Laser Vision Care

Dr. Vincent Troia is at the forefront of Laser Vision Care in the tri-state area. Dr. Vincent Troia has been involved in laser vision correction since its introduction in Canada and FDA approval in the United States. Dr. Troia has been certified by the AllSight Laser Center in the management of Laser Vision Care.

Laser Vision Correction is an exciting option that is now available to patients. Linda Troia, Dr. Troia's sister and office manager, had Laser Vision Correction in 2001. Dr. Troia has consulted with thousands of patients regarding Laser Vision Correction and would be happy to help you determine if Laser Vision Correction is an option for you.

Please call for a Laser Vision candidacy evaluation and consultation at (724) 774-8765.

Your eyes are unique and irreplaceable. We can help you make the right decision about laser vision correction. We are best equipped to give you an objective opinion. Deciding whether laser vision correction, glasses, or contact lenses is best for you can be determined by a thorough evaluation of your visual needs from a refractive and functional standpoint. Traditional refraction determines the amount of treatment applied to your eyes by the laser. This important step is best carried out in a familiar environment by a professional whom you know and trust.

The final treatment decision factors in past and current health problems, occupational and leisure activities, computer use and so much more. We will coordinate your care with the surgeon who will be performing your procedure. We will guide you through the day of surgery and continue your care here in the office the first day after your procedure until your eyes have stabilized. Refractive surgery does not eliminate the need for eye care. Eye health exams and assessments of your vision and vision needs must be conducted on a regular basis. Since we will have followed you through laser vision correction, we will be best able to care for your eyes in the years to come. Our goal for you is good vision for life.

The Laser Vision Correction Candidate

This procedure is intended for people who want to reduce or likely eliminate their dependence on glasses or contact lenses. People who expect perfect vision without glasses or contacts following laser vision correction could be disappointed.

A person who is 18 years of age, in good health, free of ocular disease, and has nearsightedness, farsightedness, or astigmatism that has been stable for at least one year, is generally a good candidate. Surgery cannot be performed on anyone who is pregnant.

Choosing the Best Surgeon and Laser Center

Just as it is important to have the best eye doctor caring for your eyes it is equally important that you have the best surgeon and laser center to deliver the surgical portion of your care. By training and experience, we know how to evaluate surgical eye care and work with many refractive surgery patients. This puts us in position to be your best advisor on the choice of a surgeon and a center.

Introduction to Laser Vision Correction

Until recently, the only options available for correcting refractive errors were with glasses or contact lenses. The power of the lens required for you to see is measured in diopters. This determines your eye glasses and contact lens prescription. Glasses and contacts compensate for the power (or lack of power) of the lens and cornea by either adding or subtracting power to the eye and focusing the light rays on your retina. Now, laser vision correction can reshape the cornea, so the eye can focus the light rays on your retina creating a clear image.

Laser Vision Correction

Surface ablation [Photorefractive Keratectomy (PRK) or Epi-LASEK] and Laser-In-Situ Keratomileusis (LASIK) are common methods for reshaping the corneal surface of the eye. Though similar, each has its own advantages and disadvantages. They correct myopia, astigmatism, and hyperopia.

Myopia is corrected by flattening the central area of the cornea. Astigmatism is corrected by smoothing the asymmetric shape of the cornea and Hyperopia is corrected by removing small amounts of peripheral or outer area tissue to steepen the cornea.

The excimer laser is a sophisticated, computer-controlled device that emits a finely tuned ultraviolet cold laser beam capable of reshaping the corneal surface. Each pulse of the laser removes 0.25 microns (0.00004 of an inch) of corneal tissue. When completed, the average correction removes less than the thickness of a human hair. Since it is a cold laser, it is very gentle to the surrounding corneal tissue.

The excimer laser offers unprecedented accuracy and safety, within a tolerance to 0.00004 of an inch. This sophisticated instrumentation, along with a well-trained support staff and the skills of the right corneal surgeon, enables your eye .doctor to assure you the highest quality vision correction.

What is Surface Ablation?

The US clinical trials of PRK (Photo refractive Keratectomy) started in 1989. After more than seven years of study and refinements, the FDA approved PRK for myopia in October 1995.

Subsequently, the treatments of hyperopia and astigmatism have been approved. Surface ablation (PRK and Epi-LASEK) are painless outpatient procedures and take about 10 minutes to perform on both eyes. For Epi-LASEK the epithelium is moved aside and then repositioned following the laser reshaping. During surface ablation the laser beam, which is programmed with your prescription, is applied to the outer surface of the cornea. After having the surface of the cornea reshaped, the patient wears an extended wear contact lens to facilitate comfort and healing. Typically the contact is removed after 3 days.

What is LASIK?

LASIK is an acronym for Laser In-situ Keratomileusis, which simply , means, "to shape the cornea from within, using a laser." This is a painless outpatient procedure that usually takes less than 20 minutes. A hinged corneal flap is created with an instrument called a microkeratome. The flap is then lifted and folded back. The laser beam, which is programmed with your prescription, is then applied to the exposed surface of the cornea. This reshapes the cornea, allowing for clearer uncorrected vision. The hinged flap is then replaced to its natural position.

How Do I Know which is Right for Me?

Surface ablation and LASIK are both elective procedures, preformed with the excimer laser, which correct refractive errors. Each has its own advantages and disadvantages, which will be carefully discussed.

Surface ablation is technically simple, which minimizes the potential number of complications. Since it is preformed on the corneal surface, the tissue requires about three days to repair itself. This does lengthen the recovery time for comfort and clear vision.

LASIK is a more technically demanding procedure due to the microkeratome and corneal "flap." This means that surgeon experience is extremely important in decreasing the potential for complications. Because the laser treatment is "under the flap," there is generally less discomfort and faster visual recovery than with surface ablation. For the first month, care should be taken not to rub or scratch the eye so the corneal flap is not disrupted. Other possible treatments for your refractive error include astigmatic keratotomy, and clear lens extraction with implantation of an intra ocular lens. We will help you decide which procedure is right for you.

The First Step to Laser Vision Correction

A comprehensive evaluation is done in our office prior to your procedure. Refractive error, current prescription, and best-corrected visual acuity are determined. Your pupils are tested and measured. A detailed mapping of the cornea is done to look at the curvature of the eye in three-dimensions. The thickness of the cornea is measured. A dilated fundus exam is performed to look for underlying eye disease.

We will review with you the risks, benefits and goals of laser vision correction and discuss your expectations to be sure they are achievable.

Contact lenses, especially if worn for many years, can distort the shape of your cornea. This can affect the desired outcome. Before proceeding with surgery, your eyes need to recover from this distortion by leaving your contact lenses out for a period prior to your procedure. These periods vary from patient to patient for different types of contacts.

During Laser Vision Correction

After the eye is number with anesthetic eye drops, a lid holder is used to gently open your eye to prevent blinking. You are awake and comfortable during the procedure. Once the surface of the cornea is prepared the treatment starts! For LASIK, a small suction ring will be placed on the eye to serve as a stage for the microkeratome. The microkeratome creates a corneal flap that is folded back. For PRK, the surgeon prepares the cornea for the laser by removing the thin outer layer of epithelium from the cornea. For Epi-LASEK, the epithelium is moved aside and then repositioned following the laser reshaping.

While you look at a red target, the laser gently reshapes the corneal tissue. A clicking sound is heard that can last anywhere from 15 to 45 seconds, depending on the amount of treatment needed.
The corneal flap is then replaced and allowed to adhere for a few minutes. With surface ablation, a contact lens is placed on the eye. More drops are instilled and the procedure is repeated on the other eye. You can expect your vision to be slightly blurry. You must have a driver take you home and relax or rest for the remainder of the day.

After Surgery

After the procedure, you may experience a mild burning sensation for the first 24-48 hours. Rest will facilitate healing. You will use drops for about 3-4 days (longer for surface ablation) that help reduce inflammation and prevent infection. Pain medication can be prescribed if needed. Follow-up care is imperative. You will be seen a minimum of five post-operative visits here in our office during the year following the procedure.

Vision will be blurry the day of surgery. For LASIK patients it usually improves by the next day when you return to our office for your post-operative exam. The return of clear vision will take longer for surface ablation. Protective eye wear is imperative. Shields are worn at night for one week by LASIK patients. Surface ablation patients wear a protective contact lens. It is removed when the epithelium is healed, usually on the third day. It is normal to experience some or all of the following symptoms. These usually diminish over time.

Discomfort or Pain
Hazy or Blurred Vision
Scratchiness or Dryness
Glare
Haloes or Starbursts

What Restrictions are Recommended?

We will advise you of your individual case. In general:

Driving is permitted, when your vision improves to a safe level.
No work restrictions, unless you work in a dirty environment.
No swimming or hot tubs for one week No eye liner or mascara for one week No contact sports for one month.
Protective shields at night for one week.
Safety goggles for all potentially dangerous situations.

Wearing Glasses after Laser Vision Correction

The goal of laser vision correction is the elimination or reduction in dependence on your glasses and contact lenses. However, there may be times that you find you need to wear glasses or contact lenses to fine-tune your vision. If the need for glasses is constant, then we will evaluate the .possibility of an enhancement procedure with you. At some time after 40 years of age you will require glasses for reading and near work. There are no exceptions. We lose our ability to change the focus of our eyes as we age. Correction for this is possible with glasses or contact lenses. The laser can be used to create monovision, which will allow clear near vision, eliminating the need for glasses or contact lenses.

Monovision Can Replace the Need for Reading Glasses

If a person is over the age of 40, then fully correcting one eye for clear distance vision and deliberately under correcting the other eye will put off the need for reading glasses. However, when choosing monovision, your distance vision may not be as sharp. A discussion and demonstration of monovision prior to the surgery will help clarify this decision.

Potential Problems after Laser Vision Correction

The chance of having a vision-reducing complication following laser vision correction has been documented in a number of clinical studies to be less than 1%. Most people who undergo laser vision correction experience a successful outcome. However, as with any surgery, there are potential complications.

Loss of Best Corrected Vision. This means that the vision can be poorer after surgery with glasses or contacts than vision was before surgery with glasses or contacts.

Under-correction and Over-correction. The more nearsighted or farsighted you are, the more likely the eye will be over- or under-corrected. As you heal your vision may be less than perfect, requiring glasses or contact lenses for clear, sharp vision. Typically, we will allow a minimum of three months for the eye to heal before considering an enhancement procedure.

Glare and Haloes. Even before having laser vision correction, many people experience poor night vision, glare and haloes with glasses or contact lenses. Following the laser procedure, some people complain of glare and haloes. In the immediate post-operative period, everyone experiences glare which almost always reduces with time. It is possible however, that this glare could be permanent and may be serious enough to prevent you from driving or other activities at night. Several factors contribute to this such as the amount of nearsightedness you have, the size of your pupils and the shape of your cornea. These measurements are taken during your comprehensive evaluation and calculated to determine if glare and haloes are likely to be a problem for you following laser vision correction.

Corneal Flap Risks. In rare instances with LASIK, a corneal flap may be created which is irregular, too short, or too thin. Should any malfunction of the microkeratome occur, the laser procedure will not be performed. The flap will be replaced back to its natural position and the eye will be allowed to heal. Typically, three to six months later, the procedure can be performed very safely. Another rare, but possible, flap complication is epithelial in-growth. This occurs when epithelial cells grow beneath the flap before it completely seals to the corneal margin. Although most cases do not require any treatment, occasionally the flap may have to be lifted and the area cleaned underneath the flap. The use of advanced technology and a skillful surgeon minimizes the risk of flap complications.

Laser Treatment Complications. It is possible, though rare, for the laser treatment to be delivered off center or irregularly, which would compromise the vision result. The surgeon has complete control over the delivery of the laser. At any time the laser can be stopped, your eye repositioned and the procedure continued.

Infection and Scarring (Haze).

Infection and scarring of the cornea are rare. Should they occur, they can result in permanently decreased vision. These are prevented with the use of antibiotic and anti-inflammatory eye drops immediately following the procedure. You will continue to use the drops for the next four days. Hazing of the cornea is infrequent but is more common with surface ablation. Rarely this can result in reduced vision requiring additional medication or surgery. Your eye doctor will be best able to care for your eyes in the years to come.

How Do We See?

"Refraction" refers to the total process by which the eye focuses or refracts light. Three factors determine the eye's refractive power: the curvature of the cornea, (the transparent tissue that covers the iris or colored part of the eye), the power of the lens (located behind the iris), and the overall length of the eyeball. When these elements function properly, light focuses sharply on the retina (a layer of light-sensing cells lining the back of the eye) and gives clear vision at all distances without glasses or contact lenses. Focusing or refractive disorders arise when these elements do not work in harmony with each other. In these cases, light does not focus on the retina and a blurred image is perceived. Common refractive disorders are myopia (nearsightedness), hyperopia (farsightedness), and astigmatism.

Myopia (nearsightedness)

Nearsightedness is the most common refractive disorder. It is estimated that one in every four people is myopic. In myopia, near vision remains clear, but distance vision is blurred. Myopia results from genetics and how patients use their eyes. Myopic eyes are too long for the steep corneal curvature, which causes light to focus in front of the retina. The term "nearsightedness" means you can see objects "near" to you more clearly than distant objects.

Hyperopia (farsightedness)

Farsighted people usually see distance objects more clearly than close objects. Farsightedness is a condition of the eyeball being too short for the flat corneal curvature. In this case, light hits the retina before it can come into sharp focus.

Astigmatism

Astigmatism is caused by asymmetric curvature of the cornea. Instead of being round like a basketball, the cornea curvature resembles a football. Light is not sharply focused at any distance. Astigmatism often occurs with

myopia or hyperopia.

Presbyopia

Presbyopia is part of the natural aging process. Everyone experiences the effects of presbyopia, typically between the ages of 40-50. It develops as the lens of the eye loses some of its flexibility, making it difficult to focus up close. Mild myopia counteracts presbyopia. That is why if you are slightly myopic, you can remove your glasses and still be able to read.

Informed Consent

The process of learning about risks, benefits and alternatives related to a surgical procedure is known as "informed consent." We will ask you to sign an informed consent form. Take the time to review it completely and go over any and all questions with us before you sign it. Remember, as with any surgical procedure, it is impossible to guarantee results.

Getting Started

Call our office today to schedule your pre-operative consultation. We will discuss in detail your surgical options and talk about what you can expect from laser vision correction.

Financing

Our office has several financing plan options that will easily fit your budget. We also accept major credit cards.

Is this Covered by Insurance or Flexible Spending Benefits?

Laser vision correction is a tax-deductible medical procedure which can be paid for with funds from your medical spending and health savings accounts. Please check with your plan administrator to determine your maximum contribution. Typically, laser vision correction is not a covered benefit through your insurance company. Some insurance companies have negotiated a discount with specific laser centers. This arrangement does not always represent a true savings. Please discuss your options with us.

The Intraocular Lens Alternative

For various reasons some patients are not able to have laser vision correction. For these patients implanting a lens inside the eye to correct their refractive error is now an option. Several procedures and lens types are available. One procedure involves inserting an artificial lens into the eye in front or just behind the pupil. This is achieved through a small incision in the eye. The second procedure is very similar to cataract surgery in that the natural lens is removed and a lens is implanted in the space previously occupied by the natural lens. One of these lenses even is capable of restoring some of the focusing mechanism of the eye for patients who wear bifocals.

While these procedures are exciting and offer wonderful options to laser surgery, they have their own unique advantages and disadvantages. These procedures have the advantage of not changing the shape of the front of the eye and not removing corneal tissue. The disadvantages include the risk of intraocular infection, retinal detachment and other complications of intraocular surgery. Also, many patients still require minor laser vision correction after the implantation of the intraocular lens to correct residual refractive errors. These procedures are as much as three times as expensive as laser vision correction.

If laser vision correction is not the best procedure for you we will discuss this option in more detail.

Laser vision correction is a year long process involving many decisions specific to your individual eye health and vision needs. Your eye doctor is the best professional to guide you and manage your care through this process.