products & services Refractive Surgery Refractive surgery has become an accepted method of correcting the eye's focusing errors over the past few years, and today most patients have several excellent options. Unfortunately, refractive surgery has also become associated with heavy media advertising, low budget surgery and is often sold like cookware on infomercials. This presents a bewildering maze of promotions, half-truths and misleading information. Refractive surgery can be quite safe and accurate, but all types of refractive surgery are just that - surgery. It is not like going for a haircut. These procedures must be treated with all of the caution and respect that a surgical procedure of any kind entails. The doctors in our practice have co-managed over 2000 refractive surgery patients of all types. We are trained and experienced to assess your eyes with respect to refractive surgery candidacy, and give you unbiased advice as to what type of surgery would be best for you. We counsel you and give you options, based on our extensive experience, as to which surgeons you should consider for each type of procedure, and other factors such as reading/monovision. We can do your pre-surgical workup and, following your surgery, provide all the post-operative care. It is preferable to have your post surgical progress closely monitored by an independent doctor rather than "in house" at a laser centre. The knowledge that a second opinion will be involved, we find, greatly improves outcomes. In general, to have refractive surgery: Your prescription should be stable, You must have no active eye or systemic disease, which could affect your eyes, If you wear contact lenses you should discontinue wear, as per your doctors instructions, Your corneas should be free of distortion, You should be of sufficient age; at least 22 for males and 21 for females, You must have sufficient corneal thickness for your prescription ( LASIK and PRK), You must have realistic expectations. Refractive Surgery Procedures There are a number of options available today to correct the focusing errors of the eye that cause blurred vision. There are non-surgical options such as glasses or contact lenses and now orthokeratology. There are surgical options - surgical alterations of the eye to change the focus of the eye. There are four types of refractive surgical procedures done in Canada presently. Two of these are done with a laser and two without. The three types refractive errors that affect vision are myopia (nearsightedness) hyperopia (farsightedness) and astigmatism. A fourth condition for which many people wear glasses or contact lenses is called presbyopia. This is an age related inability to focus up close and there is no surgical procedure to correct this condition (yet). PRK Photorefractive Keratectomy PRK was the first procedure done with the Excimer laser. It was first performed in 1986. The front layer of surface cells of the cornea is removed either mechanically or with a laser. The underlying surface is then reshaped with the Excimer laser. PRK is effective for lower amounts of myopia and astigmatism. The accuracy of the procedure tends to fall off with higher powers. It is more painful in the first few days than other procedures. There is also a much slower vision return - driving vision may take 2-3 weeks. There is also a 3 - 4 month course of steroid drops required after the procedure to reduce inflammation and control healing. There is a somewhat higher possibility of corneal infection as the protective surface of the cornea is open for the first few days. With higher prescriptions, predictability of the procedure decreases and the possibility of corneal haze increases. Although PRK has largely been replaced with the Lasik procedure, it can be the procedure of choice with small eyes or certain types of corneal surface disease. LASIK - ( Laser-assisted in Situ Keratomileusis ) has now become the primary procedure for surgical correction of eye focusing errors. In LASIK, the same Excimer laser is used as in PRK, except a flap is cut by a very precise surgical instrument, across the cornea, folded back, and the laser applied to the resultant bed. The flap is then put back and the surface of the cornea is left intact. There are many advantages of LASIK over its predecessor, PRK. There are lower risks of general complications, infection and haze. The return to normal vision is much faster with LASIK following surgery; over 90% of patients have driving vision on the day after surgery. This allows a much faster return to work and activities. There is far less use of steroid drops on the eye following LASIK surgery, so there is little or no chance of elevated pressure inside the eye. There is also little or no post-operative pain with LASIK. The most frequent post-op complaint is of dry eye, which is treated with artificial tears. LASIK can be used to correct significant amounts of astigmatism and hyperopia, as well as nearsightedness. The difficulty with LASIK is that it is a much more difficult procedure and operation than PRK, and is very surgeon dependant. It is very wise to follow the guidance of your own eye doctor as to who, in their experience, would obtain the best result for you. Similar to how he or she would select any other eye specialist, for example cataract or retinal surgery, your eye doctor is in a good position to select a refractive surgeon based on considerable experience and outcomes. To tell whether you may be a candidate for LASIK, your optometrist will assess your prescription, eye health, and certain general health factors. Because with both PRK and LASIK, a certain amount of corneal tissue must be removed, you will be assessed as to whether you have sufficient corneal thickness to safely perform the procedure. INTACS - (Intrastromal Corneal Ring Segments) A relatively new refractive procedure is called INTACS. This comprises the insertion of two tiny plastic crescent shaped pieces of plastic into the cornea through a small incision at the top of the cornea. The main advantage to INTACS is that the corneal shape is altered by adding to it - not taking away. The central optic zone of the cornea is not touched in the INTACS procedure and this usually leads to exceptionally clear post-op vision. (Vision return is slightly slower than that of LASIK, but faster than PRK. INTACS also have the advantage of being exchangeable or removable, if required. INTACS are currently available only for nearsightedness, of relatively low amounts. In addition, only patients with low amounts of astigmatism are considered candidates for this procedure. ICL - Intraocular Contact Lenses This is a very new, non-laser procedure in the field of refractive surgery. The technique itself, however, is not new and is based on cataract "clear cornea" surgery. A small incision is made in the cornea and a correcting lens is injected into the eye in front of its own lens, behind the coloured iris. The implanted lens is firmly, permanently in place but may be removed if necessary. As ICL's are a very new procedure we are not recommending them except for patients with very high prescriptions. It is not possible to correct astigmatism with this procedure at this time. Refractive surgery can be a very effective and rewarding experience. People who have had to wear thick heavy glasses all their lives can now see without correction. It is often a fundamental lifestyle change. Wonderful as it is, it is still a surgical procedure and should be treated with respect and caution. No matter what the ads say, it is not like going for a haircut. Understand all about the procedures and their benefits and risks. See your optometrist for a full oculo-visual assessment and consultation regarding refractive surgery. Make sure you ask all your questions and you understand all the answers. Please feel free to call our office and speak to our laser vision consultant if you have any general inquiries regarding refractive surgery.