Dr. Hyver performs wavefront-optimized "All Laser" LASIK at our three ScottHyver Visioncare laser vision correction centers in Daly City, Santa Clara and San Ramon.

Each center is equipped with the same advanced diagnostic and treatment infrastructure, comprising the Oculus Pentacam and the Nidek Magellan corneal topographers; the Ziemer FEMTO LDV Femtosecond Laser; and the Alcon Allegretto WAVEŽ Eye-Q 400 Hz Excimer Laser.

Pre-Op Evaluation

A central part of the LASIK screening process -- i.e., the process Dr. Hyver undertakes to evaluate your medical candidacy for the treatment -- is the 3D imaging of your cornea, the transparent dome-shaped front part of the eye that covers the iris, pupil and anterior chamber. Dr. Hyver employs not one but two advanced diagnostic instruments to generate these 3D images: the Oculus Pentacam and the Nidek Magellan.

These devices map the topography of your cornea — including its shape, thickness and contour — giving Dr. Hyver essential data with which to determine your candidacy for laser vision correction. And because we employ both of these advanced devices — rather than just one — Dr. Hyver can cross-check the data from the two instruments, giving him a more refined understanding of the patient's corneal geometry and, thus, the prospect for a more accurate assessment of the patient's LASIK candidacy.

Wavefront-Optimized "All Laser" LASIK Treatment

Wavefront-Optimized "All Laser" LASIK is an elective medical procedure designed to reduce or eliminate your need to wear contact lenses and glasses. The "All Laser" LASIK procedure entails two primary steps. First, Dr. Hyver uses the Ziemer FEMTO LDV femtosecond laser to create a thin corneal flap, which he then lifts, exposing the underlying corneal tissue. Dr. Hyver then applies the Alcon Allegretto WAVEŽ Eye-Q 400 Hz excimer laser to this exposed tissue, reshaping the cornea to correct the patient's specific vision error, after which he restores the flap over the treated area, whereupon it heals, preserving the new correction.

The Swiss-designed and -engineered Ziemer FEMTO LDV laser is one of the fastest femtosecond lasers on the market. Within the seconds required to create the corneal flap, the Ziemer laser produces approximately 400 million tiny, closely-spaced gas bubbles at a predetermined depth in the corneal layer. When these bubbles pop they cleave the adjacent corneal collagen fibers, collectively forming the LASIK flap. This level of resolution gives Dr. Hyver the potential to create LASIK flaps of precise thickness, size, and orientation.

Once Dr. Hyver creates and lifts the flap, he applies the Allegretto WAVEŽ Eye-Q excimer laser to the exposed corneal surface to reshape the cornea based on the patient's vision error.

The German-designed and -engineered Allegretto pulses at 400 times per second (i.e., thus the "400 Hz" designation). As a result, treatment is remarkably quick, with treatment times of less than 10 seconds for most prescriptions. The faster the treatment time, the less the patient's eye is exposed to the environment and the effects of prolonged dehydration on the quality of the patient's visual outcome.

The Allegretto also employs advanced "wavefront-optimized" ablation profiles designed to preserve the natural corneal shape, an advantage that may help address spherical distortions that can cause glare or affect night vision. For example, in the FDA's approved labeling of the Allegretto for the treatment of myopia ("Summary of Safety and Effectiveness" p. 22), the agency concludes that "patient reports of glare from bright lights, light sensitivity, night driving glare and visual fluctuations all improved after LASIK."

Toward the goal of greater safety and accuracy, the Allegretto laser minutely and continuously adjusts its laser to the position of the patient's eye. Every four to six milliseconds, the eye's location is measured and the internal mirrors of the Allegretto are automatically aligned. Just before the laser's pulse is released, a second check is made to confirm that the eye has not moved. This happens 400 times every second, once for every laser pulse. If, at any time, the eye moves too quickly to be measured or moves out of range, the laser will instantly stop and wait for the eye to return to position.

While "All Laser" LASIK employing the Allegretto wavefront-optimized laser may reduce or eliminate the patient's need for contact lenses and glasses, like all elective surgery, LASIK is not risk-free. Potential risks include dry eyes (which can be severe); the possible need for glasses or contact lenses even after treatment; visual disturbances such as halos, glare, starbursts, and double vision (any one of which can be debilitating); and vision loss. Further, you should be aware that there may be alternatives to LASIK for the correction of your vision error including, but not limited to, eyeglasses, contact lenses, PRK and other refractive surgeries.

You should thus ensure you have a clear understanding of the potential risks involved before you elect LASIK treatment. Toward that end, we suggest you visit the FDA's LASIK Page. Here you'll find a link to the FDA's list of the most common risks associated with LASIK, along with a link to the list of the lasers FDA-approved for LASIK treatment, including the Allegretto WAVEŽ Eye-Q. For your reference, the following are the FDA's approved labeling for LASIK treatment using the Allegretto WAVEŽ Eye-Q, comprising the Approval Order, a Summary of Safety and Effectiveness, a Procedure Manual, and a Patient Information Booklet:

• PMA # P020050: October 7, 2003 approval for the reduction or elimination of myopia of up to -12.0 diopters (D) of sphere and up to -6.0 D of astigmatism at the spectacle plane.

• PMA # P030008: October 10, 2003 approval for reduction or elimination of hyperopic refractive errors up to +6.0 diopters (D) of sphere with and without astigmatic refractive errors up to 5.0 D at the spectacle plane, with a maximum manifest refraction spherical equivalent (MRSE) of +6.O D.

• PMA # P030008/S4: April 19, 2006 approval for the reduction or elimination of naturally occurring mixed astigmatism of up to 6.00 diopters (D) at the spectacle plane.

Keep in mind that Dr. Hyver is an experienced and conservative surgeon who disqualifies about one in four prospective patients for any form of laser vision correction. Of those patients who do qualify, a significant number are treated with PRK, as Dr. Hyver believes that, in these cases, LASIK presents an unacceptable long-term vision risk to the patient. Thus, we endorse the FDA recommendation that when it comes to choosing your LASIK surgeon, "don't base your decision simply on cost," but rather, on your evaluation of your surgeon's experience and the technology he employs, among other key factors.