August 30, 2024
By Stephen C. Coleman, MD, and Colman R. Kraff, MD
By Stephen C. Coleman, MD
The 1st International Wavefront Congress was held in Santa Fe, New Mexico, in 2000. Because the meeting was nearby and I was free that weekend, I went. In many ways, the experience changed my life. Most attendees were optical scientists and engineers, but among the smaller group of ophthalmologists present was Theo Seiler, MD, who had flown in from Dresden, Germany.
I learned that day that, depending on what it is made of, a mirror can deform, and I was introduced to the field of adaptive optics. (Click on the button below to watch my TEDTalk on the evolution of wavefront technology.)
The story of the iDesign Refractive Studio (Johnson & Johnson Vision), the wavefront-guided (WFG) system I use and that is used around the world, begins here in New Mexico with Dan R. Neal, PhD. Scientists eager to avoid the optical problems that nearly doomed the Hubble Space Telescope turned to Neal and his team of researchers at Sandia National Laboratories to fine-tune the giant mirror on the James Webb Space Telescope to ensure that it returns sharp images of the universe.
Neal adapted the same technology that helps image objects in deep space for use in an aberrometer—an instrument used to capture information about an eye and subsequently drive the laser profile for LASIK. Visx (now Johnson & Johnson Vision), in a prescient move, purchased Neal’s system around 2001 and called it the WaveScan System. I consider this to be one of the most significant advances in the nearly 3 decades that I have been performing LASIK. It has largely fueled the excellent results and reputation that we surgeons enjoy today with modern LASIK.
The aberrometer has an array of approximately 5,000 lenses, each with the diameter of a human hair. They are housed in a chip about the size of a thumbnail. The sensor measures the direction that light is traveling at many points across the pupil to produce a highly accurate characterization of the light path. The versatility of the aberrometer allows it to measure any kind of light, whether it is bounced off a mirror or, as is the case with LASIK, reflected from the retina.
A WFG procedure addresses the next level of mathematical terms, known as higher-order aberrations (HOAs), which also contribute to the way a person sees. The Zernike polynomial describing these aberrations is theoretically infinite. HOAs include spherical aberration, coma, trefoil, and quadrafoil. They are a small refractive component of vision, but they can be measured and treated. Correcting HOAs creates an opportunity for patients to see better after LASIK than they did before surgery with their glasses or contact lenses.
Together with the ability to gather more information from an aberrometer came the change in the laser profiles required to treat these newly acquired measurements. Eliminating myopia and astigmatism can be efficiently accomplished with a relatively straightforward beam profile. Treating the mathematical terms that are much smaller but also affect vision requires far more precise laser pulsing and, more specifically, the ability to change pulse diameter and speed rapidly, resulting in an exceptionally accurate correction.
Every wavefront procedure is unique to the individual eye and, by definition, cannot be repeated. Treatment can address not only a prescription but also a symptom. For instance, what a patient calls halos wavefront scientists call spherical aberration, and a correction for this is built into the laser algorithm as part of the treatment.
I was a principal investigator on all of the US FDA clinical trials for this WFG laser technology, starting with the initial one in 2002, and the results have made me a true believer. Conventional LASIK essentially matches a Placido disc image from a topographer to a patient’s prescription. A WFG procedure takes into consideration a patient’s entire optical system from back to front. This was a paradigm shift in our approach to laser vision correction. This is not hyper-bole. I remember receiving a phone call from Colman R. Kraff, MD, halfway through the first study for low myopia during which he exclaimed, “This is game-changing technology!”
Marc Odrich, MD, one of the most influential ophthalmologists to greatly improve our understanding of this technological advancement, described it to me with the following analogy: If a patient’s prescription is like a wall that needs painting, a conventional treatment accomplishes this using a roller. It’s effective but lacks precision. AWFG procedure also uses a roller but, more importantly, can use multiple small, fine paintbrushes for added accuracy and precision to make the corners and edges just right.
A consequence of this precision is that a WFG procedure is often the cleanup hitter for other amazing refractive procedures currently offered to patients. Whether a procedure is lens-based or intracorneal, its outcome requires fine-tuning or enhancement in a small percentage of patients, and this is generally accomplished with a WFG correction, either on the surface or under a flap.
Many consider our current era of vision correction to be one of the greatest collaborative efforts in the history of medicine. Ophthalmologists, optometrists, opticians, optical scientists, engineers, celebrities, venture capitalists, patients, big pharma, LASIK corporations, and the US military are just some of the players who have contributed significantly. This team effort, coupled with patient demand, is a fundamental reason why the future of LASIK remains very, very bright.
BY COLMAN R. KRAFF, MD
In his portion of this article, Stephen C. Coleman, MD, describes the early days of the WFG technology currently used to treat LASIK patients worldwide. I, too, recall the first patients I treated with Visx technology. In 1999, the initial WFG treatments in my office used the Visx WaveScan aberrometer. Patient treatment tables were calculated manually using Microsoft Excel(Microsoft) spreadsheets. The first patients obtained excellent results, which spurred the expansion of US FDA trials across the country using the WFG Visx system.
Nearly 2.5 decades later, multiple laser manufacturers offer variations of this wavefront technology for laser vision correction worldwide. This progress required a commitment from refractive surgeons to conduct US FDA trials and clinical studies, investments from medical device manufacturers, and patients who believed in the technology and sought a lifestyle free from glasses and contact lenses. Over the years, the technology has evolved significantly, and the Table reflects the current excimer laser systems available in the United States that are used to perform these customized treatments.
As an early principal investigator focused on refractive surgery, I participated in numerous US FDA clinical trials. Today, commercially available technology provides outstanding clinical outcomes for a wide range of refractive errors. This was not always the case. Robert Maloney, MD, Dr. Coleman, and I were among dozens of investigators treating patients under stringent US FDA–guided clinical trials using what is now the iDesign Refractive Studio.
After completing the most recent US FDA trial that led to the approval of the iDesign system for the treatment of myopia, hyperopia, and astigmatism, my fellow investigators and I aimed to replicate the trial results in a real-world setting. Treating patients in a commercial setting versus a highly regulated US FDA trial can be significantly different.
Our study used similar approved indications and labeling. The goal was to create a simple nomogram for surgeons of any skill level using the iDesign Refractive Studio and then, in a clinical setting, replicate the results achieved in the US FDA trial. Our results were published in the Journal of Cataract & Refractive Surgery. This study is one of many published in peer-reviewed journals worldwide using this and similar technologies from various medical device manufacturers.
The development of new technologies during the period when the original Visx platform was released and their evolution raised the bar on patients safety and outcomes. what began as an idea at Sandia Labs in New Mexico 25 years ago has become an industry that enables refractive surgeons to provide excellence to patients seeking freedom from spectacles.
■Director, Coleman Vision, Albuquerque, New Mexico
■ Member, CRST Editorial Advisory Board
■ stephen@colemanvision.com
■ Financial disclosure: Consultant (Johnson & Johnson Vision); International Medical Advisory Board Member (Optical Express)
■Director of Refractive Surgery, Kraff Eye Institute, Chicago
■ Member, CRST Editorial Advisory Board
■ ckraff@kraffeye.com
■ Financial disclosure: Consultant (Johnson & Johnson Vision); International Medical Advisory Board Member (Optical Express); Medical Advisory Board Member (Lenz Therapeutics)
February 2, 2023
You may be wondering what the Courtyard by Marriott has to do with the pandemic. Well as it turns out, a lot. At the start of the pandemic, in early March 2020, businesses began to shut down in record numbers, including hotels and restaurants. While all of the hotels surrounding Coleman Vision closed, the Courtyard by Marriott located directly next door to our office, was deemed essential and remained open.
More than half of our patients come from outside Albuquerque, mostly from the southwest but also from around the country. We provide an overnight stay for these patients at the Marriott which is why Coleman Vision has been the single biggest client for this hotel for 22 years. They take incredible care of our patients, many of whom are understandably a little nervous when they arrive.
LASIK has always been a great way to get out of glasses and contact lenses but its’ popularity soared to new heights at the beginning of the pandemic. There were multiple reasons for this; many that could be anticipated and some that were unexpected.
First and foremost, for many people glasses and masks are completely incompatible. Frames slipping down their nose as well as constant fogging can make things difficult at best. Not surprising, our healthcare workers, and specifically nurses, have great difficulty wearing glasses over a mask, particularly when you add a face shield to the equation as well as sterile gloves. This makes for an unsafe environment to read monitors, start IV lines, and chart progress notes for optimum patient care.
In the early days of the pandemic, the route of transmission of the coronavirus was not fully understood and as a result many healthcare facilities placed a ban on wearing contact lenses. For a person accustomed to wearing contact lenses, especially the extended-wear type, this dynamic became particularly problematic. Going from always wearing a contact lens to only wearing glasses can be life-altering when considering the loss of peripheral vision as well as the effect of all images being made smaller by the eyeglass prescription.
Additionally, and somewhat unexpectedly, when doctor’s offices began to close many patients immediately lost access to contact lenses, new prescriptions, and routine eyecare. This really drove home the point for many people regarding their true dependence on their preferred way to correct their vision and left many feeling not only vulnerable but unsafe. Similar to being caught in a remote area and developing an eye issue related to a contact lens, or suddenly losing a pair of glasses in an area unfamiliar to you, not having a way to correct vision can be quite threatening. These scenarios made a lot of people consider LASIK as a way to allow them to see independently.
So thank God for modern LASIK, motivated patients, and the wonderful staff at the Courtyard by Marriott!
August 9, 2022
LASIK Surgery Myths
If you are considering LASIK eye surgery, you may have heard some common myths surrounding the surgery, but not all these are indeed facts. Dr. Stephen C. Coleman, Director of Coleman Vision, compiled a list of common myths you may encounter when researching LASIK eye surgery.
Myth: I am too young or old to get LASIK
At Coleman Vision, we begin to evaluate patients for LASIK eye surgery at age 18. Age plays a role but is not the only determinant as to whether you would be eligible for the procedure. Each patient is assessed on an individual basis by Dr. Coleman. Candidacy is driven by pre-operative measurements and data, not only age.
Myth: LASIK is Painful
Patients may experience slight pressure during the procedure, but most report that they do not feel anything at all. During recovery, patients may experience itching and burning, which is short-lived. We give all of our patients a prescription sleeping aid for after the procedure in hopes they sleep comfortably in the immediate hours following their LASIK.
Myth: LASIK Can’t Treat Astigmatism
Laser vision correction has had many technological advances. Dr. Coleman has a particular interest in treating astigmatism and specializes in this. Dr. Coleman did the first FDA approved LASIK procedure to treat astigmatism in 1998. Here at Coleman Vision the amount of your astigmatism is secondary to the shape of it. We can treat multiple eye conditions, like nearsightedness, farsightedness, with or without astigmatism, and astigmatism alone.
Myth: LASIK Can Wear Off
LASIK is a permanent reshaping of the cornea. Laser vision correction will last a lifetime, but it does not prevent eye conditions that come with age. The need for reading glasses is a normal change related to aging that typically starts around 40 years old. Over the course of many years, you will likely need more magnification to see things up close.
Dr. Coleman is a leader in the field and has over 27 years of experience in laser vision correction. Reach out to us today to schedule your free LASIK consultation and get on the road to see more clearly!
June 30, 2022
The success of the James Webb Space Telescope, launched Christmas Day 2021 and considered the world’s most powerful, in part belongs to New Mexico’s Dan Neal.
Scientists eager to avoid the optical problems that nearly doomed the Hubble Space Telescope turned to Neal and his team of Albuquerque researchers to fine-tune the giant mirror on the James Webb Space Telescope to help ensure that it returns sharp images of the universe.
Neal uses the same technology to measure tiny aberrations in the human eye, providing an accurate prescription for correcting vision. A diagnostic tool Neal developed is approved by the U.S. Food and Drug Administration to guide LASIK procedures.
A 1976 Eldorado High School graduate, Neal developed a sensor during his 13 years on staff at Sandia National Laboratories that can precisely measure light using thousands of tightly packed lenses.
“It is an array of lenses,” Neal said of the sensor. “Each lens is about the diameter of a human hair, and there are about 5,000 of them in a little chip about the size of your thumbnail.”
The sensor measures the direction that light is traveling at many points, allowing researchers to fully characterize the light beam. The versatile sensor can measure any kind of light, whether it is bounced off a mirror or transmitted through the eye.
“If you want to measure the eye, you project a little bit of light into the eye and see how light comes back from the eye,” he said.
The ability of the sensor to accurately map the eye led to the development of a diagnostic tool called an aberrometer, which Neal first introduced in 2000.
The aberrometer measures an eye’s prescription at 1,000 data points across the pupil, mapping the cornea back to the retina, making it ideal for LASIK treatments.
LASIK is a surgical technique that uses lasers to correct vision by reshaping the surface of the cornea.
Neal co-founded a Sandia Laboratories spinoff firm called WaveFront Sciences in 1996 that was purchased by Abbott Laboratories in 2009.
Neal’s operation today employs 20 people in Albuquerque. The term “wavefront” refers to the measurable light that emerges from the eye.
Dr. Stephen Coleman, an ophthalmologist and Director of Coleman Vision in Albuquerque, which specializes in LASIK, met Neal in 1999 at the first International Wavefront Congress in Santa Fe, where Neal demonstrated a prototype of his aberrometer to a few scientists and ophthalmologists.
Coleman was a Principal Investigator in the first FDA clinical trial for Neal’s invention in 2002 and all subsequent studies since then. He uses the technology in his clinic today.
Neal “to a great extent changed the way LASIK is done, not just nationally, but internationally,” Coleman said. “It literally changed the way that we approach LASIK, which is why modern LASIK is so incredibly powerful.”
Neal’s aberrometer, marketed by Abbott Laboratories as the iDesign Advanced WaveScan Studio System, is approved by the U.S. Food and Drug Administration and is now widely used across the U.S., a spokesman for Abbott said. The device has also been widely used in Europe and Japan since 2012.
June 21, 2021
There are thousands of stories detailing how LASIK eye surgery has improved the performance of athletes across a wide range of sports. Examples at Coleman Vision in Albuquerque, New Mexico include professional golfer DJ Brigman, tennis professional Jeremy Dyche, and New Mexico United professional soccer player Sergio Rivas. Dr. Stephen Coleman says that sports enthusiasts of all stripes can benefit from LASIK eye surgery whether it be cross-fit, cycling, swimming, skiing or just playing catch with a kid in the backyard.
A not so obvious comparison can be made between what LASIK eye surgery can do for athletic performance and the trajectory of accomplishments made by South Africa’s now fallen hero Oscar Pistorius. Born missing the outside of both feet as well as bones in his lower leg, Pistorius underwent bilateral below-knee amputations at 11 months old.
Despite this, he went on to compete with prosthetic legs as a sprinter in the Paralympic Games. But as the technology around prosthetic limbs advanced, Pistorius, christened the “Blade Runner” by his Nike sponsors and also known as “the fastest man on no legs,” began to compete in the Olympic Games against able-bodied opponents which ignited a firestorm of controversy. The suspicion was that the advanced protheses actually served as an advantage, not a disadvantage, to Pistorius while sprinting.
A similar observation can be made regarding patients who undergo LASIK eye surgery at Coleman Vision in Albuquerque, New Mexico. Dr. Coleman frequently observes patients who, once they’ve had their cornea optimized with the precision of today’s laser in the era known as Modern LASIK, see better than 20/20 without glasses or contact lenses and frequently see better than their counterparts who never wore glasses or contact lenses and therefore have never had LASIK eye surgery.
This observation is supported by a recently published paper in the Journal Of Cataract And Refractive Surgery (May 2021) in which Dr. Coleman was a Principal Investigator showing that 96.4% of eyes achieved 20/20 or better uncorrected visual acuity.
So if you are thinking about upping your game a notch, Schedule A Consultation to see if you are a candidate for LASIK eye surgery at Coleman Vision!
April 6, 2021
Follow Dawn Perez, the chief writer, designer and creator at Wild Simple Joy, a Certified Life & Nutrition Coach, as she chronicles her LASIK journey at Coleman Vision!
January 27, 2021
Dr. Stephen Coleman, a LASIK eye surgeon in Albuquerque, New Mexico, believes that the history of LASIK can most accurately be summed up with 2 words: progress and cooperation. Many people are convinced that there has never been a more successful example of a true team effort in the history of medicine. Significant contributors to the changes in LASIK surgery have come from a variety of fields and walks of life including ophthalmologists, optometrists, opticians, optical engineers, optical scientists, venture capitalists, national laboratories, the United States military, well known TV and movie personalities, as well as patients themselves.
Perhaps the single most significant advancement in LASIK surgery resulting from this wide-ranging collaboration is the transition to using an aberrometer to measure a patient’s wavefront and then using an excimer laser to correct this wavefront on the cornea. LASIK eye surgery done in this fashion are 100% unique to an individual and by definition cannot be reproduced.
The wavefront aberrometer was substantially developed in Albuquerque, New Mexico in the late 1990’s at a company initially called Wavefront Sciences. As is the case with many great technologies, the intent at first was not to build an instrument that would fundamentally change the way in which LASIK is performed around the world. It started as an attempt to eliminate atmospheric distortion when viewing objects from deep space with telescopes on earth.
A brief, 10 minute summary of this technology can be found in Dr. Coleman’s TEDx Talk titled “Seeing Clearly in the Future.” The evolution to the iDesign that Dr. Coleman uses for his LASIK surgery is based on the use of internal adaptive optics, with hundreds of tiny lenslets located within the aberrometer that adjust the shape of a patient’s wavefront in order to optimize the shape of the cornea. Particularly when compared to glasses and contact lenses, the precision, accuracy, and reproducibility of this approach to LASIK eye surgery cannot be overstated.
December 14, 2020
Dr. Stephen Coleman, founder of Coleman Vision in Albuquerque, New Mexico, has been performing LASIK eye surgery for the past 25 years. He has seen many advances and changes in LASIK and has been at the forefront of cutting-edge technology over the years. Much of this technology has been developed in his hometown of Albuquerque, New Mexico by companies that had their start at Sandia National Laboratories.
Dr. Coleman remembers well the “early adopters” of LASIK eye surgery. These were primarily patients who had very large eyeglass prescriptions and no longer wanted to deal with the limitations of wearing glasses which include seeing everything smaller than it actually is (image minification) as well as the loss of peripheral vision. These highly nearsighted patients trusted the accuracy, precision, and reproducibility of laser technology for LASIK even in its early stages.
Wow, have times changed! As Dr. Coleman’s recent TEDx talk illustrates, found on the Coleman Vision website for LASIK eye surgery, the technology today is typically far superior for correcting vision with LASIK than what contact lenses or eyeglasses can offer. But what has been truly surprising at Coleman Vision is the patient population that is driving the current world-wide surge in LASIK eye surgery.
Our on-going COVID-19 pandemic has placed many people in a difficult position to navigate their day while wearing a mask over eyeglasses due to excessive fogging and slippage. This is particularly problematic for our first responders, nurses, firefighters, and law enforcement officials. In addition, contact lenses can act as a reservoir or receptacle for pathogens and air-borne particles which in these uncertain times has become a greater concern. There are several ways to correct vision and in the proper setting, LASIK eye surgery is a great option!
November 2, 2020
The United States Military has played a pivotal role in advancing the use of lasers to correct vision from the very beginning. The groundwork for the current acceptance of LASIK surgery by all branches of the military was laid in San Diego starting in the late 1980’s when NAVY SEALs underwent laser vision correction as part of a prospective study established and championed by Steven C. Schallhorn, M.D., a dear friend of Dr. Coleman’s and true pioneer in the field of refractive surgery.
Especially for high profile and very expensive-to-train soldiers, such as pilots and SEALs, having laser surgery is a much more practical, safe, and effective way for the military to retain these assets in their job profile without wearing glasses or contact lenses. The United States Military considers vision to be part of the “human weapons system” and every bit as important as the tactical weapons that are deployed in combat.
Many years ago, Dr. Coleman had the opportunity to spend the night on an aircraft carrier, the USS John C. Stennis, in order to watch Navy pilots who had had LASIK land their fighter jets, at night – a trip organized by Dr. Schallhorn. He considers this to be one of the most awe-inspiring and life-changing events he has ever witnessed.
This, coupled with his years as a flight surgeon for an Apache attack helicopter brigade after spending time with the Ophthalmology Consultant to the Surgeon General at Walter Reed Army Medical Center in Washington, D.C., made Dr. Coleman a true believer in the military commitment to ensuring that soldiers have the very best vision possible when in the service of defending our great nation.
Thank you to all our Military personnel for your service and commitment. Special thanks to Dr. Coleman, recipient of a total of ten prestigious honors including the Bronze Star and Air Medal.
September 25, 2020
Dr. Stephen C. Coleman is a leader in the field of LASIK surgery. He performed the first laser vision correction surgery for nearsightedness in New Mexico on June 14th, 1996. Since that time, Coleman Vision has been dedicated exclusively to LASIK surgery. Dr. Coleman does not fit or sell contact lenses or glasses. Advancing the technology used for LASIK surgery is the very foundation of Dr. Coleman’s practice. Dr. Coleman has been a Principal Investigator on countless FDA Studies for over two decades evaluating laser profiles to improve LASIK surgery outcomes. He currently treats patients with LASIK who have nearsightedness (myopia), farsightedness (hyperopia), and astigmatism. Over the years, Dr. Coleman has developed an intense concentration on the treatment of astigmatism with LASIK.
As a result of the many FDA studies that he has conducted, Dr. Coleman has been directly involved in Advancing The Technology Used For LASIK Surgery and as a result has witnessed many developments in laser profiles. Additionally, he has advanced the use of the diagnostic instruments which assess who should, and perhaps more importantly who should not, have LASIK surgery. Having these tools available at Coleman Vision contributes to the overall success of his practice. Just as no two snowflakes are exactly alike, no two eyes are exactly alike and Dr. Coleman performs fully customized, individualized LASIK treatments for each and every patient. No two treatments are ever exactly alike. This individualized approach maximizes the potential outcomes for LASIK.
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5051 Journal Center Blvd. Ste 400
Albuquerque, NM 87109
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