Refractive surgery again has made another major change in Amarillo with the addition of the Allegretto WaveLight Excimer Laser System. Correction of myopia (nearsightedness) up to -12.0 diopters alone or in combination with astigmatism up to -6.0 diopters is possible. Treatment of hyperopia (farsightedness) of up to +6.0 diopters alone or in combination with up to 5.0 diopters of astigmatism is available. This Excimer laser is a fourth generation system with many new technologies not available on older systems. It has the fastest treatment available today which makes the time taken to perform the correction short. Shortening the time makes the comfort factor for the patient much higher.

 PRK SURGERY
    There are two procedures that can be used for myopia or hyperopia alone, myopic astigmatism, or hyperopic astigmatism. Both use the Allegretto WaveLight Excimer Laser which is a computer controlled Excimer light source which removes corneal tissue in the shape of a lens. Photo Refractive Keratectomy (PRK) & LASIK surgery are the procedures. PRK is performed by removing the surface layer of cells (epithelium) from the center of the cornea. Using the Allegretto WaveLight Excimer Laser the desired correction is "carved" on the underlying tissue. The epithelium is allowed to grow back, which takes from 3-5 days usually & during which time there is some discomfort and blurred vision present. A "bandage lens" is worn until the cells cover the cornea again. When they do, the vision may be good & usually is for those patients with small degrees of myopia &/or astigmatism, under 2 diopters or so. For higher degrees of myopia, the cells may not grow back like they were but become thicker as if trying to fill the space created by the laser. Eventually they smooth out but this may take weeks or even months to occur. Meanwhile the vision is not good. For that reason I encourage my patients to have only one eye operated on at a time. There is also another procedure that can be performed called LASIK surgery which will be described below.

  In the past several years there has been a suggestion that PRK surgery may produce better long term correction.  For this reason I have been encouraging some of my patients to have this procedure, one eye at a time, rather than LASIK surgery. The final result takes longer to achieve but is more likely to obtain the desired result.

PRK PRE-PROCEDURE INSTRUCTIONS

1. Please arrive on time.
2. DO NOT wear make-up.
3. Please arrange for someone to drive you to The Laser Center and to take you home.
4. You may eat & drink whatever you want prior to the procedure. Do not consume alcohol.
5. Wear comfortable clothes.
6. If you wear soft contact lenses, remove lens from operative eye for at least seven days prior to scheduled surgery. If you wear hard contacts, remove them for at least two weeks prior to scheduled surgery.

PRK POST-PROCEDURE INSTRUCTION FOR DAY OF SURGERY

1. One pain pill every four hours as needed for pain.
2. DO NOT REMOVE THE TAPE, SHIELD, OR CONTACT LENS FROM YOUR EYE.
3. DO NOT RUB YOUR EYE FOR ONE MONTH.
4. Tobradex one drop in the operated eye as directed by Dr Howell.
5. Tetracaine one drop in the operated eye as necessary for relief of pain.
6. You should not operate any machinery or drive a car after surgery while your eye is taped &/or while taking pain medication.
7. Keep all foreign matter out of your eye, including soap & water.
8. Avoid swimming & hot tubs for one month.
9. Call Dr Howell if you have any problems.
10. Use dark glasses if in the bright sun.
11. Return visit to Dr Howell on day & time assigned.

PRK POST-PROCEDURE INSTRUCTIONS BEGINNING THE DAY AFTER SURGERY

1. One pain pill every four hours as needed for pain. DO NOT TAKE ON EMPTY STOMACH.
2. DO NOT REMOVE THE BANDAGE LENS FROM YOUR EYE.
3. IF THE LENS SHOULD COME OUT UNDER NO CIRCUMSTANCES ARE YOU TO PUT IT BACK IN YOUR EYE.
4. Do not get anything in your eye during the first five days after your surgery, especially particulate matter such as mascara.
5. Avoid potentially contaminated water such as lakes, hot tubs, or swimming pools for one month.
6. You should wear dark sunglasses if needed.
7. Use Tobradex one drop as directed by Dr Howell in the operated eye.
8. Use Tetracaine drops for pain as necessary.
9. Call Dr Howell if you have any problems.
10. Keep all follow up appointments.

LASIK SURGERY
LASIK is used to correct higher degrees of myopia, astigmatism, & hyperopia. LASIK is an acronym for Laser Assisted In Situ Keratomileusis. Keratomileusis is an operation that has been performed since 1949 to correct high myopia. It had limited success, as the technique to carve the lens was less accurate than with the laser. With LASIK surgery a microkeratome instrument is used to create a thin corneal flap which is folded out of the way. The Allegretto WaveLight Excimer Laser is then used to carve the corrective lens on the corneal bed under the flap. The flap is then replaced & allowed to become adherent. The flap will stick in place requiring no sutures to hold it there. Because the central epithelial layer is not disturbed, it remains post-operative the same as pre-operative, its normal thickness. Recovery time is much shortened because the only epithelium that has to grow back is the thin partial circle where the corneal flap was created. This occurs in a matter of a few hours & causes a scratchy sensation until it has. This usually is the only pain associated with this surgery.

  Hyperopia affects the vision more commonly after the age of thirty when the patient notices that they are having trouble with their reading. Reading glasses become necessary. By the time they reach forty they have difficulty seeing good in the distance also. Glasses become necessary to see good in the distance at this stage. The distance problem can be reduced or eliminated with hyperopic LASIK for as much as +6.0 diopters of correction. Patients who had radial keratotomy (RK) surgery years ago & who were overcorrected making them hyperopic are good candidates for this surgery.

MONOVISION CORRECTION
  For those patients who have to wear bifocals or reading glasses & want to get rid of glasses completely, this can be done by using one eye to see in the distance & the other eye for reading & near vision. This called monovision & can be achieved with contact lenses or Excimer Laser surgery. If the patient is hyperopic or myopic to start, the dominant eye can be changed to see in the distance & the other made or left myopic to see clearly close. Anyone contemplating this type situation should try it with contacts before having permanent laser surgery performed. I, myself, have had surgery to create monovision & like this arrangement very much.

  If you have been waiting for ultimate laser to have any type of refractive error (glasses correction) corrected, that laser is available to Dr Howell NOW in Amarillo. This laser produces a smoother surface after treatment. It has a tracking device that follows the eye so the patient does not have to hold their eye so still for the treatment to be placed correctly. It is attached to an advanced computer which makes many calculations for the treatment. If you are interested in finding if you are a candidate for any of these procedures, call 358 7558 locally in Amarillo or 1-800-658 6662 for a free consultation.

 

LASIK PRE-PROCEDURE INSTRUCTIONS

1. Please arrive on time.

2. DO NOT wear make-up.

3. Please arrange for someone to drive you to The Laser Center and to take you home.

4. You may eat & drink whatever you want prior to the procedure. Do not consume alcohol.

5. Wear comfortable clothes.

6. If you wear soft contact lenses, remove lens from operative eye for at least seven days prior to scheduled surgery. If you wear hard contacts, remove them for at least two weeks prior to scheduled surgery.

LASIK POST-PROCEDURE INSTRUCTION FOR DAY OF SURGERY

1. One pain pill every four hours as needed for pain.

2. DO NOT REMOVE THE TAPE & SHIELD FROM YOUR EYE.

3. DO NOT RUB YOUR EYE FOR ONE MONTH.

4. Tobradex one drop in the operated eye as directed by Dr Howell.

5. You should not operate any machinery or drive a car after surgery while your eye is taped &/or while taking pain medication.

6. Keep all foreign matter out of your eye, including soap & water. Avoid swimming & hot tubs for one month.

7. Wear the shield over the operated eye for the first three or four nights.

8. Call Dr Howell if you have any problems.

9. Use dark glasses if in the bright sun.

10. Return visit to Dr Howell on day & time assigned.

LASIK POST-PROCEDURE INSTRUCTIONS BEGINNING THE DAY AFTER SURGERY

1. One pain pill every four hours as needed for pain. DO NOT TAKE ON EMPTY STOMACH.

2. DO NOT RUB YOUR EYE FOR ONE MONTH.

3. Do not get anything in your eye during the first three days after your surgery, especially particulate matter such as mascara.

4. Avoid potentially contaminated water such as lakes, hot tubs, or swimming pools for one month.

5. Wear the shield over the operative eye for the first three or four nights after surgery.

6. You should wear dark sunglasses if needed.

7. Use Tobradex one drop as directed by Dr Howell in the operated eye.

8. Call Dr Howell  if you have any problems.

9. Keep all follow-up appointments.