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Refractive Surgery and Excimer Laser

Refractive Errors

To see the objects clearly, rays of light pass through the eye and focus on the retina, which constitutes the back wall of the eye. Lens inside the eye is responsible for refracting the rays of light to ensure the best focus. Retina receives the vision formed by the rays of light and sends it to brain through the optic nerve.

The most important symptoms of the fracture errors are low vision, pain and discomfort in eyes. Short-sightedness (myopia and hyperopia), farsightedness (presbyopia), difference between vertical and horizontal refractivenesses of eye (astigmatism) are the names of visual impairments. While vision focuses in front of retina in myopia, it focuses behind in the back of retina and a blurred vision occurs in astigmatism due to focusing on two different points.

Laser therapy is one of the latest treatment methods applied in the refractive errors of eye and eliminating the dependency to contact lens. While LASIK is the most common method, all other refractive surgical methods (iLASIK, WAVEFRONT LASIK-LASEK, PRK ,LASEK, Epi-LASIK, INTACS, Phakic IOL) with proven reliabilities are also being applied in our hospital.

Who can be applied to?

You will primarily be applied a detailed ophthalmologic examination and other tests. If you are currently using contact lens, soft lenses should be removed 1 week and rigid and gas permeable lenses should be removed 3 weeks before the examination. Your refractive defects and eye-glasses numbers will be determined firstly without and then with eye drops. Your intraocular pressure will be measured and particularly cornea and retina will be analyzed through biomicroscope in detail. The corneal mapping, corneal pachymetry, Schirmer test, day and night pupil size measurement and wavefront measurements showing the vision quality will be performed with our state of the art technology product device called PENTACAM.

The purpose of laser eye surgery is to protect the eye health of people and relieve them of glasses and lenses. The success rate of the operation varies from person to person according to the structure of eye due to it is not suited to each eye. Therefore, patient selection must be made correctly and patients must be informed in detail for a successful operation.

Besides, if you have a systemic disease and regularly used drugs during the examination, then you must certainly inform your doctor.

→ People at least 18 years of age,

→ whose visual impairments did not change more than 0.50 D in the recent year,

those with myopia up to -8 dioptrics,  

hypermetropia  up to +5 dioptrics,

and astigmia up to 5 dioptrics,

→ and people with sufficient thickness of cornea can undergo laser operation.

Who cannot be applied laser?

Laser must not be applied to

→ Patients with rheumatism,

→ Diabetic patients,

→ Pregnant women,

→ Breastfeeding mothers,

→ Those who previously underwent eye surgery,

→ Keratoconus patients,

→ Patients with eye diseases such as high eye pressure and cataract.

iLASIK

iLASIK is the state of the art laser technology used in our day and it is a new type of treatment administered with the combined application of forming corneal flap through the computer controlled personal IntraLase laser technology and the Advanced CustomVue (Wavefront) therapy, which is also a personal treatment. Everything in iLASIK is planned according to your ophthalmological findings and eye structure and a treatment is administered specially for you.

Besides being an FDA approved therapy, the iLASIK treatment is approved to be administered to NASA astronauts and fighter pilots in the U.S. Army. This shows that it is a type of treatment which ensures visual acuity for people who work in jobs requiring perfect sight like astronauts and fighter pilots. This treatment can easily be administered even in people working under heavy conditions which require very good sight.

What is LASIK

A thin flap is removed through a special and automatic device called microkeratome from the transparent surface called cornea which is like a watch glass. The purpose of removing this flap is to reach the middle layer of the cornea. Cornea is reshaped as planned by the surgeon through excimer laser under the guidance of a computer program following the flap is formed and lifted up. Then the flap is placed without the need of any adhesive. The total operation time is 10 minutes.

Although sight is good on the 1st day, getting a clear result may take 1 month. A success over 90%-95% may be achieved according to the degree of visual impairment. In case your eye is determined to be still impaired during the control operation performed at least 6 months after the first operation, all examinations and tests are repeated and the former flap is removed without the new one is cut and the 2nd laser operation can be made if, with PENTACAM, the cornea thickness allows for the operation.

What is Custom Lasik?

Lasik can be applied personally according to the cornea structure through a special program called Wavefront. This is a laser application suited for the cornea structure and all optical system of eye measuring the light scatterings and aberrations. The WaveScan analyzer is being used in our center. This method decreases the cases of seeing less at night and light scatterings and enhances the seeing quality.

What are PRK and LASEK?

No flap before laser is formed in cornea in both methods. This is preferred in patients with thin and plane corneas or lower degree of visual impairment at whom lasik surgery cannot be applied. LASEK is a relatively new application which is a modified form of PRK.

PRK is the application of laser to sublayer skinning the thinnest tissue called epithelium on the top of cornea. The differences between LASEK and PRK are epithelium which is removed using alcohol to be put back into its place, lesser pain and the rate of recovery.

In both applications, patients wear contact lens for 3 or 4 days period to accelerate the epithelium’s process to renew itself and protect the eye.

Patients feel pain, watering and increased luminous sensitivity for 2 or 3 days. Vision is blurred during this period. They reach to the clear vision level in 3 or 4 weeks.

What is EpiLASIK?

EpiLASIK is an alternative method used for eyes with thin cornea which cannot be implemented Lasik, where epithelium is faultlessly removed through a device called epikeratome rather than the use of alcohol. Cornea must be removed 50 micron rather than 160 micron as is the case with LASIK because of being thin. Following the application of excimer laser, flap is closed as is the case with LASIK and the operation finishes. Pain continues for 1-2 days and a faster recovery is seen compared to PRK and LASEK.

What is Phakic IOL?

It is an operation performed for those whose eye structures are not convenient for laser therapy (for example thin cornea) or highly myopic or hypermetropic eyes to have a clear vision without using glasses or lens.

During the operation, a second lens is placed into eye in front or in the back of iris, the structure that gives color to eye, without touching patient’s own eye lens. In addition to the laser operation preparations, anterior chamber depth and determination of the number of corneal cells are important for this operation.

Intracorneal Ring Placement (Intacs, Ferrara, Ring, Keraring)

It is a treatment method that is applied in the keratoconus (cornea to become pointed frontward) disease, where the structure of cornea is not suitable for the LASIK treatment, both to reduce the degree of visual impairment and to slow down the process of or prevent the cornea transplantation, which is the only treatment method in the advanced stage of keratoconus.

Turning the transparent layer into its normal structure is the primary purpose in this treatment. It is applied to reduce visual impairment, rather than removing it completely. It can be easily removed at any time.

About Excimer Treatment

Things to Pay Attention before the Excimer Laser Treatment

  • There is no inconveniency in eating on the day of treatment.

  • Do not discontinue if there is a medication you used regularly but inform your physician.

  • Do not put on perfume or eye make-up on the day of operation.

Treatment Process

  • Your eyes will be benumbed before entering the laser room and an ataractic agent will be given to you 45 minutes before the treatment. These activities are performed on the purpose of relieving the operating stress and enhancing adaptation.

  • Due to it is a sterile environment, you will put on a shirt, a bonnet and a slipper used in the section before the operation.

  • When you enter the laser room, you will be requested to lie flat on the special laser bed and keep your head smooth.

  • Following lying down the laser bed, your eyelids are wiped with antiseptic solution and you are covered with a sterile cover. A special eyelid ecarteur is used to open your eyelids. Thus, you cannot close your eyes even if you want to.

  • When the treatment starts, a special device will be fitted to open a flap in cornea if it is a LASIK operation. You will not be able to see anything when vacuum starts with this device; so please do not panic.

  • The laser will follow the eye even if patient wriggles his/her eye, due to it is locked to the eye during the treatment.

  • Being relax and comfortable will considerably shorten the time of operation.

  • The operation time will be approximately 4-5 minutes for each eye.

  • Following the completion of the operation, you will get out of the laser room and be taken to the waiting room for one last check of your physician before being discharged from the hospital.

  • In the meanwhile, antibiotic eye lotion is dropped into your eye.

  • You may return to your home after waiting for approximately 30 minutes and being checked.

Post Treatment Steps of Excimer Laser Treatment

  • Blurred vision is completely normal. You may feel burning, stinging and watering in your eyes for 2 hours.

  • Pain is rare and but it will end with a simple painkiller.

  • Do not touch, scratch or scrub your eyes.

  • Do not take bath or wash your face.

  • Do not watch TV or read.

  • Use your eye lotion as instructed by your physician.

  • Our patients will need to be checked shortly in our hospital the day after the treatment and this check is all important. Patients whose treatments are completed can return their daily lives following this control.

  • You will be checked on the 1st week and 1st month.

  • Make-up is inconvenient for 10 days time.

  • Entering the pool or sea is inconvenient for 20 days time.

  • You may take a bath following the check performed the day after the treatment but avoid from soup or shampoo enter into your eye on the first days.