TREATMENT OF VISUAL DEFECTS WITH EXCIMER LASER IN EKOL EYE HOSPITAL
In our hospital, Lasik flap creation process and Excimer laser process are performed comfortably in a short time without ever getting up from the bed thanks to the state-of-the-art ALCON EX500 Refractive Unit.
Vision defects (Myopia, hyperopia and astigmatism) can be corrected completely with computer controlled Excimer Laser devices by changing the shape of the transparent layer of the eye, so called cornea.
By applying the excimer laser to the corneal tissue in the anterior part of the eye, it destroys the tissue by evaporation, causing the carbon bonds that hold the tissue in the cornea to break. With the excimer laser, a very well adjusted amount of laser is sent to the desired areas in the cornea, and some part of the cornea is almost shaved in the desired dimensions. Thus, the desired value is achieved by changing the refractivity of the cornea.
Excimer laser vision defect correction methods are being used in the world for over 25 years and 22 years in Turkey. During this period, there have been considerable changes in both laser devices and application techniques, and with each change, it provided achieve a better and desired result, to keep patient comfort at a higher level giving less complications (undesirable results). Excimer laser, which was introduced with the PRK method with the first application, has developed up to the Femtolasik method today.
Who can get Excimer Laser Treatment?
In a normal eye without any defect, the image falls on the retina, which is the visual layer where the image is perceived.
Myopes: In myopes, the corneal surface is very curved or the eye has a longer length than normal. In these patients, blurred vision occurs at a distance because the image falls in front of the retinal layer.
Hyperopia: Patients with a flatter cornea or shorter anterior-posterior length of the eye, so the image falls behind the retina. The problem of seeing near in these eyes is more than distant vision.
Astigmatism: When the eye surface is inclined like an egg, both far and near vision defects occur.
Presbyopia: It is a close vision difficulty that usually occurs after the age of 45 as a result of the decrease in the elasticity of the eye lens due to age. As a result of the natural aging process, people use close glasses after an average of 45 years old for near vision or need a second close glasses in addition to their distant glasses.
Excimer Laser Application Methods:
PRK: It is the first application method of Excimer Laser. Here, the extremely thin living tissue called epithelium is scraped on the cornea with a scraper called spatula. Corneal surface is about 9 mm.
Excimer laser is applied after it has been completely epithelial in one area. The eye then removes the removed epithelium. It is painful after the operation, a stinging and pain sensation occurs for about 3-7 days. The relief of vision can last up to 3-6 weeks.
TPRK: It is a feature of only Schwind Amaris Excimer Laser device and it is applied directly on the laser cornea without removing the epithelium. In this technique, the stinging sensation is less and vision improvement is faster.
Lasik: Lasik Excimer laser is a surgical method developed to be able to apply the correction with satisfactory and painless. Lasik method has 4 main advantages;
1) According to the PRK, it is a more painless method for the patient, and on the day of surgery, a number of stinging and pain complaints in the patient decrease or disappear from the 2nd day.
2) Vision correction is faster. The patient will have a very satisfactory vision within 3-5 days.
3) After the operation, the return of the number or the formation of turbidity in the cornea does not occur.
4) It can be applied in high numbers up to 10 degrees in myopia.
There are basically 2 steps in the Lasik method;
1) Corneal Flap Creation
2) Excimer Laser Application
In Lasik method, the eye surgeon cuts a thin and circular layer before applying Excimer laser; then this layer (corneal flap) is carefully folded backwards so that the central part of the cornea remains open. The important thing here is how flap removal is done. For this process, blades called microkeratoma are used in the classical Lasik method.
After the cornea flap is removed from the area and taken under protection, a laser is applied to the cornea bed. Later, the flap that is laid back is placed back to its original position and it is ensured that it takes the appropriate position.
Is Lasik painful?
Lasik technique is completely painless and takes a very short time. While making the incision with microkeratome, there may be a feeling of tension due to the microkeratome sucking and holding the eye tightly, but this is a short-term and uncomfortable feeling. The form of anesthesia applied for Lasik is drop anesthesia. There is absolutely no needle or sewing process. After the application of a few drops of anesthetic agent, these operations are performed painlessly on the eye.
After lasik vision will increase rapidly so you can go home after 15 minutes. There may be little itching and light discomfort, but they are not advanced. In painful situations, taking a painkiller will relieve the discomfort. Vision will reach a satisfactory level in 2-3 days.
Is the method of correcting vision with Lasik safe?
In a very developed country like America, the organization named FDA (Food and Drug Administration) gives the approval of all kinds of treatments after a lot of examination. The PRK method was approved by the FDA in 1995 and the LASIK method as a reliable therapy in 1999.
Is Lasik Totally Risk-Free?
The undesirable results we call complications in Lasik are extremely low. Almost all reported complications are due to the incision of the mechanical keratoma during the creation of the corneal flap.
Complications that may occur during flap removal with blade microkeratomes during the application of Lasik are reported as 2.2% in large series.
Some of the complications that may occur in the desired thickness, order and integrity during the cutting of the cornea with knife mechanical keratomas may be serious and threatening to see, but there is never a loss of eye.
As a femto-lasik, this new technological method is one of the most important developments in refractive surgery. Fully computer controlled system that does not allow any mechanical interference, required for lasik
it makes the corneal incision with a laser without any blade and with an unprecedented precision.
Although Lasik method, which has been applied to 10 million eyes in the world, is quite safe, it also contains some complications. And almost all of these complications are associated with mechanical keratomas and flap removal in the 1st step of the method. FEMTOSECOND Laser technology has completely solved this problem. The flap cut, which is the first step of the method, is made with a computer-controlled laser. Thus, there is a chance to create a flap with the desired thickness, desired diameter and desired area, with a flawless flap cut, unfailing precision and accuracy.
In the methods applied by creating a corneal flap with the microkeratome blade, there may be an infrequent inflammatory reaction (DLK: Diffuse Lamellar Keratitis) between the flap and the cornea bed. If this reaction occurs, your corneal flap may need to be lifted and washed again, and you can use a number of additional medications. DLK development rate is much less in femto-lasik application and it is mild.
Another rare and undesirable situation is the progression of the cornea's most superficial cell layer, the epithelium, under the flap, which is negligible in the femto-lasik method due to regular incision (below 1 in a thousand).
Why we are pro-Femto-Lasik use:
* It brings extra safety to our patients by eliminating the potential complications of mechanical keratomes with femto-lasik blades.
* Since we have the chance to remove thinner, desired thickness flaps with femtolaser, we have the chance to apply lasik in our patients with thin corneal layer.
* Since we can remove thin flaps with femtolaser, we can apply Excimer laser to our patients with high vision defects as well as myopia up to 10.00 degrees.
* Femtolaser makes Lasik application completely, from start to finish laser method.
* Cornea flap cut by femtolaser When excimer laser is laid back again, it creates a more suitable flap.
* Creating a flap using femtolaser is painless and much more comfortable since less pressure is created on the cornea.
WAVEFRONT (EAGLE EYE) TECHNOLOGY:
In some eyes, in addition to vision defects such as myopia, hyperopia or astigmatism, the eye has optical irregularities due to irregular islets in the corneal layer of the eye. Aberrations can cause decreased night vision and visual acuity. In this treatment, which is generally known as Eagle Eye, these irregularities in the cornea are detected with topography taken very precisely and in addition to the treatment of the patient's myopia, hyperopia or astigmatism, these islets are corrected. In addition to this, it provides a better visual acuity and night vision than its eyesight.
Evaluation before Excimer Laser treatment:
The examinations performed before Excimer laser treatment are very important. Excimer laser treatment is applied to eligible patients who do not have any risk as a result of these examinations. 3D detailed maps of the cornea (corneal topography) will be taken, corneal thickness will be measured from many points and corneal irregularities will be detected. There will be no eye contact during these procedures.
How will I see it after Excimer Laser?
Almost all of the results of the study show that after the standard lasik, unhealthy (without glasses) visual acuity will be over 60/100 with a probability of 99% and 100/100 with a probability of 80%. These ratios are even better with devices that use Wavefront (Eagle Eye) technology. However, it is still impossible to guarantee that no glasses will be used. Although our goal with the new technology is the complete elimination of vision defect, depending on the type and degree of vision defect of the eye, some structural factors, your eye may not be fully emetroped (the eye without vision defect). However, it will never be like your old high condition and you will most likely live a very comfortable life without glasses. Very few people may have night vision problems, but with Wavefront technology, this is exceptionally small..
Can I see my close vision with Excimer Laser treatment?
Despite the correction of distant vision problems for about 25 years, it was not possible to correct the vision defect, which we call presbyopia, which requires using near glasses after 45 years of age with Excimer laser. However, there have been important developments in recent years to correct this. For this correction, the effects of wearing certain materials placed inside the cornea layer have been limited and there have been problems in performing the operations. For this reason, in some clinics, although the person does not have cataracts, lenses that provide far and near vision are replaced by taking an eyepiece.
Today, the newest technology in correction of near vision with Excimer laser is the technology called PRESBYMAX. This is a technology that can only be applied with the Schwind Amaris device. Here, near vision impairment or only near vision impairment can be treated. Treatment procedures are the same as lasik treatment procedures as mentioned above. In this process, the corneal flap is lifted with a mechanical keraom or femtolaser device. This technology is still applied in Germany, France, England, Korea, China, Japan and Russia.
In patients treated with this technology, near vision becomes quite good from day one, but there may be a temporary decrease in distance vision. Following the detailed examination of the diameter of the pupil and the cornea, PRESBYMAX treatment is applied to the patient group suitable for this treatment. It gives the best results in patients who need closer vision without seeing far. One of the important advantages of PRESBYMAX treatment is that this treatment can be reversed in the same eye for patient dissatisfaction.
Can anyone have Excimer Laser treatment?
Lasik may be inconvenient in various systemic or ophthalmological conditions that can prevent the cornea from forming safely. Your eye should definitely be evaluated with highly advanced high-tech devices before Lasik. However, it should be known that individuals under the age of 18, in case of pregnancy and breastfeeding, mainly cataract, keratitis, keratoconus, dry eye, etc. Excimer laser should not be applied in some eye diseases such as diabetes and immune based systemic diseases and individuals whose eye numbers change frequently.
* In the Excimer Laser method, drugs such as needles and narcosis are not used, only a drop is applied to make the eye superficially numb.
* Both the Excimer laser process and the flap removal process are short procedures that take 1-2 minutes. With the new laser technology, the laser duration usually takes less than 1 minute. However, with the process of preparing the eye for surgery, it should be accepted as 5 minutes per eye.
* You can communicate with your doctor during laser operation.
* We recommend that you do not squeeze yourself and move your eyes during the operation. However, since the advanced Excimer laser devices have a high sensitive eye tracking system, even if you move your eye, the laser will follow your eye and apply the laser beam to the required area.
* Your eyes will not be closed after the operation; you can return home immediately.
* It is useful to spend a few hours resting after the operation.
* If lasik or femto-lasik treatment is applied, you can continue your life the next day. Using protective sunglasses will be beneficial because it reduces the sensitivity of light that may be possible in the first days. It will be a little late to start your job, as the corrections made without lifting the flap on the cornea such as PRK and TPRK may be the first few days of sinking.
* It is inconvenient to rub, press and scratch your eyes.
* You must use the prescribed drops as desired.
Frequently Asked Questions
* Since it's such a good technology, why don't most ophthalmologists get surgery?
One of the most important reasons for this is that an ophthalmologist who is experienced enough to treat you has the problem of near vision as well as distance vision by age. Distant vision correction is not suitable for the group of experienced physicians, since there has been no suitable treatment for years.
In addition, ophthalmologists who perform very intensive surgery may experience difficulties in the microscope after laser since they work under a microscope compared to other people.
Another reason is Excimer laser treatment is a reason for preference. A person who is happy with his glasses does not need to have surgery. Doctors may not prefer surgery since they are used to using glasses for years and this does not pose a problem in their work life.
However, there are many ophthalmologists who have surgery.
* Will my number return after the surgery?
This was happening with the devices and techniques used in the first years of Excimer laser. But today, especially in lasik technique, there are no exceptions.
* Can people with Excimer Laser treatment have cataract surgery in the future.
This is one of the most misunderstood points. Cataract surgery can be performed like a person who does not have an excimer laser treatment. Excimer laser treatment is a treatment applied without getting into the eye and does not constitute any obstacle to cataract surgery performed by entering the eye.
* Will my number progress after the operation? Can I have surgery again?
There is no more than 0.25 change in the number in the last 1 year before the operation and the person is 18 years old is an important criterion for surgery. Although there is no turning back with new lasik techniques, vision defects that usually stop at the age of 18 can sometimes make progress. 6 months after the operation, if there is a significant number change or exceptionally, the desired number cannot be provided, it is possible to be a second operation with a much easier operation.
* Is there a risk of surgery? Do I lose my eyes?
The risk is not completely zero in anything. As mentioned above, a significant portion of the risks associated with lasik treatment occurs during knife corneal flap removal, which is 1% or less in an experienced surgeon. In femto-lasik, this risk is much lower. None of these risks are untreatable and there is no loss of time or complete blindness of the eye.
* At what age can Excimer Laser Treatment be applied?
Surgery can be performed at any age from the age of 18 to the age of 65. However, the age range of 18-40 is more suitable for the correction of distant vision, and the age range of 40-65 for the correction of near vision.