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Las Vegas Eye Institute
Address: 9555 S Eastern Ave Suite 260, Las Vegas, NV 89123
Phone: (702) 816-2525
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On nearly every cataract evaluation we perform we get questions about whether or not cataract surgery is laser surgery. The short answer is “no.” However, we do perform laser assisted cataract surgery in which a few of the steps are performed by a femtosecond laser and other steps are performed manually. The truth is that the majority of all cataract surgery is performed with a device call a phacoemulsification handpiece through a very small incision. At the conclusion of the procedure a very small lens is folded and implanted in the eye. The type of lens implanted, and the accuracy of measurements taken to choose that lens, likely plays a much larger role in your final visual outcome than whether or not laser assisted cataract surgery was performed. The following article goes into much greater detail on laser assisted cataract surgery and can hopefully help you understand more about the situations in which laser assisted cataract surgery may be a better option from the traditional surgery and also situations where it may not.

Which is better laser cataract surgery or traditional?

Traditional or manual cataract surgery can be nearly identical to laser cataract surgery in many situations but in certain situations the femtosecond laser can provide a distinct advantage. The type of femtosecond laser and whether or not it integrates with other technology used in the office also plays a role in how helpful the technology can be. In traditional small incision cataract surgery, the surgeon makes the incisions with a metal or diamond blade. Some practices will make the incisions with the laser however, Dr. Swanic finds that manual incisions made with a diamond blade seal better than incisions made with the laser, so he actually turns this feature off and makes a well-constructed beveled, self-sealing incision.

The femtosecond laser is also able to make perfectly sized and centered circular incision into the lens capsule. This can be important because an improperly sized and centered lens opening can create issues later on where the lens will may tilt or decenter leading to decreased refractive outcomes. Fortunately, most experienced surgeons, like Dr. Swanic, have made thousands of these openings so it is very rare for them to make a lens opening that is decentered to the point that a lens won’t center well or becomes tilted. Femtosecond laser manufacturers and some surgeons commonly tout this feature of the laser to be a strong selling point. We feel it is a nice feature, but studies have not shown that this feature dramatically alters the visual outcome for most patients and it is not a reason that we recommend femtosecond laser technology in cataract surgery.

Laser Assisted Cataract surgery has one very large advantage over traditional cataract surgery in that your surgeon can use the femtosecond laser at the time of cataract surgery to make incisions in the cornea to decrease astigmatism. This can be an excellent option for people with astigmatism under 1 diopter. The Catalys femtosecond laser integrates with our Cassini corneal topographer that measures your astigmatism that we have in our office. The Cassini takes a highly detailed infrared image of your iris that is electronically transferred to the Catalys femtosecond laser. When you are under the laser during cataract surgery it then aligns the laser to your unique iris features to perfectly place cuts that decrease your corneal astigmatism. Unfortunately, as amazing as this technology is, it is expensive, and it is rarely used by most practices. We are fortunate to be able to offer this precision laser assisted cataract surgery at Las Vegas Eye Institute.

Traditional cataract surgery with a small incision, using ultrasound energy to break up the lens, has been the dominant form of cataract surgery in the United States since the 1990s. Prior to this, traditional cataract surgery, was referred to as extracapsular cataract surgery and it was performed through a large incision, without an ultrasound probe. A much larger incision was made and the lens was actually pushed out of the eye in one large piece. This is rarely performed in the United States anymore as the large incision was not as stable and often lead to a very high level of astigmatism after the procedure. If you were to compare this form of surgery to our modern ultrasound procedure the difference was vast.

What are the disadvantages of laser cataract surgery?

There are very few disadvantages to laser assisted cataract surgery. But any procedure in life has some disadvantages. The largest disadvantage is the cost of the procedure. The lasers we use are highly sophisticated advanced computing machines with complex imaging systems along with complex laser energy delivery. This technology took years to develop and requires continued maintenance and calibration to continue to function at its peak. This means that the companies that developed and support the technology need to recoup their investment. Surgeons pay for the machine, they pay for interfaces used for each case, they pay a royalty fee on each case, and lastly, they pay a significant yearly maintenance fee to keep the lasers working. These costs are not paid for by insurance companies and so the cost has to be incurred by the patient.

Another disadvantage to laser assisted cataract surgery is that in some patients the energy delivery can make the pupil that was dilated for the surgery get smaller. A small pupil is actually the highest risk factor for surgical complications during cataract surgery so this can be a significant disadvantage. Fortunately, the majority of patients don’t have this occur and usually when the pupil becomes smaller it is only smaller by a relatively low amount to the point that it doesn’t affect surgical safety.

Which method is best for cataract surgery?

Generally, Laser assisted cataract surgery is superior to traditional manual surgery but it is not always by a large margin. If there was no fee Dr. Swanic would likely use the laser for nearly all cases (except for small pupil cases as described) but for some people the costs don’t provide enough of an advantage to justify its use in every case. For people with significant astigmatism that additional cost may be better placed into using a toric intraocular lens that can more reliably reduce astigmatism when it measures over a diopter. The femtosecond laser is an inferior option to toric lenses for correcting higher levels of astigmatism over a diopter. For people who strongly desire to have near and far vision the laser assisted cataract surgery costs may be better spent on implantation of a multifocal intraocular lens. The laser can be used when placing toric lenses or multifocal lenses but that will also raise the cost of the overall procedure and may not provide any noticeable visual benefit.

Dr. Swanic has performed thousands of cataract surgeries and has an incredibly low surgical complication rate (well under 1%) so he does not recommend laser assisted cataract surgery to increase safety of the surgery very often. We occasionally recommend laser cataract surgery to increase safety when a cataract is very dense because the laser can soften the lens and decrease the amount of ultraound energy needed to remove the cataract. Most studies have shown equivalent safety between manual and laser assisted cataract surgery for cataracts of lower lens density. Dr. Swanic is a corneal specialist, so he also sees patients with a condition called Fuchs’ Corneal dystrophy. This condition weakens the corneas natural pumping system that maintains its clarity. Traditional phacoemulsification cataract surgery can damage these pumping cells through ultrasonic energy waves. In these patients, laser surgery can improve safety by decreasing energy waves that can damage these cells. If you are affected by this condition, we will discuss it with you during a preoperative evaluation.

They have also showed no statistically significant difference in visual outcomes in cases where laser cuts are not used to improve vision. Dr. Swanic typically recommends Laser assisted surgery when he wants to utilize the laser to make precise incisions in the cornea, called limbal relaxing incisions, to decrease preexisting astigmatism. In this case the Laser assisted surgery clearly provides better outcomes when comparing laser cataract surgery to manual.

Wavefront is a key topic to understand when we are discussing modern LASIK because nearly all of the procedures done these days are either “wavefront guided” or “wavefront optimized”.  A wavefront is simply a light beam that is analyzed after it exits your eye. Our iDesign device specifically sends an infrared beam (that you cannot see) through your eye and then an advanced sensor picks up and analyzes the infrared beam when it exits your eye.  A wavefront is unique to your specific eye and when it is captured it shows us precisely how your eye tends to distort light. A nearsighted patient will have a completely opposite wavefront capture compared to that of a patient that is farsighted. Astigmatism is also captured up on a wavefront.  Of course, we don’t capture wavefronts merely to determine if a patient is nearsighted, farsighted, or has astigmatism. All of those things can be determined with a much more basic device called an autorefractor and then confirmed by a doctor or technician using the typical “which is better 1 or 2” device called a phoropter.  The reason we actually began to capture wavefronts was that in the early 2000s we were aiming to give patients “superhuman” vision by correcting things beyond what glasses were capable of correcting. Nearsightedness, farsightedness, and astigmatism (things that can be corrected with glasses) are referred to as “lower order aberrations.”  Wavefront goes beyond this to try to correct more subtle optical abnormalities called “higher order aberrations” which primarily include things called coma, trefoil, and spherical aberration.

Over the last few years, there has been a lot of buzz about a procedure abbreviated RLE or Refractive Lens Exchange. As an eye surgeon at Las Vegas Eye Institute, I commonly get asked about this procedure and who the procedure is right for. Refractive Lens exchange is where the natural lens of the eye is removed and a new synthetic lens is put in its place. The procedure is actually performed in the exact same fashion as cataract surgery.  Like cataract surgery, it is a procedure that can correct nearsightedness, farsightedness, and astigmatism. It is also a treatment for presbyopia which is the natural decline in near visual function as we age.

When do you consider refractive lens exchange and why?

In my practice, I tend to focus this procedure on people who are farsighted.  Farsightedness is a confusing term because people who are “farsighted” can see well at a distance only when they are young and their natural lens can overcome the condition.  As a farsighted person ages, they begin to have difficulty with near tasks first and later have difficulty with both near and far tasks. A farsighted eye is a short eye that doesn’t have enough power to focus the image onto the retina. In the following image, you can see that the image is focusing behind the retina. When we are young our natural lens can change its shape to increase power and get the image into focus on the retina.  As we age the lens loses it pliability and can no longer change shape enough to get the image in focus on the retina.

Now that we understand farsightedness it may be easy to guess what a surgeon like me does to correct the problem… I increase the power of the lens in the eye.  Refractive lens exchange is great for this because we have a variety of lens powers at our disposal and we can correct high levels of farsightedness and still give very good visual quality.  If you read our post on LASIK you will find that LASIK can also correct farsightedness but the issue with LASIK is that while the visual quality is good it begins to decline in quality once we correct past approximately 3 diopters of power in farsighted treatments (for nearsighted this is more like 8 diopters).  So if a person is farsighted by 5 Diopters their very best option tends to be RLE or refractive Lens exchange as LASIK cannot compete with the optical quality of refractive lens exchange. Even at an advanced practice like Las Vegas Eye Institute where we use customized wavefront-guided iDesign treatments, RLE is still superior for high corrections of farsightedness.

What type of lens should I have put in my eye during refractive lens exchange?

Once we remove a lens during refractive lens exchange we have to replace the power of the lens.  This can be done with a conventional monofocal, toric, extended depth of focus or multifocal intraocular lens.  If we determine during your evaluation that you don’t have any significant astigmatism a monofocal lens can be a perfect choice and lower your expense as there is no additional cost beyond the cost of the surgery itself.  A monofocal lens is usually placed in monovision format for RLE because with this you can see well at distance with your dominant eye and see well at near with your non-dominant eye. To do monovision treatments your surgeon simply needs to increase the power of the lens in the non-dominant eye to give you increased power to see up close.  If a patient has significant astigmatism then they may need to opt for a lens that can correct astigmatism, these lenses are referred to as toric lenses. Finally, in 2019 we have the option of extended depth of focus or multifocal intraocular lenses that allow people to see at a distance and near. An extended depth of focus lens allows good computer vision (what ophthalmologists refer to as intermediate vision) while a multifocal lens can allow excellent near vision for finer tasks like reading a book or the newspaper. Both extended depth of focus and multifocal lenses do have a drawback in night driving.  Right after their placement people will notice some level of haloes around lights. Fortunately, most of my patients describe it as mild and it does tend to diminish over the first several months after placement.

I am 50 years old and nearsighted. Why did you tell me that RLE isn’t a good idea?

As a refractive surgeon when I encounter patients who are nearsighted I am much more inclined to offer LASIK over RLE for several reasons. The first reason is that LASIK is excellent for nearsightedness.  With wavefront-guided treatments on the iDesign platform, we can get outstanding visual outcomes with up to 8 diopters of nearsightedness and correct astigmatism at the same time. Also, we can easily do monovision treatments with LASIK and its even easier in 2019 as the iDesign platform is now the only FDA approved LASER for monovision.   This means that we can still offer excellent custom treatments and leave one eye for near. All other FDA approved lasers can only perform wavefront optimized or conventional treatments instead of treating the unique wavefront features of your eye when performing the treatment on the near eye. Lastly, and the most important reason why I don’t perform RLE on nearsighted people is that it is not as safe.  Studies have consistently shown that performing cataract surgery (essentially the same procedure as RLE) on myopic patients around the age of 50 leads to a higher rate or retinal detachments after the procedure. If I can give someone an excellent result with a time tested and safe procedure then I will choose that route every time.

You will notice that at Las Vegas Eye Institue, Dr. Swanic does not offer LASIK procedures that are performed with a blade (known as a microkeratome).  Although the microkeratome is an excellent device that Dr. Swanic previously utilized, he feels that with recent advances in technology, the new Visumax femtosecond platform which is a bladeless, all-laser platform, provides for a significant improvement in the safety of LASIK.  The Visumax platform, in particular, is also remarkable in that the flap thickness can be programmed to any depth that Dr. Swanic customizes for your case and it is accurate to a 3-micron standard deviation. This means that most flaps should be within 3 microns of target and nearly all flaps should be within 10 microns of target.  To give you a frame of reference one strand of human hair is 75 microns in thickness. The accuracy of modern all-laser LASIK is truly marvelous.

On August 27th of this year Alcon announced the FDA approval of their new trifocal intraocular lens for use at the time of cataract surgery or refractive lens exchange. Since this launch my Instagram has been flooded with doctors all over the country announcing that they have been the first to implant it in their city. As a result of this I have found patients have a lot of questions about this lens during consultations at my office. I thought it might be best to get some good data out there from a doctor who has implanted multiple IOL designs from multiple manufacturers over the years, to get the pros and cons of many of the intraocular lens designs currently on the market.

What is a trifocal intraocular lens?

A trifocal intraocular lens is different from a trifocal pair of glasses. In a trifocal pair of glasses you can see the distance through the top portion, your computer through the middle portion (intermediate vision), and a book (near vision) through the bottom. This is different from a trifocal IOL because in a trifocal IOL you can see distance, intermediate, and near vision all at the same time. The reason is that this lens technology is splitting light for all of those distances and having them all reach your retina at once. This is the same technology we have been using in multifocal lenses for years, but bifocal multifocal lens just had light from distance and near reaching the retina at once and they left out an intermediate focal point.

If we are splitting light in multifocal lenses does that affect image quality?

This splitting of light is great because it allows you to see distance and near objects at the same time. However, because light is essentially a form of energy it can be neither created nor destroyed (1st law of thermodynamics.) This means that a multifocal lens is simply transforming this light energy. So, the distance image is at a lower light intensity in a multifocal lens than it is in a monofocal lens. For most people this is not an issue, but lower contrast images can be issues for people who have had altered optics from prior LASIK or RK (we can test for this at Las Vegas Eye Institute), for patients with retinal diseases like macular degeneration or diabetic retinopathy, and patients with moderate to severe glaucoma (mild glaucoma this is not an issue.) So, you can probably guess that the trifocal lens is taking light energy away from distance and near vision to provide you with this third intermediate vision level. In physics, and life, it seems that nothing is ever for free!

Is the Alcon PanOptix new technology?

No. The Alcon PanOptix is a multifocal intraocular lens that has been used in Europe for about 4 years. It received the EU CE mark approval in October of 2015. In Europe, they have had access to other trifocal intraocular lenses including the Zeiss AT LISA and the Finevision Trifocal. In the United Stats we don’t have access to these other lenses and the Alcon Panoptix is the first and currently “only” trifocal available here.

What is an extended depth of focus lens and how is it different from a multifocal lens?

An extended depth of focus (EDOF) lens is a lens that allows for patients to see both distance and intermediate vision at the same time. Some patients will even find they have adequate near vision with this lens once it has been implanted in both eyes. In the United States we have one lens in this class and it is called the Symfony lens and is made by Johnson and Johnson. It uses technology that essentially blends the image from distance and intermediate. This lens was designed to give better optical quality than the multifocal lenses that came before it, however it’s biggest downfall in my practice has been that patients are sometimes disappointed that they need to use reading glasses more often than they had hoped. Although their computer (intermediate) vision is usually quite good.

The following video discusses the EDOF lens but it has what I consider to be a few important errors in the video. First, most of my patients do get a form of halo with this lens that is often described as a “fuzz” and is usually not overly problematic for driving at night. However, it is definitely present and nearly never seen with a monofocal lens. The next problem with this video is that is shows that patients have good “near” vision. I find this to only be the case for about half of my patients with this lens implanted in both eyes. The other half feel they need reading glasses for extended periods of reading and for looking at finer levels of print. Regardless the video does at least give an idea of what the engineers were aiming for with this technology.

I often get asked about LASIK and dry eye, especially being a LASIK surgeon in the very dry city of Las Vegas, Nevada.  Let me be straight with you. Yes, LASIK can make dryness worse, but the good news is that the dryness is typically temporary.  In my experience, the dryness takes about a week to kick in, and is the most prevalent for the first month after the procedure. This is part of the reason it is very important to see a LASIK doctor that has a lot of experience in treating dry eye.  You will find that doctors who have completed fellowships in Cornea and Refractive surgery tend to treat a larger volume of dry eye patients than doctors who have not. This also means that we tend to be very proactive in treating it early.

Be Wary of the Internet When Researching LASIK and Dry Eye

I remember a few days before I had PRK performed on my own eyes while I was a resident in ophthalmology, I stumbled upon a website that warned that LASIK and PRK caused serious eye dryness that was devastating and irreversible.  At the time, I was still a resident at Tufts and had not yet started my fellowship in Cornea and Refractive Surgery at UCLA at that point. Since residency training in ophthalmology focuses more on the core areas or ophthalmology such as glaucoma, cataract surgery, retinal disease, and eyelid disorders more than it does on refractive surgery, I actually had not seen that many LASIK or PRK patients at that earlier point in my training.  So, when I stumbled on this website claiming LASIK was dangerous, just days before my procedure, I was concerned.

Fast forward 10 years and I have experienced zero issues with dryness after my PRK procedure.  There are some people who develop serious dryness after LASIK, but my experience has been that most of these people had serious dryness issues before the procedure that may have gone undiagnosed.  All patients at Las Vegas Eye Institute and other quality LASIK practices are screened for pre-existing dry eyes. It is important to realize that LASIK has been performed on millions of patients throughout the US since the FDA first approved the excimer laser in 1995, and the vast majority of these patients have experienced either short-lived dryness or no dryness at all.

Why do people experience initial eye dryness with LASIK?

Doctors and researchers are quite certain that the reason patients get dryness with LASIK has to do with cutting of corneal nerves during the LASIK procedure.  It is important to remember that with modern thin-flap femtosecond LASIK (the only kind performed at Las Vegas Eye Institute) we are cutting far fewer nerves than we did with LASIK performed in with a blade back in the 1990s and 2000s.

Now it’s time for some eye anatomy.  Our cornea on average is 540 microns thick.  The original LASIK performed with a blade cut 160 microns deep into the cornea.  Our Visumax Laser is programmed to create flaps that are only 110 microns thick – a reduction of approximately 31%!  Even with the thinner flap, nerves are still being cut even if it is a huge improvement over the procedures of the past.  The good news is that corneal nerves do regrow. Studies looking at recovery of corneal sensation after the procedure show over 50% recovery in sensation by three months, approximately 80% recovery at six months, and essentially a return to baseline at one year.  Interestingly this mirrors my clinical practice where most dryness symptoms are completely gone by six months after the procedure.

Why Might PRK Be Better for People with Pre-Existing Dryness?

In contrast to LASIK, the PRK procedure does not require the creation of a flap in the cornea.  Instead, a very thin layer of the cornea is removed using a very dilute alcohol solution. This means that the only nerves cut during this procedure are those that are removed during what is known as the advanced surface ablation.  This advanced surface ablation generally affects only the central 6mm of the cornea. In comparison, the flaps created by the Visumax LASIK laser are typically about 8mm in diameter for myopic ablations (our cornea is on average 12mm in diameter.)  Because of the smaller amount of nerves being cut with the PRK procedure, the dryness I see in my practice from PRK is typically minimal or nonexistent. PRK, however, does have longer recovery time and is not right for everyone so please read our LASIK page to find out more.  You can discuss whether you are a better candidate for PRK or LASIK during your initial consultation.

I often get asked about LASIK and dry eye, especially being a LASIK surgeon in the very dry city of Las Vegas, Nevada.  Let me be straight with you. Yes, LASIK can make dryness worse, but the good news is that the dryness is typically temporary.  In my experience, the dryness takes about a week to kick in, and is the most prevalent for the first month after the procedure. This is part of the reason it is very important to see a LASIK doctor that has a lot of experience in treating dry eye.  You will find that doctors who have completed fellowships in Cornea and Refractive surgery tend to treat a larger volume of dry eye patients than doctors who have not. This also means that we tend to be very proactive in treating it early.

When selecting a LASIK provider, it is important to understand what your LASIK cost includes. Some providers advertise for a low initial cost, only to charge more for “add-ons” which result in a much higher cost of LASIK than the price that was initially quoted. At Las Vegas Eye Institute we do not have a multiple tiered pricing programs like you may find at other LASIK providers. This means that whether you opt for PRK or LASIK or need some mild dry eye treatment after your procedure, you will not incur any additional costs for any necessary post-operative treatments. At Las Vegas Eye Institute, we strive to provide a premium LASIK experience which includes transparency in pricing. We do not want people to find out after the fact that any additional services they may need to get the optimal visual results are not included in the price they paid.

At Las Vegas Eye Institute, Custom LASIK is included with each LASIK procedure at no additional cost.  With Custom LASIK, specific data points unique to your eyes are taken into consideration when planning your LASIK procedure.  Small abnormalities in your eyes are measured with the advanced technological device called the iDesign 2.0. The iDesign 2.0 was FDA approved in 2018 and can capture over 1,200 data points to design your LASIK treatment while older technology can only capture about 250.  With this device, treatments are customized to patients individual eyes and provide better visual results than that offered by older technology.

You will notice that at Las Vegas Eye Institue, Dr. Swanic does not offer LASIK procedures that are performed with a blade (known as a microkeratome).  Although the microkeratome is an excellent device that Dr. Swanic previously utilized, he feels that with recent advances in technology, the new Visumax femtosecond platform which is a bladeless, all-laser platform, provides for a significant improvement in the safety of LASIK.  The Visumax platform, in particular, is also remarkable in that the flap thickness can be programmed to any depth that Dr. Swanic customizes for your case and it is accurate to a 3-micron standard deviation. This means that most flaps should be within 3 microns of target and nearly all flaps should be within 10 microns of target.  To give you a frame of reference one strand of human hair is 75 microns in thickness. The accuracy of modern all-laser LASIK is truly marvelous.

Some patients may experience a temporary period of eye dryness that can make vision initially slightly less clear than targeted or provide mild discomfort in the weeks following the LASIK procedure.  The good news is that at Las Vegas Eye Institute, we treat your case according to your individual needs and provide punctal occlusion at no additional cost if we find that it may be helpful after the procedure.  Prior to Dr. Swanic starting his own ophthalmology practice in 2013, he worked at other ophthalmology practices where patients are told to pay for punctal occlusion at the time they sign up for their LASIK procedure as an add-on to the initial LASIK cost.  We do not do this at Las Vegas Eye Institute because this is not necessary for many patients and it is not easy to predict prior to the LASIK procedure who will need this service. Regardless, patients of Las Vegas Eye Institute can rest assured that punctal occlusion, if necessary, is an included portion of your procedure. Some patients may benefit from very short-acting plugs that dissolve in 3 months or 6 months.  These are simple to place and you will not feel them at all. Dr. Swanic also utilizes permanent plugs that are made of silicone, but we don’t use them often for our LASIK patients. The reason is that the dryness of LASIK is temporary and is usually fully resolved by 6 months. Also, permanent plugs can be felt by a small percentage of patients after placement for about the first week, so we would prefer to only use them for patients that really need them.

Our treatments all include 2 years of LASIK enhancements if needed.  Fortunately, with the new Visx iDesign 2.0 platform our current enhancement rate is well under 5%.  Again we feel asking patients to pay for some form of “assurance” enhancement package doesn’t make sense because the vast majority of patients will never need it.  Ultimately, when choosing the right doctor to perform your LASIK surgery, finding the right surgeon is more important than price. Dr. Swanic completed his ophthalmology residency at Tufts, his refractive surgery fellowship at UCLA and is dedicated to providing the highest and most technologically advanced level of care to all his patients.

As we mentioned before, regression of the effect of LASIK is now very rare with nearsighted treatments with modern lasers with blend zones. More importantly, if I program my laser to correct -6.00D of nearsightedness the effect will be immediate and the next day the vision will be close to 20/20. Farsighted LASIK is programmed as positive treatments so if I program +3.00D the next day the patient is typically overcorrected. This overcorrection is intentional by both the surgeon and the laser to help keep your vision good long term. The issue is that all farsighted treatments have some level of regression over the first few months to even a year so if we don’t overcorrect in the short term we will end up undercorrected in the long term.

When selecting a LASIK provider, it is important to understand what your LASIK cost includes. Some providers advertise for a low initial cost, only to charge more for “add-ons” which result in a much higher cost of LASIK than the price that was initially quoted. At Las Vegas Eye Institute we do not have a multiple tiered pricing programs like you may find at other LASIK providers. This means that whether you opt for PRK or LASIK or need some mild dry eye treatment after your procedure, you will not incur any additional costs for any necessary post-operative treatments. At Las Vegas Eye Institute, we strive to provide a premium LASIK experience which includes transparency in pricing. We do not want people to find out after the fact that any additional services they may need to get the optimal visual results are not included in the price they paid.

At Las Vegas Eye Institute, Custom LASIK is included with each LASIK procedure at no additional cost.  With Custom LASIK, specific data points unique to your eyes are taken into consideration when planning your LASIK procedure.  Small abnormalities in your eyes are measured with the advanced technological device called the iDesign 2.0. The iDesign 2.0 was FDA approved in 2018 and can capture over 1,200 data points to design your LASIK treatment while older technology can only capture about 250.  With this device, treatments are customized to patients individual eyes and provide better visual results than that offered by older technology.

You will notice that at Las Vegas Eye Institue, Dr. Swanic does not offer LASIK procedures that are performed with a blade (known as a microkeratome).  Although the microkeratome is an excellent device that Dr. Swanic previously utilized, he feels that with recent advances in technology, the new Visumax femtosecond platform which is a bladeless, all-laser platform, provides for a significant improvement in the safety of LASIK.  The Visumax platform, in particular, is also remarkable in that the flap thickness can be programmed to any depth that Dr. Swanic customizes for your case and it is accurate to a 3-micron standard deviation. This means that most flaps should be within 3 microns of target and nearly all flaps should be within 10 microns of target.  To give you a frame of reference one strand of human hair is 75 microns in thickness. The accuracy of modern all-laser LASIK is truly marvelous.

Some patients may experience a temporary period of eye dryness that can make vision initially slightly less clear than targeted or provide mild discomfort in the weeks following the LASIK procedure.  The good news is that at Las Vegas Eye Institute, we treat your case according to your individual needs and provide punctal occlusion at no additional cost if we find that it may be helpful after the procedure.  Prior to Dr. Swanic starting his own ophthalmology practice in 2013, he worked at other ophthalmology practices where patients are told to pay for punctal occlusion at the time they sign up for their LASIK procedure as an add-on to the initial LASIK cost.  We do not do this at Las Vegas Eye Institute because this is not necessary for many patients and it is not easy to predict prior to the LASIK procedure who will need this service. Regardless, patients of Las Vegas Eye Institute can rest assured that punctal occlusion, if necessary, is an included portion of your procedure. Some patients may benefit from very short-acting plugs that dissolve in 3 months or 6 months.  These are simple to place and you will not feel them at all. Dr. Swanic also utilizes permanent plugs that are made of silicone, but we don’t use them often for our LASIK patients. The reason is that the dryness of LASIK is temporary and is usually fully resolved by 6 months. Also, permanent plugs can be felt by a small percentage of patients after placement for about the first week, so we would prefer to only use them for patients that really need them.

Our treatments all include 2 years of LASIK enhancements if needed.  Fortunately, with the new Visx iDesign 2.0 platform our current enhancement rate is well under 5%.  Again we feel asking patients to pay for some form of “assurance” enhancement package doesn’t make sense because the vast majority of patients will never need it.  Ultimately, when choosing the right doctor to perform your LASIK surgery, finding the right surgeon is more important than price. Dr. Swanic completed his ophthalmology residency at Tufts, his refractive surgery fellowship at UCLA and is dedicated to providing the highest and most technologically advanced level of care to all his patients.