LASIK Surgery Las Vegas | Laser Vision Correction Nevada | Dr. Swanic

LASIK

LASIK Surgery in Las Vegas

What is LASIK?

Zeiss Visumax MachineLASIK is a form of corneal surgery that uses an excimer laser to ablate corneal tissue in a fashion that can correct nearsightedness, farsightedness, and astigmatism. LASIK specifically involves the making of a flap on the surface of the cornea that can be lifted prior to the laser ablation. This flap can be made with a blade or with a femtosecond laser. Dr. Swanic has experience with both modalities but at this time exclusively uses all laser LASIK as he feels it provides a higher level of safety compared to blade based devices. At Las Vegas Eye Institute we are proud to be the only practice in Las Vegas that utilizes the Zeiss Visumax platform to create our LASIK flaps. The Zeiss Visumax utilizes a laser that fires 500,000 very low energy pulses per second to safely create a precise flap with an incredibly smooth bed on which to begin your customized excimer laser ablation. The main advantage that patients love about the Visumax laser compared to its competitors is that the vision does not black out during flap creation. Patients simply look at a green flashing dot while the laser works its magic. In under 20 seconds, the flap creation procedure is complete. An added benefit of the Vizumax is the low suction it utilizes which allows most patients to avoid getting hemorrhages to the whites of the eyes that are commonly seen using other platforms.

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Once Dr. Swanic has created the flap you will be transferred to the excimer laser to begin your custom corneal treatment. Dr. Swanic is certified on the Alcon Wavelight and the J&J Visx platform for excimer photoablation. He loves both technologies but chose to go with the Visx Platform when he established the Las Vegas Eye Institute LASIK suite in 2019. We utilize the iDesign platform which is an advanced wavefront capture device that also captures corneal topography and pupil data to create an ablation profile that is unique to your eye. The iDesign is the successor to Visx’s prior product called Customvue. The older Customvue platform is actually the platform that Dr. Swanic had performed on his own eyes in 2010 and still affords him with excellent 20/20 vision. iDesign obtained FDA approval in 2015 and brought with it 5 times the data points for its wavefront capture compared to Customvue. The iDesign also expanded wavefront-guided astigmatism correction from 3 diopters up to 5 diopters which essentially covers all appropriate LASIK candidates. This iDesign capture device is housed in our clinic where it captures an image of your iris – this image is then transferred to our excimer laser where your iris image is captured again and the previously planned ablation is overlaid exactly where it should be. This is truly remarkable technology which became even more advanced in 2018 when the FDA approved it to utilize your corneal topography to further enhance the quality of ablation. We are excited to be one of only a few practices in Las Vegas to offer this advanced technology.

Chart Showing the Steps of LASIK

Some patients are not great candidates for LASIK due to a complex variety of reasons. You will find during your laser vision evaluation at Las Vegas Eye Institute that it seems as though your eyes are undergoing countless tests collecting thousands of data points (hint: because they are). This testing is being performed not only to get you the best possible results but also to ensure that laser vision correction is right for you. If abnormalities are uncovered that make you not the “ideal” LASIK candidate then Dr. Swanic will discuss your alternatives. Many patients will prove to be excellent candidates for an advanced surface ablation technique known as PRK (Photo Refractive Keratectomy) or LASEK (Laser Assisted Sub Epithelial Keratomileusis). These techniques are both quite similar. They do not involve the creation of a flap into the cornea. This allows for the preservation of corneal tissue which may lead to less Dry Eye and a lower risk of postoperative complications. Both procedures are offered at the Las Vegas Eye Institute. Do not hesitate to discuss the subtle differences between these procedures. Dr. Swanic had PRK performed on his own eyes and is a strong believer in LASIK, PRK, and LASEK for appropriate candidates.

Wavefront Guided versus Wavefront Optimized Ablations

Many patients ask about the difference between “wavefront-guided” LASIK/PRK and “wavefront optimized” LASIK/PRK. The difference really comes down to whether or not a capture device, like the iDesign, is used on your eye. Other than that simple difference, it is essentially a difference in technology between the leading excimer laser manufacturers in the United States: Alcon and Johnson and Johnson. Dr. Swanic thinks they are both excellent platforms and has utilized both with outstanding outcomes. Alcon’s “wavefront optimized” ablation is not based on a capture device and is instead based on the prescription of your glasses or contacts. The laser optimizes its ablation by providing additional pulses in the peripheral cornea to decrease a phenomenon known as spherical aberration. Spherical aberration is a fancy term which means it decreases the risk of haloes after LASIK (especially after high corrections of nearsightedness.). This technology works very well and is part of the reason modern LASIK is superior to the original LASIK procedure originally approved in 1995.

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“Wavefront-Guided” ablations in the U.S. are nearly all done on the Visx excimer platform utilizing either the original Customvue wavefront capture device or the newer iDesign device discussed above. These devices shine an infrared light through your eye and pick it up as it exits the pupil. Abnormalities of the wavefront are captured by a device known as an aberrometer and the ablation of the cornea is altered to try to minimize any abnormalities that are unique to your particular eye. We capture these images multiple times to ensure that we have good data before we transfer this data to our excimer laser. The Visx platform also applies peripheral energy pulses to minimize spherical aberration but can also provide pulses to minimize other “higher order aberrations” known as coma or trefoil to sharpen your vision after your procedure.

As stated previously Dr. Swanic thinks both “wavefront-guided” and “wavefront optimized” treatments lead to remarkable results that are definitely a cut above “conventional” treatments which do not correct abnormalities like spherical aberration.

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Frequently Asked Questions About LASIK Eye Surgery

What is LASIK? What is PRK? What is ASA (Advanced surface ablation)?
LASIK is a form of Laser vision correction where a flap is created in the cornea either with a blade (never done at LVEI) or a femtosecond laser (the Visumax at LVEI). If your surgeon only made a flap in your cornea, you would experience no improvement or change in your vision. Hence, once the flap is made it must be gently lifted by your surgeon so that a different Laser can be used that reshape the cornea. This reshaping laser is called an excimer laser. You can think of this laser as a laser that molds your cornea into the perfect shape to correct your vision. PRK is really the same procedure but instead of creating a flap we simply remove the surface layer of the cornea known as the epithelium. We then laser directly onto the cornea with the exact same excimer laser used in LASIK. The epithelium then grows back in the next few days. Advanced surface ablation refers to a form of PRK where the surgeon doesn’t use a blade or a brush to remove the surface cells. He instead uses very dilute alcohol that simply loosens the cells on the surface. The cells are then pushed off the eye so the laser can reshape the cornea. When Dr. Swanic refers to doing PRK he really means that he will be doing Advanced Surface Ablation because that is all he performs at LVEI. The recovery and the final visual outcome is generally the same between ASA and PRK. The final visual outcome is the same between PRK and LASIK but the recovery for PRK is longer than that seen with LASIK.
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What can LASIK treat? Will it treat my astigmatism?
LASIK can treat nearsightedness and farsightedness both with and without astigmatism. LASIK is most commonly performed for nearsightedness as this is by far the most common reason that people wear glasses in the United States. Our Visx iDesign platform can treat myopia (nearsightedness) up to 11 diopters with up to 5 diopters of astigmatism and it can treat hyperopia (farsightedness) up to 4 diopters with up to 2 diopters of astigmatism. However, Dr. Swanic finds that in general LASIK and PRK are best done for nearsightedness up to approximately 8 diopters and farsightedness up to approximately 3 diopters. We will determine your exact level during your complimentary LASIK screening.
Is LASIK painful?
LASIK generally isn’t painful with any platform but with older technology, we did have patients notice some significant pressure and the vision would become dark during the procedure. This was due to high levels of suction necessary with the original lasers used to create a flap and the older blades (not used at LVEI) that we originally used to create flaps with LASIK. With the new Visumax laser by Zeiss, the pressure increase is so minimal that people’s vision no longer blacks out and a feeling of pressure is highly unlikely. Dr. Swanic has actually had his own eye docked with the Visumax so that he could describe the feeling and the procedure to his patients and found that it was as though he “felt nothing at all.” No loss of vision, and certainly no pain. We’ve really come far in vision correction surgery!
What is Custom LASIK?
Custom LASIK is when the reshaping laser, aka “the excimer,” utilizes data that is custom to your eye to plan its reshaping. When a procedure is not custom it is simply based off of what we call refraction. A refraction is a procedure that your optometrist performs where they keep asking you “which is better 1 or 2?” This is a great way to do LASIK and is the way most of us do LASIK. However, it doesn’t take into consideration small abnormalities that are unique to your specific eye. We call these abnormalities higher-order aberrations and they are measured with an advanced device known as an aberrometer. At Las Vegas Eye Institute we routinely do custom LASIK and charge absolutely nothing extra for it. Dr. Swanic had custom PRK done on his eyes with an aberrometer called the Customvue by Visx. The Customvue was state of the art in 2010 when his procedure was performed. We now use the iDesign 2.0 Aberrometer by Johnson and Johnson that was FDA approved in 2018 and can capture over 1200 data points to design your treatment while the older Customvue only captured about 250.
What is wavefront optimized LASIK? Is it the same as custom LASIK?
Wavefront-optimized LASIK is another excellent form of LASIK correction. It truly isn’t the same as custom but it does tend to rival its results. Optimized treatments do not address higher order aberrations that are unique to your eye; instead, they use a form of corneal reshaping that is aimed at decreasing nighttime haloes by providing additional laser pulses to the peripheral cornea. Dr. Swanic has utilized wavefront optimized treatments in the past with great results but has chosen the iDesign treatment for his office so that we can help decrease preexisting aberrations in our patient’s visual pathways.
I have Presbyopia (poor near vision associated with aging). Can I still get LASIK?
Yes. This is a common misconception that people over the age of 40 are no longer LASIK candidates as they begin to have difficulties with distance and far vision. In fact, some of our happiest patients have been patients on whom we performed LASIK as “monovision.” Monovision is where we will set your dominant eye for excellent distance vision and your non-dominant eye for near vision. This is usually done for patients that are nearsighted and is done by simply undercorrecting the near eye. Many people over the age of 40 are already doing this with their contact lenses. Monovision has many false beliefs associated with it. People believe that the vision in the near eye will be very poor or the same as it was before the procedure. This is hardly the case. Dr. Swanic will typically leave this eye with reasonable distance vision even in the near eye and people are amazed at how quickly their brain will adapt. We tend to find that patients already utilizing monovision in contacts will adapt to monovision LASIK by the next day and those who have never used it before tend to adapt within 3 to 4 weeks.
I’m looking for the best LASIK surgeon in Las Vegas. What should I be looking for?
We recommend that when you are looking for a LASIK surgeon that you look for a surgeon who has completed a cornea and refractive fellowship after their residency. Why? The reason is that fellowship programs such as the UCLA Jules Stein Eye Institute fellowship that Dr. Swanic completed, give your surgeon exposure to the best technology and in-depth one on one training with an experienced refractive surgeon. This isn’t a weekend course or a quick dinner instruction, this is one full year of rigorous training in advanced corneal analysis and hands-on refractive surgery.
Is LASIK expensive at Las Vegas Eye Institute? Can I finance this procedure?
LASIK is not expensive when you factor the cost savings of getting out of glasses and contacts. The typical cost for LASIK in Las Vegas using an all -LASER platform is between 3,500 and 4,500 dollars. Our pricing can vary but is right in this range and we offer no interest financing options with Alphaeon and CareCredit. You can get your procedure with no interest for 24 months and typical payments of only approximately 150 dollars per month. Now is the time to consider this life-changing technology.
Does LASIK cause dry eye?
LASIK does tend to make patients eyes drier for several months after the procedure. However, this does not mean that your eyes will “feel” dry. Often Dr. Swanic sees dry spots on a patient’s cornea after the procedure but the patient doesn’t feel dry at all. Regardless most post LASIK dryness lasts from approximately 3 to 6 months and is easily treated with artificial tears and a procedure called punctal occlusion. If you require punctal occlusion to assist your recovery we offer this as no cost procedure included with all of our LASER vision correction treatments. The key take-home message is that dryness is not at all likely to be severe or permanent in patients that enter the procedure without signs or symptoms of dryness. A preoperative examination to check for dryness is essential and always performed at Las Vegas Eye Institute.

Have other questions about LASIK eye surgery at Las Vegas Eye Institute? Contact our team today or request an appointment with Dr. Swanic!

 

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