Dr. Kurt Andreason, M.D.

I've done thousands of corneal refractive surgery cases, like LASIK, and as long as patients follow the instructions carefully, people do well, and are almost always ecstatic with the life changing results. I have had many people tell me it is 'the best thing they have every done' for themselves, and they wish they had done it years earlier. I only do all laser LASIK.

Conservatively, the most important thing to do on the day of surgery and over the following week is to use your eye drops every day as prescribed, and NOT rub your eyes. We generally ask people on the day of surgery to take at least a 90 minute nap to help their eyes feel better, as they are usually pretty scratchy/burny the first day.

We often ask people not to work out the first week because we don't want sweat and bacteria running into their healing eyes, just like we don't want patients working in a very dusty/dirty environment the first week, or swimming. Otherwise, after they are examined the day after surgery, they don't need to rest and can go about their regular routines.

Lifelong patchy areas of color, if she is darker complected or with ancestry of darker complexion, is usually either nevi or complexion associated pigmentation that is normal. However, if all the whites of the eyes are brown, there are some metabolic diseases and other causes that should be evaluated and ruled out, that may require treatment. I would recommend she see a Pediatric Ophthalmologist for an examination if that is the case.

Hello!

For soft contact lenses, it is a little tricky.
The optometrist who fitted you for contacts and prescribed them to you should (or his/her staff) train you on placement and removal.

Generally people develop a technique that includes (with washed hands) pulling down the lower lid while looking up and away, then either pinching the bottom of the contact lens, or placing a finger on the edge and sliding it down and over to the outside corner and then sliding it out.

I would emphasize that, no body what anyone tells you, you should never never sleep in them or use any other water or solutions to clean them. I would also avoid swimming/hot tubbing in them (if you do take them out and throw them away right after).
I would strongly recommend daily wear, and not wearing them every day, but taking some down days with current glasses to let your eyes breathe and get nourished.

That's a good question, but there is more breadth to this answer. Even within Ophthalmology, there are many different lasers for different types of laser surgeries.



LASER, as you know, is an acronym for Light Amplification by Stimulated Emission of Radiation.



There are common in office laser procedures, like the Yttrium Aluminum Garnet (YAG) laser used for posterior capsule opacification after cataract surgery, or to create peripheral iridotomies (little hole in the iris) to prevent acute angle closure glaucoma in at-risk individuals. This type of laser creates a focused burst of energy that breaks open tissue.



Another laser that is commonly used is the Q-switched, frequency doubled YAG laser for open angle glaucoma treatment of the angle or drain of the eye. This procedure is called Selective Laser Trabeculoplasty (SLT) and is commonly used throughout the country as one of the primary treatments of this condition to help decrease eye pressure. This laser uses less than 1% of the energy of the older laser that this new laser replaced (a similar surgery called ALT). This gentler laser stimulates the tissue to induce the body’s natural processes to improve aqueous outflow and thus decrease eye pressure.



There are also Argon and Diode lasers that are used for photocoagulation, or creating little focused burns of the tissue. This may be done to create a barrier around a small retinal tear to prevent it from becoming a large retinal detachment. It could also be used to extinguish aqueous producing cells that lead to higher pressures in glaucoma patients where other treatments have failed. Some lasers are used to treat certain types of cancers.



The Femtosecond laser is used to create cleavage planes in translucent tissues by creating a series of tiny contiguous micro-pulses. Femtosecond lasers have come into use in the last 20 years, and more especially in the last decade, not only for creating a corneal flap in LASIK surgery, but also for very precise corneal limbal relaxing incisions to decrease astigmatism, for precisely shaped corneal buttons for corneal transplants, and most recently, to assist in cataract surgery creating precisely shaped incisions and openings in the cornea and in the cataract lens.



LASIK surgery, or similar surgery called Advanced Surface Ablation surgery (similar to PRK) has used an excimer laser since the 1990s to ablate the anterior portion of the cornea, carefully and permanently reshaping it to decrease one’s dependents on glasses or contact lenses. Hundreds of thousands have safely benefited from this procedure over these decades, and the latest technology and approaches to patient screening has made this surgery even safer than the first years of its use.



I have only ever performed “All Laser LASIK” (bladeless LASIK) for my LASIK patients because it is the safest approach and what I would want for myself and my family members. I have treated other surgeons and physicians, pilots and engineers, deploying troops and four-star generals with this procedure and with great success. Just this past week I treated a veterinarian who went from 20/200 uncorrected (legally blind) before surgery, to 20/20 uncorrected in both eyes the day after surgery. He said what many have said: “This is life changing! Thank you! I’m so glad I had this done.”



Advances in technology have enabled improvements in the delivery systems of lasers of all types, decreasing the time required for the different procedures, improving their repeatability, and creating pulsed algorithms that deliver less energy to the tissue. All of these lasers are very safe and precise and have been of great assistance for eye surgeons/physicians (known as Ophthalmologists) to help treat their patients for many different conditions.



Dr. Kurt W. Andreason, MD

Absolutely! But it depends on the reason and if glasses can’t correct it. See an ophthalmologist—especially one who specializes in lasik and cataract surgery.

There are several eye conditions that Ophthalmologists (physicians/MDs) treat with very different types of lasers.

The first one everyone knows something about is LASIK, which requires an excimer laser to ablate or remove precise, small amounts of tissue by focused energy that basically turns it into smoke. Once a flap is created, or the surface cells removed by other means, an excimer laser can reshape the corneal tissue to remove or reduce one's dependence on glasses.

That same procedure in modern times and practices, uses a second laser: a femto-second laser to cut the initial flap (instead of using a blade). Subsequently, this type of laser has also found use in premium cataract surgery where initial incisions and lens softening are done using this laser. It is used as well for corneal astigmatism correction during that surgery.

There are a number of lasers used in both retinal and glaucoma surgery. In the case of surgery for a retinal tear, typically an argon laser is used to burn tiny weld spots around the border of a tear (called a pexy) in order to wall off a small tear to keep it from growing, or possibly when reattaching an already partially detached retina. Sometimes this laser is used in the clinic setting, and other times in the operating room.

In glaucoma surgery a YAG laser is used in patients that have a narrow angle which could lead to a context where the angle closes obstructing the eyes drainage system, which then leads to an eye pressure that shoots up very high and can cause permanent nerve damage to the nerves of the eye, most importantly the optic nerve which is the pipeline to the brain and how we see. So, by using the yag laser to create a little fluid vent hole in the iris, the cascade of events leading to a closed drain and high pressure can be avoided.

That same YAG laser is also used to clean off the back of an artificial lens, sometime in the months or years following cataract surgery. The cataract never comes back, but sometimes the natural membrane that the new artificial lens sits on can become somewhat opacified over time. The laser is used to open up a window, like a glass cutter, returning the patient to her prior clear post-op vision. This takes only a short time in clinic.

This same laser has been used to cut tiny sutures and for other purposes as well.

There is also another laser used to stimulate the actual drain of the eye in glaucoma patients, as over time it may decrease its outflow rate. The SLT laser technique works well for many patients, opening up the flow rate through the trabecular meshwork drainage system, and lowering the average intraocular pressure.

Finally, laser can be used to destroy some of the cells producing fluid in the eye, thus reducing pressure by lowering the inflow of fluid into the eye.

There is a long list of possibilities for sharp stabbing pain in the eye. It could be something as routine as dry eye, or something more serious like high pressure or inflammation in the eye. If it persists despite some artificial lubrication tears, you should be seen soon for a full eye exam.

There are different ways to approach this question.

First, as we age, and with some skin types more than others, it is common to have the oil glands, (about two dozen each) that lie within our eyelids and open behind our lashes, become thickened and inflamed. When that happens instead of mixing with our tears every time we blink, they become obstructed or their contents more like Crisco. Then your tears evaporate more quickly, and feel more irritated, and sometimes with vision fluctuation.

For natural improvement, the first step I would recommend would be to make a habit of warm compress/massage of the upper and lower lids. Most patients prefer the reusable moist heat masks you can buy and put in the microwave each day for about 20 seconds. Then, heat and massage the lids for about 5 minutes, giving particular focus to the lower lid.

In addition, cleaning away dead cells, bacteria, pollen, excretions and other debris, as well as mites, will help the eyelids be healthier, including those oil (meibomian) glands. There are in office advanced technology therapies which can also be of proven additional benefit to many patients.

Next, before further treatments, consider a good, preservative free artificial lubricating tear replacement. Some of the better newer brands we recommend include: Mega-3 by Refresh, and Oasis Tears Plus.

Best,

Dr. Kurt Andreason, MD