Refractive Surgery

epi-LASIK

Introduced by the inventor of LASIK, Epi-LASIK combines the best features of LASIK and PRK while reducing complications such as haze and halos, dry eye, loss of nerve sensitivity, post-operative pain, vision regression and continued need for eyewear.

Candidates for the Epi-LASIK Procedure

Patients who would be eligible for the Epi-LASIK procedure include those with the following conditions:

• Thin corneas
• People who have a risk of being exposed to trauma
• Dry eye
• Large pupils
• Abnormalities of the eye

The Epi-LASIK Procedure

While Epi-LASIK is considered safe for most patients, there are certain risks associated with any surgical procedure.

During the Epi-LASIK procedure, the epithelium is smoothly separated by an epikeratome and lifted, like a sheet, from the rest of the cornea. Using an excimer laser, the underlying corneal tissue is then reshaped. The epithelial sheet is placed back on the eye and covered with a protective contact lens to keep the flap in place and to aid in the healing process.

iLASIK

Many improvements have been made in LASIK procedures, among the newest and most advanced is iLASIK, which is the exclusive combination of IntraLase and CustomVue technologies to produce the best possible vision enhancement for patients.

• Uses wavefront diagnostic technology
• Creates custom-designed corneal flaps
• Provides an accuracy for ablation

IntraLase® has redefined the world of LASIK vision correction. Also known as blade-free LASIK, the IntraLase® all-laser procedure eliminates the need for a metal blade during surgery, helping bring clear vision to many people who feel uneasy about going "under the knife" during LASIK.

The iLASIK Procedure

The state-of-the-art IntraLase® laser technology replaces the microkeratome blade that has traditionally been used to create the corneal flap needed for the LASIK procedure. The IntraLase laser applies rapid pulses of laser energy to the top outer layers of the cornea. The IntraLase laser moves back and forth across the cornea creating microscopic bubbles at a specified depth and position just below the corneal surface. The bubbles under the cornea eventually create a perforation which is then lifted aside by the surgeon. The surgeon is then able to continue with the next step of the laser vision correction procedure.

The Advanced CustomVue laser combines the technologies of the WaveScan WaveFront with the STAR S4 Excimer Laser system to provide patients with a high-definition, high-accuracy LASIK vision correction. Advanced CustomVue technology makes it possible to perform customized refractive surgeries using information gathered from the patients eyes. This allows for the correction of the very specific refractive errors so patients can enjoy the best post-operative vision quality possible. The FDA has approved both the STAR S4 Excimer Laser and the WaveScan WaveFront for the following refractive errors:

• Myopia - up to -11.0 diopters, with or without astigmatism, up to -3.0 diopters
• Hyperopia - up to 3.00 diopters, with or without astigmatism, up to 2.0 diopters
• Mixed astigmatism - up to 5.0 diopters

Refractive Lens Exchange (Clear Lens Replacement)

Refractive lens exchange (RLE), also known as clear lens extraction (CLE), is a surgical procedure for vision correction that replaces the natural lens of the eye with an artificial intraocular lens (IOL). Using the same surgical techniques as cataract surgery, RLE is an alternative to laser vision correction, which modifies the cornea.

Patients who choose RLE have several options when it comes to the type of IOL that will be implanted. RLE is able to treat most types of visual disorders, including farsightedness, nearsightedness, presbyopia and astigmatism.

Candidates for Refractive Lens Exchange

Candidates for RLE meet the following criteria:

• Want to reduce/eliminate dependence on corrective lenses
• Are between 45 and 75 years of age
• Have high myopia (advanced nearsightedness)
• Have high hyperopia (advanced farsightedness)
• Have presbyopia or astigmatism, with or without cataracts
• Have early symptoms of cataracts
• Are poor candidates for LASIK or PRK
• Have no other health conditions that affect the eyes

Patients with astigmatism can have additional corrections, known as Limbal Relaxing Incisions, during their procedures. These incisions create a symmetrical cornea, helping to reduce or even eliminate astigmatism in the affected eye. Alternatively, there are IOLs that can correct some astigmatism.

The Refractive Lens Exchange Procedure

RLE is performed, using the same techniques as those employed during cataract surgery, on an outpatient basis. A topical or local anesthesia is administered to minimize discomfort. Through a single tiny incision, the natural lens of the eye is removed, and replaced with an IOL. As in cataract surgery, there are several types of IOLs, including the following, to choose from:

• Monofocal fixed-focus IOLs
• Multifocal IOLs
• Accommodating IOLs

Once inserted, the lens is unfolded and moved into its permanent position in the eye. There are no stitches needed because the incision seals on its own. RLE takes just 20 minutes to perform, and offers significant and immediate results. Recovery is usually complete after 4 weeks, whereas recovery from laser procedures can take 6 months.

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