Risks and Considerations
DR. ANDREW HOLZMAN: And what Custom Treatment has done is it's improved the quality of eyesight. And it addressed the biggest knock on LASIK for years, which was night time vision, okay? So night vision where patients were getting glare and halos and around lights and things like that—we don't want that to happen to you and Custom Treatment seems to be prohibiting that from happening to you. So you're going to have glare after LASIK for a few days and a few weeks and if your eyes are really bad preoperatively you might have some glare at night for a few months. But we know that it's going to settle down and that you're ultimately going to end up with a very happy outcome. So for years we used to worry about glare, and I don't worry about glare any longer, okay? I just don't. So this is another one of the advances that has revolutionized our procedure. This is a schematic what a laser treatment will look like, okay? So that is interesting. Picture that this is a point of light that you're looking at, but when your glasses are off it's a blob of light, okay? And this is what your vision problem is in a map form, okay? So what's happening when the laser starts off is it starts off with a large treatment area, as you can see here. And what's going to happen is it's going to get the bigger problems first with this large treatment area. It's kind of like Mount Rushmore. At the beginning you use dynamite to start the process. So the larger treatment zones. And then it's going to get smaller and smaller. And you see the laser's going smaller and smaller, and that's kind of like the finer chisel for the detail of the treatment. And at the end you can see the point of light and all of that is driven by the laser and mapping systems that we've taken in advance of the procedure, okay? So that's what a Custom Treatment looks like. During the entire process, which sometimes takes anywhere between—as far as five seconds and maybe up to 40 seconds, it depends on bad your eyes are—during the entire process your eyes are being tracked with a digital tracker. So if you feel like you're going to be a little fidgety or your eyes are going to be moving a little bit, we're coaching you through this and it's very calm and I've got all kinds of pearls of wisdom to get you through this easily. But even still, we have digital trackers behind all that and I've never had to stop a treatment entirely because of the patient's movements, okay? So it's usually incredibly controlled. So we waited for a long time to get away from cutting these flaps with blades. And the IntraLase came about, I guess it was about six, seven years ago. Since then the technology has just gotten a little faster. I mean, it's basically the exact same technology, but it takes us less time to create the flap with the laser. So over the last six, seven years we've gone through three or four software changes where, you know, it used to take a minute, 20 seconds to create the flap with the laser; now it takes us 20 seconds. There are other competing companies from Europe that are trying to, you know, enter the U.S. market and create a bladeless flap, the same way as IntraLase. But we will have—LASIK is basically a two-step process. There's going to be a lifting of a flap and there's going to be the removal of tissue. So there's nothing really on the horizon other than competing companies to IntraLase to do the same thing. And the same thing with Custom Treatments. We waited a long time for Custom Treatments. And that's why I said this is a great time to have LASIK because we're really at the pinnacle of what I think is going to be our treatment for many years. I mean, there's going to be small software tweaks, but not major changes in how we do the procedure for quite a while. Well, I'm going to get into risk, and the good news about risk is when I first sat you down I told you we won't operate on you unless you're low risk. So we eliminate most of this risk before the surgery. You're still going to have to read the consent forms which are written by attorneys. They scare people. They have all these scary little things in there. And of course, I apologize for that, but if we thought those things were going to happen to you, you would definitely be in the 20% of patients that we turned away, okay? We just—I feel very strongly about that. So you still have to read the forms and sign the forms, but feel comfortable that we don't want to take risk with you. Infection is incredibly rare. I've seen one infection and I've been doing this—one infection of consequence, okay, and I've been doing this, like I said, for 20 years, okay? So this is not a common occurrence. You're going to need to use antibiotic drops before and after and it's not a dirty procedure. So it's unlikely that you're going to get the infection. Fluctuating vision is very, very common in this post-op period so for the first few weeks, maybe even a month or two, your vision may fluctuate. One day it might seem it's a little better than the other. And most of the time that's because of dryness. You know, and your eyes are just healing. So there might be one day that you're on the computer for long periods of time, you didn't put any lubricant times, or you drove in your convertible, and later on that night it feels like, you know, you're not seeing as well, okay? And then so the next day you'll see better. So this is temporary and it will get better over the course of a few months. Under and over-responders. These are the folks that end up needing the second treatment. We've covered this. This was the people that need the enhancement because they had a response to the laser energy that we didn't predict they were going to have. Okay? And then we go back and we do a second treatment. Dry eyes is common post-op. I would say that's the number one thing that we see post-operatively still. Now it's nowhere near as severe and it's nowhere near as common as it used to be prior to the IntraLase. However, we pretreat a lot of people for dry eyes. So we'll test you for dry eyes before the surgery and if we determine that you're at risk for dry eye post-op we'll pretreat you with some special medications that have been devised and released over the last few years that will help you through the healing process and it really has made a big impact. So we're going to do a lot of pretreatment and we're going to get you through the next couple of month post-op by also using lubricant drops and keeping your eyes a little moist after the surgery. Glare at night time. You're going to have some glare at the very beginning after the surgery. We just changed the shape of the window of your eye, okay? This has to heal. When a headlight hits this at night, at the very beginning there's going to be a little bit of swelling in there and it's going to scatter some light. And when that settles down you should be back to the normal level of glare that you have now, okay? Now hopefully, we can even improve on that. If you wear contacts and you get a lot of glare from your contacts or you get a lot of glare off your glasses, that kind of glare we'll be able to get rid of, okay? Flap abnormalities. This is what most people really worry about at the time of the surgery. Like they're worried about the surgery. What's going to go wrong in the surgery, okay? Well, I have good news for you, okay? We've gone probably about 10,000 consecutive eyes—and I'll knock wood here—without a significant flap complication during the surgery, okay? So that's very important to know. We're very experienced at this. I've been doing this for a long time. This is all I do. We take it seriously. We're good at it. It's very unlikely that during the surgery you're going to have a significant flap complication. But post-operatively it could happen where you bang your eye or somebody hits you in the eye, accidents, or something happens in the first week or two where the flap is more fragile and more apt to be disturbed. And if that happens to you then we're going to have to have you back in here and we'll fix the cornea, fix the flap and get your vision back. And that's usually when people are quite happy I'm a corneal specialist. So we can, you know, easily do that and fix your vision. It's not likely to occur to you, but we'll give you some goggles to sleep with for the first few nights and so that you don't bump your eyes or rub your eyes in the middle of the night. So we prefer if you avoid things that are going to, you know, that are going to put you at risk for eye trauma in the first few weeks following the surgery. And then there's this syndrome called Sands of Sahara, which is a syndrome of swelling under the flap. It occurs in about one percent of patients in the United States. Usually the patient doesn't even know they have it. It has to be treated with a whole lot of eye drops. It's kind of a rockier first week for the patient and then you get better. The incidence in this center is about a tenth of the national average. I mean, I probably haven't seen a case of this in about six months. And so it's rare, okay, here. And the reason it's rare here is because we pretreat you for a lot of these things. I mean, I'm a big believer in preventative care. So if you're having surgery here you're going to have a lot of things to do before the surgery so that these kinds of problems don't occur to you. Okay? So it's just following instructions and usually that's all it takes. Okay? Well, this slide just tells us that we have all the very best technology here under the roof here, and there's no center or there's no place or there's no place in the world that you can go that's going to have better technology than we have, okay? And that's something that's important to know. We have Leibert systems in the ceilings which control temperature and humidity. That's going to make our operating room more of a controlled environment. And that's going to allow us to operate when it's raining or when it's dry outside. We're going to have the same temperature and humidity inside and our laser's going to operate at the same functional capacity. That lowers our enhancement rates.