As an optometrist, Dr. Langer can treat most medical eye conditions not requiring surgical intervention. When surgical intervention is needed or desired, Dr. Langer works closely with area ophthalmologists to co-manage ocular surgeries. The most common ocular surgeries Dr. Langer co-manages are LASIK and cataract surgery.
LASIK refers to an elective surgical procedure where a laser is used to remove corneal tissue, leading to clear vision without the need for glasses or contact lenses.
The first question patients who are interested in LASIK often ask is, “Am I a good candidate?”. The answer to this question is usually yes. Previously, LASIK wasn’t available to patients with large prescriptions, but with advances in laser technology, most prescriptions can be corrected with LASIK. Modern lasers can correct up to 6 diopters of hyperopia (farsightedness), 6 diopters of astigmatism, and 12 diopters of myopia (nearsightedness). If your prescription falls in this range, there is a good probability you will qualify for LASIK.
There are a few exceptions. During LASIK, a flap is created with a laser on the cornea, or front surface of the eye. After this flap is created, the laser ablates (essentially removing tissue) areas of the cornea. This procedure allows light to focus directly on the retina, which gives patients crisp clear vision without glasses. If the cornea is very thin, the LASIK surgeon may not be able to safely ablate enough corneal tissue to complete the procedure. Additionally, if the cornea has extensive scarring or the patient has a corneal disease, LASIK may not be an option.
Another consideration to make before proceeding with LASIK is the age of the patient and if the eyeglass prescription is stabilized. Before age 18, prescriptions are unlikely to be stable in many patients, changing from year to year. For this reason, patients under 18 are not good candidates for LASIK surgery. Between ages 18 and 40, many patients have minimal to no change in their glasses prescription, making them prime candidates for LASIK. There are always exceptions to this rule, so it is important to look at two to three years of prescription data to determine if the glasses prescription is stable. If the prescription is changing, it is likely to change again making the LASIK procedure ineffective.
For patients over age 40, the decision of whether to proceed with LASIK surgery is more complex. Between ages 40 and 60, glasses prescriptions tend to change and patients lose the ability to focus at near. This condition is known as presbyopia. Even though the distance prescription will likely change after LASIK surgery, it won’t change drastically. Patients with large prescriptions often appreciate several years of perfect distance vision after LASIK, followed by a much milder prescription in years to come. Patients who start out with milder prescriptions, may not appreciate LASIK, as their original glasses prescription can return several years after LASIK is performed. Unfortunately, LASIK can only correct distance or near vision in presbyopic patients, not both. Patients over age 40 have to make a compromise when it comes to LASIK. Luckily there are other options for corrective vision surgery that may be more suitable for presbyopic patients. Elective lens replacement surgery is one alternative.
As adults age, the lens of the eye clouds forming cataracts. Cataracts cause patients to experience: blurry vision, needing more illumination to read, an increase in glare at night, and colors not appearing vivid. Most cataracts develop slowly, with a gradual onset of symptoms.
When cataracts are small and not causing symptoms, they are typically monitored on an annual basis. Once cataracts grow and begin impacting vision and quality of life, patients are referred to an ophthalmologist for cataract surgery. Cataract surgery involves making an incision in the front of the eye, from which the cloudy lens is removed. The cloudy lens is replaced by an artificial intraocular lens or lens implant. The lens implant contains a prescription that can correct patients vision, often reducing or eliminating the need for glasses.
Intraocular lenses have come a long way since they were first introduced. There are lens implants available that can correct almost any prescription including myopia, astigmatism, hyperopia, and presbyopia. Depending on your prescription, lens implants such as the Tecnis Symphony lens can provide vision across multiple distances. Many patients are thrilled to be free of glasses following cataract surgery.
The same artificial lens technology implanted during cataract surgery can also be used for elective lens replacement. If a patient is not a good candidate for LASIK, or would like an option to correct presbyopia, elective lens replacement (also known as refractive lens exchange) is a good alternative. In elective lens replacement surgery, before cataracts develop the natural lens of the eye is removed and an artificial lens with corrective prescription is inserted in its place. After lens replacement surgery, the prescription is stabilized and stops changing, which is an advantage over LASIK surgery. Like LASIK, this procedure provides clear vision without the need for glasses. A bonus for patients who choose elective lens replacement surgery is that they will never develop cataracts later in life.
While Dr. Langer does not perform LASIK, cataract surgery, or elective lens replacement surgery, she has close relationships with area ophthalmologists and is able to provide pre-and post-operative care. If you are unsure which procedure is right for you, Dr. Langer is happy to offer her expertise.