Frequently Asked Questions
The most common question I get asked by patients, friends and colleagues is how can you and why do you provide this service at such a low price?
The Coal Harbour Eye Centre staff (myself included) had been through high cost-low volume, and low cost-high volume corporately managed laser centres prior to opening at Coal Harbour.
When we opened we agreed on a philosophy to provide the highest quality of care at the most affordable price and to run Coal Harbour Eye Centre as a medical practice, not as a business. In keeping with that philosophy I as a medical doctor believe that affordability of a surgical procedure that enhances one's life, whether deemed cosmetic or not (and it can be argued either way), should not be an issue to most people. This surgery which I believe strongly in (having had it myself and having performed it on my daughter, brother, sister-in-law, many friends, numerous physicians and other laser refractive surgeons) should be made available to most and not just to those who can afford $3000 - $4000 as it was in the past. This surgery should not be restrictive or elitist.
Does price affect the quality of care?
Absolutely not. Quality of care is dependant on equipment, it's service, backup equipment, expertise and experience of staff and surgeon, and attention to detail. High price does not ensure high quality. What a high price does ensure is lower volume.
Our equipment: We have the Bausch and Lomb Z100 Laser, and a Bausch and Lomb 217C Laser. Most clinics run with one laser, which would be fine but in order to maximize our outcomes we have purchased 2 lasers. Because our high volume is linked to our low cost, the lasers are working to their optimum efficiency and continuously serviced. I have used four (4) 4th and 5th generation lasers, including the Wavelight Allegretto, the VISX S3, and the MEL 80 in addition to the B&L technology, and feel that they were all excellent. I selected the Bausch and Lomb lasers because in my experience it has yielded the best results. Now with the purchase of the Bausch and Lomb Z100 we've taken a step forward, and raised the bar as far as safety and accuracy. Our microkeratomes are leading edge technology and the most popular microkeratomes used worldwide.
The single most important step in the LASIK procedure is the flap. Bad flaps equal bad outcomes regardless of the technology that is used afterwards. So the cutters are of paramount importance.
How experienced is my surgeon?
You would be hard pressed to find a surgeon anywhere who has done over 35,000 procedures since June 1998 as I have. That is the surgeon, not the centre, not his associates, not people he may or may not have trained. The more surgery one does, the more proficient one becomes. Would you rather have a surgeon who performs 100 procedures a week or one who performs 10 procedures a month regardless of price. Generally the lower the price the higher the volume, which translates to greater the experience and expertise.
Likewise the technical staff: At our clinic the laser technicians, the medical technologists, and the laser vision specialists have been involved with tens of thousands of patients. They've heard and seen it all (or at least most of it).
Is everyone a candidate for surgery?
No. It depends on your prescription, corneal shape and thinkness, age, other eye problems, general health, etc. Your personal care specialist or we, at Coal Harbour Eye Centre will determine if you are a good candidate during your free no obligation eye exam.
Would I need to have a re-treatment after my initial surgery?
No, not everyone requires an additional re-treatment however it is important to know that sometimes re-treatment's are necessary to achieve best corrected vision. This happens to less than 4% of our patients for LASIK, and if required an additional procedure is completely covered by our Lifetime Enhancement policy at no cost to the patient. The re-treatment rate for PRK procedures is 1% of patients at our clinic.
Will I still need glasses after my surgery?
Most patients below the age of 40 do not require glasses to see after the surgery procedure. If you are 40 years old or older, due to the natural aging process of the eye you will require reading glasses. Laser vision surgery will correct your distance vision but will not prevent the need for reading glasses.
Does it hurt?
The surgery itself is generally pain free, however LASIK patients feel pressure and discomfort for a few moments with the lid speculum and microkeratome. Patients may find this unsettling. We do provide a sedative and soothing eye drop medication to minimize discomfort, and most patients are quite relaxed and comfortable. After surgery, LASIK patients do not experience pain however PRK patients can experience pain, which is alleviated by medicating drops. After PRK, 50% of patients feel very little if any pain, 40-45% felt mild discomfort, 5-10% experience some pain.
What if I have astigmatism?
Having astigmatism is quite common and does not discount you from being a candidate. Our lasers are able to treat the astigmatism along with correcting the nearsightedness or farsightedness. It is all done in the same procedure.
Will I achieve 20/20 vision after my surgery?
The goal of refractive surgery is to reduce the dependency on glasses or contacts. Patients goals can vary based upon their level of correction and expectations. Most patients achieve 20/20 correction after surgery while others still require the need to wear glasses for night driving and reading. Your outcome is based on your individual parameters and will be discussed with you by our medical staff during your consultation.
What is "No Touch" or "touchless" PRK?
"No touch" is transepithelial PRK (Photorefractivekeratotomy) with the where the top layer of the cornea (the epithelium) is removed by the laser beam.
Is this method of removing the epithelium the most accurate?
In my opinion as a surgeon, it is not as accurate as using the cornea's natural plane between epithelium and it's underlying tissue to gently wipe away the epithelium. I have done over 1000 transepithelial PRKs, and over 5000 alcohol removal PRK procedures. All methods of epithelial removal yield very similar outcomes. I have no strong opinion on one method versus another. I have performed several different techniques and have selected the method I use as in my hands it is the most accurate.
Does a surgical instrument touch the eye in the "No Touch" procedure?
The laser is a surgical instrument. It removes tissue from your eye. The only way to correct vision without touching the eye is to wear glasses (contact lenses touch the eye). "No Touch" is a trademarked name for transepithelial PRK coined by one clinic. It is not a patented form of surgery, it is a procedure developed in 1991. I still do this procedure on appoximately 10 patients per year, only under very specific circumstances.
Which is a better procedure, LASIK or PRK?
This is best determined by a discussion with your doctor and by having a pre-operative eye evaluation. Although techniques are different, similar results are achieved. What makes one person a candidate for one surgery over the other is dependent on their corneal thickness or any irregularities or scars on or near the front surface of the cornea. The eye care specialists at CHEC will be able to identify which procedure would best meet your refractive needs.
What are the pros and cons of each procedure? (PRK & LASIK)?
- Pros- Rapid recovery, very little discomfort after the procedure.
- Cons- When the "flap" is created for lasik, complications can occur although this occurs very rarely in experienced surgeons.
- Pros- No "flap" is created so no risk of flap complication.
- Cons- Longer recovery, increased risk of infection.
What about the laser? Which one is the best laser?
All modern lasers are excellent. I have used the four most popular and state of the art lasers used world-wide. They may be slightly different but in general our results were very similar in use of the Bausch & Lomb Z50, Wavelight Allegretto, the Visx S3, and the Carl Zeiss MEL 80. I have selected to use of the Bausch & Lomb Z100 laser in my clinic as it has provided better and safer results. I have had the most experience with it, and the service of the laser was superior. As well, the calibration of this laser is the most reproduceable and accurate in our hands.
What is Wavefront Technology?
"Wavefront" is a new technology used to measure high order aberrrations (defects) within the optical system. The procedure potential rids the patient of these abberations. Most people do not have high order aberrations. Wavefront technology can be indicated in approximately 15% of patients to enhance their outcome. The only way to identify if you have high order abberations is to have a complete evaluation and testing on a specialized piece of equipment called a "aberrometer". Age, glasses prescription have no bearing on the potential for high order abberations in the eye. The size of the pupil does have a direct correlation. The larger the pupil, the increased incidence of abberations.
How do I start the process?
After reviewing this material, you are on your way to educating yourself about laser eye surgery. Your next step is to contact us and arrange a no-obligation eye examination at our centre. This will determine your eligibility for laser refractive surgery. If you are unable to come to our centre you can arrange this examination with your own eye care professional and have the results faxed to our facility for consideration.
Does my insurance cover laser eye surgery?
Some insurance companies are providing coverage for this surgery. You will need to check with yours to determine this. If however yours doesn't you will be required to cover the cost of surgery yourself. For your convenience we have provided various payment options including monthly financing.
I hope I've answered these questions to your satisfaction.
Steven L. Kirzner, MD