Laser-Assisted In Situ Keratomileusis, known as LASIK, is the most commonly performed laser vision correction procedure that is used to correct myopia, hyperopia, and/or astigmatism. Millions of people, world-wide have had LASIK.  LASIK is one of many vision correction surgeries that work by reshaping the cornea, the clear front of the eye, so that light entering the eye can be properly focused on the retina to provide clearer vision. LASIK is a quick procedure that is virtually pain-free and allows for almost immediate results.
Dr. Iskander, medical director and lead refractive surgeon, of San Antonio Eye Specialists in San Antonio, Texas has been performing LASIK for over 20 years and is one of the few LASIK surgeons in the San Antonio area to have completed fellowship training in refractive surgery.  He is highly regarded in his field and sought out by colleagues and associates as an expert in complex cases.  Dr. Iskander has also coauthored a book on LASIK.  In his private practice, there is in excess of 200 years of combined eye care experience among Dr. Iskander, his associates and extensive professional eye care team. Dr. Iskander continually keeps up with new technology, researching and implementing proven technologies and surgical techniques for his patients in order to achieve the highest visual results attainable.

LASIK is the most commonly performed refractive surgery and for good reason. It provides outstanding results, is virtually painless and offers fast results. So, it’s no surprise that it is such a sought after procedure.   However, not everyone is a good candidate for LASIK.
There are many factors that go into determining if a patient is a good LASIK candidate. Generally speaking, patients considering LASIK should be at least 18 years old and have a steady prescription with good general and ocular health. Pregnant women and nursing mothers should not have LASIK due to a fluctuation in hormones and changes in refractive prescription. Certain health conditions such as uncontrolled diabetes, autoimmune disorders or certain eye diseases can interfere with a patient’s eligibility. Dr. Iskander and his skilled team at San Antonio Eye Specialists conduct a thorough screening on all patients considering LASIK. Age, general and ocular health, lens prescription, even lifestyle and occupation are important considerations when determining eligibility.
The good news is, even if you aren’t an ideal LASIK candidate, there are other refractive options. Many patients come consult with Dr. Iskander thinking LASIK is the only option for removing glasses or contact lenses.  This is not true, Dr. Iskander will help you find the procedure that is best for you.

During your complimentary refractive consultation, the team at San Antonio Eye Specialists will perform a series of diagnostic tests to help determine if you are a good candidate. If you are a good candidate for LASIK, Dr. Iskander and his team will take additional tests needed for LASIK surgery to maximize a patient’s visual results. For example, some patients elect having one of our most advanced LASIK procedures called Contoura technology.  This specialized device captures special images of your eye that integrates with the EX500 excimer laser. Contoura technology often results in better than 20/20 vision and improved night vision, eliminating the need for glasses and contact lenses.
To perform LASIK, Dr. Iskander will use eye drops to numb the eye and make sure you are comfortable. In order to keep the eyes open during the procedure without blinking, a speculum holds the eyelids securely.  He will then create a very thin protective corneal flap using a femtosecond laser. This flap is carefully lifted to expose the underlying corneal tissue. Next, the excimer laser is used to shape the corneal tissue to the exact specifications based on your individual measurements to bring your vision into clear focus. The protective flap is then carefully repositioned and serves as a natural bandage as the eye heals. The LASIK procedure typically takes less than 10 minutes for both eyes.  There is mild to minimal discomfort and results are almost immediate. Patients will need to be driven home on the day of their procedure.  All patients are encouraged to keep eye lubricated and moist to facilitate healing.  Dr. Iskander encourages all his patients to return home and sleep as much as possible.  The next day, patients are seen for their one-day post-op appointment.  Many patients come alone for this appointment and they are driving alone. Once examined, patients are free to return to normal routine such as work or school, within 24 hours.  Yes, it’s that fast of a recovery time.  No pain with LASIK and usually patients can see 20/20 or better the next day after surgery.  Sports activities are encouraged after a week and avoid rubbing eyes or any face trauma.  

A cataract occurs when the clear lens of the eye becomes cloudy or opaque, over time. This is part of a natural process as we age, but a cataract can occur for other reasons such as eye trauma or diabetes and some patients have congenital cataracts (present at birth). Cataracts are the most common cause of vision loss in people over the age of 40 and the leading cause of blindness around the world. Most people will develop a cataract during their lifetime, but at first they are hardly noticeable. As the cataract matures in opacification, many patients will experience loss of vision, loss of seeing vibrant colors resulting in objects having a yellowish hue, trouble reading small print at a distance, such as street signs, and most describe glare and halos while driving at night.
Cataract removal surgery at San Antonio Eye Specialists is nothing like it was 30, 20 or even 10 years ago. Our leading refractive surgeon, Dr. Iskander, uses an all-laser technique, which helps make cataract removal more precise and more predictable than ever before. Even a surgeon with steady hands cannot duplicate the accuracy and predictability like that of the laser.  Laser cataract surgery uses a femtosecond laser rather than a blade to create the incisions, for dissolving the cataract and creating the opening needed to remove the cloudy portion of the lens.  Dr. Iskander is a proponent of laser-assisted cataract removal for optimal visual results.
San Antonio Eye Specialists also offers multiple premium lens upgrades.  Multifocal lenses help patients see near, intermediate and distance vision.  Toric lenses, help patients with astigmatism see well in the distance with little or no dependence on glasses. In fact, patients that elect to have a premium lens implants, can do most things, most of the time without glasses.

Often, patients will ask, “When should I have my cataract removed?” Dr. Iskander will generally tell his patients, “When your cataract begins to interfere with your vision, it’s time to have cataract removal surgery.” However, there are other determining factors in when this should be. Since cataracts can cause symptoms to occur very slowly, over several years, some patients don’t realize they’ve had a loss of vision. This is why it’s best to schedule a cataract examination at San Antonio Eye Specialists. Especially if you have been diagnosed with cataracts, have any symptoms of vision loss or issues with glare and haloes while driving at night. Dr. Iskander and his skilled team of professionals will perform a series of diagnostic tests to assess if cataract surgery is warranted or can be delayed to a later date.

Cataract surgery today is performed as an outpatient procedure at a private ambulatory surgery center. After being checked in, the surgical team will monitor vital signs such as blood pressure and go through your recent medical history. Next, the patient is taken back to the operating room and prepped for surgery. Dr. Iskander will place numbing drops in the eye, then a couple of small openings are created in the cornea, either manually by the surgeon or via the laser in order to gain access to your cloudy lens. Next, Dr. Iskander will make a small opening on the outer surface of the cloudy lens which can be achieved manually or by laser. This procedure is called, capsulorhexis. Think of the cataract being like an M&M candy. The surgeon is removing one side of the candy coating to get the chocolate, or in this case, the cloudy lens of the eye. Dr. Iskander will then cut the cloudy lens into multiple sections, making it easier to remove. All of the steps above can also be performed with laser assisted cataract surgery. Afterwards, Dr. Iskander will use a procedure called phacoemulsification which uses ultrasound to further breakup the cataract and remove it using suction. Once the cataract is removed, Dr. Iskander will insert a new lens, which goes in place of the old cloudy lens. Patients are sent home accompanied by a driver and return the next day for a follow-up post operative visit.
Dr. Iskander removes one cataract at a time. If you have bilateral cataracts (cataracts in both eyes) he will perform surgery on the dominant eye or the eye with the more mature cataract.  Usually after a couple of weeks, the second eye is scheduled for surgery.
If a patient is referred to the practice, by an optometrist, the patient may be co-managed.  This means the patient receives surgical care from the ophthalmologist, Dr. Iskander, and then returns to the referring optometrist for continued post-operative care after the one-day post-op appointment with Dr. Iskander to ensure the eye was examined after surgery.  This is done for convenience for the patient.

Photo Refractive Keratectomy, known as PRK, is a type of laser vision correction that is used on patients to correct myopia, hyperopia, and or astigmatism. It is one of the most common laser vision correction procedures, along with LASIK, and the two procedures share many similarities.
PRK was FDA approved in the mid 1990s. It is an excellent alternative for those who are not good candidates for LASIK laser vision correction. Dr. Iskander, the medical director and leading refractive surgeon of San Antonio Eye Specialists, has been performing PRK for over 20 years. PRK uses the same laser technology as LASIK laser vision correction.

PRK is often used when a patient has thin corneas, corneal irregularities, epithelial cell deficiencies, and or strong refractive prescriptions. Below are some additional details on why some patients might be a better candidate for PRK vs LASIK.
Corneal Thickness: Patients who have thinner corneas may be better suited for PRK vs LASIK, because LASIK requires the creation of a protective corneal flap and PRK does not. PRK involves less tissue of the cornea with the laser, which leaves more residual tissue for a stronger cornea.
Corneal Anomalies: Some patients might have corneal scarring from trauma or long-term contact lens wear. Some have corneal opacities, surface irregularities or corneal dystrophies. Oftentimes, doctors have to use a procedure called Photo Therapeutic Keratectomy or PTK in order to correct the corneas. PTK allows the removal of superficial corneal opacities and surface irregularities, but does not correct for visual errors. PRK can correct visual errors AND correct the same issues that PTK does as well… all at the same time.
Vision Prescription: For patients that have large amounts of myopia (nearsightedness), hyperopia (farsightedness) and or astigmatism, more corneal tissue must be removed in order to correct the cornea to its ideal shape/prescription. Even if a patient has normal or thick corneas, patients with high prescriptions may be a better candidate for PRK because less tissue is involved vs LASIK, since a corneal flap is not created with PRK.
Employment & Recreation: Since PRK laser vision correction doesn't require the creation of a corneal flap, it is often the preferred procedure for those who work in industries such as construction, the military, or fields in which there is a risk of displacing a corneal flap created by LASIK. This is important, because if their eye were to suffer trauma, in some cases, the protective corneal flap (only created in LASIK, not PRK) could become dislodged. For example, military pilots could have to eject at any time and face hand to hand combat over enemy territory. Professional boxers or UFC fighters get hit in the face all of the time. Construction workers could have objects fall on their face, possibly affecting the eye. The same holds true for people involved in martial arts or boxing classes. In general, if your career, recreational sports or hobbies could displace your corneal flap, that is created by LASIK, then PRK would be a preferred option as an alternative laser vision correction treatment.

PRK is virtually the same procedure as LASIK, except a protective flap is not created. Dr. Iskander begins the procedure by numbing the patient’s eye with numbing drops, and placing a speculum in the eye to hold it open during the procedure. Next, he gently removes the outer most layer of cells on the eye, called epithelial cells, using a special instrument. After the cells are removed, he then uses an excimer laser to gently reshape the cornea surface to the targeted prescription, with no flap creation. After the laser treatment is completed, Dr. Iskander places a clear contact bandage lens on the eye which the patient will wear for approximately one week. PRK does have slightly more discomfort than LASIK and does require a longer recovery time, up to one week. This is very normal and to be expected with PRK.  Patients who undergo PRK eye surgery will typically be able to drive within a few days, and their vision will continually improve during the week duration. 20/20 vision or better is the desired goal for both LASIK and PRK, only the surgical process and healing time differ.
All our laser vision correction consultations are absolutely complimentary and at that appointment, you will learn if you are in fact a good candidate for laser vision correction. If you are a candidate, Dr. Iskander will discuss which laser vision correction procedure is best for you. Dr. Iskander personally meets, evaluates and creates a treatment plan unique to each patient prior to any surgical intervention.

Clear lens extraction is an elective procedure not covered by medical insurance plans. As such, we offer financing options and accept FSAs and HSAs to offset the price of surgery. Contact our office to learn more.

In addition to improving vision, a CLE procedure done bilaterally can reduce a patient's likelihood of developing cataracts.

During your CLE procedure, Dr. Iskander will use anesthetic eye drops to numb the eye. This helps make the procedure pain-free.
All our laser vision correction consultations are absolutely complimentary and at that appointment, you will learn if you are in fact a good candidate for laser vision correction. If you are a candidate, Dr. Iskander will discuss which laser vision correction procedure is best for you. Dr. Iskander personally meets, evaluates and creates a treatment plan unique to each patient prior to any surgical intervention.

The Visian ICL™ is used to correct a wide range of myopia without the need to remove corneal tissue, like an IOL implant procedure. The ICL is a small, foldable lens that is injected through a tiny, 3mm incision that does not require sutures. The ICL provides excellent quality of vision and optical performance due to its placement inside the eye. The lens is made of collamer, which provides unparalleled biocompatibility.

No, unlike a contact lens, the Visian ICL™ is designed to remain in place within the eye without requiring maintenance. Dr. Iskander recommends an annual eye examination to ensure everything is fine, but generally we see little to no change in the ICL's placement or performance over time.

No. Because the ICL is positioned behind the iris, neither you nor an observer will be able to identify the lens in place.