Lasik / Bladeless Femto I-Lasik


 


Allegrato LASIK

Few Facts about LASIK-refractive surgery to remove spectacle power (Are you a good candidate for LASIK?)

If you're tired of wearing glasses or contact lenses, you may be considering Lasik eye surgery — one of the finest procedures to correct spectacle related vision problems. Lasik  has evoked queries and doubts in past and before you sign up for the surgery, this article  will help you get a clear picture of whether it is a good option for you or not ; what you can expect and the difference between Standard, Customized,  Intralase- Bladeless Lasik or RE-Lex.

WaveFront Analyze

Lets begin by understanding the optics of your Eyes:

 To see clearly, light rays pass through cornea, lens and focus on the retina — a layer of light-sensing cells at the back of the eye. The retina converts the light rays into impulses that are sent to the brain, where they are recognized as images. If the light rays focus either in front or at back of retina , the image you see is blurry. This is called a refractive error and to correct this you need concave or convex lens in the spectacles. Glasses, contact lens and refractive surgery attempt to correct these errors by making light rays focus on the retina.

Refractive errors are caused by altered shape or length of eyeball, cornea or lens, and are of these types:

  • Myopia — nearsightedness; only nearby objects are clear.
  • Hyperopia — farsightedness; only objects far away are clear.
  • Astigmatism — images are blurred at a distance and near.
  • Presbyopia — difficulty in reading / near work, occurs after 40 yrs of age
 

What is LASIK?

LASIK –Laser Assisted In Situ Keratomelieusis is a procedure by which the front mirror portion of eye-cornea is reshaped by laser to nullify spectacle power. The result of  procedure is based on highly sophisticated computerized automated machine. A thin flap of cornea is raised by microkeratome, highly precise laser is delivered on cornea bed and the flap put back. There are no sutures or pain involved. It is a walk in walk out procedure.


Corneal Topography

Am I a candidate for Lasik?

  • You should be at least 19 years old 
  • Your refraction (spectacles number) should have been stable for more then a year (minor 0.25 or 0.5 change is not significant).
  • You will have to undergo detailed eye examination to decide if LASIK is suitable for your eyes- corneal thickness &curvatures, eye pressure, retina examination etc
  • You should not be pregnant or nursing as these conditions might change the measured refraction of the eye. It is best to wait for 6 months after delivery to get Lasik done.
  • You should be in good general health. Lasik may not be recommended for patients with diabetes, rheumatoid arthritis, lupus.
  • You should not have eye diseases like keratoconus, glaucoma, herpes infections of the eye, severe dry eye . 
  • Understand your expectations from the surgery. Are they realistic? Discuss all the pros and cons in detail with the surgeon
 

Can any spectacle power be corrected?

  • Myopia -1 to -8 can be safely treated. However with modifications in procedure and using advanced versions of software, powers upto -14 can be removed, depending on individual’s corneal thickness or doing modified procedures like epilasik or using ultra thin flaps.
  • Hyperopia +1 to +6
  • Astigmatism 1 to 6
 

How is LASIK done?

The actual procedure takes 10 to 15mins and is done under topical anesthesia ,ie,  drops are used to anaesthetize and make eye painless. A hinged corneal flap of 90 to180 um and 7.5-9.5 mm diameter is raised using a high precision instrument called microkeratome. In bladeless lasik, the same flap is created by femtosecond laser. Excimer laser is then applied to the exposed stromal bed of cornea according to the correction required. The flap is replaced; the interface is washed and allowed to dry. This gets re-attached in few minutes without any stitches. Thus there is virtually no wound and the patient is able to leave operation theatre without any pain, pad or bandage.


Allegrato LASIK

How long does the surgery take?

The procedure takes around 15 minutes, the actual laser treatment time being in seconds. It is a walk in-walk out procedure with no eye pad or bandage. Most of the patients resume normal activities next day.

 

Can both eyes be done at the same sitting?

Yes, most surgeons do perform LASIK procedure on both eyes at the same time.

 

What are the tests which one needs to get done before LASIK?

Pre-LASIK detailed eye checkup is very important.It is done as a part of routine OPD consult and takes about an hour or so.We take a detailed history, do a thorough prelasik check which includes: refraction ie glasses number check, measure corneal thickness-pachymetry , corneal mapping-topography/scans-pentacam, aberrometry, measure intraocular pressure, assess eyelids, tear film, any squint, pupil size, check retina periphery and do cycloplegic refraction. If you are a contact lens wearer then you need to stop wearing them for  atleast one week -soft contact lens and 2 weeks-RGP (semisoft) contact lens before this eye check-up and Lasik procedure.

 

Will LASIK  procedure hurt?

No, the procedure will not hurt. Local Anesthetic drops are used for the procedure. You may have watering or feel itchy or irritation for a day for which we advice lubricating tear eye drops. Next day onwards the comfort level is normal.

 

How soon does one attain visual recovery following LASIK? Is prolonged medication required post-operatively? 

First day the vision may be a little blurry and the next day you can see quite clearly. The fine tuning of focusing for some may take a week or so. Most people join back work after 2 days .The post-operative eye drops are required for 3-4 weeks, that too in reducing dosage.

 

What are the precautions that I am required to take after LASIK? 

You can resume normal lifestyle within a day or two.For a period of about three weeks after LASIK you have to avoid rubbing your eyes and splashing water forcefully into the eyes. When moving outdoors in dusty environment it is desirable that the eyes are protected using sunglasses.

 

Does the correction obtained after LASIK last a lifetime? Is it true that I will not require any glasses whatsoever in future?

Yes, if the eye does not suffer any other disease no glasses would be required. Very few patients, especially with high powers may have regression-wherein their corneal tissue is inherently more elastic and hence small amount of spectacle power may come back in few years time. Also if you are above 45 years of age, the presbyopic changes will require you to wear reading correction for near work.

 

What is the long term effect of this procedure on one’s eye?

As much clinical data we have, shows that it has no side effects on other parts of eye in long term. The laser is done on front surface of the cornea and the studies have shown no effect on endothelium i.e. the back surface of cornea. It is important to keep the details of your original corneal mapping / scans as these will help to calculate correct lens power if you ever undergo cataract surgery in future.

 

What is Customized LASIK?

This technique is an advanced version of Standard Lasik and the soft wear used – Wave Front Technology ensures that the ablation (laser treatment) profile is more aspheric and corrects the normal aberrations of eyes. In terms of results, customized LASIK offers better contrast sensitivity and improved night vision by reducing glare problem. We examine your eyes in terms of  pupil size, spectacles power, cornea and high order aberrations to decide whether you should undergo standard or customized Lasik.

 

What is Blade-Less LASIK? Is it better than LASIK?

The procedure for both is same with a minor modification in the way corneal flap is created. In Lasik, we use a microkeratome (fine oscillating blade) to create the corneal flap while in blade-less, femtosecond laser is used to create the same. Rest of the procedure, laser delivery, correction etc. remains same. The type of flap created in both is comparable and retrospective studies are not showing any major advantage. The blade-less technique is much more expensive as an extra machine is used in procedure.

 

How safe is the procedure?

Lasik is quite a safe procedure approved by FDA of USA. Over 30 million eyes have undergone Lasik in the world in past 15 years. The high end Lasik machines and microkeratomes have made this possible. For safe and best results, one has to ensure that all selection criteria are meant. We are very stringent on that and if there is the slightest doubt of unpredictable result in an individual eye, we motivate the patient to keep wearing his glasses or contact lens.
 
With more then a decade and millions of procedures being conducted, LASIK has established itself as a safe procedure but like any medical procedure it has its share or rare complications. Usually these are not related to surgeon or type of machine but are due to limitation of the procedure itself. Most patients will get full correction, but very few may have a small under or over correction in one of the eye. There are so many factors playing a role eg. laser fluence, dryness of stromal bed, healing nature of the corneal tissue etc that one has to be realistic about small errors. Usually for small errors you will not need to wear glasses as your own accomodative system of eye will take care of it in few days to week's time.    

Complications such as overcorrection, undercorrection,  inflammation, ectasia and very rarely  infection have been reported in literature across the world, but are few .Corneal Flap related complications like button holes, free flap, haze under flap etc can happen rarely. Most of these can be managed well with timely intervention.

 

Can people between 40 & 60 yrs of age also get Lasik done?

Sure, they can. Though if you are above 45 years of age, Lasik can correct only your distant vision but you will still need reading glasses as and when required.

 

My cornea is thin, can I get Lasik done? What are the other options for me to remove glasses?

There is a selection criteria based on corneal thickness and detailed mapping of anterior + posterior surface of cornea. Some eyes with thin corneas would not be suitable for any kind of laser and have an option of getting Implanatable Contact Lens. The borderline thin corneas with no keratoconus may benefit by  PRK-surface ablation, LASEK or Epi-LASIK. These procedures save cornea tissue but have more post-operative pain and a longer visual recovery time.

 

Will The Health Insurance Company cover the procedure?

No, usually the procedure is not covered under the health insurance in any country as it is considered as a cosmetic correction by them. 

 

Is it true that LASIK Treatment is cheaper in India then other countries?

Yes, that is true. Many international patients are coming to India for the treatment as the surgery is expensive overseas. The machines are the same world over and India has highly qualified and experienced surgeons. 

 

What is the cost of LASIK procedure?

This will vary from country to country. In India, the cost for Standard Lasik on an average will be Rs. 30,000 to Rs. 35,000 while the Customized LASIK procedure would be Rs. 40,000 to Rs. 45,000. The bladeless femto lasik cost is around Rs 90,000.

 
While, in USA the procedure costs close to Rs. 2 lakhs while the bladeless is around 3.5 lacs.

 


We at Max Eye Care-Superspecialized Eye Institute of Max Healthcare have Allegrato Wave Excimer Lasik machine which is one of the fastest and most precise in the world. Option of creating very thin cornea flap allows correction of higher powers with safety of adequate corneal bed being left behind. The Allegrato Wave Excimer Laser with the Aberrometer provides the most advanced laser vision technology available to date, designed to provide patients to achieve the best possible quality of vision i.e. more contrast sensitivity and sharpness.

I would summarize by saying that Lasik is an option vis a vis spectacle or contact lens. It makes you free from dependence on them. You have to make a choice and once you decide, we execute and assure safe and precise procedure.

 

For any further clarification / query, e-mail me at: parul.sharma@maxhealthcare.com or call us at +91 - 95829 23456

 

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