Lasik or lenses | See without glasses

LASIK

LASIK (laser-in-situation-keratomileusis) is probably the most well known and most used method of refractive surgery. In combination of microsurgery-like cutting technique and removal of tissue by the Excimer-Laser, quick and exact results can be reached.

Special andvantages of LASIK:

• wide area of correction
• fast regeneration of visual acuity
• pain-free healing phase
• stable results

What is going to happen?
After covering the lids with anesthetic eye drops, first there will be a dissection of the cornea-lamella by microtome or femtosecond laser, which will be lifted, so that the corneal tissue below can be modeled suitably. When the lamella is back in place, it will suck itself onto the eye and will strongly reconnect to it in a matter of days. The pure laser treatment usually takes less than a minute and the whole operation takes less than 15 minutes. The laser procedure is completely painless and invisible for the patient.

After one to two days very good visual acuity will develop and become stable within the next month. For a few days after the operation antibiotic and moisturizing eye drops should be used and, if necessary, a protective shield should be worn while sleeping.

In the first few days, most patients will feel only a slight sensation of a foreign body in the eye. Higher glare and lower visual acuity during the night are often observed in the first weeks and especially can occur for people with relatively large pupils and higher corrections. Even though, for a majority of patients, the exact correction that has been requested is reached after the treatment, another correction can become necessary. Usually after some months.

LASIK is a very safe and scientifically approved method. Complications normally do not occur, and when they do they can mostly be corrected with another treatment. We also provide preservative-free antibiotic eye drops for pre-operative pretreatment during the preliminary examination.

BEFORE SURGERY
Three days before the operation, eyelid-makeup should not be used and on the day of the operation one should not use perfume.
The operation is done on an outpatient basis. The patient should be picked up because he/she is not allowed to drive for 24 hours after surgery. In addition, because of the general medication (ibuprofen and dormicum), no machines can be operated and no meaningful decisions should be made.

The operation is done on an outpatient basis. The patient should be picked up because he/she is not allowed to drive for 24 hours after surgery. In addition, because of the general medication (ibuprofen and dormicum), no machines can be operated and no meaningful decisions should be made.

AFTER SURGERY
An eye which has been recently operated on requires careful handling. In the days after the operation the concerned eye should not be rubbed. The patient also should not be too physically active, should not visit a public pool and should not apply any makeup. Eye drops, eye ointment and other medication(s) should be used regularly or taken as ordered. All follow-up examinations are essential. For our patients, we usually recommend: one day after surgery, one week, one month, three months, one year.

A laser surgery of the cornea has effects on subsequent measurements of the eye. Therefore, the patient should tell the ophthalmologist about the any such laser operation prior to measurement of ocular tension or pre-examination for cataract surgery. If any abnormalities occur that may indicate complications, the doctor should be contacted immediately. Our surgeon will always be available for you.

POSSIBLE COMPLICATIONS OF A LASIK-TREATMENT

• If left untreated, infections can lead to corneal clouding and permanent reduction of visual acuity. They are extremely rare in Central Europe.
• Deviation of the cutting quality
• Under certain anatomical conditions of the eye, certain technical problems can lead to difficulties in the preparation of the corneal flap. This may result in interruption or rescheduling of the procedure, or another method may be advisable.
• Healing disorders (or delays) can cause asymmetric surfaces and thus irregular astigmatism which usually nomalize after a few months or, if necessary, need to be corrected.

PERSONALIZED TREATMENTS The correction of spherical aberrations using the laser treatment was started years ago. At first, there was euphoria but it needed to be critically reviewed. As a result, we examined various factors influencing aberrations in the eye. Our results from this "world's first large-scale screening of this issue" were published at the ESCRS 2001 Cannes Congress and honored with the Congressional Prize.

Personalized treatment with "Custom vue"® - a new way with the VISX Star S4™ IR On the one hand, CustomVue ™ consists of the iDesign, a highly sensitive diagnostic device that produces wavefront maps, so-called "fingerprints of the eye" on the other hand, from the excimer laser VISX STAR S4 ™ IR, which uses this information to reshape the corneal tissue using LASIK or PRK. Together, these devices provide a very precise method for individual refraction correction.

Iris registration and Fourier transformation Other technical features of the VISX Star S4 ™ IR also help to improve surgical results. By means of iris registration (IR), the finest movements of the eye can be corrected under the excimer laser. Since all wavefront measurements are made while the patient is sitting, but treatment is done while the patient is lying down, cyclorotations (twisting of the eye) may occur (J. Stevens, ASCRS 2005). These movements can be compensated for by means of a complex iris registration, which is particularly important in treatments of astigmatism.

3D ActiveTrak™ Eyetracker In addition to the other technical refinements, the VISX laser has also incorporated a 3D ActiveTrak eye tracking system, which follows the small movements of the eye automatically and instantly in all three dimensions. For the best possible correction it is necessary to keep the laser focused on the treatment zone. The VISX 3D Eyetracker controls the laser to correct the spot position for even the smallest movements of the eye and to allow a precise individual correction.

Femto-LASIK

Excimer laser treatment after flap preparation with femtosecond laser

The difference between the LASIK and the Femto-LASIK or iLASIK is found in the preparation of the coverage (Flap), which must be flipped aside during the treatment to make the desired correction in the cornea with the excimer laser.

The femtosecond laser achieves a separation of the corneal lamellae through extremely short laser pulses (in the femtosecond range) through the smallest "explosions" in a precisely defined corneal depth. The result is a cut with great precision. The advantages of this method are:

• more accurate cut and depth
• less mechanical parts during preparation
• Thinner slats ("flaps") are possible. This is especially useful at higher diopters.

But - femtolaser does not necessarily mean femtolaser.
In October 2008 we decided in favor of the most modern and the safest device: the IntraLase 60 kHz. We have been able to significantly improve the quality of the cut. But even with this device, the development did not come to a standstill. From May 2009, the IntraLase femtolaser with 150 kHz will be available: a module of iLASIK technology. As studies have shown, the cuts are even smoother and more precise. Also, the treatment time is reduced by half - less stress for the patients, less strain on the eye.

WAS IST ILASIK?

iLASIK ™ describes the combination of the most advanced laser and diagnostic equipment, the IntraLase® FS femtosecond laser, the VISX STAR S4 IR® excimer laser, and the iDesign aberrometer.

Extraordinary technology with every step

The iLASIK ™ system provides a fully integrated, fully customized treatment, using the most advanced technologies in each step..

Step 1 - Creating your personal visual profile
Step 2 - Preparing the iLASIK ™ Flap
Step 3 - Correcting your vision defect with the VISX STAR S4 IR® Excimer Laser

ReLEx smile

For the correction of refractive errors, the individualized femto-LASIK has been regarded as the best scientifically recognized procedure for more than 10 years. The ReLEx smile technology takes a different approach: A narrow opening is prepared by means of a femto laser to prepare a 3D slice (lenticle) inside the cornea (stroma) and remove it via the opening. This lenticule, corresponds in volume and shape to the amount of tissue of your ametropia to be corrected. The stability of the cornea is largely preserved and the production of the tear film is less disturbed. Therefore, ReLEx smile may also be more appropriate for patients with dry eyes or contact lens intolerances.

PRK & PTK

PRK
A PRK (photorefractive keratectomy) may be useful if, for example, a LASIK is contraindicated because of too little thickness of the cornea, or in the case of superficial corneal scars. These can be simultaneously reduced during the treatment. With the PRK, e.g. Ametropia with a myopia can be corrected to -5 dioptres as well as a low-grade astigmatism.

In contrast to LASIK, no cut is made in the tissue. Only the corneal epithelium is removed and then the tissue removal is done from the outside. For a few days, the patient wears a so-called therapeutic contact lens.

• Complications
  Pain and burning eyes as well as increased tears often persist after the procedure. An eye dryness can also occur. Scars sometimes form, but usually disappear within months. Therefore, vision may be somewhat limited during this time. Especially in the first few months, there might be an increased glare sensitivity. The visual defect can be under- or over-corrected. Also, in very rare cases, the ablation site is not centered exactly so that distorted and blurred images may occur. The procedure can rarely lead to recurrent corneal erosion. The open cornea also rarely causes infections and extremely rare corneal ulcers. In such cases, it could lead to permanent vision deterioration, to blindness or loss of the eye. Also allergic reactions can not be excluded.
  Hinweis: Dieser Abschnitt kann nur einen kurzen Abriss über die gängigsten Risiken, Nebenwirkungen und Komplikationen geben und erhebt keinen Anspruch auf Vollständigkeit. Das Gespräch mit dem Arzt kann hierdurch nicht ersetzt werden.
  
  
• Forecast
  In most cases, the PRK can be used to correct the ametropia, provided that the presupposed dioptric values have not previously been exceeded. However, it can not be ruled out that seeing does not get better or even worse. In about 5% of cases, glasses or contact lenses must still be worn. A presbyopia, in which the elasticity of the lens decreases, can not be satisfactorily corrected. Correction attempts have been in trial for years. A disadvantage of PRK is that scarring can form in the cornea.
  
  Most of the time the day after laser surgery visual improvement without correction is noticeable. The end result can only be fully assessed after several months, during which time vision may still vary.
  
  LASEK and Epilasik are operationally equivalent to a PRK. We will gladly inform you about the differences on our information evenings or in a personal consultation.

PTK
If the removal or reduction of corneal opacities is the goal in the removal of the tissue "from the outside", one speaks of a PTK (Photo-Therapeutic Keratectomy). The indications can be very different. It is also the drug of choice for recurrent corneal erosion. The PTK is in many cases covered by public health insurance. It then will not be done by the eye clinic, but by the practice of Dr. Rasch and his colleagues. (see aslso "PTK-treatment")

Bandförmige Hornhautdegeneration

nach der PTK

Lens implants

Lens implants can either be inserted into the eye (Phake lenses, P IOL) or replaced after removal of the lens (intraocular lenses = ICL).

Phake anterior chamber lens (Verisyse, Artisan) The desired refraction change may also cause a lens implanted between the cornea and the iris into the anterior chamber. It can be attached to the iris or resiliently supported in the chamber angle. With bifocal optics, the presbyopia can be corrected as well.

Possible complications: Loosening of the lens and contact with the cornea may cause opacification of the cornea.

Intraocular contact lens (VISIAN ICL) The ICL is implanted in the eye and remains there permanently to change the refractive power of the eye. The lens is made of well-tolerated materials so that virtually no repulsion reactions occur. The ICL is implanted through a 2.5 mm small incision and placed behind the iris and in front of the eye lens. The operation is performed on an outpatient basis under local anesthesia and lasts about 20 minutes. The implantation of an ICL is a reversible method, meaning the contact lens can be removed at any time.

Possible Complications: The contact of the ICL with the body's own lens can lead to clouding of the natural lens.

Clear lens extraction

Astigmatismus-correction

Varia

The LaserSoft of the company Katana Technologies is a so-called solid-state laser. It is one of the most advanced and sophisticated systems in refractive surgery. It does not require gas and has other advantages along with the world's smallest 0.2 mm spot size: less corneal temperature and less pain after water treatment. The tissue removal is thus independent of the moisture of the tissue. With a pulse rate up to 4 KHz, the system is considerably faster than all excimer lasers. The very fast video eye tracker is used to track the eye movements and is suitable for the treatment of fine irregularities of the cornea. The "LaserSoft Intelligent Software" allows corrections for myopia, astigmatism and hyperopia and over topolink and ocular wavefront measurement, such corrections as the one of presbyopia are possible. Our clinic has been working with Katana since the development of this new technology.

Radial Keratotomie (RK) Here, several deep cuts are placed in the cornea, radiating from the vicinity of the center to the outside. Since the method has many disadvantages, it is no longer recommended today.

Intracorneal ring segments (ICR),INTACS® Not only cuts, but also implants in the cornea, can lead to a change in the refraction. The ring segments reduce the refractive power like a diverging lens. The "tunnel"-cuts necessary for the implantation of the segments are performed with the femtosecond laser today. Nowadays, intacs are mainly implanted to stabilize the cornea in a case of cratoconus.