Anybody who has met Dr.Gulani knows his desire to educate each and every patient. He loves to say “Grill me with questions” to every new patient and it is strict rules at our institute that a patient can proceed for surgery only after all their questions are answered.
Most people who are in good health and are either nearsighted or farsighted or have astigmatism are candidates for some form of laser vision correction. In general, you should:
As long as your prescription falls within FDA-approved limits, LASIK or another advanced refractive procedure can correct either nearsightedness or farsightedness.
Being nearsighted, or myopic, means you cannot see things clearly in the distance. Nearsighted people need glasses to drive or to watch television, and some people with more extreme prescriptions may need glasses even to see the alarm clock in the morning.
If you are farsighted, or hyperopic, you may have trouble seeing things up close. Without glasses or contacts, reading, eating or even talking to friends can all be difficult.
Astigmatism refers to an asymmetric curvature of your cornea. A "normal" cornea is round, like a basketball. If you have astigmatism, your cornea is shaped more like a football. Astigmatism can occur alone or in addition to either nearsightedness or farsightedness and can be corrected with Lasik.
As we age, our eyes lose the ability to focus on images up close. We continually move an image, such as a book or newspaper, farther and farther from our eyes in order to bring it into focus. This condition is called presbyopia. When presbyopia progresses to the point that our arms are not long enough, we need reading glasses or bifocals. Lasik may be used to partially offset the effects of presbyopia through a technique called monovision.
Monovision is an option to help correct both your distance and near vision. The procedure corrects the focus of one eye for distance vision and the other eye for near vision. One eye will see things close up, the other eye will see things farther away, and the brain will integrate the visual information from both eyes and filter out any blur. It is similar to the sound you hear from stereo speakers. A different sound comes from each one, but they work together to provide the entire range of sound. Monovision has been used successfully for over 20 years.
Wavefront Lasik or Custom-Lasik: No two eyes are alike, and like your DNA or fingerprint, your vision is unique. For hundreds of years, glasses correct vision by eliminating nearsightedness, farsightedness and or astigmatism. However, advances in optics have demonstrated that these three basic elements are only part of the picture. There are tiny imperfections or distortions in every eye, even when the perfect glasses or contact prescription is used.
This technology is the same that has been used in the Hubble space telescope. Custom laser correction involves diagnostics that map the entire optical path of your eye, including the tiny distortions and imperfections naturally present in all eyes. This is effectively a unique "fingerprint of your vision," providing extremely precise and detailed information in the form of a customized map of your eye which is then loaded into the computer of the excimer laser which generates a wavefront customized treatment appropriate for the individual "fingerprint" of your eye.
Though FDA clinical trials of this technology demonstrated superior vision compared to conventional LASIK, Dr. Gulani cautions that this may not be indicated in all patients and a thorough evaluation is essential to determine its application.
Florida Custom Lasik Surgeon Dr. Gulani was among the first in the entire country to perform Wavefront Lasik surgery abroad and was invited by the faculty at Cleveland Clinic to publish his experience in the Clinics of North America (Prestigious Peer Reviewed Publication)
Dr. Gulani teaches Wavefront/ Custom Lasik courses to Lasik surgeons throughout the world and is a medical advisor to the Wavefront Laser Industry itself.
Most people, including those with higher-order aberrations, can benefit from Wavefront Lasik. Until Wavefront was developed, those patients with a significant amount of higher-order aberration had less satisfactory results with conventional Lasik than others. Over 90% of people who currently wear glasses or contact lenses for nearsightedness, farsightedness or astigmatism can now benefit from some form of laser vision correction. The best way to determine how a customized procedure may benefit you is to have a comprehensive eye evaluation and obtain a WavePrint™ map of your own individual visual "fingerprint."
Lasik (laser-assisted in situ keratomileusis) and advanced surface ablation procedures like LASEK and PRK are all laser vision correction techniques used to correct nearsightedness, farsightedness, and astigmatism. They each use a computer-controlled excimer laser to reshape the cornea, and each has excellent post-operative results.
Lasik involves the creation of a thin corneal flap and the use of the laser on the internal tissue of the cornea. The surgery takes only a few minutes per eye and is generally painless. Afterwards, there is very little discomfort, and patients are often able to return to work the next day. Post-operative care typically involves at least three office visits.
Unlike Lasik, PRK and LASEK do not involve the creation of a flap. With PRK and LASEK, the epithelium (skin layer of the eye) is either removed (PRK) or moved gently aside (LASEK), and the laser operates on the surface of the cornea rather than internally. Again, surgery takes only minutes per eye and is generally painless. Post-operative recovery for PRK and LASEK, however, takes a little longer than recovery from Lasik. To assist healing after PRK/LASEK surgery, a clear bandage contact lens is placed over the cornea during the 3-5 days needed for the epithelium to re-grow. Additionally, LASEK/PRK patients typically use steroid drops for 3-6 months, and there is somewhat more discomfort during the healing process.
There are some patients who prefer LASEK/PRK, as well as some medical conditions that make advanced surface ablation more suitable. Dr. Gulani will help you determine which procedure is best for you.
IntraLase™ (also known as IntraLasik and All-Laser Lasik or Blade-less Lasik) is an innovative new procedure designed to make corneal flaps for Lasik surgery with a laser rather than a microkeratome (blade).
Dr. Gulani has used this technique and continues to evaluate this new technology and monitor the field data before recommending this technology for our patients.
LASEK (laser epithelial keratomileusis) and PRK (photo-refractive keratectomy) are both advanced surface ablation procedures to correct vision by using the excimer laser to gently reshape the surface of the cornea. With PRK, the epithelium (skin layer of the eye) is fully removed and the laser is applied to the surface of the corneal tissue. During the LASEK procedure, the epithelial layer is lifted gently to the side and then replaced after the laser treatment. In each case, a clear bandage contact lens is placed over the cornea for 3 to 5 days to allow the epithelium to re-grow. Each procedure can be suitable for certain prescriptions and under certain conditions. Dr. Gulani will help you decide which procedure is best for you.
As with any surgery, there are certain risks. Fortunately, however, the risks of laser vision eye surgery are low and patient satisfaction is high. The main risks include infection, overcorrection or undercorrection of your prescription, halos, a flap that shifts after eyesurgery, and dry eyes.
· Infection - The risk of infection is VERY low, affecting only about 1 patient in 5000 procedures. Dr. Gulani will prescribe antibiotic drops for use after surgery and monitor your eyes to ensure that there is no sign of infection.
· Overcorrection or undercorrection of your prescription - Since the cornea is living tissue and everyone's eyes are different, it is possible for your vision to be slightly overcorrected or undercorrected after surgery. If your eyes are over- or undercorrected, it is usually possible to do an enhancement to correct the remaining prescription.
· Halos - After surgery, patients may see a "halo" of light around bright lights at night. For most patients, this occurs only for the first week or two after surgery, but some patients continue to see halos longer. During your pre-operative evaluation, Dr. Gulani will advise you of your risk for seeing halos long term.
· Shifting flap - It is possible that the flap created during Lasik may shift slightly immediately after surgery. This is most often a result of bumping or rubbing the eye early in the post-operative period. Twenty-four hours following surgery, the risk of the flap shifting decreases greatly. You should contact Dr. Gulani if you experience any sort of eye injury within the first day or two after surgery.
· Dry eyes - The eyes are typically drier than normal for the first week or two following surgery, though some patients may experience dry eyes for a longer period of time. It is important to use lubricating drops frequently. If the eyes are uncomfortably dry for a prolonged period of time, Dr. Gulani can prescribe other drops or suggest techniques that can help.
The FDA approved the use of the excimer laser for laser eye surgery in the U.S. in 1996, although the microkeratome that creates the corneal flap has been used in other types of eye surgery since the late 1950s. Since the mid-1990s, Lasik has become increasingly popular with leading eye surgeons throughout the world, with over 6 million successful procedures performed to date.
The cost of your Lasik procedure is determined at your eye evaluation. Most insurance plans consider LASIK to be elective surgery, but there are a few that offer some benefit that can save you money on the cost of the procedure. Your employer's flexible spending or cafeteria plan may also offer tax advantages for Lasik. We can help you understand your options and what questions to ask your benefits administrator. In addition, Gulani Vision Institute offers different payment options.
Schedule a Lasik eye evaluation. Dr. Gulani and the staff at Gulani Vision Institute can explain all of the refractive procedures available and help you determine the best option for you.
The procedure itself takes 5-10 minutes per eye, with the actual laser treatment time lasting less than one minute per eye in most cases. Patients are usually in the surgery suite for 15 minutes or more and at the center for an hour and a half usually.
A small restraining device is used to keep your eyelids open during the procedure and prevent blinking. You will not be able to blink and affect the outcome of the procedure.
Yes. All you need to do is relax and focus on the red light. The Excimer Laser we use - VISX STAR4 will track and compensate for any eye movements during the surgery. Dr. Gulani will talk to you throughout the procedure so that you know what to expect. You may elect to take a mild, oral sedative before surgery to help you relax.
The procedure is performed using a VISX STAR4 ActiveTrak™ eye-tracking laser. These advanced systems will track any small eye movements and automatically make any needed laser adjustments. Dr. Gulani is in full control of the laser at all times during the procedure. The laser will not fire if your eye movements take you outside the treatment zone.
Patients experience virtually no discomfort during LASIK, and eye drop anesthesia to numb the eye is administered prior to the procedure. If you experience post-operative discomfort, you may use Tylenol or ibuprofen during the first day or two after the procedure.
Dr. Gulani performs bilateral (both eyes) procedures on the majority of his Lasik patients because he believes it is safe, and patients prefer the convenience. Because the Lasik procedure affords a rapid visual recovery, you can comfortably enjoy the convenience of having both eyes treated at the same time. However, it is always an option to have each eye treated on a different day.
On the day of the procedure, you will be at the laser center for about 1-1/2 hours. After surgery, we recommend that you go home and rest, keeping your eyes closed as much as possible. Most patients do not require medication for pain. Sleeping or listening to the radio or a book-on-tape is a good way to pass the time. Watching TV or going out to dinner is not recommended. On the day following surgery, most patients are able to return to work and other normal activities but we recommend caution and Dr. Gulani will discuss your individual expectations with you.
Many people notice an immediate improvement in their vision when they sit up after surgery, although there will be an initial haziness that should clear by the next morning. The vast majority of Dr. Gulani's Lasi patients see 20/40 or better the day after surgery.
Approximately 98% of patients can see 20/40 or better after Lasik. Of course, your individual results may vary depending upon your pre-surgical prescription and the condition of your eyes. Dr. Gulani can provide more information regarding your potential outcome after he examines your eyes.
You will be given plastic shields to wear over your eyes immediately after surgery and for the five nights following surgery to protect your eyes while sleeping. For the first month, care should be taken to not touch your eyes for any reason, and patients should avoid getting sweat, dust, or smoke in their eyes. It is also better to avoid swimming for two weeks, but with care, there is usually no problem with showers.
Any visual side effects from Lasik are usually temporary though based on your individual eyes the outcomes may vary. The most common ones are a "ghosting" or lighter second image around the edge or border of objects, nighttime halos (a rim of light around bright lights at night), mild fluctuations of vision, and light sensitivity. These effects can last anywhere from days to weeks and in some cases may last for months. There is also a possible decrease in your ability to see well in low contrast situations, such as driving at night. Dr. Gulani will discuss the possibility of these visual side effects in more detail after he examines your eyes.
There is no guarantee of 20/20 vision following Lasik or any of the other vision correction procedures. It is possible, however, to have enhancement surgery if Dr. Gulani feels that it is medically safe and will improve your vision. An enhancement is a second Lasik procedure, used to "fine-tune" vision not corrected in the original surgery. The healing time after the enhancement is the same as after the first surgery.
Since everyone's eyes heal differently, no one can predict a patient's outcome with 100% accuracy. Generally, the worse your vision was before treatment, the greater the chance that you will need an enhancement. Enhancements are done at Dr. Gulani’s discretion no sooner than 2-3 months following the original surgery, allowing time for the eye to heal and the vision to stabilize.
The intention of Lasik is permanence and hence Dr. Gulani carefully determines candidate eligibility to begin with. The vision achieved with Lasik is generally the vision you will have for the rest of your life. The correction achieved with Lasik is long lasting and very little vision change has been seen after years of patient follow-up in clinical studies. Cataracts or other eye health-related problems may occur later in life, but are not caused by or directly related to Lasik.
Lasik does not, however, prevent presbyopia, the age-related condition that makes people need reading glasses.
Since almost 98% of conventional Lasik patients achieve 20/40 vision or better very few choose to wear glasses again. Those who do, generally use them only in certain circumstances such as driving at night or in the rain. For most people in their 40s, though, whether they have had Lasik or not, reading glasses may be necessary.
Dr. Gulani does not believe that information on telephone can determine good candidacy for laser Vision Surgery (Lasik).
Being a World Renowned Teacher to Lasik surgeons and an Industry consultant, Dr. Gulani has strict criteria with which he selects patients.
He has advanced Diagnostics and each patient must pass each of these extensive tests after which they will have a personal consultation with Dr. Gulani to determine their candidacy.
Dr. Gulani's approach is unique in that despite his world renown and reputation, he is extremely personal and takes great interest in educating his patients and selecting what is best for them. There is no vested corporation to intervene in his philosophy of personalized patient care, which highlights his "High Tech and High Touch" approach.
After you have been through a thorough diagnostic testing, you will have a detailed consultation with Dr. Gulani personally. He will then decide if Lasik is or is not the best surgical choice for you.
The advantage of having Dr. Gulani as your surgeon is that he is not limited to Lasik and has the expertise and experience to perform the whole spectrum of refractive surgery (Surgery to decrease dependence on glasses), thus he can select which surgery or technology is best suited for you (Provided your eyes do not have any disease).
Also, if there is no technology in the present times that he feels is best for you and since he is constantly involved in advanced technology and futuristic research, he can confidently inform you about what would be available in the near future in your best interest.
This is elective surgery and the decision to have the procedure is yours.
If you are determined to be a good candidate following Dr. Gulani's evaluation then you can proceed with surgery.
Since Dr. Gulani himself is involved in new technology and research, he has first hand information about future developments across the world and if needed, can guide his patients accordingly.
Lasik is a corneal (Clear front part of your eye) surgery. Your surgeon should be comfortable operating on the cornea and have a proficiency to address corneal diseases.
Dr. Gulani is recognized all over the world for his expertise in corneal surgery including the highly complex Artificial Corneal transplant surgery for which he was selected to be among the first in the world and first in the entire state of Florida.
He teaches his corneal surgical techniques and has invented instruments for advanced corneal surgery for eye surgeons from all over the world.
Like any surgery, Lasik too can have complications. It is important that your surgeon be capable and highly proficient in management of these situations if they were to arise.
Dr. Gulani is a world resource for Lasik surgeons and patients who seek his opinions and expertise in complication management following Lasik surgery.
He has successfully corrected a number of affected patients and has been publishing his work, inventing instruments and teaching courses and workshops for Lasik complication management to Lasik surgeons at National and International meetings.
Research your surgeon. This may still not be possible by visiting their websites (Since the surgeons themselves endorse their own websites).
With the transparency of the internet today, you may type your surgeons name in any search engine on the web (Google/Yahoo/MSN etc) and see what comes up. This way you can determine your surgeon's reputation, publications, contributions, presentations and recognition for the surgery of your interest.
Also, insist on meeting with your surgeon before surgery and ask direct questions. Don't settle for vague or blanket answers. Ask for proof if they say they are pioneers or teachers or world famous.
These are your eyes. Selecting the right surgeon is your utmost responsibility.
Actually we do see a number of patients who come to us from outside of Jacksonville and even from all over the country and world seeking Dr. Gulani's expertise. You can call in advance and we will happily guide you towards your local accommodations.
Affordability is often a concern. We feel there should be a reasonable way to finance your refractive procedure, just as you would other important things in life. As an added service to our patients, we are pleased to offer affordable financing options. All financial arrangements must be completed prior to the day of eyesurgery.
Financing allows you to enjoy your visual freedom now – then pay for it over time with low monthly payments.
1. CareCredit - 0% Interest and Low Interest Payment Plans
As a service to our patients, we are pleased to offer CareCredit, North America's leading patient payment program. CareCredit has several payment plans to meet every financing need each with low monthly payments and no up front costs. It's easy to apply and you'll receive an online decision in seconds. www.carecredit.com/patients/apply.htm
2. Vision Fee Plan.
You can apply online here
3. Some insurance plans will cover
Some or all aspects of your laser eye surgery. You can check your specific insurance coverage for your eyes.
4. Flexible spending or Cafeteria plans can be used to cover
The costs of laser eye surgery. Many employers offer flexible spending accounts to help offset their employees' medical expenses. This may allow you to set aside pre-tax dollars for certain medical costs, including Lasik. Open enrollment usually occurs once a year for a short time period. Ask your employer if they offer a flexible-spending plan.
5. The IRS has deemed that
Laser eye surgery is a valid medical expense and is tax deductible in some cases. Please consult with your tax professional for details.
References in Publications: