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
Choosing a Laser Center and Surgeon
- 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
These are some questions to answer when evaluating a laser center and surgeon
for your procedure.
What Makes a Good Lasik Candidate?
- 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
- 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
- Does the surgeon statistically monitor outcomes and maintain a continuous
quality improvement program? This allows the surgeon to tailor treatment
to your individual characteristics.
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
- 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
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
Created: 8/17/2002  - Peter S. Hersh, M.D.