LASER REFRACTIVE SURGERY

Laser refractive surgery can correct myopia (short-sightedness), hypermetropia (far-sightedness) and astigmatism (misshapen cornea) through the use of excimer laser technology. Laser refractive surgery is one of the most commonly performed ocular surgical procedures worldwide and renowned for elegance and extremely high levels of success.

THE PRINCIPLES OF LASER REFRACTIVE SURGERY

The cornea is the main refractive surface of the eye and is responsible for bending rays of light from the object we are looking at to land appropriately on the retina. In short-sighted people, light rays come to focus before the retina and in far-sighted people they would focus beyond the retina. This causes blurred vision and the need for glasses or contact lense. By increasing or decreasing the curvature or steepness of the cornea its refractive power can be altered and this way the rays of light can be made to focus correctly on the retina. The excimer laser is used to decrease the corneal steepness for short-sighted patients and increase the corneal steepness for far-sighted patients.

LASER REFRACTIVE SURGICAL TECHNIQUES

LASIK (Laser in-situ keratomileusis)

This is the most commonly performed laser refractive procedure. In LASIK an extremely thin flap of corneal tissue is created by the surgeon using a device known as a microkeratome. This flap of cornea is lifted up exposing corneal stroma beneath. Excimer laser is applied to the stroma, thinning the cornea and changing its overall shape. The flap is then replaced over the lasered tissue and healing of the corneal tissue happens rapidly over the next few hours and days.

LASIK is a relatively quick procedure and takes about 15 minutes for both eyes. The eye is anaesthetised with drops making it a completely painless treatment. Patients are only aware of a pressure sensation for a brief moment during the operation. A speculum keeps the eyelids apart so that blinking is not an issue. Tracking technology is utilized so that inadvertent movements of the eye do not affect the outcome.

PRK (Photorefractive keratectomy)

PRK is very similar to LASIK except that a flap is not created with a microkeratome. Rather, access to the underlying corneal stroma is achieved by removing the corneal epithelium. The excimer laser then reshapes the stroma and the epithelium slowly regrows over several days after the treatment. A contact lens is placed onto the treated eye at the end of the procedure to assist in healing and to minimise discomfort. It is removed after 5 days in the consulting rooms.

Certain patients are more suitable for one procedure than the other. The final outcome of both laser refractive treatments is the same although PRK has a slower rate of recovery of vision. In LASIK the vision is excellent after 1 or 2 days. In PRK it takes 1 to 2 weeks to get functional vision and sometimes several weeks before full visual recovery.

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SAFETY OF LASER REFRACTIVE SURGERY

Laser refractive surgery is very safe with a very low rate of serious complications. It has been shown to have the same risk of serious eye complications as wearing soft contact lenses for 2 years.

THE PRE-OPERATIVE ASSESSMENT

Candidate suitability is assessed through careful examination – a 60 to 90 minute process of evaluating the eyes for surgery. An appointment can be made for this assessment to be done by contacting the consulting rooms.

On the day of the assessment the following is important:

  • Do not wear your soft contact lenses for 1 week and hard lenses for 2 weeks before the visit
  • Come with a driver – the pupils will need to be dilated
  • Bring your glasses – current glasses and all old prescription glasses as well

MEDICAL AIDS AND MEDICAL INSURANCE

Most medical aids consider this ‘cosmetic surgery’. Some medical aids cover aspects of the treatment but usually not all of it.

COSTS OF REFRACTIVE SURGERY

A detailed quote of the surgical costs is available from the consulting rooms on 031-2018423 or reception@ophthalmic-surgeon.co.za.

BEFORE SURGERY

  • Do not use your soft contact lenses for at least 3 days prior to surgery and do not wear hard lenses for 1 week prior to surgery.
  • You will need to start using Tobradex drops 4 times daily for 24 hours before the operation.

ON THE DAY OF SURGERY

The procedure is done at Lasersight – 1st Floor, Umhlanga Hospital Medical Centre, 323 Umhlanga Rocks Drive, Umhlanga, Durban. Tel: 031 582 5253

  • You should arrive about 20 minutes before your scheduled treatment.
  • We will prescribe a mild tablet for anxiety which can be taken 1 hour before the treatment.
  • Arrange for somebody to drive you to and from the laser centre.
  • Wear light, comfortable clothes – you will wear the same clothes during the procedure – and avoid make-up around the eyes and face
  • You may eat or drink and use all your normal medications
  • The procedure will last approximately 15 minutes and you will able to leave shortly thereafter.

FOLLOWING SURGERY

  • There will be a quick post-operative check-up in the consulting rooms at St Augustine’s the next day.
  • For LASIK patients a second check-up will be done 1-2 weeks later.
  • For PRK patients the second check-up will be after 5 days to remove the bandage contact lenses.
  • Tobradex drops should be used 2 hourly on the day of the procedure and 4 times daily to completion thereafter.
  • Clear plastic eye shields will be used to protect the eyes after the treatment. The shields can be removed after waking up the next morning.
  • A good night sleep is very useful following laser refractive surgery. A sleeping pill will be provided for the 1st night.
  • Slight discomfort after LASIK is uncommon.
  • Analgesics may be necessary for a few days after PRK.
  • Try to keep your eyes closed for the first 2 hours after the operation. Lie down, relax and avoid using the eyes too much for the first 12 hours.
  • Clear vision will take some hours and days of healing, especially after PRK.
  • Take care not to rub the eyes vigorously.
  • You can bath or shower but do not let water actively run into the eyes for at least 48 hours.
  • It is advisable to wear sunglasses for comfort when outdoors for the 1st 7 days.
  • Avoid any eye makeup for 1 week. This includes mascara, eye shadow, eye liner or any other type of makeup around the eyes.
  • Avoid any smoky or dusty environments for 1 week.
  • Avoid any alcohol consumption for the first 48 hours following the surgery. Alcohol increases dryness and will interfere with the healing process.
  • Avoid mild, non-contact sport for 3 days and avoid strenuous and contact sports for 4 weeks.