Category Archives for Astigmatism

Types of PIE or Presbyopia implant in eye

Presbyopia implant in eye has been the new revolution in vision restoration. It has eclipsed Lasik as the number one choice to improve vision in people over age fifty years.

A good tailor as well as a good surgeon knows that one size does not fit all. This holds true even with PIE. There are four classes of FDA approved PIE. These are Accommodative, extended depth of field (EDOF), Trifocal and Multifocal.

Accommodative PIE: This class of PIE were the first to be approved by FDA in 2005. They heralded the advent of PIE. Crystalens was the first out of the stable. It had various modifications till it evolved int Crystalens HD. Today we have Crystalens AO and Trulign. They are made of silicone. Crystalens AO has aspheric optics whereas Trulign has aspheric optics and built in astigmatism correction. They work by assuming a curved shape in the eye, increasing the range of focus. This shape and the unique design of the lens may also allow it to move forward and backward mimicking the natural lens. This lens has proved very useful in patients who have had previous eye surgery like lasik vision correction, radial keratotomy and other corneal procedures.

Extended Depth Of Field (EDOF)PIE: They are in a class of their own. They resemble multifocal PIE in appearance but function on a different optic principle. They increase the natural depth of field. It provides a continuous field of vision, though the range is not as extreme as in multifocal. Symfony and Symfony toric are the two contenders here. As you may have guessed from the names, sympfony toric can also correct astigmatism. Hence, they find great use in eyes with astigmatism. Both also are used in eyes where crystalens may not be an option.

Trifocal PIE: These PIE have apodaizations or rings in their center. The unique heights of the rings of this lens allow the incoming light to be split into three foci. One for distance, second for intermediate and third for near. Optical engineers can modulate the height of rings and distance between rings to design varying focal length for each zone. Currently we have Panoptix and astigmatism correcting Panoptix toric.

Multifocal: These are the lenses which arrived earlier than trifocal. They are truly bifocal but were labelled multifocal to distinguish them from bifocal glasses and contact lenses. Their mechanism of action is totally different than bifocal glasses. In bifocal glasses the top segment is for distance and lower for near. These are refractive lenses. This method was tried in the previous century but was not successful. Multifocal PIE are diffractive in construction and have a focal length for distance and one for near with an overlap for middle. They allow more light for far and therefore better distance vision. Restor and Tecnis are the two lenses in this class.

A surgeon who is an PIE expert needs to be proficient in all these types of presbyopia implants. Matching the best PIE to the patients’ after understanding the goals of the patients is paramount to success. This can sometimes involve implanting a different class of PIE in each eye.

Treatment for Kearatoconus eye disease

Kertatoconus Expert Answers Your Questions

​Q1. Is Keratoconus eye disease hereditary?                                                                          A1. Genetics are supposed to play a part in transmission of this disease.

Q2. Neither my parents nor my grand parents had the disease. Why did I get it?           A2. Your grandparents may have had subtle disease. In those times diagnostic equipment to detect this sight threatening disease did not exist. There is also a possibility that your disease may be a new mutation. Finally there is a chance it may be not be hereditary.

Q3. Besides genes is there any cause for getting Keratoconus?                                         A3. Rubbing the eye is a major culprit. In fact there is a school of thought that this is the major common pathway for progression. So please do not tub your eyes.

Insurance and keratoconus treatment reimbursement.

​Q. Does vision insurance like VSP or Spectra cover surgical treatment of keratoocnus?                                                                                                                               A. VSP covers for contact lens like scleral contact lens​ for improving vision in keratoconus eyes. They do not reimburse for cornea cross linking or intacs.

Q. Which medical insurance covers cxl for keratoconus?                                                   A. Many medical insurances have started reimbursing for prevention of progression of keratoconus. An important caveat is that the surgeon has to be certified  to use FDA approved riboflavin. Currently Avedro Photrexa is the only FDA approved.

Q.If I have a high deductible, can I still have cxl?                                                                A. Yes you may even use affordable monthly payment plans.

Q. Can i use my flex or HSA plan towards my keratoconus eye procedure.                   A. Since this is a medically necessary procedure you can pay for it by HSA or FLEX funds.

Treatment options of Astigmatism

Astigmatism – Everything you wanted to know about it

Scleral Contact Lenses – a new hope


If you have actually been told in the past that you cannot wear contact lenses due to an irregular cornea or various other problems, you might wish to get a second opinion and also ask your ophthalmologist regarding scleral contact lenses.

Scleral contacts are large-diameter or larger in size than normal contact lenses or gas permeable contact lenses specially designed to vault over or cover the whole corneal surface area and also hinge on the "white" of the eye (sclera). In doing so, scleral lenses functionally replace the irregular cornea with a flawlessly or perfectly smooth optical surface area to correct vision problems caused by keratoconus and various other corneal irregularities.

Additionally, the space in between the cornea and the back surface area of a scleral lens acts as a fluid reservoir to provide convenience for individuals with extreme dry eyes that otherwise might not endure contact lens wear.

Types of Scleral Lenses

Scleral contacts are significantly bigger than conventional gas permeable General Practitioner contacts and have a diameter equivalent to or greater than that of soft contact lenses. The smallest sclerals are around 14.5 mm in diameter, and also the biggest can be approximately 24 mm.

How a scleral lens vaults over a misshapen cornea to assist somebody with keratoconus see far better.

Large-diameter scleral and semi-scleral General Practitioner lenses hinge on the sclera and vault over the irregular cornea of an individual with keratoconus, for better vision. Increase the size of generally lenses that are 18 mm or smaller are subcategorized as mini-sclerals.

The ordinary human cornea is around 11.8 millimeters in diameter, so also the smallest scleral contacts are developed to cover the entire} corneal surface area.

In contrast, the majority of traditiona General Practitioner contact lenses are 9.0 to 9.5 mm in size and cover only 75 to 80 percent of the cornea.

An additional category of gas permeable lenses bridges the size gap between traditional General Practitioner lenses and mini-sclerals. These lenses, called corneo-scleral lenses, normally are roughly 13 to 15 mm in diameter.

Corneo-scleral lenses often} are a great {option for people who require larger-than-normal General Practitioner lenses for betterconvenience}. They also are frequently used when contact lenses are required after LASIK or other corneal refractive surgical treatment to correct irregular astigmatism.

The dimension of lens used usually is identified by the level of complexity of the condition. Milder types of keratoconus and irregular astigmatism from corneal grafts as well as refractive surgical treatment frequently are conveniently managed with scleral lenses at the smaller sized end of the spectrum.

Smaller sized scleral and mini-scleral contacts can be much easier to apply, can be less expensive and need less} care products

Much more complicated problems, consisting of advanced keratoconus, pathologically dry eyes or serious eye surface condition that may call for a huge tear storage tank, commonly are fitted with bigger scleral lenses, as they have a lot more capability to hold liquid or bridge huge adjustments in corneal curvature.

Throughout your contact lens examination as well as fitting, your eye treatment expert will certainly establish the most effective scleral lens type and also size for your particular requirements.

Scleral Contact Lenses for Keratoconus

Several optometrists as well as ophthalmologists advise scleral contact lenses for a range of hard-to-fit eyes, consisting of eyes with keratoconus.

In instances of very early keratoconus, a common GP lens might be made use of.  Nevertheless, if the lens does not center correctly on the eye or moves excessively with blinks and also triggers discomfort, switching over to a large-diameter scleral contact lens might solve the problem.

Since scleral lenses are developed to rise the corneal surface and also hinge on the much less sensitive surface area of the sclera, these lenses usually are much more comfy for an individual with keratoconus.

Additionally, scleral lenses are developed to fit with little or no lens activity or movement during blinks as they are hinged on the sclera, making them much more stable on the eye, compared to conventional corneal gas permeable lenses.

Scleral Contact Lenses for Various Other Eye Troubles

Along with keratoconus, scleral contact lenses can be utilized for various other eye problems such as eyes that have actually undergone a corneal transplant, and also for individuals with serious completely dry eyes triggered by problems such as Sjogren's disorder, graft-versus-host disease (GVHD) and also Stevens-Johnson disorder.

Advancements in lens design technology are enabling makers to develop scleral lenses that can remedy a lot more problems than ever, consisting of bifocal sclerals for the correction of presbyopia.

Special-Effect Scleral Contacts

Often the term "scleral lenses" (or "sclera lenses") additionally is used to explain special-effect contact lenses that significantly change the look of the user's eyes.

Nevertheless, these costume contact lenses also called theatrical contact lenses, Halloween contacts or gothic lenses generally are soft lenses that bear little resemblance to scleral gas permeable contacts in -- apart from their big diameter size to completely mask the cornea. Likewise, soft theatrical contacts generally are made for aesthetic functions just and not for vision correction.


Scleral Contact Lenses Aid Celebrity Perform Crazy Movie Stunt

Star Tom Cruise is known for doing his very own adrenalin-pumping, in some cases crazy film stunts. In his 2015 movie Mission Impossible Nation, Cruise put on scleral lenses during one of his stunts.

Enjoy as Tom Cruise prepares for one of his most talked-about motion picture stunts. See if you can catch the clip where they insert his scleral contact lenses.

Cruise put on the scleral lenses to safeguard his eyes as well as enable him to open them while dealing with {high speed winds. Why did he require them? Due to the fact that the star did a scene hanging onto the wing of a turboprop armed forces transport airplane the Airplane that flew 5,000 feet in the air.

Scleral contact lenses are tailor-made for every user, so suitable scleral contacts needs better know-how as well as even more time than fitting conventional soft or GP contact lenses.

Typically, computerized maps of the curvature of the whole cornea are produced to assist in the lens installation, as well as a number of test lenses of various dimensions and also curvatures might be related to the eye during the fitting process.

Cataract Surgery Los Angeles

Cataract surgery Los Angeles county is what you need when cataracts interfere with your activities. Do you feel you have cataracts or has your eye doctor diagnosed you with cataracts? Either way, you may feel a haze in front of your eyes. Some people require extra reading light. This may be just inconveniences. Watch out for more debilitating symptoms. Glare and  haloes may make driving unsafe. Work may be affected by vision which cannot be corrected with glasses.

What is Cataract Eye Surgery?

A method to enhance vision by removing the natural lens which turns hazy and in many cases opaques. In the past (and maybe still in some third world countries the lens was removed in toto. Currently in Los Angeles, USA the most common is to open the natural lens and remove only its contents. Dr. Khanna replaces these degenerated lens fibers with state of the art biocompatible synthetic lens implants. So it is similar to an engine oil change. Out with the bad and in with the good. It is vey important to remember that Dr.K does not like to replace the entire lens. Keeping the outer covering of the lens intact allows him to place the artificial new lens in a natural stable position. If the entire lens were to be removed there would be no support for the replacement implant.

Advanced Refractive Cataract Surgery Los Angeles

Los Angeles is a big county. Cataract Surgery Los Angeles therefore offers many choices. You have to inform yourself with the latest knowledge. This will allow you to select what is best for your eyes. Cataract surgery is not same what it was 40 years ago. Believe it or not Dr.Khanna has been performing cataract eye procedures for over 25 years.Today you should choose Advanced Refractive Eye Care Cataract Surgery Los Angeles. 

What is Advanced Cataract Surgery?

Cataract Surgery Los Angeles

Small incision : The size of the wound affects astigmatism. Smaller wounds also heal quicker.

PIE: Presbyopic Implants in eye. These special lenses inserted in a natural position allow good vision at all distances, in each eye

Laser cataract surgery: Femtosecond lasers for cataract surgery add precision to the procedure.

No astigmatism: Astigmatism free results give better visual outcomes.

Quick recovery: Allows you to return to daily activity and work sooner

No patch : You don’t need to look like a pirate.

No needles :  Do you really want to be poked around the eye? If not come to us.

No pain.  We have enough pain as we age. Fear of pain prevents people from having eye surgery. We strive to make the experience pain free.

No stitch; The small openings do not require needles and threads. Stitches cause foreign body sensation and redness.

No wait: Tired of waiting weeks to see your HMO/ACO doctor? Come to us. Quick appointments. We respect your time and you will be seen at your appointed time.

Good outcomes : The purpose of surgery is to deliver great results. All steps carefully executed lead to amazing vision.

Yes we have come a long way in our techniques and outcomes for cataract surgery. Do not settle for older methods.Your eyes are important. Decide what you want out of the procedure. Its a once in a lifetime opportunity to do any with all sorts of contact lenses and glasses. Get rid of astigmatism and poor vision. Obtain clear vision at all distances in each eye. Yes – ALL distances – Not monovision. CALL NOW (805) 230 2126 to improve your vision and change your lifestyle!




What to expect on day of Lasik Eye Surgery

This is an updated article about what to expect on day of Lasik Eye Surgery. Many people are anxious about the procedure and this informative piece is directed to them. One of our secrets is work on this anxiety even before the day of procedure. How do we do this? We go over all consents and explain the procedure in detail a few days before. Our considerate staff even helps them finance the procedure ahead of time. For the special extra nervous or claustrophobic folks we even lay them under the laser and do a demo.

LASIK surgery is very beneficial and in most cases a painless procedure. The procedure itself is only about 4 to 5 minutes for both eyes. At Khanna Institute we strive to make it as comfortable as possible for each of our patients.

We make all patients feel welcome at our office. There is always someone at the front desk to greet and help the patient. This eases anxiety. We offer Xanax in low dose to further lower apprehension. Last minute questions are answered by our knowledgable techs. Once everything is ready for surgery the patient is taken back and prepared for their LASIK surgery. This includes  getting a bonnet to cover their hair and Cleaning the eye with Betadinde solution swab. It is the strongest antiseptic. It kills bugs hiding in the lashes of the eye.

When in surgery suite the patient is lasik flat under the idesign laser system. The patients family or friends can watch all of the laser eye surgery through the window. Advanced automated idesign lasik surgery is performed. Throughout the procedure there is patients fav music in the background. Doctor and surgical and laser techs explain each step so nothing comes as a surprise.

After the LASIK surgery the surgeon checks each eye to make sure the patient is fine. Then the post up instructions are given. The eyes are shielded and dark sunglasses given. Postoperative instructions are given. The patient then is free to go, but will come back the next day for a follow up. Patients are always satisfied with their noticeable improved vision as soon as the next day.

We hope what-to-expect-on-day-of-lasik-eye-surgery helps you to overcome anxiety of your Los Angeles  lasik procedure. If you have suggestions for this or future posts please do not hesitate to contact us.

How to fix lazy Eye

How to Fix a Lazy Eye

How to Fix a Lazy Eye is a question often posed by young parents. Lazy Eye is a term used to define an eye that cannot see to its full potential. You may be aware normally an eye should see 20/20. That means that a person standing at 20 feet should see what a normal person sees at 20 feet. If a normal person can see at 40 feet what you see at 20 feet than your vision is 20/40. If after correction with glasses or contact lenses the vision does not improve to 20/20 than the eye is termed as Lazy. The medical nomenclature is Amblyopia.

Let us understand why an eye becomes lazy. The role of eye is transfer information from the surrounding universe to the brain. The eye condenses the light reflected from various objects on the macula. Electric signals generated are transferred to the brain by optic nerve. A specialized area of the brain called the occipital lobe converts these neuroelectrical signals into vision.

Any flaw in this process leads to an Amblyopic or Lazy Eye. There are three types of Lazy Eye.

The first kind is Neurological. This occurs when there is an obstruction in the neurological pathway or the brain. If the optic nerve is not developed, or the conduction pathways are malformed the light is not transmitted to the grey matter. Also the brain may be underdeveloped due to infections or genetic causes. This is the most challenging kind; currently this is not amenable to treatment.

The second kind is deprivation amblyopia. If the light is prevented from reaching the macula, it fails to stimulate the brain. There are various causes for this. Cornea may be opaque. There may be cataract in the lens. The jelly behind the lens may be fibrotic and hazy. The good news is that treatment can be provided. The earlier it is instituted the better the chance of fixing the lazy eye. Cataract procedure may have to be performed even before the baby is one year of age.

The third kind is refractive Amblyopia. The cause is nearsightedness, farsightedness or astigmatism. When the eye is very small or very large or has astigmatism significantly higher than the corresponding eye it is at risk of developing Amblyopia. Here the light reaches the macula and messages are delivered to the brain. But the messages are distorted. Since the brain keeps receiving information it has the best potential to recover.

How to Fix a Lazy Eye caused by Refractive Error

The way to do this is to fix the refractory error. The correct procedure would be influenced by the age and the refractive power. If the numbers are in the range of Lasik eye surgery this may be the simplest procedure. In such instances Lasik may even be performed on kids as young as six years. Sometimes an artificial lens may need to be implanted over the natural lens. If the person is above fifty years of age a presbyopic implant may be the best option.

In summary Refractive Amblyopia has the best chance of improving. This is possible in kids, young adults and even older individuals.

If you have any questions on how to fix a lazy eye please call (805) 230 2126

Idesign wavescan lasik

Los Angeles Custom Lasik IDesign or Topo guided Catz or Contoura

Los Angeles Custom Lasik has reached a new level of personalization. In 2017 we have more choices of sophisticated technology than ever before. Idesign wavescan from Johnson and Johnson is leading the brigade. Catz from Nidek and Contoura from Alcon are on its heels.

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FDA approves iDesign Lasik for mixed astigmatism

Breaking News Jan 11 2017 – Mixed Astigmatism meets its match

FDA approves iDesign Lasik for mixed astigmatism. Mixed astigmatism is the most problematic of refractive disorders. The two curvatures are are unequal. Thier relationship with the length of the eye causes one curvature to be farsighted and the other to be nearsighted. With the iDesign wavescan studio system, doctors can map the most extensive visual path of the eye. This helps in generating a very accurate ma of the problems in eye which the laser can than fix.

Symptoms of mixed astigmatism

You may not even realize you are suffering from mixed astigmatism. A person with defect of the eye is not able to see sharp inspite of glasses. The vision can fluctuate. Contact lens slip and fall off. With blinking contacts can move and make vision blurry. You may even have redness of eyes requiring visine. Headaches may be a symptom.Many patients suffer through life. Some have been turned doen for lasik eye surgery previously as laser were not adept at getting good results with this anamoly.

Free Screening for mixed astigmatism.

We at Khanan Vision Institute want to help you in your battle against mixed astigmatism. We are offering a free analysis of your eyes on the idesign wavescan studio. The best part is you even get to take your idesign waveprints home. Call (310) 482 1240 to schedule your consult.

In the FDA approved clinical study of the idesign lasik eye surgery, 91.9% of 149 eyes reached uncorrected visual acuity of 20/20 or better without glasses at 3 months after surgery. Of interest was the fact that the eyes were stable at three months.

FDA approves iDesign Lasik for mixed astigmatism

Rajesh Khanna MD opines this approval is a giant leap in the accuracy for this complicated disease. He is one of the handful of lasik doctors in Los Angeles and Ventura counties offering this new safer lasik technology.

How to fix Astigmatism

Is Your Astigmatism Bothering you?

Do you or someone you know suffer from headaches, eyestrain, squinting, and distorted or blurred vision? If so, you may suffer from astigmatism, but do not fret! Astigmatism is not a disease it is merely a refractive error, caused by an irregularly shaped cornea which hinders how your eye absorbs light. Lucky for you, in this day and age there are many ways on how to fix astigmatism! You will find three of these ways listed below.

How to fix Astigmatism in the 21st century

One way to fix astigmatism is through a procedure called Customvue Wavefront Laser Vision Correction, or Lasik eye surgery. Through Lasik eye surgery, we are able to reshape the cornea, which in turn decreases or completely eliminates the refractive error of the eye, aka the astigmatism.

Another way is through Limbal Relaxing Incisions, or LRI. In LRI, small incisions are made at opposite ends of the cornea. Once the incisions heal the cornea becomes more spherical in shape and helps to reduce or eliminate astigmatism.

The last way we are going to cover is through the use of Toric Implantable Lenses.  These are premium intraocular lenses that correct not only astigmatism, but also near and farsightedness.  These lenses are able to correct astigmatism, because they have different powers in different meridians of the lens. The surgeon is able to adjust the orientation of the lens inside the eye by using the alignment markings on the peripheral lens, optimizing astigmatism correction.

How to fix astigmatism

If you believe you may be suffering from astigmatism, help is here. There is no need to suffer any longer! Through Customvue Wavefront Laser Vision Correction, Limbal Relaxing Incisions, and Toric Implantable Lens, there are plenty of ways to fix astigmatism.

A consultation with an expert in astigmatism correction will be beneficial to you. Feel free to contact us and we may even be able to offer you a free screening visit. Call Now 310 482 1240