PATIENT’S ROLE IN THE SUCCESS OF LASER PROCEDURE | 11
Patients eligible for laser procedure
Important information for contact lens users
Pre-procedure assessment
Preparation for laser procedure
Procedure day
Aſter the procedure
INFORMED CONSENT | 17
Information process
Service fee
Staff’s role
Repeat procedures
POSSIBLE RISKS | 21
Limitations to correction
GOOD TO KNOW | 27
Functioning of the eye and refractive errors
KSA Vision Clinic equipment
Welcome to KSA Vision Clinic!
We wish everyone to have good vision. To this end we have combined contemporary high tech solutions with our best knowledge and skills. KSA Vision Clinic is a highly specialised vision clinic, whose main field of activity is correcting short-sightedness in people who wear minus glasses.
Thank you for your interest in correcting your vision with the help of a laser at KSA Vision Clinic. We understand that this is an important decision that can significantly improve your quality of life. You are probably excited to see what a new life without glasses and lenses will bring, but you are also likely to have questions. In this information booklet we will try to answer your questions about the nature of the procedure, its benefits, related risks and alternative treatment methods.
This information booklet provides a general overview of laser eye procedures and a detailed description of the method used at KSA Vision Clinic. Here you can find information on conditions that cause vision problems and instructions on what to do before and aſter the procedure.
Please read the whole booklet carefully. It is important to remember that this is designed to supplement your conversation with your optometrist and eye surgeon, not to replace it. You may find additional useful information on the KSA Vision Clinic website at www.ksa.ee, blog at ksa.ee/blogi or our Facebook page at www.facebook.com/ksasilmakeskus. You can use all of these channels to contact us or communicate with our clients independently should you wish.
Benefits of the procedure
Our patients have said that many restorative activities, such as sports, work and recreational activities, are considerably more enjoyable aſter laser eye correction.
Glasses and contact lenses have proved to be an efficient way of correcting refractive errors, but may restrict everyday activities. In some professions or situations, use of glasses or contact lenses may even be dangerous – e.g. in the military, during diving and various water sports, etc. A laser eye procedure can make you independent from all optical aids required in order to see clearly.
Every person has different reasons for correcting their vision with the help of a laser procedure. For those who have had to wear optical aids for almost their entire life, the prospect of driving a car or waking up with clear vision without having to use glasses or contact lenses is in itself a sufficient reason. Similarly, the amount of money spent on glasses and contact lenses over the years is several times greater than the cost of the procedure. Reduced dependence on optical aids gives people with an active lifestyle significantly more freedom. Our patients have said that many restorative activities, such as sports, work and recreational activities, are considerably
more enjoyable aſter laser eye correction.
ADVANTAGES OF LASER PROCEDURE OVER GLASSES
Glasses are a safe, relatively affordable and quite a convenient solution for most people. Depending on the nature of the correction, spectacle lenses may be thick, reduce, increase or distort the size of objects viewed and obstruct peripheral vision. Additionally, the level of detail and contrast of the vision with people who wear glasses is more modest than that of contact lens wearers or people who have undergone a laser procedure.
Just like everyone else, short-sighted people start needing reading glasses aſter 45 years of age. This problem may be solved by glasses with multifocal lenses, which may be difficult to get used to.
ADVANTAGES OF LASER PROCEDURE OVER CONTACT LENSES
Another non-surgical way to correct your vision is to use contact lenses. Contemporary contact
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lenses have become very user-friendly and the time and energy spent on their maintenance is reduced significantly thanks to the lens materials developed over the last few years. Nevertheless, infections of the mucous membrane and the cornea are dozens of times more common among contact lens wearers than among wearers of glasses or people who have undergone a laser procedure.
Contact lenses are placed directly on the cornea, but some people cannot manage this themselves or may experience discomfort while wearing them – allergic reactions, dry eyes and eye strain, infections or corneal abrasions, ulcers and other injuries. It must also be taken into account that in order to use contact lenses correctly, you constantly need to plan your day and logistics to ensure that you have all of the necessary equipment with you at all times.
LIMITATIONS OF LASER PROCEDURE
Laser eye correction is a voluntary procedure. There are no diseases or unexpected situations that would make it strictly necessary. Nor can a
laser procedure correct all refractive errors known to nature and is not therefore suitable for all people who wish to undergo it.
We cannot fully guarantee that the procedure improves your vision or eliminates the need for glasses or contact lenses. Aſter the procedure you may still require glasses or contact lenses, either immediately aſter the procedure or years later (e.g. reading glasses due to aging). Your optometrist and eye surgeon will tell whether you are among those who may need glasses or contact lenses aſter the procedure already before you sign up for it.
There is also the chance that your vision may not stabilise, either due to short- and long-term changes in the cornea caused by the procedure or the eye changing over time. In rare cases, the instability of vision caused by the procedure may last up to 90 days. You need to discuss the details of the problem with your eye surgeon. Your vision may also change over time due to your general health.
KSA Vision Clinic’s laser procedure
Your eligibility for a laser procedure is determined by a doctor or an optometrist depending on your diagnosis.
KSA Vision Clinic performs laser procedures as outpatient procedures – aſter the procedure you may go home and do not have to stay at the clinic. The procedure, including the preparations and provision of treatment instructions, takes around 1.5 hours. The actual correction of your vision takes less than 20 minutes and the laser is used on both eyes only for around 20 seconds. The time spent on the procedure depends on the type and extent of the refractive error that needs to be corrected. As a result of the procedure you will see better than with the best glasses or contact lenses – both the level of detail and contrast are improved.
You will be administered anti-inflammatory numbing eye drops prior to the procedure. Due to the numbing, you may feel as if all of the surgical activity of the procedure takes place somewhere nearby, outside the window. While you are lying calmly on the operating table, your eyes are kept open by a lid speculum. Even though your eye will remain open throughout the procedure, you will still experience the
reflex and feeling of blinking. The use of a lid speculum makes the procedure easy for both the patient and the surgeon, because the eye is kept open throughout the procedure and you do not have to worry about blinking.
During the procedure the work of the laser is monitored by an eye tracker*, which tracks eye movement in seven dimensions 1,050 times per second. This ensures that the laser beam lands on your eye exactly on the right spot. This means that you do not need to worry about moving your eyes involuntarily – the laser will always hit the mark.
You will be completely awake during the laser procedure and the eye surgeon talks to you, constantly informing you of what is going on during the procedure. We have made the procedure so convenient that most patients have refused sedatives. If you still feel that you need a sedative, ask our staff to provide it to you on the day of the procedure. We strongly ask you to refrain from using any sedatives
Patient information | 7
or painkillers independently without notifying the clinic staff.
You need to use certain eye drops and medication during your recovery from the laser procedure. KSA Vision Clinic provides you with all the necessary eye drops and medication. The clinic also gives you high-quality sunglasses aſter the procedure.
During the active recovery period, you can contact KSA Vision Clinic by calling on a special 24/7 helpline (+372) 5626 1212.
*Read more about the equipment used at KSA Vision Clinic in the chapter ‘Good to know’.
No-cut no-touch Flow procedure
Flow laser procedure is 100% blade-free, correcting the eye with a laser beam only.
Flow is a no-touch surface laser procedure complex, which combines the advantages of various blade-free procedures. Flow laser procedure is performed with a laser only and no cuts are made to the cornea. This results in a smoother recovery, reduces the likelihood of complications and enables you to resume an active life as quickly as possible.
One advantage of Flow is also that the risk of dry eyes, redness and corneal traumas is reduced to a minimum.
The lifestyle restrictions resulting from the procedure are generally liſted as early as aſter one week of recovery, which is why the solution is suitable for active people.
HOW DOES FLOW WORK?
A successful procedure requires precise tests and eligible candidates. Before we give you the permission to undergo a laser procedure, we perform a thorough examination and measurement of your eyes. We examine the general health of your eyes and use diagnostic equipment designed specifically for the procedure.
Prior to the procedure we conduct dozens of measurements, investigate different parameters of vision and provide you with a thorough consultation in order to exclude all circumstances that may put the safety of the procedure into question.
The measurement results are entered into the laser procedure planning soſtware. On the basis of these data, the technology determines the working area of the laser, the exact location thereof on the eye and the profile required for changing the shape of the cornea. Contemporary laser technology is extremely precise: the thickness of the layer to be polished is calculated with an accuracy of one micrometre.
Flow is quick and painless to the eyes. During the procedure you may experience only some slight discomfort, hear the sound of the laser device and detect a characteristic smell resulting from the polishing of the cornea.
Aſter the procedure, your eyes will be protected with special ultra-thin contact lenses that promote oxygen permeability to allow for a
quick and convenient recovery. Contact lenses are removed aſter 6-7 days.
Immediately aſter the procedure your eyesight will be sufficiently clear to move around safely. On the day of removal of the contact lenses, your vision will be clear enough to resume an active lifestyle. 100 % visual acuity is generally reached in a few weeks and maximum quality of vision gradually over 2-3 months.
ELIGIBILITY
Flow is above all designed to treat short-sightedness, i.e. myopia and astigmatism. The procedure can be used to correct combined shortsightedness with up to 9 dioptres. The best age
for the medical manipulation of eyes is between 20-45 years of age and the same applies to Flow.
The no-cut approach to the cornea ensures that the procedure is as comfortable as possible to the eye and immaculate visual acuity and contrast. KSA Vision Clinic’s experience and many scientific studies confirm that the procedure gives better results than a laser eye procedure performed with a microkeratome even over the long-term. Thanks to a technology that goes easy on the eyes, the strength of the different layers of the eye and visual acuity and stability will be at a completely new level both during the day and night.
Patient’s role in the success of laser procedure
For us to improve the quality of your eyesight as much as possible it is important that you cooperate with our specialists. Please follow our recommendations prior to the laser procedure and during your recovery.
PATIENTS ELIGIBLE FOR LASER PROCEDURE
We perform laser eye procedures on adults only. Your prescription for glasses or contact lenses must not have changed considerably over the last 12 months. Other factors, e.g. the general condition of the eye, are studied thoroughly during eye examinations prior to the procedure.
Certain conditions may entail additional risks or complications, preventing you from recovering and requiring extra care. If you have or have had any of the conditions listed below, we strongly advise you to consult your optometrist and eye surgeon beforehand.
The absolute or relative contraindications for the procedure are: eye diseases, such as keratoconus, cataract or glaucoma and recurrent herpes infections;
diseases such as diabetes, rheumatoid arthritis, systemic lupus erythematosus, psoriasis, scleroderma, HIV and AIDS.
The laser procedure is also contraindicated during pregnancy and nursing. You need to have stopped nursing at least four months before you can attend pre-procedure examinations and the laser procedure. If you suspect that you might be pregnant before coming in for the procedure, we recommend that you use a pregnancy test available in pharmacies.
IMPORTANT INFORMATION FOR CONTACT LENS USERS
Contact lenses may change the shape and curvature of the cornea, which may cause deviations upon measuring the refractive error. In order to provide as precise diagnosis as possible, you need to refrain from using contact lenses for 24 hours prior to the eye
Patient information | 11
examinations. Our goal is to offer the most precise treatment and this can only be done if the surface of the cornea is stable and has a natural shape. Scientific studies confirm that the longer a patient has refrained from using contact lenses before the procedure, the less likely they are to require a repeat procedure. Therefore we ask you to stop wearing contact lenses for 10 days before the laser procedure.
PRE-PROCEDURE ASSESSMENT
During the first visit, be prepared for a thorough eye examination, which may last up to 1.5 hours. During that time, we measure your vision and conduct various tests. Please note that if necessary, we may use numbing eye drops during the examination, which make the pupil dilate for a short period of time. If you are administered eye drops during the eye examination, we ask you not to drive a car aſterwards, as your near vision will be blurry due to the drops used. You will also have temporary difficulties reading and seeing clearly. Additionally, your eyes may be sensitive to light for around 12 hours aſter the examination.
Please take care to ensure that your visit to the Vision Clinic is as convenient as possible to you and other patients alike. Consequently, we ask you not to bring your children, as they get tired and we do not have a playroom.
Please note that the clinic is not liable for any travelling or accommodation expenses, loss of remuneration or other additional costs incurred due to the patient being unsuitable for the procedure or requiring a repeat procedure, postponement of the procedure or other unex-
pected delays.
PREPARATION FOR LASER PROCEDURE
We advise you to take some time off from work for the procedure – up to 7-10 days in the case of Flow Please consult the Vision Clinic staff and your GP and employer on this topic prior to the procedure.
There are generally no restrictions on eating or use of medicines prior to or on the day of the procedure. Nevertheless, we ask you to inform the procedure assistant and the surgeon of all of the medicines you are taking.
Please remove all of your eye makeup at least 24 hours before the procedure and ensure that you do not apply any cosmetics to your face or eyes on the day of the procedure. The same applies to hairspray, mousse and perfume. The substances in cosmetics, incl. alcohol, reduce the dosed effect of laser beams on the cornea. We strongly recommend you to avoid alcohol 24 hours before and one week aſter the procedure, as alcohol reduces the water content of tissue, causes dry eyes and slows the recovery process.
We also ask you to limit the use of digital screens (TV, smartphones and computers) when wearing protective contact lenses during your recovery period. We advise you to minimise your screen time and take breaks as soon as you feel that your eyes are tired.
Vitamins and eye drops must be used before the procedure according to the written instruction of the KSA Eye Center.
PROCEDURE DAY
If you regularly use medications prescribed by other doctors, notify the Vision Clinic staff thereof already when you come in for the preprocedure eye examination. As a rule, you may use your regular medication also on the day of the procedure.
Please do not take any sedatives on the day of the procedure. You can ask for sedatives at KSA Vision Clinic, if necessary, but experience shows that less than 5 % of people need them before the procedure.
Remember that aſter the procedure your vision may be blurry and your eyes slightly sensitive to light and there may be tear secretion. This usually passes in a few days.
Wear comfortable clothes to the procedure. Avoid clothes made of material that may generate lint underneath the protective cloth-ing worn during the procedure (such as wool).
On the day of the procedure you will be at the Vision Clinic for up to 1.5 hours. Please ensure that the visit is as convenient as possible to you and avoid bringing small children to the clinic on that day.
AFTER THE PROCEDURE
Remember that post-procedure care is as important as the procedure itself! There are things you can do yourself to help your eyes heal quickly and achieve good vision. KSA Vision Clinic will provide you with everything you need (medication, eye drops and sunglasses) for recovering on the day of the procedure. The price of the laser procedure includes aids and medication, so that you will not have to make any extra expenses on the day of the procedure. Follow the eye-drop administration scheme provided by KSA Vision Clinic.
The first mandatory visit aſter the Flow procedure is scheduled on the 6th or 7th day aſter the procedure. The precise time for the follow-up is set on the day of procedure. Additionally, you need to come in for post-procedure follow-up checks, which generally take place on the first, third, sixth and twelſth month aſter the procedure.
Each follow-up appointment lasts around 15 minutes. This allows us to assess the healing process of the eyes and check your visual acuity.
Aſter Flow procedure
The day aſter the procedure should be free of any obligations. Use eye drops according to the administration instructions received from KSA Vision Clinic.
ON THE DAY OF THE PROCEDURE
The day of the procedure must be a day of rest.
Be careful with activities that may make you touch or rub your eye hard. (Rubbing is never a good idea – use suitable lubricating eye drops instead.)
Avoid staring at objects for a longer period of time without lubricating your eyes on the first day.
When showering aſter the procedure, keep water away from the eye until the protective lenses are removed.
Stick to activities that require minimal effort, such as going for a walk or light housework or exercise.
Reading and minimal television watching is not prohibited, but these activities may cause discomfort to your eyes at first. We advise you to strain your eyes as little as possible and ensure that they are properly lubricated.
You can fly, but are advised to lubricate your eyes every 30 minutes – the air in planes is oſten very dry.
Your vision will be slightly blurry aſter the Flow procedure and therefore driving is not recom-mended. Rest your eyes for a couple of hours aſter the procedure. There is no need to keep them closed. Simply use lubricating eye drops to feel more comfortable and ensure that you do not move the contact lenses out of place during the following five or six days. Your vision will still be relatively unstable, but it will be suffi-cient for coping without glasses for up to three days aſter the procedure. Aſter that, your visual acuity will improve with each day.
It is recommended to avoid driving for a week aſter the procedure.
REMEMBER!
Do not drive or move around in a dangerous environment until your eyesight is sufficiently clear.
If you live or travel in geographical areas with a high UV level aſter the Flow procedure, use sunglasses for three months aſter the procedure in order to protect your eyes from strong UV radiation.
As no cuts are made to the eye that could weaken its structure, all other lifestyle restrictions are liſted seven days aſter the procedure.
Informed consent
The Vision Clinic staff and the surgeon are always there for you to help you find answers to your questions – do not be afraid to ask.
Firstly, a laser procedure requires a precise medical diagnosis, and secondly, your informed consent. Before you consent to the procedure, we will provide you with a thorough overview of the details thereof.
Giving your consent is a multi-stage process, which includes the patient, an optometrist, an ophthalmologist and the clinic staff. The staff are there to help you receive answers to your questions – do not be afraid to ask!
INFORMATION PROCESS
Our customer service representative provides you with a booklet containing information on the cost and possible risks of the procedure and a patient personal data sheet during the eye examination. Please make sure to read the KSA Vision Clinic’s patient information booklet. The procedure assistant or an optometrist will answer any questions you may have and reviews the personal data sheet with you.
Our optometrist conducts thorough eye examinations before the procedure in order to determine whether you meet the eligibility
criteria. They explain the nature of the procedure, possible risks and expected benefits, talk about other methods of improving your vision and describe special circumstances that may affect your decision to agree to the procedure.
Our eye surgeon assists you in giving an informed consent. Before the procedure you will meet our eye surgeon who will describe the course and the steps of the procedure. They also stress the most important recommendations that you need to follow immediately aſter the procedure and the following week. The procedure assistant provides you with patient information, which includes the activity plan for the post-procedure period.
If you have any unanswered questions or if you do not understand something, ask your eye surgeon. The eye surgeon does not need to explain to you generally known or rare dangers or risks they are not aware of at the time, even if the existence of these is determined later. However, the surgeon must inform you of the procedure to a degree sufficient for you to make a decision to go through with or refuse
Patient information | 17
the procedure.
Once you have read this booklet, consulted the optometrist and the surgeon and decide to undergo the procedure, you will be issued a patient personal data sheet for signing. By signing this, you confirm that you have been informed of the nature of the procedure, its risks, benefits and alternative possibilities, consent to the procedure and that the decision to undergo the procedure constitutes an informed consent.
SERVICE FEE
The fee for the laser procedure at KSA Vision Clinic includes medication and follow-up visits required after the procedure, based on the selected package. Your task is to ensure that the service fee is paid by the day of the procedure. You can pay for the service through various payment channels.
We also offer instalment plans in cooperation with banks, which allow you to pay for the procedure in instalments. If you decide to use an instalment plan or a loan to pay for the laser procedure, please contact our staff in order to obtain more information. KSA custom-er service specialists will guide you upon applying for an instalment plan. You can also acquaint yourself with KSA’s cooperation part-ners or submit an application for using an instalment plan independently on the KSA Vision Clinic’s website at www.ksa.ee.
STAFF’S ROLE
Eye surgeons (ophthalmologists), medical nurses and optometrists are trained healthcare professionals, who have extensive experience in refractive surgery-related pre-, periand post-procedural treatment.
The eye surgeon oversees the course of your recovery either directly or with the help of assistants for five to seven days aſter the procedure until the protective contact lenses are removed from the cornea.
The surgeon has a higher education in medicine and extensive experience in both medical and surgical treatment of refractive errors and eye diseases. In addition to graduating from the University of Tartu Faculty of Medicine, the surgeon of KSA Vision Clinic has also completed a three-year residency in the field of eye diseases and additional certified training in refractive surgery, excimer laser technology and microkeratome all over the world.
Our optometrists have completed the 3.5-year optometry training at Tallinn Health Care College and have a Bachelor’s degree in ophthalmic optics. KSA Vision Clinic optometrists are specialists in non-surgical diagnosis and the treatment of refractive errors and have extensive experience in post-procedural treatment of refractive surgery patients. The optometrist will resume monitoring you 5-7 days aſter the procedure.
REPEAT PROCEDURES
Our goal is to use a high-tech laser procedure to offer you a life free from glasses or contact lenses, but sometimes this may require a repeat procedure.
In general, we are able to achieve excellent quality of vision with one laser procedure, but some patients may require additional procedures due to the extent of their refractive error and physiological characteristics.
Repeat procedures are normal in refractive surgery, but their likeliness in KSA Vision Clinic is 1-2 %. The greater or more complex a refractive error is, the greater the possibility that you need to repeat the procedure. If you are likely to require a repeat procedure, your optometrist and eye surgeon will inform you of this already aſter the initial eye examination. Certain refractive errors are only corrected with a multistage procedure.
In general, patients have to wait at least six months to undergo a repeat procedure. During this period, the result of the first procedure will stabilise completely. The final decision regarding a repeat procedure is made by the eye surgeon, who will consider factors such as the condition and amount of the corneal tissue, the type of astigmatism and other eye parameters. They will decide on whether or not a repeat procedure is possible and necessary on the basis of these data.
The second Flow procedure and recovery are similar to the first one. You do not have to pay extra for a repeat procedure or the second stage of the procedure during 7 years.
Regardless of whether or not you require a repeatprocedure,youmuststillrememberthat all patients may one day require reading glasses due to the natural aging of the eye.
Possible risks
During the pre-procedure visit you are informed of the likely result of the procedure on the basis of the extent of the refractive error.
Even though a laser procedure may seem simple, it is still a serious surgical intervention that may lead to permanent unwanted changes. Nowadays, the likeliness of complications is less than 0.1 %, but you need to be aware of all risks. In order to achieve a positive result, you need to follow all of the Vision Clinic’s written and oral instructions. Whether the benefits of laser surgery outweigh the possible risks to you is for you to decide.
KSA Vision Clinic has performed over 200,000 eye examinations and 30,000 laser procedures and all of our employees undergo constant training. Nevertheless, medical treatments entail risks and people are physiologically different, which is why you need to be aware of possible complications. Our patient selection criteria are strict and people who are granted permission to undergo the procedure aſter examinations can do it with full confidence.
Our optometrist and eye surgeon help you to make a decision and inform you of any risks. During the pre-procedure visit you are informed of the likely result of the procedure, i.e.the possi-
bility of having good eyesight aſter the procedure without using glasses or contact lenses, on the basis of the extent of your refractive error. You are also informed of risks that may make the procedure dangerous or postpone it until additional examinations are conducted.
Similarly to all surgical procedures, refractive surgery entails a potential risk of failure and serious injuries with unknown or unforeseeable causes. There is a theoretical possibility that the procedure or a related complication may cause blurry, double or distorted vision or create a halo or glare around objects or other visual problems that cannot be corrected with glasses or contact lenses.
In the event of complications, the eye surgeon will discuss the situation with you and provides recommendations on further treatment, which may involve either medication or additional surgery. If the result cannot be corrected with medication or by operating on the outer layer of the cornea, the only way to restore the vision is corneal transplantation. Contemporary methods and technology reduce the com
bined risk of needing corneal transplantation to around 1:10,000 cases or less.
Certain conditions may cause corneal infection. In rare cases, corneal infection may cause corneal thinning, which in turn may lead to a permanent loss of clear vision or other visual problems listed above.
It is impossible to list all of the risks and complications associated with the procedure, but many of them are nevertheless described below.
OVER- OR UNDERCORRECTION
The recovery process of the eye sometimes interferes with the exact measurement of the amount of tissue to be removed with a laser. The objective of the treatment is to neutralise the refractive error completely (unless otherwise agreed with the surgeon), but the treatment is planned based on the statistically average eye. If your eye recovers more quickly than average, it may lead to over- or undercorrection of a refractive error.
In most cases, this can be corrected with a repeat procedure. There are only a small number of patients who cannot undergo extra laser treatment safely, mostly due to lack of corneal tissue. The surgeon is able to say before the procedure whether or not you will have enough corneal tissue for repeat procedures, if necessary.
SLOWER THAN AVERAGE REGROWTH OF EPITHELIUM
The transparent cornea of the eye is covered
with a 50-micrometre film, i.e. epithelium, which is the fastest self-renewing tissue in the human body – in general, completely removed epithelium regrows in full in 3 to 5 days. In rare cases the recovery process is slower, in which case you need to keep the contact lenses on the cornea for a longer period of time aſter the procedure. If you remove the lenses before the epithelium has regrown, your vision will take considerably longer to recover.
INFECTION, HAEMORRHAGE, OCCLUSION AND OTHER COMPLICATIONS
Other rare risks include serious infections that cannot be contained with antibacterial treatment, haemorrhage, corneal swelling, retinal detachment, venous or arterial occlusion, clouding of the lens, reactions to medications and other complications.
DRY EYES
Dryness of eyes is a normal and generally temporary side-effect of refractive surgery. This can generally be treated with lubricating eye drops, but sometimes temporary or permanent punctal plugs (tear duct plugs) are also used to keep the eye’s moisture from draining naturally to the nose. The punctal plugs used are mostly dissolvable and usually break apart in three months aſter the insertion.
The problem of dry eyes is usually resolved in a few months aſter the procedure, but in rare cases the problem may persist longer and require long-term use of lubricating eye drops, permanent punctal plugs or tear duct cauterisation. In patients who have had trouble with dry eyes before the laser procedure, the prob-
Patient information | 22
lem is likely to persist also aſter the procedure.
EXCESSIVE CORNEAL HAZE
Slight blurriness of the cornea, i.e. corneal haze caused by steroid drops and microtraumas may be part of the normal recovery process and goes away in a couple of weeks without causing permanent vision damage. If corneal haze is strong or persists, the surface of the patient’s cornea may require additional cleaning with a laser.
Patients who are subjected to superficial refractive surgical methods may experience significant corneal haze when the procedure is used to correct a strong refractive error (e.g. over –8D).
Corneal haze is more common among patients who have a very strong refractive error prior to the procedure or who spend a lot of time in a dry living or working environment where many electronic devices are used. Eyes may even remain sensitive to these factors for up to six months aſter the procedure. Use of preventive measures, such as regular lubrication, insertion of temporary dissolving punctal plugs and making necessary changes in the surrounding environment may considerably reduce the possibility of corneal haze.
INCREASED INTRAOCULAR PRESSURE
The steroid medication used on the first week aſter the procedure may increase the intraocular pressure in some patients. Increased pressure usually normalises aſter the end of the steroid treatment. Increased pressure must be carefully monitored and additional administra-
tion of eye drops may be needed. It is very important that you attend the scheduled follow-up visits, because each visit involves monitoring of your intraocular pressure and adjustment of our treatment plan where necessary. Intraocular pressure and the condition of the ocular nerve is checked prior to and aſter the procedure with special laser scanners (OCT, i.e. optical coherence tomography) and tonometers. If necessary, we will include eye drops designed to reduce intraocular pressure to your post-procedural treatment plan in order to prevent increased intraocular pressure during the weeks following the procedure.
HALOS AND GLARE
On rare occasions some patients may see optical effects around light sources and illuminated objects, which are called halos or glare. Patients who experience this may require special glasses when driving at night.
This is generally a passing phenomenon that lasts up to two weeks until refraction has stabilised. Glare and halos may also be permanent, but this is likely to occur in patients with severe short- or far-sightedness and those whose pupil diameter is larger than average or who experienced similar symptoms already before the procedure. Halos are oſten caused by the fact that in the dark, the diameter of a patient’s pupil is larger than the corneal area treated with a laser. Considering that new generation lasers can be used to treat larger corneal areas, only a few people experience halos following a laser procedure.
RELAPSE
Once tissue has been removed from the cornea, the surface epithelium may become thicker in order to balance out the changes in the shape of the cornea that occurred during the procedure. This process affects treated patients differently and is the reason why some patients immediately achieve stable results (minimum epithelial thickening), while others experience a relapse (more significant epithelial thickening). Patients with strong short-sightedness or very strong astigmatism are more likely to experience relapse.
In most cases the patient can request an additional laser procedure. The surgeon shall decide on whether a repeat procedure is possible on the basis of the condition and thickness of the corneal tissue. In some cases additional removal of tissue may not be possible and the residual refractive error must be corrected with glasses or contact lenses.
TECHNICAL MALFUNCTIONS
We maintain our excimer laser in accordance with the manufacturer’s instructions and trust it completely. However, technology is still technology and technical malfunctions may sometimes occur. The laser malfunctions very rarely. The laser’s condition is regularly tested and the laser is connected to the manufacturer’s support centre every two hours. A rare technical malfunction usually means that the laser displays a technical notification during the test conducted prior to every procedure, locks itself and requests the manufacturer’s engineer’s presence in 24 hours and the laser procedure is postponed.
SENSITIVITY TO LIGHT AND CHANGING VISION
Patients may become hypersensitive towards light or glare or discover that their visual acuity fluctuates aſter the procedure. This is usually temporary and goes away in a few days or weeks aſter the procedure once the eye recovers and your vision becomes stable.
LIMITATIONS TO CORRECTION
The procedure cannot be used to correct visual problems that are not caused by refractive errors, such as severe fundus or optic nerve pathologies. Patients with these problems may experience additional risk and side effects, which have to be discussed with the eye surgeon and the optometrist prior to making the decision to undergo the procedure.
AMBLYOPIA (LAZY EYE)
Amblyopia (lazy eye) is a disorder of sight that develops in early childhood, in which case an eye with reduced visual acuity relies on the other eye, causing the development of the amblyopic eye to stop. Refractive surgery cannot be used to correct or reduce amblyopia in adults.
CATARACT
Cataract is a disease that may cause reduced visual acuity if leſt untreated and can be corrected with a cataract surgery. Refractive surgery cannot be used to prevent cataract or treat the effects of emerging cataract.
PRESBYOPIA
(AGE-RELATED FAR-SIGHTEDNESS)
As we grow older, our eye lens gradually loses its ability to focus on close objects. This condition, known as presbyopia, usually begins once we reach 45-50 years of age and is caused by the loss of elasticity of the eye tissue, incl. the lens, due to the surrounding environment or age. Presbyopia can be conveniently corrected with reading glasses.
The Flow procedure does not prevent you from needing reading glasses due to the lifestyle factors listed above.
STRABISMUS (CROSSED EYES)
Strabismus is an eye condition caused by weaker eye coordination resulting from eye muscle weakness. The Flow procedure cannot be used to treat or prevent strabismus.
Good to know
Functioning of the eye and refractive errors: Before undergoing a laser eye procedure it is recommended to know how the eye works. Below is a brief explanation.
An eye is like a camera: the cornea is a clear, curved window that forms the front wall of the eye while the retina is light-sensitive tissue at the back of the eye, which is connected via a network of nerve fibres to the visual centres of the brain. The retina functions like a film in a camera while the cornea acts as a lens that concentrates light on the retina. Upon refraction of light in the eye’s refractive structures, an image appears on the retina, which is forwarded to the brain and later interpreted as visual perception.
The curvatures of the cornea and the intraocular lens determine whether the rays of light that enter the eye from distant objects are concentrated in the macula area of the retina. A refractive error occurs if the eye is not able to focus light exactly on the retina.
Refractive errors are corrected by using a suitable additional lens (e.g. glasses or contact lenses) that converges the light entering the eye exactly on the retina, which results in clear vision.
Refractive surgical procedures with an excimer laser are conducted on the cornea. The cornea is the main transparent refractive structure of
the eye. 90 % of the cornea is made up of a tissue that is called the stroma. This is covered by an external layer called epithelium. The shape of the cornea can be changed permanently by polishing the stroma of the cornea with a laser. This improves the cornea’s ability to focus rays of light and results in good and natural visual acuity.
The eye also includes a lens, which also refracts light. The functioning of the lens is similar to that of a camera lens: it is constantly changing the focus depending on whether we are looking at close or distant things. The lens must be elastic in order to function immaculately. The lens loses its elasticity with age and therefore people in their 40s or 50s normally find themselves in a situation where they have difficulty looking at close objects due to the rigidity of the lens. This process is called presbyopia, i.e. age-related far-sightedness. Presbyopic people generally use plus lenses for looking at close objects and reading.
MYOPIA (SHORT-SIGHTEDNESS)
The cornea of a healthy and functioning eye focuses light precisely on the retina, enabling a person to see clearly without glasses or contact lenses. In the case of myopia, the diameter of the eye is a few millimetres longer or the cornea more curved than it should be. The light concentrates before the retina and is out of focus once it reaches it, forming a blurry image on the fundus. Distant objects seem
blurry while close objects may appear clear.
HYPEROPIA (FAR-SIGHTEDNESS)
In the case of hyperopia the eye is shorter or the cornea flatter than it should be. Rays of light converge on a spot behind the retina and are therefore out of focus once they reach the retina. Close objects may seem blurry while distant objects appear more clear. Distant objects may also appear blurry to people with strong hyperopia (more than +2D) and those older than 40 years of age.
ASTIGMATISM
The cornea is normally curved both horizontally and vertically like a football. When rays of light pass through the cornea, they converge in one spot. In the case of astigmatism, the curvature of the cornea is different in either the horizontal or vertical direction, so that it looks like a rugby ball – round on one side and flat on the other. Consequently, the rays of light passing the cornea do not converge in one spot but several. As a result, the vision is distorted and the image on the fundus unclear. Most people with myopia or hyperopia also experience a certain degree of astigmatism.
In all of those cases, the person needs some type of a corrective lens, e.g. glasses or contact lenses, in order to ensure that light is focused correctly. These refractive errors are corrected by using various laser procedure methods.
KSA Vision Clinic equipment
LASER SCHWIND AMARIS 1050RS
KSA Vision Clinic conducts its procedures with cutting-edge laser technology by SCHWIND eye-tech-solutions. The Schwind Amaris 1050RS used at KSA Vision Clinic is the most powerful excimer laser in the Amaris product family. It has the highest repetition rate of all lasers currently available – a total of 1050 Hz. The highest available frequency combines speed with extreme precision and safety, which is why the laser platform of the Schwind Amaris 1050RS eye laser ensures the best high-tech conditions for eye treatment.
The laser quickly covers the cornea with a profile prepared on the basis of data collected during the eye examination, using a topographic map of the eye and programs patented by Schwind Eye-Tech.
We hope that this information material has provided you with a comprehensive overview of how laser eye surgery helps you to free yourself from short-sightedness: how the procedure works, what the benefits of the laser procedure are and what you can do to take care of yourself during the process.
If you have any questions or wish to specify something, we are happy to help. The decision to free yourself from short-sightedness improves your quality of life to a considerable degree. As a result of the procedure your vision improves significantly, making your life more convenient and carefree.
If you have decided that you want to see better and our eye examinations have confirmed your eligibility for the procedure, we advise you to book an appointment for the laser procedure as the next step. KSA Vision Clinic welcomes you!
