FAQ - LASIK, LASEK, IOL 

LASIK vs. LASEK
 

Main difference Between LASIK and LASEK is thickness of the flap which includes corneal stroma tissue in LASIK and only epithelial tissue in LASEK.

LASIK

NAME DETAIL

Laser-Assisted In Situ Keratomileusis

CORRECTIVE USES

Refractive error correction for nearsightedness, farsightedness, astigmatism and presbyopia.

PROCEDURE LENGTH

Outpatient procedure. Laser treatment requires less than one minute for each eye; total procedure lasts about 15 minutes per eye.

PROCEDURAL NOTES

Uses a microkeratome knife and excimer laser in procedure. The epithelium and stroma are cut to a thickness of 100-180 microns, then an excimer laser ablates corneal tissue under the epithelial/corneal tissue flap. An alcohol solution helps lift the epithelium.

HEALING & RECOVERY

2 days – 1 week; faster than LASEK. Allowed to drive 1-3 days after surgery.

BENEFITS

Appropriate for people who have more corneal tissue, less discomfort than LASEK, almost no pain, 20/20 vision or better is typically achieved, corneal haze very rare, immediate clear vision, follow-up enhancements are easier if needed.

POTENTIAL DRAWBACKS

Those with thinner corneas may suffer less than ideal results, flap may dislodge with trauma, increases higher order aberrations, uneven flap edges may lead to astigmatism, flap may result in scars, post-operational treatment is needed in approximately 5% of patients.

INDICATIONS FOR PROCEDURE

Required thickness of corneal tissue achieved, requirement for painless procedure and/or extremely fast recovery, probably best for correcting over 6.00 diopters of refractive error.

LASEK

Laser Assisted Sub-Epithelial Keratomileusis

Refractive error correction for nearsightedness, farsightedness, astigmatism and presbyopia.

Outpatient procedure. Laser treatment requires less than one minute for each eye; total procedure lasts about 15 minutes per eye.

The epithelium is cut to a thickness of 50 microns while the stroma is left uncut. Uses a trephine, a finer blade than that used in LASIK. An excimer laser ablates corneal tissue under the epithelial flap. An alcohol solution helps lift the epithelium.

Flap edges heal within a day. Can drive in about a week with crisp vision in about 6-8 weeks. Recovery slightly longer than LASIK - about 4-7 days.

Better choice for poor LASIK candidates including people with less corneal tissue, fewer haze outcomes than LASIK, preserves more corneal tissue than LASIK, no complications of stromal flap as in LASIK, less risk of dry eye than LASIK.

More discomfort than LASIK, takes longer to heal than LASIK, many diseases, medications, and conditions are contraindications, trauma, such as being hit in the eye may cause flap to dislodge, as a fairly new technique, long-term outcomes are not well established, increases HOA, blade can create uneven flap edges leading to astigmatism.

Corneas too thin or flat for LASIK.

For both of these procedures, extensive screening is required for qualification. Participants must be between the ages of 18 and 40, vision must be less than -14.00 diopters of nearsightedness, less than +6.00 diopters of farsigntedness, and less than 6.00 diopters of astigmatism, a stable prescription must be in place, must not have a history of eye disease or abnormality, the corneas must be within a treatable shape range, the pupils must be of approximately normal size (with slightly larger pupils deferring patient to PRK instead of LASIK), and there must be adequate tearing in both eyes (eye moisture must be healthy).

CONTRADICTIONS TO PROCEDURE

Thin cornea, not within age limit***, uncorrectable range of vision, unstable prescription, eye disease or abnormality, diabetic retinopathy, cataracts, glaucoma, ocular hypertension, autoimmune disorders, contradictory medication, pregnancy, nursing, large pupils, dry eye, prior eye surgery, naturally elevated HOA.

Possible inability to maintain thin flap (resulting in removal of epithelium), not within age limit, uncorrectable range of vision, unstable prescription, eye disease or abnormality, diabetic retinopathy, cataracts, glaucoma, ocular hypertension, autoimmune disorders, contradictory medication, pregnancy, nursing, large pupils, dry eye, prior eye surgery, naturally elevated HOA.

RISKS

The Eye Surgery Education Council (ESEC) reports less than 1% experience serious problems if proper screening is done and an experienced surgeon performs the procedure, and 3-5% experience less serious problems that are correctable. There are NO reports of blindness resulting from LASIK or LASEK surgery. Possibility of complications if the flap (created by surgical cutting) is not thick enough or of proper diameter. Diffuse Lamellar Keratitis (DLK), (infiltrates beneath the LASIK flap) can cause inflammation and scarring. This must be treated with antibiotics and steroids, of possibly scraped for removal. Infection - can lead to loss of vision Irregular astigmatism, double vision, ghosting, can result from not centering the laser correction properly (decentered ablation), halos or starbursts when looking at lights, incomplete corrections, over- or under-correction. Undercorrections can be retreated. Over corrections may require using glasses or contact lenses. Erosion of the epithelium, dry eye, infection, keratectasia, weakened, bulging cornea, the alcohol used in this procedure can kill epithelial cells, loss of visual acuity or best corrected vision (BCV) after the procedure, corneal scarring, eyelid droop, chronic discomfort, inability to tolerate contact lenses.

HOW TO AVOID PROBLEMS

Find a surgeon with thousands of procedures of experience. Exams to include routine eye exam, slit-lamp, fundus, corneal thickness, topography and pupillometry, and a Shirmer test. Follow instructions carefully after surgery. Request wavefront diagnostics or a reason why this is not recommended. Replace old makeup and don't use for several days after surgery. Avoid strenuous exercise for 1 week. Avoid contaminated water for at least 1 week, including seawater, lakes, swimming pools, spas, etc. Avoid rubbing eyes for 2 weeks. According to studies, surgeons with experience of 700-1,000 or more cases have significantly lower intra-operative complications than surgeons with fewer than 700 cases.

IOL
 

WHAT IS PHAKIC IOL

(a.k.a. IOL)

HOW IOLs WORK

The Food and Drug Administration (FDA) recently approved an implantable lens that helps correct moderate-to-severe nearsightedness and allows the patient to return to normal daily activities relatively quickly. The Phakic Intraocular Lens (IOL) reduces the need for glasses or contact lenses by correcting your vision inside the eye, without removing the eye's natural lens.

 

Clear Lensectomy (Refractive Lensectomy or clear lens extraction) may be an appropriate option for people who find their prescription falls outside the accepted range for laser refractive procedures, have extreme near or farsightedness, or who may otherwise not be an ideal candidate for vision correction procedures. Clear Lensectomy involves the removal of the natural lens in your eye and replacing it with an Intraocular Lens (IOL), resulting in improved near and distance vision.

Phakic IOLs are inserted in the eye and correct refractive errors by focusing light properly on the retina, the sensory tissue on the back of the eye. Because people who are nearsighted have difficulty focusing light and images properly, distant objects come to focus in front of the retina instead of on it, making them appear blurred or out of focus. When a Phakic IOL is implanted, it corrects this by bending and focusing light directly on the retina reducing the need for contacts and glasses. The procedure is also fully reversible.

IOL PROCEDURE

AFTER THE PROCEDURE

As with any vision correction surgery, a comprehensive examination with your eye care professional is necessary to determine if you are a candidate. Patients may be asked to discontinue wearing contacts several weeks before the examination so an accurate reading of your prescription can be taken. Others may need to schedule a procedure prior to surgery which will help manage the pressure within the eye after the IOL has been implanted.

 

Phakic IOL surgery is an outpatient procedure. During the surgery, your doctor may use eye drops or injections to numb or prevent movement of the eye. A precise incision will allow the doctor to insert the Phakic IOL in front of or just behind the colored part of the eye (iris). A bandage contact lens and a clear eye patch will be used to cover and protect the eye until your doctor feels it is ok to remove.

HOW IOLs WORK

Phakic IOL surgery, although minimally invasive and relatively brief, is a serious procedure. Because the incision used to insert the IOL is so small, sutures are often not required and post operative discomfort is minimal. Your vision may also be somewhat hazy or blurry immediately following the surgery and you may notice an increased amount of sensitivity to light. Your scheduled, post-operative visits with your doctor will determine if you will require any additional follow up care.

Phakic IOLs are inserted in the eye and correct refractive errors by focusing light properly on the retina, the sensory tissue on the back of the eye. Because people who are nearsighted have difficulty focusing light and images properly, distant objects come to focus in front of the retina instead of on it, making them appear blurred or out of focus. When a Phakic IOL is implanted, it corrects this by bending and focusing light directly on the retina reducing the need for contacts and glasses. The procedure is also fully reversible.

Source: www.TheLASIKDirectory.com.

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