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LASIK is an acronym for Laser In-situ Keratomileusis, which simply means "to shape the cornea within using a laser." It corrects vision by reshaping the cornea so that pictures focus more precisely on the retina.
One hour prior to the procedure you are given a mild sedative (Valium) for relaxation. In the laser suite, you will be placed on a comfortable reclining chair. Eye drops are then administered to completely numb the eye. The eye is gently held open for you and there is no urge to blink nor are you aware of anything approaching the eye.
The laser computer will already be programmed with your prescription and it will precisely calculate the way the cornea will be reshaped.
A thin flap of cornea (which resembles a soft contact lens) is made with a microkeratome or with Intralase. This flap is laid back and the laser treats the tissue underneath, called the stromal bed.
Dr. Pulaski will position the laser and ask you to focus on a blinking red fixation light overhead. He will activate the excimer laser and begin reshaping the cornea. Each pulse you hear removes a microscopic layer of cornea. This treatment takes about 1 minute. There is no sensation or discomfort during any part of the LASIK procedure.
  
After the laser treatment, Dr. Pulaski will replace your corneal flap and apply several eye drops. No sutures are necessary. The flap seals itself naturally within a few minutes, but you must not rub your eyes as this might dislodge the caps.
Protective eyewear is given to you to wear until the next day, along with eye drops to be used 4 times a day for 1 week.
The center of your cornea is now reshaped to a proper curvature, so light rays can focus directly on the retina and pictures are in better focus. Your vision will usually be 90-95% of normal by the next day and will continue to clear over the ensuing weeks and months.
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 VISX Star S4 Laser
There are currently several lasers approved for refractive surgery in the U.S. By far the most popular has been the VISX Star Laser.
Dr. Pulaski uses the VISX Star S4 laser model, which allows eye tracking during the procedure. Other approved lasers are LADAR, Nidek and Bausch & Lomb. The VISX Star S4 will correct nearsightedness, farsightedness and astigmatism. |
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 Bausch & Lomb Hansatome Keratome
The "gold standard" for mechanical keratomes -- the instruments that make the corneal flap during LASIK -- is the Bausch & Lomb Hansatome. This is the instrument Dr. Pulaski uses when performing LASIK with a mechanical keratome. It is among the most precise and gives the best results in our experience. |
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 Intralase
Intralase is a new femtosecond laser that may be used in place of the microkeratome to make the Lasik flap. It is very sophisticated technology that can pre-select the position of the hinge and may be slightly more accurate in achieving the desired cap thickness.
In most Lasik cases, however, whether the flap is made with a microkeratome or the Intralase, it does not affect the result. The flap is simply laid back, however it is fashioned, and then the excimer laser is used to perform the actual treatment. |
We are pleased to offer either method of flap-making to our Lasik patients. Dr. Pulaski will go into the minor differences between the two methods at the time of your evaluation.
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Lasik is now regarded around the world as the premier refractive procedure. Millions of people have received the remarkable benefits of this sight-restoring surgery in North and South America, Europe, and many parts of Asia.
Dr. Pulaski was one of the first refractive eye surgeons in the U.S. and has over 20 years of experience in this field. The benefit of LASIK over earlier refractive procedures is that it can correct higher amounts of nearsightedness, farsightedness and astigmatism with greater accuracy.
At the Rancho Bernardo Laser and Vision Center, we find that most people with low and moderate amounts of pre-operative refractive error will achieve 20/20 vision or better after surgery. With current technology, even patients with high refractive errors will often achieve 20/20 after LASIK. Another way to put this is:
It is important to note that people over the age of 40-45 usually need reading glasses after LASIK but can usually see well without glasses or contacts for distance vision, such as driving, sports, etc. Often, we will recommend a small monovision treatment for patients in this age group, which should allow computer and larger-print reading without the need for glasses.
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