LASIK SURGERY WANT TO KNOW MORE

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1 LASIK SURGERY WANT TO KNOW MORE The shape of your eye determines how well your vision can focus. Light rays enter the eye through the clear cornea, then through the pupil and the lens. In a normal eye the light rays are focused onto the retina, a light-sensitive tissue lining the back of the eye. Signals from the retina are sent through the optic nerve to the brain, where they are interpreted as the images we see. Refractive errors exist because the curvature of the cornea doesn't match the length of the eye so light rays cannot focus properly on the retina. Refractive surgery procedures attempt to fix this by changing the shape of the front surface (the cornea) or adding a permanent lens to improve the focus. Eye conditions treatable by refractive surgery include: Myopia (short sightedness) Hyperopia (far sightedness) Astigmatism (irregular curvature of lens or cornea) Presbyopia (loss of reading vision) Cataracts (a clouding of the lens) Designed to eliminate or reduce the need for glasses or contact lenses, refractive surgical procedures are a safe and popular choice for those people seeking freedom from visual hardware. Refractive surgical procedures are a safe and popular choice for those people seeking freedom from visual hardware. Refractive procedures are designed to eliminate or reduce the need for glasses or contact lenses. These procedures correct refractive errors by changing the focus of the eye. Common procedures such as LASIK and PRK do this by reshaping the curve of the cornea (the clear front window of the eye) to move the point at which light is focused onto the retina (light-sensitive tissue lining the back of the eye). Procedures such as Conductive Keratoplasty (CK) use radio frequency energy to bend the cornea, and Intraocular Lenses (IOLs) place an artificial lens inside the eye to more accurately focus light onto the retina A thin flap of epithelium and superficial cornea is cut and reflected exposing a central area of deeper cornea. A UV laser removes corneal tissue from the deeper surface in the central area. The flap is repositio ned and allowed to naturally adhere. Brief description of procedure After instillation of a drop of anaesthetic, the area is cleaned and sterilized. The eyelids are held widely open by a speculum to allow good access. A suction ring is applied to the eye this stabilizes the eye, increases the pressure in the eye and securely attaches to the eye. Once the microkeratome (a motorised plane) is attached to the suction ring it can pass across the cornea, cutting a thin flap as it goes. The flap consists of the surface epithelium and some of the anterior stroma of the cornea. The flap is left attached (hinged) at one edge so it can be gently reflected. The layer of the cornea deep to the flap is then reshaped using the excimer laser (very similar to PRK). The flap is then repositioned and sticks back in place. Because the front surface has been replaced there is less pain than in PRK and vision recovers very rapidly with good vision common after 1 day.

2 Experience Initial studies began in Dr Peter Stewart (Laser Sight of Australia) started treating patients in There has been a rapid rise in popularity since then to become the most commonly performed refractive operation. Limitations Excellent results can be expected in the range to +4 to -10 diopters provided corneal thickness is adequate. Sufficient remaining corneal thickness must be left deep to the flap after ablation with the laser. This may limit treatment range and compromise optical zone especially in thinner corneas and higher corrections. The cor neal flap does not become totally secure for some time and there is a small risk of trauma displacing the flap especially in the first few weeks. LASIK Patient Information This information sheet is designed to help you understand the operation and expected postoperative course. If you know what to expect during the operation you should be more relaxed and able to assist me making the whole procedure much easier for both of us. The operation will be performed under topical anaesthetic as an outpatient at the Eye Surgery Foundation. This is a purpose built operating complex with a state of the art laser (the Technolas 217) and other fully equipped operation rooms. The laser operating room is precisely controlled for both temperature and humidity so light comfortable clothes are all that will be needed. It is better to have only a light snack and drink well prior to the operation as anxiety and a full stomach can make you uncomfortable when lying flat. The staff will greet you when you arrive at the centre and then prepare you for the operation. Some antibiotic eyedrops will be instilled in your eye to prevent infection. Prior to the operation several drops of local anaesthetic will be inserted. These are the same drops I used when I first examined you and sting a little for a second. Then you will be taken into the laser theatre and will lie flat on a bed with your head under a microscope. Initially the light from the microscope is a little bright but you will rapidly adjust and it should not be any problem. After I have cleaned your eye and eyelids with antiseptic I will use a sterile plastic drape to cover your eyelashes, eyelids, cheek and forehead. To prevent blinking a metal speculum is used to hold your eyelids held wide. This feels a little tight but does not hurt. Only once I am perfectly happy with your position will the operation start. The process is quite complex so we have a series of safety checks in place. You will hear me talking to the staff as well as to you. I will endeavour to talk to you at every step so you know exactly what to expect and what I would like you to do. You can talk to me and ask questions as we proceed. There are some times when movement is not allowed and I will ask you then to keep still and quiet.a suction ring will be placed on your eye. This holds your eye steady and raises the pressure in the eye to enable the flap to be cut. As the suction is applied you will hear a sucking sound and feel slight pressure then your vision should grey then black out. This is a good sign as it means that the pressure is correct for creating the flap. The microkeratome is attached to the suction ring and the flap created. As the flap is created there is quite a loud vibrating buzz and it is much easier and safer if you do not squeeze your eye or move during the few seconds that this will take. The microkeratome and suction ring are removed. If I am totally happy with the flap we can proceed to the laser reshaping. There are a few steps getting organised and setting the laser to track your eye movements, then the laser treatment commences. The computer controlling the laser divides the treatment into a number of fractions and I will be monitoring your eye and telling you how the treatment is progressing. The laser makes quite a loud noise and does smell a

3 bit but is painless and over in about 1 minute. On completion the flap is repositioned and washed with sterile saline. After about 3 minutes of drying the flap has adhered so the speculum and drape are removed. Antibiotic drops are instilled and a clear plastic protective shield is applied. Often, despite the after effects of the microscope light and the shield you may see quite well immediately. Once the anaesthetic wears off the eye will feel quite gritty and irritable for a few hours. You may find the best solution is to go to bed for those few hours and keep both eyes still and closed. It is imperative that the eye should not be rubbed in the first week as the flap could be dislodged. Please leave the shield undisturbed, as I prefer to remove it myself. Vision will fluctuate the first night but if there is severe pain with reduced vision the flap may have been displaced and you should contact me. Normally vision is quite reasonable the next morning and will improve over the next week. Most normal activities can be resumed immediately but remember that the flap is not secure for some time. For safety swimming should be avoided for 2 weeks, rubbing should be avoided and any situation where the eye could be knocked (eg. contact sports) avoided for at least 3 months. Eyedrops are routinely used for 2 weeks to help the eye heal and prevent infection. It is not uncommon for the eye to feel a little dry and irritable for several months and during this time a lubricant eyedrop may be used for comfort. Refractive eye surgery aims to reduce a person's reliance on corrective lenses. In most patients who have the procedure it will remove the need to use them, but it does not guarantee perfect vision. Understanding the realistic, expected outcome for your individual case will help you make the right decisions about your refractive eye surgery choices. Our free assessment by a qualified surgeon will give you a clear picture of what treatment will work best for you and what outcome you can expect. Before undertaking any medical procedure it is important to understand the associated risks and limitations so you can make an informed decision. We understand the concerns you have for your eyes health and hold your safety in the highest priority. Please feel free to talk with any of our specialised laser surgery staff about any of your concerns. The chance of having a serious vision-threatening complication is less than 1% at Laser Sight, due to our experience and the sophisticated equipment we use. Many concerns relate to the eyes natural adjustment and either self correct over time, or can be fixed with further enhancement procedures. If this is necessary, you will be covered in our 'Vision for Life' and 'Clear Vision Commitment' programs. Undercorrection And Overcorrection - Initial overcorrection is usually expected and regresses as the cornea stabilises. Both under and overcorrection can be rectified with an enhancement. Incidence of significant overcorrection: 1-3%. Incidence of significant undercorrection: 2-3%. Regression - Regression is an individual healing characteristic and refers to the tendency of your eye to move towards its original refraction following LASIK procedure. If regression does occur, an enhancement may be necessary. With LASIK the regression experienced is minimal and is accounted for when planning your procedure. Decrease In Best Corrected Visual Acuity - A small number of patients experience a slight loss of visual sharpness following LASIK refractive surgery. In most cases the sharpness returns

4 over 6 months. Incidence for myopia: 1% or less. Incidence for hyperopia: 2% or less. In cases where visual sharpness is a concern, CustomEyes may increase visual quality. Flap Complications - Serious flap complications are rare. Incidence: 1 in 800. Glare - Sensitivity to glare may be a concern with LASIK. Night glare is more common and may last up to 3 months. Incidence of significant glare: 1 in Dry Eye - If there is a pre-existing dry eye problem, LASIK surgery can exacerbate this for the first three months after surgery. Some people need to use lubricating eye drops for the first 3-6 months. Incidence: Varies with age being more problematic in older females. Post-Operative Discomfort - Discomfort is rare but may include mild irritation, sensitivity to glare, watering and dry eyes. These symptoms are usually short term. Incidence: 1 in 50 experiences a scratchy sensation or mild discomfort. 1 in 500 experiences severe discomfort or even pain for the first 4-6 hours after surgery. Post-Operative Corneal Haze - Healing haze is the term for the collagen protein that develops on the surface of the eye following refractive surgery. Almost everyone develops trace degrees of haze, usually during the first few weeks and it rarely affects vision. Incidence of serious haze: less than 1 in Infection - Antibiotic eye drops are used during the procedure and for the week following the procedure. Infection is extremely rare. Incidence of infection: The worldwide statistic is 1 in Laser Sight has had only one infection in over 55,000 procedures. QUESTIONS AND ANSWERS AM I ELIGIBLE FOR LASIK OR CUSTOMEYES? Generally, a suitable candidate will be at least 20 years of age, have had a stable vision for the last 12 months, is not pregnant, is free of certain diseases of the cornea and retina and is generally in good health. HOW LONG WILL THE PROCEDURE TAKE? Each procedure takes only a few minutes on each eye but you will need to be at the centre for a few hours to ensure all pre- and post-operative checks are carried out. WILL I BE ABLE TO THROW AWAY MY GLASSES? Yes, in fact over 99% of our patients no longer need glasses or contact lenses for their vision in everyday life after LASIK or CustomEyes. HOW SOON AFTER THE PROCEDURE CAN I DRIVE? Most people have vision that is legal for driving without glasses on the day of surgery. However we would recommend that you do not drive for a day or two after surgery. DO I NEED TO TAKE TIME AWAY FROM WORK? As most patients can expect 90% of visual recovery within 24 hours, you can return to work the day after your procedure. Minor visual fluctuations may occur during the first few weeks.

5 IS THE PROCEDURE SAFE? LASIK and CustomEyes are considered to be very safe. Over 10 million cases have been performed worldwide in the past 14 years. In the hands of an experienced surgeon utilising stateof-the-art equipment the procedure has an extremely low incidence of complications that are significant. Lens Implants are increasingly popular ands very safe, with Cataract surgery the most commonly performed eye procedure in Australia. Conductive Keroplasty to resolve age -related loss of reading vision in those over 40 is approved by the FDA and routinely performed in a doctor's surgery in under 3 minutes per eye. WHAT IS THE RISK OF COMPLICATION? Like with all surgical or medical procedures there is a risk of complication. These are rare, and usually minor if they do occur. However, treatment should not be done if the patient cannot accept the remote possibility of a complication that could compromise the vision in an eye. ARE THERE LIKELY TO BE ANY LONG TERM UNSUSPECTED SIDE EFFECTS? This type of surgery, the procedure of creating the flap, has been performed for 40 years now and follow-up results show no side-effects. The excimer laser has been used on the cornea for over 15 years and there have been no long term effects documented. WHAT IF I CAN'T KEEP MY EYE STILL ENOUGH OR IF I BLINK DURING THE PROCEDURE? We use a small device to prevent the eyelids blinking. We have an active eye tracker which detects even microscopic eye movement and can redirect the laser beam as required. WILL MY VISION BE CORRECTED FOREVER? Once the cornea has been modified it tends to stay modified permanently. There can be occurrences of regression in the first three months, which can be corrected with an enhancement procedure. The vast majority of corrected eyes remain stable, permanently correcting nearsightedness, far-sightedness and astigmatism. Near vision deteriorates in all people over forty. This deterioration is called presbyopia and occurs regardless of whether a person is short or long sighted, or started with normal vision. It can be corrected with Conductive Keroplasty. The onset of cataracts in older age can also affect vision. Cataract surgery is one of the most common eye procedures in Australia and can fix this problem. WHAT IS THE MAIN DIFFERENCE BETWEEN LASIK AND CUSTOMEYES? Like fingerprints, no two eyes are the same. When your refractive error is unusually affected, CustomEyes takes into account your own unique eye print, including all imperfections, and aims to correct these using sophisticated wavefront guided scanning laser technology. The result is vastly improved vision. The surgical experience for the patient remains the same for both treatments.

6 I WEAR GLASSES FOR READING. CAN LASER SURGERY FIX THIS? Yes. Monovision provides independence from reading glasses and contact lenses. The word monovision' literally means one vision', in which one eye is focused for near vision and the other for distance. Monovision is subject to individual adaptation and can be trialled with contacts or glasses prior to surgical treatment. Your suitability to monovision can be discussed at the time of your consultation with the ophthalmologist. WILL I BE ABLE TO WEAR CORRECTIVE LENSES AFTER LASIK OR CUSTOMEYES? Most patients do not require any correction after their procedure. However, there is usually no problem if you do require a minor prescription. Contact lenses can be worn 1 month after the procedure. CAN I HAVE CUSTOMEYES EVEN IF I ALREADY HAD LASIK? Yes, it is possible to enhance your vision after having LASIK treatment. The benefit will be potential better distance vision and overall quality of vision. IS CUSTOMEYES REPLACING LASIK? CustomEyes is complimentary to LASIK treatment. CustomEyes maps the individual characteristic of each eye and helps the surgeon to design a custom LASIK treatment, which is useful for more complex cases. IS CUSTOMEYES MORE EXPENSIVE THAN LASIK? Yes, advanced technologies are usually more expensive as millions of dollars were spent in research and development to improve results and safety even further. Most patients agree that the superior visual results and safety is well worth the additional cost of approx. 10% compared to standard LASIK when considering CustomEyes. ARE ALL EXCIMER LASERS THE SAME? No, the first generation lasers were called broad beam lasers'. The results were satisfactory and still today a small number are used. Later, scanning lasers were developed where a small spot or strip of laser beam rapidly scans the cornea. Nearly all lasers today are made of this type and most experts are of the view that there are significant advantages of flying spot lasers like the Bausch and Lomb TechnolasTM 217 used by Laser Sight. Take your next step to visual FREEDOM. Online: Book your free assessment Phone: EYES ( ) Please call our Toll Free number EYES ( ), if you would like to speak to one of our Clinical Educators to discuss your options and answer any further questions you may have.

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