Dr. William Ellis has performed over 60,000 LASIK procedures providing thousands the precious gift of sight!
ANSWER: It goes back many years to my engineering training at UC Berkeley. Back when I was a young engineering student, I realized that there was very little technological input in medicine. In those days we had Sputnik and the space race, but technical knowledge somehow wasn't getting into medicine.
QUESTION: So it was your goal to help bring technical knowledge into medicine?
ANSWER: Yes, it was always my plan to go through engineering and to continue on into medicine. I'm lucky I
completed my engineering and pre-med in four years. Most people took five years to get through engineering, but
I knew I had to move quickly because of the training involved.
QUESTION: Where did you go for medical school?
ANSWER: At Washington University in St. Louis. Following this, I received a year of surgical training at Duke University. After my initial training I went to the National Heart Institute in Bethesda, Maryland, where I helped to do research on the artificial heart. I became increasingly concerned about problems of vision and blindness and decided to pursue a career in ophthalmology.
QUESTION: You did that at Stanford University didn't you?
ANSWER: Yes, I finished my training in 1974 and embarked on a trip around the world to visit with some of the greatest surgeons of that era.
QUESTION: Is that how you happened to meet Professor Fyodorov, the world-famous Russian eye surgeon who developed radial keratotomy?
ANSWER: While traveling the globe to meet the greatest surgeons, I learned about a new procedure in Moscow to correct nearsightedness called radial keratotomy.
QUESTION: That's quite a while ago, isn't it Dr. Ellis?
ANSWER: Yes, it's been 28 years since I began my quest to learn how to restore vision with refractive procedures, and I've learned a lot in those years. What we learned back then continues to help us now because refractive surgery isn't just one modality.
QUESTION: Does that mean that in some instances you don't strictly use LASIK?
ANSWER: Yes, that's right. In some cases we may use epilasik, advanced surface ablation or CK. Refractive intralocular lenses may also offer an alternative.
QUESTION: Dr. Ellis, does that mean that the laser may not be perfect?
ANSWER: Yes, over the past months and years we have heard a lot of hype about lasers. The laser companies have expensive machines they've sold to ophthalmologists, and ophthalmologists are going to have to do a large number of patients to make it pay. As an engineer who learned about lasers from the ground up, I can say that it's a wonderful device, but if not used properly there can be problems and complications.
QUESTION: Dr. Ellis, do you mean that Excimer laser treatment may be associated with problems in certain instances?
ANSWER: Yes, it's not all the pretty picture that the laser manufacturers like to paint. Some doctors without a background in refractive surgery will depend on a cook book "one size fits all" solution. Unfortunately, it isn't that easy. Surgeons need to think for themselves and computer programs cannot be relied upon 100% of the time to treat patients. We have the greatest computer in the world sitting right in our brain. As a trained refractive surgeon, we have to change and vary our procedures to tailor fit the individual.
QUESTION: Do you mean, Dr. Ellis, that some laser machines as they come off the assembly line now are fixed with one program?
ANSWER: Yes, that's right. One laser manufactured by Summit Technology in the past required that all PK surgery be performed at a 6.0 mm. optical zone - that's the width of the beam and that beam has a fairly high power level of 180 mj/cm squared.
QUESTION: Dr. Ellis, that sounds complicated. Would you simplify it for the audience?
ANSWER: What that means is we have to deliver very high amounts of power to the eye, and recent evidence indicates that retinal detachments and other problems can sometimes develop at these high levels of power. New lasers such as the Technolas 217 by Bausch & Lomb reduce the energy concentration by scanning a small spot across the cornea.
QUESTION: Dr. Ellis, how do you solve that problem?
ANSWER: Well, we can reduce the level of power in the beam, or use a smaller scanning spot instead of a large broad beam. By rapidly scanning a smaller spot to perform the laser ablation less power is delivered, this results in a smaller shock wave on the eye and offers a smoother ablation. This helps to reduce the possible complication of retinal detachment by the laser shock wave.
QUESTION: Dr. Ellis, you've talked about the LASIK procedure earlier. Tell us a little bit about it.
ANSWER: I don't want this to be perceived as an advertisement for LASIK. We're just talking about it as an alternative to other refractive procedures.
QUESTION: Dr. Ellis, tell us again what the difference is?
ANSWER: When we perform surface ablation on the cornea, we simply put the patient under the laser, set the computer, aim and fire. It's just that simple. Some surgeons remove the outer covering of the cornea called the epithelium, and others ablate right through it. Regardless of the technique, at the end of the procedure you have an open wound that requires 6 or 7 days for the epithelium to recover. That usually means wearing a bandage contact lens and the recovery period, with or without a contact lens, is somewhat uncomfortable. Many of the problems have been solved by new methods of surface ablation called Advanced Surface Ablation combined with Epi-LASIK.
QUESTION: How new is the LASIK procedure?
ANSWER: The LASIK procedure evolved from lamellar refractive surgery or ALK. Automated Lamellar Keratoplasty was invented in 1948 by Professor Barraquerer, one of the most famous names in refractive surgery. Both Professor Barraquerer and Professor Fyodorov are recognized as the two founders of refractive surgery. I am proud to have known both Professor Barraquerer and Fyodorov for almost 20 years prior to their deaths. In fact, Professor Fyodorov co-authored a refractive surgical textbook with me, and Professor Barraquerer quotes my writings in his surgical textbook.
QUESTION: How was the LASIK procedure evolved?
ANSWER: The LASIK procedure was developed as a refinement of Dr. Barraquerer's work. He began his procedures almost 50 years ago. That's a long track record! LASIK represents a combination of procedures. An ALK flap is raised and the cornea is sculpted by the laser underneath this protective flap. When the procedure is done, the flap is simply laid back over the cornea. This helps promote faster healing. A very precise instrument called the microkeratome is used to produce the flap.
QUESTION: Dr. Ellis, what does the microkeratome do?
ANSWER: The microkeratome raises a thin flap of cornea in the LASIK procedure. Therefore, instead of using the laser to remove tissue from the outer surface of the cornea, the laser can sculpt the cornea underneath this protective flap. When the laser PK is finished, the flap is replaced over the ablation site. Healing is usually quicker this way. In contrast to surface ablation, there is no open wound on the surface of the cornea. In surface PK, an open wound is left which must heal. This healing is slower in contrast to the rapid healing we see with LASIK.
QUESTION: Tell us more about LASIK, Dr. Ellis?
ANSWER: In the LASIK approach, a thin 130 micron corneal flap is raised by the microkeratome. The flap is not taken all the way off the cornea, but remains hinged towards the nose. The laser then precisely removes a small portion of underlying corneal tissue, which is often less than the thickness of a single human hair. The corneal flap is then folded back and re-aligned on the corneal surface, just the way it was before the surgery. This flap often heals quickly and aides in speeding up the entire healing process. Suturing is rarely required. In most instances our patients feel quite comfortable the next day. I've been amazed that even when looking at the eye through a microscope, it is sometimes difficult to detect the flap even on the first day following surgery.
QUESTION: Dr. Ellis, how does this compare to surface PK?
ANSWER: In surface PK, the laser ablation creates an open wound on the very front surface of the eye. The epithelial covering of the cornea usually takes about four days to cover the defect. The refraction, or visual correction, takes slightly longer to stabilize in surface PK. Corticosteroid drops are used to help control the healing. These steroid drops are thought to help reduce haze in order to achieve a better result.
QUESTION : Dr. Ellis, do you have to use steroid drops in LASIK?
ANSWER: Yes, most often steroid drops are used. The healing is quick, and we usually don't need them for long. There is much less concern about hazing or scarring with the LASIK procedure.
QUESTION: Can there be complications with the LASIK procedure?
ANSWER: Of course, there can be complications with any procedure. If the surgeon is not experienced with the refractive procedures, the results for that particular surgeon might be better if he used simple surface PK. For an experienced surgeon, who is comfortable using the microkeratome, LASIK may be the best way to go. However, more recently, with the advent of wavefront custom ablation, advanced surface ablation combined with Epi-LASIK appears to be yielding the best results. This is because the thinner Epi-LASIK flap better reflects the multiple small changes achieved on the surface of the cornea with the wavefront correction.
QUESTION: So, Dr. Ellis, what you're telling us is that there are variations on laser vision correction.
ANSWER: Yes, there are variations on PK. In many cases combinations of techniques such as ALK can give a better result. As an example, astigmatism correction can be performed under the corneal flap using arcuate incisional keratotomy, or AK for short. An experienced laser surgeon can help to chose the best procedure.
QUESTION: We've heard that keratotomy can cause side effects such as night glare and starbursts.
ANSWER: In RK, the incisions come very close to the center of the eye, but in arcuate keratotomy, or AK, the incisions are far away from the center of the pupil and rarely cause this side effect. Lasik can also cause glare. This can be reduced markedly if wavefront LASIK is done.
QUESTION: Dr. Ellis what you've been telling us seems to indicate that experience is very important, and that more than one technique may help to achieve the best result. Combined techniques may include CK or refractive lens exchange.
ANSWER: Yes, the laser manufacturers would like you to think laser PK is quick and easy; that any surgeon can do it. They try to give the impression that the laser, not the surgeon, does the work. The laser is just part of the story. It's in the doctor's power to manipulate the laser and use it to it's best advantage, depending upon the patient. These modifications, combined with combinations of procedures in the hands of an experienced laser surgeon, may yield the optimal result in each case. There is no such thing as "one size fits all" surgery. Every individual is different, and the thinking experienced surgeon may vary his approach in order to achieve the best results.
QUESTION: Dr. Ellis, your engineering background is certainly an asset to you.
ANSWER: Yes, it has been an asset and we at the Ellis Eye and Laser Centers plan to continue to perform PK surgery in the very best manner, so that we can achieve the best results possible for our patients.
Thank you, Dr. Ellis