You Can Trust Dr. Khanna at KVI for Lasik because:
- He has successfully performed tens of thousands of vision correction procedures.
- He offers various kinds of advanced lasers and flap making technology.
- Dr. Khanna has done Lasik on his son, mom, his staff members. He will treat you like family too!
- Trustworthy with excellent bedside manners. Voted best Lasik eye surgeon in Los Angeles.
- He personally performs exams before and after Laser surgery on all patients.
- Board Certified by the American Board of Ophthalmology.
- Dr. Khanna offers alternatives to Lasik like Superlasik, PRK with cross linking and ICL.
- Certified caring staff.
- If you want to know more about Dr. Khanna click Rajesh Khanna, MD
Am I a candidate for Lasik Eye Surgery?
We look at four variables to determine a person’s eligibility for Lasik eye surgery which can be summed up in the mnemonic “PAST”.
Power The power of the glasses or contact lenses.
Age The age of the patient. The best candidates are between 21 and 39 years old. We can do Lasik on patient’s younger than 21 and older than 39.
Shape The shape of the cornea as determined using a color corneal topography.
Thickness The thickness distribution map obtained from OCT of the cornea.
Indications: 1) Nearsightedness, or myopia, less than 10 D. 2) Hyperopia, preferably less than +3 D, though Allegretto has given good outcomes up to +6 D. 3) Astigmatism less than 5 D, though we have treated up to 7 D with good results
Contraindications: 1) Keratoconus 2) Pellucid Marginal Degeneration 3) Fluctuating vision 4) Significant change in refraction 5) Very thin cornea 6) Pregnancy
Detection Analysis: 1) Corneal topography 2) Pachymetry map by OCT 3) If needed, analysis by Pentacam
Variations in Procedure: As discussed below, based on the choice of laser and the type of flap, we can have a lot of combinations.
What is Lasik Eye Surgery?
Lasik eye surgery has now been around for close to thirty years. It was introduced in the US in the mid nineties. At that time, if you were in school, in diapers or just a twinkle in your parent’s eyes, you were a good prospect for Lasik eye surgery. If you are a Baby Boomer the chances of still qualifying for Lasik vision correction are dim. You should instead look at PIE, or Presbyopic Implant in Eye.
Lasik is a type of eye surgery in which an extremely precise computer controlled laser is used to reshape the corneal surface so as to fix irregularities that have impaired your vision. The cornea is the clear front part of the eyeball. Lasik eye surgery corrects: Nearsightedness (myopia), Farsightedness (hyperopia) and Astigmatism. It does not correct presbyopia, which causes the need for reading glasses. Presbyopia overtakes all of us once we reach the age range of 40-50. Presbyopia treatments must deal with the stiffening natural lens in the eye and weakening eye muscles, rather than just modifying the corneal surface.
Procedure: Lasik eye surgery
Synonyms: Laser vision correction, all laser lasik, zlasik, ilasik, custom lasik, catz lasik, idesign lasik, Wavefront lasik, Wavefront optimized lasik. You may wonder why there are so many confusing names for a simple sounding procedure. It stems from the manufacturers trying to distinguish their machines from one another. We will make it clearer in the next few paragraphs.
There are three a la carte choices for this procedure.
- Type of flap – a) Thin flap made by automated microkeratome or by laser b) Disposable, no cut by epikeratome c) No flap lasek using chemicals
- Lasers – All approved by the FDA a) Allegretto 500 b) Visx c) Nidek d) Technolas
- Laser cornea interaction a) Conventional by all of the above lasers b) Wavefront optimized by Allegretto c) Wavefront – Visx d) Topography guided by Nidek (catz) and Allegretto d) idesign Wavefront – Visx
We can select one choice from each category above. Our philosophy is to make the best choice for each unique eye. We are unique and lucky to have access to the best in class technology, as judged by our peers in our area.
Let’s look at the choice of flap first. The cornea must meet certain requirements for Lasik eye surgery to be performed. The criterion is more lax for Superlasik, using a no cut epikeratome.
The option of flap or no flap is dictated by the safety aspect regarding the shape of the cornea. If the cornea is normal, then a flap by automated microkeratome or laser is fine. Please note, keratome by free hand is not acceptable and will not be mentioned further. If the eye has had previous radial keratotomy, previous Lasik or has a pterygium, then no flap will be created. In a thinner cornea, or a cornea shaped abnormally, any cuts by a laser or microkeratome are avoided. In such instances, Superlasik or Epilasik is the treatment of choice.
The final choice is determined by Corneal Thickness Distribution, Percentage of Tissue Ablation and Residual Stromal Bed.
The exact laser technology used determines the final outcome in vision. Conventional laser treatments are outdated as they have a smaller optical zone, leading to glare, haloes and regression. Wavefront optimized lasers overcome this issue. Topography guided laser is better for corneal astigmatism, though the FDA has yet to approve treatment of asymmetric corneas. Idesign is the most advanced laser. This advanced technology eliminates guesswork and avoids errors due to manual entry of data. It also detects and treats the entire refractive error, not just the corneal astigmatism.
What are the steps of Lasik eye surgery?
Step 1: Designing a cornea flap using an automated machine or a femtosecond laser.
Step 2: iDesign Wavefront active track laser to change the thickness and shape of the cornea.
Step 3: Re-position the corneal flap and seal it.
How Lasik Works:
Lasik stands for Laser In-situ Keratomileusis, a procedure designed to “shape the cornea from within.” During Lasik surgery, this is exactly what happens: your cornea is re-shaped using a state-of-the-art Excimer laser. The laser vaporizes tiny amounts of corneal tissue so the cornea is made less steep, which then allows the light rays to focus on your retina correctty. This improves your eyes’ ability to focus, providing you with clear vision.
Lasik eye surgery is done to enhance the natural vision and gain freedom from glasses and contact lenses. The eye cannot be made longer or shorter, so instead we alter the focusing power of the eye. As with a camera, where we can add or remove lenses to get a good picture, lasers achieve this by changing the shape of the cornea, the clear front part of the eye. Before Lasik is performed, every microscopic irregularity that is affecting your vision will be mapped out using an advanced technology called Wavefront Diagnosis. This “map” of your eyes will then be used to guide the Excimer laser in re-shaping your cornea, helping the laser target and correct each irregularity. The result is clear, unhindered vision that does not require dependence on glasses or contact lenses.
Does Lasik eye surgery hurt?
No, Lasik does not hurt at Khanna Vision Institute! This is something which is on everyone’s mind. Many people are concerned if Lasik eye surgery will be painful. They also wonder if they will be awake or asleep. Some are concerned with keeping their eyes open, while others worry about holding their eyes still. Let us reassure you that in Dr. Khanna’s hands the surgery is not painful. You may experience some pressure and feel the temperature of the liquids that are instilled into your eyes, but IT IS NOT PAINFUL.
There are certain steps we take in our practice to keep the process a pleasurable experience. The first step is education about the procedure. Our wonderful staff gives a preview of the laser suite and goes through the entire process with you from start to finish. We allow prospective Lasik candidates to talk to patients who have had Lasik recently. This method alleviates anxiety. Xanax before the procedure also helps lessen the remaining anxiety. As we perform the procedure we let you know about upcoming steps so that nothing comes as a surprise.
Thin Flap Lasik
In the early days of Lasik, surgeons did free hand flaps and used primitive instruments. The flaps were variable in thickness, irregular and generated many complications. Today that is below standard of care. The accepted method is to produce a consistent flap with thickness varying between 90 and 120 microns. The designer Lasik flaps are 8.5 to 9 mm in diameter and with uniform edges and hinge.
This is achieved by automated microkeratome.
Blade Free Lasik or All Laser Lasik
This method of fashioning a flap utilizes a femtosecond laser. The design of the flap can be seen on the computer monitor. The flap has a vertical cut, the angle of which can be modified. The thickness of the flap, as well as the size, can be adjusted. The final diameter is dependent on the apposition of the docking mechanism on the cornea. Intralase femtosecond laser has had the longest duration of proven reliability and is our current preferred choice.
iDesign Lasik Eye Surgery for Astigmatism and Nearsightedness
Astigmatism has FINALLY met its match. iDesign, closed loop, automated technology knocks astigmatism out the ball park. This painless, non contact machine sends 1287 beams of light into your eye. The beams reflect off the retina and are captured by a microchip in the iDesign machine. It analyzes the change in different beams passing through the eye. The advanced computer then calculates the exact treatment needed over the 1287 zones of the cornea. It treats not only the the astigmatism of the cornea but the entire eye.
Wait, there is more! iDesign also takes pictures of the iris (the colored part of the eye). All this information is stored on a flash drive and transferred to the latest generation of excimer laser. The laser uses pattern recognition technology to identify if the iris has rotated since the last round of calculations and measurements. The laser also locks onto the eye so any eye movements are compensated for during the procedure.
This allows superb outcomes where patients see better than ever before. Yes, even better than when wearing contacts!!
Allegretto 500 Ultrafast Laser for Nearsightedness (Myopia) and Farsightedness (Hyperopia).
This is the fastest laser available today. It can complete modification of the cornea before humidity or temperature fluctuations can affect the laser beam. It is especially great for hyperopic treatments. In our Beverly Hills laser suite we have obtained terrific outcomes for treatment of up to +6 Diopters.
If you want to learn more details about this laser click Allegretto Laser.
No Cut Lasik, Epilasik or Superlasik
This is the go to option when safety is a concern. A derivative of Lasik and PRK, this method uses an epikeratome to push away an ultra-thin layer of the cornea, called epithelium, without any cut into the cornea. This procedure can be performed on any patient who is a candidate for Lasik, as well as some who are not. Read more here about superlasik eye surgery
Risks of Lasik and how we avoid Lasik complications
Common Side Effects of LASIK
The most common side effects of LASIK are:
- Dry eyes
- Itchy or burning eyes
- Increased sensitivity to light
- Halos and starbursts
- Glare around lights
- Loss of contrast sensitivity
These side effects are most often temporary and will self-correct as your eyes adjust to their new shape. Dr. Khanna will provide you with instructions on how to deal with issues such as dry eyes and will check other side effects during your follow-up visits at one of our Los Angeles office’s.
In very rare instances, a side effect of LASIK may be visual regression. Women who are on hormone therapy are at a greater risk for this complication. However, as with other side effects of LASIK, visual regression usually self-corrects, particularly when medications that can cause it are temporarily suspended.
Preventing risks & side effects of Lasik eye surgery
Before the procedure
Accurate, multiple measurements are essential. If the readings do not correlate with each other they should be repeated on a different day. Identification and treatment of dry eyes should begin before the Lasik surgery. Improper or abnormal corneal shape/thinness need to be looked for diligently.
During Lasik Eye Surgery
The eye to be operated on should be identified. Data entry into the laser needs to verified by the surgeon and the laser tech. The lashes should be carefully draped.The flap and interface should be carefully washed and the flap apposed diligently.
Close follow up by the surgeon is the key in the post Lasik period. Early flap problems need to be addressed, as well as any inflammation. Once again, dry eye management is key.
Preparation for Surgery
It is important to be out of contact lenses until a good corneal shape is detected and there is refractive stability. Typically it is best to be out of contacts for 3-7 days before the Lasik procedure. The surgery counselor and the doctor will go over the consents so you can understand the exact procedure and ask any questions. Specific directions for pre-operative preparation will be given on a hand out with details such as how often to instill the prescribed eye drops and the do’s and don’ts for before surgery.
At the end of your procedure you will be given a hand out with detailed after care instructions such as what drops to instill and how often, as well as do’s and don’ts during recovery. It is normal to have the following symptoms: Watering eyes & nose, light sensitivity, redness and swelling of eye, or the feeling that something is in your eye. Vision may be foggy, like seeing under water. We recommend going home and relaxing for the duration of the day. Try to rest and sleep immediately following your procedure. Your eyes will feel most comfortable when closed.
You will be given a pair of dark glasses/googles to wear home. This is for your comfort to decrease light, as well as to keep you from rubbing your eyes.
- All water activities such as swimming, scuba diving and hot tubs for 2 weeks.
- Avoid direct sunlight, especially sunbathing for the first few weeks.
- Avoid rubbing or touching your eyes.
Virtual Consult: Free
Live Consult: Free – includes screening for safety and a discussion with the Lasik Surgeon about the best choice of procedure.
Preoperative Exam: $350
The exam includes all of these extensive measurements:
- Uncorrected vision and best corrected vision
- Manual refraction
- Cycloplegic refraction
- iDesign treatment measurements
- Eye dominance test
- Full slit lamp exam, including cornea exam and ruling out cataracts
- Fundus exam
- OCT scan of the Optic Nerve, Macula and Cornea
- Color corneal topography
Lasik Eye Surgery: $2825/Eye (includes the following listed below)
- Lasik or superlasik eye surgery
- All laser suite, royalty and assistant fees
- Surgeon fees
- Dry eye therapy – a) Preservative free artificial tears b) Punctal occluder insertion c) Restasis, Xiidra or Sequa (one week supply)
- Drops – one set of antibiotic and steroid drops needed before and/or after surgery
- Postop Kit
- Rayban, Oakley or Prada designer sunglasses
- Uber/Lyft ride on day of surgery
- Free parking
- 12 month follow up exams
- Lifetime enhancement guarantee with an annual paid exam after the first 12 months of covered post operative visits
- Affordable monthly payments (subject to credit check)