Refractive Surgery LASIK PRK, LASEK Refractive Lens Surgery

Refractive Surgery LASIK PRK, LASEK Refractive Lens Surgery Institut für Refraktive und Ophthalmo-Chirurgie

Dear patient! You wear glasses and/or contact lenses, because you cannot see well enough to cope with your daily life without these visual aids. Now you want to know whether an operation can help your eyes to become independent from glasses and contact lenses. Such an intervention ought to be well thought out, because whenever a physician operates, there are risks of the treatment alongside the success. Even modern medicine can only offer the greatest possible chance of success with minimum risk, but cannot guarantee success. Using the modern laser medicine (latest generation equipment) in ophthalmology, for example myopia corrections with success rates of over 97% have become possible, with a complication rate of significantly less than 1%. However, this requires an experienced surginal team, advanced technology and an adequate treatment environment. These are precisely the maxims of the IROC Laser Centre in order to achieve a unique level of quality: - We have the longest experience in refractive laser surgery in the world: We performed the world`s first laser surgery (PRK) in 1986, and in 1997, we performed the world`s first treatment for super-normal vision (wavefront-guided LASIK, "Eagle eye"). - The challenge in refractive surgery for us doctors, in addition to the surgery itself, is especially the interpretation of all data prior to surgery. This ensures maximum security for you. - We use only the most advanced laser devices, including customised laser treatment ("customised ablation"). These include femto second lasers and the "EX 500 excimer laser", which is currently the fastest excimer laser in the world. - Due to the extensive experience, we have become conservative and only perform laser treatments given a maximum chance of success. In addition to the refractive laser surgery, we have used other techniques, such as the refractive lens surgery for years and we can, therefore, also present you alternatives to laser correction. With us, the entire spectrum of refractive surgery is offered. Please read the brochure thoroughly and make note of any questions you may have. These questions are the foundation of your pre-operation discussion, which is to be carried out in each case, and which should precede your decision for or against the operation. We look forward to seeing you in the IROC. Prof. Dr. med. Dr. rer. nat. Theo Seiler - 1 -

Table of Contents Refractive errors... 3 Possibilities for correcting refractive errors... 6 Process of laser treatment... 7 Refractive laser surgery... 9 What do I have to do/know?... 10 Typical healing process... 12 What are the risks?... 13 Refractive lens surgery... 14 Who is behind IROC?... 15 How to find us... 16-2 -

Refractive Errors You contact us to correct a refractive error that is currently being compensated with glasses and/or contact lenses. Before discussing the possibilities of such a correction, however, we want to inform you about the nature of the refractive error, to be sure that we mean the same. The task of the eye is to take in visual images and passing them on to our brain. As in a camera, there is both imaging optics (in the camera: the lens) and a photosensitive layer (in the camera: the film). The optics of the eye are formed by the cornea and the lens, where 2/3 of the refractive power in the cornea and 1/3 lie in the lens. The photosensitive layer in the eye is the retina, in which the optical image of our environment is converted into electrical stimuli, which are then sent via the optic nerve to the brain. Optics and eye shape (especially the length of the eye) are well synchronised. If the eye is too long, it is called myopia, or near-sightedness, if it is too short, then it is called hyperopia or far-sightedness. In Central Europe, about 15-20 % of the population are near-sighted and about 5% are far-sighted. Normal vision (Emmetropia) If the focal point of the eye is on the retina, we speak of an eye without a refractive error. Near-sightedness (Myopia) If the focus of the eye is in front of the retina, we speak of a myopic eye. The objects that are seen in the Far-sightedness (Hyperopia) If the focus of the eye is behind the retina, we speak of a far-sighted (hyperopic) eye. Items that are The objects that the person with normal vision looks at are clearly visible in the distance as well as nearby. The optical system of the eye (cornea, lens) deflects the light rays so that a sharp image of the environment arises in the retina at the point of sharpest vision. distance can be perceived only vaguely. If an object is seen in the distance, the image of the environment is projected in front of the retina by the optical system. On the other hand, nearby objects are seen in sharp focus. Usually this is because the eye is longer than normal. being viewed close up and in the distance can be perceived only vaguely. The reason is usually an eye that is shorter than normal. Up to a certain age, this can be compensated by increased effort of the lens. This accommodation of the lens decreases with age and therefore glasses must often only be worn in adulthood. - 3 -

The eye with normal vision sees sharply nearby and in the distance The near-sighted eye sees nearby, but not sharp in the distance The far-sighted eye often sees well in the distance, but not nearby Patients often experience the astigmatism as double vision - 4 -

Astigmatism The focus of the eye in humans with corneal astigmatism is scattered due to different curvatures. Objects in the distance and near look distorted. The reason is that the cornea of the eye resembles a football rather than a ball. Astigmatism usually occurs coupled with near-sightedness and far-sightedness. To compensate for astigmatism, refractive power, the differences are levelled out in different meridians. Presbyopia Young people can see everything from the distance to close-up: they can look at a landscape and read a newspaper. A restoration of the elasticity of the lens is not possible at this time. In the alternative, the dominat eye has normal vision (emmetropia), whereas the non-dominant eye is short sided. This constellation is called monovision (Wunderrefraktion) and is used since many years for presbyopia compensation. Another form of compensation is reading glasses. Monovision Monovision is a variation of refractive surgery to balance out the problem of presbyopia. This change with age is natural and becomes manifest in every person between 40 and 50. The goal of monovision for patients with presbyopia is to optimize the dominant eye for looking into the distance and the other eye for near vision. So that one eye can see well nearby, it has a myopia of about -0.5 dpt to -1,5 dpt. However, this eye is then not able to see 100% in the distance without glasses or contact lens. Once one eye is adjusted to the distance and one is adjusted for nearby objects, it may be that the eyes need some time to learn to coordinate. On the other hand, only less than 10% of the patients cannot cope well with the difference between the two eyes in everyday life. Therefore, before a monovision correction we will often perform a test with contact lenses where the monovion will be simulated for a day or so. If the monovision is acceptable, the correction can be performed with a benefit for the patient. In certain cases, this contact lens test can only be performed after surgery. However, in principle and if necessary, the two eyes can be matched by a subsequent correction at a later date. Because our eye lens is elastic, it has the possibility to adjust like a zoom lens to different distances (accommodation). However, with age, due to its diminishing elasticity, it increasingly loses this ability and becomes firmer and harder. This process of decreasing accomodation takes place in every person. A common reason that patients opt for surgery is the intolerance of contact lenses after years of wearing them. Prof. Dr. med. Dr. rer. nat. Theo Seiler, Ophthalmologist - 5 -

What are the possibilities for correcting refractive errors? The refractive errors can in principle be corrected safely with the following methods. In addition to traditional methods of glasses and contact lenses to correct refractive errors, there are a variety of modern operations and techniques that can reduce or completely compensate for the refractive error. 1. Glasses 2. Contact lenses 3. Photorefractive keratectomy (PRK) using an excimer laser; LASEK 4. Laser-assisted in situ keratomileusis (LASIK) by means of an excimer laser and a femto second laser 5. Refractive lens surgery Classical methods 1. Glasses: The most common is the correction using glasses. Besides the fact that the person is dependent on his glasses to see clearly, a pair of glasses for low and moderate refractive errors has virtually no disadvantages. At higher refractive errors, however, limitations of the visual fields occur. 2. Contact lenses: They also provide a good correction of refractive error and are also tolerated well by most people for some time. However, for many people there is a growing intolerance over the years and a sometimes significant reduction of comfort in wearing them. The risk of infection is as high as 0.2% per year. Modern methods 3. PRK: The oldest of these methods is the photorefractive keratectomy (PRK) using an excimer laser. With this method, the refractive errors in myopia up to -5 dpt and astigmatism up to -3 dpt are corrected. LASEK is a modern version of PRK, which may pose less subjective problems. CTEN is also a company version of this older method with limited experience. 4. LASIK: This procedure is more comfortable for the patient. The laser-assisted in situ keratomileusis (LASIK), is carried out with an excimer laser and a femtosecond laser. LASIK allows refractive errors of myopia up to -10 diopters, hyperopia up to +4 diopters and astigmatism of up to -6 diopters to be corrected. We use the most modern technology to determine your exact refractive error. Dr. med. Tobias Koller, Ophthalmologist 5. Refractive lens surgery: In some cases (thin cornea, high refractive error) laser correction, is not the method of choice. This is especially true for myopia from approximately -8.0 dpt and hyperopia from about +3.0 dpt. Here, the refractive lens surgery, which has also been established for years, is used. For one thing, the actual lens can be replaced by an artificial lens (likely in patients over 50); in young patients it is also possible to implant an additional lens in the eye. - 6 -

How does the laser treatment work? LASIK method (Laser-assisted in situ keratomileusis) 1. An automated blade (microkeratome) or a femtosecond laser is precisely positioned on the eye and used to cut a very thin flap of 100-130 microns (0.1-0.13 mm) from the front of the cornea. 2. On one side of the flap it remains connected to the cornea. This "hinge" acts like a ligament when the lamella is later folded to the side. Folding the flap exposes the stroma- the middle area of the cornea. 3. Light pulses of a computer-controlled excimer laser vaporise individual areas of the corneal surface. Modern scanning spot lasers are able to treat the corneal surface within seconds and give it any shape with sub-micrometer accuracy. 4. After the refractive error has been corrected, the corneal flap is placed back down on its original site and then continues to grow on there. - 7 -

LASIK LASIK has been used since 1994 and has also been investigated in 10-year studies. We therefore already have long-term experience! The advantage of LASIK compared to the PRK procedure, which has also been known for some time, is that the surface of the cornea is not destroyed. Therefore, scarring of the cornea after LASIK is significantly lower than after PRK and you have almost no pain after surgery. The corneal surface is comparable to the skin: a large abrasion of the skin is much more painful and leaves a scar larger than a small incision. Another advantage is the rapid return of vision. Just one day after surgery the majority of our patients see 80% and more. If complications occur during LASIK, however, they are often more severe than in PRK. Femto-LASIK The blade cut for the formation of the flap is today made with a laser - the femtosecond laser. The femtocut has the advantage of greater accuracy (accuracy of 5 microns flap thickness), but the disadvantage of additional cost. After the preoperative examination, we will discuss whether the use of the femtosecond laser is advantegous or even necessary in your case. PRK, LASEK und CTEN (Photorefractive keratectomy) PRK has been used since 1988. This unpronounceable foreign word means the "ablation" (removal by vaporization) of the cornea with an excimer laser. In this method, first the top layer of the cornea, the epithelium, is mechanically removed. Subsequently, by means of an excimer laser, the corneal surface is selectively treated to compensate for the refractive error. In almost all cases of PRK/LASEK, mitomycin C is applied for 20 seconds at the end to reliably prevent possible scarring. The epithelium is formed new in a few days and closes the wound surface. Disadvantages of PRK are in the slower healing and in some considerable pain after surgery. In terms of success and complication rates, PRK and LASIK are approximately equivalent, in the range of +1.0 diopters to -5.0 diopters. Even the CTEN process, which has been the subject of much marketing, is nothing more than a PRK where the epithelium is removed with the laser. This method has been around for more than 15 years, so it is by no means a modern method. The advantage is its speed (the operation takes less time). The disadvantages are a low hit accuracy, problems with a re-treatment and the slow recovery of vision. One advantage of LASIK is the rapid return of vision. However, this is a surgical procedure with all the advantages and disadvantages. This should never be forgotten. Prof. Dr. med. Dr. rer. nat. Theo Seiler, Ophthalmologist - 8 -

Refractive laser surgery Reasons Glasses and contact lenses cannot always be worn without any problems. Glasses are often not optimal in the leisure sector and in particular for some sports, but are also a hinderance in certain professions (examples: actress, cook, policeman, etc.). Cosmetic arguments also speak against glasses. In most cases, this disadvantage can be remedied with contact lenses. Who is eligible? Quite generally, patients should consider a refractive surgical procedure only if they do not get along with using glasses or contact lenses. However, you should meet the following criteria in order to provide optimal results: Your refraction should be stable (minimal changes within the last two years). Who is NOT suitable? Patients with eye diseases such as cataracts, advanced glaucoma, corneal diseases, especially corneal protrusions (keratoconus and similar). Patients with unrealistic expectations. Each intervention carries some risk. In the case of laser surgery, the risk is very low, but you should be aware that this risk exists. Unfortunately, contact lenses cannot be worn by all persons. Often, contact lens supply is successful for some time, however, after years of use, irritation of the eye by the "foreign body" lens arises, which then leads to contact lens intolerance. You should be of age (18 years and older). Your cornea should have a sufficient thickness (to be tested in the preoperative examination). Patients who are not sufficiently informed about the procedure, its benefits and limitations. As a precaution, an opertion should not be advised during the pregnancy and lactation. Sometimes, the quality of the tear film on which the contact lens floats decreases. Last but not least, allergies also limit the use of contact lenses. You should be healthy, e.g. no rheumatic diseases. Your eyes should be healthy. In fact, allergies are not a contraindication, but it does not make sense to operate in an acute episode. We can only tell you whether your eyes are suitable for laser surgery after a detailed examination. The decision to opt for surgery is made together with you Dr. med. Michael Wolff, Ophthalmologist - 9 -

What do I need to know? Before treatment Wearing contact lenses On the day of treatment The LASIK cut You should definitely not wear contact lenses before your initial examination. Contact lenses change the shape of your cornea. The formation of the natural cornea shape after removing the lens may take up to several weeks, depending on type. If the contact lens is not removed sufficiently long before the preoperative examination, this might result in a surgical procedure not adapted to the true corneal shape and thus a poorly planned surgical procedure. As a consequence, you will have an unsatisfactory result due to suboptimal vision after surgery. Please do not wear contact lenses at least 2 weeks before the preoperative examination. This applies to all types of contact lenses. Between the preoperative examination and the day of surgery, you can wear contact lenses again. However, please do not use contact lenses on the day of surgery. Do not use face creams, lotions, makeup or perfume!! These products can increase the risk of infection or contamination of the surgical field during and after the procedure. Clean your eye area thoroughly on the morning of the surgery and do not use contact lenses! During the treatment Preparation After the surface of your cornea has been anaesthetised with drops, a so-called lid retractor is placed into the eye. The lid retractor prevents you from blinking the eye during the procedure. The other eye is covered during the entire period of treatment. The surgery itself takes less than 15 minutes. A ring is used to hold the treated eye steady for the LASIK cut. The ring sucks in the eye with a high pressure. Your eyesight will diminish during this period and you will perceive the suction as pressure. The microkeratome or the femtosecond laser, which is connected to the suction ring, now cuts a corneal flap within a few seconds. Microkeratome/fs-laser and suction ring are removed from the eye. Your eyesight will return, but is still blurry. The surgeon then opens the corneal surface and folds the flap over the remaining hinge. Arrange your journey to and from the IROC for the day of the intervention and for the first check on the following day. On the day of treatment, your ability to drive may be impaired by the medication Claudia Kindler, Team Leader - 10 -

Laser surgery A flashing green fixation light is now positioned over your eye. This light is your fixing aid which makes your eye remain in the correct position during the treatment. Sometimes the fixation image is hard to see. However, you should keep looking roughly the direction of fixation. If your eye is in the correct position, the surgeon will begin with the laser procedure. During these 20 seconds you will notice unusual noises and odours. A computer controlled laser system monitors the exact number and position of the laser pulses which are applied to your eye. If too large or rapid eye movements occur, the laser system automatically stops the laser procedure. Treatment can be continued after the break, when the eye is again correctly positioned. After application of the laser pulses, the corneal flap is placed back on its original site, and the interface is rinsed carefully. Immediately after the procedure, your eye is covered with a bandage lens and the position of the corneal flap again checked. At this point, you can see only 20% (very foggy). Over the next few hours, however, your eyesight improves step by step. After the treatment Immediately after the treatment, the eye may itch, burn, or it may feel as if you have something in the eye. In a few cases, there may be slight pain. This is usually caused by the bandage contact lens that we will remove on the first day after surgery. Both eyes may tear, be red and your vision will very likely seem blurred and faded. These symptoms should subside in the first days after surgery. Generally speaking, for the first few weeks after surgery, you should avoid any kind of activity where your operated eye may be hit or pushed. If your eye moves slightly during the laser procedure, these eye movements are detected by the laser system and the position of the laser pulses adjusted for the eye movements ("eye-tracking"). Please concentrate on the flashing green fixation light during surgery. Movements that your eye makes during treatment are identified by the laser and offset. This automatic control of your eye movements takes place hundreds of times per second. Prof. Dr.med. Dr. rer. nat. Theo Seiler, Ophthalmologist - 11 -

Typical course of healing when using LASIK and PRK LASIK and PRK are performed on an outpatient basis. Before surgery, the eye to be operated is anaesthesised with drops so that there is no pain during surgery. The surgery takes only about 20 minutes and is virtually painless. Shortly after the operation, you will be re-examined. You get painkillers and a protective bandage for the night. During the first hours after surgery, your eyes will tear and itch and vision will be blurred. Severe pain is not normal in LASIK, but is normal in PRK. Call your doctor in the event severe pain or a sudden deterioration in vision. Ensure when washing or showering that no water gets into the operated eye and do not rub the eyes. Nearly normal vision is usually achieved on the first day after LASIK; after PRK it takes a week. In the first few weeks there will still be changes in vision, a sufficient stability is achieved in most cases 4 to 6 weeks after LASIK and 2 to 3 months after PRK. Therefore, a follow-up appointment is scheduled after 4 to 6 weeks. In the first few weeks to several months, your eye will appear slightly dry. In this case, we will prescribe "artificial tears" that you can use as needed. Unfortunately it cannot be ruled out that after months or years, a certain regression of refractive error may occur. In addition, the refractive error cannot be fully corrected in all cases. In principle, the chance of no longer needing glasses for long-distance vision after surgery is all the greater, the smaller the refractive error was before the correction. Complete independence from glasses cannot be guaranteed, but the glasses are always much weaker that before. Even with optimum success, it should be expected that from about the age of 42, reading glasses will become necessary, as needed even by a person with normal vision at this age (exception: monovision). In the first few days, you should avoid rubbing the eye and contact with water and not play sports. During the first weeks, do not use cosmetics or lotions around the eyes, and avoid contact sports (karate,squash) for 4 weeks. Dr. med. Michael Wolff, Ophthalmologist - 12 -

Possible risks The vast majority of patients are impressed and satisfied with the result of refractive surgery. Nevertheless, as with any medical procedure, one must expect risks during and after treatment. Over- or under-corrections: A large percentage of patients (depending on initial refraction 90% to 98%) achieved a vision of 100% without any additional correction. However, it is possible that you will still need a pair of glasses after the treatment, although with much lower diopter values. This applies above all for activities, where you depend on excellent sight (e.g. night driving). The results in eyes with astigmatism, or with very high corrections, are often not as good as in patients with only slight vision defects. You should certainly discuss your personally expected result with your eye doctor and possibly accept that you need glasses or contact lenses even after the surgery. In most cases, a re-operation (included in our offer) can remedy the undercorrection or over-correction. Stability of the result: The vision which can be reached very soon after surgery can worsen somewhat over time, but in most cases it improves in the first year. Dry Eye : As a result of surgery, a reduction in tear production may occur in the first few months. In most cases, this state gets better within 3 to 6 months. Your eye doctor can effectively counteract this symptom by means of the appropriate therapy. Sands of Sahara : In some patients there is an inflammation under the flap. This can be effectively treated with anti-inflammatory drops and, in most cases, leaves no persistent problems. Keratectasia: If the strength of a cornea is weakened too much by removal of tissue or corresponding cuts, keratectasia may occur: the pressure in the eye pushes the weakened cornea forward. If there is such a process, in almost all cases there is already preoperative mild local bulging of the cornea, which we specifically look for during the preoperative examination. In this way, keratectasia can be almost always avoided and occurs only very rarely (about 1 in 15 000 surgeries). Should keratectasia occur, the cornea must be strengthened by means of cross-linking. This means, however, another surgery. General complications: Severe complications are extremely rare during proper procedures. Infections are reported in less than 1 per 10 000 cases. Cutting errors occur in LASIK in 1-3% of cases with the mechanical microkeratome, but then only rarely lead to loss of visual acuity. When using the femtosecond laser, there is no such complication. In some cases, it may lead to epithelium growing under the flap, which sometimes makes additional surgery necessary. As a result of all these possible, but rare complications, less than 1% of the cases lead to reduced vision. But even this figure can be further reduced by post-treatments. Remember, if necessary, to change the entry in your driver's licence at the Road Traffic Office regarding driving with glasses or contact lenses (one month) after the treatment. - 13 -

Refractive lens surgery for very high refractive error On the previous pages we introduced modern laser surgery of refracrive errors in detail. Limits of LASIK The laser surgery in the event of high ametropia reaches a natural limit that should not be exceeded. For near-sightedness this begins at about -8 to -10 diopters, for farsightedness at 3 to 4 diopters. Where does this limit come from? For each diopter, which we correct with the laser, a certain amount of corneal tissue is removed. Of course, the greater the refractive error, the more so tissue is removed. The cornea becomes thinner as a result of the LASIK or PRK. This in itself is no problem as long as the cornea thickness does not fall below 300 microns. How many diopters can be corrected for a person therefore depends above all on how thick the cornea is. The corneal thickness depends on the individual and varies between 460 and 600 microns. In a patient with a thick cornea, therefore, more diopters can safely be corrected than in a patient with thin corneas. For affected patients, this means that laser surgery can be performed, but for safety reasons, a full correction does not make sense. Then the refractive lens surgery proves its worth. Refractive lens surgery The laser surgery changes a part of the optic (the cornea) to produce the normal vision. The optics in the eye may also be influenced in other places (for example inside the eye, the lens) to achieve a normal vision. This is consistent with refractive lens surgery. It is divided into two areas: the removal of the natural lens and replacing it with an artificial lens ("clear lens exchange", a "cataract operation" in advance) or the insertion of an additional lens into the eye (phakic lens). Clear lens exchange The "clear lens exchange" represents a cataract surgery in advance. Here, the natural lens inside the eye by means is removed using a 2.8 mm cut and replaced by an artificial lens. The strength of the artificial lens can be chosen so that it later results in normal vision. The big advantage of this operation is that it is identical to the cataract opation. The only drawback is that the patients become presbyopic through the surgery, which means that they may need reading glasses afterwards. The "clear lens exchange" is therefore particularly suitable for strongly near-sighted and farsighted people. You can find more information on the operation in our brochure: "Cataract surgery". Phakic lenses In the case of phakic lenses, a diverging or converging lens is attached to the eye in the vicinity of the pupil. All of these lenses are now made of gel materials to be brought into the eye folded. This is necessary in order to get along with a small cut (<3mm) that rapidly regrows. The Artiflex lens is clamped on the iris, while the Cachet lens is supported in the chamber angle. More than five years control data from the two lenses is available with minimal complications and a high success rate. For this reason, in some places around the world the phakic lens has been considered as a preferred alternative in the case of even low refractive errors. The risk profile is similar to cataract surgery (see brochure) with a complicated rate of significantly less than 1%. The phakic lens may be explanted again if necessary. - 14 -

Who is behind IROC? IROC, Institute for Refractive and Ophthalmic Surgery IROC was founded in summer 2002 and provides a unique association of eye-surgeons, physicists, laserdevelopers and opticians. Our team of surgeons represents more than 5 decades of academic experience in the field of the anterior eye-segment (a total of 20'000 interocular surgeries). Its our aim to sustain our unique quality standard and to make it accesible to our patients. Centre of competence With your decision of having your surgery made at our institute, you place yourself in the hands of your treating doctor. This requires a bond of trust. In addition, we possess an experience of more than 15'000 Laser-surgeries and are classified as a global centre of reference for other eye-surgeons regarding very complex cases of refractive surgery. The surgical Team of IROC Wolff, Michael. Dr. med., medical studies in Bonn (Ger). Specialist registrar in Düsseldorf (Ger) and London (UK). Further education in medical retina (London) and refractive surgery (Zürich). Koller, Tobias. Dr. med., medical studies in Zürich. Specialist registrar in Zürich and Stanford (USA), further education in anaesthesia, internal medicine and pathology. Further education in refractive surgery. Dr. Koller is reviewer for many international journals and has published more than 50 articles. Seiler, Theo. Prof. Dr. med. Dr. rer. nat., medical and physics studies in Heidelberg and Berlin (Ger). Specialist registrar in Berlin. Full professor of ophthalmology and director of the university eye clinics of Dresden (Ger) and Zürich. Prof. Seiler has more than 30 years of academic experience. Furthermore, he developed PRK, customized ablation, cross-linking and published more than 200 scientific articles and obtained many national and international awards in the field of ophthalmology. Out team at the institute for refractive and ophthalmic surgery offers far more than the "secure handling" of your treating doctor. We offer a service where not only your doctor is keen to fullfill his task, but our whole network of eye-doctors, eyesurgeons, opticians and physicists who are specialised in physiological optics. Such a combination of experts in different fields, who offer you the best possible comfort at the highest possible security, is unique in Europe. - 15 -

How to find us Contact information IROC AG Institut fur Refraktive und Ophthalmo-Chirurgie Stockerstrasse 37 8002 Zürich Tel +41/(0)43-488 38 00 Fax +41/(0)43-488 38 09 info@iroc.ch www.iroc.ch Position and accessibility IROC lies in the heart of Zürich. Its only a few steps away from the Bahnhofstrasse (Zürichs famous shopping street), the lake, the hystoric district and the Fraumünster with its world famous Chagallwindows. Approach By car: 2 minutes from the citycentre, 20 minutes from the Airport. By train: 20 minutes from the Airport. By tram: the trams 6,7,8 and 13 take you to the stop "Stockerstrasse", which lies only 50 metres from our clinic. - 16 -

IROC AG Institut fur Refraktive und Ophthalmo-Chirurgie Stockerstrasse 37 8002 Zürich Schweiz Tel +41 / (0)43-488 38 00 Fax +41 / (0)43-488 38 09 info@iroc.ch www.iroc.ch Patienteninformation Refraktive Chirurgie Englisch,, 10/2012 2012 IROC AG