Optometry PathwayLaser Refractive Surgery

Charlotte Hazel

Patient Assessment - Summary

• 2 page questionnaire• History• Refraction• Pupil sizes• Orbscan

• Aberrometry• Anterior Eye• Fundus Assessment• Pachymetry• Counselling

History

• Questionnaire • Health - exclusion criteria• Pattern of spectacle and/or contact lens wear

• History• Why surgery? Why now?• Expectations?• Visual Activities - work, sports, hobbies?• Symptoms? -e.g. dry eye, CL intolerance

Refraction

• Refraction– Stability, e.g. young myopes– Cycloplegia for young hypermetropes

• Pupil sizes– Photopic and mesopic

Orbscan Topographer

• Contour map of the cornea

• Posterior AND Anterior surface

• Thickness

• Curvature information

• Is the cornea healthy and thick enough to perform treatment?

Orbscan tiff

Orbscan tiff

Aberrometry

• Zywave® II Wavefront Aberrometer– Hartmann-Shack Principles– Up to 5th order– Personalised measure of refractive error– Wavefront guided treatment produces better

quality of vision and less likely to induce night vision problems

Aberrometry tiff

Anterior Eye

• Blepharitis/ Lid disease

• Tear film assessment

• Cornea

• Pachymetry– Ultrasound– Bowmans to descemets membrane

Posterior Eye

• Usual fundus assessment

• Is the eye healthy?

Counselling

• Healing phase - symptoms, time-scale • Potential side effects • Effect on presbyopia - e.g. removing myopia• Surgical/ Post-surgical complications• Ensure expectations are realistic

= Make sure what we can offer and what the patient wants are the same thing!

Counselling 2

• What happens on day of treatment?– Before, during and after treatment

• What does the laser look like?

• Drops, eye shields, do’s and don’ts

• Initial preparation for nervous patients

• Patient understands what is involved

Thank-you!