REFRACTIVE EYE SURGERY
LASIK
"Lasik " comes from "Laser Assisted In-Situ Keratomileusis". This is the most advanced method for the correction of visual errors up to date. The name of LASIK was first described by Dr Pallikaris of Greece.
Lasik consists of two procedures namely microlamellar keratoplasty and excimer laser photorefractive keratoplasty. Classical keratomileusis is a lathing procedure originating in 1949 with the work of Dr. Barraquer of Bogota, Columbia. In 1977 this procedure was introduced into the United States where after Louis Ruiz did further advancements in 1982 as well as 1987. Since then technology has constantly been improving up to the point where it can now be regarded as a feasible safe option in refractive surgery.
was one of the pioneers of this procedure in the world and the first to perform it in South Africa with a Nidek laser.Lasik surgery is subject to risks as in all types of surgery. The clarity of vision will fluctuate during the day and from day to day during the healing period. Sensitivity to light and an increased glare in the evening might also be experienced initially during the healing phase.
The newest generation LaserSight excimer laser is now used at the Healthy Eye. With this new technology (flying spot and eye tracking), hyperopia and astigmatism can now be corrected much better than with the older generation lasers.
One hundred percent post operative vision can not be guaranteed and the possiblity might exist that you will need some corrective lenses. Both eyes are usually operated on at one time, but only one can be done at a time as well. It is more comfortable for the patient and it heals quicker.
PRE OPERATIVE INSTRUCTIONS
During a consultation it will be confirmed whether you
are a good candidate for the Lasik.
Once this has been established, the operation procedure as well as all the
relevant costs will be explained. As this operation can be considered by medical
aids as a "functional improvement of lifestyle" operation and not a "life
supporting" operation, they might not all be keen to carry the full cost of this
procedure. Therefore, you have to confirm with your medical aid what their
position will be. We will gladly provide a letter of motivation to be submitted
to your medical aid, based on your circumstances giving all the necessary codes
and information needed. Send us the details of your eyes and we will let you
know if your eyes are suitable for refractive surgery.
Once all the above are clear, a complete eye evaluation will be performed to ensure your eyes are healthy and suitable for the specific procedure. You will receive drops in your eyes after which certain measurements will be taken of the cornea and eye to further determine if your eyes will be suitable and to plan the operation. If you wear hard or gas permeable lenses, they should be removed for a minimum of one week where as soft contacts should not be worn for a minimum of three days prior to the day on which the measurements will be taken as well as for the actual operation.
OPERATION
Do not wear any mascara or eye makeup on the day of surgery. The Lasik
procedure is done on an outpatient basis. Topical eye drops are used to
anaesthetize the eye and the procedure will take approximately 30 - 45 minutes
but anticipate a 2 - 3 hour stay at the hospital.
The surgical procedure consists of first creating an anterior lamellar corneal cap (or flap) of 8.5 mm in diameter and 160 microns in thickness using a microkeratome. The flap is then hinged over followed by the second step which is the refractive correction performed with the excimer laser.
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The excimer laser sculpts or reshapes the central cornea. The treated area is washed with a balanced salt solution and covered with the original flap. It takes a couple of minutes for the corneal flap to adhere itself to the rest of the cornea. In a couple of days the cornea will be crystal clear and an almost imperceptible scar will barely be seen.
Any of the above procedures can be stopped for instance if the conjunctiva is too loose resulting in the inability of the suction ring to fixate properly on the eye.
POST OPERATIVE
You will need to wear an eye shield for 2 nights and use eye drops for 3
days. You can go back to work again the following day. It takes between 1 and 14
days for the vision to stabilize in most cases.
POSSIBLE COMPLICATIONS
The size of the eyeball and eye slit may be too small
to get good suction in which case the procedure might be changed to a
PRK or Lasek (epi-flap) procedure. With the PRK or Lasek
procedure the end visual result is also good but it will be painful initially
and take much longer to heal. If the microkeratome becomes stuck along the way
or the cut or flap is not as good as expected, the flap can be repositioned and
left to heal. The procedure can then safely be repeated again after 3 months.
In a few cases where the vision is not good enough post operatively, an enhancement procedure can be done if necessary, however this is seldom required. The incidents of enhancement procedures is less than 6%. In extremely rare instances, corneal scarring may occur. This may then require further treatment.
BENEFITS OF REFRACTIVE SURGERY
Refractive surgery normally enhances people's lives by giving them more
freedom through natural vision. Some people have difficulty adjusting to glasses
or contact lenses. This can be for a variety of reasons such as the shape of
their eyeball, nose or face. It can also be because of the lubrication of their
eyes, living or working environment, or the type of work or sport they
participate in. It takes away the fear that you might be visually handicapped
and embarrassed when you lose your glasses or contact lenses.
Most people simply don't like thick glasses or contacts. Whether it be simple appearance or their ability to take part in certain sports such as swimming, tennis, skiing, scuba diving, wind surfing, squash, rugby, soccer or some other physical activity. In some cases, certain professions require a minimum level of visual acuity without corrective lenses, such as pilots, fire-fighters or police officers.
HOW DOES THE LASER WORK?
The excimer laser uses a mixture of argon and fluoride gasses to produce a
beam of ultraviolet light. Energy is produced emitting a narrow, uniform light
beam which, when focused through a lens system, produces vaporisation of corneal
tissue. By controlling the energy, size and shape of the laser beam, one can
reshape the cornea so that the light coming through it is bent to focus properly
on the retina.
LASIK
Lasik combines the precision of the excimer laser with
the benefits of Lamellar Keratoplasty. It is now the procedure of choice world
wide. This procedure has the distinct advantage that it allows quicker healing
than with PRK (Photorefractive Keratoplasty) and decreases the incidence of
corneal glare and haze that can sometimes take up to one year to clear. Bowmans
membrane (one of the layers of the cornea that provides it with strength) is
also preserved in this procedure and this may also be an added advantage. This
procedure requires more skill, training and experience and is therefore not done
at all centers. It is therefore
essential that you check on the training and number of operations that the
surgeon of your choice has done before the operation is done.
WHERE IS THE PROCEDURE DONE?
Being a microsurgical eye operation, it has to be done
in a sterile area that is suitable equipped for these types of operations. Such
as at the Healthy Eye.
THE FUTURE
Excimer laser has only been in use since 1991 and the Lasik procedure since
1994. Because of extensive experience with other corneal procedures such as RK
and corneal transplants, no long-term undesirable effects are anticipated.
WHO DOES THE LASIK PROCEDURE?
The Lasik procedure is done by Ophthalmic Surgeons, suitably qualified to perform this
procedure. The training and experience of the surgeon in this procedure is vital
to the final visual outcome. Dr. Maritz in
Benoni was one of the first surgeons in the world to perform this procedure and
the first to perform the procedure with the advanced Nidek excimer laser in
South Africa and now uses the more advanced newest LaserSight excimer laser at The Healthy Eye
Clinic.