The Eye Practice

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.

Laser Eye Surgery depending on the patient and the outcome required can come in many forms.  By far the most common is LASIK.

If you’ve decided on LASIK to correct your vision, you’ve probably found out that there are many different types of laser eye surgery. Also, you’ve probably also found out there are a number of different instruments that can be used to complete the LASIK procedure.

One of the biggest debates among doctors, and, subsequently, among patients, is the use of the Femtosecond laser versus the microkeratome blade. A simple look at the differences between the two are presented below — from the perspective of patients and their doctors.

A Comparison, Side-By-Side

There are several reported differences between the use of the femtosecond laser and the microkeratome blade, by both doctors and patients. Below are several points to examine when considering LASIK surgery.

•    Discomfort levels. Some doctors have reported that patients seem to experience more feelings of pressure and discomfort during the procedure with the femtosecond laser than patients who have had the surgery with a microkeratome blade.

•    Recovery time. While recovery time with LASIK, both using a femtosecond laser or microkeratome blade, is similar. However, some patients report fuzzy vision for the first week or so with femtosecond, but not with microkeratome. However, there are some conflicting reports that femtosecond has faster visual accuracy recovery over microkeratome usage.

•    Length of time in surgery. The actual time in surgery with femtosecond usage is longer than with microkeratome blade usage.

•    Cost. Femtosecond is more expensive than microkeratome.

 

•    Accuracy of flap shape and completeness. Some doctors report that the flap creation is cleaner and sharper with femtosecond laser usage, and a thinner flap can be created with femtosecond lasers — the thinner the flap, the better the post-surgical outcomes.

•    Risks and complications. The difference in risks and complications is often said to be negligible. However, for patients with certain eye conditions, such as epithelial basement membrane dystrophy, a microkeratome blade is not advisable, and a femtosecond laser is the better choice.

•    Evolution of technology. Side-by-side, improvements of both the femtosecond laser and the microkeratome blade come along often enough to not put one too far ahead of the other.

Ultimately, finding a doctor you trust who uses the tools you want used on your eye is the important part. The treatment outcomes for both femtosecond laser use and microkeratome blades are similar, and have negligible differences in risk. In fact, the differences between femtosecond laser and microkeratome depend on physician and patient comfort and experience. When consulting with your eye doctor, you will want to take into consideration some of the following things:

•    Do you have any conditions that would make one piece of technology the superior choice over the other?

•    What kind of tools does your eye doctor or surgeon have the most experience with?

•    What kinds of complications have they seen with their patients, with both femtosecond laser usage, and microkeratome blade usage?

Dr Jim Kokkinakis has worked as a consultant and an optometrical educator in the largest Laser Vision Correction Centre in Australia for 6 years between 1996 and 2002.  During this time up until now he has seen thousands of patients that have had the procedure.  He is therefore very experienced in choosing the right procedure and the right laser Eye Surgeon for the appropriate patient.  Call us on 9290 1899 now to make an appointment to work out if Laser Eye Surgery is right for you.

Laser Eye Surgery to try and reduce the dependence on glasses has been around in Australia since 1991.

These days some people who are tired of having to wear glasses and contact lenses all the time often find themselves looking into LASIK eye surgery to correct their vision problems.

If you’re one of the many looking for an alternative to traditional vision correction, you might be wondering about LASIK and other laser eye surgeries.

Which one is best?

There are many different types of laser eye surgeries, and determining which one is “best” could be misleading. The better question might be, “which one is best for you?”

•    PRK Surgery: This is the “pre-LASIK” surgery that was developed in the 1980s. It stands for “photorefractive keratectomy,” and uses a cool ultraviolet light beam to ablate corneal tissue to reshape the cornea. Recovery takes a lot longer than with LASIK, but it is often a better alternative for patients with thin corneas.

•    LASIK: “Laser-assisted in situ keratomileusis” is a popular choice for many people due to its fast recovery time (as short as a day in many cases), and reshapes the cornea with cool ultraviolet light — after creating a flap in the cornea, which can be done with a special tool called a microkeratome, or a laser. This surgery is not recommended for people with very thin corneas.

•    Wavefront LASIK: This is also known as “custom LASIK,” and follows regular LASIK procedures. It is not for people with thin corneas, but will often work for those have high degrees of nearsightedness, farsightedness, or astigmatism.

 

•    LASEK: Standing for “laser epithelial keratomileusis,” and is different from PRK and LASIK procedurally. A thin, epithelial layer is removed prior to reshaping the cornea with a laser, and then replaced onto the surface of the eye. This surgery is for those with thin or steep corneas so much so that LASIK is inappropriate for them.

•    Epi-LASIK: While similar to both LASIK and LASEK, Epi-LASIK uses different tools in order to preserve epithelial cells. This type of surgery works best for patients who have lower degrees of myopia. The recovery time is longer than with LASIK, with final results of vision improvement sometimes taking as long as six months.

•    Bladeless LASIK: The procedure is similar to LASIK, but uses 100% lasers (femtosecond) in order to cut the corneal flap and to reshape the cornea. While complications with regular LASIK are rare, bladeless LASIK reduces the risks even further.

Currently, LASIK is not appropriate for people with presbyopia (both near and farsightedness), although PresbyLASIK is currently being developed for approval in the United States, it is approved in other countries. If you’re in the US and have presbyopia, you may want to talk to your eye care professional about getting in on a trial study. In Australia PresbyLASIK is available but success is far from guaranteed.  It compromises distance and near vision to try and get an overall independence.  Some people will love it, some people will hate it - careful assessment and boxing in of expectations are required.

Some laser surgeries for the eye are not for everybody. People with diabetes, autoimmune disorders such as AIDS, lupus, rheumatoid arthritis, or similar disorders, or eye conditions such as glaucoma, retinal disease, cataracts, or corneal scarring, possibly would not do well with the surgery.

Discuss your personal options with Dr Jim Kokkinakis at The Eye Practice.  He has worked part-time in the largest laser centre in the country from 1996 to 2002.  During this time he was responsible for the Laser Eye Surgery education program and lectured nationally and internationally on Laser Eye Surgery - its advantages, its disadvantages, its complications and it solutions - make an appointment now for a Laser Eye Surgery Assessment on 9290 1899 or book an appointment online by <CLICKING HERE>.