Refractive Surgery

When making a decision about refractive surgery, it is important to consider the knowledge and experience of the surgeon.  Dr. Holicki is a laser certified Ophthalmologist and performs LASEK. 

He was the first physician in Michigan to insert INTACS®, an FDA approved Surgery for the correction of nearsightedness, using micro thin prescription inserts, gently changing the shape of the cornea. 

In 2005 he obtained certification to perform NearVision CK, a simple procedure that can reduce or eliminate the need for reading glasses.

The LASEK Procedure

In LASEK, the epithelium, or outer layer of the cornea, is cut not with the microkeratome cutting tool used in LASIK, but with a finer blade called a trephine. Then the surgeon covers the eye with an alcohol solution (perhaps one part alcohol and four parts sterile water) for around 30 seconds. The solution loosens the edges of the epithelium.

After sponging the alcohol solution from the eye, the surgeon uses a tiny hoe to lift the edge of the epithelial flap and gently fold it back out of the way. Then he or she uses an excimer laser, as in LASIK or PRK, to sculpt the corneal tissue underneath. Afterward, the epithelial flap is placed back on the eye with a kind of spatula.

After LASEK

In many ways, what you can expect from LASEK is similar to what you can expect from LASIK, but there are some differences. According to doctors who perform LASEK, the flap edge heals in about a day, though patients usually wear a bandage contact lens for around four days. You may feel eye irritation during the first day or two afterward. Also, the time it takes to recover good vision is often longer — up to four to seven days. Of course, it varies from one person to the next.

If you are considering LASIK, but your doctor says you need LASEK instead, ask why. It's not for everyone, but many surgeons who perform LASEK consider it a better option for some patients who will probably not do very well with LASIK.

INTACS (Intracorneal rings)

Intacs is a revolutionary corneal ring prescription insert that is entirely reversible. Thus, patients who elect to have Intacs are not “locked in” to the procedure forever, as are patients who undergo other refractive procedures such as LASEK. 

Vision correction with Intacs entails implanting a micro-thin intracorneal rings into the cornea by a trained eye surgeon. Intacs produce a reshaping of the curvature of the cornea, reliably reducing low degrees of myopia (nearsightedness). Intacs cannot be felt by the patient, require no maintenance, and are probably less visible than a contact lens to the naked eye. Intacs have been studied for more than 10 years and are FDA approved. The primary drawback at the present time is that Intacs are only available in the U.S. for low degrees of myopia (-1.00 to –3.00 diopters). However, these levels of myopia account for about 54% of all myopes. 

Since Intacs are prescription inserts, they can be removed or replaced if one’s vision needs change or there is any dissatisfaction with the corneal ring inserts. In the U.S. clinical trials, all of the very few people who had Intacs removed could subsequently be corrected to 20/20 or better vision.

Intacs produce excellent results. In U.S. clinical studies, 97% of patients saw 20/40 or better, 74% saw 20/20 or better, and 53% saw 20/16 or better. Furthermore, placement of Intacs maintains the “normal” positive asphericity (shape) of the cornea whereas Excimer laser procedures such as LASIK and PRK frequently produce oblate corneas. The latter condition may result in reduced contrast sensitivity. Visual correction with Intacs is also rapid and stable. Eighty percent of patients have 20/40 or better vision the day after surgery. A year after surgery, over 50% of patients see 20/16 or better as a result of their first procedure, i.e., without enhancements. 

Indications for Intacs

• -1.00 to ­3.00 diopters of nearsightedness (myopia)
  (Note: this range of myopia is considered "mild" by EyeMDs, yet accounts for 54% of all myopes)
• Relative intolerance of glasses or contact lenses
• Properly motivated and realistic patient

Visual Results

Amazingly, 53% of patients see 20/16 or better as a result of their primary procedure and 34% see 20/20 or better the day after the procedure! One month after surgery 79% of patients see 20/25 or better and by one year 87% of patients see 20/25 or better. Fully 97% of patients are 20/40 or better one year following surgery (20/40 is a "benchmark" of visual acuity as this level of vision allows unrestricted passage of a driver's license test in most states).

The Procedure

Intacs corneal ring prescription inserts are placed within the substance of the cornea under topically applied (eye drop) anesthesia. No needles or injections are required. Some patients may experience mild and temporary discomfort during the procedure. The surgeon makes a tiny incision in the top of the cornea, creates a 180 degree tunnel in which to place the first prescription insert, and then places the Intacs ring in the corneal tunnel. A similar procedure is used to place the second Intacs ring. 

Two Intacs inserts are placed in each eye, each of which approximates a near half-circle. The tiny incision through which the Intacs are placed is usually closed with a single stitch that can be removed within a few days or weeks. The entire procedure usually takes about 15 to 20 minutes per eye.

What to Expect After Surgery

The day of surgery, the operated eye may feel somewhat scratchy and vision may be blurred. Do not be alarmed. Any discomfort will usually be relieved by anti-inflammatory eye drop medications. You will be instructed to use both antibiotic and steroid eye drops, generally for about two weeks following surgery. On the first postoperative day, vision is usually good enough to drive a car, i.e., 20/40 or better, but may be reduced if the eye remains dry or an abrasion of the corneal surface has occurred. 

You will not be able to feel your Intacs inserts, however, you may feel the tiny incision and or stitch as the incision heals. This will usually resolve within a couple of days. If a suture was placed, your surgeon will probably remove it in about 2 to 4 weeks. With Intacs prescription inserts, you may expect your vision to recover very quickly and to continue to improve for up to 6 to 12 months.

Intacs for Keratoconus

Restoring quality of life through better vision...

A new FDA approved option for keratoconus: filling the gap between contact lenses and a corneal transplant!

Keratoconus is a progressive eye disease, which causes a thinning of thecornea, the clear front surface of the eye.  As keratoconus progresses, the quality of one's vision deteriorates and contact lenses or glasses no longer become a satisfactory solution for most people.  For many, an invasive corneal transplant was the only option – until now!  Intacs prescription inserts are an exciting new option between contacts and a corneal transplant that may be the best possible option to stabilize the cornea and improve vision. 

Intacs prescription inserts are indicated for use in the correction of nearsightedness and astigmatism for patients with Keratoconus, where contact lenses and glasses are no longer suitable.

Intacs prescription inserts are approved by the FDA for keratoconus under a Humanitarian Device Exemption (HDE).

For more information on INTACS for Keratoconus, click this Link
http://www.intacsforkeratoconus.com/main/termuse.html

Near Vision CK

Refractec was founded in 1993 to develop and market proprietary technology that would help baby boomers improve their near vision. The result is NearVision CK® a safe, non-laser vision-correction procedure that is allowing patients to end their frustration with reading glasses. Using the first FDA-approved technology for patients who are presbyopic and hyperopic, physicians have performed over 125,000 treatments, and in the process, are helping patients "see young, again."

For more information on Near Vision CK, click this Link

http://www.refractec.com