The most common question I get asked by patients, friends and colleagues is how can you and why do you provide this service at such a low price?
The Coal Harbour Eye Centre staff (myself included) have been through high cost-low volume, and low cost-high volume corporately managed laser centres prior to opening at Coal Harbour.
When we opened we agreed on a philosophy of providing the highest quality of care at the most affordable price and to run Coal Harbour Eye Centre as a medical practice, not as a business. In keeping with that philosophy, I, as a medical doctor believe that affordability of a surgical procedure that enhances one's life, whether deemed cosmetic or not (and it can be argued either way), should not be an issue to most people. This surgery which I believe strongly in (having had it myself and having performed it on my daughter, brother, sister-in-law, many friends, numerous physicians and other laser refractive surgeons) should be made available to most and not just to those who can afford $3000 - $4000 as it was in the past. This surgery should not be restrictive or elitist.
Does price affect the quality of care?
Absolutely not. Quality of care is dependant on equipment, it's service, backup equipment, expertise and experience of staff and surgeon, and attention to detail. High price does not ensure high quality. What a high price does ensure is lower volume.
Our equipment: We have the Bausch and Lomb Z100 Laser, and a Bausch and Lomb Z50 Laser. Most clinics run with one laser, which would be fine but in order to maximize our outcomes we have purchased 2 lasers. Because our high volume is linked to our low cost, the lasers are working to their optimum efficiency and continuously serviced. I have used four (4) 4th and 5th generation lasers, including the Wavelight Allegretto, the VISX S3, and the MEL 80 in addition to the B&L technology, and feel that they were all excellent. We do the majority of our work on the Bausch and Lomb Z100 laser because in my experience it has yielded the best results. With the purchase of the Bausch and Lomb Z100 we've taken a step forward, and raised the bar as far as safety and accuracy.
Our microkeratomes (the equipment used to create a flap for LASIK procedures) are leading edge technology and the most popular microkeratomes used worldwide. The single most important step in the LASIK procedure is the flap. Bad flaps equal bad outcomes regardless of the technology that is used afterwards. The cutters, therefore, are of paramount importance.
How experienced is my surgeon?
You would be hard pressed to find a surgeon anywhere who has done over 55,000 procedures since June 1998 as I have. That is the surgeon, not the centre, not his associates, not people he may or may not have trained. The more surgery one does, the more proficient one becomes. Would you rather have a surgeon who performs 100 procedures a week or one who performs 10 procedures a month regardless of price. Generally the lower the price the higher the volume, which translates to greater the experience and expertise.
Likewise the technical staff: At our clinic the laser technicians, the medical technologists, and the laser vision specialists have been involved with tens of thousands of patients. They've heard and seen it all (or at least most of it).
Is everyone a candidate for surgery?
No. It depends on your prescription, corneal shape and thickness, age, other eye problems, general health, etc. Your personal care specialist or we, at Coal Harbour Eye Centre will determine if you are a good candidate during your free no obligation eye exam.
Would I need to have a re-treatment after my initial surgery?
No, not everyone requires a re-treatment, however, it is important to note that sometimes re-treatments are necessary to achieve best corrected vision. Retreats occur in less than 6% of our patients for LASIK and 2-3% of our patients for PRK. If a retreatment is needed the additional surgical procedure is covered by our Lifetime Enhancement policy. Patients will be required to purchase their medications at an approximate cost of $100.00 CDN.
Will I still need glasses after my surgery?
Most patients below the age of 40 do not require glasses to see after the surgical procedure. If you are 40 years old or older, due to the natural aging process of the eye you will require reading glasses. Laser vision surgery will correct your distance vision but will not prevent the need for reading glasses.
Does it hurt?
The surgery itself is generally pain free. LASIK patients do feel pressure and discomfort for a few moments with the lid speculum and microkeratome. Some patients may find this unsettling. We do provide a soothing eye drop medication to minimize discomfort, and can provide a sedative to help patients relax and feel more comfortable. After surgery, LASIK patients do not experience pain. PRK patients can experience pain, which is alleviated by using medicating drops. After PRK, 50% of patients feel very little if any pain, 40-45% felt mild discomfort, 5-10% experience some pain.
What if I have astigmatism?
Having astigmatism is quite common and does not discount you from being a candidate. Our lasers are able to treat the astigmatism along with correcting the nearsightedness or farsightedness. It is all done in the same procedure.
Will I achieve 20/20 vision after my surgery?
The goal of refractive surgery is to reduce the dependency on glasses or contacts. Patients' goals can vary based upon their level of correction and expectations. Most patients achieve 20/20 correction after surgery while others still require the use of glasses for night driving and reading. Your outcome is based on your individual parameters and will be discussed with you by our medical staff during your consultation.
What is "No Touch" or "touchless" PRK?
"No touch" is transepithelial PRK (Photorefractivekeratotomy) where the top layer of the cornea (the epithelium) is removed by the laser beam.
Is this method of removing the epithelium the most accurate?
In my opinion as a surgeon, it is not as accurate as using the cornea's natural plane between epithelium and it's underlying tissue, to gently wipe away the epithelium (that is, using the alcohol removal process). I have done over 1000 transepithelial PRKs, and over 12,000 alcohol removal PRK procedures. All methods of epithelial removal yield very similar outcomes. I have performed several different techniques and have selected the method I use, as in my hands it is the most accurate.
Does a surgical instrument touch the eye in the "No Touch" procedure?
The laser is a surgical instrument. It removes tissue from your eye. The only way to correct vision without touching the eye is to wear glasses (contact lenses touch the eye). "No Touch" is a trademarked name for transepithelial PRK coined by one clinic. It is not a patented form of surgery, it is a procedure developed in 1991. I still do this procedure on approximately 10 patients per year, only under very specific circumstances.
Which is a better procedure, LASIK or PRK?
This is best determined through having a discussion with your doctor and by having a pre operative eye evaluation. Generally speaking for low corrections, both LASIK & PRK can provide excellent results. With the LASIK procedure the advantages include little or no pain, faster healing time, minimal regression and low incidence of scarring. 95% of surgeons prefer LASIK. PRK is a less complicated procedure, but has a longer healing time, more irritation, and requires more time away from some of one's daily activities during recovery. PRK is considered the more desirable procedure for patients with occupations where risk of direct trauma to the eye may occur (boxers, martial arts professionals, law enforcement, etc) If one does not have enough corneal tissue for LASIK, then PRK is the safest and most preferred method.
What are the pros and cons of each procedure? (PRK & LASIK)
LASIK:
- Pros- Rapid recovery, very little discomfort after the procedure.
- Cons- When the "flap" is created for lasik, complications can occur although this occurs very rarely in experienced surgeons.
PRK:
- Pros- No "flap" is created so no risk of flap complication.
- Cons- Longer recovery, increased risk of infection.
What about the laser? Which one is the best laser?lt;br />
All modern lasers are excellent. I have used the four most popular and state of the art lasers used world-wide. They may be slightly different but in general our results were very similar in use of the Bausch & Lomb Z50, Wavelight Allegretto, the Visx S3, and the Carl Zeiss MEL 80. I have selected to use the Bausch & Lomb Z100 laser in my clinic as it has provided better and safer results. I have had the most experience with it, and the service of the laser is superior. As well, the calibration of this laser is the most reproduceable and accurate in our hands.
What is Wavefront Technology?
Wavefront technology treatment is an additional refinement to laser surgery. The primary goal of surgery is to remove the prescription from the patient's eye and eliminate the need for glasses. There can be irregularities within the optical system, however, that do not allow for the clear focus of light at a point on the retina, in spite of the treatment to eliminate any refractive error (near-sightedness, far-sightedness, astigmatism) within the eye. These are called optical aberrations and in laymans terms these are irregularities within the optical system which can cause 'imperfect' vision. This would manifest itself as halo, glare, other nighttime problems or complaints that vision isn't 'quite right'. The majority of people do not have significant high order aberrations, which are measured by a piece of equipment called the aberrometer. We do not know whether a patient will have high order optical aberrations until measured on the aberrometer. We do occasionally make a judgement that they may exist under certain conditions.
1.) A patient can not achieve 20/20 vision despite having what appears to be a totally normal eye, that is, no corneal, lens or retinal problems.
2.) The patient has problems obtaining an accurate refraction and gives inconsistent answers when measuring their refraction, that is, they have trouble distinguishing between two different lenses when presented with 'lens #1', 'lens #2', 'lens #3'.
3.) The patient does experience nighttime problems, such as, halo, glare, etc.
If aberrations are significant, then Wavefront technology may help decrease them post-operatively, but more importantly, will prevent the aberrations from increasing post-operatively versus pre-operatively. Aberrations are a peripheral phenomenon and if the pupil does not enlarge to at least 5.5 mm in diameter, then Wavefront is never considered. I explain to patients that what we are trying to prevent post-operatively are nighttime problems and comments like "In spite of seeing 20/20, my vision isn't quite right". We have found that since implementing this strategy of using Wavefront technology for patients with High Order Aberrations, we have eliminated the majority of these complaints, although truthfully we didn't have too many patients complaining of this prior to the advent of this technology. With this in mind, the second generation of Wavefront technology has proven itself to be useful in our hands and if a patient does have significant High Order Aberrations when measured on an aberrometer, we would recommend the Wavefront technology be used. We do utilize this technology in treatment for approximately 2-5% of patients.
This technology is not useful for treatment where there are no High Order Aberrations simply because if nothing is being measured, then nothing can be treated. The take-home message is that unless you have been tested on an aberrometer, the surgeon can not decide whether or not you need a Wavefront treatment and it is certainly not necessary on each and every patient. It does have a tendancy, especially in lower prescriptions, to overcorrect the prescription, therefore it must be used judiciously.
How do I start the process?
After reviewing this material, you are on your way to educating yourself about laser eye surgery. Your next step is to contact us and arrange a no-obligation eye examination at our centre. This will determine your eligibility for laser refractive surgery. If you are unable to come to our centre you can arrange this examination with your own eye care professional and have the results faxed to our facility for consideration.
Does my insurance cover laser eye surgery?
Some insurance companies are providing coverage for this surgery. You will need to check with yours to determine this. If your insurance company does not provide coverage, you will be required to cover the cost of surgery yourself. For your convenience we have provided various payment options, including monthly financing.
I hope I've answered these questions to your satisfaction.
Sincerely,
Steven L. Kirzner, MD
