LASER VISION CORRECTION SURGERY A GUIDE FOR PATIENTS. Professional care for your eye health

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1 LASER VISION CORRECTION SURGERY A GUIDE FOR PATIENTS Professional care for your eye health

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3 Contents About Dr John Males... 1 COMMON QUESTIONS How does an eye work?... 2 What is Myopia (short sightedness)... 3 What is Hyperopia (long sightedness)... 3 What is Astigmatism... 4 What is Presbyopia (age reading changes)... 4 Can these conditions be treated?... 5 How Laser Vision Correction works... 5 SURGERY INFORMATION ilasik explained... 6 Are you suitable for Laser Vision Correction... 7 Which treatment is right for you... 7 Treatments available at Sydney Cornea Clinic... 8 The Laser Vision Correction experience at Sydney Cornea Clinic... 8 Benefits of Laser Visions Correction... 9 Possible risks and side effects of surgery Frequently asked questions Recovery/Post operative period... 14

4 About Dr John Males Dr Males is a consultant ophthalmologist at Sydney Eye Hospital, St Vincent s Public and Private Hospitals, Concord Hospital and Macquarie University Hospital. Dr Males is a clinical Senior Lecturer at Macquarie University and the University of Sydney. He has consulting rooms in Sydney and Liverpool and is the chair of the Corneal Unit at Sydney Eye Hospital as well as the Head of Department at St Vincent s Public Hospital. He is also the Production manager of the NSW Lions Eye Bank. Dr Males is a Principal Co-ordinator for the Masters of Refractive Surgery at the University of Sydney, the first post graduate degree in refractive surgery in the world. Dr Males performs all forms of laser vision correction surgery for the treatment of myopia (short sightedness), hyperopia (long sightedness) and astigmatism. At Sydney Cornea Clinic all of the latest surgical and technical advances are available and Dr Males tailors the treatment to the individual and their specific needs. 1

5 How Does an Eye Work? A normal eye works by bending the light as it enters the eye. This is done by the cornea (the front surface of the eye) working in conjunction with the lens of the eye. In an eye that sees well for near and distance these two surfaces are perfectly balanced and the lens focuses for both near and distance. Light has to fall perfectly on the retina for all distances at all angles for us to see well. Any disturbance in this balance is called refractive error. 2

6 What is Myopia (Short Sightedness)? Myopia, or more commonly, short sightedness is caused when the eye is generally too powerful making near vision very sharp but the distance vision blurry. The light enters the eye and falls before the retinal surface creating a blurry image. What is Hyperopia (Long Sightedness)? Hyperopia or long sightedness is caused when the eye is under powered and the distance vision is clear but the near and especially reading vision is blurry. Light falls behind the retinal surface making close objects blurred. 3

7 What is Astigmatism? Astigmatism is when the front surface (the cornea) of the eyes curve is unequal. A shape that is similar to an AFL football curve rather than the symmetrical curve of a soccer ball. This asymmetry means that both near and far objects are blurred. What is Presbyopia? (Age Reading Changes) Presbyopia, or the need for reading glasses especially in those over 40 occurs when the natural lens inside the eye becomes less flexible over time. This causes near objects to become blurred and reading glasses are prescribed. 4

8 Can these conditions be treated? All of the conditions previously described can be treated with laser vision correction as long as the patient is a suitable candidate and the eye is healthy. How Laser Vision Correction works Laser vision correction works by reshaping the cornea for the individuals specific refractive needs. This may be done in several different ways, either by creating a flap and applying the laser treatment to the internal surface of the cornea (LASIK). Or in some circumstances by removing the upper most cells from the corneal surface and applying the laser to the outer layer (PRK/ASLA). All of these treatment options are available at Sydney Cornea Clinic and Dr Males will discuss which option is best for you and your needs. At present there are two ways in which LASIK is performed. The older style microkeratome technique uses a handheld blade to create the corneal flap. At Sydney Cornea Clinic the blade free ilasik technique is used by Dr Males as it has been proven over time to be a safer and superior option for our patients. 5

9 ilasik explained The Femtosecond ilasik Laser is applied to the front surface of the eye. The Laser creates a tiny space in the cornea, working from the inside out. The corneal flap is then lifted and the second laser is applied to correct the refractive error i.e. the long, short sight or astigmatism. 6

10 Are you suitable for Laser Vision Correction? Many people are suitable for laser vision correction but believe that they are not due to astigmatism, a thin cornea or a high prescription. With the newer generation of lasers and Wavefront Guided Analysis most people can be treated. Generally 75% of people are suitable for either an ilasik or PRK treatment and the remaining 25% may be suitable for another refractive surgery like a clear lens exchange or implantable contact lens. As a general rule for suitability patients need to meet the following criteria: 21 years of age or older Stable prescription for 18 months (minor changes to glasses and contact lenses are acceptable) Healthy eyes Not pregnant or breast feeding Which treatment is right for you? The treatment that is selected for you by your surgeon will depend on your prescription, age, corneal thickness and health of the eye. Dr Males will discuss all of your options with you in detail after a thorough examination and tailor a treatment plan to your eyes. 7

11 Treatments available at Sydney Cornea Clinic ilasik PTK/ PRK Clear lens exchange Implantable contact lenses Cataract surgery Collagen cross linking Intacs/Kerrarings The Laser Vision Correction experience at Sydney Cornea Clinic As a service to our patients a free booking can be made with our clinical staff to assess your suitability before seeing the doctor. Before this appointment we ask that soft contact lenses are removed for 3 days prior to the consultation to allow the cornea to return to its natural shape. Rigid gas permeable contacts need to be removed for 3 weeks before the initial consultation as they substantially change the cornea s surface. However glasses may be worn as normal and it is advisable that your glasses are brought to the consultation to measure their strength. After an initial successful suitability screening an appointment can then be made with the surgeon to look at the health of the eyes and discuss your refractive options further. If required a trial of contact lenses can be arranged to assess suitability for blended vision (otherwise known as monovision) for those patients over 40 having trouble with their reading vision. 8

12 Benefits of Laser Vision Correction The benefit each individual receives from a laser vision correction procedure depends upon the nature of their eye condition, amount of prescription required to be treated and patient expectation. On the whole, if you are a suitable candidate, it is expected that after the initial recovery period that your vision should be the same as it was in your glasses or contact lenses. The benefit comes from the freedom that you will experience without being hampered by multiple sets of glasses (reading, distance, clear and tinted), contact lenses and all of the solutions that go with them. Imagine a lifestyle where you wake up and see the alarm clock straight away in the morning. Where you can fall asleep in front of the television and not worry about waking up with sore eyes because you slept in your contact lenses. Of being able to see your children playing in the water at the beach and joining them in the surf not having to worry about losing your contact lenses in the water. 9

13 Possible risks and side effects of surgery While the frequency of a poor outcome and adverse events are very low patients still need to be informed. Many of these complications are not vision threatening and with proper aftercare resolve over time. Complications can be divided into intra operative and post operative. Intra operative complications are issues that arise at the time of surgery. These may include incomplete, irregular flaps, free flap- the hinge is not preserved and in growth of cells under the flap edge. The industry standard for these types of complication is 1-2%. Post operative complications may be divided into: post operative over/under correction, regression and can be remedied with re-treatment (enhancement) or mild glasses for the required distance. Dry eye, generally this is a short-term problem and resolves as the cornea heals. Lubricating drops are given to all patients as some level of dryness is expected. Patients with pre-existing dry eye are at an increased risk of severe dryness post LASIK. Visual changes such as increased glare or haloes may be noticed while driving at night. This is more prevalent in people with high prescriptions or pre-existing night vision problems. Wavefront technology used by the Sydney Cornea Clinic surgeons aims to minimise these changes and generally over time patients notice a 10

14 Corneal ectasia can occur when the cornea becomes progressively thinner after a laser procedure and the vision is distorted and blurred. Glasses or contact lenses may be prescribed to correct the vision and Collagen Cross Linking may be performed to halt any progressive thinning. All efforts are made by your surgeon to screen out any patients who are at a greater risk of this complication. Presbyopia/ age related reading changes affect everyone over the age of 40 to some degree or another. Short sighted people simply take their glasses off to read while normally sighted or long sighted people wear reading glasses. While we cannot halt the natural processes as the eye ages your surgeon may discuss monovision or blended vision to minimise these natural changes. 11

15 Frequently asked questions How long will it take? After the initial consultation if you are suitable, you will be booked in for your surgery at your earliest convenience. Generally the waiting period is no more than a few weeks for a surgical date. On the day of surgery you will be at Perfect Vision for 2-3 hours and during this time you will be looked after by the highly trained nurses, orthoptic staff and your surgeon. How much will it cost? Please ask the friendly booking staff at Sydney Cornea Clinic for a financial quote. Will it hurt? LASIK surgery is not a painful procedure, both during and in the post operative healing period. Anaesthetic eye drops are given to you throughout the surgery and you will be offered a Valium tablet prior to the surgery commencing. There is some level of discomfort and pressure sensation involved in creating the corneal flap, but this is momentary. In the immediate post operative hours the eyes may feel gritty, irritated and teary. This is a normal part of the healing response and it is suggested that you go to bed and sleep through this phase if possible. PTK and PRK procedures take longer to recover visually and the sensations of grittiness and irritation are generally greater in the hours and days after surgery than that of LASIK patients. 12

16 When can I drive and go back to work? For the majority of people who undergo LASIK two days (the day of surgery and the day after) are enough before resuming normal duties like working at a computer and driving. PRK and PTK patients are advised to take a week off work and driving while their vision recovers. When will I see clearly? Some of our patients notice and improvement as soon as the procedure is over while others take a few days or weeks to settle. LASIK patients tend to notice a vast improvement in the hours after surgery while PRK/PTK patients may find that it is a few weeks before the vision settles. What do I need to do to prepare for the surgery? Generally there is little to do to prepare yourself before your laser vision correction surgery. Make sure that your soft contact lenses are not worn for at least 3 days before surgery and your hard contact lenses are not worn for 3 weeks. Wear loose, warm, comfortable clothing on the day of surgery and make sure that there is someone to take you home afterwards. 13

17 Recovery/Post operative period Your eye surgeon will prescribe some medicated eye drops and lubricant drops for you after your surgery. It is essential that you use these as directed. While it is normal for the eyes to be gritty, irritated and teary after your laser vision correction surgery and excessive pain that is not tolerable after taking Panadiene needs to be reported to your surgeon immediately. Some level of blur is also to be expected but any sudden loss or worsening of vision must also be reported to your surgeon. The post operative visit schedule is one day after your surgery, one week and one month. For any further information please do not hesitate to call us on as we are happy to answer any questions to make your laser vision correction experience a smooth and enjoyable one. 14

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20 f p Level 12, 187 Macquarie St Sydney