Refractive Surgery

Refractive Surgery

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Refractive errors known as myopia, hyperopia and astigmatism can be permanently treated with refractive surgery.

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Refractive Errors

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The eye can be roughly compared to a camera. Light rays from the external environment pass through refractive surfaces such as the cornea (the transparent layer at the very front) and the lens, and focus on the macula (the yellow spot), which is responsible for sharp vision in the retina. When light rays focus at a different point, this is called a refractive error. Refractive errors are examined in 3 different groups: myopia, hyperopia and astigmatism. Apart from these, the decline in the eye lens’s ability to focus on near objects after the age of 40, which causes a loss of near vision, is called presbyopia. This is not an eye disease but a natural part of the aging process.

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Myopia

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Myopia, defined as the inability to see distant objects clearly, is the result of light rays focusing in front of the retina. It most commonly develops because the front-to-back axis of the eye is longer than normal. It is a structural characteristic and is frequently inherited. It generally begins in school age and increases as growth continues..

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Hyperopia

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Generally, it is the inability to see near objects well. It occurs when light rays entering the eye focus behind the retina. Contrary to myopia, the structure of the eye here is smaller than normal. Structural and hereditary characteristics are the most common cause of hyperopia. Untreated hyperopia increases the risk of amblyopia (lazy eye) in children. For this reason, all children should have an eye examination before school age.

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Astigmatism

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It results from the cornea’s light-refracting power differing across different meridians. Astigmatism is an eye condition that causes blurred vision at every distance. It can be structural, and it can also develop as a result of degenerative diseases that may cause changes in the corneal layer, infections and trauma.

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Excimer Laser

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iLASIK treatment means that all stages of the laser treatment are tailored to the individual. Blurred vision lasts for 3–6 hours after treatment. Most of our patients can return to their daily lives the day after treatment. iLASIK is the combination of bladeless laser (INTRALASE) and personalized treatment (Advenced CustomVue). The unique structural differences of each eye have made personalized treatment (wavefront-custom ablation) necessary. Applying this treatment together with the iris recognition system has produced extremely successful results in treating all eye defects. Excimer laser treatment treats refractive errors by reshaping the corneal layer of the eye. Every eye structure and every disorder is different. For this reason, a different method is used for each person, and even for each eye.

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Who Can Have Laser Treatment?

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• Whose prescription has not changed in the last 1 year,
• Who has reached the age of 20
• Myopia up to 10 diopters
• Hyperopia up to 6 diopters
• Astigmatism up to 6 diopters,
• Laser treatment may be possible if the eye structure is suitable. Eyes whose structure is not suitable can be treated with other methods.

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Excimer laser treatment has two main stages:

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1. Creating a flap in the cornea

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2. Applying the laser to the eye

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In iLASIK, the flap is created with Intralase technology. The INTRALASE method is a bladeless approach used to create the flap in the cornea. The corneal flap is created with great precision exactly as planned. The flap is lifted with the laser, and disposable (single-use) materials are used during the procedure. It is much safer than standard LASIK. Then excimer laser treatment is applied to the corneal layer. During wavefront treatment, an iris recognition program is used. In this way, a correction is made. Known colloquially as ‘eagle vision’, this method provides better vision after treatment than glasses or contact lenses.

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What is iLASIK?

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iLASIK is a combination of today’s laser technology INTRA-LASETM and personalized treatment (Advanced CustomVueTM). iLASIK is a completely personalized treatment, performed based on personal vision quality. The technology used in the iLASIK method is a reliable method.

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Who can have iLASIK treatment?

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Anyone who has reached the age of 18, whose prescription has not changed in the last 1 year, and whose general health and eye structure are suitable can have iLASIK.

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What are the advantages of iLASIK?

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• The visual acuity achieved with iLASIK treatment is extremely high.
• The iLASIK procedure is a result of technological developments over the last 10 years.
• iLASIK is a Lasik procedure that efficiently brings together the latest developments in laser technologies.
• iLASIK is a technology that offers positive results, whose effectiveness has been proven and which has received FDA approval.
• Every stage of iLASIK is performed entirely based on the person’s eye structure and vision capacity.

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iLASIK stages

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1. Step – Creating your personal vision profile

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The first stage of the iLASIK procedure is to determine the characteristics specific to your eye through some tests, including the use of Wavescan technology. The Wavescan system creates a three-dimensional map of your vision defects. Then the Advanced CustomVueTM process uses the digital information obtained from this map to design your personal treatment for your eyes. Another feature of advanced personalized treatment (Advanced Custom-VueTM) is the use of Fourier analysis, which can create a personal, one-to-one, three-dimensional vision map with the wavefront aberrometer. In laser treatment, it is very important that the device fires at the planned point on the eye. For this reason, there must be a digital locking system between the device and the eye. In wavefront treatment, measurements are taken while sitting and treatment is performed while lying down; a slight rotational movement of the eye may occur in these positions. Thanks to the iris recognition system in the Wave-scan device, the person’s iris layer is detected by the laser device, and even the slightest rotational movements of the eye can be detected. Unlike the eye tracking systems we know, this technology can also follow the movements of the eye around its own axis.

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2. Step – Creating the iLASIK flap

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In iLASIK, the flap is created with Intralase™ technology. The Intralase™ method is a bladeless approach used to create the flap in the cornea. During the creation of the corneal flap, it allows exactly what was planned to be created with unwavering precision. The diameter, thickness, attachment site to the cornea, centering and regularity of the corneal flap are created exactly as planned. Thanks to Intralase LASIK, in which disposable (single-use) materials are used throughout the entire procedure, a better quality of vision can be obtained after the laser. In a clinical study in which patients had a flap created with a blade in one eye and with the Intralase method in the other eye, the vision in the eye treated with Intralase was rated 3 times more favorably than the other eye.

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3. Step – Your personal laser treatment

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Up to this step, your personal vision profile was created using Wavescan technology, and your corneal flap was created without a blade using Intralase; now your vision can be corrected within the iLASIK procedure using the Advanced CustomVue technique. The Advanced CustomVue procedure is an FDA-approved system with a wide application range for treating vision defects (myopia, hyperopia and astigmatism). Clinical studies conducted 1 year after treatment show that:

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• 100% of myopic patients, and more than 95% of all participating patients, were able to pass driving tests without glasses or contact lenses.
• 98% of patients with mild or high myopia achieved 10/10 or better vision without glasses and contact lenses.
• The night vision of participants with mild or high myopia improved after treatment.

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LASIK

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In this method, a flap is lifted from the corneal layer with a microkeratome blade. It is still used in many centers around the world. Since our clinic uses (iLASIK), this method is not preferred much.

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PRK-LASEK-EPILASIK

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It is a superficial excimer laser application. These methods are especially preferred for thin corneas. The laser treatment is applied by scraping off the epithelial layer without lifting a flap in the cornea. Blurred vision and a stinging sensation occur for three to four days. During this time, a temporary contact lens is applied to the patient.

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LASIK Method

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WAVEFRONT TREATMENT (ADVANCED CUSTOM VUE)

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In standard laser treatment, a laser correction is made based solely on the patient’s glasses prescription. In wavefront treatment, the wavefront device measures in detail the light scattering that occurs in the corneal layer, the eye lens and the retinal layer, and prepares a treatment plan according to this measurement. The treatment plan calculated by the wavefront device is transferred to the laser device, and thus a personalized laser treatment is performed. In patients who have undergone laser treatment with the wavefront system, better vision is obtained after treatment compared to standard laser treatment, and night vision problems also occur less frequently. For this reason, wavefront treatment is more suitable for drivers who need to drive at night for long periods or for those whose profession is related to night. In patients whose pupil diameter is structurally large in the measurements taken before laser treatment, wavefront is also the only option. One of the most important application areas of wavefront treatment is patients in whom standard laser treatment has failed. In patients who still have a defect in the eye after standard laser treatment, who have night vision problems, or in whom treatment cannot be performed appropriately for any other reason, wavefront treatment should definitely be preferred.

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PHAKIC INTRAOCULAR LENS IMPLANTATION – CLEAR LENS EXTRACTION

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These are the preferred methods for patients with myopia above 12 D or hyperopia above 6.0 D, which exceed the excimer laser treatment limit, or in whom laser treatment cannot be applied due to corneal characteristics. In phakic intraocular lens implantation, custom-made intraocular lenses are placed on top of the person’s own lens, in spaces we call the anterior or posterior chamber. Thus, the patient’s eye defect is corrected. In clear lens extraction, on the other hand, as in cataract surgery, the person’s lens is removed and an intraocular lens with the appropriate power is placed in the same location.

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What is presbyopia?

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When a distant object approaches, the signal reaching the brain is transmitted to the eye through nerves. Here, in the region of the eye called the “ciliary body”, the muscles contract and relax, and the fibers connected to them stretch or relax. When the fibers contract, the lens thickens and its refractive power increases, and we become able to see near objects. However, the eye loses this ability with age. As age advances, the contraction strength of the muscles decreases and the weight of the eye lens increases, and the points we can see up close move away from the eye. In this case, glasses or multifocal contact lenses can be used to see near objects. Or near vision can be achieved with some surgical interventions.

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What are the symptoms of presbyopia?

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Presbyopia patients have difficulty seeing when they bring objects closer than 50 cm; for this reason, they may hold objects away from their eyes in order to see them.

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Which methods are used in presbyopia treatment?

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There are many treatment methods applied worldwide for this condition. Currently, the methods accepted and considered reliable throughout the world for presbyopia treatment are primarily corneal inlay (Kamra) and then multifocal intraocular lens applications. Other applications are: Intracor, Supracor and Presbylasik laser applications, scleral implant applications and CK applications. In some of these applications, irreversible structural changes occur in the cornea (laser applications); in others, recovery is seen within a short time.

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Corneal Inlay Treatment

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Kamra Inlay treatment is a reliable treatment method developed to address age-related near vision problems and preferred by many eye physicians. The treatment is a micro implant, compatible with the eye structure, placed inside the cornea, the outermost layer of the eye, using a femtosecond laser. In Kamra Inlay treatment, the operation is performed from start to finish under only drop anesthesia. A flap is created on the cornea with the Intralase laser. If the patient also has a distance vision problem, this problem is first corrected with laser treatment; immediately afterward, the Kamra is placed and the flap is closed. For people without a distance vision problem, a special pocket is created for the inlay. Again, no pain is felt during the operation with the Intralase laser. The treatment is completed in approximately 10 minutes. No stitches or bandages are used after the treatment. After the operation, the patient can be discharged after resting for 15 minutes and can return to social life as early as the following day. When the treatment is combined with laser treatment, both near and distance vision defects are corrected. Unlike other presbyopia treatments, although there is no adverse change in near vision with Kamra Inlay treatment, the distance vision problem is also solved in the same operation.

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Multifocal Intraocular Lens Treatment

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In multifocal intraocular lens treatment, the lens inside the eye is removed and replaced with a lens that has more than one focus. These lenses have various rings. Some of these rings provide distance vision, and some provide near vision. Thus, both distant and near images fall sharply onto the vision point of the eye. After an adaptation period, patients perceive distant and near images, and their problems are resolved. Another advantage of the treatment is that, in patients who need cataract surgery, it removes the cataract and also solves the distance and near vision problems in the same session. Patients who undergo this treatment will not need cataract surgery in the future. The patient first undergoes a detailed examination. Not every patient’s eye may be suitable for this type of surgery. The patient’s occupation, age, social activity, reading habits and intellectual level are also important in patient selection for those with cataracts. High success rates are seen in these operations thanks to proper patient selection, the appropriate technique, the environment in which the surgery is performed, professional experience and, of course, correct lens selection.

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Contact Lens

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All contact lenses must be applied under the supervision of an eye physician. At our clinic, all prescription and colored lens applications are performed by expert physicians. Patients first undergo a complete eye examination to investigate whether there is any obstacle to lens use. If there is no obstacle, the appropriate lens option is determined. Then, how to use the lenses and how long they can be used are explained. If any problem is encountered, a doctor should be consulted as soon as possible.