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?