Excimer Laser Surgery

Who is a candidate for Refractive Surgery?

Laser refractive surgery can treat people who:

• are at least 18 years of age
• are not pregnant or nursing
• are in good general health
• have a stable prescription for eyeglasses or contact lenses
• have no eye diseases

LASIK

LASIK (Laser-Assisted In Situ Keratomileusis) is an FDA-approved outpatient procedure that uses the excimer laser to reshape the cornea to correct your vision. LASIK involves the creation of a corneal flap that can be created with a blade or a laser. LASIK is one of the most frequently performed healthcare procedures in North America. It can correct myopia, hyperopia and astigmatism.

PRK

Like LASIK, PRK utilizes the excimer laser to reshape the curvature of the eye and treats nearsightedness, farsightedness, and astigmatism. PRK differs from LASIK as it is performed on the surface of the eye and no flap is created during the procedure. PRK is suitable for people with thinner corneas, dry eyes or lower corrections. Some patients simply prefer not to have a flap created. Visual results are comparable to LASIK but recovery is slower.

Custom Treatment / Wavefront

With custom surgery, an individual customized map is created for each eye. This data allows for diagnosis and treatment of small imperfections in the eye that can impact quality of vision. Custom treatment offers the potential for the highest quality of vision including night vision with less incidence of glare and halo. Doctors at Cornea Consultants of Albany were the first surgeons in Northeastern New York to perform Custom LASIK.

Included in a custom treatment are iris registration and pupil tracking:

• Before surgery, a wavefront map is obtained and the iris is scanned. At the beginning of surgery, the equipment compares the iris scan with the iris of the patient. Once multiple areas of the iris are registered, the laser treatment is placed precisely on the cornea.
• Pupil tracking makes sure that the laser is centered on the eye. It is impossible for someone to remain completely stable during the surgery, but the laser uses pupil tracking to compensate, and the laser moves with you assuring that every pulse of the laser is centered on the eye.

Conventional LASIK

With conventional LASIK, your prescription is entered manually into the laser. Conventional LASIK is the original LASIK procedure and is still an excellent choice. In some cases, conventional surgery may be the only option available.

Monovision

Monovision is a specialized form of laser surgery in which one eye is corrected for distance and the other one for near. It represents an option for those patients experiencing presbyopia. Monovision is not for everyone and should be discussed individually with your surgeon.

What are the risks of laser vision correction?

As with any surgery, there is a potential for risks and complications. Every eye heals differently, making it impossible to predict your exact outcome. While uncommon to experience a complication, it is important for you to discuss risks with your surgeon prior to the procedure. Proper screening and testing will determine your candidacy only when it is medically advisable. Diligent post-operative care also helps to identify and address potential healing complications.

Unrealistic expectations are among the most common reasons for a dissatisfied patient. It is our goal to “under promise and over deliver” in this regard. This procedure will reduce your dependence on glasses or contact lenses but no one can guarantee that you will not need glasses or contact lenses for any reason for the rest of your life. Also, in general, your quality of vision after surgery should be about the same as it is before surgery acknowledging that no one’s vision is perfect at all times. We will do everything possible to assure you the best chance to have the best vision possible after your procedure.

Despite everyone’s best attempts, some patients will have a routine procedure and be unhappy with the visual outcome. An enhancement or “touch-up” may be indicated at the discretion of your surgeon. Risks of such procedures must be weighed against possible complications.

Among the more serious complications of laser vision correction is Corneal Ectasia (or keratectasia). This is a serious side effect that occurs when your cornea becomes steeper and begins to bulge after surgery. You will be screened for the risk factors using the most sophisticated equipment available but in some rare cases it is impossible to predict its occurrence.

Again, a thorough screening will be conducted individually to determine your candidacy and review complications and expectations in detail.

What to expect?

Preoperative consultation - Before you have LASIK eye surgery, you will be given a packet of information to guide you as you prepare for surgery. Read it carefully to be sure you understand what is expected of you and how your doctor and the staff at the surgical center plan to take care of you. You will set a date for the surgery, and if you wear contacts, you must leave them out for at least two weeks prior to your evaluation.

Procedure - On the day of your surgery, you will be asked not to wear any lotions creams or makeup on or around the area of your eyes. Some additional testing may be required the day of surgery. You should expect to be at the laser center for up to 3 hours on the day of your procedure. While in the laser suite, the area around your eyes will be cleaned, and then the staff will numb your eyes with drops and use a tool to hold your eyes open and keep them form blinking. When you are ready, the doctor will perform your LASIK eye surgery. The doctor will use a device to create a flap in your cornea. Then the doctor will ask you to look at a light to keep your eyes fixed as the laser reshapes your corneal tissue. The corneal flap will then be replaced over your eye to adhere. You should not feel any pain, but you will feel uncomfortable pressure from the eyelid holder. It takes about five or ten minutes to operate on each eye. You must arrange for someone to drive you home after your surgery.

Post-operative follow-up - After your surgery, you may feel a scratchy sensation in your eye. You should not rub your eyes. Your doctor will give you a post-op packet to take home with you. You will receive eye drops to help prevent dryness, infection and inflammation. You should rest for the remainder of the day and try and nap as much as possible. You will be given an appointment for the next day for the doctor to examine your eyes. You should be able to drive and return to work within a few days or as your doctor advises. Follow up appointments will be made to assess your vision. Your vision will begin to make rapid improvement by the next day and will stabilize within three to six months.

Phakic Intraocular Lens

Phakic Intraocular Lenses (IOLs) are lenses that can be surgically placed inside the eye; they resemble the IOLs that are implanted during cataract surgery, but differ from traditional IOLs because they don’t replace the original lens in the eye. Instead, they compensate for nearsightedness by correcting the refractive errors of the original lens. It’s like wearing a contact lens inside the eye instead of on the surface of the eye, except that you can’t feel it and don’t have to change it. Phakic IOLs are currently being used to correct for nearsightedness in cases where the cornea is very thin or the nearsightedness is moderate to severe.

Phakic IOL Options:

• The Verisyse phakic IOL is a plastic lens implanted between the cornea and the iris. The surgeon inserts the lens through a small incision and clips the new lens to the iris. Several sutures placed at the time of surgery will typically need to be removed in the office.
  
  FDA approved in 2004, this lens has been used outside of the United States for over 15 years with an excellent safety record. Dr. Schultze was the first surgeon in Northeastern New York to perform Versisyse lens surgery.
  
  Please see the attached patient information brochure for more information about the Verisyse Phakic IOL.
  
  

• The Visian Implantable Collamer Lens (ICL) is a lens made in part from collagen, which is biocompatible, and then implanted behind the iris. An ICL can be folded while it is being inserted, so the surgeon can insert it through a smaller incision than would be possible otherwise. (A smaller incision means quicker recovery time from the surgery.) The lens unfolds itself after it’s inserted, and the incision is so small that it doesn’t need sutures.
  
  FDA approved in 2005, this lens has a shorter track record and has very precise sizing requirements. Dr. Schultze was the first surgeon in Northeastern New York to perform Visian lens surgery. This was done prior to FDA approval outside of the United States.

Phakic IOL Facts:

• If you aren’t a good candidate for LASIK surgery, you still might be a candidate for these lenses.
• Sometimes the visual results are better than they would be if you had LASIK surgery.
• Surgeons can use phakic IOLs in combination with LASIK surgery to get a better result than would be possible with either technique by itself.
• This procedure requires a visit to an operating room. The procedure takes about 45 minutes and you will be consciously sedated and comfortable throughout your surgery
• Phakic IOL surgery costs several thousand dollars per eye to cover surgeon fees, lens cost, operating room time and anesthesia fees.
• Visual recovery can take several weeks and for this reason both eyes are usually treated several weeks apart.

Clear Lens Extraction

Clear lens extraction is essentially premature cataract surgery. The clear natural lens of the eye is removed and a man-made implant of a better power is placed within the eye. Risks are similar to those with cataract surgery. Many lens implant options are available. Clear lens extraction is typically considered cosmetic and is not covered by insurance.

Standard Lens Replacement

A standard intraocular lens, or IOL, is a monofocal lens. A monofocal lens can focus light rays at distance or near but not both. Typically vision is optimized for distance and reading glasses are necessary for near tasks. This is the first kind of lens that was developed, which means it has the longest and best-documented history of all the lenses.

Toric Intraocular Lens

Toric IOLs can correct astigmatism if it is present. Astigmatism can be caused by the shape of the cornea or the shape of the lens. These monofocal lenses are used to improve the quality of distance vision and reduce dependency on glasses for distance only.

Mutifocal Intraocular Lens

A multifocal IOL has different zones within the lens that allow you to focus on objects that are near or far away. This type of lens is used to reduce dependence on glasses at BOTH distance and near.

ReSTOR® - If you're seeking freedom from glasses, the AcrySof® IQ ReSTOR® multifocal IOL may be the best choice for you. The AcrySof® IQ ReSTOR® IOL gives you the best opportunity for improved image quality and a full range of vision – near, far and everything in-between – with increased independence from glasses or bifocals.

However, the results of the AcrySof® IQ ReSTOR® IOL clinical trials have indicated that there is a slightly greater chance of experiencing glare and halos around lights, when compared to a traditional monofocal IOL. Over time, some people grow accustomed to these disturbances and cease to notice them; others may continue to see them long after surgery.

Although not all IOLs provide a full range of vision like the AcrySof® IQ ReSTOR® IOL, there are instances when a monofocal lens may offer more desirable outcomes for certain patients. For these situations, Alcon offers the AcrySof® IQ IOL. Both the AcrySof® IQ IOL and the AcrySof® IQ ReSTOR® IOL can restore your vision following cataract surgery, and both offer the enhanced image quality of an aspheric optic.

Dr. Schultze was the first surgeon in Upstate NY to preform ReSTOR® IOL surgery.

Please see the attached brochure for more information.

ReZoom® - Unlike conventional single-vision (monofocal) lens implants, state-of-the-art ReZoom® lenses have been specially designed with multifocal zones that provide good vision across the spectrum of varying distances and light conditions. So you can see well anywhere and anytime, be it near, far or in between. Patients no longer have to settle for monofocal lenses that only provide good distance vision with limited ability to see objects that are near without glasses.

However, the results of the ReZoom® IOL clinical trials have indicated that there is a slightly greater chance of experiencing glare and halos around lights, when compared to a traditional monofocal IOL. Over time, some people grow accustomed to these disturbances and cease to notice them; others may continue to see them long after surgery.

The ReZoom® Multifocal Lens is a clear, foldable implant made of a high-refractive-index acrylic material. This new technology multifocal lens is designed to provide a full range of vision – near, distance and intermediate – after cataract treatment.

Please visit the ReZoom website for more information.

Accommodation Intraocular Lens

An accommodating IOL can actually shift position, in much the same way the original lens does. This type of lens is used to reduce dependence on glasses at BOTH distance and near.

Crystalens® - Crystalens® is an accommodating intraocular lens that, unlike a standard IOL, can treat both a person's cataracts and presbyopia—loss of near and intermediate vision. You probably noticed in your forties that you started to lose some of your up-close vision and had to start wearing reading glasses. Crystalens® not only treats your cataracts (a clouding or hardening of your lens), but can also reduce or eliminate your dependence on glasses. It does so by recreating accommodation similar to your eye's natural lens. The unique Crystalens® can reduce or eliminate glasses for most activities, including: reading a book, working on the computer, and driving a car. With this lens the induction of glare or halo is less common however there may be more dependence on reading glasses for near activities.

Crystalens® was modeled after the human eye. Like the natural lens, it uses the eye muscle to flex and accommodate in order to focus on objects in the environment at all distances. Crystalens® dynamically adjusts to your visual needs.

Please see the attached brochure for more information.

Conductive Keratoplasty

Conductive Keratoplasty (CK) is a method for improving farsightedness. CK utilizes radio-frequency waves to steepen the cornea. A tiny probe is used to place 8 to 32 spots in a concentric ring pattern on the peripheral cornea. The heat from the wave shrinks your eye’s collagen fibers in each spot touched by the probe, and the fibers pull the cornea into a new shape. It is fast (about three minutes per eye) and has a quick recovery time. You can probably go back to work the next day. You’ll see some improvement to your vision immediately, and it will continue to improve for a few weeks.

The most appropriate CK candidates have had no need for glasses until age 40 when near vision begins to become blurry (presbyopia). In such cases, CK is used in a monovision technique in which only one eye is treated to obtain near vision. CK is also an appropriate method to improve your farsighted vision if you are more than 40 years old, your vision has been stable for at least six months, and your farsightedness is in the range between +0.75 diopters and +3.00 diopters. A full consultation is required to determine whether you are a good candidate.

You should understand that your eyes are going to continue to change as you age and the effects of the CK treatment are not permanent in many cases. You will probably still need to have reading glasses eventually, but it will be postponed. Also, even if the effect regresses, you may still find that your ability to see intermediate distances is still better than it was before your CK.

Astigmatic Keratotomy / Limbal Relaxing Incision

Astigmatic Keratotomy (AK) and Limbal Relaxing Incision (LRI) are procedures in which partial thickness incisions are made in the peripheral cornea to relax astigmatism. They are most commonly used in conjunction with multifocal and accommodating IOLs to reduce coexisting astigmatism. This procedure is done at the same time as the lens implant surgery.

Call Cornea Consultants of Albany today at 518.475.1515 to schedule a personal refractive consultation.