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Peter S. Hersh, M.D.is the Director of the Cornea and Laser Eye Institute of Hackensack University Medical Center.  An honors graduate of Princeton University, Dr. Hersh received his medical degree from the Johns Hopkins School of Medicine. He completed his ophthalmology residency at the Massachusetts Eye & Ear Infirmary, Harvard Medical School, where he received additional specialized fellowship training in corneal surgery. Dr. Hersh remained on the full-time faculty at Harvard until 1990 and is currently a full Professor of Ophthalmology at UMDNJ-New Jersey Medical School. 

Dr. Hersh's professional interests are devoted exclusively to LASIK, LASEK, PRK, and other corneal and refractive surgery procedures. Most prominently, he was lead author of the clinical study that led to first FDA approval of the excimer laser in the United States. As a result of his extensive clinical and research work, Dr. Hersh has published four textbooks and more than 150 research articles and book chapters. Dr. Hersh has also coauthored a book for patients, entitled LASIK Vision Correction. In addition, he is actively involved in a number of international projects to bring education and eye care to developing countries.

Dr. Hersh has been selected for Best Doctors in America, and both New York Magazine and New Jersey Monthly have listed him as one of the top doctors in the New York metropolitan area.

What You Should Know About Lasik

The excimer laser has been developed over the past decade and is now capable of improving the vision of many people with nearsightedness, farsightedness, and astigmatism. Though an extensive pre-operative exam may show that you are medically suitable for a laser procedure, the final decision is ultimately based on your needs and comfort level with the procedure and your surgeon.  Laser vision correction, after all, is an elective procedure and the decision to undergo the treatment is a personal one.

Here are a few questions you may want to ask yourself to first help you decide if YOU think you're ready for LASIK:

  • Do I feel very dependent upon my glasses or contacts?
  • Do I constantly misplace or lose my glasses or contacts?
  • Do my glasses or contacts prevent me from enjoying every day living?
  • Do my glasses or contacts interfere with recreational activities?
  • Do I consider myself intolerant to contact lens wear?
  • Do my hobbies or occupation require "perfect vision"? Remember, LASIK may not achieve perfection.
  • Can I wear my contact lenses comfortably each and every day for as long as I would like?
  • Do my contact lenses get dry and/or gritty during the day?
  • Am I happy with my appearance with glasses?
Choosing a Laser Center and Surgeon

These are some questions to answer when evaluating a laser center and surgeon for your procedure.

  • Will you meet and discuss your procedure with the performing surgeon?
  • Who performs the follow-up examinations?
  • What are the qualifications of the physician providing follow-up care?
  • How thorough is the preoperative evaluation? (This is critical to assure you are a good candidate and to choose the best approach for you particular case.)
  • How is the most appropriate treatment selected?
  • Does the surgeon's training include a fellowship in corneal surgery?
  • Does the surgeon specialize only in corneal and refractive surgery?
  • How long has the surgeon been performing laser vision correction and how many procedures has he or she done?
  • Is the surgeon trained and experienced in performing the full range of vision correction procedures?  Nowadays laser eye surgery is not one-size-fits all.  A variety of procedures are available (e.g. LASIK, PRK, LASEK, CK, PTK) and these should be chosen to give the best result and safety for your particular situation.
  • Does the surgeon statistically monitor outcomes and maintain a continuous quality improvement program?  This allows the surgeon to tailor treatment to your individual characteristics.
What Makes a Good Lasik Candidate?

Once you've decided that you're ready to consider a laser vision procedure, a number of clinical qualifications must first be met. Your doctor will perform a full eye exam with a number of specialized optical tests.  This examination will determine whether you are a good candidate for LASIK or another procedure. The examination should include:

  • Multiple refractive error and optical measurements.
  • Pupil and corneal thickness measurements.
  • Corneal topography map.
  • Tear function analysis

If you wear soft contact lenses, you should not wear them for one week prior to your eye exam; if you wear hard or gas permeable lenses you should not wear them for two to three weeks prior to the exam. This will ensure that your refractive error is measured properly.

In general, the ideal patient has a healthy cornea, free of diseases like cataracts, glaucoma, kerataconus or herpes infections of the eye, to name just a few problems. Patients should be free of any corneal scarring caused by a previous injury or infection. People with certain medical conditions, like uncontrolled diabetes, rheumatoid arthritis, lupus or an autoimmune disease are not good candidates since these may impair healing and lead to inflammation.

Women who are pregnant or nursing may not be good candidates. Hormonal changes can affect the eye's refraction, leading to a less accurate long-term result.  In addition, the interaction of the laser with the corneal tissue may be less predictable, possibly on the basis of hydration changes.  We advise against treatment in pregnant women, and waiting 1-3 months after completion of nursing before undergoing a procedure.  The effects of hormone replacement therapy (HRT) on LASIK are unknown.  We do prefer waiting until hormonal status is stable if HRT is being used.

 A good candidate should have realistic expectations. Your refractive error, occupation, leisure activities, age and personal expectations all help to determine whether you are a good candidate for vision correction surgery. Not everyone should expect a perfect result. Of course, we will always attempt to achieve the best possible visual result.  Some patients (approximately 10%) will require a second "enhancement" procedure to achieve their best outcome. Still, some patients may require glasses for certain activities. Finally, around the age of 40, presbyopia, or the age-related need for reading glasses, eventually finds its way into everybody's life.  Reading glasses, or magnifiers, will still be necessary for up-close work.  Although there are some ways to minimize this, it is a subject that is a little confusing and should be discussed with your surgeon.

Laser refractive surgery and other procedures have come along way in the past ten years.  Proper evaluation, treatment selection, and follow-up care will assure whether you are a good candidate, determine the procedure best for you, maximize safety, and insure the best possible result.

For more information about Lasik or to reach Dr. Hersh, click here.

Created: 8/17/2002  -  Peter S. Hersh, M.D.

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