Los Angeles LASIK Eye Surgery

Serving Los Angeles, Santa Barbara, and Surrounding Areas

As you all might be well aware, our colleague Ioonis Palikers invented Lasik in 1991. It was the culmination of two evolving techniques; one was the lamellar surgery popularized by Baraquer and modified as automated lamellar keratoplasty or known colloquially as ALK.

The second technique was the one invented by Srinivasan in New York called the Excimer Laser. When the two were merged we had Lasik.

Now, as you all know Lasik was invented in the last century and we have proceeded to the 21-century now. In the interim, millions of Lasik procedures have been done and Dr. Khanna himself has performed thousands. Today we are going to see what we have learned in the last 15 years and how our thinking has changed on the safety of Lasik. We will also learn when Lasik should not be performed at all.

So the first thing we have to remember is what the doctors learned in medical school and taking on hippocrates oath-first do no harm. That is, the first thing we need to look at is to be sure the intended surgery will not cause any harm. So what that means is we have to make sure the patient is systematically fine. In other words, they are not suffering from any disease like Rheumatoid Arthritis, Diabetes Mellitus or Thyroid disease. Investigate if they are on any medications which might affect the outcome of the surgery. Also, we have to make sure the women we perform on are not pregnant and are not going to be pregnant or lactating soon.

Second point is that we have to make sure the eye itself is stable. What that implies is that the eyes should not be having any active inflammation, cataract, glaucoma, or corneal problems.

Third point is that we have to make the refraction of the eyes stable, so the eye should not be having a change in stigmatism of the power rapidly. A lot of patients ask: when they went to the doctor they changed their glasses, so does that mean that the eyes are unstable? The answer is somewhat no. The eyes could still be stable and your lens may have been changed because either the glasses were scratched or a better prescription could be found for you. Stability means that on successful examination performed, the change should be less than half a diaopter.

Fourth point is we have to be very careful about the corneal topography. What that means is the shape of the cornea should be within the acceptable parameters. Dr. Khanna follows the system of KISA Index devised by Dr.Rabinowitch, which looks at the symmetry of stigmatism in an eye and also compares the amount of a stigmatism related to the other. If the astigmatism is within one half diaopter of the other eye and the superior inferior difference in stigmatism is less than 1.5 diaopter. If the corneal curvature is less than 47 diaopter and the astigmatism is orthogonal, that means the two axis of both eyes shaped astigmatism are 180 degrees away from each other or within 15 degrees of 180 degrees then it is relatively safe to do Lasik. Now the difference between the two eyes can be up to a 1.5 diaopter can still be done. But the overall points mentioned in the KISA Index taken together gives more knowledge about the safety. Now KISA Index tries basically to pick up if a patient has a degenerative disease like Keratoconus or Pellucidal marginal degeneration. These are degenerations where the collagen fibrils are not able to withstand the intraocular pressure of the eye; the cornea thins and bulges outward. In Keratoconus, the bulge is near the apex of thinning whereas Pellucidal Marginal degeneration the thinning is near the limbus & inferior to the apex to the bulge.

The last criterion regarding the safety of Lasik is the corneal thickness. Currently people think any cornea less than 475 microns should not have Lasik, most of our colleagues are of the view it should be at least 500 microns. Even more important than the beginning thickness what is the thickness of the residual bed. When the flap is made that part of the flap does not contribute to the stability of the cornea anymore is the remaining bed of cornea where the ablation is done, which contributes to the safety.

Over the years we have learned that 250 microns is at least what must be left behind. Dr. Khanna always tries to keep at least 75 to 300 microns and that has led him to switch to more refined technique of doing Lasik on thin flap Lasik. When Lasik was first invented it was as we have mentioned before derived from automated lamellar keratoplasty ALK. At that time the flaps made in Lasik were around 160 to 200 microns. We have learned that as the flaps are made thinner, they get more accurate and also leave behind much more untouched cornea. So right now, we are performing Lasik at our center with only 100 microns flap. This means the corneal tissue remaining behind is increased by up to 50 to 20 percent. Now, much of what we have discussed above may be technical and medical jargon but it's important that at least your doctor understands these terms and applies these to your eyes before doing any invasive procedure such as Lasik.

Most of the time, if these conditions are adhered to, Lasik is a relatively safe, painless & quick procedure, yielding great vision especially at night and also increasing the visual field.

To summarize, Lasik has been refined in the last 15 years but there are certain conditions when Lasik shouldn't be done, such as if there is eye instability, any systemic diseases which are uncontrolled, cornea is abnormal, or the remaining bed would be too thin.

Thank you. Watch out for our next broadcast.

Click here for 10 things you need to know about LASIK.

Los Angeles Lasik Eye Surgery Disclaimer: Dr. Khanna serves eyecare patients in Los Angeles and surrounding areas. This site is for informational purposes only. It is not intended to be medical advice for those seeking LASIK surgery, but to provide information about the Los Angeles, California LASIK Surgeon, Doctor Rajesh Khanna, M.D.

Dr. Khanna proudly serves patients throughout Southern California and Orange County including: Alhambra, Altadena, Anaheim, Arcadia, Baldwin Park, Bakersfield, Beverly Hills, Burbank, Camarillo, Carson, Cerritos, Chino, Chino Hills, Compton, Corona, Costa Mesa, Diamond Bar, Downey, East Los Angeles, Fontana, Gardena, Glendale, Hacienda Heights, Hawthorne, Huntington Beach, Huntington Park, Inglewood, La Habra, Laguna Niguel, Lake Forest, Lakewood, Lancaster, Long Beach, Los Angeles, Lynwood, Mission Viejo, Montebello, Monterey Park, Newhall, Newport Beach, Norwalk, Ontario, Oxnard, Palmdale, Palos Verde, Paramount, Pasadena, Pico Rivera, Pomona, Redondo Beach, Riverside, Rosemead, Santa Barbara, Santa Clarita, Santa Monica, Santa Rosa, Simi Valley, South Gate, Thousand Oaks, Torrance, Trabuco, Upland, Ventura, and West Covina.

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