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There are two types of Laser Trabeculoplasty offered in our Fort Lauderdale office:

• Argon Laser Trabeculoplasty (ALT)
• Selective Laser Trabeculoplasty (SLT)

Argon & Selective Laser treatments are clinically proven methods to treat glaucoma by safely and effectively reducing intraocular pressure, often in a single office procedure. They use a focused beam of light to treat the drainage angle of the eye. This surgery makes it easier for fluid to flow out of the anterior chamber of the eye (the space just behind the cornea) and thus decreasing the pressure inside the eyes

Both types of laser treatments can be an effective adjunct to medication therapy, especially for those patients whose open-angle glaucoma continues to get worse in spite of medication treatment or for those patients who are not able to use topical medicines to treat the condition. Laser treatment may also be used as a primary treatment to reduce or eliminate the need for topical glaucoma medications which has the potential to save patients thousands of dollars in prescription medication costs and improve patient compliance. Patient compliance to glaucoma treatment regimens is one of the biggest challenges in successful management of the disease.

Laser trabeculoplasty is not done for patients who have closed-angle glaucoma.

What to Expect

• Laser trabeculoplasty is done as an outpatient procedure and takes about 10 minutes. Most patients feel little or no discomfort, but some will report feeling heat during the procedure.
• The patient’s pressure will be checked by the doctor at our office in Fort Lauderdale within 2 hours of the surgery and follow-up visits will be scheduled at appropriate intervals for their case.
• Complications of laser trabeculoplasty are rare.

During the LPI at out office in Fort Lauderdale, a laser is used to make a small opening in the peripheral iris (the colored part of the eye). This changes the fluid dynamics in the eye and “opens” the angle. The small opening that is made in the peripheral iris allows fluid to drain more normally and also lowers the eye pressure.

Laser Peripheral Iridotomy is generally recommended for:

• Patients with narrow angles, narrow angle glaucoma, or acute angle closure glaucoma.
• It is generally considered to be a preventative, in that it helps reduce the risk of developing acute angle closure glaucoma.
• It can also be used during an acute attack of angle closure glaucoma, along with other medications or procedures.

LPI is an outpatient procedure, taking only a few minutes with little or no discomfort. The risks are minimal and would be discussed on an individual basis.

Photorefractive Keratectomy or PRK is a type of refractive laser eye surgery used to correct a patient’s vision to eliminate or reduce their dependence on glasses or contact lenses. PRK is the style of laser eye surgery that preceded LASIK, having been the former most common type of refractive surgery until LASIK came along.

PRK is effective in correcting nearsightedness (myopia), farsightedness (hyperopia) and astigmatism and has very similar rates of success and outcomes as LASIK. PRK remains a common option for laser eye surgery.

How Does PRK Differ From LASIK

PRK and LASIK both permanently reshape the cornea to improve vision by using a laser (an excimer laser to be exact) to remove part of the tissue underneath the corneal epithelium. The epithelium first needs to be removed in order to get access to the tissue and how this is done is what differentiates the two procedures. While LASIK creates and lifts a flap on the outer corneal layer, reshapes the corneal tissue underneath and then replaces the flap, PRK removes the outer layer of the cornea completely. The outer layer will regenerate usually within a few days.

Advantages of PRK

Since PRK completely removes the outer corneal layer, there is a greater area of the cornea to work with. This is ideal for patients with a thin cornea who would otherwise be at risk with LASIK. It is also usually recommended for patients with chronic dry eyes. With PRK, there is also less risk of infection or issues having to do with the flap and the related healing process. This is an advantage for individuals who lead a lifestyle in which they are at risk for eye injuries (athletes, military, law enforcement etc.) which may subject the flap to injury or complications.

So, Why Is LASIK More Popular?

The main advantages that LASIK has over PRK are two-fold and mainly have to do with comfort and recovery time. First of all, PRK patients usually experience slightly more discomfort during the first couple of days of recovery, mainly because it takes time for the outer corneal layer to heal. They will be prescribed eye drops to be taken for several months to prevent infection, increase comfort and assist the healing process. LASIK patients on the other hand, typically experience less discomfort and if they do, it subsides very quickly.

Additionally, vision recovery takes longer with PRK. While LASIK patients can typically see normally within a few hours after the surgery, with vision gradually continuing to improve within the next few months, PRK patients may experience blurred vision for up to three days and it can take up to six months until they achieve full visual clarity. While patients who undergo LASIK can usually drive and resume normal functioning within a day or two, PRK patients shouldn’t plan on returning to normal for at least several days until the outer layer of the cornea has grown back.

Whether PRK or LASIK is a better option for you depends on a number of factors, including the health and structure of your eye. This is a decision that your eye doctor or surgeon will help you make. Rest assured however, that both procedures have been shown to be incredibly successful in correcting vision, with minimal complications.

What You Need to Know About PRK

Prior to any laser correction surgery, you will meet with a surgeon for a thorough exam to assess your eye health and determine whether you are a candidate and if so, which type of surgery would be best suited to your needs. During this exam it is essential to tell the doctor any relevant medical history (injuries, hospitalizations, diseases etc.) and existing conditions you have. The surgeon will determine if you are currently eligible for surgery and if not, if you will be at a future point, and whether you require any specialized care pre or post surgery.

The surgery itself is an ambulatory procedure. It takes about 15 minutes or less for both eyes and you go home the same day. You will need someone to drive you home from the procedure.

The first step in the procedure is that your eye will be anesthetized using numbing eye drops and then a device will be inserted to prop your eyelids open so you won’t blink. Once the eye is numb, the surgeon will remove the outer epithelial layer of the cornea to expose the underlying tissue. Then the surgeon will use the laser to reshape the corneal tissue. You may feel a small amount of pressure during this step. Lastly, the surgeon will apply medicated eye drops and place a temporary contact lens that is used as a bandage to protect the eye.

Following the surgery you will be instructed to apply medicated eye drops multiple times each day to reduce the risk of infection and you may also be given prescription pain relievers to alleviate any pain or discomfort.

As with any type of surgery, it is critical to carefully follow your surgeon’s instructions after PRK. Make sure that you take your medication as prescribed, get enough rest, and call your eye doctor immediately if you experience any problems.

It is normal for it to take several days or even weeks for your vision to improve and up to 3-6 months for full recovery to clear and stable visual acuity. Usually, your doctor will require you to refrain from driving for a week and up to three weeks depending on how fast your vision recovers.

Risks and Complications of PRK

While serious complications are rare, like any surgery, there are some risks to PRK, and these happen to be very similar to any laser corrective surgery like LASIK. They include:

• Dry eyes- this condition usually goes away within a couple of months, but there is a chance that it could become chronic.
• Infection or Inflammation- the risk of infection is greatly reduced if you take proper care to follow your doctor’s instructions following the procedure.
• Vision Problems- which can include glare, seeing halos around lights poor night vision and sometimes a general haziness.
• Incomplete Vision Correction – sometimes an additional procedure might be needed to achieve optimal visual acuity.

In general, PRK is considered to be a relatively safe and effective treatment for vision correction. If you wish to live a life without depending on your glasses or contact lenses, speak to your eye doctor about whether PRK is an option for you.

Some patients from Fort Lauderdale are not candidates for LASIK, typically because they have a thin cornea, mild corneal scars, or other corneal problems. About two years ago, LASEK (Laser Assisted Sub-Epithelial Keratectomy) was described. In this procedure, also known as E-LASIK or thin-flap LASIK, the corneal epithelium, or skin of the eye, is treated with alcohol for about 30 seconds to detach it from the underlying tissue. It is then lifted and rolled back. Pulses from, the computer-controlled, cool light of the excimer laser then reshape the cornea, just as in LASIK. The corneal epithelium is replaced after the laser portion of the surgery.

Advantages of LASEK include:

• It conserves corneal tissue, because a thick corneal flap is not made, as in LASIK.
• It may also be more appropriate for patients who engage in activities that put their eyes at increased risk for injury.

Disadvantage of LASEK include:

• Patients must use topical steroid drops for a minimum of several weeks after their procedure.
• Postoperatively, patients are not quite as comfortable as LASIK patients. A bandage contact lens is worn during the first 3 to 7 days after surgery to minimize this discomfort. Vision is somewhat blurry for the first 4 to 7 days after surgery. However, after 1 to 12 weeks, vision with LASEK is as good as with LASIK.

For a Free LASEK Consultation to check for your candidacy, contact our office today.

Read more about Vision Surgery.

For procedures not covered by insurance we offer Financing Options

LASIK is a surgical procedure intended to reduce a person’s dependency on glasses or contact lenses. It is a procedure that permanently changes the shape of the cornea, the clear covering of the front of the eye, using an excimer laser.

Nearsightedness, farsightedness, and astigmatism may be reduced so that the need for contact lenses or eyeglasses is reduced or eliminated. This short, outpatient treatment allows minimal time off work and minimal post-operative discomfort. Some fluctuation in vision may occur until all the healing is done.

No longer using a mechanical microkeratone (a blade devise), Dr.Kalski now uses only a laser keratome (a laser device) to cut a flap in the cornea. A hinge is left at one end of this flap. The flap is folded back revealing the stroma, the middle section of the cornea. Pulses from, the computer-controlled, cool light of the excimer laser then reshape the cornea to focus light rays back on the retina. The flap is then gently laid back down.

LASIK is an elective treatment. As with any surgery, there are risks, which Dr. Kalski will discuss with you in great detail. But generally the below hold true:

• There is no guarantee that it will completely eliminate the reliance on corrective lenses.
• As with any type of surgery, there is a small chance of infection, which is greatest during the first 3 days to one week after surgery.
• Night glare or blurriness may occur.

For a Free LASIK Consultation to check for your candidacy, contact our office today.

Learn more about other Vision Surgery options.

For procedures not covered by insurance we offer Financing Options

Safety and precision with computer controlled blade-free technology

Traditional cataract and lens replacement surgical techniques have been time proven as safe and successful. Our experience and commitment to excellence has allowed us to achieve excellent surgical outcomes with the traditional methods; and while we will continue to offer cataract surgery at our office in Fort Lauderdale utilizing the traditional techniques, we are proud to be able to offer the newest blade-free LenSx computer-assisted laser cataract surgery. This new technology provides many advantages, including using a femtosecond laser specifically calibrated for each person’s eye.

Dr. Richard Kalski is one of the few cataract surgeons in the United States trained and certified to perform this newly FDA approved procedure.

What are the major benefits of Laser Cataract Surgery?

Custom Precision

• A higher level of precision to traditional cataract surgery is made possible by using real-time, 3D computerized digital scanning technology that carefully maps and measures the eye to exact specifications generally not attainable by traditional surgery.
• Astigmatism can be more accurately treated with the bladeless method.
• The laser creates a circular opening in the lens capsule, making it possible for the most precise placement of the new intraocular lens implant. This is particularly important for the Advanced Technology Implants where maximum independence from glasses is the goal.

Gentler Approach

• The laser pre-softens the cataract nucleus for a less traumatic removal, i.e. the cataract can be removed with less ultrasound energy and fewer instruments are needed in the eye.
• Studies have shown the use of the laser often reduces swelling and speeds recovery time.

Safety

• The introduction of the laser assisted cataract surgery will help ensure our patients outstanding outcomes and safety.

How Do I Know Which Procedure is Best for Me?

After your comprehensive exam at our office in Fort Lauderdale and the specialized testing done during the cataract evaluation, our doctors will review the results and partner with you to create a surgical plan that best matches the physical characteristic of your eyes and your lifestyle.

For procedures not covered by insurance we offer Financing Options

Presbyopia is the normal age-related loss of near focusing ability. If you’re over 40 and have to move the newspaper farther away to read it, you are beginning to experience presbyopia.

Even if you’ve had your vision corrected with LASIK surgery in your 20s or 30s, you’ll still experience reading vision problems from presbyopia in your 40s, 50s and beyond.

Monovision LASIK

Monovision is a presbyopia-correcting technique where your eye doctor prescribes lens powers for one eye to see clearly across the room (leaving it slightly blurred up close) and the other eye to see well up close (making it slightly blurry far away). The two eyes still work together as a team, but one eye does more of the work for your distance vision, and the other supplies more of your near vision.

Though it may sound odd, monovision contact lens fittings have been done for years, and most presbyopes who try monovision adapt to it quite well. Reading glasses may still be needed for very small print or sustained reading, but a person can usually be glasses-free most of their day with monovision.

Recently, LASIK surgeons have begun using this monovision technique as well, and success rates should be as good as or better than monovision with contact lenses. Before you commit to monovision permanently with LASIK surgery, however, try it with contact lenses first. If it works for you with contacts, you can then proceed with monovision LASIK with greater confidence (provided you meet the other criteria of a good candidate for LASIK).

Advanced Technology Implants and Clear Lens Exchange

Multifocal intraocular lenses (IOLs) are a variation of the lens implants that have been used for years in cataract surgery. But instead of having just one lens power to correct nearsightedness or farsightedness, these new lenses have multiple powers to correct vision at all distances.

Multifocal IOLs can be used in cataract surgery to replace the eye’s cloudy natural lens, or they can be used to replace a clear natural lens that has just lost its ability to change shape for reading due to presbyopia. This second procedure is called Clear Lens Exchange (CLE).

Because both cataract surgery and CLE are intraocular procedures, they may have more associated risks than less invasive procedures like LASIK. Possible complications of IOL procedures include glaucoma and retinal detachment.

Accommodating IOL (Crystalens®)

Another type of IOL that’s used in the same manner as a multifocal IOL is the “accommodating” IOL. This intraocular lens has just one lens power, but the central optical portion of the device is supported by structures called haptics that enable the lens to move slightly forward and backward inside the eye in response to focusing effort. In this manner, an accommodating IOL restores some of the eye’s ability to change focus on demand.

The accommodating IOL is approved for use in the United States as part of cataract surgery, and has the same risks as other intraocular lens surgeries.

In recent years there have been tremendous advances in the field of vision correcting eye surgery which is also known as refractive or laser surgery. Corrective eye surgery offers patients clear vision without the use of glasses and contact lenses. There are a number of types of refractive surgeries that are able to correct different vision problems, so if you are considering surgery here are some of the options you should know about.

LASIK

LASIK (laser-assisted in situ keratomileusis) surgery is perhaps the most well-known refractive surgery today. LASIK can help patients with myopia (nearsightedness), hyperopia (farsightedness) and astigmatism. During the procedure, the doctor makes a flap in the outer layer of the corner to reach the underlying tissue and then uses a laser to reshape the tissue which allows the cornea to then focus light properly. The procedure is usually painless and vision is usually clear within a few hours.

Recent advances in the field have developed subcategories of LASIK surgery such as Bladeless LASIK, which uses a laser rather than a mechanical tool to make the initial flap or Wavefront (custom) LASIK which uses computer mapping to guide the reshaping of the cornea and is able to create a much more precise visual correction for very subtle optical imperfections. There is also a procedure called Epi-LASIK in which following the procedure, the doctor applies a soft contact lens to protect the surgical area, holding the flap in place while it heals.

PRK

PRK (photorefractive keratectomy) also uses a laser to correct mild to moderate myopia, hyperopia and astigmatism. PRK was a precursor to LASIK which eliminated many of the complications of prior surgeries such as glare, seeing halos around lights, blurred vision and regression of vision. Unlike LASIK, the procedure only reshapes the surface of the cornea and not the underlying tissue. Consequently, there is often some discomfort for a couple of weeks until the outer layer of the cornea heals. Additionally, the patient may experience blurred vision during this period of healing. PRK does offer an advantage over LASIK in that there is less risk of certain complications. Wavefront technology is also available for PRK surgeries.

Due to the increased comfort of LASIK there was a period that PRK saw a decline. Recent studies show however that LASIK and PRK have similar long-term success for improved visual acuity and with the assistance of newly developed effective pain medications, PRK has become more popular again as an option.

LASEK

In LASEK or laser-assisted sub-epithelial keratomileusis, the doctor creates a flap smaller but similar but to LASIK, and then uses an alcohol solution to loosen the tissue around the cornea which is pushed aside, and then a laser is used to reshape the cornea itself. In an Epi-LASEK procedure, the doctor may apply a soft contact lens to hold the flap in place to assist in reattaching to the cornea as the eye heals. Patients that undergo LASEK generally experience less discomfort and quicker vision recovery than PRK patients. LASEK may be preferred over LASIK as a safer option for patients with a thin cornea.

Cataract Surgery

Cataract Surgery is a very common refractive surgery that removes the clouded natural lens of the eye and replaces it with an artificial lens called an IOL (intraocular lens). Many patients these days will receive a lens that also corrects any refractive error they have such as nearsightedness, farsightedness or presbyopia.

RLE

RLE or refractive lens exchange is a non-laser procedure the replaces the natural lens of the eye. This is the same as the surgery that is used to treat cataracts, ,yet for non-cataract patients, RLE is used to correct severe nearsightedness or farsightedness. The procedure involves the doctor making a small cut in the cornea, removing the natural lens and replacing it with usually a silicon or plastic lens. It is particularly useful for patients with minor corneal problems such as thin corneas or dry eyes.

RLE is more risky than the other procedures mentioned and can affect the patient’s ability to focus on close objects, possibly requiring reading glasses following the procedure. However, in cases of severe vision correction it is often the preferred method.

PRELEX

PRELEX or presbyopic lens exchange is for patients with presbyopia, the age-related condition in which you lose the flexibility of your lens and can no longer focus on close objects. Patients that prefer not to wear reading glasses or multifocals, can opt for a procedure in which the doctor removes the natural lens of your eye and replaces it with a multifocal artificial lens. This procedure is often done in conjunction with cataract surgery.

Phakic Intraocular Lens Implants

Phakic IOLs are implants that are used for individuals with very high nearsightedness who do not qualify for LASIK or PRK. The implant is attached to your iris or inserted behind your pupil, while the natural lens remains intact. Because this is a procedure that involves the inner eye, it is more risky than LASIK or PRK and is therefore also typically more expensive.

Conductive Keratoplasty (CK)

CK uses a hand-held radio wave device to shrink tissue on the cornea to reshape it. The procedure is typically used to treat mild farsightedness and presbyopia, particularly for patients who have already undergone LASIK.

Any surgical procedure has risks and may have some side effects or complications that you should research before you decide to go ahead with the surgery. Nevertheless, as technology advances these complications are being significantly reduced making refractive surgery a great option for vision correction in many patients.