Krp eye surgery. Definition Purpose Demographics Description Diagnosis/Preparation Aftercare Risks Normal results Morbidity and mortality rates Alternatives. Krp eye surgery

 
 Definition Purpose Demographics Description Diagnosis/Preparation Aftercare Risks Normal results Morbidity and mortality rates AlternativesKrp eye surgery  Aging is the most common

Reston Eye Associates provides the services below: • Complete annual eye exams • Cataract evaluation and surgery • Diabetic eye exams • Glaucoma screening and treatment Contoura LASIK. Our locator makes it easy to find a LASIK eye surgery center in your local area. ERMs most often cause minimal symptoms but in some instances can result in a painless loss of vision and visual distortion. Showering and applying makeup. Small Incision Lenticule Extraction (SMILE) Small incision lenticule extraction (SMILE) is a relatively new type of laser surgery that corrects myopia. When you present for services, please have your photo identification. coinsurance between 10% to 50%. Advantages include quicker epithelialization, minimal scarring and a resultant smooth corneal surface. Khanna Vision Institute offeris free consults & customized refractive surgery solutions based on age, prescription. A LASIK enhancement may be needed to sharpen vision after your first laser eye surgery. It is not uncommon for a patient to experience new visual sensations and perceptions immediately after cataract surgery in both eyes. 24, 2023. Some of these surgeries reshape the cornea. Weight capacity: 150 kg Length: 2,040 mm Width: 690 mm. The operation involves swapping out the cloudy natural lens of the eye, or cataract, with a new artificial lens. Luke’s Eye Institute–committed to making your vision transformation affordable and stress-free. Other types of corneal refractive surgery. Like any other surgical procedure, a cornea transplant comes with certain risks. I had PRK eye surgery done last year. Detached retina surgery carries the same risks as any surgery, and some recovery time is to be expected. Erin Doe, MD is an ophthalmology specialist in Katy, TX. Antonio Capone, Jr. 1. Kar. Doe's phone number, address, insurance information, hospital affiliations and more. Blepharoplasty is a surgical procedure that improves the appearance of your eyelids. 2014;24(2):103-. Photorefractive keratectomy (PRK) is a laser eye surgery — specifically a type of refractive surgery. Six months after LASIK. The average cost of Lasik eye surgery is $2,632 per eye. Don’t pull on your eyelids while using the eye drops. Laser eye surgery and lens surgery. Preoperative and postoperative care is usually included in that price, as are follow-up procedures to ensure recovery is progressing as it should. Apply the eye drops every 4 hours to the inner part of your eye. com by market research firm Market Scope. Recovery. Cataract eye surgery is one of the most common, safest eye surgeries in the world. 50 in both eyes). Depending on the form of the optical phenomenon and the effect it. 30 am to 4. Eye surgery is a way of removing, repairing or manipulating your eye and its surrounding tissues. Feeling should start to return to your eye within a few hours of surgery, but it may take a few days. Centre for Sight UK Laser Eye Surgery and Vision Correction. The average cost of LASIK is $3,979, according to 211 reviews from RealSelf members. When these visual impairments interfere with. People can treat. LASIK (Laser-Assisted in situ Keratomileusis) is a laser vision correction procedure that can treat myopia (nearsightedness), hyperopia (farsightedness), and astigmatism to reduce or eliminate. Prior to the 1970’s, one of the only treatments for myopia, or nearsightedness, was to wear corrective lenses. The cost of corneal cross-linking for the treatment of progressive keratoconus typically ranges from $2,500 to $4,000 per eye. This technology captures 22,000 separate images of your eye to guide in reshaping the surface. It can be used to: cut thin tissue in the eye that blocks vision. LASIK or Lasik (laser-assisted in situ keratomileusis), commonly referred to as laser eye surgery or laser vision correction, is a type of refractive surgery for the correction of myopia, hyperopia, and an actual cure for astigmatism, since it is in the cornea. They'll remove the epithelium, or outer layer of cells on the cornea. How cosmetic eye surgery worksPlease subscribe for more amazing facts videos#shorts #facts #amazingfacts #short Knee rotationplasty (KRP) is a type of surgery in which the rotated ankle serves as a new knee after being removed for bone tumor. Weight capacity: 150 kg Length: 2,040 mm Width: 690 mm. glaucoma surgery. dots, stars, spots, squiggles, and flash bulb effects. A vampire facial can be useful for those who have scars, wrinkles or sun damage. Vitamin C. D. The average cost of SMILE eye surgery is between $2,000 and $3,000 per eye. Search by Region. Manoj Motwani is performing some of the most advanced, cutting edge Refractive Surgery in the world today. Bleeding in the eye. There are two types: argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT). Lord, I commit my body unto your holy hands for grace to go through in the name of Jesus. Please feel free to contact me on 0428 400 277, Monday to Friday 8. Edmonton. You might consider this surgery for either aesthetic reasons or if your eyelids feel heavy and are bothersome. Definition. Laser Vision Correction. Dr. Your eye doctor may give you eye drops or other medicines to help with these side effects. Intrastromal corneal ring segments (ICRS). On average, cataract surgery costs between $3,500 and $7,000 per eye. People who wear glasses or contact lenses can benefit from ICL surgery. Summary. Others implant a lens in your eye. Posterior capsulotomy (or YAG laser capsulotomy) is laser surgery you might need sometime after cataract surgery. The initial step in penetrating keratoplasty should be the preparation and punch of the donor tissue. Clinical Services and Specialties. 1850 Town Center Pkwy. [1]LASIK is a form of refractive surgery — surgery that changes the shape of the cornea, the transparent window at the front of your eye. LASIK enhancement: When additional surgery is needed. Case 3. Trust your eyes to Price Vision Group, Indiana’s first and most experienced LASIK provider! Give us a call at (317) 814-2933. Reproduced with permission from Steinert RF, Ashrafzadeh A, Hersh PS: Results of phototherapeutic keratectomy in the management of flap striae after LASIK. This kind of surgery uses a laser to treat vision problems caused by refractive errors. It is performed to improve vision and eliminate the need for glasses or contact lenses. During a posterior capsulotomy, an opening is made in the eye’s natural lens capsule so light can enter the eye more easily and vision becomes more clear. It’s amazing how quickly the human body creates a new normal for itself. The only anesthetic used is eye drops that numb the surface of the eye. However, it’s not an ideal treatment for age-related farsightedness (presbyopia) due to lens changes. K. His goal is to have the central part of the graft attach first—then the bottom, temporal. The condition can occur in one eye or in both eyes at the same time. We used the pinhole test to determine the dominant eye. Cataract surgery 2020 update. Understanding these stages ensures that people are informed about what happens after their doctor completes the procedure. Industry-leading surgeons and vision outcomes with more than 2 million successful procedures. Trans-PRK is a cutting-edge laser eye surgery that has been gaining popularity in recent years. Common side effects include: Dry eye. A discount from your health insurance company can often save you about $715 per eye, and a vision insurance discount averages a savings of $948 per eye. Specifically, the total cost of cataract treatment for a patient who doesn’t have an insurance provider can range from: $3,000 to $5,000 per eye for standard cataract surgery. The cornea is the dome-shaped clear tissue at the front of the eye. Cataract surgery is a relatively common procedure that treats cataract, a clouding of the eye’s lens. The back of the eye naturally. Getting the eyepatch removed was a crazy experience. 005-mL injection of this suspension creates a sphere or ampule of medication that is suspended behind the iris in the ciliary. As a cataract forms, the proteins naturally start to break down, causing the lens to become cloudy and yellowed. This lets the trabecular meshwork in your eye cool down between laser pulses. In addition to. 2. sensation of looking through water or heat waves. 30 am to 4. At this point, the doctor cuts a flap into the cornea and folds it back. PRK or LASEK surgery may be an option for those. The incision is hidden in the eyelid's natural crease. Contents Overview Procedure Details Risks / Benefits Recovery and Outlook When to. (may not be covered if it is not. It is typically recommended for people with good eye health in their mid- or late-50s or slightly younger people who need reading glasses. 3 (26 ratings) Leave a review. The exact cause of pancreatic cancer is unknown. Before the procedure, anesthetic drops are used to numb the eye. PRK and LASIK are two different types of laser eye surgery used to help correct vision. S. It uses a laser in quick bursts instead of a constant laser beam. Refractive surgery refers to a group of laser procedures designed to accurately correct nearsightedness, farsightedness and astigmatism. The cornea is the dome-shaped clear tissue at the front of the eye. Your doctor may provide antibiotic or other eye drops. “Every region has a slightly different preference. K-Beauty’s market size was valued at $9. Prescribed Treatments. She is affiliated with Reston Hospital Center. com What Is Photorefractive Keratectomy? Also known as PRK, this type of laser eye surgery can help if you are nearsighted , farsighted, or have astigmatism. But it’s not for everyone. Stanford Laser Eye Center, Stanford Medicine. Korean beauty standards have evolved to a face that, according to Ji Yeo, a. This laser eye surgery is done in an outpatient surgery center or your ophthalmologist’s office. 4. , MD, and His Pioneering Work in Face-Down Positioning after Macular Hole Surgery. New York City LASIK Eye Surgery. During a vitrectomy, your surgeon removes the vitreous. Erin A. It is an alternative to LASIK and may be recommended if you have thin corneas, dry eyes, or are involved in high-impact activities. The day after your surgery, your eye surgeon or other eye doctor will test your vision. Decreased distance visual acuity. Advanced surface ablation with the Carl Zeiss MEL80 or Visx S4 IR. Sometimes the macula can deteriorate and. I paid $3,363. R. " LASIK surgery is essentially pain-free and takes only about 15 minutes for both eyes. Steps to iLASIK - Victoria Eye. In these patients the cornea may need to be ‘smoothed’ using topography guided laser eye surgery and vision may be improved by combining with one of the procedures listed above. dots, stars, spots, squiggles, and flash bulb effects. About 99% of people have uncorrected vision that’s 20/40 or better after their LASIK surgery. Additional surgery – Another surgery may be needed to remove the lens to correct related issues. Nageshwari Nanda. A vampire facial can be useful for those who have scars, wrinkles or sun damage. Weekly blood work (pro time) is performed (the Home Health team can check this) to ensure that the blood is not “too thin”. Cataracts cause cloudy areas to appear on the eye’s lens. Itchiness in the eye. Learn what kind of vision you can expect after LASIK; read the latest statistics. LASIK is an outpatient procedure that is performed by an ophthalmologist, or eye doctor. The surgery corrects vision problems such as nearsightedness, farsightedness and astigmatism, reducing or eliminating the need for eyeglasses or contact lenses. A 0. They treat vision problems like nearsightedness, farsightedness, and astigmatism. Best vision is o btained with a type of ALK known as Deep Anterior Lamellar Keratoplasty (DALK) , in which the surgeon only leaves behind 5% or less of your original corneal thickness. 30 am to 4. The bare sclera technique involves excising the head and body of the pterygium while allowing the bare scleral bed to re-epithelialize. Reston Eye Associates was established in 2004 and since then has been committed to delivering the highest quality of ophthalmology care to the community. Some people need superficial keratectomy due to eye health problems, but others might want to consider the procedure to ensure that their cataract surgery goes as smoothly as possible. Recovery time is longer and can sometimes be more painful than LASIK. LASIK results: What to expect. Find a Doctor. During PRK, you'll receive numbing eye drops, and the eye surgeon will use a special holder to stop your eye from blinking. Dr. Schematic diagram of the reduction in optical disturbance of striae by transepithelial phototherapeutic keratectomy. For the most part, LASIK is considered an elective procedure, which means that private insurance is unlikely to cover the cost. TransPRK removes the outer layer of the cornea, which grows. The cornea is the strongest refracting surface of the eye. During the operation, the surgeon will make a tiny cut in your eye to remove the cloudy lens and replace it with a clear plastic one. The 280 Optometrists available in West Valley, UT average 4 stars across 34 reviews. But, for most people, having their vision improved or restored outweighs the potential complications associated with cornea transplant surgery. Invest in your vision with St. Protective eye shields will be placed over your eyes. LASIK financing: How to afford LASIK surgery. Ophthalmology • Male • Age 58. First, the doctor uses special eye drops to make your eyes feel numb. Dr. The Aura XP™ 15-watt laser system delivers steady-state reliability that can be applied to a wide range of soft tissue clinical ENT applications. Eye surgery for astigmatism ; Double vision in one eye ; Eye health and computer monitor. Advantages include quicker epithelialization, minimal scarring and a resultant smooth corneal surface. More than 90% end up with 20/20 vision. Learn more about the LASIK eye. Thinner corneal flap versus LASIK, more suitable for thin corneas. Sep. Some plans offer discount programs and other perks to help you cover the cost, but few will cover all the fees outright. LASIK Eye Surgery: Overview. In the patent information, the Raindrop inlay has various listed risks: Worsened glares, halos, blurred or double vision, visual fluctuation, dryness, foreign body sensation, and pain or discomfort. Definition Purpose Demographics Description Diagnosis/Preparation Aftercare Risks Normal results Morbidity and mortality rates Alternatives. General Surgery - Lap Appendix, Lap Cholecystectomy, Excision Lump, Vascular Surgery. A study showed that PKR patients require fewer narcotics following surgery, for a shorter duration of use, less refills, and have a lower likelihood of narcotic requirement at 4 weeks. Our board-certified, specially trained eye surgeons use the latest laser technologies to. When I close my both my eyes and can still see the zig-zags, which really worried me. average cost of PRK $2,300 per eye or a total of $4,600 for both eyes, according. She is affiliated with Reston Hospital Center. Ophthalmologists can remove excess eyelid skin in a procedure called blepharoplasty. Be careful walking around after surgery, and don't bump into doors or other objects. Prevention of Blood Clots: Some type of blood thinner is used in almost all cases to prevent the formation of blood clots. Book your suitability screening today. 12 including a discount of $1,000 for my type of insurance to correct my nearsightedness (-5. Swelling of the retina (the nerve layer at the back of your eye). According to the Academy’s recently published Adult Strabismus Preferred Practice Pattern, strabismus is common among adults, with an estimated inci­dence of 4%. Shifts, fluctuations, and starbursts. The cornea is the clear front surface of. Then, a circular cut is performed on the eye’s lens. State during surgery: Awake with eye numbed. R. With PRK, your ophthalmologist uses a laser to change the shape of your cornea. Researchers are looking for new ways to predict who will benefit from corrective eye surgeries. 4. Unstable vision is common in the first 3 months after surgery. Cataracts make your vision cloudy. In an eccentric or peripheral lesion, the surgeon needs to manually rotate the patient’s head or eye for ablation or use the joystick to place the laser beam in the desire location. In some cases, your surgeon may move the muscle to make it looser. Doe is a Ophthalmologist in Katy, TX. A penetrating keratoplasty, or corneal transplant, is the surgical removal of a damaged or diseased portion of the cornea and the implantation of a. Cataract surgery is performed by an eye doctor, also called an ophthalmologist. He is an attending surgeon at. Swelling of the retina (the nerve layer at the back of your eye). With the laser, the doctor reshapes the cornea. 3 (26 ratings) Leave a review. Blurred vision. PRK laser refractive surgery package. 5 - 15 W. Using advanced, all-laser eye surgery, Dr. 5 mm, (2) any ocular or systemic disease that could influence postoperative VA, (3) previous refractive surgery and/or any other ocular surgery history, and 4) intraoperative or postoperative. Blurred vision. In fact, DMEK provides 20/25 or better vision for about 3 out of 4 patients. This enables many to be less dependent on glasses and contacts. Anesthesia residual effects, like grogginess, dizziness, or nausea. 17; Important Safety Information. Post ICL Surgery. watery eyes. She currently serves as Adjunct Assistant Professor in Surgery with the Texas A&M Medical school as well as educates other surgeons on performing robotic surgery by proctoring and teaching at the Intuitive training lab in Houston, TX. LASIK has replaced many of the other refractive eye surgery methods. LASIK is a popular and effective type of laser eye surgery that treats refractive errors, including farsightedness (hyperopia). Cataract surgery is the most commonly performed surgical procedure, compared with any other surgery in medicine. Eye - Cataract Surgery, Vitrectomy Surgery, Corneal Transplants, Squint Surgery. The analysis was performed assuming pupil diameters from 0. 4. It works best if your eye problem. The clinic is visited by doctors like Dr. Remove them with the help of cataract surgeons from Koby Karp Doctors Eye Institute in. full coverage for standard. Double vision. For example, some people hope to use a multifocal lens to replace their clouded one. It has been largely supplanted by newer, more accurate operations, such as photorefractive keratectomy, LASIK, Epi-LASIK and the phakic intraocular lens. Anesthesia residual effects, like grogginess, dizziness, or nausea. Elle Milani, MD is an ophthalmology specialist in Reston, VA. After ICL surgery most people experience only minimal discomfort and are able to go back to work within a few days after the procedure. Nearsighted or farsighted individuals, as well as those with astigmatism, can undergo LASIK surgery as an. About Padmashree Maternity & Nursing Home. 5 It’s an extremely safe and effective treatment for cataracts. Oxidative stress associated with surgery and inhalation anesthetics. You may only need surgery in one eye. The average cost of Lasik eye surgery is $2,632 per eye. 82K views 15 years ago. There is a wide range of surgical specialties offered at the Day Surgery Centre. PRK - Photorefractive Keratectomy ₱67194 - ₱67195. 0/5 rating from patients. After six months, these symptoms should go away or be reduced significantly. The cornea is the clear front part of the eye that covers the iris, pupil, and anterior chamber. 12 including a discount of $1,000 for my type of insurance to correct my nearsightedness (-5. Strabismus surgery is a one-day procedure that is usually performed under general anesthesia most commonly by either a neuro- or pediatric. LASIK and PRK surgery both use. She had had many previous injections by her cosmetologist. Click on the image or this link to view the entire manuscript. Photorefractive keratectomy (PRK) is a type of laser eye surgery. Please refrain from wearing soft contact lenses for 1 week prior to undergoing the refractive surgery. Blepharoplasty. 4 (39) 516-548-2889 115 E 61st Street Suite 1B New York, NY 10065 . Anatomy of the eye and layers of the cornea. Cataract surgery is performed by an eye doctor, also called an ophthalmologist. Clinical Services and Specialties. Cataract surgery is a procedure to remove the lens of the eye and, in most cases, replace it with an artificial lens. Show Phone Number. Summary. The average cost for PRP treatment in Malaysia is about RM 1,000. During the surgery, your surgeon removes the vitreous and replaces it with another solution. King LASIK – Scottsdale. Patients and methods: This retrospective cohort study included 33 patients who. List of Services. Meet Antonio Capone, Jr. With the average cost of LASIK surgery settling around $2,250 per eye, it's likely you will need more than your FSA to pay for the procedure. Dr. Many times, a lens prescription (refractive correction) will restore proper eye alignment. This eliminates or reduces the need of glasses and contact lenses to have clear. 50 in both eyes). Radial keratotomy (RK) was one of the first and most commonly performed refractive surgical procedures of the 20th century. Next, the doctor adds two compounds, Tri-Moxi and Tri-Moxi-Vanc, into the vitreous cavity of your eye. Health insurance will only cover the cost of ptosis surgery if it’s deemed medically necessary, meaning vision is impaired. LASIK works by permanently reshaping the eye. Opacification of the posterior capsule so early after the cataract surgery is quite uncommon by not rare. Many patients who have LASIK end up with 20/20 vision. This procedure replaces the natural lens of your eye with an artificial lens. It is critical to prepare the donor tissue prior to entering the patient's eye, to be prepared for any need for urgent closure. These side effects usually go away after a few months. 1800 Town Center Dr Ste 316. The timings of Padmashree Maternity & Nursing Home are: Mon-Sat: 11:30-14:00, 15:00-21:00. Vitrectomy is a type of eye surgery used to treat problems of the eye’s retina and vitreous. Oper Tech Orthop. Cataracts. LASIK eye surgery to correct vision issues like farsightedness, nearsightedness, and astigmatism can cost anywhere from $2,300 to $6,000, depending on your surgeon’s technique, location, credentials, and a few more key factors. Find a Specialty Service. In this surgery, an ophthalmologist may: During vitrectomy, the ophthalmologist removes some or all of the vitreous from the middle of your eye. If the shape of your eye makes it hard to see clearly, glasses and contact lenses can help bring the world into focus. Double or. First, a surgeon will flatten the eye, then cut a flap in the cornea, peeling it back to reveal the section underneath, which is called the stroma. Reston Eye Associates Pllc . Information supplied by The Dudley Group NHS Foundation Trust. Some people opt for premium intraocular. Photorefractive keratectomy (PRK) is a laser eye surgery — specifically a type of refractive surgery. The most common option utilized is the oral administration of Coumadin (warfarin) for 3 weeks. Vitamin B12. They replace it with a clear, artificial intraocular lens (IOL). Summary. I pray, Lord, for strength for my body to go through this eye surgery. An upper eye blepharoplasty helps treat sagging tissues along the eyelid area. After surgery, the patients continued to receive antifungal therapy with gradual tapering of the dose over a 1-2 month period. They represent some of the most common reasons for patient dissatisfaction after uncomplicated surgery for cataract phacoemulsification with in-the-bag intraocular lens (IOL) implantation. Beauty is in the Eye of the Beholder. Cataracts can eventually affect vision. The eye is cleaned with an antiseptic solution and draped with a sterile covering. Cyclosporine was used to prevent graft rejection beginning 2 weeks after PKP. LASIK is short for laser-assisted in situ keratomileusis. Your surgeon may shorten or tighten the muscles by cutting them or folding them over. Stop taking herbal medications and diet medications at least two weeks before orthopedic surgery. Blepharoplasty (BLEF-uh-roe-plas-tee) is a type of surgery that removes excess skin from the eyelids. We would like to show you a description here but the site won’t allow us. A vitrectomy is a type of eye surgery to treat various problems with the retina and vitreous. Analysis of intraoperative changes in the ferric‐reducing ability of plasma may lead to a. It is a more permanent solution than. In cataract surgery, the eye surgeon removes the cloudy lens and replaces it with an artificial lens called an intraocular lens. Cataract surgery is a procedure to remove the lens of the eye and, in most cases, replace it with an artificial lens. These often resolve after a few days, but it can take up to 8 weeks for a full recovery. The artificial lens is called an intraocular lens (IOL). About. References. Penetrating Keratoplasty. Pars plana vitrectomy is a type of eye surgery used to treat a variety of problems with the retina or the vitreous. LASIK is a newer and slightly more complicated procedure due to the flap doctors create to expose corneal tissues. Report an issue with the information on this page. With a focus on using the most state-of-the-art technology and the most advanced treatment techniques, Dr. Fax: 617-726-0222. Roughly speaking, laser eye surgery in 2023 costs $2,000 to $3,000 per eye. We provide patient education about pediatric conditions and treatments. With the experience of over 120,000 laser vision correction procedures, Dr. Cataract surgery is a straightforward procedure that usually takes 30 to 45 minutes. The average cost for PRP treatment in Malaysia is about RM 1,000. PRK, also known as surface ablation, was performed outside the United States during the 1980s and received FDA approval in 1995. Find Dr. During surgery, the clouded lens inside your eye will be replaced with a clear artificial lens. This technique is usually used for people whose cornea may be too thin to safely. Practice. com. Typical anti-infective postoperative treatment for LASIK is 1 drop every 4 hours while awake for the first week after surgery. Cataract surgery is most often an outpatient procedure, so you will be able to go home the same day your cataract is removed. For mild to moderate keratoconus, your eye doctor may recommend inserting small synthetic rings in your cornea. Immediately after the procedure, your eye may burn, itch, or feel like there is something in it. Protective eye shields will be placed over your eyes. By reintroducing PRP back into the skin, cell turnover is encouraged, which leads to. My eyes or any part of my body will not crash in the process of the operation. It may take: 3 or. Recovery time from retinal detachment surgery takes an average of 3–8 weeks. A discount from your health insurance company can often save you about $715 per eye, and a vision insurance discount averages a savings of $948 per eye. Email: Voice_Center_2@partners. LASIK is very safe, but some people worry about their risks and opt to skip the surgery instead. In addition to these complications and risks, RK patients often complain of dry eye, double or triple vision, fluctuations in vision quality, halos, glare, reduced indoor or night vision, and even depression. Eyelid surgery (blepharoplasty) lifts and reshapes sagging eyelid skin. A surgical microscope with a special lens allows a. To maintain your good health after surgery, eat balanced meals of lean proteins, fruits, vegetables, whole grains, dairy, and raw juices. I went in several times and had students from India inspect my eyes. 3 billion in 2018 and is projected to reach $21. How cosmetic eye surgery worksPlease subscribe for more amazing facts videos#shorts #facts #amazingfacts #shortKnee rotationplasty (KRP) is a type of surgery in which the rotated ankle serves as a new knee after being removed for bone tumor. blind spots, tunnel vision, or total loss of vision for a short period. These maps can help your provider determine what changes you need and how best to make them.