Laser Vision Correction
Reduce or eliminate your dependence on glasses with published refractive surgeon Medi Eslani, MD, FAAO, serving San Diego County.
How It Works
A precise excimer laser gently reshapes the cornea to correct nearsightedness, farsightedness, and astigmatism.
A thin corneal flap is created and the laser reshapes the tissue beneath. Recovery is rapid. Many patients see clearly within a day and return to normal activities quickly.
No flap is created; the laser reshapes the surface of the cornea. PRK is an excellent choice for thinner corneas, dry eyes, or active lifestyles, with a slightly longer healing period.
Options like refractive lens exchange (RLE) and the implantable collamer lens (ICL) can correct higher prescriptions. Dr. Eslani will help you choose.
Candidacy
Most people who want laser vision correction can have it, but not everyone should, and a good refractive surgeon is as willing to say no as yes. Candidacy comes down to your prescription, the shape and thickness of your cornea, the health of your tear film, and whether your eyes have stopped changing.
You are 18 or older and your prescription has been stable for at least a year
You are nearsighted, farsighted, or astigmatic within the treatable range
Your corneas are healthy and thick enough for the correction needed
Your eyes are otherwise healthy, with no active disease
You are not pregnant or nursing, which can shift your prescription
You have realistic expectations about what the surgery can deliver
Your prescription is still changing year to year
Your corneas are too thin, or topography suggests keratoconus
You have significant untreated dry eye or ocular surface disease
You have uncontrolled glaucoma, an advancing cataract, or retinal disease
Your prescription is beyond the range a laser can safely correct
What actually bothers you is needing reading glasses after 45
That last point matters more than people expect. If near vision is the real problem and you are past about 45, reshaping the cornea is often the wrong tool: refractive lens exchange or an implantable collamer lens usually gives a better result. Dr. Eslani will tell you if that is your situation rather than treating you with the laser he happens to own.
The Evaluation
The most important part of laser vision correction happens before any laser is switched on. Screening is what separates an excellent result from a complication, and it is where corners are most often cut. Expect a thorough workup, and expect it to take time.
Corneal shape
Detailed maps of the front and back surfaces of your cornea. These reveal early keratoconus and other irregularities that would make laser surgery unsafe, and which a glasses prescription alone would never expose.
Corneal thickness
The laser removes tissue, so there has to be enough to begin with and enough left behind afterward. Thickness determines whether LASIK, PRK, or neither is appropriate, and how much correction can safely be applied.
Stability
Your prescription is measured with and without dilating drops and compared against your previous records. Treating a prescription that is still moving means treating a moving target.
Surface and pupils
Dry eye is assessed and treated before surgery rather than after, because laser surgery temporarily worsens it. Pupil size in dim light is measured too, since larger pupils influence night-vision quality.
If screening shows you are not a good laser candidate, that is a useful answer rather than a wasted visit. Dr. Eslani's research background in cornea and ocular surface disease means borderline corneas and marginal tear films are identified before they become your problem.
Laser Technology
The surgeon planning your treatment matters more than the machine performing it, but the machine still matters. Dr. Eslani treats on the Alcon WaveLight Refractive Suite and screens every candidate on Scheimpflug tomography before anyone is cleared for surgery.
The platform
Two lasers work together. The WaveLight FS200 femtosecond laser creates the corneal flap in about six seconds, with its diameter, depth, and hinge position planned for your eye. The WaveLight EX500 excimer laser then performs the correction at 500 pulses per second, roughly 1.4 seconds per diopter of treatment.
Speed here is a clinical point rather than a marketing one. Less time with the cornea open means less drying of the corneal surface during treatment, which helps keep the correction accurate. The EX500's tracker samples your eye 1,050 times per second with a two-millisecond response, following small movements continuously and pausing if you move beyond its range.
Standard profile
Corrects your sphere and astigmatism while removing extra tissue peripherally to preserve the cornea's natural curved shape. The purpose is preventive: it avoids introducing the spherical aberration behind many of the night-vision complaints associated with older-generation LASIK.
Topography-guided
Rather than treating your prescription alone, Contoura imports thousands of measured elevation points from your own cornea and treats its actual irregularities as well. In the FDA clinical trial, 92.6% of eyes saw 20/20 or better without glasses at twelve months, and more than 30% could see better uncorrected afterward than they could with glasses beforehand.
The choice
Contoura is approved for nearsightedness and astigmatism, and it helps most in corneas carrying measurable irregularity. A regular cornea with a straightforward prescription may do just as well on a wavefront-optimized treatment. Your maps decide that, not the marketing.
Screening
Candidacy is settled using the OCULUS Pentacam, a rotating Scheimpflug camera that builds a three-dimensional model of your cornea. A conventional topographer reads only the front surface, by reflecting rings off your tear film. The Pentacam measures the front surface, the back surface, and the thickness of the cornea across its entire area.
That back surface is the point. Early, subclinical keratoconus often reveals itself in the posterior cornea and in how thickness progresses outward, well before anything shows on the front surface or in your glasses prescription. Detecting it is the single most important safety step in refractive surgery, and it is the reason some patients are told no.
The Procedure
The visit takes a couple of hours, though the laser itself is measured in seconds per eye. You will need someone to drive you home.
Before you start
Anaesthetic drops numb the eye completely. There are no injections and no general anaesthetic, and a mild sedative is usually offered to help you relax.
Step one
For LASIK, a thin flap is created and lifted. For PRK, the surface layer of cells is gently removed instead and no flap is made. This is the step where the two procedures actually differ.
Step two
The excimer laser reshapes the cornea, typically in well under a minute per eye. It tracks your eye continuously and pauses instantly if you move. You look at a fixation light throughout, and you do not feel the laser.
Finishing
For LASIK the flap is repositioned and seals without stitches. For PRK a protective contact lens is placed for several days. You rest briefly, receive your drops and instructions, and go home.
Recovery
This is the most important practical difference between the two procedures, and it is worth understanding before you choose. The destination is comparable; the road there is not.
LASIK
Vision is often noticeably clearer within hours, and most people are functional the next day and back at desk work within a day or two. Mild scratchiness, watering, and light sensitivity settle quickly. Rubbing the eyes, swimming, and dusty environments are off-limits briefly while the flap seals, and most patients are cleared to drive within a day or two once vision meets the legal standard.
PRK
The surface layer of cells has to regrow, which takes several days under a protective contact lens. Expect genuine discomfort and blurred, fluctuating vision for the first three to five days, and several weeks before vision fully sharpens. Many patients take a week off work. The trade-off is that no flap is created at all, which is why PRK suits thinner corneas, contact-sport athletes, and certain occupations.
Both procedures cause a temporary increase in dry eye that improves over the following months. If your tear film is marginal to begin with, it is treated first, which is one reason the pre-operative surface assessment matters so much.
Safety & Expectations
Laser vision correction is among the most studied elective procedures in medicine, with an excellent safety record and consistently high patient satisfaction across decades of follow-up. It is still surgery, and being clear about the limits is part of doing it properly.
Common, and temporary
Almost everyone notices some increase in dryness after laser surgery. It typically improves over three to six months and is managed actively rather than simply waited out. Pre-existing dry eye is treated before surgery, not after.
Usually settles
Starbursts and halos around lights are common early and usually fade as the eye heals. Larger pupils and higher prescriptions carry a greater chance of these persisting, which is why pupil size in dim light is measured beforehand.
Sometimes needed
A small proportion of patients need a second, smaller treatment to fine-tune the result, usually months later once vision has stabilised. This is a normal part of refractive surgery rather than a failure of the first procedure.
Not prevented
Laser correction does not stop presbyopia. Corrected for distance, you will still need reading glasses in your forties and fifties, and you can still develop a cataract later in life. Neither is caused by having had LASIK.
The useful question is not whether laser surgery is safe in general, but whether it is the right operation for your particular eyes. That is what the evaluation is for.
FAQ
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Dr. Eslani provides the full range of surgical and medical eye care across San Diego County and the Imperial Valley.
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Find out if you're a candidate for laser vision correction.