back in place, and even more rarely, a flap may be

lost - making this essentially a surface treated pro-

cedure with a more variable result and the possibil-

ity of significant corneal scarring. If the flap/cap is

lost, a corneal transplant operation may be re-

quired. Occasionally, adequate ring suction cannot

be maintained, and LASIK cannot be performed.

Other uncommon flap problems include unwanted

material such as cotton fibers in the interface

(which usually causes no problem), infection (very

rare), folds in the flap or epithelial ingrowth be-

neath it (requiring repositioning and cleaning the

flap) - the flap is usually easy to lift up for several

months post-op

One of the world’s best

Wrote the first textbook chapters on

lasik in the world

Organized the first and largest United

States lasik course

Helped teach the world LASIK

Popularized name LASIK

Over 30,000 surgeries performed

See the future with confidence

Lasik

Prk

Organizer of First United States Lasik

Course

Organizer of Largest Lasik Wet lab course

in the world

First textbook chapter written on the lasik

technique

First textbook chapter written on hyperop-

ic lasik

First textbook chapter on Sutureless Cor-

neal Transplantation

Editor Advances in Refractive & Corneal

Surgery

Helped teach the world LASIK

Popularized name LASIK

Over 30,000 surgeries performed

Largest Corneal Fellowship program in

USA

Reviewer for the Journal of the American

Medical Association [JAMA] and Middle

East African Council of Ophthalmology

worldwide firsts and notables: than 2 lines is about 0.5 to 2% for both LASIK and

PRK.

Inflammation (sterile white blood cell infiltrates)

in the treated area occur occasionally in surface

PRK/ usually while wearing the therapeutic band-

age soft contact lens. These usually respond well

to treatment with topical antibiotics and steroids.

Infiltrates are also occasionally seen with LASIK.

Steroid-induced glaucoma. Unlike LASIK, most

surface PRK/ patients require topical steroids for

one to four months to reduce scarring and prevent

regression. A small percentage of patients have a

genetic tendency to develop secondary glaucoma

when given steroids topically for this long. Most

of these cases will return to normal pressures when

steroids are stopped, but a small percentage will

require treatment for glaucoma from then on.

LASIK patients use steroid drops for only one

week and cannot develop steroid-induced glauco-

ma.

Complications Specific to LASIK

These include problems with the instru-

ment that makes the flap (microkeratome) which

result in incomplete flaps, irregular flaps, flaps

with thin spots or holes in it, or a flap that comes

totally off. These require the procedure to be abort-

ed, and then re-done in about three months. Occa-

sionally, if scarring occurs, the LASIK cannot be

repeated and the patient must wear a contact lens

for best vision. Rarely a flap may require suturing

Side Effects

Both LASIK and PRK have a low rate of side ef-

fects. These include mild irritation, glare or halos

(more prominent at night), ghost images, and un-

der or overcorrection. Both procedures may pro-

duce a decrease in the quality of night vision

(decreased contrast sensitivity).

Complications

Haze or scarring occurs initially in a mild form in

almost all surface PRK/ cases, but clears in 97% of

cases by one year. Nationally, about 3% of surface

PRK patients may require re-treatment with either

the laser or a non-laser polishing instrument be-

cause of excess haze. In our experience, this rate is

less than 1%. When re-treated, about 90% of these

clear. On the other hand, haze or scarring is ex-

tremely rare in LASIK.

Overcorrection occurs in about 1% of cases with

PRK or LASIK. Significant overcorrection requir-

ing contact lenses or future hyperopic LASIK are

uncommon.

Infections are rare but can result in scarring. Irreg-

ular astigmatism (i.e., a wavy corneal surface) due

to decentration of the laser optical zone or uneven

healing is uncommon with both procedures (less

than 1%). Loss of best correctable vision worse

PAGE 3

ORGANIZER

FIRST UNITED STATES LASIK COURSE

EXPERIENCE DOES MATTER FELLOWSHIP TRAINED IN CORNEAL AND

REFRACTIVE SURGERY

PAGE 4

FIRST BOOK CHAPTER ON

LASIK TECHNIQUE

PUBLISHED WORLDWIDE

In: Duplessie MD, Rocha G, Sanchez-Thorin JC, eds.,

Advances in refractive and corneal surgery. International

Ophthalmology Clinics , 1996 . Little Brown & Co., Boston.

priate.

DLK

Diffuse lamellar keratitis (DLK) is a

unique and relatively rare post-operative condition

following LASIK. Severe cases comprise only

about 1 in 5,000 surgeries.

When caught early, the inflammation asso-

ciated with DLK is easy to treat. Therefore it is

imperative that all patients maintain their recom-

mended post-operative follow-up examination

schedule.

If you notice something about your vision

that deviates from Dr. Duplessie and your expecta-

tions, you should notify him immediately.

Payment for Surgical Procedures: Payment is

required at time of procedure.

· LASIK/PRK

Includes:

Unlimited Post-Op Visits for One Year

5 year Enhancement Plan - $

Enhancement plan is not available for patients

with Hyperopia or

Hyperopia with Astigmatism.

May be an option, but not everyone is eli-

gible for an additional procedure. Eligibility for

enhancements depends on a number of factors.

For some patients, prescription eye drops

to prevent dilation of the pupil at night may be an

option.

Diagnosis and treatment of clinical dry eye

may alleviate many of the symptoms. Toric con-

tact lenses may be prescribed for those who have

astigmatism. Future advances in laser technology

offer great promise.

Overcorrection, under correction & Regression

About 10-15% of LASIK or PRK/ patients

may require a re-treatment (enhancement or touch-

up) for under correction or regression back to-

wards myopia. Retreatment is more common in

patients who are more myopic or hyperopic and

have higher amounts of astigmatism. With either

PRK or LASIK regression and under correction is

very uncommon with less than 3.00 diopters myo-

pia. Regression can occur quickly, within the first

few weeks after surgery, but it also can occur

slowly over time. Patients who experience regres-

sion will notice their vision changing progressive-

ly. An enhancement procedure can be performed

to correct the residual error, just as is done to treat

an under correction or overcorrection. With laser

treatment there is a potential for both over and un-

der correction. I prefer to wait 3 months to perform

an enhancement. As that point, a LASIK proce-

dure can be performed to correct the residual error,

if the patient and Dr. Duplessie believe it is appro-

PAGE 5

FIRST BOOK CHAPTER ON

HYPEROPIC LASIK

PUBLISHED WORLDWIDE

In: Duplessie MD, Rocha G, Sanchez-Thorin JC, eds.,

Advances in refractive and corneal surgery. International

Ophthalmology Clinics , 1996 . Little Brown & Co., Boston.

Who is qualified for laser vision correction?

There is little more precious than the gift of

sight. We process almost everything in our lives

through our eyes, and yet 50 percent of people

wear glasses or contacts simply to function.

Are you tired of living in a world you cannot see

without the aid of contact lenses or glasses? Are

you fed up with the hassles of contact lenses or

glasses? Can you imagine starting your morning

able to see not only what time of day it is, but also

what type of day awaits you?

If you answered, “Yes” to any of these ques-

tions, please read through the rest of this booklet

so that you can educate yourself about the laser

vision correction services our practice provides.

What is LASIK?

LASIK is a surgical procedure intended to re-

duce a person's dependency on glasses or contact

lenses. LASIK stands for Laser-Assisted in Situ

Keratomileusis and is a procedure that permanent-

ly changes the shape of the cornea, the clear cover-

ing of the front of the eye, using an excimer laser.

A laser or a knife, called a microkeratome, is used

to cut a flap in the cornea. Pulses from a computer-

controlled laser change the curvature of the cornea

and the flap is replaced.

Dr. Duplessie organized the First United States

Lasik course to teach American doctors how to

perform Lasik. It has become the pre-eminent vi-

sion correction procedure due to rapid healing and

a quick return of vision.

Eye and Vision Errors:

The cornea is a part of the eye that helps focus

servative-free eye drops to insertion of punctal

plugs, depending on the severity of the case. For

almost all patients, dry eye symptoms gradually

subside over the first few weeks or months after

LASIK surgery. If you suspect that you may have

post-operative dry eye, you should contact Dr. Du-

plessie for an evaluation.

Glare/Halos/Starbursts

Many LASIK patients notice a temporary

decrease in night vision with symptoms that in-

clude glare, halos, and starbursts. The experience

of the phenomena can range from mild to severe.

These symptoms usually subside within six

weeks; however, some will continue to experience

them for a greater length of time.

There are several potential causes of de-

creased night vision. The most common is the nor-

mal mild swelling of the LASIK flap, which re-

solves within a few weeks of surgery. Another

cause is incomplete correction of the nearsighted-

ness, farsightedness or astigmatism. Clinical dry

eye can also contribute to the experience of glare

and halos. Rarely the cause is mild irregularities

that the LASIK surgery produces in the shape of

the cornea.

Depending upon the cause, those patients

who experience significant, persistent glare, halos

or starbursts have several treatment options.

Enhancement procedures:

months post-operatively. During that time, patients

may experience slight fluctuations in vision

throughout the day. These symptoms generally

diminish with time.

Crispness of Vision

For some patients, vision after LASIK

matches the sharpness of vision they had with

glasses or contact lenses before LASIK. However,

many patients notice that 6/6 vision after LASIK

can be different from 6/6 vision with contact

lenses before LASIK, especially gas permeable

contact lenses. These symptoms often dissipate

within the first six months.

Several published scientific papers have

measured patients' pre-operative and post-

operative contrast sensitivity, and nearly all have

reported that it returns to pre-operative levels with-

in the first six months.

Dry Eyes

Some patients experience dry eyes post-

operatively. The symptoms can vary widely.

When the dry eye is treated, those symptoms di-

minish.

Clinical dry eye is comparatively easy to

diagnose and the great majority of patients respond

well to treatment options ranging from use of pre-

light to create an image on the retina. It works in

much the same way that the lens of a camera fo-

cuses light to create an image on film. The bending

and focusing of light is also known as refraction.

Usually the shape of the cornea and the eye are not

perfect and the image on the retina is out-of-focus

(blurred) or distorted. These imperfections in the

focusing power of the eye are called refractive er-

rors. There are three primary types of refractive

errors: myopia, hyperopia and astigmatism.

· Persons with myopia, or nearsightedness, have

more difficulty seeing distant objects as clearly

as near objects.

· Persons with hyperopia, or farsightedness, have

more difficulty seeing near objects as clearly as

distant objects.

· Astigmatism is a distor tion of the image on the

retina caused by irregularities in the cornea or

lens of the eye.

Combinations of myopia and astigmatism

or hyperopia and astigmatism are common. Glass-

es or contact lenses are designed to compensate for

the eye's imperfections. Surgical procedures aimed

at improving the focusing power of the eye are

called refractive surgery.

In LASIK surgery, precise and controlled

removal of corneal tissue by a special laser re-

shapes the cornea changing its focusing power.

The Options: Surface PRK vs. LASIK

Photorefractive surgery:

PRK was the first surgical procedure developed

to reshape the cornea using a laser. The exact

same laser is used for the two types of surgery.

Below 5.00 diopters of myopia, there is a choice

between surface PRK/ and LASIK. Both proce-

dures are approved. What are the advantages and

disadvantages of each? With respect to results and

expectations, PRK and LASIK are identical.

LASIK has a miniscule increase in risk of compli-

cations due to creation of the flap. ILasik in an ad-

vanced form of Lasik.

Results

Overall, there does not seem to be a significant

difference between PRK/ and LASIK in the per-

centage of patients achieving 6/6 at the end of six

months. In my hands, they are essentially equal.

Thin Corneas

Sometimes, if a patient's cornea is too thin to safe-

ly perform LASIK, then PRK is the only available

option for refractive surgery. .

Length of Procedure

Both are quite short. Surface PRK takes about

three minutes of actual treatment time. LASIK re-

quires about one to two minutes additional actual

treatment time. There is no discomfort during ei-

ther procedure. With LASIK, there is a pressure

sensation and a graying out of vision for about 30

seconds while the corneal flap is created.

Complexity

LASIK is definitely more complex with

respect to both equipment and performance of the

procedure itself. The surgeons experience and ex-

and examine your eye. Dr. Duplessie may give you

one or more types of eye drops to take at home to

help prevent infection. You should wait one to

three days following surgery before beginning any

non-contact sports, depending on the amount of

activity required, how you feel, and Dr. Du-

plessie's instructions.

To help prevent infection, you may need to wait

for up to three days after surgery or until Dr. Du-

plessie advises you otherwise before using lotions,

creams, or make-up around the eye. Dr. Duplessie

may advise you to continue scrubbing your eye-

lashes for a period of time after surgery. You

should also avoid swimming and using hot tubs

or whirlpools for 1 week.

Strenuous contact sports such as boxing, and

karate, etc. should not be attempted for at least 3

months after surgery. It is important to protect

your eyes from anything that might get in them

and from being hit or bumped.

Visual Recovery

Most patients notice an improvement in

their vision immediately upon completion of their

surgery.

By the next day vision is often dramatically

improved. However, patients should understand

that, while fast visual recovery characterizes the

operation, it can take several months before some

patients achieve their final vision after LASIK.

Several studies demonstrate that the vision of a

number of patients continued to improve up to six

within the first few days after surgery.

Post-Operative Course

The post op result is similar in both procedures. In

the greater majority of cases, LASIK is more com-

fortable during the first week than surface PRK.

Discomfort is a bit less, achievement of visual acu-

ity is faster, return to full activity is quicker, and

the need for post-operative medications is greatly

diminished with LASIK. Vision becomes crisper

quicker and patients feel more comfortable during

the early post-operative period. It is just a fraction

risker.

Post-Operative Care

· LASIK: A clear plastic shield is worn over

the eye for the first 24 hours, and then

nightly for 2 nights to prevent inadvertent

rubbing of the eye. Eye drops are started

immediately and are used for only 4 days.

· Surface PRK: A therapeutic soft bandage

contact lens is worn for around four days

(depending upon your rate of healing) to

reduce discomfort. Antibiotic, anti-

inflammatory, and cortisone eye drops are

used four times a day while the lens is on.

After removal, the topical cortisone is used

four times a day for a week. Artificial tears

are used as needed.

You will see Dr. Duplessie at regular intervals

for at least the first six months. At the first postop-

erative visit, Dr. Duplessie will test your vision,

pertise is vital. Dr. Duplessie wrote the first text-

book on Lasik; he is one of the best. He has per-

formed over 30,000 procedures.

As with anything, with increased complexi-

ty, there are more possibilities that can go wrong.

Although the overall percentage of complications

of surface PRK and LASIK are approximately the

same, the complications with LASIK are potential-

ly more severe than with PRK.

The technology used in

the ILasik Procedure has been in use for years and

very safe. Dr. Duplessie wrote the first textbook

chapters Lasik and has been performing laser vi-

sion procedures for seventeen years and has per-

formed over 30,000 procedures; 31.4 million pro-

cedures have been performed worldwide to date

making it the most common elective vision proce-

dure. In the U.S. all branches of the U.S. military

and NASA allow the treatment of LASIK for their

servicemen and women, thanks to studies us-

ing ILasik Technology.

The iLASIK Procedure- Space age Technology

- a more advanced technique The iLASIK Procedure only takes minutes. It re-

shapes your cornea to correct the refractive imper-

fections in your eye (these imperfections are essen-

tially the reason you are nearsighted, farsighted,

etc.). Computers/software are used to make an in-

dividual blueprint of your eyes; this blueprint is

used to drive your laser correction and is what

gives you a truly customized result

Just Asking

It's natural to have a bunch of questions when con-

sidering the iLASIK Procedure. Dr. Duplessie is

an expert at answering those questions and his

staff are real pros who will provide plenty of sup-

port during the process.

Custom Vue:

Extremely high success rates with potentially su-

perior vision correction. Makes the laser more ac-

curate. Additional fee for Custom Vue.

LASIK VERSUS CONTACTS- MAYBE CONTACTS

AREN'T THE LONG-TERM ANSWER?

The iLASIK Procedure is safer than wearing con-

tacts lenses.

FINANCIAL FACTS— THE ILASIK PROCEDURE

IS WITHIN YOUR REACH

Money shouldn't be the reason you're putting off

having the iLASIK Procedure. We know that the

simple saying, "you can't put a price on great vi-

sion" doesn't change the fact that you have to find

a way to pay for the procedure.

Dr. Duplessie can help you with financing

What to Expect Before, During and After Laser

Vision Correction:

What to expect before, during, and after surgery

will vary from patient to patient. This section can-

not replace the dialogue you should have with Dr.

Duplessie, but it can help you gain a general un-

derstanding of the pre-, post– and operative stages

the rest of the procedure. Dr. Duplessie will then

lift the flap to dry the exposed tissue.

The laser will be positioned over your eye and

you will be asked to stare at a light. This is not the

laser used to remove tissue from the cornea; it is a

light to help you keep your eye fixed on one spot

once the laser comes on.

When your eye is in the correct position, Dr.

Duplessie will start the laser. At this point in the

surgery, the pulse of the laser makes a ticking

sound. A computer controls the amount of laser

delivered to your eye. Before the start of surgery,

Dr. Duplessie will have programmed the computer

to vaporize a particular amount of tissue based on

the measurements taken at your initial evaluation.

After the pulses of laser energy vaporize the corne-

al tissue, the flap is put back into position.

A shield will be placed over your eye at the end

of the procedure as protection, since no stitches are

used to hold the flap in place.

Postoperative:

Immediately after the procedure, your eye may

feel like there is something in it and Dr. Duplessie

may suggest you take a mild pain reliever. Both

your eyes may tear and water and your vision will

probably be hazy or blurry. You will instinctively

want to rub your eye, but don't! Rubbing your eye

could dislodge the flap, requiring further treat-

ment. In addition, you may experience sensitivity

to light, glare, starbursts or haloes around lights, or

the whites of your eye may look red or bloodshot.

These symptoms should improve considerably

the-counter medications and any medications you

may be allergic to.

Dr. Duplessie will perform a thorough eye exam

and discuss what you should expect before, dur-

ing, and after surgery, as well as your responsibili-

ties will be before, during, and after surgery. You

will have the opportunity to ask Dr. Duplessie

questions during this discussion.

The day before surgery, you should stop using

creams, lotions, makeup and perfumes. These

products as well as debris along the eyelashes may

increase the risk of infection during and after sur-

gery. Dr. Duplessie may ask you to scrub your

eyelashes for a period of time before surgery to get

rid of residues and debris along the lashes.

During the procedure:

The procedure should take less than 20 minutes.

You will lie on your back in a reclining chair in an

exam room containing the laser system. The laser

system includes a large machine with a micro-

scope attached to it and a computer screen.

A numbing drop will be placed in your eye, the

area around your eye will be cleaned, and an in-

strument called a lid speculum will be used to hold

your eyelids open. A ring will be placed on your

eye and your vision may dim. The microkeratome,

an instrument, is attached to the ring. Dr. Duples-

sie will use the microkeratome to make a flap in

your cornea.

The microkeratome and the ring are then re-

moved. You will be able to see, but you will expe-

rience fluctuating degrees of blurred vision during

of the procedure.

Preoperative:

If you wear contact lenses, you must stop wear-

ing the lenses four days before your baseline eval-

uation and switch to wearing your glasses full-

time. Contact lenses change the shape of your cor-

nea for up to several weeks after you have stopped

using them depending on the type of contact lenses

you wear. Not leaving your contact lenses out long

enough for your cornea to assume its natural shape

before surgery can have negative consequences.

These consequences include inaccurate measure-

ments and a poor surgical plan, resulting in poor

vision after surgery. These measurements, which

determine how much corneal tissue to remove,

may need to be repeated at least a week after your

initial evaluation and before surgery to make sure

they have not changed, especially if you wear RGP

or hard lenses.

If you wear:

· Soft contact lenses, you should stop wear ing

the lenses for 4 days before your initial evaluation.

· Toric soft lenses or rigid gas permeable (RGP)

lenses, you should stop wear ing them for at

least 3 weeks before your initial evaluation.

· Hard lenses, you should stop wear ing them for

at least 4 weeks before your initial evaluation.

You should tell Dr. Duplessie about your past

and present medical and eye conditions and about

all the medications you are taking, including over-