Freedom From Glasses

Understanding The Need for Vision Correction.

• Our ability to see depends on the way that your eyes bend (refract) light.
• A refractive error occurs when they do not bend it perfectly, preventing the eye from focusing light correctly. Common refractive errors can be corrected with glasses and contact lenses temporarily but surgery improves them on a long term basis.
• Anatomical features affect the ability of your eyes to refract light and focus properly.

Below are the factors that can cause refractive errors:

1. Eye Length: While it may not seem to you that the shape of your eye is too long or too short, either condition can affect your vision. You may have nearsightedness if it is too long or farsightedness if it is too short.
2. Curvature of the Cornea: The lens on the front of your eye needs to maintain an entirely spherical shape to refract a proper image. Refractions from irregular cornea shapes can produce astigmatism.
3. Curvature of the Lens: When the curve of the lens conforms to the shape of your cornea and the eye length, there is no refractive error. However, a lens that is too flat causes farsightedness, and a curve that is too steep may produce nearsightedness types of problems.

The Eye & The Vision Errors.

1. A normal person or an Emmetrope sees well because rays from the outside world fall exactly on the light sensitive retina allowing them to see sharp and clear images of the world.
2. In people with refractive error (or poor vision, such as nearsightedness or farsightedness), the light rays do not get focused on to the retina and blurred images are formed.
3. The cornea is a part of the eye that helps focus light to create an image on the retina. It works in much the same way that the lens of a camera focuses light to create an image on film. The bending and focusing of light is also known as refraction.
4. Usually the shape of the cornea and the eye are not perfect and the image on the retina is out-of-focus (blurred) or distorted.
5. These imperfections in the focusing power of the eye are called refractive errors. There are three primary types of refractive errors: myopia, hyperopia and astigmatism.
   • Persons with myopia, or nearsightedness, have more difficulty seeing distant objects as clearly as near objects. 
   • Persons with hyperopia, or farsightedness,  have more difficulty seeing near objects as clearly as distant objects. 
   • Astigmatism is a distortion of the image on the retina caused by irregularities in the cornea or lens of the eye.
   • Combinations of myopia and astigmatism or hyperopia and astigmatism are common.

Glasses or contact lenses are designed to compensate for the eye’s imperfections. If you are happy wearing contacts or glasses, you may not want to have refractive surgery. Together, you and your ophthalmologist can weigh the risks and rewards of LASER Procedures.

Surgical procedures aimed at improving the focusing power of the eye are called refractive surgery.

If you are considering refractive surgery, you should discuss with your ophthalmologist the benefits and risks — including quality of life issues — that could result from correcting vision with surgery rather than eyeglasses or contact lenses.

Refractive Surgeries options available at Saluja Eye Care Center:

• Laser Vision Correction
  1. LASIK
  2. PRK
  3. Advanced Monovision for Presbyopia
  4. Presbyopia LASIK
• Lens based Refractive surgery
  1. ReLEX
  2. Multifocal IOL
  3. Toric IOL
  4. Phakic IOL/ ICL/IPCL
• Others.

You should consult with your doctor to know what is the best option for you.

Before the refractive eye surgery

1. You and your ophthalmologist will discuss your vision needs based on your lifestyle. For example, if you play sports, you may be seeking clear distance vision from surgery.
2. Also, you and your ophthalmologist should discuss your expectations for LASIK. People who have LASIK to achieve perfect vision without glasses or contacts run the risk of being disappointed. This laser eye surgery allows people to do most of their everyday tasks without corrective lenses. However, you might need to wear glasses for certain activities, such as reading or driving at night.
3. The day before surgery, you should stop using:
   • Creams
   • Lotions
   • Makeup
   • Perfumes
4. These products as well as debris along the eyelashes may increase the risk of infection during and after surgery. Your doctor may ask you to scrub your eyelashes for a period of time before surgery to get rid of residues and debris along the lashes.
5. Also before surgery, arrange for transportation to and from your surgery and your first follow-up visit. On the day of surgery, your doctor may give you some medicine to make you relax. Because this medicine impairs your ability to drive and because your vision may be blurry, even if you don’t drive make sure someone can bring you home after surgery.

Important information Related to Refractive Surgeries

1. Know what makes you a poor candidate.
2. Career impact – does your job prohibit refractive surgery?
3. Cost – can you really afford this procedure?
4. Medical conditions – e.g., do you have an autoimmune disease or other major illness? Do you have a chronic illness that might slow or alter healing?
5. Eye conditions – do you have or have you ever had any problems with your eyes other than needing glasses or contacts?
6. Medications – some medications that might prevent healing?
7. Stable refraction – has your prescription changed in the last year?
8. High or Low refractive error – do you use glasses/contacts only some of the time? Do you need an unusually strong prescription?
9. Pupil size – are your pupils extra large in dim conditions?
10. Corneal thickness – do you have thin corneas?
11. Tear production – do you have dry eyes?
12. Know all the risks and procedure limitations.
13. Over-treatment or under-treatment – are you willing and able to have more than one surgery to get the desired result?
14. May still need reading glasses – do you have presbyopia?
15. Results may not be lasting – do you think this is the last correction you will ever need? Do you realize that long-term results are not known?
16. May permanently lose vision – do you know some patients may lose some vision or experience blindness?
17. Dry eyes – do you know that if you have dry eyes they could become worse, or if you don’t have dry eyes before you could develop chronic dry eyes as a result of surgery
18. Development of visual symptoms – do you know about glare, halos, starbursts, etc. and that night driving might be difficult?
19. Contrast sensitivity – do you know your vision could be significantly reduced in dim light conditions?
20. Bilateral treatment – do you know the additional risks of having both eyes treated at the same time?
21. Patient information – have you read the patient information booklet about the laser being used for your procedure?
22. Know preoperative, operative, and postoperative expectations
23. No contact lenses prior to evaluation and surgery – can you go for an extended period of time without wearing contact lenses?
24. Have a thorough exam – have you arranged not to drive or work after the exam?
25. Read and understand the informed consent – has your doctor given you an informed consent form to take home and answered all your questions?
26. No makeup before surgery – can you go 24-36 hours without makeup prior to surgery?
27. Arrange for transportation – can someone drive you home after surgery?
28. Plan to take a few days to recover – can you take time off to take it easy for a couple of days if necessary?
29. Expect not to see clearly for a few days – do you know you will not see clearly immediately?
30. Know sights, smells, sounds of surgery – has your doctor made you feel comfortable with the actual steps of the procedure?
31. Be prepared to take drops/medications – are you willing and able to put drops in your eyes at regular intervals?
32. Be prepared to wear an eye shield – do you know you need to protect the eye for a period of time after surgery to avoid injury?
33. Expect some pain/discomfort – do you know how much pain to expect?
34. Know when to seek help – do you understand what problems could occur and when to seek medical intervention?
35. Know when to expect your vision to stop changing – are you aware that final results could take months?
36. Make sure your refraction is stable before any further surgery – if you don’t get the desired result, do you know not to have an enhancement until the prescription stops changing?
37. You are probably NOT a good candidate for refractive surgery if:
    • You are not a risk taker. Certain complications are unavoidable in a percentage of patients, and there is no long-term data available for current procedures.
    • It will jeopardize your career. Some jobs prohibit certain refractive procedures. Be sure to check with your employer/professional society/military service before undergoing any procedure.
    • Cost is an issue. Most medical insurance will not pay for refractive surgery. Although the cost is coming down, it is still significant.
    • You required a change in your contact lens or glasses prescription in the past year. This is called refractive instability. Patients who are:
      1. In their early 20’s or younger
      2. Whose hormones are fluctuating due to disease such as diabetes,
      3. Who are pregnant or breastfeeding, or
      4. Who are taking medications that may cause fluctuations in vision, Who are more likely to have refractive instability and should discuss the possible additional risks with their doctor.

38. You have a disease or are on medications that may affect wound healing. Certain conditions, such as autoimmune diseases (e.g., lupus, rheumatoid arthritis), immunodeficiency states (e.g., HIV) and diabetes, and some medications (e.g., retinoic acid and steroids) may prevent proper healing after a refractive procedure.
39. You actively participate in contact sports. You participate in boxing, wrestling, martial arts or other activities in which blows to the face and eyes are a normal occurrence.
40. You are not an adult. Currently, no refractive procedures on persons under the age of 18.
41. During the first few months after surgery, your vision may fluctuate.

• It may take up to three to six months for your vision to stabilize after surgery.
• Glare, haloes, difficulty driving at night, and other visual symptoms may also persist during this stabilization period. If further correction or enhancement is necessary, you should wait until your eye measurements are consistent for two consecutive visits at least 3 months apart before re-operation.
• It is important to realize that although distance vision may improve after re-operation, it is unlikely that other visual symptoms such as glare or halos will improve.
• It is also important to note that no laser company has presented enough evidence for the FDA to make conclusions about the safety or effectiveness of enhancement surgery.

Contact your eye doctor immediately if you develop any new, unusual or worsening symptoms at any point after surgery. Such symptoms could signal a problem that, if not treated early enough, may lead to a loss of vision.

What percentage of patients attain 20/20 vision or better without glasses or contacts?

A: Data in the Approval Orders and related documents summarizes the outcomes from the clinical trials submitted to the FDA for each approved device. Links to these documents are included on the FDA-Approved Lasers page.