GLAUCOMA –ELEVATED INTRAOCULAR PRESSURE
GENERAL OPHTHALMOLOGICAL QUESTIONS
LASER VISION CORRECTION
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How much does the laser vision correction cost?
The price of laser vision correction is 1000 KM per eye. The information about current discounts is available at home page of our Clinic.
Which methods are available?
from -0,50D to -7,00D the following methods are used: PRK, LASEK, EPILASIK I LASIK
from -7,00D to -10,00D the method LASIK is used.
over -10,00 no laser method is used; the method of refractive operation of implanting the phakic intraocular lens is used instead.
from +0,50 to +5.00 the method LASIK is used
for the diopters that are developed after 40 years of age and disable a good reading vision, the INTRACOR method on TECHNOLAS femtosecond laser is used.
LASIK (Laser In Situ Keratomileusis) is currently the most commonly performed type of the operation as it gives the most predictable results and ensures high satisfaction for the patients. The procedure is short and gives noticeable results immediately after the operation. LASIK procedure is composed of two steps of the operation. In the first step the “flap” is formed (a cap on the cornea), and in the second step the surface of the cornea is remodeled with the excimer laser.
There are two possible methods of forming the corneal flap, namely:
1. with femtosecond laser – Z – LASIK
2. with mechanical microkeratome (blade)
LASIK with the use of Femtosecond laser – with Z-LASIK procedure every step is automated and computer guided on two lasers. The first step of Z-LASIK procedure is carried out on Ziemer Femtosecond LDV laser (”Leonardo Da Vinci”) and enables the operation without the use of microkeratome. The flap is formed by a laser beam. The operation with femtosecond laser becomes fully automated and precisely computer controlled and offers even more comfortable and completely painless treatment to the patients. The second step of the operation of the laser removal of the diopter by modeling the cornea surface is done on the new SCHWIND AMARIS 750S laser and ”Allegreto” EyeQ-400HZ . This method ensures higher precision in terms of size, form and the thickness of the corneal flap.
LASIK with the use of microkeratome – the operation is also done in two steps. In the first step the corneal flap is formed by mechanical use of microkeratome (small knife). In the second step the corneal surface is remodeled by the use of the new SCHWIND AMARIS 750S laser and ”Allegreto” EyeQ-400HZ laser.
Photorefractive keratectomy (PRK) is a method that is applied mostly with lower diopters and thinner corneas. During the operation the epithelium and the surface layer of cornea are removed and the diopter is directly removed with the laser without cutting the cornea.
PRK is divided into mechanical PRK and transepithelial PRK. The methods differ by the way of removal of the surface layer of the cornea – epithelium.
Mechanical PRK –epithelium is removed by a special instrument (brush) and then the diopter is ‘polished’.
Transepithelial PRK –epithelium is removed by laser, and then laser ‘polishes’ the diopter too.
Phototherapeutic keractomy (PTK) is actually a PRK in which the laser is used to treat the eye for treatment of different corneal diseases.
Neither PRK nor LASIK methods are painful during the operation itself. The main difference between the PRK method on the one hand and LASIK on the other is in that the first method is a little bit more painful during the post-operative procedure, which means that during the first 3 days the patient may feel a burning sensation in the eyes until the epithelium heals. On the other hand, with LASIK method there is no pain during the post-operative period and full recovery of the vision is somewhat faster (as soon as in 3 days the patient may go back to work, unless he/she works in inconvenient conditions such as exposure to dust, wind, hard physical work etc).
INTRACOR method is done with the femtosecond laser under the name TECHNOLAS 520F.
The laser beam forms 5 concentric circles in the cornea (the front transparent part of the eye) exactly above the apple of the eye thus restoring the sharp focusing of the image. The procedure is minimally invasive, which means that neither the surface nor the depth of the eye is damaged. The laser beam is programmed in a way to enter the exactly defined limited area where it forms its circles that increase the strength of the central part of the cornea necessary for sharpening the vision up close, while there is no practically influence on the distance vision (even slight improvements of distant vision have been observed). The procedure takes 3 minutes per eye, while the operation of the laser itself for about 20 seconds
Am I a candidate for laser vision correction?
To determine whether you are a candidate for the operation, a pre-operative examination should be done. This is a detailed examination that provides us full insight in the condition of your eye and lasts for an hour to an hour and a half.
Over 90% of the people who wear the glasses and contact lenses are eligible for laser vision correction. The LASIK method may remove the diopter from 10.00D to +5.00D and up to ±6,00D of astigmatism. Every patient who is over 18 years of age and has a diopter within this range may be eligible for laser vision correction; however, a detailed ophthalmological pre-operative examination is necessary to establish whether, in terms of the eye, there are some contraindications for laser vision correction. The persons who have a diopter higher than this may be candidates for some other method of vision correction, such as implantation of intraocular lenses.
The diopter must be stable for at least a year; stable implies the change of diopter of up to 0.5 D..
Pre-operative examination that determines whether the patient is an eligible candidate for laser vision correction, and which does not bind the patient to undergo the operation itself, is painless and includes the following:
o Determining the visual acuity without glasses
o Determining the diopter on automatic computer refractometer and examining the visual acuity with the obtained correction, i.e. checking the obtained diopter on refractometer
o Measuring the intraocular pressure on contactless tonometer
o Examining the front and back eye segment on biomicroscope
o Computerized corneal topography (scanning the surface of the cornea to exclude the existence of any abnormalities)
o Determining the number of endothelial cells on endothelial microscope
o Determining the eye aberrations on the aberometer
o Automatic computer refractometries in mydriasis (with dilated pupils)
o Final interview.
If required by the eye condition, a number of additional scans may be done – they prolong the time of examination but are not additionally charged.
Not a single examination undertaken during the pre-operative examination is harmful to the eye and the only discomfort are dilated pupils that cause the blurred vision with the patient during the period of 2 hours after the examination, until the pupils are restored to their original state.
Both the doctor and the patient decide about the method that will be applied to correct the vision.
Does the pregnancy have any effect on return of diopter?
Laser eye surgery and pregnancy are not interconnected in any way, while the operations are also done with the girls who have not given a birth. There is an extremely slight possibility that, under the influence of hormone changes during the pregnancy, the diopter might change while the type of corrective aid (glasses, lenses) or the laser operation itself do not have any influence on that process. With the ladies whose diopter did not change during the first pregnancy, there is a very slight possibility that something like that would happen in the second one. The laser operation itself has no influence whatsoever on the choice of the type of delivery.
How long should we wait for an examination?
The examination may be done within seven days from the day of your call. Our nurses will book the first available appointment at the time of your convenience. There are more doctors who do the laser examinations so we have a possibility to accommodate you in that way as much as possible.
What do I need to do before the examination?
Before the examination you should remove the lenses, and make sure that you have a company, because you will not be able to drive with your pupils dilated. You should also take with you your old medical documentation if you have some.
How long do I need to be without the lenses?
Before the examination you should not wear the soft contact lenses for at least three full days, while for semi-hard and hard contact lenses that period of time is at least 8 days. In this way, the surface of the eye has a “rest” and this ensures the authenticity of measuring and the results.
Is it possible to do the examination and the operation on the same day?
Theoretically, it is possible to do the examination and the operation on the same day; however, this is certainly not recommended. As during the examination we dilate your pupils to examine your lens and the eye fundus, we should wait for 2-4 hours for the pupils to be restored into original condition, since this is required by the laser. The process itself then lasts for a long time, and is not comfortable for a person who awaits the operation. We believe that, both psychologically and technically, it is much simpler to make at least a one-day interval between the examination and the operation itself.
Is the operation painful and how long does it last?
Before the operation of laser vision correction, anesthesia is applied in the form of drops, so that the operation is completely painless. The operation lasts for 5 minutes per eye. The laser ‘polishes’ the diopter in seconds (to reduce 1 diopter 2 seconds are necessary) and during that time you should try to keep your eye as calmly as possible on the lights above you. The operator communicates with you the whole time, and guides you through the operation. The laser has the so-called ‘eye-tracker’ which tracks the movements and in that way prevents the possibility of a mistake. Before the operation another examination of the diopter is performed as well as another short conversation. After the operation, you will be given the instructions by our nurses and then you will get the drops and the discharge letter. On that day you will stay at the clinic a little longer than one hour.
Which are the ways of payment?
Svjetlost Clinic offers the ways of borrowing for its patients – through VISA Classic card of Nova Banka or UniCredit Zagrebacka banka you can pay for the operation in 12 installments. Additionally, there is a swift specific-purpose loan provided by Nova Banka (Svjetlost Clinic bears all the expenses of the loan processing and interest). The full amount of the price can be paid with other cards – regardless if they are domestic or foreign cards, cash payment or a combination of each.
What about the accommodation if I am not from Banja Luka?
Svjetlost Clinic offers accommodation for its patients, but you should give us a notice so that we can organize staying for you in some of the apartments or hotels that we have a contract for special discounts with.
Post-operative period and the limitations?
After the operation you should refrain from difficult physical activities during one month, while you can start with slow jogging and fitness after two weeks already. At first you should avoid staying in smoky or dusty rooms, while you can start watching television, working at the computer and driving a car as soon as the post-operative dryness does not present any difficulty for you any more, that is to say, once that you feel safe. That is to say, you can start with these activities a few days after the operation, until the moment when you start to feel uncomfortable. None of the mentioned ways can influence a possible return of the diopter, so that you needn’t worry about that. Women should not wear any makeup for 3 weeks after the operation and you can start washing your face after 3 days already. During the first 3 postoperative days, instead of washing them, you should clean your eye with artificial tears to reduce the possibility of infection. You can swim in the sea 2 weeks after the operation already, while you should restrain from swimming in a pool for one month due to the possibility of infecting your eye.
Follow-up examination after the operation?
The follow-up examinations are done one day after the operation, within seven days, after one month, then after 3 months, and after then once a year. The first two examinations are the most important, and you should preferably do them at our Clinic. Further examinations are discussed individually. All follow-up checkups within the first post-operative months are free of charge.
Safety of the operation?
The method of laser vision correction has been in clinical use for over 20 years and 20 million of people were operated by this method throughout the world. The only complications of this operation could include post-operative dryness of the eye and return of a part of removed diopter. None of these complications may lead to the loss of vision and cannot be predicted because they depend on the individual potential for healing of tissue. The post-operative eye dryness is dealt with by artificial tears in form of drops until the tear film is restored. Return of part of the diopter may be dealt with by either additional laser operation or by wearing the correction. We should say that over 95% of the patients do not experience any difficulty after the operation.
SVJETLOST CLINIC ON SOCIAL NETWORKS
Phone: 01/ 777-5656
Fax: 01/ 777-5657
10 000 Zagreb, Croatia
Borisa Papandopula 8b,
21 000 Split, Croatia
Dr. Mustafe Pintola 23,
71 000 Sarajevo, BiH
Phone: 0800/50 113
Bulevar Desanke Maksimović 12,
78 000 Banja Luka, BiH
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