Laser Eye Surgery Procedures

At the Alpha Laser Center, we take pride in maintaining the finest Lasik facilities in San Diego. From the moment you walk in, you'll notice our attention to detail.

We offer the following laser procedures:

LASIK- Laser Assisted In Situ Keratamileusis. This is a procedure where a corneal flap is made consisting of the outer clear skin layer (epithelium) and a small layer of the stroma of the cornea. This allows the stroma to be exposed, and the excimer laser is used to re-shape the cornea. With hyperopia, the laser removes tissue from the outer part of the cornea, with myopia, it is removed in the inner part of the cornea, and with astigmatism tissue is removed preferentially along one axis of the cornea. With Dr. Motwani’s techniques, discomfort and visual rehabilitation take 3-6 hours after surgery.

PRK- Photo Refractive Keratectomy. This is the original laser procedure where the outer clear skin layer of the cornea is scraped away and the cornea is re-shaped using the excimer laser. The amount of skin scraped away depends on the type of re-shaping being done, and usually takes about 2-4 days to heal. A contact lens is used as a bandage lens to aid healing and decrease discomfort. Modern PRK post-op care limits pain to mostly the day of the procedure, with little to no pain after day one. PRK is used in cases where a LASIK flap is not appropriate or not desired.

LASEK. This is a procedure where the outer clear skin layer (epithelium) is weakened with alcohol, and removed carefully in whole form to expose the stroma. The excimer laser is used to re-shape the cornea, and the loosened epithelium is replaced with a contact lens as a bandage. This procedure usually takes 5-6 days to heal, has a significant amount of epithelium loss due to alcohol being toxic to epithelium, and has been largely supplanted with Epi-LASIK.

E-LASIK or Epi-LASIK. This is a newer, advanced procedure in which a special micro-keratome is used to make a flap of only the clear outer skin layer (the epithelium). This exposes the stroma, the excimer laser is used to re-shape the cornea, and the epithelial flap is replaced and a contact lens is placed as a bandage. This procedure is used wherever a LASIK flap is not appropriate or desired, such as with thin corneas, corneal dystrophies, or where the patient does not want a LASIK flap. It has also been used very successfully by Dr. Motwani in cases of high prescriptions, which require high amounts of tissue for re-shaping. Since the entire stromal depth is available for the re-shaping, it creates a higher margin of safety also.

Laser vs. Blade Microkeratomes. The micro-keratome is a device used to make a flap in he cornea. Over the past few years, a laser micro-keratome, the Intralase, has been introduced and heavily marketed as “All Laser LASIK.” The Intralase still makes a flap, usually has longer healing times (as much as 24 hours of discomfort vs. 3-6 hours), and longer visual rehabilitation (as much as 48 hours instead of overnight), and is also more expensive. Furthermore, the Intralase does not make a smooth cut, but actually makes multiple perforations in the flap, and the flap has to be raised forcefully with a forceps.

For the past several years Dr. Motwani has been using what he considers the most advanced blade micro-keratome, the Moria M2. This device makes very smooth, quick, reliable, corneal flaps with a flap complication rate of 1-2 flaps per year. Because of the extreme reliability of this device, the extremely smooth flap beds, and the faster rehabilitation times, Dr. Motwani continues to recommend blade over laser micro-keratomes until such day as the discomfort and rehabilition times can be brought on par with the Moria M2.

Custom Ablations. These are various forms of laser ablation patterns that allow for a higher degree of 20/20 visual results, and a higher amount of better than 20/20 results (usually measured as 20/15 vision rates). Many of these use wavefront analysis to determine how to shape the cornea. Since 2002, Dr. Motwani has pioneered a custom system that allows for more prolate cornea, Aspheric Ablation. This was originally intended to decrease night glare and halos, and to decrease losses in contrast sensitivity, but this procedure also gave some of the highest 20/15 rates from any custom excimer laser system. Since then, a 68% 20/15 rate has been achieved for single eye visual acuity, a more rigorous test than bilateral visual acuity. Most other custom systems have 30-40% 20/15 rates.

Prolate Ablations. The original corneal shape is prolate, i.e. a dome like the side of a ball. When you re-shape a cornea for myopia, you create a bucket or divot like shape in the cornea, causing it to become oblate. This creates a completely different light entrance pattern at the periphery, causing night glare/halos and contrast sensitivity loss. Even if a wavefront laser pattern perfectly smooths the center cornea, the oblate overall shape of the ablation can still lead to contrast sensitivity losses and night glare/halo issues. A prolate ablation much more closely resembles the dome like shape of the natural cornea, especially in the area of pupil dilation, and therefore acts much like the normal eye with the additional advantage of corneal smoothening by the excimer laser. That is what accounts for the high 20/15 rate of this procedure. Further advantages are less central tissue removal, and excellent overall regression rates.

We recognize that visiting the doctor may make some a bit nervous. Our desire is to create a warm and welcoming space as you await your consultation or surgery.

We Use Our Own Equipment

While other laser surgeons use rented machines, we maintain our own lasers in-house. This allows us to have greater control over how the lasers are used and maintained. We believe your eyes will notice the difference.

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