“In my Manhattan office where I have one LADARVision system, I can perform 15 bilateral procedures in 8 hours, interspersed with consultations.”
Improving Night Vision
“I reported on the first 394 photorefractive keratectomy (PRK) patients that I treated for the VISX FDA trials, with ablation zone size ranging from 5 mm to 6 mm. Glare decreased as the zone size increased.
“Having performed more than 15,000 broad-beam laser surgery procedures, I am familiar with the unpredictability of relating pupil size to ablation zone. Many patients with large pupils did not complain of glare and there were some patients with small pupils who did complain of glare. There is more to awareness than just pupil size versus zone size.
“However, today the public is more aware of the potential glare associated with LASIK, so surgeons must be sure the ablation zone will be larger than the pupil. The variable zone size of the LADARVision laser system helps us safely treat the effective optical zone. The scotopic pupil must be accurately measured by a reliable pupillometer. All pupilometers are not equal and practitioners who are still measuring with cards are only fooling themselves. In the 5,000 LADARVision surgical procedures I have performed, I have not had one patient complain about glare. Another reason for a larger ablation zone is that it helps reduce the aberration, which worsens with scotopic pupil.”
“I have performed 1,000 PRK procedures during and after the clinical trials of the broad-beam laser. Hazing, scarring, and regression occurred too frequently. When I accepted LASIK, I stopped performing PRK.”
“I treat up to 10 D of myopia, 6 D of hyperopia, and 6 D of astigmatism.”
“I had a patient who had mixed astigmatism and a significant refractive error and I achieved an excellent visual outcome.”
“The results are good, far better than what I was achieving with the VISX laser. But we have to wait and see results after four to six months.”
“The hinge protector is an internal blocking system of the laser that can be adjusted to different sizes and shapes. Whether a nasal or superior hinge flap is created, the hinge protector can be moved to any position about the cornea. The hinge protector is more effective than a cellulose sponge or metal instrument. The hinge protector is an important feature because a surgeon’s flaps will not always be perfect.
“The horizontal reference line is another advantage of the LADARVision system because it prevents the degradation of the astigmatic treatment caused by cyclotorsion or poor head position under the laser. The 3 o’clock and 9 o’clock positions are marked at the slit lamp. The horizontal reference line is not only useful today but will also play an important part in treating higher order aberrations and in helping to stabilize and fixate the customizing treatment.”
“After a day of surgery, the post was no longer an issue for me. The LADARVision 4000 upgrade is superior to any other laser with which I am familiar.
“The time required to take pictures and properly dilate patients is balanced by the visual outcomes, which are superior to those achieved with broad-beam lasers. With a good staff, efficient flow can be achieved. For example, on a busy day I can perform 30 bilateral procedures, mixed with 25 consultations over a 10-hour period in my primary office where I have two LADARVision laser systems. In my Manhattan office, where I have one LADARVision system, I can perform 15 bilateral procedures in eight hours, interspersed with consultations.
“Organizing an efficient flow with my staff has been instrumental. The undilated pupil is captured when the patient screened using other tests, such as tonometry, autorefraction, and corneal maps.
“Dilation occurs after I examine and counsel the patient and he or she agrees to surgery.”
Customized Ablation and Wavefront Technology
“I believe that the large ablation zones are preferable because I imagine the larger zone will lead to better quality of vision by reducing the aberrations that we induce, more prolate than oblate. However, more research is needed to confirm this effect.”
“As more companies develop their own forms of customized corneal ablation, I believe a universally accepted term and definition of the technology will result. For example, if a patient knows that they have the option of a laser procedure with a flying-spot laser or a scanning laser, they will be able to distinguish which laser tracks the eye, and which does not.”