NEW YORK–A 10- to 15-minute procedure that gives you 20/20 vision the next day still sounds too good to be true to many people who are considering laser eye surgery.
“‘What if something goes horribly wrong for me?’ Is a common thought for patients considering refractive eye surgery,” said Dr. Steven Stetson of Diamond Vision, but advances in technology in the last 10 years have dramatically changed what’s possible.
Stetson previously served as the medical director of the Air Force Academy Laser Eye Clinic, where they had a 98 percent outcome rate of 20/20 vision or better and performed the first LASIK procedure on an active-duty Air Force member.
With refractive laser eye surgeries, the most well-known of the procedures is LASIK. Prior to its FDA approval, PRK (photorefractive keratectomy) was the most common. Procedures like these reshape the cornea with the use of a laser to improve vision.
First, the surgeon creates a small flap of corneal tissue that is gently lifted back. This is done with either a blade or a laser in less than 30 seconds. Then a cool-beam laser reshapes the cornea in a minute or less.
The corneal tissue is gently placed back and naturally seals itself, and the majority of patients are driving or back to work the next day, Stetson says.
With PRK, no flap is made. Instead, the surface cells of the cornea are removed, and the laser to reshape the cornea is applied directly to the surface.
Stetson said what’s important to realize is that every eye—and hence every treatment—is unique, even between two people with the same lens prescriptions.
In order to determine which procedure will elicit the best results, doctors at Diamond Vision first use wavefront technology to determine the unique “fingerprint” of each eye.
Stetson, who developed the first summit meeting between the six ophthalmology centers of the U.S. Armed Forces, has the goal of creating the same culture of technological responsibility at his clinic. Few refractive-surgery clinics place the same importance on technology or apply it with as broad a scope as Diamond Vision, Stetson says. The ones that do are academic centers.
“All of our optometrists—we task ourselves to go out and do research,” Stetson said. “So once a month, somebody’s writing something new to the whole collective intelligence.”
Stetson also holds quarterly meetings with his staff to assess their outcomes and attends the two annual ophthalmology academy meetings to see what new technologies are being introduced. He also monitors what different companies are working on before new products are launched.
For instance, the CustomVue machine allows a wavefront measurement 25 times more precise than current machines, and Intralase enables a bladeless and more precise surgery than traditional Lasik. Diamond Vision clinics all have VISX lasers, as they’ve consistently tested better than other lasers in head-to-head, independent surveys, Stetson says, and he looks forward to the next improvement.
“They [VISX] haven’t released [the improvement] yet, but I’ve been to … look at their facilities,” Stetson said. “It’s going to be more precise in terms of that wavefront data, and that data that we get drives what the laser is told to do.”
“There are very few people we can’t help now,” Stetson said. Technology has improved so much that even people whom they were unable to help 10 years ago, can now be helped, he said.
Stetson’s philosophy is to “give the patient the best outcome and don’t do harm.” If a patient doesn’t have a chance of getting the best outcome, he won’t do the surgery.
“What you want to look for is corneal stability,” Stetson said. A stable cornea will ensure a stable prescription over one’s lifetime.
Consultations at Diamond Vision are free, and the patient is tested for the power of their prescription (whether one is farsighted or nearsighted and the level of astigmatism), cornea shape, and cornea strength—an area for which Stetson invested over $75,000 in technology in the past years.
“We analyze how the cornea moves and how it behaves against the force [of air], which is really important,” Stetson said. This gives the doctors information on how the eye would perform under surgery. “The shape of the cornea can look fine, but the cornea strength can be weak. Cornea strength drives you to recommend certain procedures over others, which will perform better over the long term.”
For example, standard LASIK is not a good option for someone with a weak cornea. A more advanced version of the technique involves the use of Intralase, which makes that corneal-tissue flap on the surface of your eye with a laser instead of a blade. It’s more precise and allows the surgeon to make a thinner cut—thus a better option if you’re found to have a weaker cornea.
The third option is PRK, which allows the laser to be applied to the surface of the cornea without cutting into it first.
“PRK is the least invasive of the procedures that we do,” Stetson says. Only surface cells are removed, and the laser is applied right onto the surface afterward. But because it’s essentially an open wound, the cells need to grow back, and that takes about four days. “You’ll feel a bit of discomfort the first three days or so, because it needs to seal itself.”
About 10 percent of people end up being unsuitable for any of the three treatments, Stetson says, but sometimes that’s a temporary issue. For instance, the majority of his patients wear contact lenses. Sometimes a patient’s eyes are too dry because of contacts but are easily retested after the patient stops wearing contact lenses for a period of time.
According to the FDA, if the patient is pregnant, nursing, or has other hormone-related issues like diabetes, that could interfere with testing. Patients under 20 are not recommended for laser eye surgery, nor are those with certain careers that prohibit refractive surgery.
Other times, patients just don’t have suitable corneas or have other problems like a cataract at an early age or lazy eye.
“You have to recognize that certain patients are not going to get a good outcome, no matter how good of a surgeon you are,” Stetson says.
“As a kid I played piano a lot and I was classically trained,” Stetson said. At 17, he remembered looking up and seeing a floater—a common sight when proteins in your eye come together. Stetson went to an ophthalmologist then and recalled being fascinated by the equipment the doctor had.
“I said, ‘Do you have any laser that you can use to take care of this floating thing in my eye?’” Stetson said. Unfortunately the only option was surgery, which the doctor told him was invasive and not recommended.
After medical school, Stetson decided ophthalmology was his biggest interest and joined the Air Force to get the extra training he needed. Near the end of his service, he was offered a position to head the Laser Center at the US Air Force Academy.
“I was able to just really hone my skills in refractive surgery,” Stetson said. “It was a huge, fortuitous move for me.”
Stetson was able to train and meet with doctors like Dr. Robert Smith, who performed the first wavefront-guided LASIK on an aviator, and Dr. Steven Schallhorn, the Navy’s then refractive surgery program manager.
After leaving the Air Force, Stetson in time started his own private practice, initially turning down an offer from Diamond Vision when it was a LASIK-only practice. Eventually he acquired the company and broadened the scope of treatments his seven clinics are now able to provide.
“It now does cataracts, implantable contact lenses, dry eye, a lot of things that patients are coming in and needing,” Stetson said. “[Sight] is such a precious sense.”
Diamond Vision Laser Center
15 W. 44th St. (Between 5th and 6th avenues)
Six other locations in the Tri-State area.