Key Takeaways

• Glare, halos, starbursts are common post-LASIK issues that can occur due to the swelling of the cornea.
• The Caster Eye Center in Beverly Hills specializes exclusively in LASIK surgery. Dr. Andrew Caster of The Caster Eye Center was named as one of the top doctors in Los Angeles by several magazines, including Los Angeles Magazine, U.S. News & World Report, and the Los Angeles Times.
• One of the most advanced laser technology available is custom LASIK. Custom LASIK involves measuring the patient's eye front to back using a special laser, utilizing what's called "wavefront" technology to create a 3D image of the patient's eye.

Introduction

1) Side Effects

• Side effects of LASIK surgery may deter individuals from going through with the procedure. The procedure, however, has had a good track record since its introduction.
• Experienced surgeons report complication rates below 1%.
• Losing vision as a consequence of complications is extremely rare. Side effects such as temporary visual problems, however, are fairly common.
• According to a survey by the U.S. Food and Drug Administration, over 95% of survey's participants were satisfied with their vision following their LASIK procedure.

i) Dry Eyes

• Because tear production can be temporarily reduced after LASIK surgery, patients who had undergone the procedure may experience dry eyes.
• Symptoms such as dry eyes, burning, and itching is fairly common, affecting approximately 20% to 40% of patients who had the procedure.
• Vision quality can be negatively affected by dry eyes.
• Dry eyes post-surgery is usually temporary and can be treated effectively with over-the-counter eye drops.
• Dry eyes typically improve within the first week. In some patients, however, eye dryness may last up to 6 to 12 months.
• Individuals with persistent dry eyes may not be suitable candidates for LASIK.

ii) Glare, Halos, & Double Vision

• Patients may notice increased light sensitivity, glare, "halos around bright lights," or double vision after the surgery; these are common post-LASIK issues that occur due to events such as the swelling of the cornea.
• Approximately 43% of patients who've had LASIK experience these types of vision distortion issues.
• These issues do resolve by themselves during the recovery period.
• The use of anti-reflective coated lenses can help eliminate unwanted glare and halos.
• Halos and night vision issues that persist for months post-surgery may be due to over-or under-correction of the eyes.

iii) Itchy & Scratchy, Irritated, Burning Eyes

• After LASIK, patients may experience itchy, scratchy, or foreign body sensations in their eyes for several days; usually, these sensations improve with time.
• It is recommended that patients do not rub their eyes a week or so after the procedure.
• These side effects are common following the procedure. The degree of discomfort may vary from patient to patient.
• When these sensations occur, artificial tears without preservatives can help alleviate the discomfort.

iv) Sedation & Grogginess

• After the procedure, patients can expect a mix of soreness and grogginess; these sensations are very common and are part of the overall healing process.
• The individual may feel tired and/or disoriented after surgery; as a result, it may be unsafe to drive post-surgery.
• These side effects (sedation and grogginess) may be amplified if the patient opts for anesthesia or sedation.

v) Regression

• Those with a higher risk of regression include individuals with very high spectacle power and older patients.
• A study found that 35% of individuals who had LASIK procedures needed re-treatment after 10 years.
• Another study that followed individuals with astigmatism and nearsightedness who had LASIK found that in 12 years, around 10% of study participants had experienced age-related vision changes over that period.
• A second procedure is possible for individuals who experience regression.
• According to Georgia Eye Associates, most doctors will only perform the second procedure five to ten years after the initial procedure.

Risk Mitigation Strategies

• LASIK eye surgery is not suitable for everyone; the surgery can be risky or unpredictable for some patients with certain health conditions.
• These risk factors/ conditions include:
•  Autoimmune disorders. 
•  Persistent dry eyes. 
• A weakened immune system.
• Recent vision changes due to hormonal changes, medications, pregnancy, breastfeeding, or age.
•  Inflammation of the cornea.
• Eye diseases or eye injuries
• Patients with corneas that are too thin or irregular.
•  Patients with high refractive error. 
•  Patients with unstable vision. 

Pre-Surgery And Post-Surgery Risk Mitigation

• Do not use eye creams, makeup, perfumes, or lotions on the day before and day of the surgery.
• Arrange for a ride home if the patient is experiencing grogginess.

2) Practitioners

• Selecting an experienced and qualified ocular surgeon can reduce the incidence of complications.

i) Maloney-Shamie Vision Institute

• Maloney-Shamie Vision Institute, located in Westwood Medical Plaza, has performed over 75,000 procedures in total.
• The Maloney-Shamie Vision Institute offers complimentary virtual LASIK consultations; virtual consultations allow patients to expedite their path to vision correction surgery.
• As part of the original FDA trial, Dr. Robert Maloney was the first eye surgeon in Western North America to perform the procedure. Dr. Maloney has personally performed more than 65,000 vision-correction surgeries.

• Dr. Neda Shamie was the "first surgeon in northwest America to perform artificial corneal transplantation and DMEK surgery."
• In 2021, Dr. Maloney and Dr. Shamie were awarded the 2021 Southern California SuperDoctors; SuperDoctors selects the top 5% of physicians in each state (Dr. Maloney has been selected for 14 consecutive years while it is Dr. Shamie's 7th).
• The institute has received glowing testimonies from renowned celebrities such as Kim Kardashian, Kylie Jenner, Cindy Crawford, Henry Winkler, Kenny G, and more.
• They received a perfect 5.0/5.0 rating out of 526 reviews on Google Reviews.
• The institute received a 4.5/5.00 rating from 207 reviews on Yelp.

ii) Caster Eye

• The Caster Eye Center in Beverly Hills specializes exclusively in LASIK surgery.
• Dr. Andrew Caster is a Harvard-educated LASIK specialist with over 30,000 LASIK corrections under his belt.
• Dr. Caster has been an ophthalmologist for 30 years.
• Dr. Caster was "one of the first twenty doctors selected to perform LASIK as part of the FDA approval process."
• Dr. Caster is the author of the book—Lasik: The Eye Laser Miracle; the book can be found here on Amazon.
• Dr. Caster was named one of the top doctors in Los Angeles by several magazines, including Los Angeles Magazine, US News & World Report & Los Angeles Times; Los Angeles Magazine calls Dr. Caster "the best LASIK surgeon in L.A."
• Dr. Caster has appeared on the reality television series, The Swan. In that particular episode, Dr. Caster performs corrective eye surgeries on selected contestants of the show.

iii) LA Sight

• LA Sight offers "LASIK laser vision correction surgery and cataract surgery in West Los Angeles."
• Dr. David Wallace possesses an outstanding track record when using the Wavelight laser; results show that over 98% of individuals achieved 20/20 vision, and around 30% had achieved even sharper vision of 20/15 or better.
• Dr. Wallace has performed more than 30,000 LASIK treatments so far.
• Los Angeles Magazine once named Dr. Wallace one of "LA's Best Doctors"
• LA Sight has received an impressive perfect five-star rating from 605 reviewers on Yelp.
• On Google Reviews, they received a 4.9/5.0 rating out of 181 Google Reviews.
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iv) CCRS LASIK ICL Center

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• Dr. Paul C. Lee performs a personalized, advanced form of LASIK surgery.
• This advanced "form of LASIK reduces high order aberration (imperfections) of the cornea" and provides clearer vision with reduced halos and glares.
• Dr. Lee was voted the top ICL surgeon in the nation. He has over 20 years of "custom vision correction experience."
• Dr. Lee was the first U.S. surgeon certified in SMILE.
• Their practice had received a 4.8/5.00 rating out of 53 Google reviews.

v) Davidorf Eye Group

• Davidorf Eye Group has more than 50 years of experience in the industry. Dr. Jonathan M. Davidorf is a board-certified ophthalmologist. He is also the director of the Davidorf Eye Group in Los Angeles, California, specializing in laser vision correction and cataract/lens implant surgery.
• Dr. Davidorf has over 25 years of experience performing vision correction surgeries.
• Dr. Davidorf uses all-laser LASIK, commonly known as bladeless LASIK; bladeless LASIK is a "premium vision correction surgery." Like LASIK, all-laser LASIK utilizes "a femtosecond laser and an excimer laser to reshape the cornea, reducing the risk of complications developing after the procedure."
• Davidorf Eye Group received a 4.6/5.0 star rating from 55 Google reviews.

vi) Hamilton Eye Institute (Dr. Rex Hamilton)

• Dr. Rex Hamilton is a board-certified eye surgeon who specializes in premium cataract and refractive eye surgery in Los Angeles.
• For the first 15 years of his career, he worked as the medical director of UCLA Laser Refractive Center.
• Dr. Hamilton has written several peer-reviewed and non-peer-reviewed papers; they can be found here.
• Hamilton Eye Institute received a 4.5/5.00 rating on Yelp.
• Dr. Rex Hamilton received a 4.9/5.0 rating on Google Reviews.
• There is a video on Dr. Hamilton's YouTube channel where he and his colleagues are seen performing LASIK surgery live on a patient; the video can be found here.

 

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vii) Excel Laser Vision Institute

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• Dr. Ferzaad Moosa of the Excel Laser Vision Institute is an experienced LASIK doctor, with 23 years of experience in performing vision correction surgery.
• Dr. Moosa is a refractive specialist as well as a board-certified Ophthalmologist.
• The website Top10Lasik, which identifies the top 10 LASIK surgeons in each state, identifies Dr. Moosa as one of the best surgeons in the state.
• Excel Laser Vision Institute received a perfect 5.0/5.0 star rating out of 20 Google reviews.
• On Yelp, Excel Laser Vision Institute received 4.5/5.00 stars from 95 reviews.
• Their website can be found here.

3) Advances In LASIK

• Even though it formally began being performed in the '90s, LASIK has roots dating back to the 1960s. And as LASIK developed over time, the laser systems that are being used for procedures have also advanced substantially.

Wavefront-LASIK (Custom Lasik)

• One of the most advanced laser technology available is custom LASIK. Custom LASIK treatment is tailored to the unique characteristics of the patient's eyes.
• Custom LASIK involves measuring the patient's eye front to back using a special laser, utilizing what's called "wavefront" technology to create a 3D image of the patient's eye.
• The technology is considered revolutionary because it can improve not only the quantity of an individual's vision (i.e. visual acuity measured by the 20/20 Snellen eye chart) but also the quality of how well an individual can see (i.e. visual acuity "measured in terms of contrast sensitivity and fine vision").
• Benefits of Wavefront LASIK over traditional LASIK may include the following:
• A potentially higher chance of achieving 20/20 vision (without glasses).
• A potentially higher chance of achieving "better than 20/20 vision."
• A potential reduction "in the chance of losing best-spectacle corrected vision."
• A potential reduction in "the chance of losing visual quality or contrast sensitivity."
• A potential reduction in "the chance of night-vision disturbances."

iDesign

• iDesign is one of the newest methods to do Wavefront-guided custom LASIK.
• In 2018, Johnson & Johnson (JNJ) announced the launch of its next-generation personalized LASIK treatment called the iDesign Refractive Studio.
• There are several benefits to utilizing this technology. For example, iDesign is able to capture imperfections "that can't be detected by conventional methods" by utilizing a high-definition sensor with 5x the resolution of its predecessor.
• iDesign allows doctors to take an accurate measurement of the patient's eye inside and out to deliver a more personalized LASIK procedure for the patient.
• For example, the iDesign Advanced Wavescan system is "able to scan each eye over the pupil using 1,257 data points to measure the wavefront of the eye, creating a unique map for treatment."

SMILE

• In 2016, the FDA approved SMILE, one of the latest advances in laser vision surgery.
• SMILE has been proven to be as safe and effective as LASIK. It is currently available for the treatment of myopic astigmatism and myopia.
• In a majority of cases, patients who undergo SMILE surgery will generally witness an 80% improvement within the first few hours, reaching full visual recovery typically within a week.
• Although SMILE is becoming more popular in the US, it is not yet as widely available as LASIK or PRK. The volume of procedures, however, is expected to increase year over year as surgeons and laser centers adopt the technology.
• SMILE combines the advantages of LASIK and PRK; it is similar to LASIK in that it requires only a small incision, does not require a flap, and has the same quick, recovery with the "additional benefit of no postoperative restrictions."
• The most common side effects and risks of SMILE are over or under-correction of the prescription, dry eyes, or (more rarely) visual distortions, including halos.
• In terms of physical recovery time, SMILE is quicker and produces less discomfort than LASIK; LASIK, however, tends to produce quicker visual recovery.
• Compared to LASIK, SMILE is considered to be "a more gentle procedure that maintains the structural integrity and organic composition of the cornea much better."

Research Strategy