TLVC offers something called “bladeless laser vision correction” for Rs. 9000/- per eye. Normally, blade free or bladeless LASIK costs as much as Rs. 40000-50000 per eye. TLVC is not being fair to centers which have invested a lot in blade free LASIK to offer patients significant advantages.

The peculiar brand of “bladeless laser vision correction” advertised by TLVC is nothing but PRK. Giving it fancy names like ASA (Advanced Surface Ablation) or epiLASIK does not change this fact. PRK is quite different from Bladeless LASIK (Notice that TLVC does not say bladeless LASIK but bladeless laser vision correction!!!). In Bladeless LASIK, there is near immediate vision recovery. One can almost guarantee that the patient will be 20/20 the next day. The patient will only experience some grittiness in the eyes for a few hours, but there is perhaps a burning sensation for a couple of hours. Patients need to use steroids for only a few days, and the vision quickly stabilizes (more or less within a day).

The particular form of ASA or epiLASIK or PRK or bladeless laser vision correction espoused by TLVC and Shroff Eye Care is a far cry from this state of the art procedure. This type of laser vision correction procedure results in reduced visual acuity for the patient for a number of days and weeks. Patients experience intense pain for the first 24 hours, and they need to use steriods (with possible complications of rise in intraocular pressure and cataracts) for at least 4 weeks. Vision takes more than a month to stabilize.

As a blog which seeks to promote laser vision correction in India, we cannot condone such misleading behavior by centers like TLVC and Shroff Eye Care. Laser Vision Correction in India (whether Bladeless LASIK, LASIK, or PRK (ASA)) will not grow by centers engaging in unethical behavior. This is a large country, and there is always a place for centers like TLVC, which may not have the best technology, but who are willing to offer their services cheaply. But misleading patients in dubious ads is not the correct way.

By the way, many centers around the world who were reluctant to invest in bladeless LASIK technology because of its costs have tried the same method of misleading patients. Without a doubt, all of them have fallen by the wayside.

The number of centers offering bladeless lasik surgery in India is increasing at a rapid pace. New Vision Laser Centers just installed an increase Ifs laser in its Hyderabad center and a VisuMax laser at its Mumbai center. Contact info@lasersformedicine.com for more details.

It is rare to have 20/8 vision. 20/8 vision means that what objects normal people can see only at 8 feet, you can see from 20 feet again. Most people are 20/20. A minority of people are 20/15. Rarely does anyone have 20/8 vision in each eye. Sometimes people can see 20/8 with both eyes open.

LASIK or laser eye surgery is for reducing one’s dependence on wearing glasses to see clearly. If you have 20/8 vision now, then perhaps after LASIK you can eliminate your distance correction, and get 20/8 vision. But this is now always possible.

Sometimes LASIK will improve your vision. Especially, new lasers with wavefront customization will improve vision. However, that is not the current goal of LASIK laser eye surgery, and you should not count on it happening in your case.

a) Laser Photocoagulation for Retinal Treatment

b) Yag Laser Capsulotomy for After Cataract treatment

c) Laser Treatment for Glaucoma

d) Laser Vision Correction

LASIK is a type of Laser Vision Correction Surgery. Obviously a) through c) are not alternatives for LASIK. So I suppose that was not really your question.

There are different types of laser vision correction surgery. One is LASIK, the other is PRK, a third (similar to PRK) is LASEK or Epi-LASIK. While this is confusing, LASIK is the most popular, and over 90% of all laser vision correction surgery is LASIK. PRK and Epi-LASIK have more post-operative pain, and a longer visual recovery. Generally, they should be done when the cornea is thin, or there is some surface corneal disorder. Otherwise, LASIK is perhaps the best alternative.

Indeed, this is one of the biggest advances in the LASIK field since the initial use of LASIK. This change has come about with the advent of wavefront technology, and with a better understanding amongst surgeons and laser companies about the kind of tissue removal profile shapes that allow patients to retain and even improve the quality of their night vision.

Let us get a little technical here. The eye functions like a camera. It has a sensor (called the retina) and a set of two lenses (the cornea and the “lens”) which focus light from a distance on the retina. It has a shutter (the “iris”) which regulates the amount of light incident on the retina, by varying the size of the aperture (the “pupil”) depending on the amount of ambient light. During day time, the pupil is constricted (i.e., it is a very small aperture), while during night, the pupil is dilated, i.e. there is a larger aperture to capture more light.

It is important to understand, for the purpose of this discussion, that light rays which travel from the center of the cornea through the pupil to the retina travel a shorter distance than light rays travelling from the periphery of the cornea through the pupil to the retina. This difference in the length of the optical path is small during daylight. Since the pupil is small, only light rays travelling around the center of the cornea reach the retina. Peripheral rays get blocked. In the dark, on the other hand, this difference is accentuated. Since the pupil is very wide, rays incident from the peripheral cornea also reach retina.

If the cornea was a perfect sphere, which bent all rays of light by a similar amount, whether they originated in the centre or the periphery, the all the light rays would not focus on the retina. There would be a zone of focus, rather than a point of focus. This effect would be especially true at night, and there would be symptoms of glare and haloes. Obviously, this is not a happy situation. Therefore, our cornea has evolved into an “aspheric” lens, where it is slightly steeper in the center, and flatter towards the periphery. Light rays from the center (which travel the shortest distance to the retina) are focused by a steeper lens, while light rays from the periphery (which travel longer distances to the retina), are focused by a flatter lens. In such a manner, nature has ensured that all light rays, whether from the center or the periphery of the cornea, reach the retina at the same point. This is why we have naturally good night vision.

So how did LASIK change this situation? Excimer lasers remove tissue from the cornea to correct focusing errors in the eye. To correct myopia, or near sightedness, one must flatten the cornea, removing more tissue in the center of the cornea, and less tissue in the periphery of the cornea. The amount of tissue removal with an excimer laser is more or less proportional to its fluence, or the energy per area of tissue. What laser companies and eye surgeons realized in early part of this century (several years after LASIK was first performed, and after several million eyes were already treated), is that excimer lasers lose fluence as the spot moves from the center to the periphery of the cornea. In the center, the incident excimer laser spot is the smallest. In the periphery, the incident excimer laser spot is larger. This leads to a reduction in fluence. Another reason for the decrease in fluence towards the periphery is reflection losses. On earth, as we move from the equator to the poles, the amount of incident solar energy becomes less, because light rays which hit at an angle to the earth’s surface reflect more than light rays which are perpendicular to the earth’s surface. Similarly, excimer laser spots which are incident on the center of the cornea reflect less energy than excimer laser spots which are incident on the periphery of the cornea.

As a result of such fluence losses in the cornea, excimer lasers remove less tissue in the periphery than intended and remove more tissue from the center than intended. Then the cornea becomes the reverse of what nature intended. It becomes flatter in the center, and steeper in the periphery. This leads to all kinds of night vision difficulties, because now instead of a point of focus of all light rays on the retina, we have a zone of focus. In technical terms, this is known as an increase in spherical aberration, or the Zernike (4,0) higher order aberration.

Once laser companies and eye surgeons realized this (partly by using wavefront technology), this was relatively easy to correct. Laser companies started programming the lasers to remove (i.e., ablate) additional tissue from the periphery of the cornea. Such tissue removal profiles are known variously as Aspheric Profiles, Aberration Neutral or Aberration Smart Profiles, or Wavefront-Optimized Profiles. These profiles do not induce spherical aberration into the LASIK treated eyes, and prevent night vision difficulties after LASIK. Such profiles are now more or less the standard way of doing LASIK.

Often, Aspheric profiles are preferable to using wavefront-customized treatment profiles. Most people, especially in India, do not have significant higher order aberrations. Treating them with wavefront-customized profiles does not benefit these patients, and in fact, leads to the removal of additional tissue, which is undesirable. Treating them with aspheric profiles, on the other hand, would suffice, and lead to excellent day time and night vision.

There are two parts to the answer.

The first is whether your general ocular health can be improved by some form of alternative or conventional therapy. The other is whether the refractive error can be reduced by some form of alternative or conventional therapy other than LASIK.

To answer the first part, generally speaking, vitamins (especially vitamin A), and other anti-oxidants like zinc, would go some way towards improving your general ocular health. A healthy diet would similarly help. Similarly, exercise, some form of yoga, and so on should help. Generally, some therapy which improves your tear film stability and ocular surface, also goes a long way to giving you good vision. Improvement in the tear film can happen through many food sources, flax seed oil (or omega-3 fatty acid containing oils) is a good example.

The refractive error, which is the reason you need spectacles, is another issue. This is a physical thing, relating to the length of the eye, and the curvature of your cornea. This needs corneal flattening to correct, and is unlikely to be amenable to alternative cures. However, LASIK is only one way to flatten the cornea. Others include PRK (which is also done with a laser), and an older technique known as RK. It also includes Conductive Keratoplasty (for certain types of errors), or or orthokeratology or intra corneal implants, and changing the natural lens with an artificial one.

Having said all this, for the normal range of refractive errors, LASIK is the safest, most common, and most effective treatment.

1. Dr. Amar Agrawal, Dr. Agrawal’s Eye Hospital, Chennai, Intralase 60 KHz

2. Dr. Mahipal Sachdeva, Centre for Sight, New Delhi, Intralase 60 KHz

3. Dr. Rupal Shah, New Vision Laser Centers, Vadodara, VisuMax 500 KHz

4. Dr. Mahesh Shah/Dr. Bavishi/Dr. Mrudul Parekh, New Vision Laser Centers, Ahmedabad, Femto-LDV

5. Dr. Vasant Sapovadia, Netradeep Eye Hospital, Rajkot, Femto-LDV

6. Dr. Noshir Shroff, Shroff Eye Hospital, New Delhi, Intralase 60 KHz

7. Dr. S. P.S. Grewal, Grewal Eye Institute, Chandigarh, Intralase 60 KHz

8. Dr. J.S.Thind, Thind Eye Hospital, Jalandhar, Intralase 60 KHz

9. Dr. Rohit Om Prakash, Om Prakash Eye Hospital, Amritsar, Intralase 60 KHz

10. Dr. D. Ramamurthy, Eye Foundation, Coimbatore, Intralase 60 KHz

11. Dr. S.Bharti, Bharti Eye Hospital, New Delhi, Femto-LDV

12. Dr. Arul Mozhli Verman, Uma Eye Clinic, Chennai, Intralase

13. Dr. Jeevan Ladi, Dada Eye Hospital, Pune, Intralase 60 KHz

14. Dr. Rajiv Mirchia, Chandigarh, Femto-LDV

15. Dr. Kasu Prasad Reddy, MaxiVision, Hyderabad, Intralase 60 KHz

16. Dr Sri Ganesh, Bangalore, Intralase 60 KHz

17. Dr. Sardana, Delhi, Intralase 60 KHz

18. Dr. Rohit Om Prakash, Om Prakash Eye Hospital, Amritsar, Intralase 60 KHz

19. Dr. Sundermoorthy, Lotus Eye Hospital, Coimbatore, Intralase 60 KHz

• Do keep to your follow up schedule with your eye doctor. Generally, post-operative visits may be scheduled 1 day, 1 week, 1 month and 3 months after LASIK. Occasionally the doctor may call you more often or less often, depending on your progress. It is important that you note the follow up visit dates and visit the doctor on the appointed date and time.
• Do follow the schedule for medications (i.e., eye drops) prescribed to you by your eye doctor. If you sometimes miss or forget to put a drop on schedule, put it in as soon as you remember, and put in the next drop on schedule.
• Do handle the medication with clean hands, and don’t inadvertently injure the eye in putting eye drops. If you find it difficult to put the drips, have a friend or relative put them for you. Keep the medication bottles in a clean, cool and dry place. Don’t share medication bottles with someone else. If you inadvertently touch the open nozzle of the bottle, or it falls down, replace the bottle. You must protect yourself from infection.
• While bathing, make sure you are not allowing soap or water to enter the eyes. Don’t splash water into the eyes. If they feel dry, use artificial tears instead. Do however wash your face and area around the eyes (while keeping the eyes closed). Don’t allow all manner of muck to accumulate on or around the eye lids.
• Avoid activities where water or smoke will get into the eyes for the first couple of months after LASIK. Avoid smoky bars, avoid swimming, and avoid Jacuzzi’s etc.
• Do wear sunglasses while you go out into the sun, or in smoky and dusty areas.
• Don’t use eye makeup (i.e., eye shadow, eye liner) for around 2 months after LASIK or till you are on medication. Similarly don’t wear cosmetic contact lenses for the time you are on medication.
• For the first couple of months, avoid contact sports, or sports which may cause your eyes to get injured. Even after the first couple of months, please do take that your eyes don’t get poked or injured during sports or holi and so on.
• Start doing all your normal activities after the first day, on which you should be taking it easy. Don’t over strain your eyes post-LASIK, but don’t be too conscious of having undergone the surgery. Just start living your life normally, and the more you use your new vision, the more likely you will recover fast.
• If your vision suddenly gets blurred, or you get sudden sharp pain or your eyes get very red and angry, please do schedule a visit to your eye doctor as soon as possible. Don’t overreact either; wait for a couple of hours for the symptoms to persist before raising the alarm.

a) PRK is more painful than LASIK, especially on the first day after surgery. This pain can be excruciating sometimes.

b) Vision Recovery after LASIK is much faster than with PRK. With LASIK, one can be back to work or studies or whatever within a day, which is not possible with PRK. Vision after PRK returns to normal only over several weeks.

c) LASIK requires fewer post-operative visits to the eye doctor than PRK. This is also more convenient.

d) Especially for higher refractive errors, PRK can sometimes lead to a severe inflammatory reaction characterized by corneal haze and a regression of the eye correction acheived.

Because of all these reasons, LASIK is far more popular than PRK.

However, there are certain times when PRK is preferred over LASIK – a) when one has a thin cornea, a situation in which LASIK has more risk than PRK b) when one has moderate to severe dry eye, because LASIK causes more dry eye than PRK, c) when one has a corneal epithelial disorder, because PRK will also correct the epithelial disorder, and d) when one wants to leave no trace of surgery, because lasik can leave faint marks on the cornea which are visible under high magnification.

Some of these debates have become superficial as thin flap LASIK or SBK becomes more like PRK in terms of dry eye and corneal thickness, and techniques like Advanced Surface Ablation make PRK become more like LASIK in terms of pain and visual recovery.

I think it is important to choose your laser vision correction provider well-not someone who is dogmatic over the procedure to do, but someone who chooses the procedure (PRK or LASIK) which is right for you.