Following on from our recent look at short sightedness, this week we are investigating the condition...
more..Lens Implants & Laser Eye Surgery
Frequently asked questions and answers about ICL and eye laser surgery
LASIK
What is LASIK?
LASIK eye surgery (Laser in situ keratomileusis) uses a specialized, precise, and computer-controlled corneal flap-making instrument, called Intralase, to create a thin corneal flap of corneal tissue.
A surgeon gently lifts the corneal flap and uses the sophisticated Bausch and Lomb Z100 Laser to reshape the corneal by removing a small pre-determined amount of corneal tissue.
The surgeon places the corneal flap back down and, within minutes, the flap naturally heals without the need for stitches. A specially designed soft contact lens is placed on the eye to protect the corneal surface overnight. This is important as it aids healing in the crucial initial stage.
We strongly insist you do not touch the lenses (even if you are an experienced lens wearer). You will have them removed by a surgeon or specialist Laser optometrist the next day.
What is the advantage of wavefront treatment?
Wavefront describes the aberrations (imperfections) in your eyes and wavefront treatment corrects those aberrations caused by your corneas. This personalized form of treatment available at Advanced Vision Care means your resulting vision after surgery is of superior quality. It eliminates side effects such as night glare and haloes.
Why does the price of wavefront differ so much between clinics?
This is where the jargon can cause confusion. Clinics often have different names for wavefront such as ‘Optimised wavefront’. It should be noted that optimised wavefront is not wavefront in its true form and this is where meeting the surgeon is crucial so he/she can tell you exactly what surgery is going to be performed on your eyes. Alternatives to true wavefront are, naturally, cheaper.
INTRALASE LASIK (Blade Free)
What are the advantages of Intralase over the Microkeratome (blade)?
Intralase produces stronger flaps, thus improving wound healing. The visual outcome is far superior with intralase along with faster healing and an enhanced safety profile. Customized flaps are created (i.e. not all of the same uniform thickness) and as a result of this the quality of vision is enhanced.
Do you still have to ever use the Microkeratome?
Yes. It is important to remember that every patient is unique and that is exactly how they should be treated. So, although Intralase is the most advanced technique available for flap creation, if you are found to be more suited to the microkeratome then this is best for you. The surgeons at Advanced Vision Care have extremely strict parameters and will do what is going to give you the best result.
There are a number of microkeratomes available and they are used with the most technologically advanced, which is the XP. There is no longer a need to use older models such as the Hanstome.
Is the Intralase method painful?
The surgeon will apply anesthetic drops to numb the eye so no pain is felt. Rather, some patients report a sensation of pressure for a few seconds whilst the flap is being created.
Is the Intralase method safe?
Most definitely. Millions of procedures have been performed worldwide safely and effectively using the Intralase method. This is the gold standard of Laser eye practice all over the world.
Why do some clinics use a microkeratome routinely?
This is rare in the top specialist clinics but common in those with less expertise, which is often the reason why the surgeons and the clinic do not practice with the latest technology and methods. As a result they are able to offer cheap Laser surgery - but as we all know, you get what you pay for.
LASEK
What is LASEK?
LASEK (Laser-Assisted Sub-Epithelial Keratectomy) is used in those few patients who are found unsuitable for LASIK due to corneal thickness. The epithelium is treated with alcohol to loosen and separate it from the stroma and the surgeon places this tissue back. The Laser (similar to that used in LASIK) treats the underlying stroma and the surgeon repositions the top layer. The predecessor to LASEK eye surgery was PRK, which we do not use anymore due to the pain and discomfort associated with it and the poorer visual outcomes.
LASEK is able to treat myopia and astigmatism
Is LASEK painful?
No, not during treatment as the eye is numbed using anesthetic eye drops. Following treatment, LASIK is painless, whilst there is more dryness and sensitivity associated with LASEK. This settles quickly over the first few days after treatment.
Is LASIK better than LASEK?
No. LASEK is carried out by the same surgeon using the same Laser and advanced wave front nomogram as LASIK, so the visual outcome is the same. LASEK takes slightly longer to reach it than LASIK.
Can I still have customized Wavefront treatment if I have LASEK?
Absolutely! The only difference in the two forms of laser eye surgery is the way the flap is created.
I have read you can develop haze after LASEK treatment?
This is true to a certain extent and only happens in cases of aggressive healing (which cannot be predicted). The surgeons at Advanced Vision Care are highly experienced in this field and so are able to successfully treat haze with special eye drops.
Will I meet my surgeon prior to surgery?
Yes, we believe it is essential patients meet a surgeon before having treatment as it is only the surgeon who can make the final decision for treatment. In most of the clinics in UK, patients are seen by an optometrist and the surgical decision is made by them. The patients are seen by the surgeon only on the day of the surgery which is not a healthy practice as the patients are unaware of who is going to operate on them.
We regularly hear of patients who have been seen for a consultation elsewhere and on the day of surgery the surgeon makes a last-minute change, or worse still deems them unsuitable. Be assured that the clinical team at Advanced Vision Care is highly trained, but nevertheless it is always only the surgeon who can make the final decision.
IMPLANTABLE CONTACT LENSES (ICL)
Why would you recommend ICL over Laser?
ICL is the treatment of choice for those patients found unsuitable for Laser treatment due to abnormal or thinner corneas or with out of range prescriptions (it is unsafe to treat patients with over -10D of myopia with Laser eye surgery). It can also be used in Keratoconus patients who have had cross linking first.
Some UK clinics market themselves to treat patients with up -12D or +8 with Laser, but long-term scientific studies have proven that Laser treatment over -10D or + 5 D is not only unsafe but unethical. ICL is the standardized treatment for higher prescriptions recommended by American Association of Cataract and Refractive surgery (ASCRS) and European Association of Cataract and refractive surgery. (ESCRS)
Is it safe?
Absolutely. ICL has been performed for 10 years and the international surgical team at Advanced Vision Care who conduct these procedures are highly experienced. The fact that one of AVC Surgeons had ICL treatment 7 years ago speaks for itself!
In addition, the US Army has approved ICL as the treatment of choice for their recruits. Over 500,000 procedures have been performed successfully worldwide and it is very popular in USA and Europe.
Does it look like a contact lens?
An ICL is much smaller than a contact lens and is implanted behind the iris (the coloured part of the eye). It is invisible to those looking at you, unlike older lenses such as the iris clip Artisan lens which is clearly visible and can cause distortion. There are a range of ICLs available and Advanced Vision Care only use the most sophisticated design.
Is there a chance my body will reject it?
No - there is no chance of rejection as the ICL we use is made of a material (collamer) that is biocompatible with your body’s natural chemistry.
How long does surgery take and what is involved?
Surgery is micro-incision, stitch- and injection-free. It takes 30 minutes per eye with British regulations stating that both eyes cannot be treated on the same day (usually requiring a gap of 1-2 weeks, or the next day where a normal contact lens can be worn in the untreated eye).
What kind of anesthetic is used?
Anesthetic is applied in the form of drops which numb the eye area so you do not feel anything during the procedure. As it is local it wears off without any side effects soon after the procedure is complete.
What prescriptions can be treated with ICL?
ICL is suitable for a large range from -23D to +12 with astigmatism up to 7D. Advanced Vision Care recently made history by being the first clinic to treat an astigmatic hyperope (ie. the patient had high hyperopia as well as significant astigmatism).
I wear varifocals; is this best treatment for me?
This depends on what you want to achieve after surgery. If you only want distance vision corrected and are happy with wearing glasses for close vision then yes it is. If you would like both distance and near treated, then Clear Lens Exchange with multifocal implants would be the treatment of choice. A suitability assessment would determine the best option for you.How long has your clinic been conducting ICL treatments?
Advanced Vision Care has been offering this treatment for 4 years now. However, the world renowned surgical teams that perform this surgery have been doing it for more than 10 years and we are proud to say we are the country’s leaders in ICL treatment.
Can I have ICL treatment if I have had Laser surgery before?
Yes Laser eye surgery is not a contraindication to this treatment.
CLEAR LENS EXCHANGE (CLE)
What does this treatment involve?
CLE is when the natural lens is removed and an implant put in its place (similar process to that of a cataract operation but in this case the patient’s natural lens is clear)
When would this be recommended?
This treatment is suitable for those over the age of 45 where the lens has often started changing and will naturally age further with time. There is no upper age limit and no prescription limitations
This is done for people who have a very high and complicated prescription who are not suitable for Laser or Implantable contact lenses treatment.
Can this treatment correct my distance and near vision?
Yes; if you are found to be suitable for the state-of-the-art multifocal implant then both distance and near vision can be corrected.
What does the surgery involve?
Surgery takes 20 minutes per eye and due to British standards both eyes cannot be treated at the same time (usually a gap of 1-2 weeks where a normal contact lens can be worn on the untreated eye). Surgery is the modern phacoemulsification method which is stitch-free and injection-free. As with the other surgeries available, anesthetic is in the form of drops.
Is it safe?
Most definitely. CLE is as safe as other surgical refractive procedures. Advanced Vision Care utilizes the latest technology and safety management protocols to ensure this.
How long will the lens implant last?
A lifetime. The material from which the lenses are made have been subject to accelerated ageing tests. Results have demonstrated that the lens material will last in excess of 150 years before showing signs of degradation.
Do I have to stop any medication prior to surgery?
This will be discussed at your initial assessment as the surgeon will advise you which medications can continue as normal and which have to be temporarily stopped.
Are there any restrictions after surgery?
It is recommended you avoid any situation where you might be hit in the eye and you should try not to rub your eyes. It is OK to bend and do light physical activities almost immediately after the operation. Normal activities and pastimes can usually be fully resumed after about three weeks.
What is a multifocal lens implant?
Traditional monofocal implants focus light to only one point in space. A multifocal lens has more than one point of focus enabling the patient to see distance, intermediate and near. It has revolutionized the possibilities after surgery.
Are they similar to varifocal glasses?
No. This system is much more precise and specialist. You do not need to move your head to adjust the focus and can comfortably see distance and near due to the complex nature of the optics involved.
Is it a problem if I have tried varifocal contact lenses before and did not get on with them?
No. Again the optics are so different it is not possible to compare varifocal contact lenses with this multifocal implant. Many patients who have been unsuccessful with contact lenses or varifocal glasses have successfully had this treatment with outstanding results.
What are the disadvantages of multifocal implants?
There are 2 minor disadvantages, but those who have had the treatment nearly always say they are outweighed by the benefits. These are night vision glare (which the brain does adapt to a certain extent) and the need for magnification (usually in the form of off-the-shelf ready readers) for long periods of close work and computer work.
What if I am found to be unsuitable for multifocal implants?
You can still have CLE treatment with a monofocal (distance-onl) implant. This results in a low, equal prescription for reading in each eye. This still gives you the advantage of surgery for life as you cannot develop cataracts in the future
Piggy-Back Lens Exchanges
What are they used for?
These are used for complicated prescriptions where a single lens implant is not enough to correct the sight alone. A tailor-made combination of implants are made in these cases. These are also used for patients with abnormal cornea.
How do I know if I need this?
This would be determined at your initial consultation where you would undergo an extensive examination.
How is it done?
The initial implant replaces your existing lens as explained in the CLE section. The second implant is then placed in the posterior sulcus (behind the coloured part of the eye). The second lens could be an ICL or IOL.
Can piggyback lenses be multifocal?
Yes, this is possible depending on the nature of the lenses implanted.
Is this a common procedure?
No, This is an extremely expert procedure and takes great surgical skill. Advanced Vision Care is fortunate to have world-renowned specialist surgeons on its medical team who are well experienced in this field. Advanced Vision Care have carried out a number of successful piggyback procedures.
KERATOCONUS
What is keratonconus?
The cornea is the clear window on the front of the eye and provides the majority of the focusing power of the eye. Keratoconus is a common bilateral corneal condition, occurring in more than 1 in 2000 people. It is characterized by progressive corneal thinning and stretching which gradually progresses in both eyes, resulting in the corneas adopting an irregular cone shape. As a result, the eye develops astigmatism and the vision may become severely blurred. Keratoconus is not visible to the naked eye but apparent upon scans and examination.
What is Cross linking?
Corneal cross linking is a new advanced technique that halts the progression of the disease by treating the underlying cause of the corneal weakness and distortion. This is a unique treatment as until now treatments only improved vision where possible.
The principal of cross-linking is photopolymerisation. Riboflavin is administered to a de-epithelialised cornea which is activated by UVA light. The light-induced production of oxygen radicals leads to the development of strong chemical bonds between collagen fibrils, thereby stiffening and strengthening the cornea.
Can the UVA light used damage my eyes?
No – the wavelength of light used in the procedure is absorbed effectively enough to protect the deeper layers of the eye, thus posing no risk.
What is to be expected after surgery?
A contact lens is placed on the treated eye for 4 days following surgery. Once this is removed you should expect some dryness and distorted vision as the cornea settles. It takes approximately 1 month to stabilize, after which you can be fitted for contact lenses or glasses.
Can I wear my contact lenses or glasses after surgery?
After surgery it will take a month or so for the corneas to settle and during this time your prescription will be fluctuating. Once it has settled you can be refitted for contact lenses and/or glasses.
What are Intacs?
INTACS are a treatment option for mild to moderate keratoconus that is quick and effective. The procedure takes 30 minutes and involves placing small, micro-thin, clear inserts inside the cornea. The ring inserts are designed to reshape the cornea, flattening it to improve the shape of the cone, thus reducing the optical defect caused by keratoconus. They are safe, reversible and do not affect the central visual axis of the cornea.
Can my body reject the intacs?
No, as they are made of a biocompatible material. They are also removable and exchangeable so different rings can be used as the correction requires changes.
What does the surgery involve?
The eye is numbed using anesthetic eye drops and nothing is felt during the procedure. A tiny 1mm incision is made so the corneal layers can be separated to form a tunnel where the intacs are inserted one at a time. The incision is closed with a single stitch.
