LASIK

Laser Assisted In Situ Keratomileusis, a surgical procedure which uses a laser to reshape the cornea , is currently the most common form of refractive surgery. Over the last ten-plus years, LASIK has proven to be a very effective and relatively safe alternative to glasses and contact lenses for many patients. It is considered to be the procedure of choice for correcting a range of refractive errors up to 12 D of myopia, 6 diopters of hyperopia and 6 diopters of astigmatism. With LASIK, Dr. Konowal folds back a thin layer of corneal tissue (cornea cap) and then reshapes the cornea with the cool light beam from the excimer laser. The amount of tissue removed is controlled by the number of pulses and the size of the laser beam. The thin flap of corneal tissue is then folded back into its original position, where it bonds after only a few minutes of drying. No stitches or eye patches are required, and patients experience quick recovery with excellent visual results.

CUSTOM LASIK

LASIK (Laser-in-situ-keratomileusis) is the laser corrective procedure that has been performed on over 40 million people worldwide. Since its FDA approval in the United States in 1995, the procedure has improved and evolved with “custom” treatments available with several laser platforms.

The Bausch & Lomb ZYOPTIX™ laser treatment involves technology that provides a complete analysis of the eye’s corneal optical system. The ZYWAVE II Aberrometer is a precision optical instrument that measures the wavefront of the entire optical system, which includes the aberrations of all components in the eye. By combining the mapping of the cornea with the wavefront of the entire eye, the ZYOPTIX™ system maps up to 9,600 data points, giving the surgeon a precise three-dimensional picture of your eye's shape and characteristics.

This personalized laser vision treatment has been found to improve uncorrected vision to better than 20/20 in greater than 90% of patients. In fact in the U.S. clinical trial not a single ZYOPTIX™ patient was dissatisfied with the results of surgery. Patients reported "extreme" improvement in the quality of their vision, with no increase in glare, halos or night driving difficulty.

Good candidates for LASIK have healthy eyes, with a stable prescription for the past year. The surgery is performed with minimal discomfort and most people can resume normal work activities by the next day. Individuals over 40 who suffer from presbyopia may still require reading glasses for near work, or undergo MONOVISION LASIK.

If you’ve been waiting for technology to improve to have your eyes corrected permanently, the Bausch & Lomb ZYOPTIX™ personalized laser vision correction system can do more than improve your vison, it can enhance your life. Call the KONOWAL VISION CENTER at (239) 948-7555 today to set up a free refractive surgery evaluation and get ready to change your life!

ADVANCED SURFACE ABLATION

Laser surface ablations are alternative laser refractive treatments for individuals who are not LASIK candidates. The excimer laser is used to remove microscopic amount of tissue guided by the ZYOPTIX™ system. Myopia, hyperopia, presbyopia and astigmatism can be treated with a high degree of accuracy. This technique eliminates the need for a corneal cap, and is indicated for patients with thin or irregular corneas, corneal dystrophies or for those who engage in activities where they are predisposed to eye trauma. Although complete healing and stabilization of vision can take as long as a month with this procedure, excellent results are obtained with the Custom ZYOPTIX™ treatments.

PRK/LASEK

Photorefractive Keratectomy (PRK) and Laser Epithelial Keratomileusis (LASEK) are alternative laser vision correction procedures. They are a better choice for patients who have basement membrane dystrophy, orbital anatomy precluding the safe and effective use of a microkeratome, flat corneas, thin corneas, or professions or lifestyles that predispose them to trauma. Similarly to LASIK, the laser is used to remove microscopic amounts of tissue, measured in microns on the surface of the cornea, rather than underneath a cap. After a few days a new layer of surface cells grows. A bandage lens is used to aid in healing and to minimize discomfort during the healing time. Complete healing and stabilization of vision can take as long as a month with these procedures, but excellent results are obtained and Custom treatments are available for these procedures also.

NEAR VISION CK

Presbyopia (Greek for the “aging eye”) is America’s most prevalent condition. 90 million people either have presbyopia or will develop it in the next ten years. The condition causes near vision to fade with age, affecting most people by the age of 40 and everyone by the age of 51.

Conductive Keratoplasty (CK), approved by the FDA in April of 2002, is the fastest growing refractive procedure since LASIK, and is a welcomed alternative for baby boomers with presbyopic symptoms to improve near vision. Conductive Keratoplasty is designed for people ages 40 and over who use glasses or contact lenses for reading or computer work, but who otherwise have good distance vision. Criteria for Conductive Keratoplasty are being over 40 years old with good distance vision, no chronic eye disorders, not pregnant or nursing and no chronic illness.

CK is a noninvasive technique which uses radiofrequency energy to gently reshape the cornea. This is accomplished without cutting or removal of tissue. During a quick in-office procedure, Dr. Konowal uses a probe as thin as a human hair to apply radiofrequency energy around the edge of the cornea. By steepening the curvature, the cornea can bend light rays to bring near objects into focus directly on the retina.

CK is typically performed on just one eye, improving near vision in most cases without compromising the patient’s ability to see far away (binocular distance vision). Patients experience quick recovery and instant results. With CK, farsighted patients are less likely to experience side effects that are common in LASIK, such as poor night vision, glare, blurriness and dry eyes (a particular problem among menopausal women who have laser vision correction).

If you are experiencing problems with your near vision and meet the above criteria, Konowal Vision Center offers a free refractive evaluation to assess whether NearVision CK is right for you.

Phakic IOL’s

The term “Phakic IOL” means an artificial lens is implanted inside the eye, leaving the eye’s natural lens in place. Some of the IOL’s (intraocular lenses) are implanted in front of the iris (the colored part of the eye) and some behind the iris. The implantation of a phakic IOL is done as an outpatient procedure in an ambulatory surgery center under topical anesthesia. Most patients experience little to no discomfort during the actual procedure, and report an instantaneous, dramatic improvement in their vision, similar to LASIK.

The Verisyse™ IOL was the first phakic IOL to receive FDA approval. It is approved for the reduction or elimination of nearsightedness ranging from –5.00 D to –20.00 D. This is well beyond the range of LASIK, which is approved to treat up to –14.00 D. The Verisyse™ lens is made of polymethylmethacylate (PMMA, a type of plastic), and is placed in front of the iris. The lens design has been used in Europe for nearly two decades. In that time, more than 150,000 phakic refractive procedure have been performed using the Verisyse™ design. The implant has shown excellent stability of vision over time, and a very high degree of predictability. In the FDA clinical studies, 47% of eyes saw 20/20 or better uncorrected, and 93.6% saw 20/40 or better uncorrected.

The Visian ICL is a phakic intraocular lens which is placed behind the iris, in front of the natural lens of the eye. The Visian lens is capable of correcting from –3.00 D to –20.00 D of nearsightedness. It is made of collamer, a co-polymer that contains a small amount of purified collagen. It is very biocompatible and stable. It also contains an ultraviolet light filter. The soft, flexible nature of the Visian ICL allows it to be injected into the eye through a very small incision, requiring no stitches. Over 35,000 ICL’s have been implanted worldwide. In the FDA clinical studies, 59% of eyes had 20/20 or better uncorrected vision and 95% had 20/40 or better uncorrected. Learn more.

Refractive Surgery FAQ’s

What does the refractive evaluation involve?

At the initial exam, Dr. Konowal will perform a thorough dilated examination and study your health, lifestyles, activities and any special vision needs you may have. Measurements will be taken that are specific to vision correction, such as topography (mapping of the cornea), and an ultrasound measurement to determine the thickness of your cornea. In addition your pupil size will be measured to determine if you will be bothered by night glare and halos. Dr. Konowal will also discuss with you the various options for surgery, which procedure would be best, how to eliminate reading glasses and what to expect after surgery.

If you are wearing contact lenses, it is necessary to remove those lenses prior to this initial examination. Contact lenses must be removed 3-5 days prior to this appointment to allow your cornea to return to its normal shape. If this is a challenge before your first visit, you may make your first appointment only to meet with Dr. Konowal and discuss surgery options.

Can you briefly explain what a patient should expect during a procedure?

You will be instructed to take a mild sedative one hour prior to arriving at Konowal Vision Center for your corrective procedure. If you are scheduled for a Custom LASIK procedure, a Wavescan® analyzer measurement will be taken of your eyes. This is a map of the unique characteristics of your optical aberrations. This measurement will be linked to the VISX STAR S4™ to allow the laser to
resculpt the cornea to correct your nearsightedness, farsightedness, astigmatism and optical irregularities. You are in the surgical suite for about 10 minutes, however, the procedure takes only a few minutes per eye. After your procedure, you will be escorted to an exam room, where Dr. Konowal will re-exam the operated eyes and review your after care.

What should I expect when I go home?

We instruct our patients to rest when returning home. Vision will be blurry for the first 24 hours, but most people can resume normal activity the next day (including driving a car). It is important to avoid dusty, dirty environments and avoid getting water in the eyes for two weeks. If your procedure was PRK, LASIK, or CK, we will use the same protocol as indicated above. Discomfort is minimal during recovery, although it is normal to experience scratchiness and fluctuating vision for a few days. Patients who have PRK performed may find it necessary to take a pain pill during the first 24 hours.

What medications are used and for how long following a vision correction procedure?

Dr. Konowal will dispense a topical antibiotic drop for you to use 4 times per day for the week following your procedure. Additionally, you will use an anti-inflammatory drop. Over the counter lubricating drops are recommended for six months after surgery to aid in healing. If a patient is not compliant with the use of drops or has severe dry eyes Dr. Konowal may recommend the use of a punctal plug inserted in each tear duct to aid in recovery.

What results should I expect from Vision Correction?

While the standard for excellence in vision is measured as 20/20, we have the potential to see even better than 20/20 with the CustomVue™ procedure. In fact clinical trial studies found that six months after CustomVue™ more than 74% of study participants saw 20/16 or better. We must be reminded that in some patients our planned outcome may not be 20/20; since many patients choose monovision as a method of correcting both near and far vision. Conventional LASIK is not thought of as an outdated procedure and is still recommened for many patients. Each individuals recommendation will be different; depending on lifestyle, occupation and individual desires.

Is age a factor when considering vision correction?

We do not offer LASIK to anyone under 18 as their eyes may still be changing. However, there are no upper age liminations. Many seniors, who have had cataract surgery desire vision correction. With active lifestyles in Southwest Florida, such as golfing, tennis, fishing and swimming, people find glasses and contact lenses a nuisance.

Will I need reading glasses?

If you are having vision correction before you are 40 years of age, it is natural with age to have changes in the lens of the eye, which causes loss of up close vision. As this occurs you would need to wear reading glasses or seek LASIK surgery to retreat your non-dominant eye for better near vision.

If I am over 40 and considering vision correction do you have some options to minimize the need for reading glasses?

Monovision is when one eye is corrected to see well in the distance and the other corrected to focus up close. Both eyes quickly adjust to work together. Dr. Konowal may suggest you try this vision in disposable contact lenses for a few weeks prior to a surgery decision. This allows you to understand your vision prior to deciding on vision correction.

Can I get rid of monovision if I do not like it?

If monovision is not working for you in your daily activities, Dr. Konowal may try correcting you with contact lenses temporarily to determine what vision would be better for you. Once this decision is made a re-treatment would be performed to correct your eye to see distance. You, of course, then need to wear reading glasses for up close vision.

Can I wear contact lenses or glasses after surgery?

It is uncommon for someone to need to wear corrective lenses after surgery. There may be rare occasions when someone who was corrected with mono-vision may want to be corrected temporarily to 20/20 distance in both eyes, for instance while driving at night or at an evening theatre performance.. Then they could have glasses made to correct the near eye to focus on objects at a distance or wear one contact lens in their reading eye as another alternative.

What does the fee include and how much are these procedures?

Our fees are affordable and range between $1,750 to $2,100 per eye. Our fees include the surgery and follow-up care as needed for one year following surgery. In addition, any enhancement during the first year are included in the initial fee with the exception of a $110.00 per eye charge for a laser card to operate the VISX STAR S4™ laser.


LASIK Complications

LASIK does not weaken or scar the cornea, and the long-term results are expected to be stable. There has never been a reported case of blindness associated with these procedures. Complications of any kind are rare in the hands of an experienced surgeon such as Dr. Konowal. There is a less than 1% risk of serious, vision threatening problems. However, risk of infection cannot be ignored and is monitored by Dr. Konowal and controlled by the use of a topical antibiotic. During the first 3 to 5 days of recovery patients experience fluctuation in vision, some note that their eyes feel scratchy or sandy and others just note some blurry vision. These temporary side effects are a result of the dry eyes associated with LASIK surgery, and are treated with over-the-counter lubricating drops. Some patients may elect to have punctal plugs inserted into their tear ducts to help with this condition.

Overcorrection or undercorrection: While less than 7% of Dr. Konowal’s patients need retreatments, it is important to know that Dr. Konowal will decide to perform an enhancement when any residual refractive error has stabilized . If your healing results in overcorrection or undercorrection a touch-up may be performed.