Optometrist-Sydney

MYOPIA: Things are going haywire!

Fri, 18 May 2012 06:00:00 GMT

Myopia (Short-sightedness or Near-sightedness) historically has been felt to be primarily a genetic issue. Even though this is true - myopic parents are more likely to have myopic children, over the last few years, more and more evidence seems to suggest that myopia is a result of not enough outdoor activity and excessive reading.

Eastern Asian countries seem to have an epidemic of children becoming myopic, many of them significantly worse than their parents. Up to 20% of Eastern Asian children are now classified as severely myopic!

Time magazine recently published a story on how keeping children indoors is ruining their eyesight.

Myopia is not classified as an eye disease. It is normally referred to as a vision disorder that can be easily corrected with glasses, contact lenses or laser eye surgery.

Luckily in most cases this is true but...

When myopia progresses to a higher level (which seems to occur with children that are indoors excessively), all sorts of eye diseases become significantly more prevalent.

People that have high myopia are more prone to:

Retinal detachment
Glaucoma
Lacquer cracks in the macula
Earlier onset of cataracts

This is such a problem in Asian countries now that it is likely to be classified as a health disaster if something is not done to try and arrest this problem.

So what can be done?

At present it is difficult to pinpoint exactly what is the real cause. Being outdoors seems to be protective. Is this because:

Outdoor activity means you read less?
Outdoor activity means you are exposed to more Vitamin D?
Outdoor activity means you look in the distance much more?
Possibly it is multifactorial involving all of the above and other things we are ignorant to?

With the above in mind it seems wise to get our children outdoors. Get them to play. Why have we become so obsessed with academic progress? Do children really need to learn how to read from 2 years of age? What is the advantage to them in adulthood?

If a child becomes myopic and requires glasses to see properly, consideration needs to be given to a procedure called Orthokeratology. This has been shown to significantly slow down the progression of myopia. More on Orthokeratology can be found HERE. You can see a number of videos about this fascinating procedure. Even an Eye Surgeon in the USA has preferred to have orthokeratology rather than wearing glasses or having laser eye surgery.

At The Eye Practice we have been using this procedure to slow down and in many cases apparently stop any further progression in myopia for over 15 years now. Children then seem to be able to continue with their academic lifestyle and still be somewhat protected from getting worse. Imagine if we could incorporate significant outdoor activity with Orthokeratology - the Myopia epidemic could be over!

If you are worried about your child's vision - this is especially true for myopia during puberty, make an appointment now and see whether they would be suitable for orthokeratology. They will need to be at least 8 years of age and keen to have a go.

CLICK HERE to book an appointment ONLINE or phone 9290 1899.

DRY EYES: What is LipiView and LipiFlow?

Thu, 17 May 2012 12:10:00 GMT

Dry Eyes over the years has been an enigma. There are a multitude of treatment options and most of the time it is trial and error until NOW!

The main treatment that was offered was replacing the aqueous (water) component of the tear film, yet we now know from Lemp's study that up to 86% of patients have in fact a lipid (oil) deficiency due to meibomian gland blockage.

At The Eye Practice in around 3 weeks we will be installing the ground breaking dry eye technology from Tear Science. The Tear Science system consists of the:

Meibomian Gland Evaluator - this innovative device simulates the force of a natural blink and the optometrist will be able to gauge at what level the meibomian glands are functioning. On failing this test it is then recommended to proceed to the second part of the system.

2. LipiView Ocular Surface Interferometer -this non invasive instrument captures live images of the patient tear film and measures lipid content and quality. This standardized test will quantify the lipid and give the dry eye specialist confidence in proceeding to the Lipiflow procedure.

3. LipiFlow Thermal Pulsation System - consists of a unique single use component that is a combined lid warmer and lid massager. The treatment takes only 12 minutes and is pain free.

The majority of people that qualify for the treatment are delighted with the benefits.

CLICK HERE to view a number of testimonials.

More will be discussed about the LipiFlow Thermal Pulsation System in the next post. We anticipate this to become the standard of care for Dry Eye treatment over time. Finally we have something that is logical and attends to the root cause of most dry eye issues.

DRY EYES: Finally we have a treatment! Lipiflow is here!

Mon, 14 May 2012 11:19:00 GMT

Dry Eyes we know are very common. Some people that suffer from dry eyes are nearly debilitated by the burning, gritty irritation. In fact it is such a problem that there seems to be a link between dry eyes and depression (Kim et al. 2011).

To date we have had a multitude of treatments, which most of the time have proved to be ineffective. Possibly here lies the frustration that many patients face.

Dry Eyes are caused by two basic mechanisms:

Aqueous (water) deficiency
Lipid (oil) deficiency

At least 65% of dry eyes have a lipid (oil) deficiency, which most current treatments do not attend to. In fact a recent study showed that up to 86% of dry eye patients have lipid deficiency (Lemp et al. 2012).

Most treatments deal with aqueous (water) deficiency. In nearly 100% of cases eye practitioners have treated dry eyes with aqueous replenishing eye drops. Most patients will say that even though they help the effect remains for a few minutes before the symptoms come raging back.

It seems logical that treating lipid (oil) deficiency, otherwise known as meibomian gland dysfunction, might produce better outcomes for our patients.

To date meibomian gland dysfunction has been treated with warm compresses and gentle massage of the eye lids. This makes sense as meibomian gland dysfunction represents the failure of the meibomian glands in the eyelids to secrete oil into the eye and protect the aqueous (watery) layer of the tear film from evaporating. This excess evaporation of the water component of the tear is thought to produce the symptoms of dry eyes.

The concept is that by applying heat adjacent to the meibomian glands we will melt the meibomian oil that has solidified and blocked up the glands. The gentle massage will then promote the liberation of the liquified oil into the tear film and coat the eye with the protective layer that it so desperately needs.

The problem with this treatment is that in most cases to be effective requires to be done twice a day and the use of a microwaveable heat pack moulded into the eye sockets must be held against the eye for at least 5 minutes per session - compliance with this regimen is very difficult and can take weeks to get a perceived effect. From then on it is ongoing forever - only the most desperate dry eye patients will continue with this very inconvenient treatment.

Over the last number of years a brilliant optometrist (Dr Donald Korb) with the help of a company called Tears Science has developed an in office procedure called LipiView® and Lipiflow® that promises to revolutionize dry eye treatment for meibomian gland dysfunction.

Over the course of the next few posts we will discuss the introduction of the amazing technology into The Eye Practice. At this stage we will be the first eye care facility in the country to start using this FDA approved instrument to help our dry eye patients. We have had inquiries from as far as New Zealand and Melbourne. The need for this unique dry eye treatment is unquestioned. Stay tuned for more tomorrow.

References:

Lemp et al.

Lemp MA, Crews LA, Bron AJ, Foulks GN, Sullivan BD. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea. 2012 May;31(5):472-8.

Kim et al.

Kim KW, Han SB, Han ER, Woo SJ, Lee JJ, Yoon JC, Hyon JY. Association between depression and dry eye disease in an elderly population. Invest Ophthalmol Vis Sci. 2011 Oct 10;52(11):7954-8.

CONTACT LENSES: They are medical devices!

Tue, 01 May 2012 12:32:00 GMT

Contact Lenses fortunately over the years have had considerable technological advancement. What is very sad though is that it seems the incidence of severe eye infections caused by them is on the increase.

The irony here is that because they have improved both practitioners and patients have slackened off in hygiene and compliance in replacement schedules. WHAT ARE WE DOING!

Our vision is our most important sense. At The Eye Practice we specialise in contact lenses and frequently treat conjunctivitis, dry eyes and allergic reactions to contact lens solutions. Most of these complications are avoidable but the bizarre perception that contact lenses are somehow similar to putting on a pair of socks is just a frustrating process.

To get to The Eye Practice every day Dr Jim Kokkinakis walks through the Queen Victoria building and in full view of the unsuspecting public is a plasma screen advertising coloured contact lenses that can be purchased without a prescription.

This outrageous situation somehow sneaks through the legislative process in Australia because they are selling contact lenses without a power for vision. Unfortunately the power of the lenses has nothing to do with its safety. In the USA it is actually illegal to sell any type of contact lens without a prescription. The loop hole that exists in Australia does not exist in the USA, yet unscrupulous retailers still try their luck on the unsuspecting public. The following video highlights the dangers of purchasing contact lenses without a prescription.

Whether you are purchasing contact lenses from a retailer or over the internet make sure you have an up to date contact lens prescription that has been validated by an optometrist. Your eyes are so precious. Please look after them.

DIABETIC RETINOPATHY: Do you need to worry?

Thu, 10 May 2012 08:22:00 GMT

Diabetic Retinopathy is a serious eye condition that occurs commonly amongst diabetics.

What is amazing and tragic is that diabetic retinopathy is is often diagnosed very late and is the leading cause of blindness in an age group under 50 years old.

We recently came a cross a great but stressful blog written by a person that is going through the emotional trauma of diabetic retinopathy. It just does not need to be like this, yet it is an all too familiar story.

What is impressive about this story is that the gentleman writing this blog seems to be using it to get down his thoughts to the world, which no doubt help him keep on track with what he needs to do as a Type 1 diabetic to reduce the risk of complications. Even recipes for healthier eating are included.

I would encourage any reader that is interested in diabetes to subscribe to this ongoing chronicle to not only share in this gentleman's feelings, but to also raise your awareness of how a diabetics mindset needs to change.

CLICK HERE to go to mydiabeticjourney.

EYESTRAIN, DRY EYES and Smart Phones

Sat, 14 Apr 2012 12:14:00 GMT

Eye Strain and Dry Eyes are now a significant issue with teenagers. Anyone that has a teenager knows all too well that they live on their FaceBook whether they are on their computer (supposedly doing their homework) or on their phone. They all have phones don't they!

See the following short video that describes this ever increasing problem.

GLASSES and SPECTACLES: Are these the future?

Fri, 06 Apr 2012 03:29:00 GMT

As computer chips, wireless connections and speeds continue to improve, it is quite conceivable that we will have constant access to the internet through our glasses.

They are convenient, they are light and with voice recognition see the You Tube Video below at what might be possible.

CONTACT LENSES: Lecturing in Bangkok

Wed, 04 Apr 2012 12:04:00 GMT

Contact lenses are a specialty at The Eye Practice. So much so that Dr Jim Kokkinakis is often invited to lecture to optometrists not only in Australia but around the world.

March was a particular busy time as Jim visited Bangkok to present twice on Contact Lenses, their advantages, possible complications and most importantly their solutions.

Amazingly Johnson & Johnson Vision Care, which sponsored this educational event has a purpose built presentation and training facility in Bangkok, which can be used to train optometrists not only from Bangkok but from other countries as well.

This particular cohort of optometrists were from Singapore. The enthusiasm shown by this group of practitioners just proves what a vibrant profession Optometry is. Even though legislation in Singapore does not allow optometrists to do procedures that our optometrists in Australia take for granted, their level of knowledge was nonetheless very advanced.

It is a credit to the Polytechnic School of Optometry in Singapore and their newly formed association. Optometry in Singapore is certainly progressing in leaps and bounds.

This month Jim is off to the Gold Coast to present to Australian optometrists and again in May to Perth. More on these presentations later.

EYESTRAIN: Gunnar Customised Lenses

Thu, 29 Mar 2012 08:07:00 GMT

Eye Strain we have discussed in detail in previous posts. In fact it is so important that we have a website called:

EyeStrain.com.au

Eye Strain can have a number of causes and only a comprehensive examination can reveal what are the contributors to the perception of eye strain.

From next week The Eye Practice will be the first optometrist outlet to trial a new product called Gunnar Technology Eyewear.

This very innovative product can be purchased with or without a customised prescription in glasses. Even though there might be great value with no prescription, the value of these glasses will excel when it is made up with your own prescription.

Stay tuned for more on this topic soon! We will trial in house first and if we are convinced that it has a role to play in relieving the Eye Strain epidemic we will start to prescribe it soon.

KERATOCONUS: The Book is Finally Here!

Thu, 22 Mar 2012 10:48:00 GMT

Keratoconus at The Eye Practice is an extremely common encounter, as we specialise in it. Even though finding vision solutions is the reason most patients attend, explanation of the eye condition and giving peace of mind is also a very important component.

Because detailed and individualised explanation is so important a number of years ago Dr Jim Kokkinakis wrote: "The 7 critical issues that you need to know about Keratoconus... but Don't". From around the world this article has been downloaded nearly 25,000 times to date.

Recently Dr Jim Kokkinakis (Optometrist) in conjunction with Dr Michael Loughnan (Corneal Ophthalmologist), Mr Richard Lindsay (Optometrist) and Professor Gerard Sutton (Corneal Ophthalmologist) have published what they think is a very important piece of literature written in laypersons language.

If you have keratoconus or have a family member or friend with this frustrating condition, this simple text goes through all the issues involved.

Call us on +61 2 9290 1899 or email us HERE to get your copy for $19.95 plus postage.

LASER EYE SURGERY: It is not for everyone

Sun, 18 Mar 2012 02:11:00 GMT

Some people are not well-suited for laser eye surgery, typically due to a high degree of myopia (nearsightedness) that is not significantly corrected through laser procedures. Many feel they are resigned to glasses or contact lenses for the rest of their lives.

Fortunately, this is not the case. There are alternatives for those of you whose vision cannot be corrected well by laster surgery.

ICL or Phakic Lens Implants

ICL stands for “Implantable Contact Lens,” and fits over the natural lens of the eye, which is important for focusing flexibility. “Phakic” is the other term for the Intra-Ocular Lens (IOL, ICL), and it is meant to enhance, not replace, your natural lens.

The implants go behind the iris, but in front of the lens to correct and enhance your vision. The procedure is based on cataract surgery, but the natural lens is not removed.

Who Will Benefit?

The best candidates for ICL or Phakic lens implants typically fall into the following categories:

    Ages 18-40
    Chronic Dry Eye problems
    Severe Myopia (nearsightedness) - anything between -5.00 to -20.00 diopters
    Typically healthy eyed, with no history of retinal detachment
    Little to no astigmatism (less than 2.5 diopters)
    Stable eyesight, with no changes over .5 diopters within a six month period
    No presbyopia or hyperopia present (no mix of nearsightedness and farsightedness — the surgery is not suitable to correct hyperopia or presbyopia)
    Those who have thin corneas and have been disqualified from laser surgery

These implants are temporary and removable. Inevitably, as we age, cataracts develop, and the lens implant will have to come out. If, for any reason, the procedure needs to be reversed, it can be done easily.

Benefits & Risks

There are a number of benefits and advantages, and minimal risks with lens implants.

    There is less risk of post-operative issues, such as halos, glare, impeded night vision, and difficulty seeing in low light than with laser surgery.
    Unlike laser procedures and lensectomy, the structure of the eye does not change. This means that you will retain your natural focusing abilities.
    Post-operative pain and discomfort is almost entirely eliminated.

There are three risks with ICL or Phakic lens implants:

Infections. Although rare, it is possible that an infection in the eye can develop, causing complications. These risks are minimized by using a thoroughly sterile environment.

Premature cataracts. In very rare cases, premature cataracts develop. This risk can be minimized with an experienced eye surgeon, however.

Glaucoma. Also not common, but it is possible by trying to squeeze the artificial lens into position, the internal drainage system of the eye can block, which in turn raises the pressure in the eye and causes glaucoma to occur.

You don’t have to tolerate corrective lenses that make your eyes look strange, or deal with contact lens maintenance constantly. If you have been told that laser eye surgery is not for you because of severe myopia, thin corneas, or severe dry eye, you may want to discuss ICL or Phakic lens implants with your us. Dr Jim Kokkinakis can help you determine if you are a good candidate for the procedure, and teach you about the risks and benefits of the surgery.

WATERY EYES: Caused by Blocked Tear Duct

Fri, 02 Mar 2012 06:27:00 GMT

Watery eyes have so many causes – not the least of which is a blocked tear duct.

The inner corner of your eye is where your tear ducts are situated. Known as the puncta, they are responsible for draining your excess tears from your eyes and down into the nose. If the puncta are blocked for any reason, the tears will remain on the surface of your eye, and they will spill out over your eyelids and onto your face. The blockage can be partial, or complete – and this will result in the severity of overflow of tears, known as epiphora.

While watery eyes can be a major symptom of a blocked tear duct or ducts, there are other symptoms associated with this problem as well, including:

• Recurrent episodes of conjunctivitis and other eye infections (such as dacryocystitis).

• Blurred vision.

• Blood in tears (tears will be stained pink or red).

• Mucus discharge from the eye (regardless of conjunctivitis).

• Swelling, tenderness, or pain at the inner corner of the eye, where the tear ducts are located.

While the puncta are commonly the culprit of blockage, it can occur at any part of the tear duct system, such as the canaliculi – the canals in the lids that carry the tears to the sac on the side of the nose (called the lacrimal sac). In fact, any part of the system can be blocked, including the nose, and result in watery eyes.

So what causes these blockages to occur? There are several causes of blocked tear ducts:

• Congenital defects: Down syndrome, duct abnormalities, or tissue over the nasolacrimal duct can cause this problem.

• Facial injuries or eye trauma: If a facial or eye injury is present, a problem with bone or cartilage damage can cause the blockage.

• Aging: Growing older can change the shape of the eye, causing blockages in the puncta.

• Tumors, cysts, and foreign objects: Benign or cancerous tumors or cysts can develop, as well as grit from the duct system can create an obstruction.

• Eye infections: Inflammation and mucous can plug the area, causing the ducts to become blocked.

• Medications: Topical eyedrops, and certain chemotherapy treatments (such as Taxotere) can have a possible side effect of tear duct obstruction.

If left untreated, complications can occur. The tears in your eye need to move, as any liquid becoming stagnant in the body is more open to infections – bacterial and fungal. Additionally, viruses can be opportunistic and penetrate the area, causing further problems. These infections can lead to eye damage and vision impairment.

If you have watery eyes, it is best to find out the cause by visiting your eye care professional, before infections get a chance to set in. Treatments depend entirely upon what is causing the problem. Irrigation, surgery, tumor removal or shrinkage attempts (depending on the cause of the tumor), and massage techniques are all used to unblock the tear duct system.

Make an appointment to see Dr Jim Kokkinakis if you have watery eyes on (02) 9290 1899. Even though some forms of watery eyes might need referral to a specialised ophthalmologist called an oculoplastic ophthalmologist, often no referral is required and can be treated in house.

LASER EYE SURGERY: Not Suitable? What about Lensectomy?

Tue, 28 Feb 2012 09:56:00 GMT

Laser Eye Surgery is certainly not for everyone. In fact at least 25% of the people that inquire about Laser Eye Surgery are suitable for a variety of reasons. It is imperative to be screen by someone that is experienced in who is suitable as treating unsuitable patients can turn out to be disastrous.

If you’ve been disappointed to find out that you are not eligible for laser eye surgery, either due to your age, or that your prescription vision correction is too high to make laser surgery worthwhile, you don’t have to resign yourself to being stuck with glasses or contacts for the rest of your life. Actually, there is an alternative that you might find fitting for your vision needs.

REFRACTIVE LENSECTOMY

This procedure, called a refractive lensectomy, is ideal for many patients who do not fit the criteria for laser eye surgery. Basically, a lensectomy does not reshape the cornea as it would with lasers — instead, the natural lens of the eye is removed (hence the name “lensectomy”), and replaced with a permanent, human-made polymer lens. This new lens allows the eye a bit more flexibility with focusing (refractive - especially at distances), and will reduce or eliminate your dependence on glasses or contact lenses.

Best Candidates

The ideal patients for a lensectomy typically fall into the following categories:

•   Age 45 and over
•   Have been disqualified from laser procedures, due to thin corneas or other reasons
•   Have signs of cataracts (early stages)
•   High prescriptions, either nearsighted or farsighted
•   Have a dependency on corrective lenses for both nearsightedness and farsightedness
•   Have no signs of other eye ailments (such as glaucoma or potential retinal detachment).

If you have the need for bifocals or multifocals, and are over age 45, then you might be a good candidate for a lensectomy procedure. You may be able to eliminate your need for corrective lenses entirely, or ditch the bifocals and just need reading glasses.

While lensectomy greatly improves your focusing capability, it does not always correct it entirely, and, if you still have the ability to focus well (in other words, your eyesight is still flexible), you will lose your natural focus powers. Therefore, this procedure is best for those who are older than 45 years, and have lost that ability through the natural aging process.

Surgery & Recovery

The surgery is quite simple, and you would not be put under general anesthesia —you would only be given a sedative if needed, and a topical anesthetic would be used. Your natural lens is removed, and the manufactured lens is put in its place. No stitching is required (in the majority of cases), as the incision that is made seals itself through your eye’s natural pressure, and then heals itself.

There is little discomfort during the healing process, and many patients are able to see clearly in just a few hours after the operation. If you have astigmatism, it will be corrected during the procedure using limbal relaxing incisions (LRIs) —tiny incisions in the cornea —which will alleviate astigmatism symptoms. Lately lens implants have been designed that also correct astigmatism, which has nearly made the relaxing incision procedure obsolete.

During recovery, you may experience occasional blurriness as tear film and fluid in the cornea fluctuate. Additionally, light sensitivity is often reported for several weeks after the surgery.

If you are interested in this procedure, discuss it thoroughly with Dr Jim Kokkinakis. He can detail the risks and assess you for candidacy for this procedure. Call us on 9290 1899 or <CLICK HERE> for an appointment.

WATERY EYES: Caused by Ectropion

Tue, 28 Feb 2012 00:50:00 GMT

Watery Eyes can have many causes. Some can be simple to fix, yet other causes might require surgery.

The very opposite of entropion is called ectropion (eck-TROH-pee-on). It is a condition in which some of the eyelid, or all of the eyelid, turns outward. This turning outward typically strikes the lower eyelid, and is quite irritating to the eye. The globe of your eye (your eyeball), and your inner eyelid are exposed to the air. This can dry your eyes out, and, ironically enough, when your eyes start to dry out, you will produce tears to try to compensate.

One of the signs and symptoms of ectropion is watery eyes.

There are many causes of ectropion – most are from problems with the surrounding muscle and tissue of the eyelid.

•Surgery: Over-correction of previous problems, such as entropion, can cause ectropion. This can also happen with cosmetic eye surgeries, or radiation therapy to treat certain cancerous growths.

• Congenital disorders: People with Down syndrome are sometimes born with ectropion.

• Weight loss surgery and other rapid weight loss: If you have had recent, rapid weight loss, ectropion can occur.

• Growths: Any kind of growths on the eyelid can cause this problem.

• Muscle problems: Weakness in the muscles or facial paralysis (often seen with Bell's palsy), can relax the lid too much, causing it to droop. Aging can also cause this weakness to occur, causing ectropion.

• Scars: Scarring and trauma to the eyelids can also cause this disorder.
Because the eyelid is pulled away from the eyeball, your eye will not drain properly. This can cause the three major signs and symptoms of ectropion:

• Epiphora – the excessive overflow of tears is twofold. One, your eyes are trying to compensate for being dried out, and two, your puncta (the little tear ducts at the inner corner of your eye) are not draining properly.

• Gritty feeling in the affected eye.

• Irritation and burning in the affected eye.
Sagging or drooping eyelids are also a sign of ectropion.

If left untreated, ectropion can lead to serious problems with the eye, including corneal ulcers, and corneal abrasions. These complications can lead to permanent vision loss. Therefore, if you have any of these symptoms, it is important to see your eye care professional right away, as he or she can give you eyedrops and ointments to use to prevent damage until you can have surgical correction.

Surgical treatment varies, depending on the cause of your ectropion. Scar tissue may need to be managed, and other surgical procedures may be necessary. You will likely be given drops and ointments to use at home until the time of your surgery. In other words, don't try to treat this at home – the complications can be serious.

If you are experiencing any of the symptoms of ectropion, and have noticed that your eye lids are drooping, and have watery eyes, come and see Dr Jim Kokkinakis for advice. Though it may require referral to an oculoplastic ophthalmologist, it is well worth saving your sight! It is imperative that you are referred to the right ophthalmologist that specialises in correcting ec tropion.

LASER EYE SURGERY: No Flap Laser or Surface Laser Ablation

Mon, 27 Feb 2012 07:08:00 GMT

Sometimes, there’s just something about the words “blade” and “eye” that don’t want to go together. No patient enjoys the thought of having any kind of flap cut into their eye — even though the procedure is relatively safe. However, there are risks of complications when using a microkeratome blade, especially if the flap is cut too thickly. You may just not like the idea of having a blade cutting a flap open to ready your eye for the laser portion of the procedure.

Cutting the Flap: Complications

In fact, there are several potential complications with cutting a flap for LASIK, particularly with the blade. The flap can be too thin, too thick, misshapen, incomplete, or cut off completely. All of these mishaps can result in complications with the eye, and vision problems. Additionally, the problem with cutting flaps is that they can become wrinkled if you rub your eye, or later on down the road, if you are involved in contact sports. Finally, the flaps do not always heal completely, and are weakened, and can become decentered.

A Safer Alternative

Eye surgeons and eye care professionals are turning toward surface laser ablation as a safer alternative. There are several reasons for this:

• Surface laser ablation uses no blades. There is no cutting into the surface of the eye, reducing the chance of complications from the flap never healing properly, and other potential complications.
• Surface laser ablation reduces the risk of postoperative dry eye. Because the nerve endings are not cut (as there is no cutting involved), your tear secretions are not as readily affected.

• Surface laser ablation has positive treatment outcomes without the regular LASIK complications. This is a safer alternative, and, while no surgery is 100% safe, some of the normal risks are reduced with this procedure.

Above are images of eyes that have been freshly lasered with no flap. Notice the irregular finish. This gives an inferior vision result to Lasik in the first week or so, from which time this irregularity heals and the vision will finally match the Lasik result in most cases.

Procedure

Surface laser ablation uses excimer lasers to reshape the surface of the cornea to correct vision. It is indicated for people with myopia (nearsightedness), hyperopia (farsightedness), and astigmatism, and who have thin corneas.

Many people think this is the old PRK procedure. While it is similar in principle, the advancement of technology has greatly improved the procedure itself, as well as recovery times. Improvements include:

• Being able to drive within 24-48 hours from surgery (with PRK, it took at least one full week, and up to six months to see full results of the procedure).
• You would have less discomfort with surface laser ablation as it’s practiced today, thanks to improved excimer lasers, better post-operative contact lens “bandages” and comfort drops.

There are several types of surface laser ablation that can be used, to customize treatment to your specific vision needs: Epi-LASIK, where the epithelial cells are removed with a tiny separator, LASEK, where the epithelial cells are loosened with an alcohol solution and then removed manually, and trans-epithelial PRK, where the epithelial cells are ablated with the same laser that will be used to reshape your corneas.

Talk to Dr Jim Kokkinakis at The Eye Practice to determine which procedure is right for you.