“LASIK One on One” – Ask Dr. Gulani about LASIK Now
About LASIK Eye Surgery
Open Your Eyes: Arun C. Gulani MD Provides What You Really Need to Know
POSTED: Thursday, December 10, 2009
UPDATED: 12:57 pm EST December 10, 2009
Dr. Arun Gulani
JACKSONVILLE, Fla. — LASIK eye surgery involves the use of the very precise (cuts 1/4th of a micron at every pulse) Excimer Laser which re-shapes the cornea (clear front window) of the eye according to the glasses prescription of the patient.
The surgery is done in minutes, with the patient awake, active and participating; only numbing drops are used in the patient’s eyes. This method provides the quickest healing and fastest results. Visual recovery is extremely fast most patients gain driving recovery by the day after surgery.
Unfortunately, these are the very reasons that this surgery has a tendency to become a commodity in many places enough to mislead the patients.
Arun C. Gulani emphasizes that Lasik is just one among 16 Laser Vision Surgeries which themselves are among 40 different Vision Corrective Surgeries (surgeries to remove glasses and contact lenses).
Thus if one understands how Vision Corrective Surgery and all 40 combinations are what all Lasik surgeons must be capable of performing and offering, it becomes easy to realize how every patient can indeed have the best surgical technique tailored to them for the safest and most predictable outcome. Vision Corrective Surgery can then change from a Commodity to an ART
Dr. Gulani has invented Lasik surgical instruments, published Lasik protocols and teaches Lasik complication management to eye surgeons all over the world. He has recently introduced a new super-specialty in Lasik called Laser Corneoplastique™ by which many of the Lasik complications can be corrected back to excellent vision.
Nevertheless he says, Prevention is the way to go!
Among a handful of eye surgeons in the world who can correct previous Lasik patients back to 20/20 vision, Dr. Gulani has summarized basically four reasons for poor outcomes in Lasik surgery:
Misleading advertising by Lasik surgeons:
Doctors who may be new and inexperienced themselves but use the established name recognition of their more experienced, senior partners (who may have actually even retired from the practice).
Eye surgery “Mills” that advertise the joint number of cases done by all chain centers across the nation (ie. 500,000 cases done) while their surgeon may be a novice with a high chance of causing bad outcomes.
Doctors using celebrity testimonials (NFL sportsmen/movie stars etc). In many such cases, the doctors actually pay a hefty sum to be known as official surgeons of such celebrities. Also, they most often will do surgery for free to get an endorsement.
Lack of patient education and expectations:
Patients are not educated about other available options since the surgeon may themselves not be capable of performing those options.
Patients feel intimidated to ask questions about surgeon qualifications, vision expectations, side effects etc.
Cookie-Cutter surgery by Lasik surgeon “One size fits all”
Lasik may be all that the surgeon performs. They be ignorant or incapable of performing the entire range of Laser Vision Surgeries
Lack of knowledge, initiative or expertise in offering and performing vision surgery options if Lasik is not ideal for the patient (ie. New generation ICL surgery for Thin cornea patients who are not ideal Lasik candidates)
Poor pre-operative Technological analysis of the patient’s eye anatomy, vision and stability.
Lack of understanding on surgeon’s part regarding interaction between, anatomy, physiology and optics of the eye to get a great vision outcome.
Lack of technological finesse to detect early abnormalities and avoid Lasik in improper candidates
Inability to deliver the best outcomes due to lack of modern, cutting edge equipment.
Gulani Rules For Safety In Choosing A Lasik Surgeon
Besides visiting the surgeon’s website; do use a search engine (ie. Google/MSN/Yahoo etc) and type in the doctor’s name and see what comes up. “Do you find only a website and other paid advertising claims? Or do you find interviews, published articles and third party confirmations of the doctor’s status?”
If your surgeon says that they are the First or that they teach other Lasik surgeons, ask for evidence. Are they first in the world, country, state or just on their street (decreasing order of importance). Do they teach at local dinner meetings that they host or are they invited to teach nationally at prestigious podiums.
Meet with the surgeon, get a feel for the integrity and involvement of the surgeon in educating you and answering every question. Also make sure that your surgeon is contactable and that they do indeed respond when you call.
Make sure that your surgeon will see you before surgery, perform your surgery and also see you and be available after your surgery.
Find out if your surgeon performs the full spectrum of Laser Vision Surgery (remember Lasik is just one of many Laser Vision techniques) so they can offer what is truly best for you rather than suggesting the only surgery they know how to perform.
Do not fall for flashy computer screens and equipment in the office; make sure that you understand all that is going on and insist on asking the surgeon to explain in layman terms.
When meeting your surgeon, do ask about possible side-effects and complications. Ask if in the rare event that you do end up having a complication can they handle it? If the answer is yes, then ask for evidence.
Thus due diligence on part of the patient, experienced selection of individualized surgery by the surgeon and effective use of modern technology can all together raise the bar on safety and predictability in LASIK — one of the most successful surgical breakthroughs of modern times.
References:
Gulani AC, Holladay J, Belin M, Ahmed I. Future Technologies in LASIK – Pentacam Advanced Diagnostic. In Experts Review of Ophthalmology, 2010- London (in Press)
Gulani AC, Nordan L. Advances in Laser Corneoplastique: Art of Lasik Laser Vision Surgery. Mastering Corneal Collagen Cross Linking Techniques. Textbook of Ophthalmology. JP Inc. 2009; 56-63, 11.
Gulani AC. “Future Directions in Lasik” – Corneal Refractive Surgery in Video Atlas of Ophthalmic Surgery. XLV. 2008
Gulani AC. Irregular Astigmatism: Management in Unstable Cornea following LASIK Textbook of Irregular Astigmatism. Slack Inc. 2007.
Gulani AC, Probst L, Cox I, Veith R. “Wavefront in Lasik” – The Zyoptix. Platform. Ophthalmol Clin N Am 17 (2004). 173-181
Gulani AC. “A New Concept for Laser Refractive Surgery.” Ophthalmology Management 2006; 10 (4). 57-63
Gulani AC. Laser Corneoplastique. Techniques in Ophthalmology 5(1):11-20, 2007
Gulani AC. Vision Corrective Surgeries: Past Techniques, Present Trends and Future Technologies. North East Florida Medicine. 2007; 2 (58) 41-44
Gulani AC. “Laser Corneoplastique” Video Journal of Cataract and Refractive Surgery. Vol XXII. Issue 3, 2006
Gulani AC. “How to put logic into action after Lasik” – Review of Ophthalmology, 2006; XIII (9), 60-64.
Gulani AC., et al. Innovtive Real Time Illumination System for Lasik Surgery . Clin Surg Ophthalmol. 2003;6:244-246
Gulani AC. Pentacam Technology in Full Spectrum Refractive Surgery. KMSG International Conference. Madrid, Spain. June 2006.
Gulani AC. “A New Classification and Management Guide for Corneal Complications of Lasik.” Journal Canadien D’ Ophtalmologie 2000; 35 (2). 103-105
Gulani AC. “New Instrument For Revision LASIK Surgery.” Journal of Cataract & Refractive Surgery (JCRC), 1998; Vol 24: 595
Copyright 2009 by News4Jax.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Dr. Gulani: LASIK Raises Vision Surgery To An Art
POSTED: Thursday, January 7, 2010
JACKSONVILLE, Fla. — One of a continuing series of articles by Dr. Arun Gulani, who founded Gulani Vision Institute in Jacksonville, and is one of the leading laser eye surgeons in the United States.
He will be in Channel 4’s studios Jan. 21 for a live, interactive Webcast to talk about the possibilities of corrective vision.
Today, Dr. Gulani discusses advances in the technology and uses of laser eye surgery:
Since it is the curvature (shape) of your cornea (front clear window of your eye) that decides in most cases whether you are nearsighted (steep curvature), farsighted (flat curvature) or have astigmatism (football shape as opposed to a basketball shape), we Re-shape (sculpt) the cornea using an invisible, painless, highly accurate (cuts 1/4th of a micron per shot) and computerized Laser. Thus the entire range of procedures to Re-Shape the Cornea using an Excimer Laser are called Laser Vision Surgery.
With this simplified explanation, Dr Gulani cuts out all the hype around Lasik Laser Vision Surgery and prepares you to understand the underlying logic ( GulaniVision.com).
LASIK (Laser-Assisted in situ Keratomileusis), SBK (Sub-Bowman’s Keratomileusis) BladeLess Lasik, LASEK (Laser Epithelial in Situ Keratomileusis), Epi-Lasik (Epithelial flap Lasik), PRK (Photo-Refractive Keratectomy) and ASA (Advanced Surface Ablation) are all variant forms of Laser Vision Surgery used to correct nearsightedness, farsightedness, and astigmatism.
Custom Laser Vision Surgery is a technological advance wherein wavefront aberrations in the entire optical system of the eye are corrected towards best potential visual acuity.
Lasik surgery involves making a flap in your cornea (like a page of a book) and then shaping the underlying cornea with the laser. This flap can be made by a laser or a blade, it can be hinged superiorly, medially or laterally as well as be of different thickness and or sizes.
Advanced Surface Ablation or PRK are performed without cutting any flaps instead requiring separation of the epithelium (skin of the cornea) with various techniques followed by individually specific shape treatments. Once again, it becomes clear how Laser Vision Surgery including Lasik should not be a “Cookie Cutter” surgery but actually an ART demanding careful selection and skilful execution thus making it important that every Lasik surgeon be capable of performing the entire range of surgeries to best suit your individual eye and visual goals.
Laser Corneoplastique™ – Raising the bar in LASIK Laser Vision Surgery
LASIK and Laser Vision Surgery are Corneal surgeries (Laser reshaping is performed on the cornea of the eye). Corneal surgical experience and knowledge will in all probability enhance the ability of a Lasik surgeon to better select the candidacy of their patients, prevent complications and prepare them to react in an efficient manner towards any inadequate / unforeseen outcomes.
Dr. Gulani encourages Lasik surgeons to understand the cornea and hence become more confident, be able o correct their own mistakes and choose the right Laser surgery for their individual patient.
The ART of blending the full spectrum of corneal surgery to Prepare the cornea For Laser Vision Surgery or to Repair the cornea From Laser Vision Surgery is what Dr. Gulani has introduced as CORNEOPLASTIQUE™
Patients who have been previously told that they are not candidates for regular Lasik due to corneal problems like; corneal scars, highastigmatism, pterygium, previous surgeries like cataract surgery, corneal transplants, Lasik, radial keratotomy etc. may now qualify for Laser vision surgery towards a visual goal.
Copyright 2010 by News4Jax.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Dr. Gulani: Understanding Your Eyes
POSTED: Thursday, January 7, 2010
One of a continuing series of articles by Dr. Arun Gulani, who founded Gulani Vision Institute in Jacksonville, and is one of the leading laser eye surgeons in the United States.
He will be in Channel 4’s studios Jan. 21 for a live, interactive Webcast to talk about the possibilities of corrective vision.
Normal Vision
Just like a camera, the eye has a viewfinder (called the cornea) a shutter (called the iris) and a lens. Normal, clear vision occurs when light rays pass through them and the image focuses directly on the film (called the retina). When light rays don’t converge and focus directly on the retina, this results in “refractive errors” and blurry vision.
Nearsightedness (myopia)
This occurs when the cornea is curved too steep in relation to the length (front to back) of the eye. This bends the light more sharply and makes the image focus in front of the retina, as opposed to directly on it. When this occurs, near objects can be seen clearly, but objects in the distance are blurry. Advanced Myopic Lasik surgery treats this refractive problem by slightly flattening the corneal curvature, so the focal point of the image is moved back and directly on the retina.
Farsightedness (hyperopia)
This is the reverse problem from myopia. In farsightedness, the corneal curvature is too flat, or the eyeball is too short, and the focal point of the image is behind the retina. With farsighted vision, objects in the distance appear clear, while objects close up are blurry. Advanced Hyperopic Lasik surgery corrects this problem by slightly steepening the corneal curvature and increasing the refractive power of your cornea so that the focal point of the image is closer and directly on the retina.
Astigmatism
In normal vision, the cornea is more spherical or round, like a basketball. An eye with astigmatism has a cornea that is irregularly shaped, like a football. This prevents images from converging or focusing directly on the retina. Although some parts of the image may focus on the retina, others focus in front of or behind it. Astigmatism causes images to appear blurry or distorted. Astigmatism can occur along with either myopia or hyperopia, or it can occur alone. Advanced Astigmatic Lasik surgery can correct it by modifying the corneal curvature so that images can converge and focus directly on the retina.
Presbyopia
Presbyopia is most commonly associated with the need for reading glasses as we age, usually after age 40. It is caused by changes in the lens. As we age, the lens hardens and becomes less flexible, losing the ability to change shape. Like a camera, this causes the eye to lose its power to “ Zoom”. Presbyopia can also exist with any of the above vision problems and can be treated with unique approaches like Multifocal Lasik laser vision surgery or MonoVision Lasik.
Higher Order Aberrations
The above three refractive errors are called lower order aberrations. They account for about 80% of refractive error and affect how much you can see – that is, how clear your visual field is at all distances.
Our eyes also have small defects called higher order aberrations and these affect how well you see. If you imagine the eyes as being a pair of glasses, they could have smears or bits of dust on them which interfere with otherwise clear vision. This would be analogous to your higher order aberrations.
Examples of higher order aberrations are halos around lights, starbursts, and glare, which cause night vision problems. Until recently these more subtle vision problems have not been treatable by Lasik. But since the advent of Wavefront technology, they can be diagnosed in detail and treated by Corrective Lasik, PRK, Advanced Surface Ablation (ASA), LASEK, epi-Lasik, Intralase, and iLasik.
Corneal Surgery
Since the cornea has the most refractive properties to focus images clearly on your retina, the most common treatment for the above refractive errors is corneal surgery. Nearly all cornea-based refractive surgeries (including all variations of laser vision surgery, such as Lasik, Wavefront Lasik, Custom Lasik, Epi-Lasik, Lasek, PRK, Advanced Surface Ablation (ASA)) focus on re-shaping your cornea to modify how light passes through it to improve your vision.
Dr. Gulani believes that it is essential for Lasik surgeon to be an elegant corneal surgeon because this experience will give their patients added confidence and assurance that they have been allotted the right surgery for their specific needs. A thorough examination of your eyes is essential for a surgeon to then recommend the best procedure for your particular vision problems to achieve the desired visual outcome.
Copyright 2010 by News4Jax.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Dr. Gulani: Lens Based Vision Surgeries
POSTED: Thursday, January 7, 2010
JACKSONVILLE, Fla. — One of a continuing series of articles by Dr. Arun Gulani, who founded Gulani Vision Institute in Jacksonville, and is one of the leading laser eye surgeons in the United States.
He will be in Channel 4’s studios Jan. 21 for a live, interactive Webcast to talk about the possibilities of corrective vision.
For this article, Dr. Gulani discusses the option of laser eye corrective surgery:
For patients who are extremely nearsighted or farsighted (when too much corneal tissue could be compromised due to excessive Laser re-shaping), Dr. Gulani may suggest Lens based surgery as your primary approach to correct your vision.
Lets remember at this point that normally you have a natural, focusing, clear lens in your eye. So, we could either Add a lens to supplement your own lens power or Remove your natural lens and replace it with an artificial lens implant that corrects your vision.
Phakic Implants (VISIAN ICL): A miniature contact lens like implant is gently tucked into place inside the eye to add to the focusing power of your natural lens in correcting your vision.
Clear Lens Exchange / Refractive Lens Exchange – Your eye’s natural lens is replaced with an artificial lens implant of the appropriate power to correct your vision.
Both the above approaches have design, model and technique choices that allow Dr. Gulani to select a particular lens in correcting your vision.
Copyright 2010 by News4Jax.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Dr. Gulani: Presbyopia (After 40 Reading Glasses)
POSTED: Thursday, January 7, 2010
JACKSONVILLE, Fla. — One of a continuing series of articles by Dr. Arun Gulani, who founded Gulani Vision Institute in Jacksonville, and is one of the leading laser eye surgeons in the United States.
He will be in Channel 4’s studios Jan. 21 for a live, interactive Webcast to talk about the possibilities of corrective vision.
For this article, Dr. Gulani discusses the need for reading glasses as people age:
During middle age, usually beginning in the early 40s, people experience blurred vision at near points, such as when reading, sewing or working at the computer.
Dr. Gulani likes to describe this as an age-related loss of the “zooming power” (tele & wide like a camera) of your natural lens inside your eye.
When your natural lens is Clear: Monovision (the non-dominant eye is focused for near), very much like that with contact lenses can be achieved with Laser Vision Surgery to assist this condition.
When your natural lens has become a Cataract: Cataract surgery with multifocal lens implant can be performed.
More information at GulaniVision.com/presbyopia-treatment.html.
Copyright 2010 by News4Jax.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.