1. Why does Dr. Mandel recommend that contact lenses be discontinued prior to a LASIK laser vision correction evaluation, whereas other laser vision correction centers don’t?
Both regular soft and toric soft contact lenses can warp and distort the cornea, as the cornea can mold to the shape of the contact lens. The cornea molded to a soft toric lens takes even longer to return to its natural shape than that molded to a regular soft lens. The cornea is the front surface (window) of the eye that requires an extensive evaluation by Dr. Mandel to determine your candidacy for LASIK or PRK laser vision correction, and it’s important that the natural shape of your cornea be evaluated to determine your candidacy for a procedure. Warpage from contact lenses can also be difficult to differentiate from actual corneal pathology or disease. This could result in you being temporarily turned down as in inappropriate candidate for laser vision correction when, in actuality, once your corneas unwarp and return to their natural shape, you could be a safe candidate. Leaving your contact lenses out prior to your initial evaluation can save you from having to return for a second evaluation once you’ve left your contact lenses out, 100%, for the appropriate amount of time.
2. Why does Dr. Mandel use stronger dilating drops, which last longer, whereas other laser vision correction centers use the same dilating drops as are used for routine eye exams that go away more quickly?
The weaker dilating drop, which only lasts 2 to 4 hours, dilates (widens) the pupil so that the medical portion of the eye exam can be performed. This exam is called a fundus exam and includes an evaluation of the health of the posterior (back) portion of your eye, including the retina, macula, and the optic nerve. This exam is performed using a specialized lens and a bright light. If the pupil is not dilated, when a bright light is shined into the eye, the pupil naturally constricts to let in less light, and the doctor does not get a complete view of the back of your eye. This type of dilating drop is sufficient for a routine eye exam. However, there is a second, very important function of the dilating drops used at Mandel Vision, which is your safeguard to minimize overcorrections with the laser vision correction procedure. This eye drop is the longer lasting drop which relaxes the ciliary muscle of the eye to stop accommodation. When the eye accommodates, it adjusts and can artificially change the prescription of the eye. These strong dilating drops are used to relax the muscles in the eye to help attain a refraction that is less influenced by accommodation, and therefore more accurate.
The reasons for this are two-fold:
- We at Mandel Vision, realize that this is a very big decision for you and not one to be made lightly. We want to make sure that you not only have all of the information needed to make a decision as to whether laser vision correction is for you, we also want to make sure you have time to “sleep on it”. Additionally, we want you to be able to read your consent form, prior to your procedure, and this can be difficult after dilation.
- We dilate you for the evaluation so that a full medical eye exam can be performed and to repeat your prescription measurements. The latter is a safeguard against overcorrection after LASIK or PRK laser vision correction. The procedure, however, needs to performed on an undilated pupil, for proper centration. Therefore, we wait until the effects of the dilating drops have worn off before proceeding with laser vision correction.
4. Why does Dr. Mandel recommend that patients start using over the counter natural tear drops four times a day PRIOR to a LASIK laser vision correction evaluation, whereas other laser vision correction centers don’t?
Dry eye changes from wearing contact lenses can affect the measurement and analysis of our advanced diagnostic equipment. Rewetting your eyes prior to your evaluation day often makes the testing and analysis more accurate and can avoid the need to return for another evalution before your procedure.
5. Why does Dr. Mandel recommend that soft contact lenses be discontinued 10 days to 2 weeks prior to LASIK and PRK laser vision correction, and RGP lenses be discontinued at least 3 weeks prior, whereas other laser vision correction centers do not require this?
Many centers will use the measurements they attain from the day of the evaluation to treat your eyes on the day of surgery. When Dr. Mandel trains eye surgeons, he insists that they try to attain measurements on the day of surgery, as these may be more accurate in treating. This takes more time, but at Mandel Vision we believe that this increases your chance of the best visual outcome for your procedure.