What is the goal of laser eye surgery?
The basis for all laser eye surgery is to reshape the cornea so that it changes the focal point of the eye. Ideally, the focal point is changed so that it focuses perfectly on the retina, just like a normal eye.
The cornea and the lens of the eye focus light like a camera lens to form an image on the retina. The cornea, where light first enters, provides about two thirds of the eye's focusing power, and the lens inside the eye provides the other third. Variations in the shape of the eye are perfectly natural, although degrees of variation affect how well we see. Laser vision correction can be used to treat three of the most common focusing problems: myopia (nearsightedness), hyperopia (farsightedness), and astigmatism.
Myopia (nearsightedness) - Myopia, or nearsightedness vision, results when the eyeball is too long or when the front and center surface of the eye (cornea) is curved too much. Light will focus in front of the retina, causing blurred vision.
Hyperopia (farsightedness) - Hyperopia, or farsighted vision, occurs when the eyeball is too short or the corneal curvature is too flat, causing light to focus behind the retina. Hyperopia is sometimes confused with presbyopia, an age related change in vision causing the need for reading glasses.
Astigmatism- Astigmatism occurs when the eyeball is oblong (football shaped). In this condition light cannot be focused properly anywhere. Astigmatism is often present along with myopia and hyperopic.
Presbyopia- Patient's over 40 to 45 years of age may have difficulty with their reading vision, while their distance vision is clear. This happens as the natural lens loses its ability to change the eye's focus from distance to near. Use of reading glasses helps the eyes to re-focus after Lasik or PRK.
The history of Refractive Eye Surgery before Laser Eye Surgery
Prior to the advent of the excimer laser in 1987, there existed two main types of refractive surgeries.
Radial keratotomy (RK) - The original surgical procedure for vision correction, RK dates back to the 1960s. Tiny incisions are made in the cornea, radiating out from the center. These incisions cause the cornea to flatten slightly. RK was useful in correcting fairly mild cases of myopia. RK, although having a similar name to PRK, has no similarities whatsoever to PRK. PRK will be discussed shortly.
Automated lamellar keratoplasty (ALK) - A microkeratome is used to create a corneal flap that is folded out of the way. The microkeratome is then used to remove a tiny slice of the cornea. The corneal flap is placed back into position, where it flattens to fill the space left by the removed slice. ALK can only correct myopia. Both of these surgeries fell out of favor with the introduction of the excimer laser in the 1990's.
Laser Eye Surgery in the market today:
There exists two main types of laser eye surgery on the market today:
Photorefractive keratotomy (PRK) - The precursor to LASIK, PRK first appeared in 1987. Like LASIK, PRK uses an Excimer laser to reshape the cornea. However, PRK works directly on the outer surface of the cornea. PRK can correct myopia, astigmatism and, to a lesser degree, hyperopia.
Although many people have only heard of LASIK, PRK is very similar and, for the most patients, an effective alternative to LASIK. Before LASIK, PRK was the number one performed laser eye surgery procedure
How does the PRK procedure work?
PRK is a relatively straightforward procedure. After numbing the eye with anesthetic drops, the thin outer layer of the cornea (the epithelium) is removed in the planned area of treatment. Then, the laser treatment is performed on the top layer of the thick part of the cornea (the stroma). Following the laser treatment, a no-power "bandage" soft contact lens is placed on the cornea. The procedure takes about five to seven minutes to perform.
What patients would most benefit from PRK?
The patients that most would benefit from PRK are those patients who have:
Corneas that are too thin to safely make a LASIK flap
Military aviators and those in combat situations
Athletes in contact sports such as football or hockey
Corneas that are too irregular and/ or distorted to perform LASIK: these irregular corneas can be prone to "ectasia."
Over the years that laser eye surgery has been available in the United States eye surgeons have gained increase awareness of a condition known as "ectasia." As the cornea is constantly under pressure from fluid that is naturally made inside the eye (muck like air causing constant pressure on the wall of a tire), if the cornea becomes sufficiently weakened, this pressure can cause that area to bulge forward. An analogous situation, for illustrative purposes, would be a hernia.
Certain LASIK patients are at higher risk for developing ectasia. These include:
· (1) patients whose cornea are significantly thinner than normal
· (2) patients who have normal thickness cornea but whose laser treatments will remove a great deal of corneal tissue (usually because of a combination of high prescription and low corneal thickness
· (3) and patients whose corneas have unusual or irregular curvatures. Most of these patients who fall into one of these high risk categories and who may be at higher risk for ectasia after LASIK can minimize or avoid the risk of ectasia by having PRK.
The main difference between PRK and LASIK involves the creation of the flap in LASIK.
What is LASIK?
LASIK combines the best features of ALK and PRK (see above). Like ALK, LASIK uses a microkeratome to create a "flap" of the outer corneal tissue that can be folded out of the way and then replaced. Once the flap is folded out of the way, LASIK uses the same Excimer laser used in PRK to reshape the underlying corneal tissue. Then the flap is replaced over the reshaped area and conforms to the new shape.
The great thing about the cornea is how quickly it heals. As soon as that flap is replaced, it begins to naturally seal itself to the rest of the cornea. This approach greatly speeds the overall healing process when compared to PRK, which leaves the reshaped area open.
LASIK, which means Laser In Situ Keraomileusis, is a surgical procedure in which a hinged flap consisting of corneal epithelium and superficial stroma is created. After the corneal flap is created, a tissue-ablating excimer laser is used to reshape the exposed corneal stroma, and the flap is repositioned. The anterior corneal surface can be altered to modify a patient's refractive error by varying the degree of corneal tissue removal beneath the flap. The corneal tissue has natural bonding qualities that allow effective healing without the use of stitches.
The Graf Optical Pre-Operative Evaluation
A comprehensive medical eye evaluation should be performed prior to any refractive surgery procedure. In addition to the elements of a comprehensive medical eye evaluation, the refractive surgery examination includes the following elements:
Visual acuity without correction
Corneal pachymetry (ultrasound thickness of the cornea)
Measurement of pupil size in low light conditions
Evaluation of the tear film
Cycloplegic refraction (refraction performed after dilation drops are installed)
Because of the possibility of contact lens induced corneal warpage, patients who use contact lenses should discontinue their use for a period of time prior to the preoperative examination and procedure. As a general guideline, spherical soft contact lenses should be discontinued for several days, and toric soft lenses and rigid lenses should be discontinued until refractive and keratometric stability has been documented. Documentation of refractive stability increases the likelihood that the correction will be appropriate in the future.
Corneal topography should be evaluated for evidence of irregular astigmatism, corneal warpage, or signs of asymmetric steeping, since all may be associated with unpredictable refractive outcomes.
Prior to surgery, pachymetry should be obtained and an estimate of the thinnest residual stromal bed following LASIK should be calculated. While 250 microns (Um) has been suggested as a safe residual stromal bed thickness there is no absolute value that guarantees that ectasia cannot occur. This risk of postoperative ectasia may increase with decreasing stromal bed thickness and may also be influenced by other factors yet to be identified.
What Options Do I Have If I am above the age of 40?
If you are over 40 years of age and have laser vision correction to correct both eyes for distance vision, you will need reading glasses in order to see things within 36 inches and closer. This occurs sometime between the age of 38 and 46. This process is called presbyopia and it affects 100% of people. There is no current, accepted way to correct presbyopia- except for reading glasses.
One alternative to reading glasses, however, is called mno-vision: one eye is corrected for distance vision and one eye is corrected for close-up vision. Mono-vision is an alternative laser vision procedure best suited for patients who have presbyopia. With Mono-vision, the dominant eye is usually corrected for distance vision and the other eye is corrected for near vision.
There are advantages and drawbacks with Mono-vision. The single, obvious advantage is that Mono-vision allows glasses free vision at near and far for most tasks.
There are drawbacks. These may include the occasional need for glasses to see very small print, threading needles, prolonged reading or reading in dim light. Night driving, especially in unfamiliar surroundings or in the rain, as well as intensive distance activities such as tennis or golf may require distance correction in the near vision eye , to enhance depth perception. Our current glasses can be modified to meet this need if necessary.
Mono-vision is not perfect. Mono-vision is a compromise that will enable you to have distance near vision without correction, but the quality of the vision will likely not be as sharp as with your glasses or contact lenses. It requires adaptation, which may require several weeks, up to several months to fully adjust. During this adjustment period, each eye may sometimes interfere with the other, and depth perception may sometimes seem off, but these problems gradually resolve. If after three months you feel mono-vision is not working for you, the nearsighted eye may be enhanced for distance correction. You will then need reading glasses for all near tasks.
In order to gauge your tolerance, a mono-vision trial was performed during your preoperative consultation. Although this is usually a good predictor of mono-vision tolerance, it is possible that you might not tolerate or adapt to the mono-vision once you have it 24/7. You may find that the quality of the vision is significantly reduced. In some cases, this will improve over time (several weeks to months). In other cases, these symptoms persist and the only recourse will be to enhance the "near" eye to enable good distance vision both eyes; in these cases, patients will then need to wear reading glasses.
Mono-vision patients will frequently notice imperfections in their distance vision while they enjoy excellent reading vision.
The distance effects of mono-vision are accentuated in dim or dark-light settings, such as driving at night. Mono-vision can adversely affect depth perception. Mono-vision, therefore, may not be as advisable for patients who need excellent distance vision at night (such as truck drivers, law enforcement personnel, pilots, etc.). Mono-vision may also affect ability to quality for certain professional licensures.
Mono-vision will not guarantee that you will be completely free of glasses or contact lenses. Because of the distance vision effects of mono-vision, some patients who are otherwise very happy with their mono-vision will use glasses (that will improve distance vision in the" near" eye for certain distance activities (such as driving at night). Less commonly, some patients may need extremely precise near vision and will use glasses to improve the near vision in the "distance" eye).
You will have to weigh whether the benefits of mono-vision (not needing glasses for the majority of your activities) are worth its imperfections.
Graf Optical doctors have had extensive experience with Mono-Vision and offer it to our presbyopic patients. Ninety five percent of our patients are happy with mono-vision. Please do not hesitate to ask your Graf Optical eye doctor should you have any questions. Graf Optical eye doctors can fit you in a mock contact lens set up to simulate the mono-vision set up found in lasik eye surgery. If you are unsure about your ability to tolerate mono-vision in laser eye surgery ask a Graf Optical eye doctor to fit you for mono-vision in contacts to prepare you for laser eye surgery.
What Happens On the Day of Your Treatment?
Try to avoid caffeine, diet pills, workout stimulants or antihistamines as these substances may affect pupil size.
Wear comfortable clothing. All make up should be removed from the operative eye(s) prior to treatment. Also, you should not wear any perfumes or colognes on the day of your treatment.
Prior to your treatment, you will receive drops in the operative eye(s) to prevent discomfort. You may experience some discomfort during the laser treatment. You may be offered medication to calm you during the procedure, which you are free to decline should you so choose.
The non-operative eye may be patched or taped closed to better align the eye being treated.
It will take a few minutes to properly position you under the microscope. Your physician will then insert an eyelid holder to prevent blinking.
You will be asked to focus on a flashing light through the procedure. Your physician will monitor your eye through the microscope at all times.
If you are undergoing LASIK, there will be two parts to your treatment. During the first part, the physician will place an instrument on your eye that will hold your eye still during creation of the flap. You will hear a sound and feel suction on your eye. Your vision will begin to dim and you will lose sight of the flashing light. Your vision will return after the suction ends.
In the second part of the Lasik Procedure, you will hear another vacuum sound accompanied by a metallic tapping sound as the laser gently alters the refractive curvature of your eye. After the laser treatment, your corneal flap will be repositioned.
Immediately after the treatment, antibiotic and anti-inflammatory drops are place in the treated eyes(s). A shield may be placed over treated eye(s).
For PRK and Epi-Lasik procedures, the procedure will be much the same, except in PRK no flap is being created and in Epi-Lasik a small surface flap is created instead, just over the area of the eye to be treated with the laser. A "bandage" contact lens will be placed over treated eye(s) after the procedure is finished to aid the eye's healing process.
You may be asked to remain at the laser surgery center for a short time after your procedure so that your eye doctor can ensure that everything is stable before sending you home.
Please go directly home after your treatment. Arrange for friend or family to drive you home after the procedure. Do not drive yourself. You should rest for about 4 hours.
What happens After Your Treatment?
You will use antibiotic and anti-inflammatory drops following your laser vision correction. Written instructions will be given the day of your treatment. These are very important.
Do no rub or squeeze your eye(s). This has been known to cause discomfort and possible damage. You may experience the following sensation after your treatment:
Burning: This usually occurs within the first 2-24 hours. It may feel like sand in your eye(s).
Watering/ Tearing – Your eye(s) may water, or tear, for the first couple of days. Remember not to touch or rub your eye(s).
Red/ Swollen Eye(s): Your eye(s) may be slightly red and swollen during the first 48 hours. This is normal.
Blurriness- Your vision may be blurry for the first 48 to 72 hours and will gradually clear. You may notice a significant improvement by the end of a few days.
Ghosting/ Glaring: During the first few weeks, your vision may fluctuate slightly or you may experience some ghosting or glare. This is normal and will usually improve. It should not interfere with you daily activities.
Light Sensitivity: You may experience increase sensitivity to light for the first few days to weeks after treatment. A good pair of sunglasses will help.
Red Spots: You may notice one or more bright red spots on the white of the eye. This is a bruise that is caused by the suction device and is generally harmless. It is known as a "sub-conjunctival hemorrhage." It typically takes 7-10 days to go away.
If you wear glasses and had only one eye treated, you may want to remove the lens on the operated side. If you wish to have plain glass put in your frame for balancing or cosmetic reasons, any optical store can provide this service for a nominal fee. If you are a contact lens wearer, you may wear your contact lens in your untreated eye.
· After Lasik the surface of the cornea usually heals within the first 24 to 48 hours following Lasik treatment.
· You should not drive for 24 hours after treatment.
· You should not drive for 24 hours after treatment
Most patients return to normal activities including work and exercise in 24-58 hours. Avoid swimming for three weeks. IN addition, please discuss with the Graf Optical eye doctor your regular activities to assess whether you should temporarily delay such activities. Eye make up can usually be resumed one week after laser vision correction. Ask your doctor for more details.
Potential post operative complications to Lasik
As with any surgery, there are always potential problems with LASIK. The three most common problems are:
Under correction - Not enough tissue is removed during the procedure.
Overcorrection - Too much tissue is removed during the procedure.
Wrinkling - The corneal flap has a small fold or wrinkle in it when it is replaced, causing a small blurry area in your vision.
Under most circumstances, each of these problems is easily corrected with a second surgical procedure. If the under correction or overcorrection is very slight, the surgeon will most likely advise the patient not to attempt to refine his or her vision any further. In fact, many recipients of laser eye surgery never achieve normal vision but are able to reduce their corrective-lens prescription significantly.
Dry Eye and Flap Surface Irritation: Lasik involves the creation of a micro-thin flap on the outer surface of the cornea. The making of the flap produces a mild decrease in corneal sensitivity for a period of time after LASIK. During this time, the use of topical artificial tears and gels may be needed to lubricate the surface cells that protect the corneal flap. You may also experience dryness after laser vision correction. In some cases, this dryness will cause severe irritation, discomfort, and blurring of vision that may last for weeks or even months. A doctor may recommend punctual plugs or other remedies for treatment of a dry eye condition. These plus block the tear duct on an either temporary or permanent basis.
Corneal Edema: The creation of the flap causes microscopic amounts of swelling within the corneal tissue. This swelling may cause night glare and transient fluctuations of vision. Edema generally subsides during the recovery period.
Abrasions- Surface Cells that protect the corneal flap may become irritate or slough off during the procedure. Mild abrasions generally heal and typically do not cause problems with vision. Larger abrasions require the application of a bandage contact lens and may take several days or longer to heal. Visual acuity generally improves as the corneal surface heals..
Under or Over Correction: Most myopic treatments stabilize at three (3) months, whereas most hyperopic patients take longer to stabilize (up to six months or longer). PRK treated patients may also take longer to stabilize. If there is a significant amount of nearsightedness, farsightedness, or astigmatism remaining three months after surgery, an enhancing treatment may be considered to fine tune the result. The benefits and risks of an enhancement should be discussed with a Graf Optical Eye Doctor. Unintended under or overcorrection occurs in a small percentage of cases, especially in patients with more severe corrective disorders. Continued use of glasses or contact lenses after the enhancement surgery has been performed may be required. Dependence on reading glasses is also a possibility even if they were not needed before the procedure. If reading glasses were required before the procedure, they will likely continue to be required after the procedure.
Corneal Flap Complications: The microkeratome creates a thin corneal flap which allows access to the inside of the cornea where the laser reshapes the cornea. Occasionally the flap is too short, not uniform, too thin, or incomplete, thus not allowing the treatment to be completed. A partial or irregular flap may result in a situation which induces a corneal scar or haze and may cause a loss in best corrected visual acuity (BCVA). Also, it is possible that a partial or irregular flap may cause the refractive procedure to be stopped and not be performed at all thereafter. After the partial or incomplete flap is replaced and allowed to heal, plans may be made to complete the full treatment. In addition, traumatic injury to the cornea early in the healing process can result in a dislodged flap. Epithelium or corneal surface cells may grow under the flap which may induce edema, swelling , inflammation, or astigmatism. This may necessitate lifting the flap and removing the ingrowths if possible. A corneal flap that is not suitable may result in a postponement of the procedure, prolonged visual recovery, and/or temporary or permanent blurred vision. Other potential corneal flap complications include a flap incision that results in a free flap. A free flap may increase the potential for prolonged visual recovery, blurred vision and epithelial ingrowths. The most potentially serious risk is a corneal flap that is too deep, which results in perforation of the eye and possible loss of some or all vision.
Ectasia: The occurrence in which the cornea becomes too thin and irregularly shaped. This may require a hard contact lens to improve visual acuity and if thinning continues the cornea may need to be replaced.
Glare and or Halos: Two possible reasons for night glare and halos include edema from the healing process and pupil size as it relates to the laser treatment area. This occurs commonly in the early healing process. Glare and or halos from healing typically improve over the first 2-6 weeks. Permanent glare and halos can remain after 3 to 6 months. In some cases this problem may be corrected with "custom" laser treatment. Consult with the Graf Optical Eye Doctor to find out what treatment is best for you.
Infection: Although infrequently reported, infection is a possible risk during the healing of the cornea. The chances of experiencing an infection are greatest during the first few days after surgery has been performed. There may also be some additional risk of infection if both eyes are treated on eh same day. Infection maybe be preventable with antibiotic drops. If an infection occurs and leaves a corneal scar or if an unusual healing process occurs without a clear cornea, the best corrected visual acuity could be affected. Infection could also cause loss of some or all vision.
Loss of Best Corrected Visual Acuity: For most patients, visual acuity has stabilized in about 3 months, although full recovery, especially for PRK and hyperopic patients, may take longer. In some patients this may take up to 12 months. A small percentage of patients, however, develop irregular corneas that reduce the sharpness, clarity and crispness of their vision. These patients may not be able to read the last 2 or more lines of the eye chart that could be read with corrective lenses before surgery, regardless of corrective lens assistance. This is called loss of best corrected visual acuity.
Change in or Inducing Astigmatism: Laser vision correction may also result in a change in astigmatism that could require the use of glasses and/ or contact lenses. There is also a risk of inducing stigmatism or of astigmatism appearing in an entirely different part of the cornea than before the procedure.
Haze: After the procedure, some patients experience haze (or corneal cloudiness), which seems as though one is looking through a dirty window. Haze is one of the initial blurriness experienced immediately after treatment. Rather, haze may become evident in the weeks and months after surgery. The risks of haze are lower after LASIK than PRK or Epi-Lasik. Haze, which is produced by scarring of the cornea during the healing process, may be persistent or recurrent and require further surgeries. Haze may also produce loss of visual sharpness or clarity and/ or decrease in best corrected visual acuity.
Decreased Night Vision: Vision may not seem as sharp at night as during the day and may require the use of booster eye glasses at night. High myopic patients are at a greater risk of experiencing these effects, as are patients with large pupils.
Increased Sensitivity: there may be increased sensitivity to light, glare, and flucuations in the sharpness of vision. These conditions usually occur during the normal stabilization period (1 to 3 months post-procedure), but they may also be permanent.
Blurriness: Blurriness is very common in the healing process and it generally takes 3 to 10 days to clear. It may take even longer in some cases.
Further Treatment: Further treatment may be necessary including eye drops, the wearing of glasses or contact lenses (hard or soft), or additional surgical or laser correction (enhancements).
Equipment Malfunction: There is a risk the microkeratome (in LASIK) or the excimer laser (in LASIK, PRK, and Epi-LASIK) could malfunction, requiring the procedure to be stopped before completion. IN some instances the malfunction may not be detected until after the procedure. Depending on the type of malfunction, this may or may not be accompanied by visual loss.
Rare Vision Threatening Complications- In some rare cases, corneal swelling, corneal thinning (ectasia), retinal detachment, hemorrhage, venous and arterial blockage, cataract formation, optic neuritis total blindness and loss of an eye could occur. If the procedure is performed on only one eye, there may be a balance problem between the two eyes. Other complications could occur beyond those mentioned on this web page. You should discuss with the Graf Optical Eye Doctor any additional questions or concerns you may have.
Questions and Answers about Laser Correction of Nearsightedness, Farsightedness and Astigmatism
Q: If you are nearsighted, you cannot see things clearly in the distance. This condition occurs when the cornea, which is located on the front part of the eye, is too steeply curved or if the eye is too long. Because of this curvature, light entering the eye focuses in front of the retina instead of on it. This causes blurry vision.
Q: What is farsightedness?
A: If you are farsighted, you cannot see things clearly up close. This condition occurs when the eyeball is too short or the corneal curvature is too flat, causing light to focus behind the retina.
Q: What is Astigmatism?
Astigmatism occurs when the eyeball is oblong (football shaped). In this condition, light cannot be focused properly anywhere. Astigmatism is often present along with nearsightedness and farsightedness.
Q: How Does Laser Vision Correction Improve Nearsightedness, Farsightedness, and/ or Astigmatism?
A: laser vision correction uses cool pulses of ultraviolet light to cleanly, precisely, and smoothly remove a very small amount of corneal tissue at the front of the eye. This corrects the problem reshaping of the cornea and allows light to properly focus on the retina. The result is improved, clearer vision.
Q: Who Performs Laser Vision Correction?
The lasers are computer controlled and operated by ophthalmologists specially trained and credentialed to perform the procedure. Because the training, skill and experience of attending ophthalmologists and other personnel is important to the outcomes of laser vision correction, Lasik Plus ensures that their employees are highly and continual trained in the most current techniques.
Q: Will I Be Able to See Right Away?
In most circumstances, you will have improved vision immediately following treatment. IN fact, many patients return to work the next day. Your vision should continue to improve as you eye heals and adjusts to it s new shape.
Q: Is Laser Vision Correction Safe?
AS with all medical procedures, there are challenges and risks involved with laser vision correction. The procedure has passed extensive scrutiny from public health agencies and medical professionals.
Q: When Did Laser Vision Correction First Receive FDA Approval
A: The FDA approved excimer laser used in laser vision correction for patients with mild to moderate cases of myopia (nearsightedness) was in October 1995. For more information regarding laser vision corrective procedures and the laser sued for such procedures, you can visit: www.fda.gov/cdrh/lasik
Q: What about Risks and Side Effects?
A: As with any medical procedure, some risk is involved. A small percentage (by normal surgical standards) of laser vision correction patients experience complications or side effects. Among the documented side effects are infection; post-operative discomfort; corneal abrasions; corneal haze which occurs during healing; glare or halos; or unintended over or under-correction. Permanent or disabling vision loss is infrequent but has been reported in a small percentage of patients. Causes of permanent or disabling vision loss that have been reported include sever dryness; sever quality of vision loss; inflammation under the flap (known as DLK); infection; corneal haze or scarring; surface (epithelial) cells under a flap; lasik flap complications; corneal weakness (ectasia) ; damage to the cornea surface (called eptithelail basement membrane dystrophy); retinal bleeding and optic nerve damage. Please see the "General Risks" and "Surgical Risks and Possible Side Effects" sections of this Patient Information Booklet for more information about risks associated with laser vision correction.
Q: Does Laser Vision Correction Hurt?
A: Anesthetic eye drops generally render the procedure itself virtually painless. Some patient's may experience discomfort similar to sand beneath the eye for several days after the treatment.
Q: How Much Does Laser Vision Correction Cost?
A: The cost of laser vision correction is reasonable compared to ongoing expenses usually associated with glasses or contacts and often more than pays for itself over a several year period.
Q: Who is Lasik Plus?
Lasik Plus, a pioneer in laser vision correction, provides advance laser technology and facilities for some of America's leading ophthalmologists. Lasik Plus Vision Centers are owned by LCA-Vision Inc. one of the largest U. S. based providers of laser vision correction facilities. LCA- Vision Inc. is listed on the NASDAQ under the ticker symbol LCAV.
Innovation in medicine is essential to assure the future health of the American public, and Lasik Plus encourages the development of new diagnostic and therapeutic methods that will improve eye care. It is essential to recognize that true medical excellence is achieve only when the patients' need are the foremost consideration. Practice patterns are reviewed by Lasik Plus and updated. To ensure that these practice patters are current, each is valid for five (5) years from the "approved by" date unless superseded by a revision.
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