If a person is suffering from nearsightedness, farsightedness, astigmatism or a combination of any of the three, he may be suffering from a condition called errors of refraction. Having an error of refraction (refractive error) means your distance vision is blurry, making it necessary for you to wear eyeglasses or contact lenses to see clearly. There are three types of refractive error.
Nearsightedness (myopia) – an eye condition where the focus point falls in front of the retina, and the person has difficulty seeing objects at a distance.
Farsightedness (hyperopia) – an eye condition where the focus point falls behind the retina, and the person has difficulty doing up-close tasks like reading
Astigmatism – usually caused by an imperfectly shaped cornea, which distorts images at all distances by refracting light rays unevenly on the horizontal and vertical planes
Many people have a combination of either myopia or hyperopia with astigmatism.
An age-related condition common among people in their 40s is presbyopia. It is a state wherein the muscles and structures in the eye progressively deteriorate and weaken, making it difficult for him to read small print. Even patients who had LASIK surgery will start experiencing presbyopia when they reach 45 or older. A person with presbyopia needs to wear reading glasses, bifocals (doble vista), or progressive eyeglasses to read newspaper and text messages or do computer work.
Presbyopia can occur in combination with nearsightedness, farsightedness or astigmatism. This causes poor distance and near vision.
Refractive Surgery is a subspecialty of ophthalmology that deals with errors of refraction and presbyopia. Asian Eye Institute has the most complete line of services in the Philippines when it comes to the latest treatment strategies of refractive surgery. These products can lessen or eliminate the need for eyeglasses, contact lenses, reading glasses, as well as progressive eyeglasses.
TYPES OF REFRACTIVE SURGERY
· LASER REFRACTIVE SURGERY or LASER VISION CORRECTION
Laser refractive surgery is a surgical procedure that uses an excimer laser to reshape the cornea by removing a controlled amount of tissue in order to alter its refractive power. The most common surgical techniques are LASIK (laser in situ keratomileusis), PRK (photorefractive keratectomy), LASEK (laser epithelial keratomileusis) and EpiLASIK (Epithelial LASIK). The method of exposing the deeper corneal layer differentiates these four techniques of laser refractive surgery. These procedures are explained further below.
LASIK (Laser In Situ Keratomileusis)
LASIK is the most popular method of laser refractive surgery. It is indicated for those who are 21 years of age and above. It has two types: bladed and bladeless. In bladed LASIK, a smooth stainless steel blade is attached under a mechanical device called a microkeratome to cut a flap, while in bladeless LASIK, Asian Eye uses Bausch + Lomb Technolas VICTUS femtosecond laser from Germany to create a flap. The femtosecond laser uses plasma energy to create thousands of bubbles within the corneal tissue. These bubbles are then connected with a blunt instrument that creates the flap without a need for a blade. This ensures precision in the flap creation, thus, there is less chance of complication as well as discomfort and pain. After a flap has been created, laser energy is applied to vaporize tissue to reshape the cornea. The flap is then returned to its original position.
SUPRACOR LASIK for Presbyopia
Asian Eye is the only eye care facility in the country that offers laser treatment for presbyopic patients. It uses the Supracor technology by Technolas of Germany. Ideal for patients who are in their 40s and suffering from presbyopia, the Supracor LASIK treatment can be combined with customized LASIK or the treatment of nearsightedness, farsightedness, or astigmatism. Supracor can also be used for patients who had LASIK surgery using different laser systems or those who underwent cataract surgery and want to treat their presbyopia to eliminate or reduce their dependence on reading glasses. Supracor works by firing laser pulses on the cornea, resulting in a small bump of corneal tissue centrally to improve near vision.
INTRACOR FEMTOSECOND LASER for Presbyopia
The Intracor treatment is suitable for patients who are in their 40s, naturally have good distance vision, have never had any laser treatment on the cornea, and are looking for a presbyopic solution. Intracor uses the femtosecond laser to create bubbles in a circular pattern on the cornea. Five concentric rings are created to weaken the central cornea, resulting in a mild central bump. In Intracor, there is no cut and external wound on the cornea.
Advanced Surface Ablation (PRK, LASEK,EPILASIK)
A patient who has a thin cornea, a cornea with an unusual curvature, or a job or a lifestyle that may lead him to flap displacement or injury may not be qualified to have LASIK. Since Asian Eye discourages cutting thick flaps, he may be recommended to undergo surface ablation treatment instead. In surface ablation, the structural integrity and rigidity of the cornea are maintained better, more corneal tissues are preserved, and the visual outcomes are similar to LASIK. However, it may cause a significant amount of pain, has a possibility of scarring, takes longer to heal, causes tearing and light sensitivity for 3-4 days after the procedure, and takes about 2-4 weeks to recover visually.
Photorefractive keratectomy (PRK) – alcohol is used to loosen and scrape the surface layer of the cornea. The laser treatment is done on the exposed surface. The surface layer of cells is removed or discarded; then a bandage contact lens is placed, which stays on for one week.
Laser Epithelial Keratectomy (LASEK) – alcohol is used to loosen and peel the surface layer of cells as one sheet. The laser treatment is done after the surface layer is moved to one side. The surface layer of cells is then returned over the lasered area, and a bandage contact lens is placed.
Epithelial Lasik (Epilasik) – a microkeratome with a blunt blade is used to mechanically peel off the surface layer of cells. The excimer laser treatment is done after the surface layer is moved to one side. The layer will either be peeled off or returned to cover the lasered area like in LASEK. A bandage contact lens is then placed.
· CORNEAL INLAY (ACUFOCUS KAMRA INLAY)
The Acufocus Kamra Inlay can be implanted in patients who have naturally good far vision (can drive and see clearly without glasses) but do not like to wear reading glasses for small print. It is also ideal for patients between 45-60 years of age. A thick flap using a femtosecond laser is created. The inlay on the corneal stroma is placed, and the flap is returned to cover and protect the inlay. The procedure is completed in less than 10 minutes and is painless, while the recovery usually takes a day or two after surgery.
· IMPLANTABLE CONTACT LENS (ICL)
Some patients may not be qualified for LASIK because their cornea is too thin, their grade is too high and is beyond the laser range, or their dry eye is too severe. In these cases, Asian Eye recommends Implantable Contact Lenses (ICL) or Phakic Intraocular Lens. Ideal for patients who are 18 years old and above, these lenses can be inserted inside the eye and can correct grade and astigmatism beyond the reach of laser surgery. Compared to LASIK, there are no tissues vaporized or removed when a patient is implanted with ICLs. He does not need to maintain, clean, or remove them every night like regular contact lenses. Likewise, the lenses do not degrade or melt inside the eye and are reversible, so they can be removed without any harm to the patient’s eyes. A lens is injected into a small incision created on the eye. The eye is then cleaned and administered with eye drops. The procedure takes 15 minutes per eye.
· INTRAOCULAR LENS (IOL)
A person who is near or beyond his 60s and is diagnosed with cataract or has a refractive error that is too high and cannot be corrected by laser treatment or ICL can opt for an implantation of an IOL. There are several types of IOLs available at Asian Eye to suit patients’ different lifestyles and needs. Aspheric IOL improves a patient’s ability to see in low light conditions; toric IOL effectively eliminates astigmatism or blurred or distorted vision due to an irregularly shaped cornea; and multifocal and accommodating IOLs allow a patient to see at far, near, and intermediate distances. Unlike in ICL, IOL requires the natural lens to be removed. Asian Eye uses an ultrasonic device to break the lens and aspirate the remnants. This process is called phacoemulsification. The IOL is then inserted to replace the lens. The surgery takes 15 minutes to complete and is painless.
Asian Eye Institute uses the latest technology to ensure the highest level of safety for its patients. At present, it is the only eye care facility in the country that uses Active Control Eyetracker (ACE) and Iris Registration (IR).
Active Control Eyetracker – Eye movements are unavoidable during surgery. Asian Eye uses a multidimensional eyetracker that detects movements and adjusts the laser several hundred times a second to ensure that the laser pulses are fired at the correct location on the cornea. It is best used for high grade and astigmatism treatments.
Iris Registration – The iris has different patterns that differentiate one eye from another. At Asian Eye, the patient can be sure that someone else’s treatment will never be applied on his or her eyes. This equipment also detects the change in the eye position due to a change in body position. The iris registration, combined with the active control eyetracker, automatically aligns the treatment pattern once it detects the change in eye position, increasing the accuracy of laser pulse placement.
BENEFITS OF REFRACTIVE SURGERY
Refractive surgery, whether laser, inlay or lens treatment, removes the daily hassle of wearing eyeglasses, contact lenses, reading glasses, so the patient can enjoy clear vision. He can go on with life and do the things he loves to do, such as:
· Play sports like golf, badminton, diving, swimming, trekking, & rock-climbing;
· Travel without bringing contact lens kits and solutions;
· Read the newspaper or text messages without having to wear reading glasses.
The other benefits a patient can enjoy after his refractive surgery are:
· Improvement in his appearance;
· Freedom from pressure on the nose bridge caused by eyeglasses;
· Prevention from allergies, eye redness, infection and dry eye caused by contact lenses;
· Savings on the accumulated cost of buying glasses and contact lenses for many years to come.
REFRACTIVE SURGERY SCREENING PROCESS
If you would like to undergo refractive laser eye surgery (LASIK) or lens surgery, please contact us to set an appointment at (632)8982020 or www.asianeyeinstitute.com.
Here are some things-to-do before the screening:
· Stop wearing contact lenses
· For soft lens wearers, five to seven days prior
· For gas permeable lens wearers, three to four weeks prior
This is recommended to ensure safety and accuracy of the treatment. Thus, it is important that the patient rests his eyes from contact lenses before the scheduled screening.
Arrange for a companion or a driver for pick up afterwards.
To check if a patient has an eye disease, he has to undergo various tests which include eye dilation. This test temporarily blurs vision for a few hours.
Please prepare for a thorough and comprehensive screening process. Refractive screening takes approximately three hours. We perform multiple tests that will check and double-check your eye measurements. While it may seem bothersome, these tests will give the eye doctor enough data to evaluate if you are a good candidate for laser eye surgery.
Not all patients are qualified for laser or any refractive eye surgery. The results of the screening will determine if you are a good and safe candidate for the procedure. The eye doctor will explain to you the screening results and inform you if you are qualified, what procedure is best for you, and the risks and benefits of the procedure. Our surgical coordinator will also discuss with you the cost of the recommended treatment and the schedules available.
However, if you are not qualified, the eye doctor will explain the reasons and other treatment options. If an eye disease is detected, proper treatment will be recommended.
HEALING, RECOVERY, AND POST-OP CARE
A patient may experience blurry vision and feel some pain or discomfort, especially when blinking, for the first 24 hours. He may also see glare and haloes and have difficulty with night vision for the first two to three months. However, a patient may start reading books or newspaper or watch television six hours after the surgery. He may also walk around the house or ride the car. The eye doctor will advise the patient when he can drive again.
To keep the operated eyes protected, a patient must take the following measures after the LASIK procedure:
· Wear goggles as often as possible, day and night, for the first week.
· Wear sunglasses when going out after the third day of the surgery.
· Do not wet or rub the eyes and squeeze or put pressure on the eyelid for the first three days after the surgery.
· Do not engage in sports or strenuous activities for one week.
· Do not put make up on for one week.
· Do not swim or go scuba diving for one month.
Several post-operative visits will be scheduled to monitor the patient’s recovery. Medications during the recovery period will be advised by the eye doctor.
Dr. Robert Ang is a Harvard-trained refractive surgeon, a certified instructor, a recognized international key opinion leader and a prolific research investigator in refractive surgery.
Dr. Emerson Cruz is a refractive surgeon who graduated from the Asian Eye Institute Cornea and Refractive Surgery fellowship program.