LASIK (laser-assisted in situ keratomileusis) is one of the most commonly performed surgeries done with the use of laser rays to correct vision in people who are nearsighted, farsighted or have astigmatism.
Who can undergo a LASIK?
Anybody above the age of 18 who wears spectacles or contact lenses can undergo this treatment. But it is not advisable for people whose number has changed significantly in the past year or is likely to change again in the future.
How is LASIK done?
An instrument called a microkeratome is used to cut a thin flap in the cornea. The cornea is then lifted back and the underlying corneal tissue is exposed to excimer laser rays to reshape. After the cornea is reshaped, the corneal flap is put back in place and the surgery is complete.
What are the advantages of LASIK?
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Very little pain
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Vision is corrected immediately or a day after LASIK is being performed
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Usually no bandages or stitches are required after LASIK
Is LASIK 100% safe?
With technology advancements, LASIK surgeries have become almost foolproof. However, it is always better to stay in sight of the following complications:
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The most possible complication of LASIK is eye infection, that may immediately follow the procedure. This infection can be controlled by the usage of antibiotic eye drops and other medicines
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Complications with the flap such as an incomplete flap, a free cap or an irregular flap are also possible. Normally, in such an event, the surgery is postponed and repeated after 3 months
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The third post-LASIK complication is an inflammation in the flap bed interface, leading to a reduction in vision. Sometimes, cells from the top surface of the flap (epithelium) migrate to the interface and grow there. Most of the times, lifting the flap and cleansing the interface can solve these problems. In rare cases, the flap may need to be cut away. In extremely rare cases, a corneal transplant may be necessary
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Another complication of LASIK is kerastecsia, or bulging of the cornea due to excessive thinning. This condition may lead to a severe drop in vision, and may be corrected by wearing hard contact lenses or through a corneal transplant
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Complications such as glares or halos around lights, especially at night, dry eyes, and an increased sensitivity to pain are also observed occasionally
What is the duration of surgery?
LASIK takes only about 10 minutes to complete per eye.
What are pre-operative processes to be followed for LASIK surgery?
Your ophthalmologist will do a detailed evaluation including a comprehensive eye checkup, a retinal evaluation, pachymetry (corneal thickness measurement) and topography (a map of the cornea) to find out if you are an eligible candidate for LASIK.
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If you are using soft contact lenses, you must revert back to using glasses for at least two weeks prior to the baseline evaluation. This will help restore the normal shape of the cornea
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If you are using semisoft (RGP) contact lenses, you must stop using them 3-4 weeks prior to the surgery
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You should avoid usage of creams, lotions or cosmetics on the face and eyes a day before the surgery
What care should be taken after undergoing LASIK surgery?
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When you shower, don't allow the water stream, soap or shampoo to hit your eyes. Do not allow dust particles or pet hair to get into your eyes
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Avoid going out in bright sunlight without sunglasses
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Don't let your eyes get too dry - use artificial tears as often as needed
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Don't rub your eyes while you're sleeping - a special mask, provided by your doctor will protect your eyes while sleeping
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It is absolutely imperative that you faithfully follow your doctor's schedule for medications, especially during the first week after your procedure
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Don't use the PC for more than one or two hours for the first week
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Avoid swimming, jacuzzis and saunas for the first month
Is there a chance of the refractive error coming back in the long run?
No. Once the healing process is complete, there are no chances of getting the number back.
Phacoemulsification is the removal of cataract through extremely small-sized incisions.
What are the pre-operative precautions to be followed for phacoemulsification?
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Patients are usually required to remain fasting for 4 hours before the surgery
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Patients must disclose all medications to determine if they must be discontinued before surgery
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Blood-thinning medications may put patients at risk and they are discontinued, unless the risk for stroke is high
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You are required to undergo routine pre-operative investigation. Your personal physician (M.D.) needs to certify fitness for the surgery
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Your eye surgeon performs advanced testing to calculate your IOL (Intraocular Lenses) power
How is phacoemulsification done?
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The eye is made numb through the usage of anesthetic medications
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An incision or slit of approximately 2.5 mm is made in the eye, through which the tip of the instrument is introduced
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Localised high frequency waves are produced through this tip to rupture the cataract into very minute pieces, which are then sucked out through the same tip in a controlled manner
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A foldable lens is inserted through an incision or slit of approximately 2.5 mm made in the eye. In case of a non foldable lens implant, the incision must be enlarged to 5.0 or 5.5 mm
In most of the cases, no sutures are applied. However, your doctor may determine if you need a stitch for safety.
For best results, your eye surgeon may combine this with relaxing incisions (LRI's) to completely eliminate the need for glasses.
Intraocular Lenses:
At Shree Eye Care, we use a variety of intraocular lenses, according to the suitability of the patient.
Intraocular lenses are generally of two types, non foldable and foldable.
Among the foldable, the special types of lenses are:
Aspheric IOLs: These IOLs are designed for helping patients see very clearly, getting rid of vision abnormalities and ensuring better contrasts.
Toric IOLs: Foldable, single piece lenses that an eye surgeon implants during cataract surgery to replace the clouded lens. The unique design of these IOLs makes it possible to reduce or eliminate corneal astigmatism and significantly improve uncorrected distance vision.
Multifocal IOLs: These IOLs have been uniquely designed to provide enhanced image quality and a full range of vision – up close, far away and everything in-between – giving cataract patients the best opportunity to live life free of glasses.
What are the advantages of phacoemulsification?
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No stitches are required for 2.5 mm or smaller incisions. However for enlarged incisions (5.0 or 5.5 mm), one stitch might be required
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The technique uses smaller, self-sealing incisions that minimise the chances of any post-surgery complications
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Reduced healing time to help you resume work faster
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Less follow-ups
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Reduced chances of cornea distortion and astigmatism thus almost eliminating the need for glasses
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Recent advances and refinements in machine and microsurgical instruments have made it possible to carry out phacoemulsification using incisions that are less than 2.2 mm (MICS)
What care should be taken after phacoemulsification?
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Phacoemulsification allows for faster healing and the patient can get back to his/her normal routine as soon as possible
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The patient is advised to rest for at least 24 hours, until he or she returns to the surgeon's office for follow-up
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Only light meals are recommended immediately after the surgery
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Severe pain, nausea, or vomiting should be reported to the surgeon immediately
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Patients are advised to wear an eye shield while sleeping, and refrain from rubbing the eye for at least two weeks
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After the healing process, the patient will probably need new corrective lenses, at least for close vision
Shree Eye Care leverages the latest technological advancements in Phacoemulsification and offers different packages for the surgery according to the type of lens chosen. For further details contact us.
Corneal transplantation is replacing a diseased front portion of the cornea with a healthy donor tissue. Traditionally, corneal transplants involve replacement of the full thickness of cornea (Penetrating Keratoplasty). However, with advanced research and technology, selective replacement of the diseased layer is possible. These are called lamellar transplants.
In case I am diagnosed with corneal disorders, can I go for a corneal transplantation immediately?
Once your corneal surgeon checks your eye for any corneal disorders and confirms the need for a transplant, you need to first get in touch with an eye bank, which registers your case.
As soon as a fresh cornea is available for grafting, the eye bank will inform you about the same. Your corneal surgeon will then help you get ready for the transplantation process.
What are the pre-operative routines to be followed for corneal transplantations?
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If you experience fever or infection in any part of your body within 2-3 weeks of your scheduled date of surgery, you can ask for the surgery to be rescheduled
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Any active eye infection or eye inflammation usually needs to be brought under control before surgery
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Blood-thinning medications may put patients at risk and they are discontinued, unless the risk for stroke is high
What are the different types of corneal transplants available?
Penetrating Keratoplasty
Process:
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A button shaped piece of your damaged cornea is removed
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A button of the clear donor cornea is cut & placed on the eye
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The new cornea is stitched onto your own cornea using nearly invisible sutures
Duration of surgery: About an hour.
Advantages: Good optical clarity.
Deep Anterior Lamellar Keratoplasty (DALK)
Process:
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The cornea is dissected to almost 95% thickness and the top layer is removed
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A donor corneal button is prepared by removing the two inner most layers of the cornea viz. Descemet's membrane and donor endothelium
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The donor graft is then sutured to the host
Duration of surgery: About an hour.
Advantages:
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Closed eye surgery
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Better chances of success
Descemet's Stripping with Endothelial Keratoplasty (DSEK)
Process:
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The inner two layers of the diseased cornea are peeled off
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A donor cornea is then split or dissected to create a flap of the inner two layers and a third layer of stroma
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This 3 layer donor is then folded and inserted into the eye and floated up to stick onto the inside of the cornea replacing the layers removed earlier
Duration of surgery: Less than an hour.
Advantages:
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Closed eye surgery
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Gets completed quickly
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Faster visual recovery
What care should be taken post corneal transplantation?
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An eye shield or glasses must be worn until the surgical wound has healed
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Eye drops will be prescribed for the patient to use for several weeks after the surgery to prevent infection and reduce inflammation. Some patients require medication for at least a year
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For the first few days after surgery, the eye may feel scratchy. Blurred vision may persist for several months
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Sutures are often left in place for 6 months, or for as long as 2 years
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Rigid contact lenses to reduce corneal astigmatism that follows corneal transplant may also be prescribed
At Shree Eye Care, Dr. Priya Srinivas handles referral cases of corneal diseases needing opinion and surgery, referred by general ophthalmologists and has 5 years of experience in treating complex corneal disorders.
The main goal of surgery is to create a new drainage system for the eye. This can be done by fashioning a trap door on the surface of the eye to allow pressure and fluid build-up to escape when there is an excess within the eye.
How can the damage caused by glaucoma be determined?
First, a determination is made as to how much damage your optic nerve has sustained and how much of your corresponding vision has been lost.
A direct visualisation of your optic nerve is made and an estimate of the amount of damage can be inferred.
The amount of vision loss is judged with a visual field test (perimetry). Once the test is over, a diagram of your vision with many measurements is printed out and followed over time. If progression on this vision assessment test can be documented, you may need a more intensive treatment.
What care should be taken after the surgery?
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Wear an eye shield for at least 2 days after the surgery
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Avoid lifting heavy objects and keep your eyes away from water
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If your eye swells or if there is a fluid formation, visit your doctor
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Carry an umbrella or wear shades when travelling in the hot sun
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Keep your eyes away from water as it can be disastrous
For any further details on glaucoma, visit Shree Eye Care.
What are the treatment procedures for retinal detachment?
Pneumatic retinopexy: The retinal detachment is repaired by injecting a gas bubble into the eye after which laser or freezing treatment is applied to the retinal hole. The patient's head is then positioned so that the bubble rests against the retinal hole.
Scleral buckling: Scleral buckle surgery is an established treatment in which the eye surgeon sews one or more silicone bands to the white outer coat of the eyeball. The bands push the wall of the eye inward, and reattaches the retina back to the support tissue.
Vitrectomy: Vitrectomy involves the removal of the vitreous gel, post which the eye is filled with a gas bubble or silicon oil.
Laser photocoagulation: Used in conjunction with vitrectomy or scleral buckling. In laser photocoagulation, the surgeon directs a high-energy laser to burn small pinpoints on the retina. For a retinal tear or hole, the burns create scar tissue, which attaches the retina to the underlying tissue.
What care should be taken after the surgery?
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The first week after your surgery, take it easy; walk and move your head in slow motion
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In case of pneumatic retinopexy, patients may have to keep their heads tilted for several days to keep the gas bubble in contact with the retinal hole. Also, it is advised to avoid flying until the gas bubble is gone
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You may shower and wash your hair carefully. Do not scrub your head vigorously. Avoid getting soap and water in your eye
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You may use over-the-counter non-aspirin analgesics and warm compresses, to relieve any minor discomfort
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Use prescription pain medications as instructed by your physician. If you experience severe pain, please inform your doctor
All retinal cases at Shree Eye Care are handled by our visiting retinal subspecialist.
Collagen cross-linking is a procedure used to slow down the advance of Keratoconus (abnormal protrusion of the cornea).
How is collagen cross-linking performed?
A one-time application of riboflavin and a photosensitizing agent is administered to the eye after removing the skin from the surface of the cornea. The eye is then exposed to UV-A light for approximately 30 minutes.
How does collagen cross-linking help lessen the effect of keratoconus?
Collagen cross-linking helps recover and preserve the mechanical strength of the keratoconus-affected cornea. The process increases the corneal rigidity significantly and arrests any further progress of keratoconus. Owing to this, any further degeneration of the cornea can be checked and the need for corneal transplantation can be avoided.
What are the post-operative imperatives to be followed for collagen cross-linking?
Your cornea specialist will place a bandage contact lens over the treated eye. You will be asked to apply antibiotic and steroid drops for a while. The vision will be blurry for a while before returning to normal. Also, it may necessitate the refitting of a contact lens or a change in the spectacle number.
