Am I A Good Candidate For LASIK?

At my optometry practice here in Ann Arbor, I am asked by patients every day, "Am I a good LASIK candidate?" There are a variety of areas we look at to answer that question.

The first key area in determining candidacy for LASIK is stability of the eyeglass prescription. We like to see the prescription be stable for at least one year. We define stable as changing 0.25 units or less in a single year. It is generally rare for a person under the age of 21 to have a stable prescription.

A second area is corneal thickness. LASIK laser surgery thins the central cornea. Therefore, a cornea that is thinner than the average may not be a good LASIK candidate. We quickly and easily measure the central corneal thickness with Ultrasound.

A third key area is corneal surface quality. Corneas that are irregular or cone-shaped (Keratoconus) are definitely NOT good LASIK candidates. By using an instrument made by the Zeiss Corporation called a Corneal Topographer, we are able to map the shape of the cornea and measure the corneal surface quality.

Another important factor is eye wettability. Dry eyes can make a patient a poor LASIK candidate. LASIK usually makes the eye temporarily drier than usual. This can push a borderline dry eye into an inflamed, irritated dry eye with intermittently fuzzy vision. Careful tear film evaluations with various dyes are used to look for dry eye problems.

The factors discussed above are some, not all, of the key areas we will look at to determine if you are a good candidate for LASIK surgery. Good candidates generally have great surgical outcomes and are extremely satisfied with their experience.

The next time you go to see your optometrist for your eye care, ask if you are a good candidate for LASIK surgery.

Steven Lutz, OD
Serving Ann Arbor, Saline, Ypsilanti, Pinckney, Milan, Dexter, Chelsea, Brighton, Howell, Whitmore Lake and surrounding areas since 1988.

Not a Dry Eye in the House (Hopefully!)

Dry Eye is a very common problem encountered daily in an eye care practice. It is often more than a minor annoyance - it is common to see extensive inflammation due to dry eye. We have a systematic approach to treat dry eye syndrome in my optometry practice.

The first step is to select the proper artificial tear for the patient. After a comprehensive evaluation of the patient's dry eyes, we usually start with a mild steroid drop combined with the artificial tear drops. There are dozens of artificial tears on the market. Which one I choose for my patient to try often depends on if the patients has evaporative dry or aqueous deficiency dry eye.

• Evaporative dry eye is caused by poor oil production in the oil glands (meibomian glands) in the eyelids.

• Aqueous deficiency dry eye is thought to be caused by a lack of tear production by the tear glands themselves.

For evaporative dry eyes, I like to use an artificial tear that contains some type of oil. This helps keep the "oil slick" on top of the tear film thicker, which helps prevent evaporation. A good example of this product is Soothe XP from Bausch and Lomb.

For aqueous deficiency dry eyes, I like a product with hyaluronic acid (H.A.). H.A. helps "glue" more to the eye, and often lasts for several hours per drop applied. A good example of this type of product would be Blink Tears from Abbott Medical Optics.

The next time you go to see your optometrist for your eye exam or contact lens fitting, ask the doctor if artificial tears would be a good option for you, and hopefully there will not be a dry eye in your house.


Steven Lutz, OD
Dr. Steven Lutz & Associates PC.
Serving Ann Arbor, Saline, Ypsilanti, Pinckney, Milan, Dexter, Chelsea, Brighton, Howell, Whitmore Lake and surrounding areas since 1988.

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Gas Perm Bifocal Fittings Don't Have To Be Hard!

At my practice, Dr. Steven Lutz and Associates in Ann Arbor, MI, a large portion of our patients are contact lens wearers. Many of the patients we fit with contact lenses are multifocal (bifocal) wearers. Most of these patients wear soft contact lenses, but about 15% are gas permeable (rigid) lens wearers, sometimes called RGP's.

Because gas permeable contact lenses are completely customized, and have multiple variables that need to be manipulated to get the correct prescription, they have a reputation of being much more difficult to fit than a soft multifocal lens. This does not always have to be the case. If a few fundamental concepts are kept in mind, gas permeable multifocal contact lens fittings can be relatively straightforward.

I put bifocal gas perm wearers in two categories: those that the contact lens will center on the eye and those that the contact lens wants to ride up higher ("superior attached fit").

Lifestyle Corporation makes a multifocal contact lens that is designed to ride up on the eye, tucked under the upper lid. This design is my first choice for patients where the lens wants to ride up.

Art Optical Corporation in Grand Rapids, MI makes the Renovations gas permeable multifocal contact lens. This design is my first choice for centered-fit patients.

There are often clues in the eyelid and eye architecture that helps the doctor determine if a centered-fit lens or high-riding lens will be preferable. If the patient's upper lid covers much of the superior cornea (the upper lid hangs down a bit), this is often a good indicator for a high riding lens design. Patients with upper and lower lids that are quite far apart (large aperture) are usually better candidates for a centered-fit design. Diagnostic contact lenses are the key - we always put diagnostic contact lenses on the eyes to ultimately determine which design works best for each individual patient.

If you are an RGP contact lens wearer, make certain that your optometrist specializes in RGP contact lens fittings, so your next fitting doesn't have to be "Hard"!

Steven Lutz, OD
Serving Ann Arbor, Saline, Ypsilanti, Pinckney, Milan, Dexter, Chelsea, Brighton, Howell, Whitmore Lake and surrounding areas since 1988.