LASIK procedure

Procedure in 3 steps:

1. Preparation of the cornea

With a precision knife, an incision is placed to create a thin flap of the cornea (0.16 mm). If a laser is used instead of the knife, the procedure is called Intra-LASIK.
The corneal flap is flapped back like a book cover.

2. Application of the Excimer-Laser

The exposed lower corneal tissue is reshaped according to the refractive error. Nearsightedness is corrected by flattening the center of the corneal tissue. For the correction of farsightedness, the ablation takes place in a circle around the periphery of the corneal center. If, in addition to nearsightedness or farsightedness, astigmatism is present, it is corrected by ablation in a manner that the cornea regains a ball-like shape.

3. Closing of the wound

The corneal flap is repositioned back onto the stromal bed. It sticks to the corneal tissue on its own and acts like a band-aid.

LASIK application

- Myopia up to -12 dpt.

- Hyperopia up to + 5 dpt.

- Astigmatism up to -/+ 5 dpt

Over 90% of patients are suitable for the LASIK method. LASIK is the most common eye laser treatment for the correction of visual refractive errors.

LASIK advantages

- LASIK is able to accurately correct most levels of myopia (nearsightedness), hyperopia (farsightedness), and astigmatism.

- The procedure is fast, usually lasting only five to 10 minutes, and is generally painless.

- Because the laser is guided by a computer, it is very precise and results are very accurate.

- In most cases, a single treatment will achieve the desired outcome; however, enhancements are possible if needed, even many years after the initial surgery.

- The patient is able to resume his normal daily routine the next day.

- LASIK patients experience dramatic improvement in vision just one day after the procedure, with successful results even more apparent as the weeks and months go by

Wavefront-LASIK procedure

Wavefront technology was originally pioneered in the field of astronomy and physics for reducing imperfections in the telescopes lenses. In Wavefront technology, a computerized wavefront-measuring instrument passes flat waves of light through the eye. As they travel, the imperfections in the eye distort the flat light waves. The wavefront device then creates a map that represents the distortions of the eye. This map is then transferred to our VISX STAR S4 Excimer Laser system which our doctor uses to guide the laser as it reshapes your cornea. The end result is higher-quality vision, especially in dim lighting.

Wavefront-LASIK application

Wavefront technology, unlike traditional LASIK, treats both lower-order aberrations, distortions such as myopia, hyeropia and astigmatism, and higher-order aberrations, imperfections that can cause night vision, glare, shadows and halos. Higher-order aberrations do not always affect vision. However, even if 20/20 vision is achieved, visual quality may be lessened unless these added distortions are addressed.

Wavefront-LASIK advantages

Wavefront technology has the potential to improve how much and how well you can see as well as reduce the risks of post-LASIK complications.

What causes myopia?

The exact cause of nearsightedness is unknown, but two factors may be primarily responsible for its development:

a) heredity
b) visual stress

There is significant evidence that many people inherit nearsightedness, or at least the tendency to develop nearsightedness. If one or both parents are nearsighted, there is an increased chance their children will be nearsighted.

Even though the tendency to develop nearsightedness may be inherited, its actual development may be affected by how a person uses his or her eyes. Individuals who spend considerable time reading, working at a computer, or doing other intense close visual work may be more likely to develop nearsightedness.

Nearsightedness may also occur due to environmental factors or other health problems:

Some people may experience blurred distance vision only at night. This "night myopia" may be due to the low level of light making it difficult for the eyes to focus properly or the increased pupil size during dark conditions, allowing more peripheral, unfocused light rays to enter the eye.

People who do an excessive amount of near vision work may experience a false or "pseudo" myopia. Their blurred distance vision is caused by over use of the eyes' focusing mechanism. After long periods of near work, their eyes are unable to refocus to see clearly in the distance. The symptoms are usually temporary and clear distance vision may return after resting the eyes. However, over time constant visual stress may lead to a permanent reduction in distance vision.

Symptoms of nearsightedness may also be a sign of variations in blood sugar levels in persons with diabetes or an early indication of a developing cataract.

An optometrist can evaluate vision and determine the cause of the vision problems.

How is myopia diagnosed?

Testing for nearsightedness may use several procedures in order to measure how the eyes focus light and to determine the power of any optical lenses needed to correct the reduced vision.

A phoropter and retinoscope are often used to determine the lenses that allow the clearest vision during a comprehensive eye exam.
As part of the testing, letters on a distance chart are identified. This test measures visual acuity, which is written as a fraction such as 20/40.

The top number of the fraction is the standard distance at which testing is performed, twenty feet. The bottom number is the smallest letter size read. A person with 20/40 visual acuity would have to get within 20 feet to identify a letter that could be seen clearly at forty feet in a "normal" eye. Normal distance visual acuity is 20/20, although many people have 20/15 (better) vision.

Using an instrument called a phoropter, an optometrist places a series of lenses in front of your eyes and measures how they focus light using a hand held lighted instrument called a retinoscope. The doctor may choose to use an automated instrument that automatically evaluates the focusing power of the eye. The power is then refined by patient's responses to determine the lenses that allow the clearest vision.

This testing may be done without the use of eye drops to determine how the eyes respond under normal seeing conditions. In some cases, such as for patients who can't respond verbally, or when some of the eye's focusing power may be hidden, eye drops may be used. They temporarily keep the eyes from changing focus while testing is performed.

Using the information obtained from these tests, along with the results of other tests of eye focusing and eye teaming, your optometrist can determine if you have nearsightedness. He or she will also determine the power of any lens correction needed to provide clear vision. Once testing is complete, your optometrist can discuss options for treatment.

How is myopia treated?

Persons with nearsightedness have several options available to regain clear distance vision. They include:

- eyeglasses
- contact lenses
- orthokeratology
- laser and other refractive surgery procedures
- vision therapy for persons with stress-related nearsightedness.

Eyeglasses are the primary choice of correction for persons with nearsightedness. Generally, a single vision lens is prescribed to provide clear vision at all distances. However, for patients over about age 40, or children and adults whose nearsightedness is due to the stress of near vision work, a bifocal or progressive addition lens may be needed. These multifocal lenses provide different powers or strengths throughout the lens to allow for clear vision in the distance and also clear vision up close.

Eyeglasses are frequently used to correct myopia.
A large selection of lens types and frame designs are now available for patients of all ages. Eye glasses are no longer just a medical device that provides needed vision correction, but can also be a fashion statement. They are available in a wide variety of sizes, shapes, colors and materials that not only correct for vision problems but also may enhance appearance.

For some individuals, contact lenses can offer better vision than eyeglasses. They may provide clearer vision and a wider field of view. However, since contact lenses are worn directly on the eyes, they require regular cleaning and care to safeguard eye health.

Orthokeratology (Ortho-k), also known as corneal refractive therapy, involves the fitting of a series of rigid contact lenses to reshape the cornea, the front outer surface of the eye. The contact lenses are worn daily for limited periods, such as overnight, and then removed. Persons with moderate amounts of nearsightedness may be able to temporarily obtain clear vision for most of their daily activities.

Nearsightedness can also be corrected by reshaping the cornea using a laser beam of light. Two commonly used procedures are photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK).

In PRK, a laser is used to remove a thin layer of tissue from the surface of the cornea in order to change its shape and refocus light entering the eye. There is a limit to how much tissue can safely be removed and therefore the amount of nearsightedness that can be corrected.

LASIK does not remove tissue from the surface of the cornea, but from its inner layers. To do this, a section of the outer corneal surface is cut and folded back to expose the inner tissue. Then a laser is used to remove the precise amount of corneal tissue needed to reshape the eye, and then the flap of outer tissue is placed back in position to heal. The amount of nearsightedness that LASIK can correct is limited by the amount of corneal tissue that can be removed in a safe manner.

People who are highly nearsighted or whose corneas are too thin to allow the use of laser procedures now have another option. They may be able to have their nearsightedness surgically corrected by implanting small lenses in their eyes. These intraocular lenses look like small contact lenses and they provide the needed optical correction directly inside the eye.

Vision therapy is an option for people whose blurred distance vision is caused by a spasm of the muscles which control eye focusing. Various eye exercises can be used to improve poor eye focusing ability and regain clear distance vision.

People with nearsightedness have a variety of options to correct their vision problem. In consultation with your optometrist, you can select the treatment that best meets you visual and lifestyle needs.

How will nearsightedness affect my lifestyle?

Most individuals adapt well to wearing glasses or contact lenses. For those individuals who feel glasses affect their image or interfere with their activities, contact lenses, orthokeratology or refractive surgery may provide options to better meet their lifestyle and vision needs. In some cases, more severely nearsighted individuals may find the condition limits their choice of occupations.

What causes hyperopia?

Hyperopia is an inherited condition that occurs when the cornea is too flat or the distance from the cornea to the retina is too short. When this happens, the light rays coming from an object strike the retina before coming to sharp focus, or the image is theoretically focused at an imaginary point behind the retina. The result is a blurred image when trying to focus on something that is up close, but distance vision remains sharp. Children who are farsighted can sometimes compensate without corrective lenses because of the strength and agility of their natural lenses. With a high degree of hyperopia, however, they may exhibit nonvisual symptoms such as headaches and lack of interest in reading. As the eye gets older, it loses some of its ability to accommodate (focus), and eventually, most farsighted individuals need corrective lenses.

In mild cases of farsightedness, your eyes may be able to compensate without corrective lenses. In other cases, your optometrist can prescribe eyeglasses or contact lenses to optically correct farsightedness by altering the way the light enters your eyes.

How is hyperopia diagnosed?

Farsightedness can be effectively diagnosed in a comprehensive optometric examination. Common vision screenings, often done in schools, are generally ineffective in detecting farsighted people. This is because these individuals can identify the letters on an eye chart with little difficulty.

How is hyperopia treated?

The usual treatment for hyperopia is prescription eyeglasses with convex lenses that curve outward, or contact lenses that counteract the distortion created by corneas that are too flat in shape. A convex lens moves the image of a distant object forward onto the retina, thereby bringing it into proper focus. Refractive eye surgery, which steepens the cornea, has recently become an option for the correction of farsightedness. The most popular of those procedures is Laser In-Situ Keratomileusis (LASIK), which uses an Excimer laser to reshape the cornea. Other procedures that show promise for the surgical correction of hyperopia include Implantable Contact Lenses (ICLs) that fit between the iris and the natural lens of the eye, and Clear Lens Extraction (CLE) during which the eye's natural lens is replaced by a plastic intraocular prescription lens.

What causes astigmatism?

Astigmatism occurs due to the irregular shape of the cornea or the lens inside the eye. The cornea and lens are primarily responsible for properly focusing light entering your eyes allowing you to see things clearly.

The curvature of the cornea and lens causes light entering the eye to be bent in order to focus it precisely on the retina at the back of the eye. In astigmatism, the surface of the cornea or lens has a somewhat different curvature in one direction than another. In the case of the cornea, instead of having a round shape like a basketball, the surface of the cornea is more like a football. As a result, the eye is unable to focus light rays to a single point causing vision to be out of focus at any distance.

Sometimes astigmatism may develop following an eye injury or eye surgery.

There is also a relatively rare condition called keratoconus where the cornea becomes progressively thinner and cone shaped. This results in a large amount of astigmatism resulting in poor vision that cannot be clearly corrected with spectacles. Keratoconus usually requires contact lenses for clear vision, and it may eventually progress to a point where a corneal transplant is necessary.

How is astigmatism diagnosed?

Astigmatism can be diagnosed through a comprehensive eye examination. Testing for astigmatism measures how the eyes focus light and determines the power of any optical lenses needed to compensate for reduced vision.

This examination may include:

Visual acuity - As part of the testing, you'll be asked to read letters on a distance chart. This test measures visual acuity, which is written as a fraction such as 20/40. The top number is the standard distance at which testing is done, twenty feet. The bottom number is the smallest letter size you were able to read. A person with 20/40 visual acuity would have to get within 20 feet of a letter that should be seen at forty feet in order to see it clearly. Normal distance visual acuity is 20/20.

Keratometry - A keratometer is the primary instrument used to measure the curvature of the cornea. By focusing a circle of light on the cornea and measuring its reflection, it is possible to determine the exact curvature of the cornea's surface. This measurement is particularly critical in determining the proper fit for contact lenses

. A more sophisticated procedure called corneal topography may be performed in some cases to provide even more detail of the shape of the cornea.

Refraction - Using an instrument called a phoropter, your optometrist places a series of lenses in front of your eyes and measures how they focus light. This is performed using a hand held lighted instrument called a retinoscope or an automated instrument that automatically evaluates the focusing power of the eye. The power is then refined by patient's responses to determine the lenses that allow the clearest vision.

Using the information obtained from these tests, your optometrist can determine if you have astigmatism. These findings, combined with those of other tests performed, will allow the optometrist to determine the power of any lens correction needed to provide clear, comfortable vision, and discuss options for treatment.

How is astigmatism treated?

Persons with astigmatism have several options available to regain clear vision. They include:

- eyeglasses
- contact lenses
- orthokeratology
- laser and other refractive surgery procedures


Eyeglasses are the primary choice of correction for persons with astigmatism. They will contain a special cylindrical lens prescription to compensate for the astigmatism. This provides for additional lens power in only specific meridians of the lens. An example of a prescription for astigmatism for one eye would be -1.00 -1.25 X 180. The middle number (-1.25) is the lens power for correction of the astigmatism. The "X 180" designates the placement (axis) of the lens power. The first number (-1.00) indicates that this prescription also includes a correction for nearsightedness in addition to astigmatism.

Generally, a single vision lens is prescribed to provide clear vision at all distances. However, for patients over about age 40 who have the condition called presbyopia, a bifocal or progressive addition lens may be needed. These provide different lens powers to see clearly in the distance and to focus effectively for near vision work.

A wide variety of lens types and frame designs are now available for patients of all ages. Eyeglasses are no longer just a medical device that provides needed vision correction. Eyeglass frames are available in a many shapes, sizes, colors and materials that not only allow for correction of vision, but also enhance appearance.

For some individuals, contact lenses can offer better vision than eyeglasses. They may provide clearer vision and a wider field of view. However, since contact lenses are worn directly on the eyes, they require regular cleaning and care to safeguard eye health.

Soft contact lenses conform to the shape of the eye, therefore standard soft lenses may not be effective in correcting astigmatism. However, special toric soft contact lenses are available to provide a correction for many types of astigmatism. Because rigid gas permeable contact lenses maintain their regular shape while on the cornea, they offer an effective way to compensate for the cornea's irregular shape and improve vision for persons with astigmatism and other refractive errors.

Orthokeratology (Ortho-K) involves the fitting of a series of rigid contact lenses to reshape the cornea, the front outer cover of the eye. The contact lenses are worn for limited periods, such as overnight, and then removed. Persons with moderate amounts of astigmatism may be able to temporarily obtain clear vision without lenses for most of their daily activities. Orthokeratology does not permanently improve vision and if you stop wearing the retainer lenses, your vision may return to its original condition.

Astigmatism can also be corrected by reshaping the cornea using a highly focused laser beam of light. Two commonly used procedures are photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK).

PRK removes tissue from the superficial and inner layers of the cornea. LASIK does not remove tissue from the surface of the cornea, but only from its inner layer. To do this, a section of outer corneal surface is cut and folded back to expose the inner tissue. Then a laser is used to remove the precise amount of tissue needed and the flap of outer tissue is placed back in position to heal. Both procedures allow light to focus on the retina by altering the shape of the cornea.

Individuals with astigmatism have a wide range of options to correct their vision problem. In consultation with your optometrist, you can select the treatment that best meets your visual and lifestyle needs.

What causes cataract?

Most cataracts are due to age-related changes in the lens. However, other factors can contribute to their development including:

Diabetes mellitus - Persons with diabetes are at higher risk for cataracts.

Drugs - Certain medications have been found to be associated with the development of a cataract. These include:
- Corticosteroids
- Chlorpromazine and other phenothiazine related medications

Ultraviolet radiation - Studies have shown that there is an increased chance of cataract formation with unprotected exposure to ultraviolet (UV) radiation.
Smoking - An association between smoking and increased nuclear opacities has been reported.

Alcohol - Several studies have shown increased cataract formation in patients with higher alcohol consumption compared with people who have lower or no alcohol consumption.

Nutritional deficiency - Although the results are inconclusive, studies have suggested an association between cataract formation and low levels of antioxidants (e.g. vitamin C, vitamin E, carotenoids). Further studies may show that antioxidants have a significant effect on decreasing cataract development.

Rarely, cataracts can be present at birth or develop shortly after. They may be inherited or develop due to an infection, i.e. rubella, in the mother during pregnancy.

A cataract may also develop following an injury to the eye or surgery for another eye problem, such as glaucoma.

While there are no clinically proven approaches to preventing cataracts, simple preventive strategies include reducing exposure to sunlight through UV blocking lenses, decreasing or discontinuing smoking and increasing antioxidant vitamin intake through consumption of leafy green vegetables and nutritional supplements.

How is cataract diagnosed?

Cataracts can be diagnosed through a comprehensive eye examination.

This examination may include:

Patient history to determine vision difficulties experienced by the patient that may limit their daily activities and other general health concerns affecting vision.

Visual acuity measurement to determine to what extent a cataract may be limiting clear vision at distance and near.

Refraction to determine the need for changes in an eyeglass or contact lens prescription.

Evaluation of the lens under high magnification and illumination to determine the extent and location of any cataracts.

Evaluation of the retina of the eye through a dilated pupil.

Measurement of pressure within the eye.

Supplemental testing for color vision and glare sensitivity.

Additional testing may be needed to determine the extent of impairment to vision caused by a cataract and to evaluate whether other eye diseases may limit vision following cataract surgery.

Using the information obtained from these tests, your optometrist can determine if you have cataracts and advise you on options for treatment.

How is cataract treated?

The treatment of cataracts is based on the level of visual impairment they cause.

If a cataract affects vision only minimally, or not at all, no treatment may be needed. Patients may be advised to monitor for increased visual symptoms and follow a regular check-up schedule.

In some cases, a change in eyeglass prescription may provide temporary improvement in visual acuity. Increasing the amount of light used when reading may be beneficial. The use of anti-glare coatings on clear lenses can help reduce glare for night driving.

When a cataract progresses to the point that it affects a person's ability to do normal everyday tasks, surgery may be needed. Cataract surgery involves removing the lens of the eye and replacing it with an artificial lens. The artificial lens requires no care and can significantly improve vision. New artificial lens options include those that simulate the natural focusing ability of a young healthy lens.

Two approaches to cataract surgery are generally used:

Small incision cataract surgery involves making an incision in the side of the cornea, the clear outer covering of the eye, and inserting a tiny probe into the eye. The probe emits ultrasound waves that soften and break-up the lens so it can be removed by suction. This process is called phacoemulsification.

Extracapsular surgery requires a somewhat larger incision in the cornea and the lens core is removed in one piece.
Once the natural lens has been removed, it is replaced by a clear plastic lens called an intraocular lens (IOL). For situations where implanting an IOL is not possible because of other eye problems, contact lenses and in some cases eyeglasses may be an option to provide needed vision correction.

As with any surgery, cataract surgery has risks from infection and bleeding. Cataract surgery also slightly increases the risk of retinal detachment. It is important to discuss the benefits and risks of cataract surgery with your eye care providers. Other ocular conditions may increase the need for cataract surgery or prevent a person from being a cataract surgery candidate.

Cataract surgery is one of the safest and most effective types of surgery performed in the United States today. Approximately 90 percent of cataract surgery patients report better vision following the surgery

What causes glaucoma?

There are many types of glaucoma and many theories about the causes of glaucoma.

The exact cause is unknown. Although the disease is usually associated with an increase in the fluid pressure inside the eye, other theories include lack of adequate blood supply to the nerve.

Primary open-angle glaucoma – This is the most common form of glaucoma. One theory is that glaucoma is thought to develop when the eye's drainage system becomes inefficient over time. This leads to an increased amount of fluid and a gradual buildup of pressure within the eye. Other theories of the cause of the optic nerve damage include poor perfusion, or blood flow, to the optic nerve. Damage to the optic nerve is slow and painless and a large portion of vision can be lost before vision problems are noticed. Other theories also exist.

Angle-closure glaucoma – This type of glaucoma, also called closed-angle glaucoma or narrow angle glaucoma, is a less common form of the disease. It is a medical emergency that can cause vision loss within a day of its onset.

It occurs when the drainage angle in the eye (formed by the cornea and the iris) closes or becomes blocked. Many people who develop this type of glaucoma have a very narrow drainage angle. With age, the lens in the eye becomes larger, pushing the iris forward and narrowing the space between the iris and the cornea. As this angle narrows, the aqueous fluid is blocked from exiting through the drainage system, resulting in a buildup of fluid and an increase in eye pressure.

Angle-closure glaucoma can be chronic (progressing gradually) or acute (appearing suddenly). The acute form occurs when the iris completely blocks the drainage of the aqueous fluid. In people with a narrow drainage angle, if their pupils become dilated, the angle may close and cause a sudden increase in eye pressure. Although an acute attack often affects only one eye, the other eye may be at risk of an attack as well.

Secondary glaucoma – This type of glaucoma occurs as a result of an injury or other eye disease. It may be caused by a variety of medical conditions, medications, physical injuries, and eye abnormalities. Infrequently, eye surgery can be associated with secondary glaucoma.

Normal-tension glaucoma – In this form of glaucoma, eye pressure remains within what is considered to be the "normal" range, but the optic nerve is damaged nevertheless. Why this happens is unknown.
It is possible that people with low-tension glaucoma may have an abnormally sensitive optic nerve or a reduced blood supply to the optic nerve caused by a condition such as atherosclerosis, a hardening of the arteries. Under these circumstances even normal pressure on the optic nerve may be enough to cause damage.

Risk factors

Certain factors can increase the risk for developing glaucoma. They include:

Age – People over age 60 are at increased risk for the disease. For African Americans, however, the increase in risk begins after age 40. The risk of developing glaucoma increases slightly with each year of age.

Race – African Americans are significantly more likely to get glaucoma than are Caucasians, and they are much more likely to suffer permanent vision loss as a result. People of Asian descent are at higher risk of angle-closure glaucoma and those of Japanese descent are more prone to low-tension glaucoma.

Family history of glaucoma – Having a family history of glaucoma increases the risk of developing glaucoma.

Medical conditions – Some studies indicate that diabetes may increases the risk of developing glaucoma, as do high blood pressure and heart disease.

Physical injuries to the eye – Severe trauma, such as being hit in the eye, can result in immediate increased eye pressure and future increases in pressure due to internal damage. Injury can also dislocate the lens, closing the drainage angle, and increasing pressure.

Other eye-related risk factors – Eye anatomy, namely corneal thickness and optic nerve appearance indicate risk for development of glaucoma. Conditions such as retinal detachment, eye tumors, and eye inflammations may also induce glaucoma. Some studies suggest that high amounts of nearsightedness may also be a risk factor for the development of glaucoma.

Corticosteroid use – Using corticosteroids for prolonged periods of time appears to put some people at risk of getting secondary glaucoma.

How is glaucoma diagnosed?

Glaucoma is diagnosed through a comprehensive eye examination.

To establish a diagnosis of glaucoma, several factors must be present: Because glaucoma is a progressive disease, meaning it worsens over time, a change in the appearance of the optic nerve, a loss of nerve tissue, and a corresponding loss of vision confirm the diagnosis.

Some optic nerves have a suspicious appearance, resembling nerves with glaucoma, but the patients may have no other risk factors or signs of glaucoma. These patients should be closely followed with routine comprehensive exams to monitor for change.

Testing includes:

Patient history to determine any symptoms the patient is experiencing and the presence of any general health problems and family history that may be contributing to the problem.

Visual acuity measurements to determine the extent to which vision may be affected.

Tonometry to measure the pressure inside the eye to detect increased risk factors for glaucoma.

Pachymetry to measure corneal thickness. People with thinner corneas are at an increased risk of developing glaucoma.

Visual field testing, also called perimetry, to check if the field of vision has been affected by glaucoma. This test measures your side (peripheral) vision and central vision by either determining the dimmest amount of light that can be detected in various locations of vision, or by determining sensitivity to targets other than light, and comparing it to others of similar age.

Evaluation of the retina of the eye, which may include photographs of the optic nerve, in order to monitor any changes that might occur over time.
Supplemental testing may include gonioscopy, a procedure allowing views of the angle anatomy, the area in the eye where fluid drainage occurs.

Serial tonometry may be performed. This is a procedure acquiring several pressure measurements over time, looking for changes in the eye pressure throughout the day. Other tests include using devices to measure nerve fiber thickness, and look for specific areas of the nerve fiber layer for loss of tissue.

How is glaucoma treated?

The treatment of glaucoma is aimed at reducing intraocular pressure.

The most common first line treatment of glaucoma is usually prescription eye drops that must be taken regularly. In some cases, systemic medications, laser treatment, or other surgery may be required. While there is no cure as yet for glaucoma, early diagnosis and continuing treatment can preserve eyesight.


Medications - A number of medications are currently available to treat glaucoma. Typically medications are intended to reduce elevated intraocular pressure. One may be prescribed a single medication or a combination of medications. The type of medication may change if it is not providing enough pressure reduction or if the patient is experiencing side-effects from the drops.

Surgery involves either laser treatment, making a drainage flap in the eye, inserting a drainage valve, or destroying the tissue that creates the fluid in the eye. All procedures aim to reduce the pressure inside the eye. Surgery may help lower pressure when medication is not sufficient, however it cannot reverse vision loss.

Laser surgery - Laser trabeculoplasty helps fluid drain out of the eye. A high-energy laser beam is used to stimulate the trabecular meshwork to work more efficiently at fluid drainage. The results may be somewhat temporary, and the procedure may need to be repeated in the future.

Conventional surgery - If eye drops and laser surgery aren't effective in controlling eye pressure, you may need a filtering procedure called a trabeculectomy. Filtering microsurgery involves creating a drainage flap, allowing fluid to percolate into and later drain into the vascular system.

Drainage implants - Another type of surgery, called drainage valve implant surgery, may be an option for people with uncontrolled glaucoma, secondary glaucoma or for children with glaucoma. A small silicone tube is inserted in the eye to help drain aqueous fluid.

Treatment for acute angle-closure glaucoma

Acute angle-closure glaucoma is a medical emergency. Several medications can be used to reduce eye pressure as quickly as possible. A laser procedure called laser peripheral iridotomy will also likely be performed. In this procedure, a laser beam creates a small hole in the iris to allow aqueous fluid to flow more freely into the front chamber of the eye where it then has access to the meshwork for drainage.

Lifelong treatment

There is no cure for glaucoma. Patients with glaucoma need to continue treatment for the rest of their lives. Because the disease can progress or change silently, compliance with eye medications and eye examinations are essential, as treatment may need to be adjusted periodically.

By keeping eye pressure under control, continued damage to the optic nerve and continued loss of your visual field may slow or stop. The optometrist may focus on lowering the intraocular pressure to a level that is least likely to cause further optic nerve damage. This level is often referred to as the target pressure and will probably be a range rather than a single number. Target pressure differs for each person, depending on the extent of the damage and other factors.

Target pressure may change over the course of a lifetime. Newer medications are always being developed to help in the fight against glaucoma.

Early detection, prompt treatment and regular monitoring can help to control glaucoma and therefore reduce the chances of progression vision loss.

Am I happy with my glasses & contact lenses?

Wearing glasses and contact lenses can get in the way of leading an active life. Maybe these
scenarios sound familiar:

- Your glasses constantly slip while you're playing tennis

- Your contacts have popped out during a mountain biking or snowboarding adventure

- You have to swim, surf and scuba dive "blind" because you can't wear glasses or contacts in
the water

Have you ever thought about how much more fun—and success—you'd have if you could see without
glasses or contacts? If so, laser eye surgery may be the ultimate tool to enhance your lifestyle.

Contact lenses are NOT the long-term answer

Here's why:

- Contacts require meticulous cleansing to avoid infection.
- Experts consider the rate of infection higher with contacts than with corrective laser eye surgery
procedures.*
- Contacts are expensive. A 25-year-old can expect to spend tens of thousands of dollars on
contacts over his or her lifetime—as much as FIVE TIMES the price of the typical LASIK
procedure.**

LASIK: a track record of success

What kind of lifestyle compromises do you make because of your contacts? It's time to stop sacrificing
and start living your best life. The fact is, laser vision correction has never been safer or more
effective.

- Doctors have been performing laser vision correction procedures for over a decade, with 31.4 million procedures performed worldwide to date.3 It's the most common elective vision procedure in the U.S.

- About 98% of mildly to moderately nearsighted patients participating in CustomVue clinical trials submitted to the FDA could see 20/20 or better one year after treatment.***

You can keep wearing contacts for the rest of your life or opt for the corrective laser eye surgery procedure. It's easier than ever to say goodbye to contacts for good.

References
*Oregon Health & Science University (OHSU) Casey Eye Institute. Is LASIK Surgery Safer
than Contact Lenses?
**Based on an estimated iLASIK Procedure fee of $5000. Source: Michael L. Stark, DO; Jeffrey
M. Ward, OD.
***Market Scope Q1 2009 Quarterly Estimate.

IntraLASE LASIK procedure

Procedure in 3 steps:

1. Setting the Femtosecond-Laser

Two lasers are used in our bladeless Intralase LASIK procedure. The Intralase-Laser is a femtosecond laser (0.000000000000001 second), different from the type used to resurface the eye. It directs its laser beam into a tiny 3 micron (0.003 mm) spot, which is focused to a precise depth within the cornea.

2. Preparing the flap

In one minute, using computer precision and an extremely high speed of delivery, approximately 1 million pulses are delivered to the exact location desired by the surgeon. Discrete laser bursts create a million tiny bubbles which result in separation of the cornea and creation of the flap.

3. Application of the Excimer-Laser

The exposed lower corneal tissue is reshaped according to the refractive error. Nearsightedness is corrected by flattening the center of the corneal tissue. For the correction of farsightedness, the ablation takes place in a circle around the periphery of the corneal center. If, in addition to nearsightedness or farsightedness, astigmatism is present, it is corrected by ablation in a manner that the cornea regains a ball-like shape. The corneal flap is repositioned back onto the stromal bed. It sticks to the corneal tissue on its own and acts like a band-aid.

IntraLASE LASIK application

Dr. Bas advices IntraLASIK to all patients considering LASIK.

IntraLASIK is the only option for patients with:

- Flat cornea
- Thin corna or steep cornea
- anf if patient has hyperopia

IntraLASE LASIK advantages

Below is a recap of the benefits of IntraLASIK and the instruments used during surgery.

- IntraLASIK is a safer, precise treatment and minimizes the risk of complications.

- IntraLASIK is a particularly good treatment for patients with hyperopia or thin, flat, or steep corneas.

- The Intralase femtosecond laser is a cold laser that does not damage the surrounding tissue during the incision. In addition, the precicion of each incision is unparalleled.

- The Intralase laser operates with Nobel Prize-winning femtosecond technology.

Monovision-LASIK procedure

Monovision can be achieved with contact lenses or with vision correction procedures like Monovision-LASIK by correcting the non-dominant eye for near vision and the dominant eye for distance vision. Most people automatically adjust to monovision within a couple of weeks or months.

Monovision-LASIK application

Monovision LASIK is a viable solution to the vision demands of people over age 40 who are affected by presbyopia. In our experience, most people who try monovision and take the time to fully become accustomed to it, like it and find it very useful.

Monovision-LASIK advantages

The primary benefit of monovision LASIK is the ability to see acceptably well up close without reading glasses. Patients with the best monovision outcomes can expect to be free from eyeglasses at least 85 percent of their day

Contact lenses

Corneal crosslinking

Crosslinking is the only treatment that stops the progression of the disease. For this reason, crosslinking has now become the first level in treatment planning.

What is the effect of crosslinking over the cornea?
The cornea is a transparent, dome-like structure that is about 12 mm in diameter. The collagen fibers that cross the cornea constitute its roof. In corneal crosslinkling, the main objective is to send UVA rays to the cornea, thereby strengthening the U-shaped collagen fibers.

How is crosslinking performed?
The surface layer of the cornea (epithelial tissue), which measures 8.5 mm in diameter, is removed with a spatula. In order to increase the effect of the laser beam, yellow-colored 0.01 riboflavin eye drops are added every three minutes during the approximately 20-minute procedure. Afterward, UVA is applied to the cornea for 30 minutes, and riboflavin applications continue every five minutes.

At the end of the treatment, the eyes may be closed or a protective contact lens may be placed, and antibiotic drops are used. Eyes may become infected after the procedure, so care should be taken on a daily basis to prevent an infection.
The full effect of the crosslinking procedure takes six to nine months. 

Intacs: Corneal ringimplants

Corneal rings are two small transparent half circles. These rings are made from special plastic materials that are compatible with corneal tissue. They are inserted into tunnels that are created with special incision instruments. In our clinic, however, we use an Intralase laser, which is a femtosecond laser that makes very precise incisions. Corneal rings significantly correct the irregular shape of the cornea.

The rings come in different shapes and sizes, and patients should look for a practitioner with significant expertise before deciding on corneal rings. The surgery, which is completed in about 15 minutes, is done with anesthetic drops so patients do not feel pain. Within a few days, patients may experience symptoms such as burning and itching in the eye. Patients are prescribed drops to use for 30 days after surgery.

BOENIG JUMBO 

No Cure But A Reliable Workaround

There are currently no reliable and predictable surgery techniques to prevent reading problem.However, for many patients, monovision lasik  will reduce or eliminate the need for readers, bifocals, or trifocals.

The concept of monovision is very simple. One eye is corrected for near vision and the other eye is corrected for distance vision. The brain figures out which eye to use and when. How to achieve monovision varies, depending upon the patient's current eyesight.

The chief advantage of monovision is the freedom it can provide from reading glasses. After six to eight weeks the brain makes the vision changes automatically, without any conscious effort or awareness. Monovision makes it possible to repeatedly change the range of focus, without having to constantly remove or add corrective lenses.

Monovision Drawbacks

As with many good things, monovision comes with some disadvantages.Monovision does NOT maintain a perfect far and near vision, it only maintains a good vision and no need for using glasses in daily life. Patients should  form their expectations according to this way.  

People who are entering mid-life and are interested in monovision should discuss the matter with their doctor prior to undergoing surgery.

It is surprising how many patients adapt readily and happily to this vision option, however monovision is not for everybody and some people dislike its effect.

Preparation

Contact lenses affect the cornea. That why you should stop wearing contact lenses at least 2 weeks before the treatment day. Otherwise the treatment may not deliver the best results.

Day 1

1- Welcoming: You will be picked up from the airport. Please look for our private driver holding "Blumeditravel" sign, when you go out from the arrivals gate.

2- Accomodation: Your room will be pre-booked for you.

3- Meeting: Groups who check-in the hotel before 8:00 pm take a "Pre-Op patient information briefing at the hotel". Individual bookings get the briefing on second day at the hospital.

Day 2

1- Transfers: You will be picked up from the hotel to the hospital 30 min before your appoinment time.

2- Screenings: After you arrive at the hospital, you will undergo several screenings and testings. The list of screenings are given below.

3- Laser Eye Surgery by Dr.Bas

5- After surgery, you will feel blurry and foggy. Patients generally experience burning and itching in the eye for 4 hrs.

6- You will be given eye drops in order to use for 9 days.

7- Post-Operation examination with Dr. Bas

8- Transfer: You will be picked up from the hopital to the hotel.

Day 3

1- Transfer from hotel to clinic

2- Post-operation check-up by Dr. Bas

3- Istanbul city-tour (if group-date is booked)

Day 4

1- Transfer from hotel to airport

2- Departure