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Sight defects

Sight defects (near-sightedness, far-sightedness, astigmatism) are caused by improper focussing of light rays on the retina. This is a result of excessive focussing strength of the eye’s optical system, which includes the cornea and lens, or of the eyeball being too long. Laser correction is one way of correcting sight defects. The laser is used to correct the shape of the cornea, to model it so that the person with a sight defect does not have to wear glasses or contact lenses. In the case of near-sightedness, the laser beam flattens the cornea in the centre, for far-sightedness it is made more convex. There are no incisions here, so there is no risk of the cornea being damaged. The entire operation is programmed in a computer, and the computer controls the laser. An excimer laser was first used to operate in the USA in 1989. Since then, millions of people around the world have been operated on using this method.

An excimer laser can be used to treat near-sightedness, far-sightedness, astigmatism and also mixed defects.

The laser correction operation itself lasts a few minutes. The patient is given a local anaesthetic beforehand in the form of eye drops. In exceptional circumstances, a general anaesthetic can be applied. The operation is painless. After the laser correction, the patient can go home almost immediately, then return to being fully active in a few days (depending on the method).

Laser correction of sight defects

We have been doing laser correction operations since 1996. By the end of September 2017, around 42,000 laser correction operations had been carried out at our clinic. Today, so-called superficial operations are most common. These do not interfere in the deeper structure of the eye. Many years of observation allow us to state that operations of this type are safe, effective and provide better quality eyesight. We most commonly suggest the EBK method to our patients.

Remember – laser operations are always carried out using anaesthetic, the patient feels no pain.

 

Laser correction methods:

ReLEx® Smile

The procedure is carried out using a VisuMax femtosecond laser (by Zeiss). Thanks to the exceptional precision it is possible to produce an intrastromal corneal lens with a diameter of 6.0 mm to 6.8 mm, which is then removed through a small (up to 4 mm) incision.

EBK

The procedure consists in removing corneal epithelium using a special Epi-Clear tool (by Orca Surgical), leaving the deeper layers of the cornea untouched. After the cornea modelling with a laser is completed, a bandage contact lens is applied for 5-7 days.

EPI LASIK

During this procedure, an alcoholic solution is applied to soften the surface layer of the cornea – epithelium. The solution can be easily removed afterwards. The next step is to perform photoablation of the anterior surface of the cornea using an excimer laser. Finally, the corneal epithelium is placed in its original position. In order to speed up the healing process, a contact lens is put on for a few days.

LASEK

During this procedure, an alcoholic solution is applied to soften the surface layer of the cornea – epithelium. The solution can be easily removed afterwards. The next step is to perform photoablation of the anterior surface of the cornea using an excimer laser. Finally, the corneal epithelium is placed in its original position. In order to speed up the healing process, a contact lens is put on for a few days.

SBK LASIK

During this procedure, a very thin corneal flap (up to 100 micrometers thick) is mechanically produced using the “Moria One Use-Plus SBK” micro keratome or a femtosecond laser. As the microkeratome has a very superficial effect – just below the Bowman’s membrane, the deeper corneal cells remain undamaged.

Non-standard methods

In the case of some patients, visual impairment is associated with corneal surface irregularities or large aberrations in the optical system of the eye. Such changes may be congenital, but they are more often observed after previous procedures such as refractive surgery, cataract removal, corneal transplantation, as well as after trauma or corneitis. In such cases, we can combine the correction of the visual impairment with the correction of these disorders. Depending on the type of abnormality, we perform individualised procedures based on corneal topography (Topographically Supported Customized Ablation – TOSCA or TR) or Wavefront Supported Customized Ablation – WASCA or WF. Therefore, if necessary, we perform individualised procedures as a primary or secondary treatment, eliminating anomalies not corrected during the first procedure.
We are one of the few centres in the world where such procedures are carried out in conditions such as keratoconus. It should be noted, however, that not every patients is eligible for such procedures. The decision about qualification is individual and is made after a comprehensive examination and interview with the patient.

Operations using a femtosecond laser

In 2001, the femtosecond laser was approved by the FDA for layer operations on the cornea. The IntraLase Pulsion FS™ laser generates pulses lasting 10-15 seconds in near infra-red (1053 nm). These are not absorbed by optically transparent tissues. The laser beam can thus be focussed on any point in the tissue. The energy of the laser causes photodisruption – tearing off tissue with bubbles of gas forming. This produces a corneal flake of the desired thickness. A flake of any thickness can be created, even 100 μm (using the SBK technique), which makes it possible to correct larger defects. Another advantage is that the pressure produced while stabilising the device on the eye (35 mmHg) is less than that produced when using mechanical microkeratomy.

The Visumax (Carl Zeiss Meditec) femtosecond laser can also be used for surgical procedures such as SMILE (Small Incision Lenticule Extraction). This technique involves creating a properly planned intracorneal lenticule with an average thickness of 6.0 to 6.8mm, depending on the size of the defect to be corrected, which is then extracted through a 2.5-4mm incision in the upper quarter. This results in the desired change to the curvature, and therefore of the breaking strength of the front surface of the cornea, which is needed to correct the existing sight defect. This technique is devoid of any complications connected with the flap, as observed when using LASIK, including carbon paper shifting or folding, or the epithelium growing under the flap. In addition, it causes less damage to the corneal nerves (smaller symptoms of dry eye during the post-operative period), it uses less tissue to correct one dioptry compared to other techniques, which enables larger defects to be fixed and provides better biomechanical stability in the corneal tissue. SMILE enables near-sightedness to be corrected up to -10.0 dioptries, cylinder up to 5.0 dioptries (spherical equivalent of -12.5 dioptries).

Check-ups and convalescence

After laser eye-correction surgery

 

  • during the initial post-operative period the brain accustoms itself to the new sight
  • for several days there may be pain-related symptoms, over-the-counter painkillers will help with this
  • photophobia is possible during the first few days, the patient will be given special dark glasses after the operation to help with this
  • the appointment schedule is agreed with the doctor – a visit may be necessary 7-8 days after the operation depending on the technique used
  • while the cornea is healing (up to 7 days) there may be difficulties with working with a computer, watching television or reading. This is an individual matter
  • the patient receives a prescription for the medicines to be applied for several weeks according to the schedule provided by the doctor

Avoid

  • intensive work for the first week – let the eyes rest and the cornea heal
  • bathing in open water (pools, lakes, the sea) for 6 weeks
  • intensive physical effort (e.g. heavy work out at the gym, carrying weights) for 2-3 months
  • use contraception to guarantee that the patient does not get pregnant during the next six months

You can: drive a car, fly in a plane, work with a computer, read, write and live at your own pace.

Equipment

The MEL-80 laser produced by Carl Zeiss Meditec is one of the most modern excimer lasers

 

  • the frequency of the light beam it uses guarantees there will be no thermal effects – greater safety,
  • the amount of time the cornea is exposed is minimal, which means it is more comfort for the patient during the laser correction surgery,
  • the beam diameter of 0.7 mm ensures ideal corrective results. The MEL-80 LASER has a very narrow beam: 0.7 mm compared to the Visix laser, for example, (which has a beam 4.5 mm in diameter) or the Bausch&Lomb laser (here the diameter of the beam is 2 mm). The smaller the beam, the greater the opportunity for more precise correction, so the operation is safer and very effective. Correction using our laser ensures that the halo effect is minimised, and that twilight vision is very good, the MEL-80 laser is considered the best in the world in this category,
  • the MEL-80 laser has two ablation profiles: “traditional” and personal (custom v), which combines wave front with aberration – IN 2008 WE WERE THE FIRST IN POLAND TO APPLY THIS TECHNIQUE,
  • eyeball movement tracking system: the Active Eye Tracker ensures that the movement of the eyeballs is monitored during the operation. The laser is switched off if the patient looks away from the point indicated by the doctor. So if you were afraid that your eye would wander during the operation, the MEL-80 function guarantees automatic tracking of the pupil during surgery,
  • MEL-80 has a special CCA system,
  • the CRS-MASTER diagnostic platform (aberrometer and topography) enables operations to be planned very precisely, and is useful in determining its effects (possible correction of sight defects). This is particularly useful for people with astigmatism, particularly if it is irregular. The WASCA aberrometer has 1452 points which comprise an entire sensor. During an eye test, we use data from around 800 points on the patient’s eye,
  • with the aid of a visual pathway we can archive the operations,
  • MEL-80 is the only non-American made laser to be certified by the FDA (US Food and Drug Administration),
  • it enables made-to-measure corrections.

Our staff

At Laser CMO we have 3 specialists who diagnose, qualify patients and carry out laser eye correction surgery.

Dr. Hab. Justyna Izdebska MD

Graduated from the 1st Medical Faculty of Warsaw Medical University. She has been employed at…

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Dr. Elżbieta Archacka MD

Has worked with us since 1996. She was the first to carry out a topography-based…

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Dr Małgorzata Gadomska

Graduate of Warsaw Medical University. A long-term employee of the Ophthalmology Clinic at the 2nd…

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