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Refractive Surgery Seminar: An Introduction to Laser Vision Correction

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

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Refractive Surgery Seminar: An Introduction to Laser Vision Correction

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  1. Ophthalmology Associates of Mankato Refractive Surgery Seminar:An Introduction to Laser Vision Correction Emily Birkholz, MD John Hoines, MD

  2. Our Plan: • Why do people need glasses or contact lenses? • Nearsightedness, Farsightedness, Astigmatism • What is refractive surgery/laser vision correction? • PRK vs. LASIK vsIntraLASIK • Custom treatment • Who is a good candidate? • What to expect with this procedure? • Questions

  3. Anatomy of the Eye:

  4. The Refractive Power of the Cornea: 1/3 2/3

  5. Why Do I need Glasses/Contacts? • Nearsightedness (myopia) • Farsightedness (hyperopia) • Astigmatism • Presbyopia

  6. Nearsighted:

  7. Farsighted:

  8. Astigmatism:

  9. Presbyopia: • Loss of accommodation with aging

  10. How to correct refractive error? • Glasses • Contact lens • Refractive Surgery • Laser vision correction

  11. How Does Laser Vision Correction Work? • Laser energy applied to corneal tissue • Reshapes cornea to correct refractive error

  12. Myopia – flattens cornea • Hyperopia – steepens cornea

  13. Laser Vision Correction: Two Methods: • PRK (surface treatment) • LASIK (flap)

  14. 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

  15. Photorefractive Keratectomy (PRK) • Epithelium is removed • Laser treatment to anterior stroma • Corrects • Myopia • Hyperopia • Astigmatism

  16. PRK: • Advantages: • No Flap • Can be performed on thinner corneas • Disadvantages: • Pain • Longer time for vision to improve • Haze

  17. Laser-Assisted in Situ Keratomileusis (LASIK) • Flap created and lifted • hinged, partial thickness • Laser treatment to deeper stroma • Flap repositioned • Corrects • Myopia • Hyperopia • Astigmatism

  18. LASIK: • Advantages: • Minimal pain • Fast visual recovery • No haze • Disadvantages: • Flap complications • Dry eye

  19. LASIK: • How is the flap created? • Laser – IntraLase • No blade • iLASIK, Bladeless LASIK, IntraLASIK • Microkeratome - Traditional

  20. IntraLase • Femtosecond laser • Laserbeam creates tiny microbubbles at programmed depth, shape, and size • Precise depth (accurate within 10 microns)

  21. 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

  22. ® 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

  23. Custom treatment • A Custom treatment uses the information from the wavefront to reduce or eliminate all aberrations from the eye

  24. 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

  25. Who is a good candidate? • At least 21 years of age • Healthy eyes • Good health overall • Realistic expectations

  26. 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

  27. Who is not a good candidate? • Unrealistic expectations • Pregnant and nursing women • Ocular disease • Certain medical problems • History of autoimmune disease • Lupus • Rheumatoid Arthritis

  28. 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

  29. What are the common risks? • Under-correction • Over-correction • Night vision symptoms • Glare/halo • Worsening of dry eye symptoms (LASIK only)

  30. 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

  31. 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

  32. 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

  33. What is the follow-up schedule? • 1 day (LASIK only) • 1 week • 1 month • 3 months • 6 months • 12 months

  34. What is an enhancement? • Repeat treatment • Usually performed after at least 3 months

  35. 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

  36. 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

  37. 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

  38. How much does the procedure cost? **Includes all postoperative visits for 1 year **Wavescan cost $100 Custom PRK $1800 Custom Traditional LASIK $1800 Custom IntraLASIK $2350 • PRK • $1650 • Traditional LASIK • $1650 • IntraLASIK • $2200

  39. 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

  40. Thank you for your attention! Any Questions?

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