Transcript Refractive Surgery Seminar

Ophthalmology Associates of Mankato
Refractive Surgery Seminar:
An Introduction to Laser Vision Correction
Emily Birkholz, MD
John Hoines, MD
Our Plan:
• Why do people need glasses or contact lenses?
– Nearsightedness, Farsightedness, Astigmatism
• What is refractive surgery/laser vision correction?
– PRK vs. LASIK vs IntraLASIK
– Custom treatment
• Who is a good candidate?
• What to expect with this procedure?
• Questions
Anatomy of the Eye:
The Refractive Power of the Cornea:
2/
3
1/
3
Why Do I need Glasses/Contacts?
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Nearsightedness (myopia)
Farsightedness (hyperopia)
Astigmatism
Presbyopia
Nearsighted:
Farsighted:
Astigmatism:
Presbyopia:
• Loss of accommodation with aging
How to correct refractive error?
• Glasses
• Contact lens
• Refractive Surgery
– Laser vision correction
How Does Laser Vision Correction Work?
• Laser energy applied to corneal tissue
• Reshapes cornea to correct refractive error
• Myopia – flattens cornea
• Hyperopia – steepens cornea
Laser Vision Correction:
Two Methods:
• PRK (surface treatment)
• LASIK (flap)
The Excimer Laser (VISX)
• Designed in the 1970’s
• Removes 39 millionths
of an inch of tissue in
12 billionths of a
second
• Typically a layer of
tissue as slender as a
human hair is removed
• Average laser time is
less than 1 minute
No adjacent tissue destruction
Photorefractive Keratectomy (PRK)
• Epithelium is removed
• Laser treatment to anterior stroma
• Corrects
– Myopia
– Hyperopia
– Astigmatism
PRK:
• Advantages:
– No Flap
– Can be performed on thinner corneas
• Disadvantages:
– Pain
– Longer time for vision to improve
– Haze
Laser-Assisted in Situ Keratomileusis
(LASIK)
• Flap created and lifted
• hinged, partial thickness
• Laser treatment to deeper
stroma
• Flap repositioned
• Corrects
• Myopia
• Hyperopia
• Astigmatism
LASIK:
• Advantages:
– Minimal pain
– Fast visual recovery
– No haze
• Disadvantages:
– Flap complications
– Dry eye
LASIK:
• How is the flap created?
– Laser – IntraLase
• No blade
• iLASIK, Bladeless LASIK, IntraLASIK
– Microkeratome - Traditional
IntraLase
• Femtosecond laser
– Laserbeam creates tiny microbubbles at
programmed depth, shape, and size
– Precise depth (accurate within 10 microns)
Advantages of IntraLASIK
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•
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More precise flap thickness
– Less risk of a flap complication
– Thinner flaps
– Less Dry Eye
– Ability to perform on more patients
• Even those with thinner corneas
who were not eligible for
traditional LASIK
Less risk of infection or inflammation
– No blade to sterilize
– Vertical edge to flap
Low vacuum suction ring
– compared to high vacuum ring with
microkeratome
– more comfortable
What is a Custom treatment?
• CustomVue system measures low and high order
aberrations
– Low order – myopia, hyperopia, astigmatism
– High order – imperfections in system, linked to glare/halo
• Wavefront represents all aberrations
– Information obtained by a WaveScan
®
Custom treatment
• A Custom treatment uses the information
from the wavefront to reduce or eliminate all
aberrations from the eye
Advantages to Custom Treatment
• Improved visual quality
– Reduced risk of glare/halos
• Improved contrast sensitivity
– Reduced risk of nighttime vision difficulties
• Similar outcome as non-Custom for visual
acuity
Who is a good candidate?
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•
•
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At least 21 years of age
Healthy eyes
Good health overall
Realistic expectations
Who is a good candidate?
• Nearsightedness from -1.00 to –12.00D
– Astigmatism up to 4.00D
• Farsightedness between 0 and +5.00D
– Astigmatism up to 3.00D
• Astigmatism between 1.0 and 5.0 D
Who is not a good candidate?
•
•
•
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Unrealistic expectations
Pregnant and nursing women
Ocular disease
Certain medical problems
• History of autoimmune disease
• Lupus
• Rheumatoid Arthritis
When to choose PRK vs. LASIK?
• PRK
– Dry eye syndrome
– Inadequate corneal thickness
– Professions with potential for ocular injury
• LASIK
– Faster visual recovery
– Less post operative discomfort
What are the common risks?
• Under-correction
• Over-correction
• Night vision symptoms
– Glare/halo
• Worsening of dry eye symptoms (LASIK only)
What are the rare but serious risks?
• Loss of best spectacle corrected visual acuity
• Minor loss of BSCVA: 1%
• Usually due to haze/mild scarring or flap
irregularities
• Major loss of BSCVA: 0.1%
• Usually due to infection
What can I expect after the
procedure?
LASIK
•
•
•
•
•
Some discomfort for a few hours
Eye redness for 2-3 weeks
Back to work after 1-2 days
Good vision typically the next day
Excellent vision typically in 1 to 4
weeks
PRK
• Some pain for 3-5 days
– Bandage contact lens
• Back to work after 3-5 days
• Good vision typically in 1 week
• Excellent vision typically in 4 to 8
weeks
What can I expect after the
procedure?
LASIK
• Eye drops for about 1 month
• Eye shields at bedtime for 2
weeks
• Frequent artificial tears for the
first 1-3 months
PRK
• Bandage contact lens for the first
week
• Eye drops for 1-3 months
• Eye shields at bedtime for 1 week
• Frequent artificial tears for the
first month
What is the follow-up schedule?
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•
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1 day (LASIK only)
1 week
1 month
3 months
6 months
12 months
What is an enhancement?
• Repeat treatment
• Usually performed after at least 3 months
Is Laser Vision Correction Perfect?
• Laser vision correction provides uncorrected visual
acuity that closely approximates that which is
currently achieved with glasses or contact lenses
• Will not eliminate the need for reading glasses once
you reach your 40’s and 50’s
Near Problems (Presbyopia)
• Difficulty with near focus is a function of
progressive age and changes in the crystalline
lens, not the basic refractive error
• < 40 years of age: accommodation can be
used to maintain clear images at all distances
• >40 years of age: accommodation becomes
progressively more difficult; first noticed for
close work late in day and with poor light
Solutions to Presbyopia
• Reading glasses
• Monovision
– Dominant eye corrected for distance
– Non-dominant eye corrected for near
• With contact lens or Laser Vision Correction
• Cataract Surgery with implantation of
Multifocal Intraocular Lens
How much does the procedure cost?
• PRK
• Custom PRK
– $1650
– $1800
• Traditional LASIK
– $1650
• IntraLASIK
– $2200
• Custom Traditional LASIK
– $1800
• Custom IntraLASIK
– $2350
**Includes all postoperative visits
for 1 year
**Wavescan cost $100
What do I do if I am interested in
LASIK or PRK?
• Call Ophthalmology Associates and set up free
refractive surgery evaluation
– 10% discount off surgical price if sign up after
hearing this seminar
Thank you for your attention!
Any Questions?