News & Events

Earlier this week, Kiplinger ranked Omaha #1 on its list of 10 Best Value Cities. You would think that after so many top rankings on lists such as this one that the writers would stop acting so surprised when Omaha finishes highly!

Read the full article here: http://kiplinger.com/magazine/archives/best-value-cities-2011-omaha.html

This question was posed on Quora, here is my answer:

A few years ago there was a lot of discussion amongst refractive surgeons about “super vision” or “super LASIK” which was supposed to correct people even better than the long-standard for “normal” vision of 20/20. Much of this talk has subsided, however, as we have learned how complicated the factors that lead to visual quality can be, and how difficult it is to predict who will and who will not achieve this level of vision.

There are many factors that enter in to a given individual’s ability to see. Certainly the refractive error, such as nearsightedness or astigmatism, is a major contributor. However, there are other parts of the visual system, including the retina and brain, that ultimately affect visual quality.

So if we are able to completely correct the refractive error in a given eye with LASIK, then the visual potential of that eye is now dependent upon the rest of the visual system.

For the average human retina and brain, this potential is around 20/12, but many eyes are not able to see that precisely, and some are able to see even better.

There is confusion amongst patients, and even many doctors, about the role that “Custom” correction plays in the LASIK world. Custom is another word (actually a trademarked term) for Wavefront-guided LASIK. Wavefront-Guided LASIK attempts to correct high-order aberrations (such as spherical aberration and Coma) as well as low-order aberrations (such as the myopia and astigmatism that are corrected by glasses). Although this is nice in theory, the reality is that it has some drawbacks. The biggest problem is that wavefront-guided treatments correct theentire sum of refractive aberrations on the anterior corneal surface, regardless of where the aberrations actually arise.

It is true that patients may see better than 20/20 after Custom LASIK, but that is also true of patients after conventional LASIK. The reason that the data seems to suggest a higher rate of 20/15 after custom lasik is partly because the laser manufacturers quietly upgraded the treatment patterns of low order aberrations when they added custom treatment to the laser software. In fact, if one looks closely at the FDA approval for one major laser platform, it says that high-order aberrations actually increased in patients after custom treatments. The key is, however, that they did not increase as much as conventional treatments on the same laser platform.

The best treatment technique, in my opinion, is Wavefront-optimized treatments which do not attempt to treat aberrations on the anterior corneal surface that did not arise from there, but rather attempt to decrease the creation of aberrations at the time of LASIK. These patients have tremendous results, and a high percentage of them achieve “super vision” or vision of 20/15 or better!

This question was recently posted on Quora (http://www.quora.com/How-good-is-LASIK-at-fixing-an-astigmatism). Here is my answer:

Astigmatism is a complicated topic. Astigmatism means that the eye is not perfectly round, like a basketball, but more like a football. An eye that is shaped this way focuses the light in two different planes thus there is natural blur at all distances.

It used to be that astigmatism could not be corrected by LASIK or other laser eye surgery, but with modern techniques that is no longer true. Even older less-sophisticated laser systems can correct astigmatism reasonably well.

However when it comes to astigmatism simply correcting the measured astigmatism in the patient’s glasses prescription is not always adequate. That is because there may be astigmatism inside the eye arising from the lens or other structures. This is called Ocular Residual Astigmatism (ORA). In order to appropriately treat eyes with high ORA, one must use vector analysis to determine the appropriate treatment magnitude. Doing so ensures the astigmatism is corrected appropriately for the patient’s lifetime!

Here are some references that explain this concept in more detail:
Kugler L, Cohen I, Haddad W, Wang MX. Efficacy of laser in situ keratomileusis in correcting anterior and non-anterior corneal astigmatism: comparative study. J Cataract Refract Surg. 2010 Oct;36(10):1745-52.

To learn more about Astigmatism, click here!

–Lance Kugler, MD

This question was recently posed on the Quora forum (http://www.quora.com/LASIK/Can-LASIK-deliver-better-than-perfect-20-20-eyesight), and I thought I would share my answer here. By the way, if you are not familiar with Quora, it is a great site. Anyone can post questions on virtually any topic imaginable, and then experts answer the questions and generate discussions..check it out!

Here is my answer to the question “Can LASIK deliver better-than-perfect (20/20) eyesight?”:

A few years ago there was a lot of discussion amongst refractive surgeons about “super vision” which was supposed to correct people even better than 20/20. Much of this talk has subsided, however, as we have learned how complicated the factors that lead to visual quality can be.

There are many factors that enter in to a given individual’s ability to see. Certainly the refractive error, such as nearsightedness or astigmatism, is a major contributor. However, there are other parts of the visual system, including the retina and brain, that ultimately affect the visual quality.

So if we are able to completely correct the refractive error in a given eye with LASIK, then the visual potential of that eye is now dependent upon the rest of the visual system.

For the average human retina and brain, this potential is around 20/12, but many eyes are not able to see that precisely, and some are able to see even better.

–Lance Kugler, MD