You are on page 1of 5

REFRACTIVE SURGERY – LASIK, PRK, LASEK, EPILASIK, LENS EXTRACTION

WHAT REFRACTIVE SURGERY SERVICES ARE OFFERED AT THE ASIAN EYE


INSTITUTE?

The Refractive Surgery Service of the Asian Eye Institute manages vision problems (errors
of refraction) such as nearsightedness (myopia), farsightedness (hyperopia) and
astigmatism through surgery. The most popular procedure in refractive surgery is Laser
Refractive Surgery or Laser Vision Correction (LASIK, PRK, LASEK, EpiLASIK). Other
procedures include refractive lens exchange, insertion of a phakic intraocular lens and
incisional keratotomy procedures such as radial keratotomy (RK), arcuate keratotomy (AK)
and limbal relaxing incisions (LRI).

WHAT IS LASER VISION CORRECTION OR LASER REFRACTIVE SURGERY?

Laser vision correction is a surgical procedure that uses an excimer laser to reshape the
cornea by removing a controlled amount of tissue in order to alter its refractive power. The
most common surgical techniques are LASIK (laser in situ keratomileusis), PRK
(photorefractive keratectomy) and LASEK (laser epithelial keratomileusis). More recently, we
introduced a NEW innovative technique called EPILASIK. The method of exposing the
deeper corneal layer differentiates these four techniques of laser vision correction.

WHAT ARE THE DIFFERENCES BETWEEN LASIK, PRK, LASEK AND EpiLASIK?

Each patient undergoes a screening test wherein the corneal thickness is measured. A
patient with thick corneas can undergo LASIK. For patients with thin corneas, it is not safe to
cut a thick flap because this may weaken the eye permanently. The safer technique is to
create an ultrathin flap (EPILASIK or LASEK) or not to create a flap at all (PRK).

In LASIK, a special device called a microkeratome is used to create a thick corneal flap.
The flap is retracted and the laser applied on the remaining corneal bed. The flap is then
returned to its original position. The cornea has special properties that allow the flap to bond
naturally without the use of stitches. LASIK is the most popular laser procedure because of
the quick healing time, immediate visual improvement and minimal discomfort associated
with the procedure. One day after LASIK, patients see very well, experience almost no pain
and can return to their usual activities.

In PRK, the surface layer of the cornea (epithelium) is gently peeled using a special alcohol
solution and removed prior to laser treatment. The epithelial cells grow back within 5-7 days
after surgery. Vision slowly improves and patients typically experience a significant amount
of pain or discomfort during this period.

In LASEK, the surface layer of the cornea (epithelium) is gently peeled as an intact sheet
using an alcohol solution. Rather than remove this sheet of cells after laser treatment as in
PRK, this sheet is placed back on the treated surface to act as a protective covering during
the healing period. Compared to PRK, the presence of the epithelial sheet after LASEK has
been reported to cause less pain and discomfort, hasten visual recovery and provide an
additional layer of protection from infection.
EpiLASIK is the newest technique in laser refractive surgery. The same microkeratome
utilized in LASIK is used to create an ultrathin flap composed of epithelial cells (surface cells
of the cornea). This ultrathin flap is retracted, laser applied and repositioned back over the
cornea. We place a bandage contact lens to protect the cornea. Post-op pain is less
compared to PRK and LASEK. The cornea heals in three days and vision improves in one
week. It is believed that Epilasik combines the advantages of both LASIK and PRK/LASEK.

The potential for 20/20 vision is equivalent between LASIK, PRK, LASEK or EpiLASIK.
Individual response to healing is a big factor in visual clarity. The healing time is fastest with
LASIK, then EpiLASIK, LASEK and slowest in PRK. The amount of discomfort or pain is
reverse, the most pain after PRK, then LASEK, EpiLASIK, and virtually no pain in LASIK.

WHAT IS THE DIFFERNCE BETWEEN CONVENTIONAL AND


CUSTOMIZED/WAVEFRONT VISION CORRECITON?

Laser software used for treatment can either be Conventional or Customized/Wavefront


(Personalized or Aspheric). A comprehensive evaluation will be performed to determine
whether the patient is a good candidate and which type of laser vision correction software is
most suitable for him. The patient then makes the decision if he/she wants the
conventional/regular treatment or the upgraded customized treatment.

The front part of the cornea alone does not determine how well the eye can focus. The inner
parts of the eye, and how they fit and work together, also contribute to the focusing power of
the eye. Glasses and contact lenses change the way light bends even before it hits the eye.
Similarly, conventional treatment reshapes the eye based mainly on the contour of the front
part of the eye. These methods of correcting errors of refraction can help you see better, but
do not consider the inner parts of the eye that could also contribute to the vision clarity or
sharpness.

Customized or Wavefront (Aspheric or Personalized) vision correction is a higher level of


treatment. Specialized diagnostic instruments gather and analyze information on the inner
parts of the eye. Light reflected from the inner eye is measured as a “wavefront”.
Mathematical equations interpret the wavefront to deliver a treatment that is tailored to these
specific eye details. The customized treatment may therefore result in vision better than with
glasses, contact lenses, or conventional laser treatment. Personalized laser surgery allows
us to treat successfully patients with a large amount of higher order aberrations/distortions
and complicated or irregular astigmatism. Aspheric laser correction allows us to treat
patients with large dim light pupils and minimize the occurrence of night-time glare and
haloes.

WHAT LASER MACHINE DOES AEI USE?

Asian Eye Institute has the advanced Bausch and Lomb Technolas Zyoptix 100 excimer
laser. It is the only center in the Philippines with the Z100. This top-of-the-line laser can
perform conventional, aspheric or personalized treatment for nearsightedness,
farsightedness and astigmatism. In addition, it has a multi-dimensional eye-tracker and the
patented Iris Recognition technology that automatically compensates for changes in eye
position and movement during laser treatment. These revolutionary features provide a higher
level of accuracy in laser pulse placement that can translate to better vision results. Zyoptix
with Iris Recognition (IR) is the brand name of Bausch and Lomb’s customized treatment.
Asian Eye Institute has, by far, the most extensive experience in Zyoptix customized LASIK
in the Philippines.

WHO WILL PERFORM YOUR LASER TREATMENT?

Asian Eye Institute has a full-time laser refractive surgeon who performs all the laser
refractive treatments. Dr. Ang graduated from subspecialty training at the Massachusetts
Eye and Ear Infirmary, Harvard Medical School. He is part of the Asian Refractive
Committee, a prestigious group of eye surgeons, representing each country in Asia,
dedicated to advancing the science of laser vision correction in the Asian Region. He has
performed several international LASIK clinical trials, bringing Asian Eye and the Philippines
to the forefront of cutting edge research in laser technology.

WHAT ARE THE BENEFITS OF LASER VISION CORRECTION?

Laser vision correction gives clear vision without the daily hassles of eyeglasses and contact
lenses and allows a person to:
• Enjoy sports like golf, badminton, diving, swimming, trekking, & rock-climbing
• Experience convenience in travel; no more contact lens kits and solutions;
• Remove the discomfort of allergies, eye redness, dry eye caused by contact lenses;
• Improve one’s appearance and eliminates the pressure on the nose bridge caused by
eyeglasses;
• Save on the accumulated cost of buying glasses and contact lenses for many years to
come; and
• Enjoy a better quality of life

IS LASER REFRACTIVE SURGERY SAFE?

LASIK and PRK have undergone extensive USFDA testing and investigation and are now
considered by ophthalmologists worldwide as a relatively safe and effective surgical
procedure. The risks in laser refractive surgery are similar to those of other eye surgeries.
These include infection, over/undercorrection, flap problems, glare, haloes and dry eye.
Based on a review of past surgeries done, approximately 97% of patients achieve 20/20
vision after laser treatment in Asian Eye.

WHAT OTHER SAFETY FEATURES DOES AEI HAVE?

AEI offers the most sterile laser environment in the country. A dedicated laminar flow air
conditioning unit specifically designed for operating room use ensures that possible
contaminants in the air inside the refractive laser suite is kept to a minimum.

AEI is the first and only eye center in the Philippines with the top-of-the-line Bausch and
Lomb Technolas 217 Zyoptix 100 laser. This laser has the patented Iris Recognition
Technology and multi-dimensional eye tracker that offer increased safety and better visual
results.

The AEI staff is fully trained to perform a thorough evaluation to determine if a patient is
eligible for refractive surgery. The AEI doctor will discuss thoroughly with the patient any
conditions that may predispose him to any complications, so that options and realistic
expectations are considered before he decides to proceed with the surgery.

WHAT IF THE EYE MOVES DURING THE PROCEDURE?

Our laser has a special device called a Multi-Dimensional eye tracker that detects and
follows eye movement in three planes (x-y-z axis), thereby ensuring accurate laser pulse
placement during the entire procedure.

IS LASER REFRACTIVE SURGERY PAINFUL?

No. Patients typically experience little or no pain during surgery since adequate anesthesia is
given while the procedure is being performed. In addition, little or no pain is experienced
after the surgery since the flap protects the deeper layers of the cornea.

After surgery, it is common to experience a gritty feeling in the eye when blinking. It is
unusual to experience severe pain after LASIK.

In PRK, LASEK or EpiLASIK, some discomfort may be experienced during the immediate
postoperative period but this is expected to subside as the corneal surface heals.

WILL I GET PERFECT VISION AFTER LASER CORRECTION?

Because of differences in laser-tissue interaction and variations in wound healing, it is


impossible to guarantee perfect vision to everybody. Statistics from previous treatments
show that approximately 97% of patients who underwent customized Zyoptix LASIK at Asian
Eye achieve 20/20 vision.

If treatment for a patient does not result in full correction, he may opt to wear glasses,
contact lenses or have additional laser surgery (enhancement procedure). Published reports
state that approximately 5% of patients undergo an enhancement or “touch up” procedure to
improve visual results. AEI performs enhancement procedures for patients who have already
had previous laser vision correction.

WHAT IS THE TIME COMMITMENT INVOLVED IN LASER REFRACTIVE SURGERY?

Prior to Surgery
The initial visit may take up to three hours for a thorough eye examination. It is advised that
arrangements be made for someone to take the patient home, since part of the examination
would require putting eye drops that may blur vision for a few hours and make driving difficult
or unsafe. In addition, it is advised that the patient discontinue using contact lenses (1 week
for soft contact lenses and 3 weeks for hard/rigid gas permeable contact lenses) prior to the
scheduled examination to minimize the effect of the lenses on the test results.

On the day of the surgery


Refractive surgery is done on an outpatient basis. While the surgery itself may take only 5
minutes per eye, the actual stay may take up to two hours to accommodate preparations
before the surgery and resting time before the patient is sent home. Both eyes may undergo
surgery on the same day.
After surgery
Several post-operative visits will be scheduled to monitor recovery. The patient will be
advised on precautions and medications during the recovery period.

Visual recovery varies from patient to patient. With LASIK, majority of patients can return to
their usual activities a day or two after surgery. In PRK, LASEK or EpiLASIK, recovery
usually lasts up to four days after the procedure. It is not unusual for vision to fluctuate
following surgery, but normally it stabilizes within a few weeks.

WHAT ABOUT READING GLASSES?

Presbyopia is a condition wherein the ciliary muscles weaken and the natural lens inside the
eye loses its flexibility. This results in gradual difficulty in reading small print or viewing small
objects such as cellphones or watches up close. It is a natural consequence of aging that
cannot be reversed. Beginning at 40 years of age and above, patients with good distance
vision start wearing reading glass and those with eyeglasses convert to bifocals or
progressive glasses.

CAN LASER SURGERY MAKE ME SEE NEAR WITHOUT READING GLASSES?

Numerous claims have been forwarded by different laser companies and surgeons about
laser refractive surgery being able to eliminate the need for reading glasses. For hyperopia
or farsighted people, those with Plus (+) grade, significant progress has been made.
However, for the majority of people who are nearsighted (Minus grade), the solution remains
elusive. Results have been presented in different scientific meetings but no universally
applicable and replicable treatment has been accepted by the eye doctors’ community.
Unfortunately, the answer to the above question if you are nearsighted or myopic is still NO.
There is no consistent solution for the myopic patient that will give perfect distance and near
vision in the same eye if they are in the presbyopic or above 40 age group.

Currently acceptable treatments would entail some amount of sacrifice. For a patient above
40 years of age, we present three options for laser vision correction. Full correction which
results in very good distance vision but total dependence on reading glasses. Second,
compromise or intentional undercorrection makes a patient slightly nearsighted by about
1.00 grade. Distance vision clarity in both eyes is mildly sacrificed to preserve some near
vision without reading glasses. Third, monovision entails treating the dominant eye with full
correction and the non-dominant eye intentionally nearsighted by about 1.50 grade.

You might also like