Questions and Answers About Excimer Laser Refractive Surgery

1. What is excimer laser refractive surgery?
2. What is the medical condition that is treated by excimer laser refractive surgery?
3. What is the best refractive procedure?
4. Are there any limitations on who can have the procedure?
5. Will these procedures help me if I only wear reading glasses?
6. Will I have to wear glasses after refractive surgery?
7. How successful is the procedure? Will I be able to throw away my glasses?
8. Are there complications?
9. Are there alternatives to this procedure?
10. What advantage does the excimer laser offer?
11. How experienced are our doctors?
12. Why should I choose UCSF?
13. What is our approach to patient selection?
14. What does refractive surgery cost?
15. Do you offer financing?
16. Do you offer an associate surgeon program with fellows and residents?
17. How do I get further information?
18. Can I use FSA/HAS dollars for anyone not UCSF employees?

1. What is excimer laser refractive surgery? Laser refractive surgery is one of several refractive surgery procedures used by ophthalmologists to change the shape of the cornea, the clear tissue window at the front of the eye, to improve the way it focuses or “refracts” light to receptors at the back of the eye. The excimer laser produces ultraviolet light and emits high-energy pulses lasting only billionths of a second. In excimer laser refractive surgery, the ophthalmologist uses this laser energy to carve away minute amounts of corneal tissue.

2. What is the medical condition that is treated by excimer laser refractive surgery? Ophthalmologists use excimer laser refractive surgery to treat nearsightedness, or myopia, a condition where the eye is too long and images are focused in front of the receptors (the retina) at the back of the eye. This causes distant images to appear fuzzy. Most commonly, this condition is treated with spectacles or contact lenses, which change the way light is “refracted” to the retina. Approximately 70 million people in the United States — one in four — have varying degrees of myopia.

3. What is the best refractive procedure? The answer to this question varies with each individual. Some important factors to consider are the strength of your glasses prescription, age, differences in side effects, speed of recovery, and cost. Your surgeon can help you choose from among the many available options to determine the best choice for your individual situation. We encourage you to come to one of our free informational seminars to learn more about the various options available for refractive surgery.

4. Are there any limitations on who can have the procedure? Yes. We prefer that you be between 21 and 65 years of age, with no other serious eye problems. In addition, your prescription should have been stable for at least two years.

5. Will these procedures help me if I only wear reading glasses? No. The normal loss of focusing power of the eye (presbyopia) that occurs after age 40 cannot be corrected by these types of procedures.

6. Will I have to wear glasses after refractive surgery? Even with the best techniques, a specific visual result (for example, 20/20 or 20/40) can never be guaranteed. However, most people with low to moderate nearsightedness and astigmatism can achieve excellent results after refractive surgery. In many studies, more than 98% of persons with low to moderate nearsightedness will achieve 20/40 or better uncorrected vision after refractive surgery. With 20/40 or better vision you would be able to pass the California driving vision test without wearing corrective lenses. For most people, this level of vision would be adequate for the majority of their everyday activities.However, for special situations (such as night driving) in which the sharpest vision is desirable, you may still want or need to wear glasses or contact lenses with a mild correction. Also, if you are 40 or older, you may still require glasses for reading.

7. How successful is the procedure? More than 94 percent of people with mild to moderate myopia who undergo laser refractive surgery are able to pass a drivers’ license vision test without corrective lenses. Glasses may still be helpful for some situations, such as reading for those over age 40, or for night driving.

8. Are there complications? Yes, as with any surgical procedure. Possible complications of laser refractive surgery include over- and under-corrections that may require additional operations, although these are uncommon among those who seek correction for low to moderate myopia. Patients may experience minor light sensitivity, glare, and night “haloes” around images for several weeks after the operation. In very rare cases, patients may experience a persistent haze that may take up to three years or more to clear. Some patients report “dry eye” sensation that usually resolves over the months following surgery. LASIK and PRK treatments can also cause irregular astigmatism that reduces quality of vision, especially under low light conditions, and can reduce the best vision that can be measured in the eye.

9. Are there alternatives to this procedure? Corrective lenses, either eye glasses or contact lenses, are the most common methods of correcting nearsightedness. Other surgical alternatives include PRK, or laser surface treatment, and intraocular lens implantation.

10. What advantage does the excimer laser offer? Most of the laser-light generated by the excimer laser is absorbed by the tissue that is removed from the cornea. Unlike some laser procedures, the process does not create a great deal of heat, limiting the possibility of thermal damage to surrounding tissue. These attributes make excimer lasers well-suited to corneal surgery. The excimer is also very precise, with each pulse able to remove 0.25 microns of tissue. A human hair is about 50-100 microns thick.

11. How experienced are our doctors? Our surgeons are board-certified ophthalmologists with subspecialty expertise in corneal and refractive surgery. Each of our surgeons is on the full-time faculty of the Beckman Vision Center at the University of California, San Francisco, a leading referral center for the treatment of ocular diseases. Collectively, they have authored dozens of publications in corneal and refractive surgery and have lectured extensively both nationally and internationally. Dr. Hwang has co-authored a major textbook on corneal surgery and has trained dozens of surgeons across the country in refractive surgery procedures. Dr. McLeod leads the American Academy of Ophthalmology group that oversees the Academy’s guidelines for refractive surgery as Secretary for Quality of Care.

12. Why should I choose UCSF? We know you have a choice in where you will have refractive surgery. We encourage you to base your decision not on fees or marketing campaigns but primarily on the surgeon’s reputation, skill, and approach to patient selection. The Beckman Vision Center at the University of California at San Francisco is a leading center for diagnosis, treatment, and research in all areas of eye care, including refractive surgery. As a leading academic center, UCSF has available the leading technology for refractive surgery procedures including two independent custom excimer laser platforms (Alcon and VISX) as well as femtosecond technology for laser flap creation. Our mission is to exercise the highest standard of surgical care using sound judgment and the latest techniques, to provide balanced information about all available surgical and non-surgical options, and to advance the field of refractive surgery through research.

13. What Is Our Approach To Patient Selection? We feel that it is important that you have available all the facts to help you decide whether refractive surgery is right for you. As such, we are committed to providing a variety of free educational offerings to help you learn more about refractive surgery. These include evening seminars, literature, and screening appointments. We feel that your decision should be made carefully and without pressure. Once you have decided that you might be interested in refractive surgery, we will encourage you to attend an informational seminar or to make an appointment for a personalized consultation and examination with one of our refractive surgeons. In formulating recommendations, your surgeon will take into account the health of your eye, your degree of nearsightedness or other refractive error, your occupational and lifestyle needs, and your goals and expectations. UCSF surgeons will only recommend refractive surgery if it is felt that you will be an excellent candidate. If such is the case, the surgeon will apply all of his experience and skill towards giving you the best possible surgical outcome. If there are clinical findings that indicate you are not an excellent candidate, he will assist you with other, non-surgical options. At UCSF our goal is always to put your best interest first.

14. What does refractive surgery cost? The fee for a personalized consultation with one of our surgeons, which includes a comprehensive eye examination and a special computerized map of the cornea is $100, payable at the time of your visit. This $100 fee will be subtracted from the cost of your surgery if the procedure is performed within three months of your exam. With rare exceptions, insurance does not cover the cost of refractive surgery. Our fees vary depending on the procedure required to best correct your prescription. Please call Don Eubank at 415-514-6894 for further information.

15. Do you offer financing? Currently we do not offer any financing.

16. Do you offer an associate surgeon program with fellows and residents? Yes. Patients who elect this option are eligible for a 25% or greater discount on their LASIK fees. Fellows and residents are teamed with a member of the faculty to provide your consultation, surgery, and post-operative care for patients. The resident or fellow will be the primary surgeon, with the faculty member providing assistance and consultation. Patient appointments are available with fellows and residents at a variety of times throughout the week. Whether a patient chooses to be treated by a faculty member alone, or a team including a fellow or resident, all patients can expect to receive high quality care. If you elect to have your surgery done by a faculty physician, the normal fee schedule will apply. In such cases, your surgery will be performed exclusively by a faculty physician. Your pre-operative examination and post-operative care will also be performed by that faculty surgeon, although a student resident or fellow may also examine your eyes at times for educational purposes.

17. How Do I Get Further Information? Please fill out this information request or call us any weekday during normal business hours at 415-514-6894. We look forward to hearing from you.

18. Can I use FSA/HAS dollars for anyone not UCSF employees? Yes.