Refractive Surgery Seminar:An Introduction to Laser Vision Correction
Emily Birkholz, MDJohn Hoines, MD
Ophthalmology Associates of Mankato
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?
• 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• 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?
• 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
• Unrealistic expectations• Pregnant and nursing women• Ocular disease• Certain medical problems• History of autoimmune disease• Lupus• Rheumatoid Arthritis
Who is not a good candidate?
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?• 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?
**Includes all postoperative visits for 1 year**Wavescan cost $100
• PRK– $1650
• Traditional LASIK– $1650
• IntraLASIK– $2200
• Custom PRK– $1800
• Custom Traditional LASIK– $1800
• Custom IntraLASIK– $2350
What do I do if I am interested inLASIK 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?