1. Refractive Surgery Seminar: An Introduction to Laser Vision Correction Emily Birkholz, MD John Hoines, MD Ophthalmology Associates of Mankato

2. Our Plan: Why do people need glasses or contact lenses? – Nearsightedness, Farsightedness, Astigmatism What is refractive surgery/laser vision correction? – PRK vs. LASIK vs IntraLASIK – Custom treatment Who is a good candidate? What to expect with this procedure? Questions

3. Anatomy of the Eye:

4. The Refractive Power of the Cornea: 2/32/3 1/31/3

5. Why Do I need Glasses/Contacts? Nearsightedness (myopia) Farsightedness (hyperopia) Astigmatism Presbyopia

6. Nearsighted:

7. Farsighted:

8. Astigmatism:

9. Presbyopia: Loss of accommodation with aging

10. How to correct refractive error? Glasses Contact lens Refractive Surgery – Laser vision correction

11. How Does Laser Vision Correction Work? Laser energy applied to corneal tissue Reshapes cornea to correct refractive error

12. Myopia – flattens cornea Hyperopia – steepens cornea

13. Laser Vision Correction: Two Methods: PRK (surface treatment) LASIK (flap)

14. The Excimer Laser (VISX) Designed in the 1970’s Removes 39 millionths of an inch of tissue in 12 billionths of a second Typically a layer of tissue as slender as a human hair is removed Average laser time is less than 1 minute No adjacent tissue destruction

15. Photorefractive Keratectomy (PRK) Epithelium is removed Laser treatment to anterior stroma Corrects – Myopia – Hyperopia – Astigmatism

16. PRK: Advantages: – No Flap – Can be performed on thinner corneas Disadvantages: – Pain – Longer time for vision to improve – Haze

17. Laser-Assisted in Situ Keratomileusis (LASIK) Flap created and lifted hinged, partial thickness Laser treatment to deeper stroma Flap repositioned Corrects Myopia Hyperopia Astigmatism

18. LASIK: Advantages: – Minimal pain – Fast visual recovery – No haze Disadvantages: – Flap complications – Dry eye

19. LASIK: How is the flap created? – Laser – IntraLase No blade iLASIK, Bladeless LASIK, IntraLASIK – Microkeratome - Traditional

20. IntraLase Femtosecond laser – Laserbeam creates tiny microbubbles at programmed depth, shape, and size – Precise depth (accurate within 10 microns)

21. Advantages of IntraLASIK More precise flap thickness – Less risk of a flap complication – Thinner flaps – Less Dry Eye – Ability to perform on more patients Even those with thinner corneas who were not eligible for traditional LASIK Less risk of infection or inflammation – No blade to sterilize – Vertical edge to flap Low vacuum suction ring – compared to high vacuum ring with microkeratome – more comfortable

22. What is a Custom treatment? CustomVue system measures low and high order aberrations – Low order – myopia, hyperopia, astigmatism – High order – imperfections in system, linked to glare/halo Wavefront represents all aberrations – Information obtained by a WaveScan ®

23. Custom treatment A Custom treatment uses the information from the wavefront to reduce or eliminate all aberrations from the eye

24. Advantages to Custom Treatment Improved visual quality – Reduced risk of glare/halos Improved contrast sensitivity – Reduced risk of nighttime vision difficulties Similar outcome as non-Custom for visual acuity

25. Who is a good candidate? At least 21 years of age Healthy eyes Good health overall Realistic expectations

26. Who is a good candidate? Nearsightedness from -1.00 to –12.00D – Astigmatism up to 4.00D Farsightedness between 0 and +5.00D – Astigmatism up to 3.00D Astigmatism between 1.0 and 5.0 D

27. Unrealistic expectations Pregnant and nursing women Ocular disease Certain medical problems History of autoimmune disease Lupus Rheumatoid Arthritis Who is not a good candidate?

28. When to choose PRK vs. LASIK? PRK – Dry eye syndrome – Inadequate corneal thickness – Professions with potential for ocular injury LASIK – Faster visual recovery – Less post operative discomfort

29. What are the common risks? Under-correction Over-correction Night vision symptoms – Glare/halo Worsening of dry eye symptoms (LASIK only)

30. What are the rare but serious risks? Loss of best spectacle corrected visual acuity Minor loss of BSCVA: 1% Usually due to haze/mild scarring or flap irregularities Major loss of BSCVA: 0.1% Usually due to infection

31. What can I expect after the procedure? LASIK Some discomfort for a few hours Eye redness for 2-3 weeks Back to work after 1-2 days Good vision typically the next day Excellent vision typically in 1 to 4 weeks PRK Some pain for 3-5 days – Bandage contact lens Back to work after 3-5 days Good vision typically in 1 week Excellent vision typically in 4 to 8 weeks

32. What can I expect after the procedure? LASIK Eye drops for about 1 month Eye shields at bedtime for 2 weeks Frequent artificial tears for the first 1-3 months PRK Bandage contact lens for the first week Eye drops for 1-3 months Eye shields at bedtime for 1 week Frequent artificial tears for the first month

33. What is the follow-up schedule? 1 day (LASIK only) 1 week 1 month 3 months 6 months 12 months

34. What is an enhancement? Repeat treatment Usually performed after at least 3 months

35. Is Laser Vision Correction Perfect? Laser vision correction provides uncorrected visual acuity that closely approximates that which is currently achieved with glasses or contact lenses Will not eliminate the need for reading glasses once you reach your 40’s and 50’s

36. Near Problems (Presbyopia) Difficulty with near focus is a function of progressive age and changes in the crystalline lens, not the basic refractive error < 40 years of age: accommodation can be used to maintain clear images at all distances >40 years of age: accommodation becomes progressively more difficult; first noticed for close work late in day and with poor light

37. Solutions to Presbyopia Reading glasses Monovision – Dominant eye corrected for distance – Non-dominant eye corrected for near With contact lens or Laser Vision Correction Cataract Surgery with implantation of Multifocal Intraocular Lens

38. How much does the procedure cost? **Includes all postoperative visits for 1 year **Wavescan cost $100 PRK – $1650 Traditional LASIK – $1650 IntraLASIK – $2200 Custom PRK – $1800 Custom Traditional LASIK – $1800 Custom IntraLASIK – $2350

39. What do I do if I am interested in LASIK or PRK? Call Ophthalmology Associates and set up free refractive surgery evaluation – 10% discount off surgical price if sign up after hearing this seminar

40. Thank you for your attention! Any Questions?