Download Introduction - This office has changed!

Introduction
Photorefractive Keratectorny (PRK) and Laser Assisted In Situ Keratomileusis
(LASIK) are surgical laser procedures to correct myopia, hyperopia and
astigmatism. This consent form describes tile various surgical procedures
available, as well as the possible risks and benefits. The material is provided to
help you make an informed decision on whether to proceed with refractive
surgery. This information accompanies, but does not replace discussions with the
doctors and staff of Lasik Vision Canada Inc. You are encouraged to ask
questions about the procedure itself tiile risks, possible side effects and benefits
as well as alternative treatments.
The Normal eye, Myopia, Hyperopia and Astigmatism
The cornea is the clear, dome-shaped window that forms the front wall of the
eye. It acts as a lens to focus incoming light rays on to the retina, the lightsensitive tissue in the back of the eye.
In the normal eye light rays are brought to a single sharp focus directly on the
retina, resulting in clear vision without glasses or contact lenses. Any deviation
from this normal focusing is called a refractive error. Myopia, hyperopia and
astigmatism are common refractive errors
In myopia, or nearsightedness, the eye is longer than normal. The light rays
come together at a point in front of the retina, and thus are out of focus on the
retina. Distant objects appear blurry, whereas near objects may be seen clearly.
In hyperopia, or farsightedness, the eye is shorter than normal The light rays
come together at a point behind the retinal and thus are out of focus on the
retina. Near objects may appear blurry whereas distant objects may be seen
more clearly.
In astigmatism the curvature of the cornea (and therefore its focusing power) is
not the same in the horizontal and vertical directions. Light rays entering the eye
do not focus at a single point caugnp distorted vision. Many people with myopia
or hyperopia have some degree of astigmatism.
Traditional Correction of Refractive Errors
Eyeglasses remain the most common method of correcting vision, Glasses are
safe, relatively inexpensive, and usually well tolerated. To correct large refractive
errors, glasses must be thick and may reduce or increase the size of the visual
image by up to 25%.
Contact lenses rest directly on the cornea. If fitted and used properly, they are
effective and relatively safe. However, complications such as allergic reactions,
infections, and mechanical injury to the cornea can sometimes occur with the use
of hard or soft contact lenses.
Radial Keratotomy (RK) was pioneered in Russia and brought to North America
in 1979. Deep radial cuts like the spokes of a wheel, (90% of corneal thickness),
are made in the cornea. These incisions cause the peripheral cornea to bulge
and the central cornea to flatten thus correcting myopia and astigmatism.
The Excimer Laser
The Excimer laser reshapes the front surface of the cornea. This laser was
developed by IBM in the early I980's to etch silicone chips. It was subsequently
discovered that the laser could be used to cleanly and precisely remove Uving
tissue. The laser's high-energy ultraviolet light pulses break molecular bonds, but
do not heat or damage the surrounding tissue. A thin layer of tissue is removed
with each pulse. A computerized shutter controls the distribution of laser pulses
on the cornea. With multiple laser pulses, the central cornea can be sculpted,
changing its curvature and power.
Clinical treatment of sighted eyes was initiated in 1988 Clinical excimer lasers
are very complicated and sensitive instruments requiring careful calibration,
monitoring of energy output and regular maintenance.
Photorefractive Kerrtectomy (PRK)
After the eye has been anesthetized with eye drops, the surgeon removes the
front surface of the cornea (the epithelium). The excimer laser is then used to
sculpt a new shape onto the front surface of the cornea. It is this new surface that
corrects the refractive error. Following PRK, the epithelium repairs itself growing
back from the edges until it surfaces the front of the cornea. Over a period of
months following the procedure the epithelium attempts to "remodel" itself.
Therefore, eye drops are used for a period of approximately three months
following PRK in an effort to control the remodeling process.
Laser Assisted In Situ Keratomlleuds (LASIK)
LASIK uses a microkeratome to create an incisional flap on the front surface of
the cornea. This flap is then raised and the excimer laser is applied to the
exposed cornea to create a new refractive surface. The flap is then repositioned
to its original site, covering the previously exposed cornea. Mechanical,
biological, and hydrostatic forces hold the flap in place without the use of
stitches.
Patient Selection
Laser refractive surgery is appropriate for patients with myopia, hyperopia and/or
astigmatism who wish to have less dependence on glasses or contact lenses,
and are willing to assume the risks associated with the procedure. Minimum age
is 18 years. There should be no significant change in the glasses or contact lens
prescription for the previous twelve months. Patients pay for refractive surgery,
as insurance or Medicare does not cover it. Some reasons for not proceeding
with refractive surgery are:
1.
2.
3.
4.
5.
6.
Eye inflammation or infection
Excessive corneal scarring
Degenerative disease of the cornea
Uncontrolled diabetes
Use of drugs, which may interfere with the healing process
Pregnancy
Patients with presbyopia (the need for reading glasses) should understand that
refractive surgery would not affect this age-related process.
The Operation
Soft contact lenses must not be worn for at least 7 days prior to the surgery (a
minimum of 3 weeks for hard or gas permeable lenses). The operation is
performed as an outpatient procedure by fully qualified eye surgeons licensed to
practice in British Columbia at Lasik Vision Canada
Inc.
Eye drops are given before treatment; this provides suitable anesthesia. The
patient is positioned under the operating microscope. The eyelids are gently held
open with a lid speculum.
PRK:
The doctor will use a sterile instrument or the laser to gently
remove the surface layer (epithelium) of the cornea. Laser energy is then
delivered to reshape the cornea while the patient fixates on a light within the
microscope.
LASIK:
The doctor applies a sterile suction ring to the eye. This is not
painful, but some pressure may be felt. An instrument, known as a
microkeratome, is then used to create a flap in the outer layer of cornea tissue.
After removing the microkeratome and suction ring, the doctor positions the flap
to one side - it remains attached to the eye. The excimer laser is used to reshape
the cornea while the patient fixates on a light within the microscope.
Following Surgery:
PRK:
A soft contact lens is placed on the cornea in order to
protect the eye and keep it comfortable while promoting surface healing. Over
the next three to five days, until the contact lens is removed, eye drops will be
used on a regular basis. Vision will be blurry during this period. Once the contact
lens has been removed, different eye drops are to be used over the net few
months. Vision will gradually improve. Stable vision is usually achieved within
one to three months.
LASIK:
The flap is repositioned and holds itself in place through natural
forces. No contact lens is used Eye drops me applied on a regular basis and
clear plastic eye shields are worn at night only to prevent the patient
from rubbing their eyes. Drops are used for one to two weeks after
surgery. Stable vision is usually achieved in two to four weeks.
Benefits of Refractive Surgery
In most cases, vision improves enough to allow a person to function without
eyeglasses or contact lenses. Corrective lenses may still be required for activities
such as driving and reading. In addition to the visual improvement, you may also
experience psychological and functional benefits
Risks of Refractive Surgery
No surgical procedure is completely free of risk. It is not possible to list every
complication that can occur, and there may be adverse reactions, which are
unknown at this time. Since glasses or contact Ienses are currently available and
are generally safe, you need to thoroughly consider the risks versus the potential
benefits of having PRK or LASIK.
Risks Specific to PRK
1. Delayed epithelial healing and infection. The surface epithelium is removed
just prior to the laser surgery. This layer of the cornea usually heals within three
to four days, but there may be a delay in the process - associated with more pain
and increased risk of infection.
2. Microscopic corneal surface irregularities. PRK can cause microscopic corneal
surface irregularities and slight loss of best-corrected vision 1 to 2% of patients
may loose up to two lines of vision on the eye chart.
3. Excessive corneal haze. Corneal haze occurs as part of the normal healing
process. The haze peaks at six to ten weeks and then gradually subsides
over several months. In most cases, it has little or no effect on the final vision
and can only be seen with a microscope. However, there have been reported
cases of excessive haze, which ultimately require the patient to be retreated.
Retreatments for haze have been successful, but on rare occasions this risk
factor has caused some permanent decreased vision.
4.
Regression. In some patients, the effect of surgery is gradually lost over
several months. Such regression is more common in patients who are very
nearsighted (-6 diopters). In virtually all cases, this can be retreated.
Risks Specific to LASIK
1. Faulty or improperly created flap. The flap may be too thin, too thick or
uneven There is a small risk of the 'hinge' of the flap being cut. The flap may
move or wrinkle post-operatively. Rubbing the eye may cause the flap to move or
wrinkle after surgery. This may result in some permanent reduction in bestcorrected vision.
3. Epithelium or debris under the flap. A small amount of debris under the flap
does not affect your vision. If necessary, the flap can be lifted and the debris
removed.
4. lnfection under the flap. This is very rare. Medications treat this complication.
However, scarring may occur.
Risks Associated with PRK and LASIK
1. Under or over correction. If the desired corrections not achieved, glasses may
still be necessary for good vision. Significant over or under corrections can be
retreated.
2. Halo effect. Halo is an optical effect that is noticed in dim light. As the pupil
enlarges the untreated peripheral cornea produces a second faded image.
Some patients who have undergone refractive surgery notice this effect while
driving at night. Halos occur less frequently with the larger treatment zones
being used today.
3. Decentration. Significant Decentration of the zone of treatment (the laser
beam not centered on the pupil) can occur. Halo and blurry vision can result.
4. Inconvenience between surgeries. In the time between surgery on the first
and second eye, the two eyes may not work well together because of their
temporary difference in refraction (spectacle correction). If a contact lens is not
tolerated on the un-operated eye, work and driving may be difficult until the
second eye has had refractive surgery.
5. Presbyopia and reading glasses. As a person grows older, the lens of the eye
is less able to focus and near vision becomes more difficult. This is a normal
aging process called presbyopia, a condition that can be alleviated with reading
glasses or bifocal lenses. An advantage of being myopic (nearsighted) is that it
generally takes longer to be affected by presbyopia. After laser surgery, a patient
over the age of 40 may require reading glasses to see find print.
6. Remote risks. As with any eye surgery, there is a remote possibility of
severe infection, corneal perforation, drug reaction, or other rare complications
that could cause eye problems.
7. Raised eye pressure. Transient elevation of intraocular pressure. However,
monitoring eye pressure is a routine part of the follow-up care.
8. Delayed recovery of best-corrected visual acuity (BCVA). It may take several
months for full recovery of BCVA to occur following refractive surgery. This is
due to healing and/or haze of the cornea. With the passage of time, the BCVA
gradually improves and returns to its original pre-operative level. However,
further treatment may be necessary if the best- corrected vision is not fully
restored.
Frequently Asked Questions Regarding
PRK & LASIK
How many patients have you treated at your clinic in Vancouver?
The Vancouver clinic has been responsible for the treatment of over 8,000 eyes
to date. These outcomes have been presented at all major Canadian and US
Ophthalmology seminars for peer review.
How is the surgery performed?
The Excimer laser performs the treatment n7e cool light 6 the laser beam
vaporizes corneal tissue, reshaping the surface and enabling the patient to see
clearly without the need for glasses or contact lenses. The anesthetic is
administered by eye drops; there are no needles involved.
What kind of laser is it?
LASIK and PRK are performed with a Nidek Excimer laser, 3" generation, It is
state oft he art equipment.
How long does the Procedure take?
The actual surgery takes only minutes, but the amount of time the laser is active
on the eye is just seconds. Preoperative examination and preparation for surgery
is done in the clinic on the day of treatment and takes approximately I hour prior
to surgery time.
Can I drive immediately after surgery?
On the day of your surgery, we recommend that you have someone with you or
make alternate transportation plans, as you will not be driving for the first few
days. It is recommended that you wait four days to one week before driving,
longer if you are still experiencing blurred vision.
Does it hurt?
The procedure itself is painless. With LASIK, there may be some discomfort or
irritation for up to 24 hours after surgery. With PRK you may experience irritation
for one week or more after surgery. We provide pain relief medication in drop
form to help eliminate any discomfort.
What are the risks?
No surgical procedure is completely free of risk it is not possible to list every
complication that can occur, and there may be adverse reactions, which are
unknown at this time. You as the patient need to thoroughly consider the risks
versus the potential benefits of having PRK or LASIK.
Infection:
Light Sensitivity:
Visual Acuity:
others.
Post-op drops reduce risk.
This may occur in the first month (if at all) after surgery and
can be alleviated by wearing sunglasses.
Vision might be clearer at certain times of the day than at
This is not a permanent condition,
Undercorrection:
Your eye may retain some degree of myopia during the
healing process. This can be treated with an additional laser procedure
(free of charge to the patient).
Corneal Haze:
Haze is uncommon with our new scanning laser.
Unlike RK, there are no cut made in the cornea therefore scarring is
minimal. If one is vigilant using the medication in the drop regimen, the risk is
even less. If a small amount of haze were to occur, it can be treated with an
additional laser procedure some months later.
Delayed Epithelial
Healing:
With PRK, the surface epithelium is removed prior to
surgery. This layer of the cornea usually heals within three to four days,
but there may be a delay in the process - associated with irritation and risk of
infection, which can be alleviated with medication.
How long will it take to return to normal activity level (work)?
The patient will have functional vision within the first 24 to 48 hours after the
operation (with LASIK), however temporary blurred vision is common. We
suggest that the patient take four to five days off work and will be unable to drive
for approximately 3 days after surgery. Functional vision with the PRK procedure
is normally present within a one to two week period
What are the difference between LASIK and PRK?
LASIK heals much quicker and usually provides comfort and vision within a 12 to
24 hour period after surgery. It is a more intense procedure for the patient, as a
suction ring is applied to the eye creating pressure for a few seconds. The
complication rate is probably lower than that of PRK. Less medication, virtually
no haze, less down time for the patient), but if a complication were to occur with
the flap it may be more serious than the complications of PRK alone. PRK is a
less intense surgical procedure and has been very widely carried out for more
than 9 years and is therefore clinically proven It requires a contact bandage lens
on the eye for approximately five days while the corneal layer heals. Healing time
with PRK can be 3 months or more and a drop regimen of 3 months is required If
retreatment is needed the whole process is repeated.
Is it guaranteed?
No surgical procedure can be guaranteed, but our patients have achieved
excellent results. The outcome depends on the degree of nearsightedness
preoperativeiy. Initially most patients achieve 20/40 vision or better with one
treatment, even with the greatest refractive error. Should you need an additional
treatment, it will be covered by the clinic at no extra cost.
Can I correct both eyes at once?
Yes, the surgery performed in our clinic is a bi-lateral (both eyes) procedure.
Having your eyes done at different times only extends the healing time and more
post-op appointments are required. Most patients find it more convenient to have
both eyes treated at the same time, however, if a patient requests to have them
done separately that certainly can be accommodated.
What happens after surgery?
We see each patient the day after surgery. There are then 3 post-operative
examinations starting with 1 week from their surgery date, 1-month and 3
months. The purpose of these appointments is to check the healing process of
the eyes. Should any complications arise, they can be quickly addressed.
What if am travelling from out of town?
One of our counselors will have booked your surgery date and your surgical
confirmation package will be forwarded to you. This package includes important
information regarding your surgery as well as hotel referrals and a map. You may
have your pre eye-exam in our clinic or you may choose to have that with your
own optometrist (if you choose to do that, you or your optometrist will have to fax
the results of your eye exam to the clinic). You will be required to be
in our clinic on the day of your surgery, as well as the following morning for the
first post-op exam, after that you are free to travel home.
What will happen to my eyesight in the future? Will it get worse again?
PRK and LASIK do correct myopia and astigmatism permanently. However
some patients need a retreatment due to individual healing and initial corrections.
For those with high prescriptions the chance of needing a retreatment is greater.
Studies over the past ten years show that the result of the surgery will not lose its
effectiveness over time. One thing we cannot correct is the need for reading
glasses (presbyopia), as this condition affects the lens inside the eye and is part
of the natural aging process. This procedure does not change the normal course
of nature. Should you be genetically predisposed to cataracts or glaucoma, this
procedure neither promotes nor deters when this would normally happen. The
same applies should your eye physically change (nothing to do With the surgery),
leaving you somewhat more myopic.
How do I choose a surgeon and a facility?
The more experienced the surgeon, the more knowledgeable he/she will be
about preventing and managing any complications. Generally, the complication
rate of a large volume surgical practice is lower than the complication rate of a
low volume clinic. At this facility more than 8,000 laser refractive procedures and
over 10,000 cataract surgical procedures have been completed. Staff at
LASIK Vision Canada are highly trained professionals and are experienced in all
aspects of these surgeries. They will be able to answer all your questions and
concerns before, during, and after your procedure. We are available for
emergency calls post-operatively if required.
What is the cost of PRK and LASIK procedures?
The regular cost these procedures is $2,950.00 (CDN) and $1,950.00 (US) for a
bilateral procedure. There is no tax on this amount procedure and it may be tax
deductible for some patients. Travel and accommodations for "out of town"
patients are their own responsibility, however the clinic can supply you with hotel
referrals at corporate rates.
Thank you for your recent inquiry regarding laser vision correction with LASIK
Vision Canada.
We are delighted that you are seeking further information regarding this life
changing procedure!
Our Fees:
Canadian Patients
$2,950.00
both eyes
US Patients
$1,950.00 US both eyes
Canadian Corporate rate
$2,450.00
both eyes
US Corporate rate
$1,450.0qUS botheyes
Services Included: A free-screening consultation, complete pre-eye examination
to deem candidacy for the procedure, the surgical procedure and post-operative
visits at 24 hours, 1 week, 1 month, and 3 months.
Should the patient choose to have their pre and/or post-operative exams
with their own optometrist, they would have to incur the cost of those
visits. The 24-hour post-op appointment is mandatory at LASIK Vision
Canada.
If an enhancement procedure is required, LASIK Vision Canada
honors a lifetime warranty for services performed. Enhancement procedures are
provided at no extra charge.
Payment Options:
We offer the following payment options:
1.
Cash, certified cheque or bank draft
2.
Debit card: Interac bank machine card
3.
Major credit cards: Visa, MasterCard, American Express
4.
Financing - Payment Plan (Canadian Citizens only). This is
available through Citizens Bank or Toronto Dominion Bank. The patient must call
to request a financing packet be sent to them. Prior approval is required.
Authorization for financing must be received in the clinic one
WPPk nnnr tn surgery day.
PN day
"--~- r'--~ ~- --' --i. day ·
~`75~'
Please note a non-refundable deposit of $300 is required at the
time of booking each surgery. This deposit is only refundable if
tl_l~l`fie~~PStdcSm~i~ not a good candidate for medical
reasons.