set aside (the “use it or lose it” rule), although some employers add language to add flexibility to this deadline. This time of year, we see many patients who want to schedule their LASIK or PRK laser eye surgery before the end of the year so they don’t lose the money they previously set aside in their 2020 FSA accounts. Other patients contact us this time of year to see if they are candidates for laser eye surgery before deciding to commit to put funds in for fiscal year 2021 with the idea of having surgery next year using pre-tax dollars. At the Shapiro Laser Eye Center, we have extensive experience helping patients use their FSA accounts to help pay for their LASIK or PRK laser eye surgery using pre-tax dollars. If you have any questions at all regarding using FSA accounts, please do not hesitate to contact our office, either by using the “contact us” form on this website or calling us at 805-339-0566!

Mask use fogging up glasses has been challenge for many people during the COVID-19 pandemic.

TWO TOP MASK PICKS TO HELP WITH GLASSES FOGGING

Consumer Lab recently picked two masks as their “top choices” for helping with glasses fogging.

The Gifington mask was given high marks for minimizing glasses fogging because the bridge of the mask rides high up on the nose, allowing glasses to sit below the rim of the mask. The Gifington mask was also noted to have a very moldable nose wire that allowed a a good seal as it contoured to the nose and cheeks. Finally, the ear loops were considered to offer excellent adjustability to optimize mask fit on the face to reduce glasses fogging. Consumer Lab noted that even with the Gifington mask, fogging could still occur of course.

The other mask that Consumber Lab gave top marks to for helping with glasses fogging was the Atelier mask. Consumer Lab praised the nose wire on this mask for its excellent fit but felt that the ear loop design would be difficult for anyone with a hearing aid to wear.

GO AHEAD — FINALLY HAVE LASIK INSTEAD!

We have seen a significant increase in the numbers of people seeking laser vision (LASIK and PRK) correction since COVID began. Frustratoin with glasses fogging up from masks is one of the main reasons patients mention as finally spurring them to have laser eye surgery. Others say they don’t like the idea of putting contact lenses in their eyes and risking contracting COVID. Perhaps for many people these are just excuses to push themselves over the line to finally have their poor vision fixed — something they’ve always wanted to do anyway but had just put off.  After LASIK or PRK, patients so many patients say, “Why didn’t I do this sooner!!”. Masks don’t fog your vision after laser eye surgery!

SMILE (small incision lenticular extraction) is a relatively new laser vision correction procedure that is an alternative to LASIK and PRK. SMILE involves two steps: 1) a small incision is created with the laser at a similar diamter to where a LASIK flap edge would be and then 2) the laser is then focused within the cornea to sculpt out a disc shaped segment of tissue called the lenticle. The lentical is then removed through the small incision creating a cavity in the cornea. The top of the cornea then sinks down to fill in that cavity, changing the shape of the cornea and correcting nearsightedness and astigmatism.

NEW STUDY ON SMILE LASER EYE SURGERY

A study published this month in the British Journal of Ophthalmology compared the safety and efficacy of SMILE in patients under age 35 versus those over age 40. 102 eyes of 53 patients were included in the study. Results were recorded at six months after surgery. In the words of the authors, “Post-SMILE refractive outcomes in those patients over 40 years of age, although acceptable, are not as good as those obtained in younger patients, showing a significantly lower efficacy and safety indexes, and poorer astigmatic outcomes, with a tendency towards undercorrection.” There is a theory that the human cornea becomes stiffer and biomechanically stronger with age. The authors felt that this increase in stiffness might be causing the lower safety and efficacy found in the older patient group. Ironically, this increase in corneal strength would in theory only help the results of LASIK or PRK, certainly not hinder them.

Kansas City Chief’s Cornerback Charvarious Ward had terrible eyesight his entire life and now he’s 20/20 thanks to having LASIK laser eye surgery. Ward thinks his new eyesight will help him become “one of the best corners in teh game.”

A LIFETIME OF POOR VISION

Ward suffered from terrible eysight since kindergarten. In fact, he had to repeat kindergarten as his school thought he had a learning disability. In fact, he did not have any learning disabilities at all, he simply needed a pair of glasses and was fine in school after that. Ward even says of his life before LASIK, ““I couldn’t see a thing, man. I couldn’t see nothing.”

NFL STAR EVEN WHILE UNABLE TO SEE

After high school, Ward joined the Kansas City Chiefs. As a testament to his raw talent, Ward  eventually worked his way onto the starting roster even though he could not see the football once it was in the air. As Ward said, “I could see a human body that’s right in front of me, but once that ball is in the air, who knows what’s going to happen? I could see it when it first got in the air, but once it starts traveling, I just lose track of it and have to pray I put my hands in the right spot. I just have to pray the ball comes back in my line of sight.” Despite his poor vision, Ward posted impressive statistics, ranking first in passer rating and reception percentage allowed, but — probably due to his poor eyesight — only managed two interceptions.

HAVING LASIK TO BECOME AN EVEN BETTER PLAYER

Last season, Ward talked about wanting to take his game to the next level and he knew that would mean having better eyesight to get more interceptions. This past March, just before COVID-19 temporarily shut down elective surgery, Ward underwent LASIK surgery in both eyes. He now has perfect 20/20 vision. Ward now says, “This year I’m trying to intercept everything. I’m not going to be scared to turn my head around. Because I know now I can see the ball and stay in contact with the receiver at the same time. So I feel like it’s going to make me a way better playmaker, which is what we need in the secondary: turnovers. I just want to take the next evolution in my game and become one of the top corners in the game.”

MANY PROFESSIONAL ATHLETES HAVE HAD LASIK TO IMPROVE THEIR GAME

Many professional athletes, including many I have had the pleasure to help undergo LASIK and get to know, have found LASIK to be the magic ingredient that helps them take their game to the next level. LASIK can be lifechanging for most anyone wearing glasses or contacts, but athletes have a particular benefit in gaining that extra edge in their performance.

Many people who have not had LASIK are finding another inconvenience with using glasses: their face mask for the coronavirus keeps causing their glasses to fog up. This can make for dangerous vision impairment. Removing the glasses repeatedly to clean them can involve touching the face, which increases exposure risk for COVID-19.

WHY WEAR FACE MASKS FOR COVID-19?

The CDC has recommended that people wear cloth face masks to reduce the transmission of SARS CoV2 virus that causes COVID-19. A study in the news today about the German town of Jena, the first German city to make wearing face masks in public mandatory, showed a 23% drop in the rate of COVID-19 infections over the next 20 days after the mandate went into effect. Face masks protect others if you are sick, even if you are asymptomatic. Face masks also protect you as well, although their main benefit seems to be to help prevent sick or asymptomatic people from spreading the virus through coughing or even just talking. Likely we will all be advised to wear face masks in public for a long time.

WHY DO GLASSES FOG UP WHILE I’M WEARING A  MASK?

Glasses fog up when warm, moist breath escapes upward from the face mask and touches the cool surface of your glasses lenses, causing condensation. When prescription glasses fog up, you can’t see, forcing you to quickly take off your glasses and clean them, which can involve touching your face, potentially exposing you to the coronavirus. Fogging affects not only prescription glasses, but also can be a problem for sunglasses and safety glasses as well. In fact the American Academy of Ophthalmology is seeing an increase in eye injuries from construction workers and even people doing work around the house who are not using their safety glasses simply because they are fogging up too much.

TIPS FOR REDUCING FOGGING OF YOUR GLASSES FROM WEARING CORONAVIRUS MASKS

Here are some tips for minimizing the fogging that masks cause for glasses wearers:

1. Make sure the mask is fit properly. Many masks have a flexible nose bridge that can be pushed down to seal the top of the mask against your nose to block the warm breath from going upwards to the glasses. If you are making your own mask at home, you can try sewing in a pipe cleaner or twist tie into the bride to provide this function. The American Academy of Ophthalmology has created a short video to show you how to properly wear a mask.
2. If you do not have a flexible nose bride, you can either let your glasses ride over the top of your mask to push it down or you could put tape over the top of the mask to prevent upward movement of your breath.
3. Adding soapy water to your glasses can act as a quick and inexpensive anti-fog treatment. Simply wash your glasses in soapy water, shake the excess off, and allow them to dry. If you have special coatings on your glasses, be sure to call your eye glass provider or optometrist to make sure this will not harm your lens coatings. The soap residue acts as an anti-fog layer.
4. Other anti-fog options for coating your glasses lenses include toothpaste, shaving cream, and baby shampoo. Again, if you have special coatings on your glasses, check with your glasses provider before applying these.
5. Consider solving the problem by finally having LASIK!

Winston Has LASIK To Correct His Nearsightedness After Throwing League High 30 Interceptions

Tampa Bay Bucccaneers quarterback Jameis Winston underwent LASIK ahead of his free agency in 2020. Winston had been struggling with his nearsightedness (myopia)  while playing as an elite quarterback since his college days. Last season, before having LASIK, Winston threw a league high 30 interceptions despite also throwing for a league-leading 5,109 yards. At the end of the season, Tampa Bay Buccaneers head coach Bruce Evens commented about Winston, “he can’t read the scoreboard but he can see the guys in front of him.” Obviously very talented, Winston decided to have LASIK to improve his eyesight to improve his game. Winston’s spokesperson said of his decision to have LASIK:  “Jameis did not want to count out any options that he had that could possibly help him with the game he loves so much. He doesn’t want to miss out on any opportunity that presents itself. This is the game he loves and he wants to be the best at it and if there are any options that can improve his game he is willing to do it.”  Before announcing his decision publically, Winston gave a big hint to his fans by posting a picture of himself on Instagram in post-operative dark glasses. At the bottome of the picture he wrote: “They Know!!!!”.

Many professional athletes from NFL to NBA to MLB players to race car drivers, including many I have performed laser eye surgery on, have chosen to have LASIK or PRK to be able to make their vision the very best possible and not have to rely on glasses or contact lenses during the demanding challenges of professional sports. I fully expect Winston to be an even more formidable and effective quarterback next season with his new and improved eyesight!