FAQ for Dr. David Schanzlin - Laser Eye Surgeon
1) What is the structure of the eye and
what refractive errors can occur?
2) Who will be taking care of me?
3) What can you do for me?
4) How do I know what procedure is right
for me?
5) What can be done for my astigmatism?
6) Will it hurt?
7) When will I have good vision?
8) What is your success rate and experience?
9) What will it cost?
10) When can I be scheduled?
11) What should I avoid before my procedure?
12) What follow-up care is required?
13) What should I avoid after my procedure?
14) Can I visit my usual doctor after
surgery for follow-up care?
15) What are the risks of refractive surgical
procedures?
16) Will I still be able to read as before
after my procedure?
17) I hear the FDA has not approved LASIK,
is it experimental?
1) What is the structure of the eye and what refractive errors can occur?
For a detailed diagram of the eye and descriptions of Myopia, Hyperopia, Presbyopia and Astigmatism, please refer to our LASIK eye surgery page.
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2) Which laser eye surgeon will be taking care of me?
The same surgeon and medical staff who work with you
prior to surgery will provide your continued care during
surgery and through your crucial post-operative visits.
Our expert staff is comprised
of experienced refractive surgery counselors, assistants
and world-renowned laser eye surgeons, including Dr.
David J. Schanzlin.
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3) What can you do for me?
The Shiley Eye Center at the University of California
at San Diego is one of the nation’s premier research
and clinical facilities dedicated solely to the health
of the eye. Under the direction of world-renowned laser
eye surgeon Dr. David Schanzlin, The Shiley Eye Center
in La Jolla offers the entire range of corrective surgeries
to help people with nearsightedness, farsightedness
(hyperopia) and astigmatism. For more information on
specific procedures, please view our Current
Procedures.
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4) How do I know what procedure is right for me?
Choosing the right procedure is a decision that should
be made by both you and your laser eye surgeon. You
should consider your lifestyle, your occupational needs,
and your expectations of discomfort and speed of recuperation.
We will help factor in your unique prescription, anatomy,
and health characteristics to arrive at the right decision
for you. What makes it tricky is that each individual
has a different prescription, a different occupation,
and unique lifestyle demands. Clearly, no single procedure
is best for everyone. The procedure that is best for
you and your needs should be chosen after careful consideration
of every alternative. Below is a general guideline that
might help let you know what is possible.
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5) What can be done for my astigmatism?
The VISX Star excimer laser received FDA approval for
the treatment of up to -4.00 diopters of myopic astigmatism
in early 1997. This will expand our ability to treat
almost any combination of myopia with astigmatism.
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6) Will it hurt?
Each refractive surgical procedure is different in
terms of the potential discomfort.
» Laser assisted in-site keratomileusis (LASIK)
has become the procedure of choice for most dedicated
refractive surgical practices in part because there
is normally little if any discomfort associated with
this procedure. On average, most patients will describe
any discomfort they experience as similar to the tired
sensation of having over-worn a contact lens.
» Intacs are similar to LASIK in visual recovery
and patient discomfort. Vision returns to normal quite
rapidly (1-7 days), and discomfort during and after
the procedure is minimal for most patients.
» Photorefractive keratectomy (PRK) is usually
associated with moderate discomfort. The PRK procedure
requires the laser eye surgeon to make a 6 mm diameter
scratch on the surface of the eye. While patients use
medications to decrease their discomfort, a normal reaction
to this procedure can range from minimal discomfort,
a slight scratching sensation, to severe discomfort
that requires oral pain medication for relief. Visual
recovery is typically longer than with LASIK.
» The incisional procedures such as radial keratotomy
(RK) are usually associated with mild to moderate discomfort.
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7) When will I have good vision?
Here again each refractive surgical procedure is different
in the length of recovery.
» The rapid return to functional and normal levels
of vision is one of the strong advantages of the LASIK
technique. While each patient may respond in an individual
manner to the treatment performed, on average most patients
have a usable level vision within the first 24 hours.
It is not unusual for vision to be anywhere between
20/70 and 20/10 within the first 24 hours. As with any
other surgical procedure, after treatment the tissue
treated may swell as it is healing. This swelling can
create temporary blurred vision and even cause the vision
to fluctuate over the course of the day. This effect
normally subsides rapidly with a return to stable, clear,
comfortable vision.
» In comparison, PRK takes significantly longer
for the vision to stabilize. During the first three
days the cornea's surface epithelial cells are healing
over the scratch created during the procedure. A bandage
contact lens is used to help this surface heal rapidly
without interference from the constant action of the
eyelid. While the surface cells are healing, the vision
can be quite blurry. Normally, by day three the surface
cells are sufficiently healed that the bandage contact
lens maybe removed. At this point the vision begins
to improve dramatically. Over the next couple of weeks
patients will usually see a return to their best level
of vision. Within 3 months most patients' vision is
equivalent to wearing glasses before their surgery.
Stability of the final result is usually achieved somewhere
between three and six months.
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8) What is your success rate and experience?
Results vary with each individual and procedure. In
a recent study, 98% of patients treated for nearsightedness
and/or astigmatism saw well enough to pass a drivers
test without glasses. These results were for patients
who have had the LASIK procedure. While the results
with PRK are similar, the time it took to achieve this
same level of vision was several weeks longer.
Our chief laser eye surgeon, Dr. David J. Schanzlin,
has performed thousands of LASIK procedures since the
procedure was first developed in 1995. Although Dr.
Schanzlin and his staff have a wealth of experience
with refractive surgery, we do not measure our success
in volume. We believe that attention to detail and individual
treatment is the best way to achieve expectations.
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9) What will it cost?
Expect most treatments to cost between $3,000 and $5,000
depending upon the procedure. Some medical plans may
cover the cost; please ask your health insurance provider
for details. The Shiley Eye Center does provide affordable
payment plans. Some plans allow for no initial payment
with the balance financed over three years. Other financing
plans charge 0% interest with the balance paid over
6 months.
Compared to what you would spend on glasses, contact
lenses, and lens care over the course of 20 years, laser
vision surgery is cost-effective. The difference is
that you will have clearer, natural vision, and have
reduced or eliminated your dependence on glasses or
contacts. To many, this makes the procedure invaluable.
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10) When can I be scheduled?
The first step is to call and speak with a member of our staff. They can then either schedule you an appointment for a complimentary consultation with a patient counselor for information or schedule the complete exam with our doctors to determine if you are a candidate.
Regular seminars at our office in La Jolla, California
are scheduled for informal education sessions in a small
group format. The seminars provide: an overview of our
services, an opportunity to meet the staff and laser
eye surgeon, and a chance to have your questions answered.
To speak with a Vision Correction Center staff member,
please call (866) 427-6365.
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11) What should I avoid before my procedure?
There are a few restrictions before refractive surgical
procedures. To prevent infections, do not wear eye makeup
24 hours prior to the procedure. One of the most important steps is to begin using a topical antibiotic drop the day before your procedure. We will give you a prescription for these drops on the day of your exam.
Since any contact lens wear can cause subtle distortions
to the shape of the eye, we recommend that you discontinue
soft contact lens wear a minimum of three days prior
to both your exam and procedure. Rigid gas permeable
(RGP) or hard (PMMA) contact lens wear can cause dramatic
molding to the shape in the eye. We recommend that you
discontinue rigid contact lens wear at least four weeks
prior to both your exam and procedure. For patients
who have worn rigid contact lenses for many years, it
may take months without rigid contact lens wear before
the shape of the eye begins to stabilize. However, in
most cases it is possible to wear a soft contact lens
as a transition to stability.
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12) What follow-up care is required?
The usual care required after LASIK is not complicated.
The normal post-operative scheduled visits occur in
day one, week one, month one, month three, month six.
You will be required to take antibiotic drops to prevent
infection, and drops to prevent inflammation for one
week after surgery.
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> 13) What should I avoid after my procedure?
Eyes recover quickly after Intacs or LASIK, but there
are a few precautions that you should take. Eye rubbing
could disturb the treatment within the first week. You
should try to avoid touching the eyes early on. We recommend
that you wear a plastic shield over the eyes at bedtime
for the first seven days to prevent eye rubbing during
sleep. The only other common restriction is to avoid
getting foreign matter into the eye. Cosmetics such
as eyeliner and mascara could be a source of eye infection.
We recommend that these cosmetics not be used around
the eye for the first five days. Fluids such as perspiration,
pool water, ocean water, and tap water could also bring
an infection to the eye. Perspiration in the eye should
be avoided for the first five days, however, ocean water
that might enter the eye from surfing should probably
be avoided for four weeks. You may want to be a little
extra cautious and wear eye protection if you plan to
be around dust or debris.
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14) Can I visit my usual doctor after surgery for follow-up care?
Yes, in fact we encourage it. Having the doctor who
knows you best as a part of our team is a great way
to ensure your good results. We often look to your primary
eye care provider when questions of eye health history
or refractive stability arise. In addition, we have
developed co-managing relationships with a number of
excellent doctors in San Diego County. We have chosen
these individuals because of their experience, interest,
and ability to successfully manage patients before and
immediately following refractive surgical procedures.
If you are currently under the care of one of these
doctors then you have already begun your refractive
surgery evaluation. Simply call their office to express
your interest in refractive surgery and their trained
staff can help you take the next step to better vision
without glasses.
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15) What are the risks of refractive surgical procedures?
The risks of any refractive surgical procedure include
infection, loss of best vision, over correction, and
under correction. There are other risks that should
be discussed individually with your doctor. The overall
complication rate for PRK and LASIK is about the same
for each of the different procedures in the hands of
a skilled laser eye surgeon. While the risks are different
with each procedure, their incidence is roughly equal.
See Minimizing LASIK Complications, featured in "Ranch
& Cove" May, 2001.
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16) Will I still be able to read as before after my procedure?
Reading vision requires that the eye expend some effort
to focus up close. Before age forty this close focusing
is easily accomplished. After age forty, presbyopia
begins. At that point magnification for reading will
make this task easier. Nearsighted people often discover
that the natural magnification created by their nearsightedness
is a useful effect. This natural magnification will
be exchanged for better distance vision, and these patients
will now often require reading lenses for fine detail
or for prolonged reading just as their friends do.
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17) I hear the FDA has not approved LASIK, is it experimental?
The FDA is responsible for approval of new medical
devices but not surgical procedures. LASIK is a new
use of two currently approved devices. These are: the
microkeratome, to make the corneal flap; and the excimer
laser, to change the focus of the eye. The microkeratome
has been in use for other refractive surgical procedures
since the 1950's. The excimer laser has been approved
in the United States to treat myopia since 1995. This
procedure is not considered experimental and has been
practiced worldwide since 1993. By definition, the FDA
would not approve any procedure, only the devices used
during the procedure.
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