In modified monovision, the dominant eye is fully corrected for best distance vision. The non-dominant eye is corrected to be about a half-diopter near-sighted. This results in a very small effect on the distance acuity but allows one to read menus, price-tags and larger print if held at around arms length. There is little advantage to correcting both eyes to full distance acuity. Full distance correction is basically done on patients under 35, but options should always be discussed.

How Lasik is done

LASIK involves the creation of a flap of tissue on the cornea – the front surface of the eye. The surgeon creates the flap using a keratome. There are many different types of keratomes and part of your success depends on the proper selection. The keratome cuts the flap to about 160 microns (1000 microns = 1 mm = ~1/25 of an inch). The flap is gently folded back leaving the deeper layers of the cornea exposed. The laser can then modify the shape of the underlying cornea thereby changing it’s refractive power. Once this is completed, the flap is rolled back over the exposed portion of the cornea.

The cells on the back of the cornea are constantly pumping fluid out of the cornea; this causes the flap to be “sucked” onto the underlying stroma. The interface between the two layers also has a Velcro-like texture helping the flap to adhere. No suturing of the flap is required.

Most people have vision restored to 20/20 in less than 24 hours, but it can take two or three days sometimes. With far-sighted individuals it takes longer but vision is almost always good enough for driving on the first day following the procedure.

From the time you are ready for surgery to the end takes less than 5 minutes for each eye, and there is little if any discomfort. The best thing to do after your procedure is go home and go to sleep. Keeping the eyes closed for several hours promotes healing. You will be wearing clear protective shields that day and they should only be removed for taking your prescribed drops.

For the next several days you will not need to wear the shields, except for sleeping. Routinely, you will take two different eye drops four times a day for the next four days.

What can go wrong?
  (This summary is not intended to be a complete document on all of the possible complications of LASIK.)

There are several possible complications with LASIK. Glare, halos, ghost images and star-burst have all been reported. These effects are almost completely eradicated with proper patient selection and matching each patient to the proper keratome and the proper laser. If you visit a laser center where there is access to only one or two lasers, this is a red flag. You should find out how many different lasers are used, how many different kinds of keratomes are used and find out if the surgeon is proficient in the use of all of them. Generally speaking, the best patients have uncomplicated prescriptions, normal corneas with adequate curvature and sufficient corneal thickness. Small pupils are also an advantage.

During the creation of the flap, the flap could tear or form a hole. In this case, the procedure is aborted and the flap re-positioned. The flap must then heal for at least 3 months before the procedure is re-attempted.

Post procedure inflammation can occur at the interface between the flap and the deeper cornea. This is commonly called “Sands of the Sahara” because of the appearance under the microscope. “Sands” is treated with eye drops and only poses a real threat if it is ignored. The best way to avoid this, and any permanent visual compromise, is to make and keep all post-operative appointments with an experienced, affiliated eye doctor.

The biggest danger in LASIK I think is under your own control. Rubbing the eyes too soon can cause the flap to wrinkle and therefore distort vision. If the folds are not smoothed out quickly the wrinkles can become permanent. The eyes will withstand a gentle rub after about 6 days. Even in cases where folds have become permanent, new technologies should soon be able to repair the damage done.

The most common complication is slight under, or over-correction of refractive error. If you undergo LASIK and end up a little near-sighted or far-sighted, the existing flap can be gently raised and an “enhancement” procedure corrects the remaining error.

Cost
The cost of LASIK can be from around $ 500 per eye to $ 3000 per eye. Like with everything else – quality doesn’t cost – it pays. When looking into LASIK you should always ask some important questions:

1) The Surgeon: What are the credentials of the surgeon – how many procedures has he done, how many lasers and keratomes does he routinely use. How many eye doctors and physicians has he performed LASIK on. Is he a cornea specialist?

2) The laser center: How many lasers are available? How many keratomes?

3) What does the cost include? Pre and Post-Operative care – for how long? Are enhancements included and for how long? What happens if you move or have a problem while traveling?

4) What happens if you need a doctor at night or on the weekend? Can you reach him?

These are some of the questions you should be asking.

If you use a center with several lasers and keratomes, choose a cornea specialist who has done thousands of cases using different equipment, obtain a commitment in writing for enhancements and post-op care you can expect to pay more.

An inexperienced surgeon working in a center with access to one or two lasers and one keratome, very limited post-op care and no commitment for the future will be far cheaper.

Why do LASIK through Dr. Katims?
Dr. Katims is one of only 3 staff optometrists at the TLC Laser Eye Center and is also on the advisory board. Affiliated doctors have experience, but as a staff doctor actually working at the center each week, Dr. Katims sees many more patients. Dr. Katims has performed thousands of LASIK pre and post procedure exams making him one of the most skilled and experienced affiliated doctors on Long Island.

We work only with highly trained surgeons so you wont be able to find $ 500.00 procedures here. When you proceed with LASIK through our office, there are no additional fees – we are paid by the centers we work with. By scheduling this way, you have the flexibility of being seen by either Dr. Katims or the surgeon as needed. Two experienced doctors for the price of one; and the ability to be seen at two different locations at your discretion. It also means that on a particular date when one of us is unavailable, you can be seen by the other – not a partner or on-call doctor who has never seen you before.