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
Los Angeles Lasik Surgeon Rajesh Khanna MD is a recognized pioneer in Presbyopic Implants for correction of aging eyes. He has popularized Cornea Cross Linking and Intacs forKeratoconus. He is an Expert Cataract, Pterygium Eye Surgeon, A Cornea Specialist he performs Laser Corneal Transplants, DMEK, DSEK and DALK. Rajesh Khanna MD is a well known medical writer. He has published the bestseller "The miracle of Pi in Eye".He is also a columnist for the newspaper Acorn. Dr.Khanna also hosts "Medical Magic". In his spare time he hikes with his family and German Shepard or does yoga. He also plays field hockey and loves swimming.