Eye Can See Clearly Now

The precision of LASEK brings freedom from glasses, contacts.

After nearly a lifetime of wearing corrective lenses, Judy* decided they didn’t work for her anymore.
Sometimes, her contacts would literally fall out of her eyes, and she suffered from burning and other discomfort that forced her to remove her lenses to get relief.
Worse, her world was going in and out of focus. For someone who’d already had cataract surgery on both eyes, that was especially disconcerting.Stock photo from istockphoto.com.
“Sometimes, my vision would get blurry, and it was because the contacts were not staying in place,” recalls Judy. “I was just not too happy with them.”
She complained to her optometrist, who recommended she see Clifford L. Salinger, MD, a board-certified ophthalmologist, cornea and refractive surgeon, dry eye specialist and founder of The Dry Eye Spa & V.I.P. Laser Eye Center in Palm Beach Gardens.
Dr. Salinger determined that Judy suffered from chronically dry eyes, which affects millions of Americans. Although causes may differ, dry eye syndrome produces such symptoms as intermittent blurry vision, excess production of tears, itching, burning and stinging.
In an effort to alleviate her condition, Dr. Salinger inserted biocompatible punctal plugs, also known as lacrimal plugs or eye duct plugs, into her tear ducts to block drainage, thereby increasing each eye’s tear film and surface moisture.
“There are three different kinds of plugs,” he explains. “One is the test plug that lasts a week, just to make sure that the person doesn’t have excess moisture that becomes so unpleasant that it’s undesirable. Then, there are two long-acting plugs. One dissolves slowly over three to four months, while another version is made of a silicone plastic that does not dissolve and is potentially a forever plug.”
The permanent plug would not work for Judy because her tear ducts are rotated slightly inward and “she would be feeling that silicone plastic plug on her eye every time she looked down and in the direction of that plug,” he informs.
Dr. Salinger turned to separate but simultaneous medical treatments to improve Judy’s tear film production and tear film quality. Those included hot compresses, lid massage, vitamin supplements containing Omega-3 and Omega-6 fatty acids, and anti-inflammatory steroid eye drops.
Once her dry eye condition was stabilized, Dr. Salinger was ready to correct Judy’s vision using one of several procedures – PRK, LASEK, LASIK or iLASIK™ – that he performs in his office while the patient is under eye-drop anesthesia.
Through gentle reshaping of the cornea with a laser, which allows light to be focused by the eye differently, he can improve nearsightedness, farsightedness and astigmatism.

Safe, Accurate Solutions

After meticulous evaluation of her eye health, medical history and unique circumstances, Dr. Salinger determined that LASEK, or laser epithelial keratomileusis, was the best choice for Judy.
LASEK combines certain elements of PRK, or photorefractive keratectomy, the original laser vision correction, and the more popular LASIK. For certain patients, LASEK can offer some advantages over LASIK.
“LASIK heals more quickly,”
Dr. Salinger points out, “but it is not ideal for individuals who have pre-existing dry eye or who previously had some type of surgery, like the cataract surgery Judy had.”
LASEK involves loosening the surface epithelium, or the outermost layer of the cornea, with a diluted alcohol solution, removing it. The exposed surface is then treated with the laser. A protective, soft contact lens is placed over the cornea to make the eye more comfortable while it heals.
During conventional LASIK, the eye surgeon makes a small flap in the cornea by cutting tissue with an oscillating blade. With bladeless iLASIK, the flap is created with an ultra-fast laser.
LASEK eliminates the need to pressurize the eye to make the flap, as with LASIK and iLASIK. Firming up or pressurizing the eye too much carries a risk for patients like Judy who have had previous cataract surgery, Dr. Salinger notes.
The epithelium usually heals fully within several days to several weeks. Because the return to functional vision is longer than with LASIK, some LASEK patients prefer to have one eye treated at a time.
Thanks to such laser surgeries, it’s possible for patients like Judy to improve their near or their distance vision after their cataracts are removed, Dr. Salinger emphasizes.
“We can set each individual’s eyes at whatever focal distance they might desire after cataract surgery,” he notes. “It is imminently adjustable in the majority of people.”

Fantastic Outcome

Judy decided she wanted monovision, which corrects one eye for distance and the other for close-up vision.
Monovision is an alternative approach to manage presbyopia, a normal aging process that results from gradual thickening and stiffening of the natural crystalline lens inside the eye and loss of muscle control of lens shape. As a result, those who wear lenses to correct their distance vision find they have more difficulty with ordinary, close-up tasks like reading small print.
Dr. Salinger also corrected Judy’s astigmatisms – imperfections in the curvatures of her corneas.
“I found the LASEK procedure fascinating,” she enthuses. “You can actually see the outline of your eye and the laser going over and reshaping it. It’s very easy, painless.”
Her vision “cleared up almost immediately,” says Judy, who sums up her results as “just fantastic.”
“For the first time in my life, I don’t need any type of contacts or glasses,” she marvels. “I don’t need a million pairs of reading glasses around.”
Since her surgery, Judy has found it easier to see her computer screen, which is another plus because she’s an avid researcher of world events and the latest medical technologies.
Her dry eyes have improved, too, allowing her to manage her condition with occasional over-the-counter drops.
Judy absolutely recommends Dr. Salinger to others seeking help for dry eyes and other persistent vision challenges.
“He is very competent and knowledgeable,” she asserts. “He takes his time with each patient. He’ll sit and answer your questions, which I find most important.”

*Patient name withheld at their request.
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