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Lasik

Refractive Surgery

It is the surgical procedure aimed at improving patient's quality of life by reducing the dependence on glasses. LASIK is the current state-of-the-art procedure in refractive surgery.

It works by altering the shape of the cornea to treat nearsightedness, farsightedness and astigmatism.

Understanding refractive errors

Nearsightedness (Myopia)

If you need vision glasses/contact lenses to see things clearly at a distance, you are nearsighted.

Farsightedness (Hyperopia)

If you need vision correction to read or see things close by, you are farsighted and depending on your age you may have problems focusing on distant objects too..

Astigmatism

Astigmatism is a condition in which the cornea is more egg-shaped than round with two curves, a steeper curve and a flatter curve. This causes light to focus at more than one point in the eye, resulting in blurred vision. Nearsighted and farsighted people often have a degree of astigmatism.

Reading Glasses (Presbyopia)

In middle age, the natural lens can no longer quickly alter its focus from far away to close up. By their 40s and 50s, whether they have laser surgery or not, most people require reading glasses, even if they have never had to wear glasses before.

Reasons to undergo refractive surgery:

Most likely one can undergo laser vision correction for:

  • Occupational needs
  • Inability to tolerate contact lenses
  • Improving cosmetic appearance
  • Being active in sports and hobbies
  • Convenience

Who is a good candidate for refractive surgery?

  • Patients over the age of 18 years
  • Those with no prescription change in glasses/contact lenses for 1 year
  • Individuals who do not like or cannot tolerate glasses or contact lenses
  • Individuals involved in sports or jobs (such as fire fighting, skiing, tennis, etc.) where contact lenses/glasses are inconvenient or impractical.

Who should not undergo surgery?

  • Other pre-existing corneal disorders especially keratoconus
  • Rheumatoid arthritis and other collagen vascular disorders that may have problems with wound healing
  • Pregnant or nursing women
  • Unstable refraction

LASIK screening evaluation

This comprehensive consultation takes approximately 90 minutes. The following tests are used to establish your eligibility for laser vision correction.

  • Autorefraction: An automated refractor measures how light passes through your eye in order to help determine your baseline prescription.
  • Tonometry: The device is used to measure your eye pressure. It is a key indicator in diagnosing a type of eye condition called glaucoma.
  • Lensometry: Your eyeglasses are assessed to determine the power of your present glasses.
  • Visual Acuity Testing: The test measures the eye's ability to see details at near and far distances. These tests usually involve reading letters or looking at symbols of different sizes on an eye chart. Your uncorrected visual acuity (UCVA) is what you see without glasses or contact lenses while your best corrected visual acuity (BCVA) is what you see with the optimum correction in place.
  • Refraction: The optometrist verifies your current prescription and compares this to the lensometry readings and previous prescription details to ensure stability.
  • Cycloplegic Refraction: Eye drops are used to relax your eye muscles and allow your optometrist to determine how your prescription changes after dilation.
  • Slit Lamp Exam: This test uses a microscope and a small beam of light to clinically examine every part of your eyes under high magnification.
  • Tear quality assessment: Tests will be done to know the quality of your tear film and to rule out pre-existing dry eyes.
  • Pentacam: Gives detailed information on the shape of your cornea (the outer surface of your eye). It provides the most accurate information about the surface shape and thickness of your cornea and how this varies from the centre to the periphery. This test is considered to be the gold standard in establishing if refractive surgery is safe for you.
  • Retinal Exam: The dilating drops used for the cycloplegic refraction aid in this examination as well, providing an excellent comprehensive view of the retina. It is important to rule out the presence of any pre-exisiting weakness in the retina in the form of retinal tear/hole. If it is present, these areas must be lasered before the refractive surgery.

Only a comprehensive examination can determine if refractive surgery is right for you.

Types of Refractive Surgery

  • LASIK (Laser-assisted in situ keratomileusis)
  • PRK (Photo refractive keratectomy)
  • ICL (Implantable collamer lens)

The end goal of all refractive surgeries is to decrease dependence on glasses/contact lenses.

LASIK

This is the state-of-the-art refractive procedure and the most successful elective cosmetic procedure.

Microkeratome LASIK

Microkeratome LASIK is the conventional technique which uses a blade to create the corneal flap.

Bladeless FemtoLASIK

FemtoLASIK or Bladeless LASIK involves use of femto-second laser to create corneal flap instead of a microkeratome blade. Because the flap is generated by laser itself, it is highly precise and safer than the conventional blade.

It is the most advanced refractive suite and the fastest laser available in the world. This refractive suite consists of two lasers - the Femtosecond laser to create highly precise LASIK flap and the Excimer laser to reshape the cornea and correct the refractive error.

Key features:

  • Speed
  • Precision
  • Custom ablations
  • Energy control

Wavelight refractive suite comprises of the following machines:

  • At the cutting edge of refractive technology, the WaveLight FS200 Femtosecond Laser integrates many new functions for fast, effective and reliable femtosecond laser treatments.
  • The WaveLight EX500 Excimer Laser system combines a number of innovations in refractive technology to produce fast, effective and reliable procedures. Its proven, state-of-the-art technology results in excellent Wavefront Optimised and Wavefront-Guided laser vision correction.
  • The unique WaveNet computer network connects the WaveLight systems, including the WaveLight EX500 Excimer Laser, the WaveLight FS200 Femtosecond Laser and a full range of surgical diagnostics.

The flap making in bladeless LASIK is by focusing laser energy at a precise location below the surface of the cornea. By placing thousands of such individual laser pulses side by side one can create a cut within the cornea without the use of a blade. Thus in this entire laser vision correction procedure no blade will touch your eye, making it extremely safe.

Wavelight refractive suite

It is the most advanced refractive suite and the fastest laser available in the world. This refractive suite consists of two lasers - the Femtosecond laser to create highly precise LASIK flap and the Excimer laser to reshape the cornea and correct the refractive error.

Key features:

  • Speed
  • Precision
  • Custom ablations
  • Energy control

Wavelight refractive suite comprises of the following machines:

  • At the cutting edge of refractive technology, the WaveLight FS200 Femtosecond Laser integrates many new functions for fast, effective and reliable femtosecond laser treatments.
  • The WaveLight EX500 Excimer Laser system combines a number of innovations in refractive technology to produce fast, effective and reliable procedures. Its proven, state-of-the-art technology results in excellent Wavefront Optimised and Wavefront-Guided laser vision correction.
  • The unique WaveNet computer network connects the WaveLight systems, including the WaveLight EX500 Excimer Laser, the WaveLight FS200 Femtosecond Laser and a full range of surgical diagnostics.

Steps of a bladeless LASIK procedure:

Step 1: Patient specific corneal and refraction details are first programmed in the laser machine to create the unique ablation pattern to provide a wavefront optimised correction.

Step 2: We prefer to use the femtosecond laser to create a thin corneal flap. The laser works by vaporising minute amount of tissue into bubbles forming a cleavage plane for the flap.

Step 3: After flap is lifted, ultra fast excimer laser is used to re-shape the stromal bed according to the individual's refractive errors followed by repositioning of the flap.

Post procedure:

Immediately after the procedure patients may experience foreign body sensation, tearing or watering in eyes and hazy vision. These symptoms should considerably improve within a day after surgery.

Alternatives

  • Implantable Collamer Lens (ICL) implantation: In this procedure a thin artificial lens is placed inside the eye above the natural crystalline lens. It is done in patients with high refractive error not amenable to correction by LASIK procedure or in cases where the corneal thickness is not sufficient for a safe LASIK surgery.
  • Photo Refractive Keratectomy (PRK): It is a procedure for correction of refractive error where instead of a corneal flap, the top most layer of the cornea called as epithelium is removed and then the laser is delivered. The procedure is done in patients with thin cornea and with pre-existing corneal epithelial problems.

Risks

All surgical procedures carry some degree of risk although very minimal. One may experience dryness in the eyes which can be easily treated using lubricating eye drops for 3 months after the surgery. Apart from this, there may be glare/haloes in the early period after surgery which generally gets resolved with time.

Benefits

At Medanta, we value patient's safety above everything else. Bladeless LASIK also known as femtoLASIK, has been proven to be safe and effective in large number of clinical studies.

  • It allows the creation of flaps with diameter and thickness of a wide range.
  • It creates very precise, perfect and smooth corneal flaps.
  • It avoids all sight threatening complications associated with microkeratome.

When to contact the doctor?

Ensure you contact your eye doctor immediately if you experience:

  • Uncontrolled pain, redness and watering in the eye.
  • Persistent hazy vision even after 3 days of surgery.
  • Any injury to the operated eye.

Why Medanta the Medicity?

  • Division of Ophthalmology at Medanta is one of the leading eye-care centres in Delhi NCR offering state-of-the-art diagnostic and therapeutic services in all specialities of ophthalmology
  • It consists of a highly efficient and skilled medical team with a vast experience in the surgical procedures
  • It is the only division equipped with Femtosecond technology available for both cataract (LensX) and LASIK (WaveLight Refractive Suite)