Part 1: Individual Customization
One size does not fit all at Mandel Vision. Having spent his entire career, of more than 28 years, as a corneal specialist and refractive surgeon, Dr. Mandel recognized early in his career the importance of customization in refractive surgical procedures.
After carefully monitoring Nori’s corneal topography and pentacam measurements over several months, to ensure that her corneas were no longer warped from her special toric soft contact lenses, Dr. Mandel was ready to plan his approach for Nori’s PRK laser vision correction procedure.
Once Dr. Mandel established Nori was a safe candidate for PRK, he spoke with her about what she could expect from the PRK procedure. All laser vision correction procedures are surgeon dependent. Post laser vision correction, in Dr. Mandel’s skilled hands, more than 98% of patients are able to see 20/20 or better, without glasses or contact lenses. After reviewing this with Nori, he posed one of his most frequently asked questions: “What do you hope to achieve from laser vision correction?” Nori responded that she hated her contact lenses, as they had become more uncomfortable lately but also didn’t want to be dependent on glasses for distance vision any longer. Dr. Mandel told Nori this was a reasonable expectation, and not an uncommon one among our patients prior to laser vision correction. He then spoke in detail with Nori about her outcome options which were twofold:
Option 1: Correct both eyes for full distance vision. In this case, Nori should be able to see well in the distance without contact lenses or glasses. She should also be able to read without glasses until (approximately) her mid 40’s. Between the ages of 42-45, all patients, regardless of whether or not they have had laser vision correction, begin to need reading glasses. Even those patients who have had good vision their whole lives will need reading glasses when they approach this age group.
Option 2: Correct Nori’s dominant eye for the distance and leave her non-dominant eye slightly under-corrected (nearsighted) for near vision. This option is calledmonovision.
Nori’s main goal with the procedure was to be less dependent on her glasses and contact lenses for distance vision. Currently, Nori reads well up close without the need for optical aids. Since she is still young and likely has more than 10 years before she has to worry about the need for reading glasses*, both she and Dr. Mandel arrived at a decision together: Option 1.
*Patients who are over the age of 40 will often choose monovision, so that they can be less dependent on glasses for both distance and reading vision after the procedure.
The above is the personalized portion of the customization of laser vision correction. For this, Dr. Mandel reviews each patient’s goals, daily activities, occupation and hobbies with them. He then discusses the treatment options, which include both LASIK (for those patients who are candidates for this procedure) and PRK. Once the particular procedure is agreed upon, Dr. Mandel and the patient will customize the outcome of their procedure together.
Watch the video below to hear Dr. Mandel discuss the personalized customization process for Nori:
Part 2: Wavefront Customization
Wavefront customization is the surgical aspect of Dr. Mandel’s personalized customization process for all laser vision correction patients. This is done on the day of the procedure, utilizing fresh wavefront measurements taken that day, for optimal results.
The WavePrint technology in the AMO WaveScan™ Wavefront System, utilized at Mandel Vision, leads the industry for outstanding wavefront acquisition and diagnostic capabilities.[i] The WavePrint Map is derived from technology that was first developed to correct distortions of light waves from space. This technology is now used as a diagnostic and therapeutic tool to enhance our abilities to measure the visual system with an accuracy that was previously unattainable.
The WaveScan™ captures the unique imperfections of each patient’s eye using all of the available Hartmann-Shack™ data points for more accurate wavefront error reconstruction.[ii] These data points then create a unique fingerprint of your cornea. This fingerprint is then programmed into the VISX Star S4® Laser for each eye of each patient, individually. This technology allows Dr. Mandel to correct for visual disturbances, such as spherical aberration, that cannot be corrected with glasses or contact lenses. This means it may be possible to achieve better vision following laser vision correction than was attainable with glasses or contact lenses before the procedure.
The wavefront also allows for iris registration, which enables the VISX Star S4 laser to lock onto the eye, during treatment, using 3-D tracking, to correct for cyclotorsional rotation. This creates a more centered ablation, which is the area of the cornea that is re-profiled during both LASIK and PRK laser vision correction. A better centered ablation leads to a better outcome from the procedure.
Dr. Mandel personally programs the wavefront machine with a treatment design individualized for each patient, one eye at a time. Some components of the design are: prescription adjustments, customization of the treatment zone and the amount of tissue, in microns, to be removed. The programming of the wavefront is surgeon dependent. Dr. Mandel calls on his years of experience as a refractive surgery specialist, as well as his own nomograms, created from thousands of successful laser vision correction procedures, to reach the optimal design for each patient.
Watch the next video to see Dr. Mandel program Nori’s procedure on the WaveScan™ at the Mandel Vision Laser Center, conveniently located on the upper east side of Manhattan.
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