Laser Eye Surgery: How Does I... Video Transcript

Participants

Israel Bordainick , David R. Marks MD, Julius Shulman MD

Summary

If you have poor vision you should know about laser eye surgery as a treatment option. There are two common techniques: LASIK and PRK. How do these procedures work and what are the differences between them? Join us as we walk step by step through these operations with a medical expert and one of his patients. The webcast will also feature live footage from an actual procedure.

Webcast Transcript

DAVID R. MARKS, MD: Hi, and welcome to our webcast. I'm Dr. David Marks. If you've ever thought about having laser eye surgery, you've come to the right place because we're going to show you what it's all about. And to help us are two experts, one doctor and one patient. From the doctor's side, we have Dr. Julius Shulman. He's an Associate Clinical Professor at Mount Sinai Hospital in New York and he also has a private practice in New York City. Welcome. And from the other side, we have one of his patients, Israel Bordainick. He's had a couple of eye procedures and he's going to tell us what it's like to be a patient and to have it done.

First let's talk about the procedures themselves. What are the main laser procedures that you do?

JULIUS SHULMAN, MD: The two main procedures are Lasik and PRK. Lasik stands for laser in situ keratomileusis, which basically means the cornea, the front of the eye, is made into a flap, almost like a trap door. So the top of the cornea is folded back, the laser removes a thin layer of tissue, the flap is put back in place, and that's the end of the procedure.

DAVID R. MARKS, MD: We can see it on the screen right now. What's happening there?

JULIUS SHULMAN, MD: Here are some marks being placed on the cornea to help align the flap after it's been made. And this is a suction ring which is placed on the cornea, and at the press of a foot pedal the pressure in the eye is raised enough to make the flap. An instrument goes onto that guidepost. The instrument is a microkeratome. This is just checking the pressure to make sure it's the right level. This is some eyedrops to act as a lubricant so the microkeratome glides back and forth. And here the microkeratome is placed on the post. Another press of a footpedal, it glides across the cornea, making a very, very fine incision at a precise depth and glides back. That's how the flap is made. So once the flap is made, the flap is retracted and the laser then works under the surface.

Now I'm retracting the flap and now the laser is centered with the cross hairs right over the pupil. We have to be careful that the cornea is dry because any wet areas can interfere with the laser or make an irregular laser. So now once everything is set for the laser, we basically just press a pedal on the laser. It's already programmed with the patient's prescription. You might be able to see some flashing lights. That's the laser removing a thin layer of tissue in a specific pattern. If you're farsighted it's a different pattern from if you're nearsighted. If you have astigmatism it's different. So the laser can actually correct all these different refractive errors. Once the laser is done, then the flap is put back in place, it's allowed to dry for a couple of minutes, and that's the end of the procedure.

Under the flap we irrigate it with some mild salt solution to get any debris out and it kind of gently floats back on a bed of water. Once the flap is in place, we're careful to make sure the purple lines line up. So it's like fitting a jigsaw puzzle back together. Once they line up, we know the flap is in a correct position. And here I'm just what's called squeegeeing any water from under the flap just to get the flap to stick better. And as you might be able to see, all the marks line up, the cornea is nice and clear, and I'm just putting on some antibiotic drops and allowing it to dry for about two minutes. And that's the end of the procedure.

DAVID R. MARKS, MD: I love the medical terminology with the squeegee.

JULIUS SHULMAN, MD: I knew you'd like that one.

DAVID R.