Refractive Surgeries

Refractive Error and refractive surgery

Refractive error is term used to describe eye problems that can be compensated with glasses or contact lenses, such as myopia, Hyperopia and astigmatism.

Refractive surgery describes the treatment via Excimer laser or eye surgery for correction of refractive error. Type of the treatment is determined following a structural examination of the eye and determination of the degree of refractive errors

First Examination and check – ups

Your first examination includes various check-ups and tests in order to plan the most beneficial and safe operation method for your eyes, and is a preparatory step as important as the operation itself. As contact lenses may temporarily change the curvature of the cornea, you must discontinue soft lens wear for at least 5 – 7 days and rigid gas permeable lens wear for at least 3 weeks prior to your first examination.

First appointment examination includes the following steps which may take 1 – 2hrs.

1. Schwind Sirius and Keratron Scout: for acquisition of a detailed topographic map of the cornea (transparent frontal layer of the eye).
 

2. Pachymetry Technique:  For measuring the thickness of the cornea.    

Corneal thickness is a parameter as important as your prescription, when choosing for the most beneficial surgery method.

3. Pupillometer: for measurement of pupil diameter. Pupils dilate and contract in response to the amount of light. Pupil diameter is wider with some people. Especially with these patients, it is important to plan and coordinate the operation according to this measurement. This precaution prevents occurrence of glare, haze night-vision problems and halos after the operation.

4. Examination: You will go through a detailed eye examination after the acquisition of the test results after the first three steps. Refraction and contrast tests are conducted and the refractive error is measured. Bio-microscopic examination is carried through and eye pressure is measured.

Your age, occupation and your working conditions (tailor, teacher, computer engineer, architect, pilot etc.), systematical disorders such as diabetes, goiter and high blood pressure are questioned in detail. If needed, further examination is carried on using wave front.

5. Examination using dilating drops: After application of a strong dilating drop and 20 minutes of waiting period, a comprehensive examination is carried through. This step is needed to fine-tune your prescription and to examine your retinal nerve and neural tissue. Then you will be appointed for your surgery. These examinations and controls take approximately 2 hours. The data acquired are analysed by our refractive surgeons and the most beneficial treatment methods for your eyes determined. 

Types of refractive surgery:

1. PRK

2. Tran-PRK

3. STANDARD LASIK

4. FEMTO LDV LASIK

5. EPI-LASIK

6. PRESBYMAX Laser (to correct near (reading) power and distance for the people above 40 years)

7. Cachet IOL Implantation

8. ICL Lens implantation:

 

1. PRK

Application of laser without creating flap. Epithelial cells, which are the uppermost layer of the cornea, are removed, and then laser is applied.

The epithelial cells which are removed usually revived 3-5 days.

2. Tran-PRK

The TransPRK is a transepithelial single-step treatment that avoids the eye coming into contact with any instrument.

3. STANDARD LASIK:

At the first stage of the Lasik method a corneal flap about 110 – 130 micron in thickness is created, and during the first years of this method manual mechanic keratome was used for this procedure. Later creation of the flap was made by means of automatic keratomes under computer control, and now there is a new technology of FEMTO LDV Lasik. The method of Intralase flap creation is used as an alternative to the flap creation by means of computer controlled automatic keratomes, but mechanic keratomes are still used very widely and securely.

a. A special automatic device (microkeratome) cuts a flap of thin tissue off the outer layer of the cornea. No pain is experienced during this operation.

b. This flap is lifted and laser is applied onto the central zone of the cornea for approximately 20-50 seconds. Laser reshaped the surface curve to correct the refractive error. The patient is asked to look directly to a red or green light located in the laser while the treatment is performed.

c. Flap is replaced after laser application. The patient is then released to leave.

4. FEMTO LDV LASIK:

The latest technology is the refractive surgery of myopia, Hyperopia and astigmatism:

FEMTO LDV Lasik is creation of the corneal flap using a computer controlled laser. FEMTO LDV Lasik minimizes the risks of the flap creation such as incomplete cut of flap. Dr. Haifa eye Hospital is the only Hospital in Bahrain provides this type of advanced technology.

5. EPI-LASIK:

The epithelium layer is removed with the help of special device, laser is applied, and then the epithelium layer is replaced just like a “living” contact lens. This type of surgery is safe for thin corneas and less chance of dryness compare to Lasik procedure.

6. PRESBYMAX:

This is quite very advanced technology surgery which corrects distance power as well as near power. This is type surgery available only in Dr. Haifa eye hospital in Bahrain.

7. Cachet IOL Implantation:

This is more advanced treatment for high myopic patients. Cachet IOL implantation in anterior chamber of the eye which is giving excellent results.

                                             Cachet IOL Implanted in high myopic eye

8. ICL Lens implantation:

This is another type of lens used to treat Myopia, Hyperopia and Astigmatic cases

To the attention of those who are going to have a laser surgery!

Before the treatment:

The Lasik method is a very short procedure and causes no predicaments for the patients. You should not feel any stress orhave any worries about the procedure. You may eat as you wish before the treatment.

We ask you only not to apply any eye makeup, not to use any perfume. Anesthetic eye drops will be placed in your eyes before you enter the laser room.

During the treatment:

When you enter the laser room, you will be asked to lie on your back in reclining chair. A sterile sheet will be placed around your eyes and your eyes will be fitted with a special instrument so that you do not blink during the procedure. The treatment lasts 4-5 minutes for each eye and you will feel no pain.

The first 24 hours after the treatment:

After the treatment, you will have to wait for 30 minutes and then be taken to postoperative examination. You will be released to go home afterwards. You can experience mild burning, irritation or watering for a few hours after surgery. In rare cases you may need an analgesic medicine. You will be instructed not to; drive, rub your eyes or get water in your eyes during the day of the surgery.

Few days, you can return to your normal activities. You might have headache after the surgery, you can take painkillers except aspirin. We don’t suggest you to go to work or drive. Please stay away from dusty places. Do not rub or touch your eyes. Do not shower or wash your face. Discontinue using soap and shampoo.

When does the vision improve?

What activities are allowed after the first day?

You will start to notice an improvement in your vision after four hours. Your vision will improve considerably 2-3 days following the operation but it may take up to 3 weeks for the final results of the treatment to appear.

For surface laser treatment like PRK and EPI-LASIK vision will continue improve until 3 months. you may feel some discomfort from sunlight and we recommend you to wear sunglasses. You may attend social and sports activities including jogging, cycling and aerobics. You may take plane for you travels. Avoid swimming, pools or hot tubs for approximately 30 days to protect your eyes against infections. After the first month following your surgery, you may wear cosmetic contact lenses if you wish.