One of the more recent developments in refractive surgery is wavefront
technology which allows customized Lasik surgery. Dr. Hendricks
uses the Visx brand excimer laser system and the FDA approved this technology in 2003.
So what is wavefront technology? Basically,
it refers to a customized Lasik treatment which is very specific
to an individual eye. Let’s say you wanted a pair of
gloves. You would go into a store and buy a pair of size 7
gloves in a certain color and style. This would be analogous
to the standard Lasik surgery. Now let’s say you could
buy a pair of gloves in a certain color and style that would
also take into consideration the exact size of your hand,
fingers, and even fingerprints. That would be analogous to
wavefront technology and customized Lasik treatment.
So the difference between the two procedures
is the way the refractive error is measured. Standard Lasik
is based on the manual refraction which is done in the exam
room which measures near-sightedness, far-sightedness, and
astigmatism. These are known as lower order aberrations. They
are also known as subjective measurements because you, the
patient, help derive the numbers based on what you see through
the testing lenses. The laser treatment is then based on these
measurements. Wavefront technology measures lower order aberrations
as well as higher order aberrations. This is done by projecting
a “wave” of light into the eye. This wave is then
reflected back out of the eye and is analyzed and digitized
by a computer. This is an objective measurement because it
is not dependent on the patient’s input. The reflected
wavefront is unique to each individual eye, just like fingerprints.
The laser treatment is then guided by the measurements derived
from the wavefront scan.
What are the advantages of wavefront guided
Lasik? Probably the biggest advantage is the potential for
better quality vision. Sometimes patients that have had standard
Lasik measure 20/20 but they don’t feel like they are
seeing that well. This is most often due to higher order aberrations
which are corrected with wavefront. The same applies to the
occasional patient with night vision problems. If night vision
is a concern, then you may want to consider wavefront technology.
We also anticipate lower enhancement rates with wavefront
technology. Our present enhancement rates have dropped to less than 5% with wavefront.
In summary, wavefront technology is another
great advance that we have seen in refractive surgery. Some
ophthalmologists feel this is one of the most important advances
in recent times and will influence all other areas of our
field and may eventually change the way we prescribe glasses
and contact lenses. Dr. Hendricks feels that within a few
years, all refractive surgery will be wavefront guided and
it won’t even be an issue that will need to be discussed
with the patient. It is not a perfect procedure and there
will still need to be enhancements done at times. But it does
seem to be a significant advancement that will allow us to
help patients feel more satisfied with refractive surgery.
Customized Lasik is more expensive due to charges
by Visx and because it is more labor intensive. Patients often
want to know if it is worth the extra cost ($300
eye). First of all, not every patient will be a candidate
because they do not fall into the parameters which the FDA
has approved. Most patients are candidates
for customized treatments and we do more of this type of treatment every year.
Some patients are better candidates than others. For example, if a patient
than average pupil size or if they have above average night vision needs,
Dr. Hendricks may ask you to consider the customized treatment. Another indicatin
might be an unusual corneal topographic pattern. Dr. Hendricks will help you decide what might be best for you during your evaluation. Customized Lasik is another
advance and the bottom line is that it is the best refractive procedure
to offer to date. If cost is not an issue for you, then it is definitely
worth considering. If cost is a factor, keep in mind that standard Lasik is still
a great procedure.