Corrective Eye Surgery Virginia, Maryland and Washington DC


The TLC Laser Eye Centers are equipped with advanced technology to perform a variety of corrective eye surgery treatments in Virginia, Maryland and Washington DC. Dr. Andrew Holzman explains the effectiveness of LASIK, Intralase, PRK, CK®, and enhancement treatments to help his patients achieve their desired vision.

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DR. ANDREW HOLZMAN: The next slide talks about a procedure called CK, which is standing for Conductive Keratoplasty. It's just a radio frequency treatment that do. We use radio frequency waves to steepen the cornea. And what that's going to do is it's going to allow people to read again. So if you've had LASIK and you then decide you can't stand your reading glasses as you get older, you can come back and we can do CK. Now the best way for me to discuss LASIK is for you all to think about an analogy here. Think of this cornea like it's a book, 500 pages thick, okay? And what we're doing is, it's two steps, LASIK. The first step of LASIK is we actually create a flap in the cornea so it's like opening a book, okay? And literally to page 100. So the cover of the book plus the first 100 pages gets lifted back. And in the second step we're going to remove pages of the book, okay? And it depends on how bad your eyes are. If your eyes are very, very bad we're going to remove more pages if your eyes are less bad we'll have to remove fewer pages. And then we close the book down. Okay? So it's a two-step process. And this flap will seal and heal, okay? And it sits in the cornea like sort of a manhole cover sits into a manhole. And you can take a three-hour nap, wake up and see. And that's what has made LASIK so popular, is the fact that it's a quick-healing procedure. The next day you're usually back to work. Okay? So at this point usually the patients are sitting there thinking to themselves I see how you made the flap, and it looked really easy as you lifted the flap with this little model, but how in the world do you do it with the procedure? And so there have been two ways to make the flap over the course of time. The first was with the mechanical device called the keratome, a belated procedure, okay? Which we don't use anymore. So for the last, I guess six years I've been using a procedure called Intralase, which is a laser to create the flap. So that this was one of the biggest advances in our industry over the last decade. And so we no longer have to use a metal keratome that has a blade run across the cornea and cut the flap; we use a laser. The laser has revolutionized our procedure because it's much, much safer. What we're basically doing is we're making a finer or a smaller footprint or imprint on your eye. Because we can make thinner flaps, a thinner profile, and it's a more secure procedure for you long-term. So it's not as aggressive. It's not as we don't have to make as deep of a cut. Okay? And we can tailor it to everybody's individual needs based on the size and the shape of that particular eye. So the Intralase, I could literally spend an hour talking to you about the clinical improvements that this has given us, okay? But we don't have the time to do that, but I'm going to just give you a few. It's obviously, blade-free which means it drops the complication very dramatically. Okay, we don't have to rely on gear-driven devices any longer. It's 100 times more accurate. We can make thin-profile flaps with this device. It lowers the risk of dry eye dramatically which is something that we used to struggle a little bit with in the older technology. And it lowers our enhancement rate. Now, to describe what an enhancement is, an enhancement is a second treatment basically to tighten up the first outcome. So think about it like a golf ball or a golf player. You're on the golf course and you're making a putt. The ball rolls really close to the hole, but it doesn't go in the hole. So the surgery or the golfer has to do a second putt, right? To get the ball in the hole. The cost of that second treatment is covered forever with what we have it's called a lifetime commitment from TLC. And the good news about that is we have multiple centers around the country. You can go visit any one of them and then have a second treatment if you ever need one at no additional cost. The other good news about enhancements is we don't do a lot of them, okay? The average laser center reports somewhere 5% and 15% of patients having enhancements in the United States. And my enhancement rate currently with our technology is under one percent. So we have a very low enhancement rate here. Something that we're proud of. It's one of the things that, you know, drives our business. Happy patients, good outcomes and not having to have second procedures. However, having said that, again, the game of golf if it's a 60 foot putt you must imagine that the patient is going to have a second treatment at a greater likelihood or a greater risk than the two foot putt. So based on your prescription, if you're a 60 foot putt and your eyes are horrible then you're going to have a greater chance of needing that second treatment. Most people are happy with 20/20 or better. There are other patients who are happy with 20/25 vision if they end up with 20/25 vision. Driving vision's 20/40. Most people are not going to be happy if they're at 20/40 or worse. And if the patient's unhappy at 20/30 or 20/25 we'll do an enhancement also. But most of our outcomes are in the 20/20 or better range. Okay? So Intralase allowed me to drop my enhancement rate from around 5% to under one percent now, okay? So it's one of those things that has helped us make this a more accurate procedure, okay? Now it can never be zero the enhancement rate. And the reason it can never be zero is because we're operating on human tissue. Human cornea. Which has to respond to the laser energy. So there's going to be patients who either respond a little more to the laser energy or respond a little less to the laser energy than we predicted, and those patients are going to be close to the hole and then we're going to have to go back and zap them again. Okay. And those are simple procedures; they only take a few minutes to do if you have to have one. Now some of you in this room may not end up being LASIK candidates. And we may end up telling you that you're a PRK candidate which is another laser treatment that we do here PRK is what the military had approved years ago. It was usually the first procedure; it preceded LASIK. And then LASIK came about so PRK fell out of favor a little bit, but PRK has been making a big comeback over the recent years for some safety concerns. And the military, since they originally approved PRK, has come back and approved LASIK as long as it's done with the Intralase for their personnel as well. So they've tested it and they now think that LASIK same with NASA they believe that LASIK with Intralase is safe for their personnel. But still, about 15% of people that we see are going to be PRK candidates because we find it for some individuals, for those particular people to be a safer procedure. And that's because some of you are going to have thinner corneas than average. So remember I talked about the book of 500 pages. Well, let's say your cornea's only 460 pages, okay? And that would be a thinner cornea. And we're talking in terms of pages, but in reality it's microns, okay? So instead of 500 microns, it's 460 microns. So the math doesn't work out. Even with my Intralase I can't make a flap thin enough to leave enough behind for safety and security long-term. So what we'll do is we'll do the PRK treatment which is right on top of the cornea, okay? So this is like removing the first 50 pages of the book as opposed to the middle 50 pages of the book, okay? So it's the same outcome. We still thin the cornea by the same amount, but we took the surface of the cornea off and that has to heal back over the course of about four or five days, during which you're sleeping in contacts and, you know, we put them in, we take them out four days later when the surface has healed back together. And then you slowly get better and better and better to the exact same LASIK outcome that any LASIK patient has. So it's the exact same visual results. It just takes you longer to get to that goal line. And so we offer PRK for patients as well, and like I said, about 15% of patients have this done, okay? Now we have two of the very best lasers in the industry here. One's called the Allegretto WaveLight and one's called the Visx Custom Vue Star S4. And so how do we determine which of these we're going to use? Well, what we're doing is we put you at a machine that looks like this and we shine a light into your eye and a wave of light comes back at this machine and it digitizes a wave. So this wave of light is now describing your vision, okay? Now this is more descriptive than your eye glass prescription. So, you know, for instance, before these treatments existed five years ago, if you had come into our office and all of you in this room wore the same pair of glasses, okay? You would then all have the same laser treatment, okay? We would just program the laser, minus 3 or whatever your glasses were, and you'd all get the same treatment and go home, and you'd do pretty well. But scientists found that there's more to our vision than just your glasses prescription and this is it, okay? This is called the WaveScan. And what it's describing is higher order aberrations in your eyesight. So now if all of you wore the same pair of glasses in this room, not one of you would have the same treatment. Because the mapping that we're using to drive the lasers is more intense information. It's more information than just your glasses prescription. And this is called Custom Treatment.

Dr. Andrew Holzman

Andrew E. Holzman, MD, FACS

Andrew E. Holzman, MD, FACS, is one of the most well-respected ophthalmologists in the greater Washington, DC, area. He is regularly sought out by professional athletes, media personalities, and other doctors for laser eye surgery. Dr. Holzman is a member of several prestigious organizations, including:

  • The American Academy of Ophthalmology
  • The American College of Surgeons
  • The American Society of Cataract and Refractive Surgery
  • The American Medical Association
  • The International Society of Refractive Surgery

To schedule a consultation at one of our five locations, please fill out our online form or give us a call at (703) 556-9155.

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