Aspen Chooses Dishler as the “Go To” Doctor for LASIK

After 25+ years of practice with the last fifteen being almost exclusively LASIK, we have enjoyed meeting people from throughout the world as patients and many beyond the confines of Denver, and Colorado.  Within the borders of Colorado, many patients have had vision correction from as far south as Pueblo and as far north as Fort Collins and beyond.  Westward we have seen increasing patients coming from Grand Junction, and recently an increase from Telluride which is a really long drive to our location.  While we appreciate each and every patient, it is noteworthy that Aspen has has a strong referral pattern which is due to several factors.  One of our earliest LASIK referring practices is Aspen Vision Source which has offices in Aspen and Carbondale.  Dr. Tim Bauer had just joined the practice at the time we began to do LASIK in 1995 and he decided to have the procedure himself, and has had a great result and been a strong supporter and a referral source ever since.  His associate who began the practice, Dr. Eberhardt also has sent us numerous patients over the years.  These patients were happy with their results and by word of mouth sent other patients to us who continued to see their Vision Source doctors for their pre and post operative care as well as their primary eye care. This model of local doctors working with their patients and allowing their patients to travel to an area of expertise as the surgical extension of their office has been duplicated in many different locations over the years.  This has allowed the most efficient delivery of this type of health care while maintaining the local relationships that patients place their trust thus furnishing them with advanced technology and medical experience not available in their local market.  Because Aspen is known for being an epicenter of culture, sophistication, and prestige, the fact that we have been the choice for LASIK and Laser Vision Correction by so many locals in this community is a compliment of which we are very proud.  This is especially true since in more than most places, the visual requirements for the many outdoor activities that are available in Aspen require such excellent visual acuity.

If patients are willing to travel about four hours for LASIK from Aspen, why then are we it too far to come for some patients who only live 45 minutes away?  This is a conundrum that we have not been able to fully answer.  Many potential patients cite that they prefer to see a doctor who lives closer to their location.  Thus patients from the greater metro Denver area sometimes choose to see laser vision correction centers that are closer geographically rather than make their selection based on referrals from other patients or from their own eye doctors.  While it is understandable that some of the patients who come to us from 8 or more hours away by car, and the patients who fly in for their procedures could reasonably select a different provider, we find ourselves perplexed when a patient chooses a different provider based primarily on location when we are so conveniently located in the Denver Tech Center.  As we are close to all the major freeways in Denver, and with the new I-470 loop now available, it is possible to reach our office from Boulder, Fort Collins, Colorado Springs, Golden, and beyond within an hour or less.  Since we work with more than 200 local eye doctors, usually our care is a “one visit is it” beyond the initial consultation.

Therefore if so many discriminating people from Aspen have selected Dishler Laser as the go to place for LASIK, then why not put us in your short list of potential places for your vision correction needs?  While we do not pay for professional endorsements to increase our credibility, we have provided care to a number of professional athletes as well as others where their vision is extremely important for their careers, their recreation, and their lives.  We treat every patient as if their vision was the most important of anyone’s on the planet because to them it is.  We would appreciate the opportunity to share what we have learned about LASIK with all people who have a serious interest and provide for them an extensive no cost evaluation.

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What Care Is Needed After LASIK

LASIK surgery involves making a corneal flap which is thin and delicate. It is positioned properly at the time of the LASIK procedure but care must be taken that it is not dislodged or moved during the initial healing period. This is accomplished by both instructing the patient not to rub their eyes, providing proper lubrication drops so that the flap does not stick to the eyelid during blinks, and proper eye protection especially while sleeping.

Most LASIK centers give patients specific written and verbal instruction to avoid any problems with the corneal flap. This is also verified by an examination post procedure before the patient leaves our center to be sure that the flap is not wrinkled or dislodged. Another exam is performed the next day for a similar purpose as well as checking on the visual recovery and other aspects of healing.

The eyes should be protected from both trauma and bright sunlight which is accomplished with sunglasses, usually dispensed at the time of the procedure, and night goggles for the first few nights, especially for patients who are likely to rub their eyes at night.

Another important aspect of care is using the medicated drops dispensed or prescribed at the time of LASIK. These are antibiotics to prevent the rare chance of infection, anti-inflammatory drops to soothe and aid healing, and lubrication drops since the eyes may be temporarily dryer than normal.

It is also important to keep the scheduled post operative appointments so that the doctor can verify the progress being made, especially the first few visits.

Longer term, the eyes heal well and it is unlikely to have any problems after 3-6 months but it is always a good idea to protect the eyes from severe trauma whether one had LASIK or not.

Why do we do LASIK for vision correction and why is it so successful?

Many patients have asked a relatively simple question, “why was LASIK invented at all?” A decade ago very few people even knew the word LASIK, and while the word had become a part of our lexicon, the real reason that doctors choose to do LASIK escapes many peoples understanding. We were one of the first handful of doctors in the United States, and the first to realize the potential benefits of LASIK for vision correction almost fifteen years ago. Since that time there are now over 10,000 LASIK doctors in the USA alone and a multiple of this number worldwide. The reasons for the success of LASIK are numerous but in a sentence it provides rapid, accurate, and relatively painless restoration of vision to a wide range of refractive errors. Patients are able to see like they were wearing contact lenses without all of the bother, cost, inconvenience, and risks of contacts. In general they have better visual function than provided with glasses in the same way that contact lenses are better than glasses for so many reasons.

This simple question is profound, because it touches on an invention that has changed the way in which the world views vision correction and has helped millions of people worldwide to see better without the aid of glasses or contact lenses.

For perhaps millions of years, much of human kind has suffered with vision problems. There are the serious eye diseases such as cataracts, glaucoma and a myriad of other problems. Beyond this is the simple fact that many people are unable to see clearly at distance, near, or both. This is from the imperfections of the eyeball as a camera and this was greatly helped over that last few hundred years by glasses and more recently in the last 50 years by contact lenses. Although with the advent of lasers, there was a hope that such technology could improve vision, limitations in the nature of the eye had limited laser application to vision correction until the advent of LASIK .

LASIK is a hybrid procedure, that is it involves two steps which together are able to improve vision very rapidly and predictably for patients with ametropias. The first step is to create a potential space for the laser to correct the vision and the second is to do the correction itself. In the early days of LASIK about 15-20 years ago , this potential space was made with a device called a microkeratome. This is a miniature shaver which can peel a thin layer of outer tissue from the cornea which remains attached at the edge or “hinge”. Another laser, the excimer laser then focuses on the freshly cut surface, and removes tissue in a programmed manner to reshape the eye. Finally, the flap is replaced which assumes the contour of the newly shaped cornea beneath it. It is the transfer of the shape combined with covering the treated area with living tissue that makes LASIK so remarkable. Healing occurs at the edge or seam of the flap and the eye barely knows that anything has occurred beneath. The vision is rapidly restored with no significant healing response, which is key to the success of LASIK.

Newer lasers, called femtosecond lasers, are able to make the flap layer more precisely without a cutting blade but fundamentally perform the same function. This all laser approach is a safer and slightly more effective way of restoring vision by LASIK. The current state of the art in LASIK is to use advanced femtosecond lasers such as our Visumax to make a flap, and a wavefront optimized excimer laser like our Zeiss or our Allegretto laser(s) to reshape the cornea. With this type of treatment we have a very low complication rate, and excellent vision results in most cases.

We become complacent very quickly with new technologies but it is a truly amazing and revolutionary accomplishment that in a procedure that lasts only a few minutes , a persons vision can be corrected from a lifetime of limitations.

As Seen in Forbes Magazine Top 10 LASIK centers in the United States

In 1995 we were one of the first ten LASIK providers in the United States.  This was a new procedure at that time almost 15 years ago, and since that time the success of that procedure has blossomed into an industry with over 10,000 LASIK providers today.  It is certainly impossible to say who or where is the very best LASIK providers, but it is always good to be considered amongst the best.  When one reviews the doctors and centers picked for the prestigious Goldline independent consumer research of best or most dependable LASER VISION providers in the last few years, it is obvious that they have picked very well recognized and credible choices.  This year we were notified a few weeks ago, that we were selected by Goldline as one of only 10 LASIK practices in the entire United States.  Goldline makes this decision public by  publishing their decision in cooperation with Forbes Magazine.  If you happen to get your hands on a copy of November 2009 Forbes, it is the issue which lists the “Most Powerful People in the World” and is their second most popular issue of the entire year.  In November 2009 Forbes you will find the report issued by Goldline where they list the 10 doctors for this year and the research criteria of their selection.  They required a combination of vast experience, technologically advanced care, a large number of satisfied patients, and a number of other characteristics that helped them to narrow their search to finally arriving at their list.  Here were the minimum criteria as mentioned on the Goldline website:

• 15+ Years in Practice
• 10,000+ Vision Correction Procedures Performed
• Certified By the American Board of Ophthalmology
• Specialize in LASIK and Refractive Surgery
• Use State of the Art Facilities & Equipment

We hope that this designation will make our past patients even more confident in their choice of Dishler Laser Institute as their provider.  This designation is in addition to being chosen by Trusted Lasik Surgeons as one of their acknowledged LASIK providers limited to the top 1% of all LASIK doctors along with very strict criteria for membership, is a new addition to our list of achievements.

As the only LASIK provider in Colorado and in the entire region to be selected by Goldline, we are very happy that the hard work of all of our staff has been rewarded with this distinction.  It is a tribute not only to myself, but to the many other people who are part of our organization from the patient representatives who answer the phone, the patient concierge who provides a single contact point for our patients care, and our nursing and professional medical staff who have continuously provided world class care to all of our patients for the last 25 years.

I am heading out to Barnes and Nobles this weekend to pick up my personal copy of Forbes and encourage anyone who is considering LASIK to do the same.

How likely is it for a flap to move several months after lasik eye surgery?

It is extremely unlikely for the flap to move several months after LASIK surgery, but it is possible to dislodge it with severe trauma. In the last 15 years and about 50,000 LASIK cases we have only seen a small handful of cases with late flap dislocation. These were almost always the result of severe trauma such as a tree branch directly contacting the cornea, and would have caused some degree of injury. Fortunately, we have been able to repair these cases successfully with little or not permanent loss of vision.

It is for this reason that the military and some law enforcement branches had required PRK or surface treatment rather than LASIK due to potential combat situation. It is an indication of how rare these occurrences are that LASIK is now accepted by most all of the categories previously mentioned.

We counsel all LASIK patients to wear eye protection for a minimum of six months, and it is not a bad idea for everyone to do this when there could be damage of the eye. It takes a special kind of trauma to dislodge a well healed LASIK flap, and if the vision does change after a trauma, it is best to have the eye checked right away.

One Picture is worth a thousand words

How does IOL surgery compare to LASIK for vision correction?

These are two very different types of technologies and procedures and usually for different indication. IOL surgery stands for intraocular lens surgery and is replacing the natural crystalline lens with a plastic lens. This is usually done for patients with cataracts who cannot see without having their lens removed. More recently, some patients are undergoing what is termed a refractive lens exchange. This means taking out a clear lens and putting in a plastic one for the purpose of correcting refractive error and thus enters the realm of refractive surgery. Refractive surgery, the operation(s) for correcting vision to reduce or eliminate the need for glasses or contacts includes LASIK which is a laser procedure done under a protective flap. This is the most frequently performed refractive procedure accounting for perhaps 85% or more of all refractive procedures. Next in frequency is PRK or a surface laser procedure, and refractive lens exchange is only done on less than 5% of all refractive procedures. Of course when someone needs cataract surgery there is a refractive component because these patients want to be able to see well without glasses, but this is different from a primary refractive procedure.

Refractive lensectomy or refractive lens exchange is typically done on older patients who have or will be getting cataracts shortly, that is typically over the age of 55 or 60 years. Also this can be done for types of corrections that do not do as well with LASIK such as high degrees of corrections, especially farsightedness.

Ultimately, on the same patient one would expect similar results for IOL surgery and LASIK if both were in the range to expect a good result. The technology for both are extremely good and both can result in satisfied patients. The risk profiles are different between the procedures, since the IOL is intraocular, that is within the eye, it comes with some more serious risks for complications.

Will you be happy with LASIK laser vision correction?

As important as factors related to your doctor are, laser vision correction is not just about the technology that is used, and not just about the empirical results that are obtained. The first and most important step in pursuing laser vision correction or LASIK is to pick both the doctor and the technology which will hopefully deliver for you the best results. Beyond these basics the most important consideration is known as patient expectations. The patient’s perception of success is a key indicator since what goes on behind the eyes, that is in the brain of the person who has LASIK, is just as important as the objective results themselves. While most patients are extremely happy with their excellent results, it is important to understand that LASIK is a process, and one needs to look at the most important optical diagnostic instrument available, their own mirror. The bottom line is whether one is the type of person who is happy with substantial improvement in their quality of life or will only perfection be their minimum standard of success?

Are there advantages to the vision correction procedure called “i-LASIK”?

When we first introduced Intralase, all laser LASIK it was termed IntraLASIK by the company and everyone using this technology. Since that time, the company has been acquired by AMO and they have a new term for the combination of Intralase and the VISX excimer laser which they call i-LASIK. There is nothing new or magical about this combination and in fact many had used the VISX laser with the Intralase for years before this acquisition. While the Intralase laser makes flaps that work well with VISX lasers, they work equally well with any other excimer laser on the market and there is nothing special about this particular combination other than a branding or marketing name. In our practice we have used the Intralase with the Bausch and Lomb laser, the Wavelight Allegretto laser (now owned by Alcon) and the Zeiss MEL 80 laser. All of these combinations work extremely well since the making of a corneal flap is independent of the correction of vision by the second laser platform.

 

It is important to distinguish real technological advancements, from marketing hype and this is especially true when it comes to laser vision correction. There is not much question that I-LASIK is the latter of these in that it was the matching of two existing technologies. The VISX laser was one of the first approved lasers, and although there have been some improvements, it is still a broad beam first generation technology which is limited as compared to many newer lasers that have been available for a number of years since. Yes, there is a good chance of getting to 20/20 vision with VISX but no greater than any other platform, and it has limitations in the type of ablation that can be created. This gets into subtler issues than just 20/20. For instance, it is based on the original Munnerlyn formula and does not take into account a prolate optimized ablation pattern such as the Wavelight (Alcon) or the MEL80 (Zeiss) lasers can create. Other posts on this blog have discussed the benefits of these newer patterns. Even scanning spot lasers can have this limitation which was true with the Bausch and Lomb laser where they considered doing a clinical trial with the newer ablation patterns but abandoned this effort due to economic constraints. The Nidek laser was another intermediate step with scanning slits but also based on the older ablation patterns and for this reason has been largely abandoned. Some centers still offer LASIK with the Nidek at a reduced price, but is that really worth it? In today’s world, many laser centers are moving up to the newer type ablation lasers from “VISX type” and it is worth considering this since it represent a real change in technology.

With all modesty, if anyone should know about this it would be me, since one of the earliest approved LASIK lasers was the Dishler Laser. That is correct, I was the inventor (with a lot of help of course) of a laser design that was FDA approved to correct nearsightedness and astigmatism over a very large range. This laser was also a broad beam design, and although it had significant advantages over the VISX laser at the time (they thought it was so similar to theirs that they sued me for patent infringement!) we have long ago retired this laser due to advances well beyond the capability of that design. At best I would say that the VISX laser is the vanilla of lasers, sufficient but not extraordinary. Of course, this is just my personal opinion–that is what blogs are for.

Moving on the femtosecond lasers is something which I also know something about. We had the third femtosecond laser in the United States about 10 years ago. Of the first 1000 femtosecond flaps made, we did about 900 of them making us the very first real commercial site for Intralase. We have had one of the first lasers of each succeeding upgraded model to the current FS60 which is now in thousands of sites and has done millions of procedures worldwide. It is a great machine, and makes really nice flap. This is the mainstream flap maker and as such has been paired with practically every other excimer laser in the world for LASIK procedures. To claim some specific superiority with the VISX laser and call this I-LASIK is clever marketing but no real technological advance.

There is a real technological advance in femtosecond lasers, and it is the Visumax laser, also from Zeiss. Again, there is a post specifically on this topic, but in essence, it is faster, more accurate, works more gently and at lower energy than the Intralase laser. We have both of these platforms, and at this point use the Intralase as a reliable backup system or for unusual cases where it might be a better option. We are doing about 98% of all of our femto flaps with the Visumax. Consequently we are pairing the Visumax with the Zeiss Mel 80 which is really nice since they are both part of a combined workstation which is efficient, ergonomic, and very patient friendly. But we also can use the Visumax with the Wavelight laser and these results are also very excellent. Maybe we should call it ‘very good lasik’ or v-LASIK?