InSight LASIK is the recipient of numerous honors including: Daily Camera’s Best of Boulder in 2007 and 5 of the last 6 years, Colorado Daily’s CU & Boulder’s Best, the Broomfield County Gold, CK Center of Excellence, and the Alcon Quality of Vision award. With this award winning facility you know the expert care provided by Dr. Jackson, Dr. Miller, Dr. Tripp and Dr. Johnson will be unsurpassed. We created InSight LASIK to be an ‘Eye Spa’ with the goal to treat each and every patient the same way that we want to be treated when we go to a doctor’s office. We respect your time, treat you as an individual, and work to earn your trust,” says Jimmy Jackson, O.D., President of InSight LASIK. “It’s a combination of clinical excellence and old fashioned customer service,” continues Keith Miller, O.D.. “We are the antithesis of the high-volume, run-people-through-like-cattle clinics. Every patient is unique with different expectations and different concerns. Our care is priceless.” During your free 60 minute consultation you will be evaluated by our doctors in a thorough 5-point examination to determine if you are a good candidate for laser vision correction.

Since LASIK was first approved it has been regarded as a safe and successful method of vision correction. Even so, you’re not alone if you feel hesitant to move forward with surgery, wondering what future advancements may hold. InSight Lasik now offers LASIK surgery using the IntraLase Method™—also known as all-laser LASIK or IntraLASIK™—and it could be the very advancement you’ve been waiting for.

How does the IntraLase Method improve the LASIK procedure?

The IntraLase Method is a 100% blade-free approach to creating a corneal flap, the thin layer of tissue the surgeon folds back to expose the part of the eye that is reshaped during the LASIK procedure. With the IntraLase Method, LASIK is not only 100% blade-free, but shown in clinical studies to provide more patients with vision that is 20/20 or better.1

Prior to the IntraLase Method, doctors created all corneal flaps with an instrument called a microkeratome, which utilizes an oscillating, precision steel blade. Although LASIK complications are extremely rare, when they do happen the microkeratome is commonly the cause.

The IntraLase Method, by contrast, utilizes the computer-guided IntraLase® laser to deliver rapid pulses of light, a quadrillionth of a second each, to a pre-programmed depth and position within your cornea. Each pulse forms a microscopic bubble. As the IntraLase laser moves back and forth across your eye, the bubbles connect to form a corneal flap. Just prior to laser reshaping, the doctor gently lifts the flap where these bubbles have created a smooth surface.

With the IntraLase Method, LASIK is not only 100% blade-free, but also allows our doctors to tailor-make the flap based on what’s best for your eye, providing you a greater opportunity to achieve 20/20 vision or better.1

Why IntraLase?

LASIK surgery has advanced steadily over the years; the technology used to measure your visual error prior to surgery has become more powerful and corrections can be optimized to your needs. Until the IntraLase Method, however, the creation of the corneal flap was the one step that lacked the technological sophistication of the rest of the LASIK procedure. As it turns out, that step is an important one in terms of providing you with the best possible LASIK experience.

In addition, if you were not eligible for LASIK surgery performed with a microkeratome due to steep, flat, or thin corneas, you may now be a candidate with the IntraLase Method. In fact, IntraLase training has become part of the curriculum at most of the ophthalmic teaching institutions and is rapidly being adopted by eye care practices around the world.

IntraLase® is the most advanced technology for corneal flap creation available today, and will give you greater confidence and assurance in moving forward with laser vision correction.

REFERENCE: 1. Tanzer DJ, Schallhorn SC, Brown MC, et al. Data on file. IntraLase Corp. 2005.

©2005 IntraLase Corp. All Rights Reserved. IntraLase is a registered trademark of IntraLase Corp. IntraLase Method and IntraLASIK are trademarks of IntraLase Corp. Mkt Doc 339 Rev. A

You’ve made the decision to take the plunge…it’s time to get rid of those glasses and contact lenses for good. Ah, freedom! But now comes the tough part - making the choices on where to go and which surgery is the best for your particular needs. It can be overwhelming, and it is important to have expert guidance concerning your eyesight.

InSight Lasik, located between Denver and Boulder, provides a “full-service” LASIK and laser vision correction center. A wide range of refractive surgical procedures are performed in a state-of-the-art facility, and they are experts in helping each patient decide which procedure is their best option. The specialists at InSight Lasik are board certified and have impressive credentials and years of experience. Drs. Tripp, Johnson, Jackson and Miller have collectively treated over 25,000 patients.

Jimmy Jackson, O.D., president of InSight Lasik believes in offering patients the best care before and after treatment. “We created InSight Lasik with the goal to treat each and every patient the same way that we want to be treated when we go to a doctor’s office,” he explained. “We respect your time, treat you as an individual, and work to earn your trust. A lot of centers in Colorado are using old technology because it still works. Our view is that when new technology becomes available—if it offers even an incremental improvement in quality, safety or outcome—we’re going to invest in it,” says Dr. Jackson. Their newest piece of diagnostic equipment is the Pentacam HD. The Pentacam is the next wave in comprehensive eye scanner technology; this system measures anterior and posterior elevation and curvature as well as corneal thickness. What separates the Pentacam from other instruments is its accuracy.

What causes vision problems?
First, it is important to understand what causes the problems you are seeking to correct. The cornea is a part of the eye that helps focus light to create an image on the retina. Usually the shape of the cornea and the eye are not perfect and the image on the retina is out-of-focus (blurred) or distorted. Persons with myopia, or nearsightedness, have more difficulty seeing distant objects as clearly as near objects. Persons with hyperopia, or farsightedness, have more difficulty seeing near objects as clearly as distant objects. Astigmatism is a distortion of the image on the retina caused by irregularities in the cornea or lens of the eye. Combinations of myopia and astigmatism or hyperopia and astigmatism are common.

What is LASIK?
By changing the shape of the cornea of an eye that is nearsighted, farsighted or astigmatic, doctors are able to change the eye’s focal point thus allowing patients to see more clearly without glasses or contact lenses.

During the procedure a thin, circular flap (about the thickness of tissue paper) is made on the outer surface of the cornea. The flap is folded back revealing the stroma, the middle section of the cornea, allowing pulses from a computer-controlled laser to treat the deeper corneal tissue. After the laser reshapes the cornea, the flap is replaced and heals securely and naturally.

LASIK can be performed by numerous doctors utilizing a number of different Excimer laser technologies. The training and expertise of the surgeon is important, but the laser technology is equally important.

The Ultimate in Laser Vision Correction: Blade-Free LASIK
The IntraLase Method™ is a 100% blade-free approach to creating your corneal flap, the thin flap of tissue that the doctor folds back in order to perform your LASIK procedure. The blade-free IntraLase Method virtually eliminates the most severe sight-threatening LASIK complications by using a computer-guided laser to create your corneal flap. It also enables our doctors to tailor make this flap based on what’s best for your eye, providing you a greater opportunity to achieve 20/20 vision or better.

Alcon LADARVision
LADARVision treats unique vision imperfections by using a small-spot beam to sculpt more precisely, laser radar eye tracking to protect against unintended eye movement, and large treatment zones to minimize night vision issues so that virtually all levels of nearsightedness, farsightedness and astigmatism can now be treated.

The LADARVision system employs a flying small-spot laser beam that is 0.8 mm wide. This is important because only a very small, narrow beam permits precise, gradual corneal shaping. The beam used in LADARVision, called a Gaussian beam, also has a special shape. The tip is U-shaped, with smooth round corners, unlike other laser beam tips which are flat. The Gaussian beam shape aids in producing a smooth surface on the cornea.

Wavefront/CustomCornea
Wavefront is a general term and CustomCornea is the trademark name for the Alcon laser Wavefront technology. Custom LASIK is how most doctors refer to this advanced technology and the terms Traditional or Conventional LASIK are used to describe Non-Wavefront LASIK. Traditional LASIK can provide excellent results in correcting a wide range of vision problems such as nearsightedness, farsightedness, and astigmatism.

Custom LASIK is an improved system that allows the doctor to go beyond a glasses or contact lens prescription and individualize treatment by correcting other vision problems that could not be detected previously. CustomCornea is the first laser vision correction procedure to go beyond reshaping your cornea based on your prescription for eyeglasses or contacts. The procedure is completely customized to your eyes and your eyes alone.

There is a myriad of options available to patients considering corrective surgery. It is important to find a facility which will give informed advice on treatment, has top-notch surgeons and excellent patient care. InSight Lasik offers all three.

Keith Miller, O.D, from InSight Lasik puts it this way, “InSight Lasik is a combination of clinical excellence and old-fashioned customer service.” InSight Lasik is the recipient of numerous honors including: Daily Camera’s Best of Boulder in 2007 and 5 out of the last 6 years, Colorado Daily’s CU & Boulder’s Best, the Broomfield County Gold, CK Center of Excellence, and the Alcon Quality of Vision Award.

Call InSight LASIK at 303.665.7577 today for your free LASIK consultation, or visit www.insightlasik.com for more information.

Things to Know:
1. What technology or laser will be used?
2. What is the experience and background of the doctor?
3. What kind of care will I receive?

Custom LASIK is generating excitement in laser vision correction, primarily because the quality of vision obtained with Custom LASIK is superior to conventional LASIK. By measuring the unique imperfections in the eye and treating those that cause vision problems, patients are often seeing better than 20/20, without any night vision complaints. The instrument that makes this possible is a wavefront aberrometer. And the treatment obtained by using wavefront measurements is called Custom LASIK.

The doctors at InSight LASIK use the LADAR6000® CustomCornea® system, which was recently granted expanded approval by the FDA to treat an estimated 98% of the myopic population. “We have been treating patients with CustomCornea for over three years now,” says Jimmy Jackson, OD, FAAO, Clinical Director at InSight LASIK. “The increase in our patients seeing 20/15 and even 20/10 has increased 50% vs. traditional LASIK. And the clarity and sharpness of vision that our patients report in their daily activities is outstanding.”

Wavefront has been used for years by astronomers to precisely adjust the optics of their telescopes. It has only recently been applied to human vision. The Council for Refractive Surgery Quality Assurance (CRSQA), a non-profit health organization created to provide objective information and resources to prospective patients, considers the wavefront diagnostic a must-do in any LASIK exam.

“A wavefront diagnostic test can determine if an individual has aberrations that would be exacerbated by refractive surgery to the point of causing vision problems. No other technology can determine if Custom LASIK is an absolute requirement or if conventional LASIK would be fine. This is why we perform a wavefront evaluation on every patient at the time of their consultation”, says Dr. Jimmy Jackson.

During a wavefront diagnosis, light is sent into the eye in a specific pattern, then measured after it has passed through the visual system. Any difference between the flat light pattern that enters the eye and the distorted light pattern that exits the eye is considered an aberration.

Dr. Jackson says, “Wavefront technology is unsurpassed as a diagnostic device. This technology can diagnose and measure aberrations that no other system can even see. It is impossible for us to accurately determine if wavefront-guided ablation is necessary for a good LASIK outcome without this test. More importantly, a wavefront diagnosis allows us to accurately determine when Custom LASIK is not necessary. In other words, we are able to refine the diagnosis for each patient so they are receiving the optimal LASIK procedure for their unique visual system.” InSight doctors report that approximately 75% of patients choose the Custom LASIK procedure based on the diagnosis provided by the wavefront evaluation.

To learn more about Custom LASIK or to schedule a free wavefront evaluation, contact InSight LASIK at 303.665.7577 or visit www.insightlasik.com

Successful comanagers must effectively educate patients on presbyopic IOLs, the resurgence of PRK and new laser microkeratomes.

by Jimmy Jackson, OD
Special to PRIMARY CARE OPTOMETRY NEWS

Refractive surgery is continuing to grow and evolve. New techniques and technologies are steadily becoming available. We have at our disposal a vast array of options that provide safer and better outcomes than ever. It is a wondrous time to be a candidate for refractive surgery. The downside of this venerable plethora of choices is the resultant difficulty for both eye doctors and patients to make the best choice in every situation. Patients can experience information overload and doctors may struggle to stay current. The “noise” of the marketplace is incredibly loud with claims, counterclaims, outrageous offers and incessant hype. My goal here is to help you sort through the alphabet soup of refractive surgery in 2006. My perspective comes from spending the last 16 years specializing in refractive surgery at comanagement centers, with the last five years as president of my own refractive center. I am also a patient having personally undergone several refractive procedures.

Monovision most popular
The surgical treatment of presbyopia is the Holy Grail for eye care practitioners. While this has long been true, it received an added psychological jolt in January 2006 when the first group of baby boomers began turning 60. This group is large, active, visually demanding and has much financial freedom. It is not a coincidence that we now have three Food and Drug Administration-approved presbyopia-correcting lenses – the ReStor (Alcon, Ft. Worth, Texas), the ReZoom (AMO, Santa Ana, Calif.) and the crystalens (eyeonics, Aliso Viejo, Calif.). These lenses became dramatically more appealing when Medicare changed its reimbursement policy to allow patients to additionally pay out-of-pocket for these premium lenses.

Duffey survey
The demand for the surgical treatment of presbyopia has never been higher than it is right now. It may surprise you to learn, in spite of all the recent advances and additional choices, that monovision remains the overwhelming choice of surgeons and patients. Richard Duffey, MD, has been conducting surveys of the membership of the American Society of Cataract and Refractive Surgery (ASCRS), International Society of Refractive Surgery (ISRS) and American Academy of Ophthalmology (AAO) for the past 9 years. One of the questions he puts to the group is preferred surgery for presbyopia. The 2005 combined survey response to that question is that 85% of the respondents prefer some form of monovision (monovision, modified monovision or conductive keratoplasty). The remaining 15% chose one of the presbyopia-correcting lenses. On the front page of the August 2006 issue of Market Scope (a monthly report on the ophthalmic industry) is the following headline: “Sales of P-IOLs [presbyopic IOLs] fall short of expectations.” Alcon, the industry leader in sales, has taken an unusual step and twice lowered its projections for 2006 sales of ReStor.

Acceptance low for presbyopia-correcting lenses
Why have these presbyopia-correcting lenses not been more widely accepted? If you compare the lenses with corneal procedures, laser or conductive keratoplasty, utilizing monovision in non-cataract patients, the lenses are considerably more expensive, require much more invasive surgery and do not work for everyone. Each lens has its own particular strengths and weaknesses. Some are better at near than distance, some provide better intermediate vision, some work better with small pupils and others perform best in dim illumination. This has led some surgeons to mix and match the lenses, inserting two different lenses in the same patient. I would call this an extremely expensive version of modified monovision. Clearly these are first-generation lenses and patient selection is critical to avoid unhappy patients. That being said, I do believe that these lenses are here to stay, and market penetration will grow. The keys will be the development of better lenses and increased knowledge of which patients will benefit. Currently, I would only consider P-IOLs in patients requiring cataract surgery, use only surgeons with extensive experience and make sure the patient has extensive preoperative counseling.

PRK challenges dominant LASIK
The past few years have seen a trend toward increasing utilization of PRK. The use of small spot scanning lasers and/or mitomycin C has nearly eliminated the haze problem. Outcomes are now essentially equal between PRK and LASIK, even with high myopia and hyperopia. Surgeons have become more conservative as reported cases of post-LASIK corneal ectasia have increased. This has resulted in increased minimum residual stromal thickness for LASIK patients and switching to PRK for borderline cases. For the best data on relative numbers of PRK and LASIK procedures in the United States, turn to Market Scope, a monthly report on the ophthalmic market (www.market-scope.com). Market Scope estimates that the PRK percentage of the total laser refractive procedures in the first two quarters of 2005 was 8% and it increased to 13% for the first two quarters of 2006. PRK’s biggest drawback has been its combination of slower healing and increased discomfort when compared to LASIK. In spite of all of the efforts to ameliorate these two issues, they remain resoundingly true. Many different techniques and a variety of medications, both oral and topical, have been utilized in the quest for faster healing and less discomfort. At the end of the day, PRK eyes still take 2 to 4 days to re-epithelialize, and these patients have significantly more discomfort than their LASIK counterparts. While some individual practices have switched to PRK as their procedure of choice LASIK remains the overwhelming choice of patients who are candidates for both procedures. I would suggest you ensure all of your laser candidates are aware that both LASIK and PRK are options. Be conservative and recommend PRK whenever there are concerns with LASIK. Avoid the PRK alternatives of LASEK and epi-LASIK.

IntraLase resonates with public
The proponents of IntraLase FS (IntraLase Corp., Irvine, Calif.) maintain that it improves clinical outcomes, reduces enhancements, creates fewer dry eye issues and reduces complications. Mechanical microkeratome supporters point to the tremendous number of successful surgeries performed with the units, the improvements in technology over the last few years and lower costs. It is undeniably more expensive to use the IntraLase compared to the mechanical microkeratome. On average, it costs about $300 more per eye with the IntraLase. The higher the volume in a center, the more cost effective the IntraLase becomes. Most centers are passing the increased cost on to the patient with the average up-charge just under $500 per eye. Use of the IntraLase adds a bit more time to the procedure as well. However, with the new 60 Hz unit, the time difference is minimized. Clinical outcomes of the two systems have been compared in a number of studies. The results have been mixed. Some studies have favored the IntraLase, a few have favored the mechanical microkeratome, and several have shown similar visual outcomes. What is not being debated is IntraLase’s steady gain in market share. Market Scope reports that 19% of U.S. flaps created in 2005 were by the IntraLase, and that number is predicted to grow to 26% by the end of 2006. The Duffey ISRS/AAO survey revealed that 9% of the respondents used the IntraLase FS in 2004, and 13% used it in 2005. The Duffey ASCRS survey showed that 11% were using IntraLase in 2004, and 22% in 2005. Another survey was taken of the audience at the Cataract & Refractive Surgery Today’s State of the Art Technology Symposium held during the 2006 ASCRS meeting. The results were published in the June 2006 issue of Cataract & Refractive Surgery Today. The report states that 22% of the audience responded that they currently are using the IntraLase FL for creating flaps. Furthermore, 35% said they expected to be using IntraLase by the end of 2006, and 49% were expecting to be using IntraLase by the end of 2007. A follow-up question was asked of the non-IntraLase users, “If there were no cost difference between IntraLase and the mechanical microkeratome, would you be more inclined to use IntraLase right now?” A resounding 79% answered “yes.” Clearly, IntraLase use is on the rise with refractive surgeons. It is steadily gaining market share and accounts for a significant percentage of U.S. LASIK procedures. The primary driving force has been the public’s acceptance of the technology and their willingness to pay more for it. As other femtosecond lasers enter the U.S. market (the Femtec laser by 20/10 Perfect Vision and Ziemer Ophthalmics’s DaVinci laser are both on the horizon), the move to femtosecond technology will accelerate. I would suggest that you acquaint yourself with the femtosecond technology, acquire access to an IntraLase FS if you do not currently have it and start discussing it with your refractive surgery candidates.

Comanagement wanes while OD opportunities rise
Dr. Duffey’s surveys also investigated comanagement. The trend over the last few years is for fewer ophthalmologists to comanage refractive surgery patients. Those who still do so are comanaging a lower percentage. Optometric comanagement of refractive surgery patients faces a number of challenges. These are coming from organized ophthalmology and include legislative, legal and insurance initiatives. It can be argued comanagement has high risk. It certainly is not for the faint of heart. However, the opportunity for reward is also high. The overall market for refractive surgery is flat. Surgeons and centers are actively searching for new patient streams. If you can deliver consistent patient volume, you will be courted. Therefore, if you enjoy working with refractive surgery patients, are willing to stay current with the technology and can make it work as a viable revenue stream in your office, there is no reason not to aggressively pursue it. If you decide to commit to refractive surgery comanagement, I would offer the following suggestions: truly be an expert and remain up-to-date with all of the technology; educate your staff; aggressively promote your expertise internally within your practice; and align yourself with a surgeon or center that respects the comanagement concept.

For more information:
Jimmy Jackson, MS, OD, FAAO, is president of InSight LASIK. He can be reached at 1120 W. South Boulder Rd., Suite 102, Lafayette, CO 80026; (303) 665-7577; fax: (303) 665-3633; e-mail: jimmy@insightlasik.com.

InSight LASIK is the recipient of numerous honors including: Daily Camera’s Best of Boulder in 2006 and 4 of the last 5 years, Colorado Daily’s CU & Boulder’s Best, the Broomfield County Gold, CK Center of Excellence, and the Alcon Quality of Vision award. With this award winning facility you know the expert care provided by Dr. Jackson, Dr. Miller, Dr. Tripp and Dr. Johnson will be unsurpassed. We created InSight LASIK to be an ‘Eye Spa’ with the goal to treat each and every patient the same way that we want to be treated when we go to a doctor’s office. We respect your time, treat you as an individual, and work to earn your trust,” says Jimmy Jackson, O.D., President of InSight LASIK. “It’s a combination of clinical excellence and old fashioned customer service,” continues Keith Miller, O.D.. “We are the antithesis of the high-volume, run-people-through-like-cattle clinics. Every patient is unique with different expectations and different concerns. Our care is priceless.” During your free 60 minute consultation you will be evaluated by our doctors in a thorough 5-point examination to determine if you are a good candidate for laser vision correction.