Archive: June 2017

The future of LASIK in Malaysia

Contents of this interview was published in The Star newspaper on 9th April 2015

An interview with Dr Stephen Chung:

You are one of the early adopters of laser refractive eye surgery in the country. How has the technology evolved since that time?
The technology has changed tremendously over the years. When I first started 20 years ago, we did a corneal surface procedure using the Excimer laser called Photorefractive Keratectomy (PRK).  It had a rather slow healing recovery.

The technology of the lasers and also the procedure has changed and evolved since then. The big change after PRK was the making of a flap before using the laser and this was the LASIK procedure, LASIK allowed faster recovery of vision (from many weeks with PRK to just days with LASIK) and less discomfort for the patient. The flap at that time was created using an automated blade cutter called a microkeratome.

Further advances in technology allowed improvements to be made to the flap creation method by introducing a Femtosecond laser to create the flap. This allowed us to make the flap in a more precise, accurate, and safer way, as compared to using the microkeratome (Blade LASIK).

Improvements in Excimer laser technology have made it possible for better and more predictable surgery outcomes.
Now, the latest evolution of laser technology comes in the form of the SMILE procedure, where the corneal flap is not made anymore.

What is SMILE?
SMILE is short for Small Incision Lenticule Extraction.

It is a procedure that uses only one type of laser - the Femtosecond laser for the complete procedure, in contrast to Femto-LASIK which uses 2 different lasers – the Femtosecond laser to create the flap and the Excimer laser.

The SMILE Femtosecond laser is able to penetrate the surface of the cornea (the front part of the eye) without making any cut and focus on the deeper part of the cornea and carve out a shape called the lenticule.

A small incision is also made at one side of the cornea to allow access to this lenticule and the surgeon is able to remove the lenticule from the cornea. Once the lenticule is removed, the overall shape of the cornea is altered and the prescription/power of the eye will be changed.

What are the benefits of SMILE over LASIK?
In SMILE, there is no corneal flap, unlike LASIK.  When there is no flap, there is no worry about flap complications. Eg: the flap moving or dislodging (which can occur in LASIK).

Also by not cutting a flap, we keep the cornea much stronger compared to LASIK, this is especially relevant to those with higher powers or thinner corneas where a lot of the tensile integrity of the cornea is affected by the flap or the greater amount of corneal tissue that has to be removed.

The third advantage is the preservation of the corneal nerves. Where as in LASIK, in the process of cutting the flap, we also cut a lot of the nerves, and these nerves help reduce post op dryness.

So in summary, by not having a flap, you get a stronger post operative cornea, lesser dry eyes, and no flap complications.

Also, for patient’s comfort – because only a small incision is made in SMILE, the patient experiences lesser post op irritation and pain as compared to LASIK, where a big flap incision is made.

Is SMILE better than LASIK?
In certain safety aspects, it is – no flap means no flap complications, and it maintains more corneal strength post op, compared to LASIK. It is also more comfortable, the patient experiences lesser dry eyes (because more corneal nerves are preserved) and less pain after the operation

Vision-wise, results are similar to LASIK. LASIK has been around for a long time, and is a mature technology and procedure giving good and satisfying visual results.

Is SMILE widely available in Malaysia?
At the moment, it is not.  There are only a few eye specialist centres in the country that are currently offering this procedure.

Why are so few centres offering SMILE here in Malaysia?
It is the latest, state of the art technology which requires new laser machines. These machines are expensive. Also, not many surgeons in Malaysia have the experience to adopt the procedure; it will take a while before it becomes more widely available.

What is the future of SMILE, where is it heading to? Will LASIK be a thing of the past?
In time to come, SMILE will be the leading choice in terms of cornea preservation and also safer features but for now, both SMILE and LASIK have their own benefits.

LASIK is a good procedure, and it has been giving consistent results. In the near future, eye laser centres will probably offer SMILE side by side with LASIK. This is a similar situation to ASA (Advanced Surface Ablation).

ASA, which was the first generation of laser surgery, has not faded away either. It is still being done as it has its own advantages and provides good results.

So, I believe that SMILE will compliment LASIK as an alternative for patients who prefer its advantages over LASIK.

About Dr Stephen Chung
Dr Chung is a renowned ophthalmologist and laser refractive surgeon.  His experience in performing laser refractive surgery in Malaysia for 20 years has made him one of the most sought after consultants on laser refractive surgery in the region.

Labrador – My Guardian

The Labrador retriever is well-known as a guide dog working with people with impaired sight. They are extremely intelligent and quick-witted, that’s why they are commonly trained as assistance dogs. Labradors can function as guide dogs for disabled people (impaired hearing and blind), as search and rescue dogs, and as psychiatric service dogs to help the military veterans who suffer from Post Traumatic Stress Disorder (PTSD).

History
They were originally bred as sporting and hunting dogs to retrieve birds in the 19th century.  

Role of a guide dog for those visually impaired or blind people:

  • Assist its user to avoid obstacles in their immediate path, particularly those overhead or waist high obstacles. A guide dog can stop for a waist high obstacle sooner than you may be able to find them with a cane.
  • Can allow a person to walk at their preferred pace especially in complex situations - such as maneuvering through crowds. They can quickly learn the routes you take most often.
  • They can be an “ice breaker”. It could be easier to get help from others if you are walking with a guide dog. Some people find it uncomfortable talking to a blind person with a cane.

It is not easy to become a guide dog. Here are the qualifications to become a well-trained guide dog:

  • Highly sociable and friendly. As they have to deal frequently with people on wheelchairs, crutches or canes.
  • Possess a Temperament Certificate! Passed a temperament evaluation to ensure appropriate behavior in the presence of other dogs in an unfamiliar environment.
  • Be calm and steady to provide supervision, navigation or safety from environmental hazards (such as obstacles).
  • Be able to assist with the management of mental illnesses. Some dogs are taught to identify the odor changes that are associated with life-threatening medical conditions.
  • Be ready for advanced training to improve their service skills.
  • ​Have complete immunization against important diseases such as rabies, leptospirosis, hepatitis and para-influenza.​

Things that you have to consider before getting a guide dog:

  • Do you like dogs?
  • Are you afraid of dogs?
  • Do you have any allergies to dogs?
  • Any extra space or room for a guide dog in your place?
  • Can you spend time with dogs? To groom them daily, watching over their bowel habits, taking them to the vet for check ups, playing with them.
  • Are you able to maintain a daily feeding schedule for them even when you are away?

Facts that you may not know:

  • A Labrador’s tail looks very similar to the tail of an otter!
  • They like to be around people, especially children!
  • They are very energetic, enjoy playing games like flyball, tracking and swimming!
  • Labradors love to put things in their mouths! Keep an eye on them, especially Labrador puppies!
  • They have a good appetite! Take care of his/her weight!
  • They are very muscular and strong! So, you better workout to be as fit as them!

A Labrador can truly be your BEST FRIEND!

Having difficulty finding the right doctor to do your LASIK?

Then take a few minutes to read this - you won't regret it, I promise. Ok, so before we begin: Some people in the industry would rather me not do this - but I'm gonna be rocking the boat and sharing some useful industry insights with you. I am going to show you how to look through all that marketing glitter, and ask the right questions - so your task of finding the right doctor and the right LASIK provider is made much easier. So, here goes...

#1 Celebrity doctors do not always make the best doctors
Ok, so you found yourself a famous doctor, you've heard of this doctor on the radio, you've seen them on tv, on posters, in newspapers, in the bookstores. Ooooohh great, BUT WAIT! You wanna get your eyes operated on ? What you need is a good doctor, not a rockstar.

Good LASIK doctors spend most of their time in the clinic - seeing their busloads of patients, and perfecting their surgical skills in the operation theatre. They don't have the time to worry about which tv talk show or radio station they're gonna be on next, they don't need all of that to get famous. Good doctors earn their reputation through word of mouth - through the excellence of their patient's results.

Well, I'm not saying that good doctors aren't allowed to be in the media, of course they can (in fact it's a great way of getting out there to educate the public)…..BUT, if the doctor you're looking at is one that spends most of his or her time being a hot celebrity outside of the clinic, then you'd better be worried.

"What you need is a good doctor, not a rockstar. If the doctor is spending more time being a hot celebrity outside of the clinic, then you'd better be worried."

#2 Who says you can't check on your doctor's results?
When it comes to your eyes, and in this modern, information age, there is no such thing as you should just take your doctor's word for it.

"Hey doc, how many LASIK cases have you done?
A thousand? Seriously?
How good are the results ?
That's what you said - now where's the proof?"

Public listed companies have to make their accounts transparent for a reason - people want to know what's going down when there is so much at stake. Why can't the same be applied to the LASIK industry? Why can't the public have a proper, legalized assurance of the performance of doctors and their LASIK centres? Why can't the surgical results be audited and monitored?

Well....most members of the public may be unaware of this - but LASIK results can be audited independently by a third party, and there are LASIK centres in the country that actually do this. Examples of auditing parties that can be engaged for such tasks include the HPMRS (Healthcare Performance Measurement and Reporting System).

YOU - as a consumer, should do your homework - find a LASIK provider that actually takes pains to submit their results for periodical auditing.

And if the LASIK centre does not engage in any external or independent audit activity, you should begin to question:

  • Why aren't the surgeons' results being audited?
  • Who checks on the surgeons' work?
  • Are they governed by any kind of standards? (good examples to look out for: ISO or MSQH or JCI).
  • Are the quality assurance stickers they have on their front doors coming from recognized certification bodies?


#3 The best and most expensive LASIK treatment machines or technology do not always equate to the best results.
Ok, so a Proton Saga and a Ferrari are about to race? Who'll win? Hands down on the Ferrari?

What if the guy behind the wheel of the Proton was Mike Schumacher in his prime and the guy behind the Ferrari was Mr Bean. Do you still think the Ferrari will win? - so yea, you get the picture.

LASIK treatment machines and whatever technology it comes with are just tools - what matters are the people behind the tools. Again - do your homework, who are the people behind the tools, how many successful treatments have they done? What are the results like?

Never, ever judge a treatment method by its expensive (or dirt cheap) price tag or cool looking marketing promo video.

#4 There is no single doctor who is good at EVERYTHING
There is a saying that goes - a jack of all trades is a master of none.

The same applies in the eyecare industry. Just because a doctor is a master at treating retinal detachments or performing cataract surgeries, it doesn't mean that he or she makes a good laser refractive surgeon. In fact, if they spend more of their time being good at other things and very little time perfecting their skills on LASIK, their LASIK results could actually suck.

The great Bruce Lee once said - I do not fear a man who practices a thousand kicks once, but I fear the man who practices one kick a thousand times.

Even in the LASIK world, there are so many different methods of surgery such as the flap methods, ReLEx SMILE, LASEK etc. If a surgeon is a master at performing the flap method, it doesn't mean he/she is equally as good with ReLEx SMILE or LASEK, and vice versa.

So, once you know what method of surgery you are suitable for (flap, ReLEx SMILE or LASEK), do your homework again and find the right surgeon for that particular method of surgery. Always ask:

  • How many cases has he or she done?
  • What is his or her success rate?
  • What kind of assurance do you have that what they tell you is what they have actually done - is their work being audited by an external party? Which external party?
  • If they are not being audited - why not?

These questions may make you come across as a difficult customer, but it is your eyes we're talking about here, and these are good questions to ask.

"Even if a doctor is a master at treating retinal detachments or performing cataract surgeries, his or her LASIK results could still suck "

LASIK Above 50

This article was published in The Star Newspaper on 12th May 2015.

Technological advances in laser eye surgery have brought continuous improvement in safety and efficacy. Through the years, LASIK (laser eye surgery) has become a mainstream procedure for the correction of refractive errors - over 31 million surgeries performed worldwide in the last two decades!

It is a well established fact that most people experience a decline in the quality of their vision when they hit their forties. And with a very large population of baby boomers now in their forties and above, the demand  for corrective eye surgery has been on the rise. In fact, we see more and more patients over 50 coming in and asking about LASIK.

The big question - Is there an upper age limit for LASIK?
Let’s take a look at a study done by Dr Dimitri Azar and colleagues at University of Illinois, Chicago to report the safety, efficacy and predictability of LASIK in patients 40-69 years old. The study involved 710 consecutive laser eye surgeries done by Dr Azar between January 1999 to September 2005.

The cases were divided into three groups based on age: group one 40 to 49 years old (359 eyes); group two 50 to 59 years old (293 eyes); and group three 60 to 63 years old (58 eyes). After the final follow up check ups, they found that there were no significant statistical differences in final visual acuity between the different age groups. They concluded that LASIK has reasonable safety, efficacy and predictability profiles in the 40 to 69 years old presbyopic population.

Coming back to the question above: Is there an upper age limit? I would say not necessarily. It depends on the state of the eyes rather than the age of the patient. However, this age group has its challenges as they have presbyopia and may have other co-existing eye disorder.  Thus, each candidate seeking refractive surgery must undergo a thorough eye examination, and be considered on a case by case basis.

Considerations and precautions taken before performing LASIK in this group of patients:

  1. The natural lens inside the eye has to be clear and the patient must understand that LASIK will not prevent a cataract from developing in the future.
  2. Stable vision and eye power - Changes in vision or prescription may indicate early onset of cataract. Patients who undergo LASIK when they are already developing a cataract could find that their vision a few years down the line may start to deteriorate.  This has nothing to do with the laser eye surgery not being permanent - the culprit is the cataract!
  3. Signs of age related eye diseases, history of diabetes, glaucoma and family history of corneal disorders.

Other considerations:
Dry eyes – they are more common in those above 50, due to changes in their body, and also as a side effect of certain medication usage: drugs for hypertension, hormone replacement theraphy, anti-histamines, antidepressants, and sleeping pills.

Dry eyes are a common side effect of LASIK, especially during the recovery period. In LASIK a significant amount of corneal nerves will be cut during the procedure. These nerves help to reduce dry eye. But with a newer technology called SMILE (Small Incision Lenticule Extraction) the corneal nerves are preserved and the chance of developing dry eye is significantly lesser.

Some medications taken by older patients may also cause ocular side effects:

LASIK is contraindicated if a patient is on Amiodarone (a drug to help keep the heart beating normally in patient with heart disorders). Amiodarone may cause coloured haloes around lights, photosensitivity, blurred vision, dry eyes, and lens opacities.

So prior to doing any laser eye surgery, your doctor should ask you your medical history and whether you are on any prescription drugs.

Can LASIK help with presbyopia (reading problems)?
Presbyopia is a loss of elasticity in the lens resulting in the eye losing its flexibility to adjust its power – which affects a person’s ability to see fine details up close. It normally develops in the forties and above.

In LASIK, the laser treats the cornea to correct myopia, hyperopia and astigmatism, but it cannot stop the natural lens inside the eye from aging. As a result, if you were to undergo your LASIK in your 20s, when you are in your 40s, you will still need to wear reading glasses to help you to see better at near.

In LASIK, the problem of presbyopia is commonly addressed through a method called monovision. In monovision, one eye is corrected for distance vision and the other eye for near vision. So, when both eyes are open, the brain will adapt accordingly and the patient can see clearly at both far and near.

Monovision may work well in some patients but may not for others. The patient should discuss their occupation, hobbies and other lifestyle issues with their doctor to help determine if the procedure is right for them -  it is not appropriate for people who require sharp distance vision, precise depth perception or precise near vision to do his/her job.

Some patients can adapt well and fast, especially those who have previously worn contact lenses fitted for monovision. Some may take a longer time to adapt. But at the end if they cannot adapt to monovision, a full eye correction to restore balanced distance vision to the eyes can be done.

So in conclusion, being eligible for LASIK has more to do with the condition of your eye rather than your age. Most can expect good outcome when they have realistic expectations. If you do seek laser eye surgery to correct vision problems, make sure you talk to your surgeon about the benefits and risks of surgery at your age. Make sure you are fully informed of the advantages and disadvantages as well as understand the aftercare tips to follow postoperatively.


“Being eligible for LASIK has more to do with the condition of your eye rather than your age”
 

Eye Care: Facts & Myths

Reading in dim light will get you blind
False. For centuries, all nighttime reading and sewing was done by candlelight or with gas and kerosene lamps – no one went blind from doing it. Reading in low light can strain your eyes but does not damage them. Therefore, good lighting will make reading easier and can prevent eye fatigue.

Eating carrots improves your vision
False. Carrots are rich in Vitamin A, which is essential for sight, but many other food also contain Vitamin A. A well-balanced diet, with or without carrots, provides all the vitamin A necessary for good vision.

A cataract must be “ripe” before it is removed
False. With older surgical techniques, it was thought to be safer to remove a cataract when it was “ripe”. With modern cataract surgery, a cataract does not have to ripen before it is removed. If you are unable to see well enough to do the things you like or need to do, you should consider cataract surgery.

Sitting close to the television can damage children’s eyes
False. Children can focus up close without eyestrain better than adults. They often develop the habit of holding reading material close to their eyes or sitting right in front of the TV. There is no evidence that this damages their eyes, and this habit usually disappears as the child gets older. Children with nearsightedness (myopia) sometimes sit close to the TV to see the images more clearly.

Using computers can “damage” your eyes
False. Working on computers or video display terminals (VDTs) will not harm your eyes. While it may not physically “damage” the eyes, it could contribute to a change in eye power. Often, when using a VDT for long periods of time, just as when reading or doing other close work, you blink less often than normal. The reduced rate of blinking makes your eyes dry, which may lead to the feeling of eyestrain or fatigue. Try taking regular breaks to look up or across the room. Looking at objects farther away often relieves the feeling of strain on your eyes. Keep the monitor between 18 to 24 inches from your face and at a slight downward angle. Also consider the use of artificial tears. If your vision blurs or your eyes tire easily, you should have your eyes examined by an optometrist or ophthalmologist.

Your Children Aren’t Lazy. They Just Have a Lazy Eye.

Ask yourselves this. Has your young child’s teacher been constantly informing you that your child seems disinterested and aloof during classes? Has he or she showed signs of disinterest as well at home while doing homework and even during playtime with friends? Just as you were about to find out more about your child’s weird behavioural patterns, he or she drops a bomb onto you by bringing home a report card filled with poor grades and frustrated teacher comments! Surely by now you could think that your child is just being plain lazy (and even some of you may go ballistic).

Now, before you reach for the disciplinary cane, take a moment to ask yourself, “Is my child really lazy? Or is there another reason behind it?”. Unless your child has a mild cognitive disability, they should not be acting this way. Most of the time, regular young children are so often active and inquisitive that it seems very far-fetched to call them lazy. So, what is making your child seem lazy and disinterested when it comes to the fun activities? The answer may be all too simple: that instead of being genuinely lazy, your child just happens to be having a lazy eye. OK then, please do not press the panic button yet.

Amblyopia, often termed as ‘lazy eye’, is a condition whereby there is a reduction of vision in one or two eyes in the absence of any ocular pathology. Mind you, this reduction in vision is not correctable by eye glasses. It usually happens when one of your child’s eyes (or both) begin to lose more focus in relation to the other eye. As a result, the brain will tend to ignore the image from the poorer eye and ‘disallow’ the poor eye from seeing. Over time, the vision development of the eye becomes impaired, and this impairment is permanent once the child reaches a certain age.

If your child is suffering from amblyopia, it would make total sense for them to seem lazy or disinterested, simply because of the fact that he or she cannot see very well ! Imagine that you do not have good vision, would you still be going through your daily tasks willingly? I personally would not. Now that we know the problem, we must learn how to identify and react to them quickly.

There are many causes for lazy eye and all of them involve something blocking the eye from seeing well. Most commonly, the child may have some uncorrected power in one eye that is disallowing the child from focusing clearly. Other causes could include a squint in one eye as well as something blocking light from entering the eye, namely congenital cataracts. Whatever the cause, correcting the root of the problem is always the first treatment in line. For example, if the child has significant power, we must always correct the power by putting the child on glasses.

I cannot help but keep stressing that early detection is always the key to combating the lazy eye in a child. There is a period in the human’s vision development where the visual system is especially vulnerable to disturbances from unwanted external stimuli such as a cataract or significant eye degree. This period is known as the ‘critical period’. For an average individual, the critical period for proper vision development is from birth to roughly around 8 months of age. However, this does not stop there. Research shows that significant disruption to the development of the visual system can still be done up to around 3 years of age!

Children with lazy eyes will show disinterest in many activities that require good vision – such as studying, paying attention in classes and even during games. Other symptoms would include ‘straining’ the eyes to see, having an unusual ‘face turn’ while viewing or sitting very close to the television. It is vital for us to detect these signs early, send the child for an eye examination and remedy it. If the child seems normal, a preliminary vision examination is always recommended at around 9 months of age as it coincides with the end of the critical period to ensure early detection of any eye problems. It is also advisable to have your child go through another vision screening during the pre-school years before they start kindergarten.

However, this does not mean that all is lost if we detect problems after the age of 3. There is another period which is called a ‘plastic period’ whereby we can still regain the vision lost in children by doing some simple treatments. The plastic period usually ends when the child is around 6 to 9 years old and any treatment applied after that usually does not yield significant results. Hence, treatment to the problem should be done before this period ends. You may also ask ‘what now’ if we detect and start treatment on a child after that age. Fret not as there are reports stating that some children may still benefit from treatment up to their teenage years, even if the results may not be too desirable.
In managing the problem, there are sequences that we must always follow. First of all, we must always correct the root problem first as mentioned earlier. If the child has significant power, he or she needs glasses. If there is a cataract, remove it. If that is not enough, we will need to help the poorer eye see better and this can be done in multiple ways. If we encourage a lazy person hard enough to work, chances are that he would. The basis of lazy eye treatment is the same…encourage the lazy eye to work!

Patching is the most common method to work the lazy eye. By covering the good eye, we encourage the poorer eye to work. The frequency and duration of doing so depends on the severity of the problem as well as the child’s age. While some children find this method cool (as it makes them look like ARR! PIRATES), some could be subject to ridicule from their peers. If that happens, there are still other methods which we can always fall back on such as applying a special eye drop in the good eye to temporarily blur out the vision or a use spectacle with a foggy lens over the good eye. You may discuss the various types of treatment with your ophthalmologist or optometrist.

In a nutshell, a child may seem lazy or disinterested because he or she has poor vision, a common cause is a lazy eye. Early detection and treatment is of utmost importance to tackle the problem. Once the problem is sorted out, we can then help the child to develop lifelong visual skills. So if your child seems to be lazy, always have this possibility in mind: He is not LAZY, he just has a LAZY EYE. Happy patching!

Looking Back: The History of LASIK

Almost everyone knows someone who has undergone Lasik eye surgery. This is not surprising at all. To date, there are more than 30 million people worldwide underwent Lasik surgery. Today, LASIK is now a household term and common form of surgery, but the key developments in its history took over a century to unfold.

So, how did LASIK surgery go from the experimental stages to become one of the most effective and popular elective procedures today?

The early years of LASIK
Surgical solutions to refractive errors of the eye date back as far back as the 19th century. In 1898, the basic principles of Radial Kerototomy (RK) had been laid down by Lans, a Dutch Ophthalmologist.

In 1949, a Colombian ophthalmologist named Dr. José Barraquer described the principles of keratomileusis, a Greek term that literally means “sculpting” of the “cornea. He changed the cornea’s shape by removing a piece of corneal tissue which was frozen with an instrument called a microkeratome. It was only in the 1970s that Dr. Fyodorov invented Radial Keratotomy in the Soviet Union and later introduced in the United States in 1978. This technique involved making a number of tiny radial incisions in the cornea surface to change its shape and correct refractive errors such as near-sightedness.

As time went on, the procedure continued to develop, then in 1987, Luis Ruiz, a protégé of Dr. José Barraquer, modified the principles of microkeratome corneal resection and developed an automated form of the instrument to perform the operation directly on the eye. This procedure became known as Automated Lamellar Keratoplasty (ALK).

The Game Changer: The Excimer Laser
Even greater strides were made in the history of LASIK eye surgery with the introduction and application of the excimer laser in the 1970s. Srinivasan, an IBM engineer and Trokel, an ophthalmologist recognize the potential use of excimer laser on corneal surgery. The Excimer laser uses a cool ultraviolet beam of light to vaporize tissue with exact precision while causing no heat-related damage to the adjacent tissue. The excimer laser was first used on human eyes in the 1980s with a method called Photorefractive Keratectomy (PRK). This involved the ablation of the surface of the cornea to reshape by using Excimer laser. Since then, more than two million people have had their vision corrected through PRK procedure in over 40 countries. In the late 1990s, PRKs latest variants LASEK (laser assisted sub-epithelial keratectomy) and Epi-LASIK were introduced.

Finally, LASIK is Born!
In the 1990s, Dr. Pallikaris and Dr. Buratto introduced a procedure combining the microkeratome and the Excimer laser. This created what we now know as LASIK, an acronym for “Laser-Assisted In-Situ Keratomileusis”. Due to its popularity with patients, LASIK gained U.S. FDA approval in 1999 and thus began the era of LASIK.

The advent of the Femtosecond laser and Wave-front technology marked a significant advancement in laser refractive surgery. In 2001, the FDA approved “bladeless” LASIK or IntraLASE. Instead of the microkeratome blade, a Femtosecond laser was used to make the corneal flap incision. This allowed surgeon to come up with a very predictable, reproducible flap with fewer complications. Dr. J. Trevor Woodhams was the first eye surgeon in Georgia to perform this blade-free procedure.

In 2002, the FDA approved the use of Wavefront technology, also known as Custom LASIK. Wavefront technology gave LASIK surgeons a level of refinement that was previously unattainable with other techniques. A specialized corneal map or wave scan is obtained using an instrument called aberrometer. This creates a guide for the laser and provides a personalized treatment for correction with even higher prescriptions, thin corneas, large pupils or asymmetrical eye surfaces.

Recent Innovations
Still evolving, LASIK continues to offer exciting new options for patients. Advancement of laser eye surgery led to a new flap-less form of procedure based on lenticule creation and extraction. ReLEx (Refractive LEnticule Extraction) SMILE (SMall Incision Lenticule Extaction) is performed using the VisuMax Femtosecond system (Carl Zeiss Meditec Inc., Jena, Germany). Instead of vaporizing cornea tissue, ReLEx SMILE creates a precisely shaped lenticule inside the intact cornea by using the Femtosecond laser. The removal of the lenticule through a small access measuring less than 4mm changes the form of the cornea, creating the required change to the prescription.

While the technology has improved drastically over the last two decades, the success of any form of vision correction lies heavily on suitability of the patient, and continued education on the doctor’s part is vital to evaluating patient readiness. Individuals considering the procedure should be sure to consult with their eye care provider and stay informed on the benefits and caveats of laser-assisted vision correction.

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