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LASIK and BOTOX® Questions

What is an Excimer Laser?

Excimer is a contraction of two words; excited and dimmer. When the two gases Argon and Fluorine are excited by electricity a specific wavelength of ultraviolet light is given off of 193 nanometers. This light is highly specific and causes a process called photoablation. Photoablation allows for extremely precise removal of tissue because it works to break down the carbon-carbon bonds found in biologic tissues. The Excimer Laser removes tissue at approximately 0.25 microns per pulse. It is this precision that allows us to give such precise treatments.

Are all Excimer Laser’s the same?

There many lasers available in the United States since the laser was first approved in the United States. In the opinion of Dr. Golden, the Visx S4 that he uses is the finest laser treating the broadest range of indications. He finds that his patients enjoy the treatment zone which improve the night glare issues of 80% of patients. He also likes the Visx laser because it removes less tissue per unit of nearsightedness than other lasers. More surgeons use the Visx laser in the United States than all of the other lasers combined.

What is PRK?

PRK is an acronym for Photorefractive Keratectomy. We prefer the term Advanced Surface Ablation (ASA) because modern PRK has little in common with early PRK. For PRK, we use the same Visx laser as we do for LASIK. The difference is that there is no need to make a flap for PRK. The PRK procedure starts by cleaning off the epithelium from the front of the cornea and then the laser reshapes the cornea in exactly the same way as it does for LASIK. The laser removes tissue in a cool fashion using from the top surface of the eye with the extraordinary precision. The laser removes 5-10% of the thickness of the cornea for mild to moderate myopia and up to 30% for extreme myopia which is the thickness of 1 to 3 hairs.

PRK is the preferred procedure for those with thin corneas and high prescriptions. Some individuals with a high chance of being hit in the eye like those in the military tor those involved in martial arts may also be better candidates for PRK because there is no flap to move with serious trauma. PRK can be used to treat nearsightedness, farsightedness and astigmatism.

Modern PRK has little in common with early PRK, which was the laser procedure first performed in 1988. Modern PRK, also known as Advance Surface Ablation (ASA) is an extremely safe procedure. Pain, risk of scarring and, long healing period have been mostly eliminated with modern techniques and the use of preoperative, intraoperative and postoperative medications.

What is LASIK?

LASIK is a procedure where a flap is made. This flap is a way to open up the cornea so that the laser treatment can be placed on the inside of the cornea. Once the laser treatment is completed the flap is put in to place and it heals back in to place without the need for sutures. Most people return to most of their usual activities on the day after their LASIK procedure, but need to be careful of their eyes for the first week. There can be no question that the LASIK procedure is the procedure that most people prefer because of its quick healing. LASIK can be used to treat nearsightedness, farsightedness and astigmatism.

What is the WavePrint System?

The VISX WavePrint System is a way to measure the visual system in a way that is twenty five times more precise than we were able to do with classic or older laser platforms. Each person’s WavePrint measurements are as unique as is their own fingerprint.

How does the WavePrint System work?

We use a device called a WaveScan analyzer which maps out your visual system measuring aberrations across your visual system. This information is then transferred to the computer which then treats your cornea in a way that would be different than that of any other individual.

What makes the WavePrint System unique?

The WaveScan analyzer produces the WavePrint map which gives us the ability to map the eye and this in then translated in to a unique treatment for each patient. Variable Spot Scanning means the smallest amount of corneal tissue possible is removed and the Visx tracking technology means that Dr. Golden can be certain that your treatment goes where it should be placed.

What can I expect from my VISX WavePrint Laser Vision Correction?

The VISX WavePrint System provides Dr. Golden with precise and detailed information diagnostically so that he can give the best possible treatment. This means that 85% of patients notice less glare after their procedure and 70% are able to have better vision than they ever had with their best pair of glasses or contact lenses.

What is Variable Spot Scanning?

Variable Spot Scanning, exclusively found in VISX lasers allows for a combination of large and small beams of the laser to perform the best possible laser procedure to give the best possible vision with the smallest amount of corneal tissue removal.

What is 3D ActiveTrak™?

The tracking system for the Visx laser means that if you should move a little bit during your procedure that the laser would move with you. If you move a lot, then the laser stops until you are back in position. Those worried about moving during their procedure can be certain that the laser cannot put any treatment on the wrong part of the cornea.

What kind of testing is done before a Laser Procedure?

We perform a comprehensive eye examination to make sure that Laser Vision Correction is a good option for you. We perform testing of the curvature of the front and back surface of your cornea, measure your prescription for glasses both before and after dilation, perform tear analysis, complete a full dilated exam looking for any eye diseases, testing of your pupil size in the dark, and corneal thickness measurements. In addition, we take a careful medical history to ensure that there are no systemic contraindications. We spend a great deal of time listening to you to make sure that you understand what we can and cannot achieve for your eyes.

WaveScan analysis provides us a precise and detailed analysis of your visual system. We then use all of this information to better educate you as to whether we believe you to be a good candidate for Laser Vision Correction.

What is BOTOX®?

A BOTOX Cosmetic treatment consists of a number of injections in the upper face that can smooth wrinkles on the face. We use a very tiny needle and most find only minimal discomfort. Many women say that it is less discomfort than eye brow treatments. Most BOTOX treatments take only a few minutes. BOTOX can be used to smooth the wrinkles between the eyebrows, on the forehead and crow’s feet around the eyes. The results are dramatic and apparent within a few days. Most people return to work or their normal activities following treatment. Within a few days, people notice a marked decrease in their facial wrinkles. With BOTOX Cosmetic, they’ll know you’ve done something, they just won’t know what. Most find that they like treatments about every three months to keep the wrinkles from recurring. The second year, most have treatments every four months and after that generally only need BOTOX twice a year.

Side effects are rare but can include a brief headache, respiratory infection, mild flu symptoms, temporary eyelid drooping, or nausea. BOTOX should not be given if there is an infection at the injection site.

What else can BOTOX help?

BOTOX has been found to help in a number of other conditions. Some enjoy its effects in reduction of underarm sweating. Many with Migraines find that BOTOX given to the face and neck can have a significant decrease in headaches that lasts longer than the disappearance of the wrinkles. BOTOX has not yet been FDA approved for these uses.

Who is a good candidate for BOTOX® Cosmetic?

BOTOX can be given to men or women. Men may require the use of more of the BOTOX medicine and may have a shorter duration of action as their muscles are commonly stronger than those of women. If you want a more youthful appearance, then BOTOX may be for you.

How often should I have my eyes checked?

Having your eyes checked on a routine basis is very important. If you have any concerns, we are always happy to fit you in to our schedule if you have an emergency.

  • Small Children — Pediatricians routinely check for eye problems but this is not a substitute for a comprehensive ophthalmologic examination. Parents generally know best if there is a problem. If a child seems to see well, the eyes are straight, there is not excessive rubbing of the eyes by the child or discharge, rarely is a visit to the ophthalmologist needed.
  • School age children — Most schools require an examination before a child starts school. It should be understand that as children grow, their eyes can change quickly. If your child complains of difficulties seeing the board at school or having headaches when reading a comprehensive vision examination is recommended.
  • School age to young adults — Children will generally complain if they are having difficulties seeing. An examination every two years is a good idea, but if a child has grown a lot recently, then they may need annual exams or even more often after a growth spurt.
  • Young adults to 35 — Once an individual stops growing, there is generally little change in their need for glasses for distance until late in life when cataracts occur. Small changes may occur in prescription, but these are generally not significant. Once an individual has stopped growing, they become good candidates for Laser Vision Correction. For girls this occurs somewhere between age 17 and 21. Boys may continue to grow until their early twenties. A general eye exam is suggested every two years for this population group unless they have a high prescription in their glasses or have a family history of eye diseases or they have diabetes.
  • Adults age 35 and up — An eye exam every years is strongly recommended. A glaucoma test and dilated eye examination are important as a comprehensive exam can find not only eye problems, but also a wide variety of systemic diseases may first be found in the eye.

What does 20/20 vision mean?

20/20 vision means average good vision. It may be easier to first define the term 20/40 which is the level of vision to drive without restrictions. 20/40 means that what the average person is able to see a specific object at 40 feet, someone with 20/40 vision needs to be 20 feet to be from the object. 20/20 is not perfect vision and is not the best possible vision. More than 99% of our Laser Refractive Procedures achieve 20/20 vision or better and the vast majority of our patients have better than 20/20 vision after a refractive procedure.

What is a diopter?

You may have heard the term and seen it on the box of your contact lenses or on your eye glass prescription. A diopter is a method of measuring the power of the correction needed to give someone their best visual acuity. Those with negative numbers on your eyeglass prescription are nearsighted and those with positive numbers are farsighted. Negative prescriptions cause a divergence of light so as to move the focal point further back in the eye. Positive number prescriptions cause the light to come to focus further forward in the eye. We can also measure the amount of astigmatism in diopters.