Eye Care

Eye Lasik Refractive Packages

Lasik Eye Surgery

The word LASIK is an acronym for Laser- Assisted In-Situ Keratomileusis (LASIK) and is currently a popular surgical procedure that is being performed by eye doctors to improve vision by correcting refractory errors.

The surgery improves the vision in patients who have nearsightedness, farsightedness, and astigmatism. LASIK surgery usually takes less than one minute per eye. Treatment involves reshaping the cornea - the protruding portion of surface of the eye - to improve vision.

In 1990, Dr. Lucio Buratto of Italy and Dr. Loannis Pallikaris of Greece pioneered the LASIK technique. They blended two prior techniques, Keratomileusis and photo refractive keratectomy effectively, to discover the LASIK technique, which is popularly used in the corrective refractive surgery.

Dr Jose Barraquer in 1990 in Colombia developed a device that could cut thin flaps in the cornea and alter its shape. This device was the 'Microkeratome' and the procedure was called keratomileusis. The basis of LASIK surgical technique is reshaping the cornea to correct refectory errors.

The cornea is the only transparent tissue in the human body and is on the surface at the front of the eye in front of the iris (the colored part of the eye). The cornea is curved and acts like a lens providing two thirds of the eyes focusing power. The remaining focusing power is supplied by the lens which is situated just inside the front of the eye behind the iris. The two work together like a camera, allowing light rays from an image to pass through onto the back of the eye, the retina, where it is captured and upside down ! From an early age the brain learns to automatically turn the image up the right way. As the lens changes shape the focus is adjusted according to whether the image is close or in the distance. The ability to focus clearly is commonly compromised through one of two reasons. If the eye is abnormally short or long. If the curvature of the cornea is too steep or too flat. Both cause the point of focus to fall short of or outside the retina. Often people who suffer with far or short-sight have either 1) or 2) or a combination. The degree of their prescription is determined by the amount of the abnormality (length of the eye & curvature of the cornea)

Eye Care Treatment

Lasik Treatment

"Invention" of spectacles was a great achievement at a time when patients with refractive error were severely handicapped or practically blind. Spectacles enjoyed high degree of popularity for a long time, but now their disadvantages viz., cosmetic blemish, restricted field of clear vision, aberrations, obstruction in sports and physical discomfort, are apparent. However, this should not mean that spectacles are to be condemned. There are still many situations where spectacles are not just the only alternative available for restoration of vision but a respectable visual device.

A question that always haunts the mind of the ophthalmologists and patients: why depend on prosthesis when it is possible to restore natural vision with all its inherent advantages (not just cosmetic) finds no answer.

Extensive research and technical advancements have produced following alternatives:

• Contact Lenses
• LASIK (Laser Assisted In-situ Keratomileusis)
• Customised Ablation LASIK or Wave front Guided Lasik
• Phakic IOLs
• Intra-corneal Rings (Intaacs)

Contact Lenses

These are small polymer lenses, which are placed directly over the cornea. They are of two main types - soft and semi soft. Soft contact lenses are pliable and therefore very comfortable, but require utmost meticulous care and maintenance. Infections and allergy (GPC: giant papillary conjunctivitis) are the likely complications. Semi soft lenses (or Rigid Gas Permeable) are rigid and thus, initially, slightly uncomfortable to wear, but they do not require too much care. Complications like infection and allergy are uncommon with these lenses. However, in the Indian context infection, GPC, mishandling, dust and pollution associated conjunctivitis continue to be major causes of contact lens intolerance. Patient compliance is generally not satisfactory relating to the lens care and maintenance schedules. However, they do give us a reversible alternative for vision correction especially in circumstances where other modalities are either not advisable (young individuals with unstable error) or not possible (scarred or irregular cornea).

• High degree of astigmatism can not be corrected by contact lenses.
• Extended wear lenses are not as suitable for Indian conditions as in the west.
• Hard lenses are obsolete and should never be used as they prevent oxygen supply to the cornea.

LASIK (Laser Assisted In-situ Keratomileusis)

Lasik is currently the best method of correction of refractive errors. It is accurate, effective and safe.

In LASIK an ultra-thin (130 to 180 micron) flap of cornea is raised and then using a computer controlled Excimer Laser (mostly Argon Fluoride 193nm) is delivered to reshape the corneal stroma into predetermined curvature. The flap is repositioned back. This leads to correction of both myopia and hypermetropia, and also moderate amount of astigmatism. The procedure is short and simple and being computer controlled is highly accurate.

The steps are detailed below.

Patient Selection for Lasik

Case selection is an extremely important determinant of the result of Lasik surgery:

• Refractive error: 1 to 12 diopter of myopia or up to 8 diopter hypermetropia
• Astigmatism of up to 6 diopter
• Minimum age 18 to 21 years (preferably 21 years)
• Refraction should have been stable for 2 years.
• Contraindications: keratoconus, thin corneas, corneal inflammatory diseases, herpetic keratitis and autoimmune diseases.

Preoperative Preparation for Lasik

• Refraction under cycloplegia
• Corneal Topography
• Pachymetry for corneal thickness
• Detailed Retina Examination
• Informed consent

Lasik Procedure

LASIK is performed under topical anesthesia (lignocaine 4% or Proparacaine) and the only cooperation required of the patient is to fixate at a blinking (red) light. Newer LASIK machines have an eye tracker device which realigns the Laser to any changes in the position of the eye thereby ensuring proper centration of ablation. The steps are:

• After the anesthesia the face of the patient is covered with a drape just exposing the eye and an eyelid speculum is applied to retract the eyelids (patient feels a stretch on the lids). The patient fixates his gaze at a blinking light.
• A suction ring is placed around the cornea and serves to stabilize the eyeball and act as a platform for the microkeratome. When suction is activated vision be comes hazy and a pressure on the eye is felt.
• The automated microkeratome dissects through the superficial layers of the cornea and the corneal flap is folded back. During this step the patient hears the sound of a motor in front of the eye.
• Excimer Laser ablates the stromal bed to resurface it into desired curvature. What makes the Excimer laser so well suited for corneal ablation is its ability to remove tissue with accuracy up to 0.25 micron with each pulse. Often, only 50 microns of tissue are removed to achieve the proper amount of correction. The Excimer produces a non-thermal light beam that eliminates the possibility of thermal damage to surrounding tissues. In current Lasers employing flying spot technology a 2 mm spot ablates the tissue to correct the refractive error and then a 1 mm spot blends this area with surrounding cornea by creating smooth transition zones. During this step a clicking sound is heard and an odor of ablating tissue (similar to charring hair) is smelt and a light flashing close to the eye is seen. All this while patient needs to concentrate on the center of the blinking red spot of light.
• The corneal flap is then repositioned and allowed to dry for a few minutes. The flap self seals without the need of sutures.
• The eye may be patched after instilling antibiotic drops for 1-2 hours and the patient is advised to report back the next day. Eye drops are prescribed to be started on the same day. Analgesics are prescribed for 2-3 days.

Precautions to be taken after Lasik

• Avoid swimming and splashing of water on the eyes for a month.
• Avoid rubbing the eyes for a month.
• Use sunglasses to avoid bright sun, dust, wind and air pollution.
• Avoid excessive viewing of TV or computers for a week.
• Use medicines regularly as advised.
• Consult your eye surgeon in case of any problem

Refractive Surgery India

Refractive surgery is gaining popularity in India both among the public as well as among ophthalmologists. Till a few years ago only a few centres performed high volume radial keratotomy. Today, the highest international quality of eye care for cornea, cataract, squint and glaucoma is available in over 40 centres all over India. When it comes to reliability, India has the best ophthalmic surgeons with clinico-academic expertise honed to perfection in the best possible institutions. Apollo Hospital and Max hospital in Delhi, Shankar Naytralaya in Chennai, L. V. Prasad hospital in Hyderabad are just some of the more popular eye care hospitals. The No Stitch Cataract Surgery with the most modern way of removing cataract through the use of Phacoemulsification procedure can be performed in India for as little as Rs. 20,000, for both the eyes, whereas the same surgery costs $ 45,000 in the USA. Facilities for PRK, myopia and astigmatism are now available in almost all parts of the country. Hyperopics and LASIK are available and even supra hard cataracts are treated using just 1 mm incision instead of the 3 mm incision size. Photorefractive keratectomy or PRK treats the surface of the cornea with the Excimer laser while LASIK treats the inner tissue of the cornea. For this reason, with LASIK there is less area to heal, less risk of scarring, less risk of corneal haze, less post-operative pain and vision often returns very rapidly.