Dr. Joseph J. K. Ma

Advanced Surface Ablation: ISA®


SMILE, ICL, Other Refractive Options

Eyes Over 40: Need for Reading Glasses

ISA® Customized Laser Vision Correction

Laser vision correction procedures have been safely performed for more than 25 years. They work by permanently reshaping corneal tissue in order to correct your vision. There are currently three methods to reshape the cornea with a laser:

1) Advanced Surface Ablation (ASA), which is Flap-Free and Blade-Free (also known as LASEK, or Advanced-PRK),

2) LASIK, which requires a flap (either achieved using a blade or performed bladeless), and

3) SMILE, which requires a corneal pocket and manual manipulation of a corneal lenticule.

The best method for you depends on a combination of the specific characteristics of your eye, your prescription, as well as a comprehensive assessment of your visual needs and expectations, which we can assess accurately with our ISA® 13-D Diagnostic Assessment. Sometimes, based on these exams, we may decide that Laser Vision Correction is not the best procedure to correct your vision. In these cases, other procedures such as ISA® Bespoke Blended Vision, ICL’s, RLE’s or ISA® Refractive Cataract Procedures may be more appropriate.

We believe that every patient deserves the benefit of the most advanced and proven technology for their particular situation based on more rigorous and objective metrics than the standard. As such, we offer ISA® Customized Laser Vision Correction.

There are two stages to ISA® Customized Laser Vision Correction: the diagnostic stage and the surgical stage. Using our proprietary Intelligent Systems Approach® (ISA®) we ensure that both the diagnostic and surgical stages are fully optimized for your unique eyes beginning with a rigorous in-depth assessment.

At the diagnostic stage of vision correction, gathering the most accurate, detailed, and objective measurements is critically important to ensuring the best possible vision. The more detailed and accurate the measurement, the more meticulous the correction can be. This results in superior post-operative acuity.

Each eye is unique, and as such, specific diagnostic technology is better suited at detecting and capturing certain anatomic characteristics. For that reason, to obtain the most accurate representation of your corneal and visual system architecture, we conduct an ISA® Customized 13-D Diagnostic Set to ensure superior results for you. This means that we perform multiple rounds of measurements using more than 13 uniquely specialized diagnostic tools, resulting in the most detailed and accurate measurements possible.

ISA® Customized Advanced Surface Ablation

This procedure involves reshaping the surface of the cornea based on your ISA® Customized 13-D Diagnostic Set. It is blade-free and flap-free. For some patients, this is the safer approach to laser vision correction and can result in better vision than either LASIK or SMILE. Typically, this procedure is also recommended for candidates who may have:

● Thinner than average corneas

● “Soft” corneas

● Dry eyes

● Severe refractive errors

● Lifestyles that place them at increased risk for eye injury

● Certain demographic and ethnic groups

ISA® Customized LASIK

First a confirmatory ISA® Customized 13-D Diagnostic Assessment is performed, which includes an a detailed assessment of the Wavefront of your particular visual system. Then an ISA® Customized Technique is used to create a blade-free corneal flap using a femtosecond laser. We use a laser blade-free flap because it has been demonstrated to be more accurate and reproducible with a lower incidence of complications. A second excimer laser is then utilized to reshape the inner bed of corneal tissue based on your ISA® Customized Diagnostic Set. This is currently the most commonly performed type of laser vision correction.

Between the two main types of laser vision correction, and among the many other surgical options available, there is a specific customized solution that will yield the best results for you. By using the ISA approach, our Surgeon will determine which procedure is best suited for your unique needs.


Am I a Candidate?

If you need contact lenses or glasses to see clearly, then you will likely benefit from laser vision correction. To know for certain, visit us for an ISA® Customized Surgical Consultation.

Potential candidates begin benefiting from our Intelligent Systems Approach® at the consultation stage. Our Surgeon-led team of Vision Care Associates performs meticulous diagnostic measurements using trusted and proven technology in addition to an in-depth qualitative evaluation. Drawing on over a decade of gathered insight and specialized education, our Surgeon analyzes and integrates the objective diagnostic information to develop a customized recommendation and surgical plan for you.

The purpose of your surgical consultation is for our Surgeon to assess your unique needs, make a customized surgical and refractive recommendation and answer any medically-related questions. How to proceed is always up to you. To assist with your decision-making process, our Patient Consultant will take the time to explain your options and answer any non-medical questions you may have.

We assess key deciding factors at your surgical consultation to determine whether or not you are a suitable candidate for ISA® Customized Laser Vision Correction. These include:

● Personal & Professional Considerations

● Lifestyle, Habits & Hobbies

● Physical Anatomy & Characteristics of Your Eye

● Health of Your Eye

● Overall Health

● Family History

● Age

Some of the conditions that will affect these key deciding factors include:

● Medications

● Dryness of the eyes

● Corneal thickness

● Eyeglasses prescription stability

● Eye inflammation or infection

● Corneal disease or scarring

● Diabetes & other systemic diseases

For patients who are nearing the age when reading glasses will be required, ISA Customized Laser Vision Correction can be performed in combination with ISA Customized Bespoke Blended Vision to minimize the need for reading glasses. Blended vision the use of one eye for distance vision and the other eye for intermediate near vision and is different from traditional monovision.

Advancements and research in vision correction have produced a multitude of surgical options and new information. Based on our rigorous proprietary in-depth ISA® assessment, our Surgeon will identify and recommend the specific option and relevant parameters that is best suited for your unique needs.

How is Laser Vision Correction Performed?

Laser vision correction works by definitively reshaping your cornea to correct your refractive error. There are three broad categories of laser vision correction, Advanced Surface Ablation (ASA, also LASEK, A-PRK, Blade-Free, Flap-Free) LASIK, and SMILE.

Within the broad categories for ASA and LASIK, there is a single standard method versus several customized methods. The typical standard method does not compensate for the small unique imperfections and characteristics of each individual’s eyes, known as Wavefront anomalies, and therefore is more likely to result in suboptimal post-operative results and in some cases degraded post-operative night vision. SMILE is a new form of laser vision correction that is currently only available in a standard method.

Although we have access to both standard and customized methods, we generally offer customized methods to all patients who would benefit from these more advanced diagnostic methods since they will generally result in a better visual result. There are several different subtypes of customized corrections, which include:

● WaveFront Guided

● WaveFront Optimized

● Topography Guided

● Scheimpflug Image Guided

Our Surgeon’s depth of experience allows for performing the necessary dynamic refinements to the technique for each of the chosen subtypes in every procedure.

Our Surgeon will make a surgical and refractive recommendation for which customized subtype will result in the best post-operative vision for you at your ISA® Customized Surgical Consultation.

What to Expect

Our Surgeon, Patient Consultant and dedicated Vision Care Associates will be with you every step of the way to answer questions and to make sure that you have the very best possible experience and post-operative outcome.

ISA® Customized Surgical Consultation

There are 3 important components to your ISA® Customized Surgical Consultation. First, our Surgeon-led team of Vision Care Associates will meticulously measure your corneal and visual system architecture using more than 13 different diagnostic tools in addition to administering a qualitative assessment of your lifestyle and overall health. Secondly, our surgeon will assimilate and integrate both the quantitative and the qualitative diagnostic information to determine whether or not you are a good candidate for laser vision correction, and if so, which form of ISA® Laser Vision Correction best suits your needs. If you are not a candidate for Laser Vision Correction, our other procedures including ICL’s, RLE’s and Refractive Cataract procedures may be more appropriate. Our Surgeon will make an objective surgical and refractive recommendation as well as answer any medically-related questions. Finally, to assist you with your decision-making process our Patient Consultant will discuss your options and answer any non-medical questions you may have.

ISA® Customized 13-D Diagnostic Set

Our Surgeon-led team of Vision Care Associates will thoroughly refine our representation of your corneal and visual system architecture through multiple measurements using a combination of the diagnostic tools identified as being best suited to measure your unique eyes at your ISA® Customized Surgical Consultation. To ensure that we have obtained the true representation, we perform the final phase of the ISA® Customized 13-D Diagnostic Set by validating and re-measuring your eyes on the day of surgery. This allows for an objective comparison and validation of the diagnostic dataset prior to any procedure. This overall refining process allows us to deliver unparalleled post-operative results.

Preparing for Surgery

To ensure that you have the necessary support at home, we always suggest that you involve a family member or caregiver throughout the entire process and that this individual should accompany you to all consultation and follow-up appointments if possible.

It is very important to the health of your eyes that you administer your eye drops properly. To prepare for surgery, you should familiarize yourself with the instructions.

Day of Surgery

On the day of your surgery we will perform the final phase of the ISA® Customized 13-D Diagnostic Set. Once the data has been thoroughly examined and validated, you will be ready to proceed. You can expect the procedure to last about 10 – 20 minutes. For some ISA® Customized Laser Vision Correction procedures, our Surgeon may place a protective contact lens on your eye post-operatively. You may be required to wear the protective lenses for the first 3-5 days after surgery.

After Surgery

You should wear protective sunglasses immediately after the surgical procedure and for the first several months after surgery when you are outside. It has been demonstrated that protection from ultraviolet radiation from sunlight improves wound healing. Do not allow tap water to make contact with your eyes and avoid swimming and hot tubs for the first couple of weeks after surgery.

For ISA® Customized Surface Ablation patients, it is important to be aware that you may experience moderate to significant eye discomfort from Day 2-3. This is to be expected and we will provide medications to help make you feel as comfortable as possible during the healing phase.

It is important never to rub your eyes. This is especially relevant for ISA® Customized LASIK patients, so that they do not inadvertently displacement of their corneal flap.

Customized Post-Operative Eye Drop Schedule

Each person’s recovery is unique and is often related both to their refractive error as well as their own individual physiology and health; your post-operative eye drop schedules will be custom designed to optimize your recovery. It is extremely important that you follow your customized post-operative eye drop and medication schedule to both heal and maintain your newly improved vision.

It is important to remember that you must continue complying with your customized eye drop schedule for the prescribed duration, even when your vision has become clearer and your eyes feel significantly more comfortable, otherwise you may not be able to achieve your full visual potential. We can often think of surgery as accounting for 85% of what is required to achieve excellent visual acuity. The other 15% depends on other factors including the post-operative care administered at home.

In addition to your prescription eye drops, you will be instructed to use non-preserved artificial tears. Though not a prescription medication, non-preserved artificial tears are very important to facilitating your eye’s healing process and for improved comfort. Sometimes other interventions such as lid hygiene, warm compresses, Omega 3 fatty acids, oral medications as well as punctal plugs may be suggested to improve the healing process and maximize your visual potential.