I can just say Dr. Gulani is the best
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He is an amazing surgeon
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He has gold heart, gold hands
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Truly the Surgeon's Surgeon
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An Artist for your vision
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Amazing experience, Out of the WORLD
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The World’s Eye doctor
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Corrected my surgeon’s complication;
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Indebted forever
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(904)-296-7393

LASIK Eye Surgery: OPEN your Eyes: What You Really Need to Know

Created on: Sunday, July 07, 2019

LASIK has become a household name for eye surgery and though extremely successful, complications and side effects can occur.

Since I specialize in repairing complications for Lasik eye surgeons worldwide, I was asked to help explain the recent surge in articles in major news media and its impact on both, patients and Lasik surgeons alike.
 
So as I was returning back after speaking at the World conference, I penned my thoughts on my long flight back home to give you the most current update on this surgery that pretty much is a household name today and whose impact can be felt on someone in your home or next door neighbor
 

https://www.nytimes.com/2018/06/11/well/lasik-complications-vision.html
https://www.wsj.com/articles/when-routine-eye-surgery-leads-to-debilitating-pain-11562008367

 
Nearly 30 years ago, I was privileged to have been exposed to Lasik eye surgery when it was yet to be approved and used by eye surgeons in the USA and that involvement allowed me opportunities to lead by inventing Lasik surgery instruments (Gulani Lasik instruments; Basuch & Lomb) and establish protocols as well as work with the ANSI division of the US FDA on various levels
Having had exposure to nearly 20 different Refractive surgeries (Surgery to remove glasses), it was clear to me that his surgery had a permanent future infact a safer and more predictable one compared to previous and prevalent techniques then
Having interacted with Dr. Jose Ingacio Barraquer  (South America) and Dr.Slava Fyodorov (Russia) , my passion in this direction was set as I looked to eventually take this already excellent surgery to a level of safety and predictability worthy of its 193 Nanometer Excimer Laser
 
Realizing that this surgery could practically correct all refractive errors including Nearsightedness, Farsightedness, Astigmatism and Presbyopia, was further reinforced by my patient reactions to this swift yet meticulously accurate surgical technique.
Having used practically every kind of  Lasik Laser globally allowed me to visualize a surgery that many eye surgeons could master.
There was one fear though; its speed and safety along with its predictability could be wrongly advertised in the wrong hands and I envisioned complications that could occur by surgeons who may not have trained adequately on this specialty or companies trying to reel patients in for monetary gains
 
Such a wave did happen as I saw patients being referred to me with various side effects and complications. I was able to correct many of these patients back to 20/20 using specially designed corneal surgeries (Lasik is performed on the cornea) but urged the industry to make fail safe Lasers and stronger protocols which eventually brought the success rate to today’s level of patient and surgeon confidence.
 
Complications can occur with any surgery and yes, since it involves the eyes, it can hamper any patient’s lifestyle adversely.
Therein it becomes important that patients do their research, don’t fall for any advertisement or deals and do their due diligence as outlined below.
 
LASIK eye surgery involves the use of the very precise (cuts 1/4th of a micron at every pulse) Excimer Laser which re-shapes the cornea (clear front window) of the eye according to the glasses prescription of the patient. 
The surgery is done in minutes, with the patient awake, active and participating; only numbing drops are used in the patient’s eyes. This method provides the quickest healing and fastest results. Visual recovery is extremely fast most patients gain driving recovery by the day after surgery.
Unfortunately, these are the very reasons that this surgery has a tendency to become a commodity in many places enough to mislead the patients.
Dr. Gulani emphasizes that Lasik is just one among 16 Laser Vision Surgerieswhich themselves are among 40 different Vision Corrective Surgeries(surgeries to remove glasses and contact lenses).
Thus if one understands how Vision Corrective Surgery and all 40 combinations are what all Lasik surgeons must be capable of performing and offering, it becomes easy to realize how every patient can indeed have the best surgical technique tailored to them for the safes t and most predictable outcome. Change vision surgery offering from a Commodity to an ART
 
Dr. Gulani has invented Lasik surgical instruments, published Lasik protocols and teaches Lasik complication management to eye surgeons all over the world. He has recently introduced a new super-specialty in Lasik called Laser Corneoplastique™ by which many of the Lasik complications can be corrected back to excellent vision.
Nevertheless he says, Prevention is the way to go!
 
Among a handful of eye surgeons in the world who can correct previous Lasik patients back to 20/20 vision, Dr. Gulani has summarized basically four reasons for poor outcomes in Lasik surgery:
  1. Misleading advertising by Lasik surgeons.
A.   Doctors who may be new and inexperienced themselves but use the established name recognition of their more experienced, senior partners (who may have actually even retired from the practice)
 
B.   Eye surgery “Mills” that advertise the joint number of cases done by allchain centers     across the nation (ie. 500,000 cases done) while their surgeon may be a novice with a high chance of causing bad outcomes.
 
C.  Doctors using celebrity testimonials (NFL sportsmen/movie stars etc). In many such cases, the doctors actually pay a hefty sum to be known as official surgeons of such celebrities. Also, they most often will do surgery for free to get an endorsement.
  1. Lack of patient education and expectations 
A.    Patients are not educated about other available options since the surgeon may themselves not be capable of performing those options
B.     Patients feel intimidated to ask questions about surgeon qualifications, vision expectations, side effectes etc.
  1. Cookie-Cutter surgery by Lasik surgeon “One size fits all”
  1. Lasik may be all that the surgeon performs. They be ignorant or incapable of performing the entire  range of Laser Vision Surgeries
  2. Lack of knowledge, initiative or expertise in offering and performing vision surgery options if Lasik is not ideal for the patient (ie. New generation ICL surgery for thin cornea patients who are not ideal Lasik candidates) 
  1. Poor pre-operative Technological analysis of the patient’s eye anatomy, vision and stability.
A.    Lack of understanding on surgeon’s part regarding interaction between, anatomy, physiology and optics of the eye  to get a great vision outcome.
B.     Lack of technological finesse to detect early abnormalities and avoid Lasik in improper candidates
C.     Inability to deliver the best outcomes due to lack of modern, cutting edge equipment.
 
Gulani rules for safety in choosing a Lasik Surgeon:
  1. Besides visiting the surgeon’s website; do use a search engine (ie. Google/MSN/Yahoo etc) and type in the doctor’s name and see what comes up.  “Do you find only a website and other paid advertising claims?  Or do you find interviews, published articles and third party confirmations of the doctor’s status?”  
  2. If your surgeon says that they are the First or that they teach other Lasik surgeons, ask for evidence. Are they first in the world, country, state or just on their street (decreasing order of importance). Do they teach at local dinner meetings that they host or are they invited to teach nationally at prestigious podiums. 
  3. Meet with the surgeon, get a feel for the integrity and involvement of the surgeon in educating you and answering every question. Also make sure that your surgeon is contactable and that they do indeed respond when you call. 
  4. Make sure that your surgeon will see you before surgery, perform your surgery and also see you and be available after your surgery
  5. Find out if your surgeon performs the full spectrum of Laser Vision Surgery (remember Lasik is just one of many Laser Vision techniques) so they can offer what is truly best for you rather than suggesting the only surgery they know how to perform.
  6. Do not fall for flashy computer screens and equipment in the office; make sure that you understand all that is going on and insist on asking the surgeon to explain in layman terms.
  7. When meeting your surgeon, do ask about possible side-effects and complications. Ask if in the rare event that you do end up having a complication can they handle  it?  If the answer is yes, then ask for evidence.
Thus due diligence on part of the patient, experienced selection of individualized surgery by the surgeon and effective use of modern technology can all together raise 
the bar on safety and predictability in LASIK- one of the most successful surgical breakthroughs of modern times.
 
References:
Gulani AC, Probst L, Cox I, Veith R. "Wavefront in Lasik" : The Zyoptix. Platform.. Ophthalmol Clin N Am 17 (2004). 173-181
Gulani AC. Sharpen your LASIK Technique. Review of Ophthalmology, Vol. 22, no. 2, p. 68-69
Gulani AC.   "A New Classification and Management Guide for Corneal Complications of Lasik ”. Journal Canadien D’ Ophtalmologie 2000; 35 (2). 103-105
Gulani AC. "New Instrument For Revision LASIK Surgery". Journal of Cataract & Refractive Surgery (JCRC), 1998; Vol 24: 595
Gulani AC.   "A New Concept for Laser Refractive Surgery".  Ophthalmology Management 2006; 10 (4). 57-63
Gulani AC. Laser Corneoplastique. Techniques in Ophthalmology 5(1):11-20, 2007Gulani AC. Vision Corrective Surgeries: Past Techniques, Present Trends and Future Technologies. North East Florida Medicine. 2007; 2 (58) 41-44
Gulani AC. “Laser Corneoplastique” Video Journal of Cataract and Refractive Surgery. Vol XXII. Issue 3, 2006
Gulani AC. "How to put logic into action after Lasik”- Review of Ophthalmology, 2006; XIII (9), 60-64.
Gulani AC., et al. Innovtive Real Time Illumination System for Lasik Surgery . Clin Surg Ophthalmol. 2003;6:244-246



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