Lasik eye surgery reviewed by dr. michael duplessie. In much better and more current detail at http://michaelduplessie.com/lasik-surgery-laser-eye-surgery-lasik-cost/

1. back in place, and even more rarely, a flap may be
lost - making this essentially a surface treated pro-
cedure with a more variable result and the possibil-
ity of significant corneal scarring. If the flap/cap is
lost, a corneal transplant operation may be re-
quired. Occasionally, adequate ring suction cannot
be maintained, and LASIK cannot be performed.
Other uncommon flap problems include unwanted
material such as cotton fibers in the interface
(which usually causes no problem), infection (very
rare), folds in the flap or epithelial ingrowth be-
neath it (requiring repositioning and cleaning the
flap) - the flap is usually easy to lift up for several
months post-op
One of the world’s best
 Wrote the first textbook chapters on
lasik in the world
 Organized the first and largest United
States lasik course
 Helped teach the world LASIK
 Popularized name LASIK
 Over 30,000 surgeries performed
See the future with confidence
Lasik
Prk

2.  Organizer of First United States Lasik
Course
 Organizer of Largest Lasik Wet lab course
in the world
 First textbook chapter written on the lasik
technique
 First textbook chapter written on hyperop-
ic lasik
 First textbook chapter on Sutureless Cor-
neal Transplantation
 Editor Advances in Refractive & Corneal
Surgery
 Helped teach the world LASIK
 Popularized name LASIK
 Over 30,000 surgeries performed
 Largest Corneal Fellowship program in
USA
 Reviewer for the Journal of the American
Medical Association [JAMA] and Middle
East African Council of Ophthalmology
worldwide firsts and notables: than 2 lines is about 0.5 to 2% for both LASIK and
PRK.
Inflammation (sterile white blood cell infiltrates)
in the treated area occur occasionally in surface
PRK/ usually while wearing the therapeutic band-
age soft contact lens. These usually respond well
to treatment with topical antibiotics and steroids.
Infiltrates are also occasionally seen with LASIK.
Steroid-induced glaucoma. Unlike LASIK, most
surface PRK/ patients require topical steroids for
one to four months to reduce scarring and prevent
regression. A small percentage of patients have a
genetic tendency to develop secondary glaucoma
when given steroids topically for this long. Most
of these cases will return to normal pressures when
steroids are stopped, but a small percentage will
require treatment for glaucoma from then on.
LASIK patients use steroid drops for only one
week and cannot develop steroid-induced glauco-
ma.
Complications Specific to LASIK
These include problems with the instru-
ment that makes the flap (microkeratome) which
result in incomplete flaps, irregular flaps, flaps
with thin spots or holes in it, or a flap that comes
totally off. These require the procedure to be abort-
ed, and then re-done in about three months. Occa-
sionally, if scarring occurs, the LASIK cannot be
repeated and the patient must wear a contact lens
for best vision. Rarely a flap may require suturing

3. Side Effects
Both LASIK and PRK have a low rate of side ef-
fects. These include mild irritation, glare or halos
(more prominent at night), ghost images, and un-
der or overcorrection. Both procedures may pro-
duce a decrease in the quality of night vision
(decreased contrast sensitivity).
Complications
Haze or scarring occurs initially in a mild form in
almost all surface PRK/ cases, but clears in 97% of
cases by one year. Nationally, about 3% of surface
PRK patients may require re-treatment with either
the laser or a non-laser polishing instrument be-
cause of excess haze. In our experience, this rate is
less than 1%. When re-treated, about 90% of these
clear. On the other hand, haze or scarring is ex-
tremely rare in LASIK.
Overcorrection occurs in about 1% of cases with
PRK or LASIK. Significant overcorrection requir-
ing contact lenses or future hyperopic LASIK are
uncommon.
Infections are rare but can result in scarring. Irreg-
ular astigmatism (i.e., a wavy corneal surface) due
to decentration of the laser optical zone or uneven
healing is uncommon with both procedures (less
than 1%). Loss of best correctable vision worse
PAGE 3
ORGANIZER
FIRST UNITED STATES LASIK COURSE
EXPERIENCE DOES MATTER
FELLOWSHIP TRAINED IN CORNEAL AND
REFRACTIVE SURGERY

4. PAGE 4
FIRST BOOK CHAPTER ON
LASIK TECHNIQUE
PUBLISHED WORLDWIDE
In: Duplessie MD, Rocha G, Sanchez-Thorin JC, eds.,
Advances in refractive and corneal surgery. International
Ophthalmology Clinics , 1996. Little Brown & Co., Boston.
priate.
DLK
Diffuse lamellar keratitis (DLK) is a
unique and relatively rare post-operative condition
following LASIK. Severe cases comprise only
about 1 in 5,000 surgeries.
When caught early, the inflammation asso-
ciated with DLK is easy to treat. Therefore it is
imperative that all patients maintain their recom-
mended post-operative follow-up examination
schedule.
If you notice something about your vision
that deviates from Dr. Duplessie and your expecta-
tions, you should notify him immediately.
Payment for Surgical Procedures: Payment is
required at time of procedure.
· LASIK/PRK
Includes:
Unlimited Post-Op Visits for One Year
5 year Enhancement Plan - $
Enhancement plan is not available for patients
with Hyperopia or
Hyperopia with Astigmatism.

5. May be an option, but not everyone is eli-
gible for an additional procedure. Eligibility for
enhancements depends on a number of factors.
For some patients, prescription eye drops
to prevent dilation of the pupil at night may be an
option.
Diagnosis and treatment of clinical dry eye
may alleviate many of the symptoms. Toric con-
tact lenses may be prescribed for those who have
astigmatism. Future advances in laser technology
offer great promise.
Overcorrection, under correction & Regression
About 10-15% of LASIK or PRK/ patients
may require a re-treatment (enhancement or touch-
up) for under correction or regression back to-
wards myopia. Retreatment is more common in
patients who are more myopic or hyperopic and
have higher amounts of astigmatism. With either
PRK or LASIK regression and under correction is
very uncommon with less than 3.00 diopters myo-
pia. Regression can occur quickly, within the first
few weeks after surgery, but it also can occur
slowly over time. Patients who experience regres-
sion will notice their vision changing progressive-
ly. An enhancement procedure can be performed
to correct the residual error, just as is done to treat
an under correction or overcorrection. With laser
treatment there is a potential for both over and un-
der correction. I prefer to wait 3 months to perform
an enhancement. As that point, a LASIK proce-
dure can be performed to correct the residual error,
if the patient and Dr. Duplessie believe it is appro-
PAGE 5
FIRST BOOK CHAPTER ON
HYPEROPIC LASIK
PUBLISHED WORLDWIDE
In: Duplessie MD, Rocha G, Sanchez-Thorin JC, eds.,
Advances in refractive and corneal surgery. International
Ophthalmology Clinics , 1996. Little Brown & Co., Boston.

6. Who is qualified for laser vision correction?
There is little more precious than the gift of
sight. We process almost everything in our lives
through our eyes, and yet 50 percent of people
wear glasses or contacts simply to function.
Are you tired of living in a world you cannot see
without the aid of contact lenses or glasses? Are
you fed up with the hassles of contact lenses or
glasses? Can you imagine starting your morning
able to see not only what time of day it is, but also
what type of day awaits you?
If you answered, “Yes” to any of these ques-
tions, please read through the rest of this booklet
so that you can educate yourself about the laser
vision correction services our practice provides.
What is LASIK?
LASIK is a surgical procedure intended to re-
duce a person's dependency on glasses or contact
lenses. LASIK stands for Laser-Assisted in Situ
Keratomileusis and is a procedure that permanent-
ly changes the shape of the cornea, the clear cover-
ing of the front of the eye, using an excimer laser.
A laser or a knife, called a microkeratome, is used
to cut a flap in the cornea. Pulses from a computer-
controlled laser change the curvature of the cornea
and the flap is replaced.
Dr. Duplessie organized the First United States
Lasik course to teach American doctors how to
perform Lasik. It has become the pre-eminent vi-
sion correction procedure due to rapid healing and
a quick return of vision.
Eye and Vision Errors:
The cornea is a part of the eye that helps focus
servative-free eye drops to insertion of punctal
plugs, depending on the severity of the case. For
almost all patients, dry eye symptoms gradually
subside over the first few weeks or months after
LASIK surgery. If you suspect that you may have
post-operative dry eye, you should contact Dr. Du-
plessie for an evaluation.
Glare/Halos/Starbursts
Many LASIK patients notice a temporary
decrease in night vision with symptoms that in-
clude glare, halos, and starbursts. The experience
of the phenomena can range from mild to severe.
These symptoms usually subside within six
weeks; however, some will continue to experience
them for a greater length of time.
There are several potential causes of de-
creased night vision. The most common is the nor-
mal mild swelling of the LASIK flap, which re-
solves within a few weeks of surgery. Another
cause is incomplete correction of the nearsighted-
ness, farsightedness or astigmatism. Clinical dry
eye can also contribute to the experience of glare
and halos. Rarely the cause is mild irregularities
that the LASIK surgery produces in the shape of
the cornea.
Depending upon the cause, those patients
who experience significant, persistent glare, halos
or starbursts have several treatment options.
Enhancement procedures:

7. months post-operatively. During that time, patients
may experience slight fluctuations in vision
throughout the day. These symptoms generally
diminish with time.
Crispness of Vision
For some patients, vision after LASIK
matches the sharpness of vision they had with
glasses or contact lenses before LASIK. However,
many patients notice that 6/6 vision after LASIK
can be different from 6/6 vision with contact
lenses before LASIK, especially gas permeable
contact lenses. These symptoms often dissipate
within the first six months.
Several published scientific papers have
measured patients' pre-operative and post-
operative contrast sensitivity, and nearly all have
reported that it returns to pre-operative levels with-
in the first six months.
Dry Eyes
Some patients experience dry eyes post-
operatively. The symptoms can vary widely.
When the dry eye is treated, those symptoms di-
minish.
Clinical dry eye is comparatively easy to
diagnose and the great majority of patients respond
well to treatment options ranging from use of pre-
light to create an image on the retina. It works in
much the same way that the lens of a camera fo-
cuses light to create an image on film. The bending
and focusing of light is also known as refraction.
Usually the shape of the cornea and the eye are not
perfect and the image on the retina is out-of-focus
(blurred) or distorted. These imperfections in the
focusing power of the eye are called refractive er-
rors. There are three primary types of refractive
errors: myopia, hyperopia and astigmatism.
· Persons with myopia, or nearsightedness, have
more difficulty seeing distant objects as clearly
as near objects.
· Persons with hyperopia, or farsightedness, have
more difficulty seeing near objects as clearly as
distant objects.
· Astigmatism is a distortion of the image on the
retina caused by irregularities in the cornea or
lens of the eye.
Combinations of myopia and astigmatism
or hyperopia and astigmatism are common. Glass-
es or contact lenses are designed to compensate for
the eye's imperfections. Surgical procedures aimed
at improving the focusing power of the eye are
called refractive surgery.
In LASIK surgery, precise and controlled
removal of corneal tissue by a special laser re-
shapes the cornea changing its focusing power.
The Options: Surface PRK vs. LASIK
Photorefractive surgery:
PRK was the first surgical procedure developed
to reshape the cornea using a laser. The exact
same laser is used for the two types of surgery.

8. Below 5.00 diopters of myopia, there is a choice
between surface PRK/ and LASIK. Both proce-
dures are approved. What are the advantages and
disadvantages of each? With respect to results and
expectations, PRK and LASIK are identical.
LASIK has a miniscule increase in risk of compli-
cations due to creation of the flap. ILasik in an ad-
vanced form of Lasik.
Results
Overall, there does not seem to be a significant
difference between PRK/ and LASIK in the per-
centage of patients achieving 6/6 at the end of six
months. In my hands, they are essentially equal.
Thin Corneas
Sometimes, if a patient's cornea is too thin to safe-
ly perform LASIK, then PRK is the only available
option for refractive surgery. .
Length of Procedure
Both are quite short. Surface PRK takes about
three minutes of actual treatment time. LASIK re-
quires about one to two minutes additional actual
treatment time. There is no discomfort during ei-
ther procedure. With LASIK, there is a pressure
sensation and a graying out of vision for about 30
seconds while the corneal flap is created.
Complexity
LASIK is definitely more complex with
respect to both equipment and performance of the
procedure itself. The surgeons experience and ex-
and examine your eye. Dr. Duplessie may give you
one or more types of eye drops to take at home to
help prevent infection. You should wait one to
three days following surgery before beginning any
non-contact sports, depending on the amount of
activity required, how you feel, and Dr. Du-
plessie's instructions.
To help prevent infection, you may need to wait
for up to three days after surgery or until Dr. Du-
plessie advises you otherwise before using lotions,
creams, or make-up around the eye. Dr. Duplessie
may advise you to continue scrubbing your eye-
lashes for a period of time after surgery. You
should also avoid swimming and using hot tubs
or whirlpools for 1 week.
Strenuous contact sports such as boxing, and
karate, etc. should not be attempted for at least 3
months after surgery. It is important to protect
your eyes from anything that might get in them
and from being hit or bumped.
Visual Recovery
Most patients notice an improvement in
their vision immediately upon completion of their
surgery.
By the next day vision is often dramatically
improved. However, patients should understand
that, while fast visual recovery characterizes the
operation, it can take several months before some
patients achieve their final vision after LASIK.
Several studies demonstrate that the vision of a
number of patients continued to improve up to six

9. within the first few days after surgery.
Post-Operative Course
The post op result is similar in both procedures. In
the greater majority of cases, LASIK is more com-
fortable during the first week than surface PRK.
Discomfort is a bit less, achievement of visual acu-
ity is faster, return to full activity is quicker, and
the need for post-operative medications is greatly
diminished with LASIK. Vision becomes crisper
quicker and patients feel more comfortable during
the early post-operative period. It is just a fraction
risker.
Post-Operative Care
· LASIK: A clear plastic shield is worn over
the eye for the first 24 hours, and then
nightly for 2 nights to prevent inadvertent
rubbing of the eye. Eye drops are started
immediately and are used for only 4 days.
· Surface PRK: A therapeutic soft bandage
contact lens is worn for around four days
(depending upon your rate of healing) to
reduce discomfort. Antibiotic, anti-
inflammatory, and cortisone eye drops are
used four times a day while the lens is on.
After removal, the topical cortisone is used
four times a day for a week. Artificial tears
are used as needed.
You will see Dr. Duplessie at regular intervals
for at least the first six months. At the first postop-
erative visit, Dr. Duplessie will test your vision,
pertise is vital. Dr. Duplessie wrote the first text-
book on Lasik; he is one of the best. He has per-
formed over 30,000 procedures.
As with anything, with increased complexi-
ty, there are more possibilities that can go wrong.
Although the overall percentage of complications
of surface PRK and LASIK are approximately the
same, the complications with LASIK are potential-
ly more severe than with PRK.
The technology used in
the ILasik Procedure has been in use for years and
very safe. Dr. Duplessie wrote the first textbook
chapters Lasik and has been performing laser vi-
sion procedures for seventeen years and has per-
formed over 30,000 procedures; 31.4 million pro-
cedures have been performed worldwide to date
making it the most common elective vision proce-
dure. In the U.S. all branches of the U.S. military
and NASA allow the treatment of LASIK for their
servicemen and women, thanks to studies us-
ing ILasik Technology.
The iLASIK Procedure- Space age Technology
- a more advanced technique
The iLASIK Procedure only takes minutes. It re-
shapes your cornea to correct the refractive imper-
fections in your eye (these imperfections are essen-
tially the reason you are nearsighted, farsighted,
etc.). Computers/software are used to make an in-
dividual blueprint of your eyes; this blueprint is
used to drive your laser correction and is what
gives you a truly customized result
Just Asking
It's natural to have a bunch of questions when con-

10. sidering the iLASIK Procedure. Dr. Duplessie is
an expert at answering those questions and his
staff are real pros who will provide plenty of sup-
port during the process.
Custom Vue:
Extremely high success rates with potentially su-
perior vision correction. Makes the laser more ac-
curate. Additional fee for Custom Vue.
LASIK VERSUS CONTACTS- MAYBE CONTACTS
AREN'T THE LONG-TERM ANSWER?
The iLASIK Procedure is safer than wearing con-
tacts lenses.
FINANCIAL FACTS— THE ILASIK PROCEDURE
IS WITHIN YOUR REACH
Money shouldn't be the reason you're putting off
having the iLASIK Procedure. We know that the
simple saying, "you can't put a price on great vi-
sion" doesn't change the fact that you have to find
a way to pay for the procedure.
Dr. Duplessie can help you with financing
What to Expect Before, During and After Laser
Vision Correction:
What to expect before, during, and after surgery
will vary from patient to patient. This section can-
not replace the dialogue you should have with Dr.
Duplessie, but it can help you gain a general un-
derstanding of the pre-, post– and operative stages
the rest of the procedure. Dr. Duplessie will then
lift the flap to dry the exposed tissue.
The laser will be positioned over your eye and
you will be asked to stare at a light. This is not the
laser used to remove tissue from the cornea; it is a
light to help you keep your eye fixed on one spot
once the laser comes on.
When your eye is in the correct position, Dr.
Duplessie will start the laser. At this point in the
surgery, the pulse of the laser makes a ticking
sound. A computer controls the amount of laser
delivered to your eye. Before the start of surgery,
Dr. Duplessie will have programmed the computer
to vaporize a particular amount of tissue based on
the measurements taken at your initial evaluation.
After the pulses of laser energy vaporize the corne-
al tissue, the flap is put back into position.
A shield will be placed over your eye at the end
of the procedure as protection, since no stitches are
used to hold the flap in place.
Postoperative:
Immediately after the procedure, your eye may
feel like there is something in it and Dr. Duplessie
may suggest you take a mild pain reliever. Both
your eyes may tear and water and your vision will
probably be hazy or blurry. You will instinctively
want to rub your eye, but don't! Rubbing your eye
could dislodge the flap, requiring further treat-
ment. In addition, you may experience sensitivity
to light, glare, starbursts or haloes around lights, or
the whites of your eye may look red or bloodshot.
These symptoms should improve considerably

11. the-counter medications and any medications you
may be allergic to.
Dr. Duplessie will perform a thorough eye exam
and discuss what you should expect before, dur-
ing, and after surgery, as well as your responsibili-
ties will be before, during, and after surgery. You
will have the opportunity to ask Dr. Duplessie
questions during this discussion.
The day before surgery, you should stop using
creams, lotions, makeup and perfumes. These
products as well as debris along the eyelashes may
increase the risk of infection during and after sur-
gery. Dr. Duplessie may ask you to scrub your
eyelashes for a period of time before surgery to get
rid of residues and debris along the lashes.
During the procedure:
The procedure should take less than 20 minutes.
You will lie on your back in a reclining chair in an
exam room containing the laser system. The laser
system includes a large machine with a micro-
scope attached to it and a computer screen.
A numbing drop will be placed in your eye, the
area around your eye will be cleaned, and an in-
strument called a lid speculum will be used to hold
your eyelids open. A ring will be placed on your
eye and your vision may dim. The microkeratome,
an instrument, is attached to the ring. Dr. Duples-
sie will use the microkeratome to make a flap in
your cornea.
The microkeratome and the ring are then re-
moved. You will be able to see, but you will expe-
rience fluctuating degrees of blurred vision during
of the procedure.
Preoperative:
If you wear contact lenses, you must stop wear-
ing the lenses four days before your baseline eval-
uation and switch to wearing your glasses full-
time. Contact lenses change the shape of your cor-
nea for up to several weeks after you have stopped
using them depending on the type of contact lenses
you wear. Not leaving your contact lenses out long
enough for your cornea to assume its natural shape
before surgery can have negative consequences.
These consequences include inaccurate measure-
ments and a poor surgical plan, resulting in poor
vision after surgery. These measurements, which
determine how much corneal tissue to remove,
may need to be repeated at least a week after your
initial evaluation and before surgery to make sure
they have not changed, especially if you wear RGP
or hard lenses.
If you wear:
· Soft contact lenses, you should stop wearing
the lenses for 4 days before your initial evaluation.
· Toric soft lenses or rigid gas permeable (RGP)
lenses, you should stop wearing them for at
least 3 weeks before your initial evaluation.
· Hard lenses, you should stop wearing them for
at least 4 weeks before your initial evaluation.
You should tell Dr. Duplessie about your past
and present medical and eye conditions and about
all the medications you are taking, including over-