The cornea is the clear covering on the front of the eye, which bends, or refracts, light rays that focus on the retina in the back of the eye. A certain corneal curvature is required in order to focus the rays exactly on the retina for the sharpest vision. If this curvature is not proper for the lens of the eye, a refractive error results and causes blurred vision. Refractive errors, which include myopia (nearsightedness), hyperopia (farsightedness), and astigmatism, are the most common causes of blurry vision.

Glasses and contact lenses are common treatments for these refractive errors. An excellent alternative treatment is refractive surgery. Modern refractive surgery utilizes an excimer laser to permanently alter the shape or curve of the cornea to eliminate or greatly decrease the need for glasses or contacts to achieve excellent vision. In a matter of minutes, the gentle ultraviolet laser pulses can precisely reshape the cornea to match the eye's refractive error. The following types of laser vision correction are available.

The three steps of LASIK
		1. The corneal flap is created and lifted.
		2. An excimer laser reshapes the cornea.
		3. The flap is replaced.

LASIK is the most common refractive procedure done worldwide. It has proven to be a safe, reliable, and painless way to improve vision by correcting refractive errors. With this procedure, drops of an anesthetic are placed on the cornea so it is not painful. An instrument is used to gently hold the eyelids open under the laser beam. A device called a microkeratome is used to cut a thin flap of central corneal tissue. In some cases, another laser rather than a microkeratome is used to create this flap. The flap is then lifted to expose the underlying cornea. The excimer laser then reshapes the corneal curvature by steepening it for hyperopia or flattening it for myopia. The flap is then closed and seals in place in a few minutes. The procedure may take 5 to 10 minutes per eye. After the surgery, a clear, protective shield is placed over the eyes until the next day. Eyedrops are started to prevent inflammation or infection. Vision may be somewhat hazy and the eye a bit scratchy for the first 12 to 18 hours, but this improves rapidly after that. Most people are comfortable enough to drive or return to work the next day. Full recovery may occur gradually over a few weeks.

Click here to see common questions about LASIK

To learn more about LASIK go to
http://www.fda.gov/cdrh/LASIK/

Wavefront technology has enhanced results of laser vision correction since 2003. This technology is derived from NASA technology used to detect fine imperfections in mirrors on satellites that are sending and receiving data in space. Wavefront analyses of corneas have been able to detect more subtle irregularities than myopia, hyperopia, or astigmatism, all which can contribute somewhat to blurriness in the vision. The Allegretto Wave™ laser is designed to compensate for these additional corneal irregularities during laser treatment, leading to visual results superior to that of traditional non-Wavefront lasers. In fact, the original FDA study data show that the vision results with the Allegretto equaled or exceeded the results obtained with the other leading custom Wavefront laser systems (reference to FDA study results). The treatments with the Allegretto laser were also much quicker, as the Allegretto is the fastest scanning laser system available today. Dr. Litscher is an affiliate of an Allegretto laser center in West Springfield, Massachusetts.

To learn more about Allegretto Wave™ System go to
http://www.allegretto.ca/patient/index.html

PRK was the first laser refractive procedure to be FDA approved back in 1995. PRK is known as surface ablation, as the excimer laser treatment is applied to the surface of the cornea, not under a flap, as in LASIK. It is commonly done as an alternative to LASIK, and the visual results are truly as good as with LASIK. The procedure is done much the same as LASIK, except no flap is cut. Instead, a thin layer of surface cells is rubbed off the cornea before the corneal surface is ablated with the laser. After ablation, a thin, soft, clear contact lens is placed on the eye to help the cells heal back over the treated cornea over the next four to seven days.

The disadvantage of PRK over LASIK is that it results in more discomfort for two to four days, a longer healing and visual recovery time, and potentially more corneal scarring in some patients. On the other hand, PRK avoids cutting of the corneal flap, which eliminates the possibility of many complications, such as irregular or damaged flaps, infections under flaps, and dislodged flaps after surgery. PRK actually is a safer procedure in spite of the cited drawbacks. Some people with naturally thin corneas or very dry eyes may be better candidates for PRK than LASIK.

Example of the PRK procedure

The terms LASEK or epi-LASIK are used to describe variations of PRK. The same excimer laser is used to treat the corneal surface in advanced ablation, but the surface cells are first removed using different techniques. With LASEK, the surface cells are treated with alcohol first to loosen them, then they are lifted in a sheet prior to the laser ablation. No flap is cut. The sheet of cells is then laid back over the ablation, providing some level of comfort while the new cells are healing in under the layer of old cells. A bandage contact lens is left on the eye for three to seven days.

With Epi-LASIK, a similar procedure is performed, however, the surface cells are separated from the corneal surface with an automated separator. The separator is like a mini-plow that pushes the thin layer of cells off the surface of the cornea in a continuous sheet so they can be reapplied to the surface after laser treatment. Again, no flap is cut. Healing time is about the same for LASEK, and the visual results are the same.

Most individuals who are at least 19 years of age and have stable eyeglass prescriptions are potential candidates. The best candidates will have myopia of less than 10 diopters, or hyperopia of less than 4 diopters, and astigmatism less than 6 diopters. Individuals may not be candidates if they have poorly controlled vascular or other immune disease or a history of keratoconus. Pregnant or nursing mothers are excluded, as are those taking the medications amiodarone, Accutane, or Imitrex.

You can call East Longmeadow, Massachusetts or Springfield, Massachusetts office to schedule a no-cost, no-obligation screening to see if you are a good candidate. Dr. Litscher can help you decide what procedure may be most appropriate for you. When you are ready to proceed, a full comprehensive eye exam is scheduled with Dr. Litscher. Several types of measurements will be made of your eyes. It is important to leave contact lenses off for some time prior to the exam. Contact lenses can alter the true shape of the cornea over time and could adversely effect these measurements.

• Soft contact lenses should be out for two weeks before the exam.
• Rigid, gas permeable, or hard lenses should be left out for three to four weeks before the exam.

If you have any prior eyeglass prescriptions, it is helpful to bring them with you. If your refraction (measure of eyeglass prescription) is thought to be unstable, you will be rescheduled for another measurement in one to three weeks. Back-to-back refractions should be stable before your procedure is scheduled. Additional tests include corneal topography (a mapping of the corneal contour) and corneal pachymetry (measure of corneal thickness). All these measurements are critical to obtaining the best outcome of your laser surgery. Our goal is to ensure that we meet or exceed your expectations for your laser vision correction. The Litscher Eye Center has been performing laser vision correction since 1997, the longest track record in western Massachusetts, and we are proud of our record of success.

For people over 50 years of age who are very farsighted or very nearsighted, there is an alternative to laser vision correction to obtain improved vision without glasses. This involves replacing the natural lens in the eye with a lens implant of the proper power to focus clearly in the distance. The recent availability of new technology multi-focal and accommodating implants allow the possibility of restoring the eyes' youthful focus power to see far, near, and everything in between, with little or no dependence on glasses. In fact, some people over the age of 50 may be seeking a procedure simply to restore their ability to focus up close without the need for reading glasses. The loss of reading ability with age is called presbyopia, and clear lens extraction with a new technology lens implant like Crystalens™ or ReSTOR™ is also a presbyopia-correcting surgery. These operations are essentially the same as cataract surgery, except the lens in the eye is removed before an actual cataract has developed.

Laser refractive surgery is surgery on the cornea - the thin, clear dome that covers the front of the eye. Wouldn't you like to know that the surgeon operating on your corneas is a highly trained specialist in corneal surgery, someone who has many years of experience with intricate corneal surgeries as well as laser procedures? Dr. Litscher is one of the few true fellowship trained corneal specialists in western Massachusetts who performs many types of corneal surgeries as well as laser surgeries. Dr. Litscher has 25 years of eye surgery experience and was Springfield's first corneal specialist when he arrived in 1987. Dr. Litscher was also the first surgeon in western Massachusetts to perform corneal refractive surgery, starting with radial keratotomy for nearsightedness in 1990. He became the first surgeon in Springfield, Massachusetts to perform laser refractive surgery (PRK) when it was FDA approved – thus having the longest refractive surgery track record in western Massachusetts. Dr. Litscher has been certified on both VISX and Allegretto Wave™ laser systems, and currently uses the Allegretto Wave™, the fastest scanning laser available. FDA studies have shown superlative results from this laser compared to the other currently used laser systems.

Dr. Litscher insists on examining every one of his patients personally, and answering all their questions. He takes a personal stake in their satisfaction, and takes personal satisfaction from successful results.