Q. Repeat PRK or Photorefractive Keratotomy possible? Hi, welcome this is Dr. Khanna. I’m going to speak to you about a very interesting topic which came up this morning. Somebody who ten years ago had PRK which is photorefractive keratectomy. If you remember, PRK came before Lasik about 20 to 25 years ago. I remember doing my first one in 1997 or so. At that time, we did not have all the advanced lasers that we do now, nor did we have advanced medicines and drops like today, so a lot of the experiences patients had with PRK was very bad. In fact, that’s why we don’t do PRK today and we’ve gone on to Super Lasik, Epi Lasik or Laser Scraper modifications. Today, it’s a much more comfortable journey.
The topic we are coming to is, if you had PRK 10, 15, or 20 years ago and you need a touch up, what’s the best option? The best option would depend on your age. Let’s say you’re in your 40s, the touch up is likely to be less than one or two diopters. In those cases, we would to have to check your cornea with the latest methods of pachymetry and topography mapping to see if, by any chance, Lasik is possible. Ninety percent of the time, PRK might have been done because Lasik was not an option, but there might be 10% of cases that were done because Lasik was unavailable, or the surgeon was not very confident with Lasik at the time.
It’s important to come for a full exam so we can analyze what’s best for you. There are some people who will have corneal weakening or excess refractive numbers, in those cases you would want to see if implantable collamer lens (ICL) might be an option. Let’s say you’re about 55, then before we do a laser touch up, we would first have to discuss other options like presbyopic implants.
Yes, I missed the one age range for 40 to 55, right? That’s interesting because in that group there can be multiple options available and we’ll have to discuss your lifestyle, look at the numbers, and then come up with a better solution. There is no fixed answer for that age group.
As a summary, if you’re less than 40, laser touch up with PRK or rarely with Lasik, might be an option. If you’re above 55, presbyopia implants might be the first option. In 40 to 55, one of these previous two options might work depending on your lifestyle.
If you have any more questions about PRK, Lasik, touch ups or enhancements, feel free to write to us. Thank you and have a wonderful day.
Did you feel that earthquake? Yes, we were rocked by an earthquake with the epicenter being near Channel Islands. We were very lucky, we didn’t have any injuries, and nothing broke down. But, two patients came today with some interesting observations and stories and I wanted to relate them to you.
One patient recently had Lasik with us. He said when the earthquake struck he was one of the special invitees who has the alarm on his phone which goes off a few seconds before an earthquake strikes. He was able to pack his bag and rush out of the building before the earthquake struck. The second patient who came said yesterday he realized why we should have Lasik eye surgery.
He had just taken off his glasses and was rubbing his eyes or something like that when the earthquake struck. When everybody started rushing out, he ran out as well; however, he couldn’t see well because he wasn’t wearing his glasses causing him to hit his head on the door as a result.
He came in today saying, now I need Lasik eye surgery. This is just one of the examples I’ve come across in my twenty-six years helping people see better. One of the small things in life which can change when you have better vision during some big things like a natural calamity like in a storm, Hurricane Katrina, et cetera. Or, an earthquake like yesterday.
When vision becomes one of the most important things in regards to our safety, it’s at that time that we realize how important it is for our emergency responders like firefighters to have good vision when they run into smoke, rubble, and fire to save people.
I’m sure you have other interesting stories where either you’ve already experienced the benefits of having Lasik eye surgery, or you wish you had Lasik eye surgery. We would love to hear from you, so send us your stories.
Lasik Earthquake Safety lesson is over
Thank you. This is Dr. Khanna signing off.
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Hi folks. This is doctor Khanna, your laser eye man. Coming to you with some new information. Today, I am going to talk to you about the 7 myths of cataract eye surgery. Cataract surgery has been there for many ages. You have probably heard about it but what is interesting is that your grandparents have probably heard about it. Even their grandparents knew about cataract surgery. Over the years, cataract surgery has advanced so much. The surgical finesse has become so much better that the modern day cataract surgery is way ahead the cataract surgery that was performed 60-70 years ago.
The problem is all the new information and knowledge has not circulated to the masses. Most of the information from decades old technology is still circulating amongst our friends and relatives. Today, I want to destroy all these myths, which are still existing.
MYTH 1 Cataract Surgery You have to wait for cataract to get ripe before they can have surgery.
This might have been true around 60 years ago when we did not have microscopes, surgical lubes and stitches. We did not have modern technology to pulverize the lens and take it out through small openings. At that time, the only to take it out was when you could see that the cataract is white, red or black. Freeze it and then pull it out in mass. Over the years, we have developed surgical loops, microscopes to binocular microscopes and we can see the smallest things in there. We can make minute openings, go in there and remove lens, which might not have been visible to the naked eye. That is the first myth that we have to destroy totally. In fact, the opposite is true. You should never wait for the cataract to get ripe because as the cataract matures, it gets hard and requires more energy to be taken out. Why is so much energy bad? It is because we are in a closes space in the eye and the energy is going to hit the iris (the colored part of the eye), the cornea (the clear front part of the eye) and damage the cells. We want to avoid that. The first myth has been dismissed.
Myth 2 The doctor has to decide when you need cataract surgery.
This is news from a by-era when the doctor has to see the cataract and he was comfortable with the surgery. Today, it is all about you. Even Medi-care, medical insurance and everybody says that. The best time to do cataract surgery is when you feel that the cataract are bothering you and interfering with your active lifestyle. For different people it might be different. If you are 52-years old, and you have cataract that cause a lot of glaring driving, it might be troublesome for you and you might an early intervention. If you are a librarian or a stay-at -home person who does not drive a lot, then those minor cataract might not cause a lot of difficulty to you. You get to decide not the doctor or the insurance.
Myths Cataract Surgery #3 You cannot go blind with cataracts.
It is important because many people are fearful of cataract surgery. They feel that the surgery will harm them and that cataracts are not going to cause any problem in the long run. That is wrong because the cataract is hardening and changing the lens and it gradually keeps cutting off the light until there is no light. You would be surprised to know that cataract is the most common preventable cause of blindness in the world. When the cataract hardens, it can lead to increased pressure and inflammation leading to blindness. The third myth that cataracts cannot make you go blind has been busted. You should do everything at all cost to avoid it.
Myths Cataract Surgery #4 The cataract has to be removed entirely.
This was the in the 70’s when the cataract had to be taken out in mass. That is not true and in fact, the opposite is true. We do not want to take out the entire cataract. We take out the cataract bag, clean out the contents and put in a new synthetic lens using the old lens as a support of the new lens. If you do not do that, the new lens would fall down and you do not want that. It is like taking your car for an engine oil change, out comes the old and in comes the new. You do not change the whole cask of the engine itself.
This myth is close to everybody. Today, it is not true. Today, cataract surgery is one of the simplest and easiest procedure to perform. We keep it pain free both by topical drops and specially formulated drops that are instilled inside your eye. We make sure that your eye is numb and is pain free. We do not have to numb your whole body.
Myth #6 You have to be put out during cataract surgery.
If we are operating on your eye, we do not have to numb the whole body. We can take care of the pain.
#7 Myth Cataract Surgery
Recovery is long and painful. That is not true. Why? It is because it is a simple surgery performed in a short period of time for about 7-10 minutes. You are pain free and not totally asleep. Many people can go and work or even drive the same day if we do not give them enough medications. That is not what we are recommending. It is not like before when it was six weeks, in a day or two, you can go back to your activities of daily living.
I hope this information is useful and we have destroyed these 7 myths for now and forever. Thank you and have a wonderful day.
Hi. Welcome. This is doctor Khanna. I want to talk to you about fear of eye surgery. This lesson is divided into three parts. Today’s lesson is on why we are so afraid of eye surgery. In the forth coming lesson, we will discuss how to overcome the fear. Why are we so afraid of eye surgery, we have to delve back into evolution, our upbringing and find some answers there. People are always afraid of the dark. Remember when you were a kid; you thought that there might be a monster in the closet or under the bed. People are afraid to go to the graveyard but today it is so much better. There are streetlights everywhere and we have a phone with flashlight on it.
Imagine Sherlock Holmes going out in the night when there is fog and mist around. There is an inherent fear in us coming from the times we lived in the forest. In the night, predators would come out and that fear has continued. Another thing you might have heard of is insomnia, when people are unable to sleep. It is very interesting why some people find it difficult to fall asleep and the simple answer might surprise you. The answer could be that they are afraid that they may not be able to get up if they go to sleep. They are afraid to lose their consciousness and go into a semi-conscious state. It is inculcated in every culture. Each civilization that is present on earth celebrate the festival of light in the dark days. That is their hope to overcome the darkness.
Another fear the people have is for the white coat. It is funny that people can check their blood pressure at home and it is okay and then they come to the hospital and see the white coat and the blood pressure shoots up. These are all evolutionary mechanisms that are built in for safety to preserve us and they all stack against us. There is one more called the menace reflex; when something comes near the eyes or when we sneeze, they instantly close. That is encoded in our DNA.
Corneas and eyes are every important. In fact, some evolutionary biologists feel that this reflex may have pre-dated the existence of eyes. Small microorganism who do not have eyes have had light shun on them and they immediately move away. All those things combined in the subconscious and conscious mind are all playing to develop fear about eye surgery. Do not feel fearful.
In the next lesson, we are going to come up with methods that are time tested and true to see, how we can overcome the fears regarding eye surgery. Thank you
Hi. How are you? This is doctor Khanna, laser man here once again, bringing you up to speed with the latest in eye technology. Today, we are going to talk about a very exciting and new topic; laser cataract surgery. There are a lot of myths about laser cataract surgery and we are going to bust them all. We are going to talk about 7 myths of laser cataract surgery, which has been found not to be true and we are going to go over it one-by-one.
Laser cataract surgery is safer the manual cataract surgery. Even doctors believe that but reports came out of a study that showed that it was not the case. Laser surgery is at best as good as manual cataract surgery but not safer. That is one myth, which has been busted not by me but by published and reviewed journal studies of Europe.
Laser cataract surgery is going to be free and covered by insurance. That is not true. Medical insurance has determined that if someone wants to upgrade to laser cataract surgery, they will have to pay extra.
Laser can perform all the steps of cataract surgery. I think that is one of the biggest myths out there, thinking that it is going to be a robotic surgery and robots are going to come and do everything. That is not true. Lasers do certain steps pf the procedure, mainly opening in the lens and sometimes cutting the lens. They cannot do all the steps. In fact, some steps are done better by hand.
Cataract wounds made by lasers are better than those made by diamond knives. The reverse is true, diamond knives can make better and more precise wounds than the current generation of lasers used in cataract surgery. It is very logical why this happens, because the laser will need to see where they have to act. They are seen by using ‘ocular coherence topography’. The wounds have to made at the junction between the clear part and the hazy part which is the cornea and sclera. It is sometimes not discreet for the machines and that is why human eyes can detect them better and make better wounds.
If we do laser cataract surgery, we would not have to wear glasses after the procedure. That is not true. Only ‘presbyopic implants in eye’, can free you from the bondage of contact lens and glasses after cataract surgery and not laser.
After cataract surgery, drops will not be needed. Again, that does not hold the light of day. You will need drops. Drop less surgeries is a different concept. After the laser cataract surgery, you might need more drops.
Laser cataract surgery might be less painful and faster by cataract surgery done by hand. I feel sorry but, we have to bust that one too. When we do laser cataract surgery, we have to apply something that would hold your eye while the laser moves around making the openings and cutting the lens up. That is held by negative suction pressure, which is painful and we have to give you medication for that. For that, we have to add another step, we have to do the part of the surgery done with laser first and then in the operative room, we have to do the rest of the surgery by hand. It increases the time that you would be in the operating theater.
I hope you have seen the truth about laser cataracts surgery. It is a good procedure but it is not recommended for all based on knowledge and published studies that we have. Thank you for listening to me. Have a wonderful day. Keep sending your questions here.
Interviewer: Hi guys, today we are hanging out with the laser man and we are going to ask you a few question. How are you doctor?
Doctor Khanna: Fine, thank you and welcome to this show.
Interviewer: Okay, the first thing I would like to know. Since you have been talking about laser surgery, how long does it last?
Doctor: There are two answers to that if I understand correctly. First, what I understand is how long will the procedure take. The procedure takes a minute or two per eye. The second part if I understand correctly is; will it last me a lifetime or not. In the modern technology of ‘eye design laser surgery’, it is a lifetime outcome. 20 to 25 years ago, with the other conventional lasers, it never lasted long. All infrared group was incorrect and it did not last. Without confusing you, if you are in your 20’s to 40’s and you are a good candidate for ‘Lasik’, which is a computer, controlled active laser eye design technology. The imperfections will be wiped off for life. So it is a lifetime investment.
Interviewer: Wonderful. Now that we have asked about this part, I would like to ask you what the side effects or after effects, we can have from this surgery?
Doctor: That is a very good question. We need to know about that so that we can plan ahead and in our practice we avoid those side effects. The most common being dry eye. Because we know that, we are fashion a flapping Lasik eye surgery. Whenever you do a flap whether it is by laser or by automatic microkeratomes, you end up cutting the cornea nerves. The cornea nerve supplies the eye with sensation, which helps in the production of tears. Around 3-6 months after Lasik, while the cornea nerves are recovering there can be dry eyes. We start patients on artificial tears ointment and even put in (inaudible 02:12) to preserve the natural tears. Another side effect, which used to be more common but it is less common but still occurs is ‘glaring halos’ in the post-operative period. Treating the dry eye does decrease that incidence but is somebody is inconvenienced we do prescribe yellow tinted glassed that people wear for driving bikes which cuts of the glare.
Finally, there can be under correction or over correction with eye design technology but the incidence is very little. To make sure it does not occur we have nomograms we apply and this should measure the refraction between one to three months to make sure we hit a point and brought the patient down to zero. Those are the common side effects. In some patients, especially the younger ones there can be some inflammation in the post-op period. We do start steroid drops but do not worry these are not bulk up your muscles, they are very low dose. They do help to prevent and treat the inflammation. Infection is always a treat, we do not see it commonly but we start topical antibiotics drops a day before and we continue for 5-7 days after surgery.
Those are the common side effects that we see and we work hard to prevent any of them from occurring.
Interviewer: Very nice. We have gotten to understand two things today. The first was about the laser, how long it takes and how long does it last. The second thing you were talking about was the side effects. Now that you have mentioned this few things, we just want to know if it is different for each customer or for each person?
Doctor: Yes. Not everybody is a candidate for laser eye surgery. There are certain criteria that they must fit in before we can qualify them. Age being the first, if you are less than 18 years old, you are very mature and have developed cataracts or gone beyond 50 years of age, Lasik may not be the best choice for you. In that age group between 18 and 50, we have to see if your cornea has good uniformed thickness and shape. Shape and thickness of the cornea is important and any systemic disease has to be considered. Finally, your refraction has to be stable, which is usually the case between 18 to 50 years of age. We do like to make sure, so that we do not hit a moving target. If all those qualify and your prescription had to be under 10 diopters and depending on the corneal thickness, we have to see how much tissue can be ablated so that the safety zone is empty.
To summarize, we look at age, refraction, third the stability of refraction, fourth the corneal shape and fifth the corneal thickness.
Interviewer: So it depends on every individual.
Doctor: Every individual is unique as is their eye and all of them must pass these criteria. If there is any red flag on any of that, then we cannot do Lasik for that person. We would have to switch to another kind of therapy like EPILASIK, SUPERLASIK, ICL or presbiopic implant in the eye.
Interviewer: To ensure that the eyes are going to be well kept, well maintained and well done. How do you confirm that the patient would deserve this Lasik or another Lasik that you just spoke about?
Doctor: That is another beautiful question that you have asked me. What we like to do is; we want to know what the patient wants out of the procedure. We know all the procedure we have and what they can give to the patient. Each patient is different, 18-4 it is easier because they want good distance and the eye will change its shape using the muscles to see near. If they qualify, Lasik will be the first choice but if the prescription were high for example -15, we would offer them ICL. If a patient is about 4 or definitely above 55, then ‘SUPERLASIK’ or presbyopic implant in eye is a better choice. The difference being Lasik static vision and presbyopic gives dynamic vision. What I mean by that is; there are three zones of vision.
Distance: when you are driving a car and you want to see far
Middle: which was never important 20 years ago but is definitely important now. For seeing I phones, laptops and dashboard of the car.
Close: for reading and to see small bottles
Lasik can give you one of these three. That is why they say under 50 Lasik works well, because when you see one zone distance, the muscles are strong enough to show you the other two zones by changing the shape of the lens. When you are above 50, the lens is not able to change shape. If you do Lasik, you are able to set their vision for distance, middle or near. Whereas, ‘presbyopic’ gives you all three; distance, middle and near. That is a better choice for people above 50 and Lasik is a better choice for people below 50.
Interviewer: Fantastic. Thank you so much doctor. I am personally convinced about what you have said. I would definitely come up with more questions some other time. It is great to hang out with you. I am looking forward to seeing you again and coming up with questions that the customers or people will ask me
Doctor: Thank you so much. Have a wonderful day