PRECISION LASIK™ BY UPDEGRAFF

equipmentDr. Updegraff strives to provide nothing but the finest in LASIK care – that’s why each of his patients receives Precision LASIK™ by Updegraff. Precision LASIK™ is a method Dr. Updegraff has developed over the span of more than a decade, and which he continues to fine-tune and perfect.

The best in technology makes up the first half of Precision LASIK™. Since its inception, LASIK has seen numerous advancements that have greatly improved the procedure and its results, and Dr. Updegraff has embraced and included each of these. Over the years, however, there have also been many other new technologies – such as LTK (laser thermokeratoplasty) and CK (conductive keratoplasty) – that have not proven to be beneficial, and so they have come and gone.

Dr. Updegraff’s involvement across the globe and with the industry, as well as his hands-on experience with each of his patients, have helped him select only the most beneficial technologies to include in Precision LASIK™. When you choose Dr. Updegraff, you expect the best and know that we have vetted the technology by analyzing our own results in Dr. Updegraff’s hands.

But the greatest in technology is only half of Precision LASIK™. The rest is made up of our detailed system of performing LASIK – from Dr. Updegraff’s patented instrumentation, to each of the safety checks we have developed over the last 15 years – which ensures the quality of your care at every step.

From your initial consultation and screening to your final post-operative appointment, each step of Precision LASIK™ is designed to provide you with the best possible care and experience.

CONSULTATION FOR PRECISION LASIK™

Though LASIK is the result of a wonderful blend of technique and technology, it is only as good as the information on which it is based. This is why one of the most critical steps in providing Precision LASIK™ is Dr. Updegraff’s screening process, which determines whether or not you are a LASIK candidate. Most of the complications seen today with LASIK occur when it is performed on someone who was not well-suited to the procedure.

One of the tools used in your exam is the state-of-the-art Pentacam corneal mapping computer. The Pentacam will be used to create a corneal topography (a map of the cornea’s surface) by taking a series of photographs of your eye. The rotating process of the Pentacam takes less than two seconds, and it generates 3D images of your eye. Among other things, this allows Dr. Updegraff to rule out specific corneal diseases such as keratoconus, a progressive thinning of the cornea.

We will also measure your corneal thickness, another critical factor in determining whether or not you are a LASIK candidate. Imagine that the average cornea is made up of 100 sheets of paper, and that the laser can’t go below 50 sheets. If someone has thin corneas (with only 70 sheets), then they probably aren’t a good candidate for LASIK, because they don’t have enough extra sheets for the laser to ablate. Because of this, Dr. Updegraff wants to ensure that you have enough corneal thickness for him to be able to safely perform LASIK.

Working with your prescription and your topography, we will also examine your eyes undilated, and then check them again dilated. The cycloplegic dilation we use is the best and most powerful means of dilating the eyes. It is used to not just “dilate” your pupil but, more importantly, it temporarily immobilizes the muscle in the eye that changes the shape of your natural lens. The changes seen in your flexible lens can actually lead to the “wrong” glasses prescription and laser treatment.

Many LASIK facilities bypass cycloplegic dilation because of the perceived “inconvenience” to “customers,” as well as the extra staff time required to do the testing. However, Dr. Updegraff is adamant that this is a key component to high-quality LASIK. Without cycloplegia, it is not uncommon for some patients’ vision to be overcorrected. When they are young they don’t notice it, but as they age, it becomes evident – giving them the false impression that their LASIK has changed. A solid cycloplegic exam is a key ingredient to having a stable LASIK result years later.

At the end of this comprehensive exam, you’ll know whether or not you are a candidate for LASIK, and you’ll know what outcome to expect from it. You can schedule an appointment that day for your surgery.

PRECISION LASIK™ SURGERY

LASIK surgery is done in two parts: making a flap in the cornea, and reshaping the corneaunderneath this flap.

The second step, reshaping the cornea, can only be performed with an excimer laser. The first step, making the flap, can be performed in two different ways. Originally, every LASIK procedure used a handheld microkeratome blade to create this flap. Now, a femtosecond laser can be used instead – meaning that LASIK performed with it is blade-free LASIK, or all-laser LASIK.

Dr. Updegraff brought the first all-laser LASIK technology and procedure to Tampa Bay in 2005. He had been closely following the invention and testing of the femtosecond laser – including observing the first all-laser LASIK performed in the U.S. – but before he felt comfortable offering it to his patients, he wanted to ensure that its technology included specific improvements. So once the laser’s speed improved, Dr. Updegraff determined that the greater increase in the safety and accuracy of its results made all-aaser LASIK the right choice for his patients. Since then, he has performed tens of thousands of all-laser LASIK procedures – among the most in the country done by one individual surgeon.

STEP ONE: MAKING THE FLAP

Dr. Updegraff applies a corneal suction ring to the eye to immobilize it, and then uses thefemtosecond laser to create a flap in the cornea. Unlike mechanical instruments, femtosecond lasers are able to program the dimensions of your flap based on what’s best for your individual eye. Then, the laser creates your flap from below the surface of the cornea – without ever cutting it. How?

  1. The femtosecond laser uses ultrafast pulses of laser light to position microscopic bubbles at a precise depth determined by Dr. Updegraff.
  2. The laser light passes harmlessly through your cornea. Then, the laser moves back and forth across your eye in a uniform plane, creating rows of these bubbles just beneath the corneal surface.
  3. Next, the laser stacks the bubbles so that they create the edges of your flap. They’re stacked at an angle that is determined by Dr. Updegraff and is individualized to the way your eye is shaped.
  4. Dr. Updegraff gently lifts the flap with his patented corneal flap elevator to allow for the second step of your LASIK surgery (reshaping with the excimer laser). When the procedure is complete, the flap is repositioned and smoothed by Dr. Updegraff. The flap is held in place by negative pressure created by the cornea’s own fluid-pumping cells on the back surface of the cornea (the endothelium). The edge of the flap heals with surface skin cells (epithelium) within 4-5 hours.

From start to finish, this process takes less than 30 seconds.

There are two primary advantages to using a femtosecond laser instead of a microkeratome blade. The first is accuracy: With a femtosecond laser, the contour of the flap is the same thickness from one side to the other. The other is safety: For the most part, the femtosecond procedure can be stopped and started, which markedly decreases the chance of an imperfect flap.

Since Dr. Updegraff introduced the femtosecond laser into Precision LASIK™, his retreatment rate dropped in half. Additionally, a higher percentage of our patients are 20/15 with all-laser LASIK.

STEP TWO: RESHAPING THE CORNEA

After the flap has been created and it has been lifted to expose the “bed,” Dr. Updegraff uses an excimer laser to reshape the cornea. Precision LASIK™ includes two technologies that significantly enhance and improve this procedure: Wavefront-Guided Treatment, and Iris Recognition.

In Wavefront-Guided Treatment, points of light are sent into your eye, passing through the cornea and lens. This creates a Wavefront Map, a map of the eye’s surface, that reveals the high and low places that affect your clarity and crispness of vision. This map is generated at your initial consultation. A computer analyzes the map and generates a profile of your ideal, best vision; this information is transferred to the excimer laser, which uses the data to shape this profile onto your cornea during LASIK surgery. As a result, each Wavefront-Guided Treatment is unique to each eye and to each patient.

Wavefront technology, which was originally designed to improve the optics of astronomical telescopes, is based on understanding how light is focused or misdirected in an optical system. For instance, powerful telescopes have extremely large lenses, and any imperfections on their surfaces cause aberrations that would be unacceptable for viewing the details of stars, planets, and galaxies. By using Wavefront optics, a computer can analyze waves of light passing through all the lenses of a telescope, and from this information another lens could be made to correct for errors (blur, glare, etc.) from the whole optical system. This is the same process that takes place when maps are generated for your eyes.

In theory, Wavefront-Guided Treatment would give you “super vision” – if your eye was made of plastic, the shape created by a Wavefront-Guided ablation would result in vision better than with glasses or contacts. But even though biological variability in how each eye heals can very slightly affect post-operative vision, Wavefront-Guided LASIK surgeries are still shown to provide the best results.

Iris Recognition is the latest new advancement in technology to be added to each Precision LASIK™ procedure. At your consultation, when the Wavefront image is generated, a computer map of all the peaks and valleys of your iris is imaged. This, like the Wavefront, is transferred to the excimer laser.

During your procedure, the laser takes an image of your iris and matches the one made at your consultation. This is another safety check: The laser knows it’s you and, because the Wavefront reshaping is specific for each eye, whether it’s your right or left eye. If there is a match, the eye tracker is linked to this, so no matter which way your eye moves, your treatment will be precisely placed where it was planned to be. This is extremely effective for patients with high degrees of astigmatism.

AFTER PRECISION LASIK™

Within a half-hour of your Precision LASIK™ surgery, we examine your eyes at a microscope. Dr. Updegraff believes most postsurgical complications can be avoided with this critical step. Although many other centers do not want to invest the time necessary to examine each LASIK patient shortly after surgery, Dr. Updegraff has believed for years that it is too important not to.

Most patients can immediately “see the difference.” Some patients, however, can take a little longer. After surgery, Dr. Updegraff will provide you with a sleeping pill and advise that you return home to rest, with your eyes closed, for the next 4-5 hours. Your second post-operative exam will be within the next 24 hours, at which time patients are generally cleared to resume most normal activities.