Surgery

What is LASIK?

2007-07-27T10:08:00.000-07:00

The eye and vision errors

The cornea is a part of the eye that helps focus light to create an image on the retina. It works in much the same way that the lens of a camera focuses light to create an image on film. The bending and focusing of light is also known as refraction. Usually the shape of the cornea and the eye are not perfect and the image on the retina is out-of-focus (blurred) or distorted. These imperfections in the focusing power of the eye are called refractive errors.

There are three primary types of refractive errors: myopia, hyperopia and astigmatism. Persons with myopia, or nearsightedness, have more difficulty seeing distant objects as clearly as near objects. Persons with hyperopia, or farsightedness, have more difficulty seeing near objects as clearly as distant objects. Astigmatism is a distortion of the image on the retina caused by irregularities in the cornea or lens of the eye. Combinations of myopia and astigmatism or hyperopia and astigmatism are common. Glasses or contact lenses are designed to compensate for the eye's imperfections. Surgical procedures aimed at improving the focusing power of the eye are called refractive surgery. In LASIK surgery, precise and controlled removal of corneal tissue by a special laser reshapes the cornea changing its focusing power.

Other types of refractive surgery

Radial Keratotomy or RK and Photorefractive Keratectomy or PRK are other refractive surgeries used to reshape the cornea. In RK, a very sharp knife is used to cut slits in the cornea changing its shape. PRK was the first surgical procedure developed to reshape the cornea, by sculpting, using a laser. Later, LASIK was developed. The same type of laser is used for LASIK and PRK. Often the exact same laser is used for the two types of surgery. The major difference between the two surgeries is the way that the stroma, the middle layer of the cornea, is exposed before it is vaporized with the laser. In PRK, the top layer of the cornea, called the epithelium, is scraped away to expose the stromal layer underneath. In LASIK, a flap is cut in the stromal layer and the flap is folded back.

Another type of refractive surgery is thermokeratoplasty in which heat is used to reshape the cornea. The source of the heat can be a laser, but it is a different kind of laser than is used for LASIK and PRK. Other refractive devices include corneal ring segments that are inserted into the stroma and special contact lenses that temporarily reshape the cornea (orthokeratology).

What the FDA regulates

In the United States, the Food and Drug Administration (FDA) regulates the sale of medical devices such as the lasers used for LASIK. Before a medical device can be legally sold in the U.S., the person or company that wants to sell the device must seek approval from the FDA. To gain approval, they must present evidence that the device is reasonably safe and effective for a particular use, the "indication." Once the FDA has approved a medical device, a doctor may decide to use that device for other indications if the doctor feels it is in the best interest of a patient. The use of an approved device for other than its FDA-approved indication is called "off-label use." The FDA does not regulate off-label use or the practice of medicine.

The FDA does not have the authority to:
Regulate a doctor's practice. In other words, FDA does not tell doctors what to do when running their business or what they can or cannot tell their patients.
Set the amount a doctor can charge for LASIK eye surgery.
"Insist" the patient information booklet from the laser manufacturer be provided to the potential patient.

Make recommendations for individual doctors, clinics, or eye centers. FDA does not maintain nor have access to any such list of doctors performing LASIK eye surgery.
Conduct or provide a rating system on any medical device it regulates.

The first refractive laser systems approved by FDA were excimer lasers for use in PRK to treat myopia and later to treat astigmatism. However, doctors began using these lasers for LASIK (not just PRK), and to treat other refractive errors (not just myopia). Over the last several years, LASIK has become the main surgery doctors use to treat myopia in the United States. More recently, some laser manufacturers have gained FDA approval for laser systems for LASIK to treat myopia, hyperopia and astigmatism and for PRK to treat hyperopia and astigmatism.

Preparation for LASIK Eye Surgery

2006-10-30T20:23:00.000-08:00

Baseline evaluation includes mapping of the cornea to know the exact amount of tissue to be removed

Preparation for LASIK Eye Surgery starts well before the surgery. The doctor should be told about the medical history, medications currently being taken and medications allergic to, if any.

The patient before surgery should take the following precautions:
If using soft contact lens, the patient must revert to using glasses for at least two weeks prior to the baseline evaluation. This is to restore the normal shape of the cornea.

If using hard contact lens the user should stop using them from 6 weeks prior to the surgery

Usage of creams, lotions or cosmetics on the face and eyes should be avoided a day prior to the surgery

Before accepting LASIK eye surgery, a thorough baseline evaluation of the eye is required by the ophthalmologist (eye doctor). Once the patient's eyes are prepared for surgery a computer and a low wattage laser is used to scan and map the cornea. This information creates a map of the cornea and it helps the computer to determine its exact shape. The surgeon uses this information to calculate the exact amount and depth of corneal tissue to be removed during the operation to get the right shape.

lasik eye surgery

2006-08-20T12:23:00.000-07:00

Lasik

The word LASIK is an acronym for Laser- Assisted In-Situ Keratomileusis (LASIK)
and is currently a popular surgical procedure that is being performed by Eye
Doctors to improve vision by correcting refractory Errors.

The surgery improves the vision in patients who have nearsightedness,
farsightedness, and astigmatism. LASIK surgery usually takes less than one
minute per eye. Treatment involves reshaping the cornea - the protruding
portion of surface of the eye - to improve vision.

In 1990, Dr.Lucio Buratto of Italy and Dr.Loannis Pallikaris of Greece
pioneered the LASIK technique. They blended two prior techniques,
Keratomileusis and photo refractive keratectomy effectively, to discover the
LASIK technique, which is popularly used in the corrective refractive
surgery.

Dr Jose Barraquer in 1990 in Colombia developed a device that could cut thin
flaps in the cornea and alter its shape. This device was the 'Microkeratome'
and the procedure was called keratomileusis. The basis of LASIK surgical
technique is reshaping the cornea to correct refrectory errors.

The Facts of Lasik eye surgery

1.Lasik is surgery to a very delicate part of the eye.

2.Hundreds of thousands of people have had Lasik, most very successfully.

3.As with any surgery, there are risks and possible complications.

4.Lasik may not give you perfect vision. The American Academy of
Ophthalmology (AAO) reports that seven out of 10 patients achieve 20/20
vision, but 20/20 does not always mean perfect vision.

5.If you have Lasik to correct your distance vision, you'll still need
reading glasses around age 45.

6.Lasik surgery is too new to know if there are any long-term ill effects
beyond five years after surgery.

7.Lasik surgery cannot be reversed.

8.Most insurance does not cover the surgery.

9.You may need additional surgery — called "enhancements" — to get the best
possible vision after Lasik.

Alternatives to LASIK laser eye surgery

Alternatives to LASIK laser eye surgery for
myopia, hyperopia and astigmatism

1.Continue to use glasses or contact lenses, and if you are over 40 you will
automatically need reading glasses or bifocals.

2.Excimer Laser PRK surface ablation

3.Lensectomy with intraocular lens implant.(The natural lens is removed and
is replaced with an intraocular lens implant.)

4. Phakic IOL (Intraocular Lens) or ICL (Intraocular Contact Lens --
insertion of an artificial lens without removing the crystalline lens.)

5. Intracorneal rings (INTACS)

Advantages and Disadvantages of Lasik eye surgery

Advantages of LASIK Laser Eye Surgery

It works! It corrects vision. Around 80% of patients will have their desired
vision after LASIK laser eye surgery. An enhancement can further increase
this number.

LASIK laser eye surgery is associated with very little pain.Vision is
corrected nearly immediately or by the next day after LASIK laser eye
surgery.Recovery is quick and usually no bandages or stitches are required
after LASIK laser eye surgery.

Adjustments can be made years after LASIK laser eye surgery to further
correct vision.After having LASIK laser eye surgery, most patients no longer
need corrective eyewear.

Disadvantages of LASIK Laser Eye Surgery

Changes made to the cornea cannot be reversed after LASIK laser eye surgery.
Corrections can only be made by additional LASIK laser eye surgeries.LASIK
laser eye surgery is expensive, typically costing $2,200 to $2,250 per eye;
though compared to the cost of glasses and contact lenses, the price is
reasonable.LASIK laser eye surgery is technically complex. Problems may
occur when the doctor cuts the flap, which can permanently affect
vision.LASIK laser eye surgery is can cause a loss of "best" vision with or
without glasses at 1 year after surgery. Your best vision is the highest
degree of vision that you achieved while wearing your contacts or
eyeglasses.

Intralase

Intralase Femtosecond Laser

The INTRALASE FS laser currently the only one in the UK installed at the
Centre for Sight since August 2004. The Centre for Sight is a reference
centre for the laser and numerous surgeons from Europe and other countries
have visited us to learn more about the laser and see it in action.

The Laser works by using light in the Infrared spectrum to separate tissue.
The pulse of the laser is VERY short (Femtosecond - a very small fraction of
a second) and if travelling at the speed of light would only partially cross
a human hair. Contrast this to a particle travelling at the speed of light
which in ONE second would go around the world 7 times!

The pulse of the laser separates the cornea precisely and accurately in full
view of the surgeon. Use of the laser makes the Laser vision correction
procedure INTRALASIK extremely SAFE, ACCURATE, PREDICTABLE and in turn gives
us BETTER OUTCOMES and BETTER VISION.

Advantages of Lasik eye

1.Intralase permits precision in flap creation with accurate flap
dimensions and minimal variation.

2.Intralasik flaps are defined by the surgeon and customised to suit the
patient.

3.Intralase provides the Centre for Sight, UK with the ability to treat
THIN, FLAT and STEEP corneas in patients felt not to be suitable in the
past.

4.Safety and reproducibility of a laser - the Intralase FS30 laser.

5.Intralase enables use of disposable instruments and thus no issues of
sterilization, further improving safety.

6.With Intralasik, there is no need to abandon surgery because of inadequate
flap dimensions.

7.With intralase we are able to treat deep-set eyes.

8.Intralasik provides BETTER VISION.

* We have evaluated patients treated by us using this Bladeless Lasik
procedure and have found that they have obtained better visual outcomes than
Traditional Lasik procedure. Patients gained 1 line or more of vision in 58%
and 2 lines or more in 17% of case.Our patients also had similar contrast
vision when checked after surgery and compared to levels before.

9.Less DRY EYE

* Flaps from this bladeless Lasik procedure avoids cutting deep nerve
bundles like the traditional lasik procedure.This results in more less
severe dry eye and more rapid recovery.

Intralase first available in the UK at Centre for Sight provides a margin of
safety.This bladeless lasik procedure is more precise, safer and results in
better vision.UK patients now have the comfort of bladeless lasik at a
centre for excellence, the Centre for Sight.

Thinking about Laser vision correction in the UK ? Consider Intralase at the
Centre for Sight - a leading independent centre for corneal and laser eye
surgery in the UK.

Intra Lasik Process

Screenings: Complimentary screenings are offered at Centre for Sight.
This usually determines your suitability for surgery and involves some of
the tests listed below in consultation. If you are suitable, time
permitting, a full consultation will be carried out.

Consultation: A thorough evaluation of your eyes along with multiple
investigations will determine your suitability for surgery. Because of the
number of tests required (probably more than most centres), we follow a
linear model for assessment which means that you will be moved forward from
one testing area to the next. This may necessitate your having to wait for a
short while between tests. The staff responsible for each area will explain
the tests to you. Please be reassurred all candidates are evaluated by a
consultant surgeon.

Intra Lasik

IntraLASIK is a combination of two words : The" Intra" component denotes our
use of the INTRALASE Femtosecond laser and LASIK is an abbreviated term for
"Laser Assisted In situ KERATOMILEUSIS".Conventional LASIK as practiced in
most laser vision centres as a first step, uses a device called a keratome
that houses a BLADE to make a flap on the cornea. The flap is lifted and the
reshaping of the eye is then accomplished.

With IntraLASIK, the first step of cutting the flap is accomplished using a
highly precise Laser - the INTRALASE Femtosecond Laser. This silent laser
separates a layer on the cornea and converts this into a flap. The flap is
lifted and the laser reshaping with the Excimer laser is accomplished as it
is with Traditional Lasik and the flap is replaced. So with IntraLASIK TWO
lasers are used - the IntraLASE to create the flap precisely and the other
(Bausch and Lomb Z100) to reshape the cornea.

Use of the Intralase Femtosecond Laser to perform the flap creation portion
of the Lasik or Intralasik procedure adds a huge margin of safety and is the
principle reason for its acquisition at Centre for Sight. Some of the more
serious complications from Lasik arise from flap creation - these Lasik
complications just do not occur with proper use of the Intralase laser.