Download Laser Blended Vision - Saint James Hospital Eye Clinic

Laser Blended Vision (LBV)
Presbyopia is the term given to the loss of the eyes ability to alter its focus from distant to near objects. It
is an age related condition which affects everyone at about the age of 45.
Presbyopia can come as a shock especially to people who never needed glasses in their younger years. It
also can be very frustrating to people that used glasses for distance and now they have to use different
glasses for intermediate and near vision. It is important that when thinking of presbyopia patients consider
at least three separate focal distances
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Distance vision
Intermediate vision
Near vision
For many years, ophthalmologists have provided for contact lens wearers a technique called monovision.
Monovision means that one eye (the dominant eye) is corrected fully for distance and the other eye will be
slightly under corrected to compensate for reading. This can work very well for middle aged patients who
still have a little flexibility in their eyes focusing system. With increasing age, a patient depth of focus or
accommodation will decrease and the reading strength will need to be increased accordingly. This
ultimately creates a blur zone for intermediate distances such as when looking at the dashboard of a car,
or prices in a shop window. So the situation is that we have 2 eyes and we need to consider three focusing
distances. So as we grow older, monovision becomes less tolerable because of the difference in correction
of the two eyes. And this is what causes the blur zone.
SJH-EC-PI/frm 008 v1.0
Authors: Tanya Costa
Date: August 2016
Saint James Hospital – Eye Clinic
The image represents full monovision correction without the benefit of Presbyond.
Due to the difficulty that some patients have in adapting to full monovision correction, many refractive
surgeons are providing patients with laser blended visual correction. Laser blended vision takes
monovision to the next level. Complex wavefront guided laser ablation profiles expand the depth of focus
available to each eye. The expanded depth of field allows for a wider range of focus to be achieved reducing
dependence on spectacles as far as is possible.
One eye is profiled to allow full distance vision and some mid -range vision and the other eye is profiled of
focus at the mid- range, but allowing for some closer focus to be achieved. In such a way laser blended
vision, aims to reduce a patient’s need for spectacles to the absolute minimum.
All patients whatever their age, need to be aware of the aging changes that will take place in their eyes
eventually. Patients need to consider their long term visual needs very carefully, as increasing age brings
compromises that must be understood and accepted.
Patients also need to consider the type of jobs and lifestyle choices before choosing this type of treatment.
Eligibility test:
You are eligible* if:
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you are over 40
Myopic from -1.0D up to -10.0D
Hyperopic from +1.0D up to +4.0D
Astigmatic from +2.5D up to -4.0D
Have not had significant change in refraction for one year prior to the procedure date
Want to see clearly without your glasses / reading glasses or contact lenses
* This table is intended to serve only as a guidance and is not a substitute for a professional eye examination
SJH-EC-PI/frm 008 v1.0
Authors: Tanya Costa
Date: August 2016
Saint James Hospital – Eye Clinic
Contraindications for laser treatment:
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Diabetes
Autoimmune disease
Wound recovery problems, keloid susceptibility
Amblyopia, lazy eye
Cataract/Glaucoma
Pregnancy planned within six months
Nursing mothers
Keratoconus (irregular shaped cornea)
Previous Herpes infection in the eye
Severe dry eye syndrome
LBV – The Procedure
Topical Anesthesia
What are the advantages of topical anesthesia?
A topical anesthetic generally works well at preventing you feeling any pain during the operation. It also
gives you pain relief after the operation. It usually has few risks and side effects. This is because it doesn’t
affect any other part of your body, such as your breathing or your heart. People recover more quickly
following surgery under topical anesthetic and can go home on the same day. You can continue to take
any prescribed medicine you are on and may be able to eat and drink as normal.
Who administers the topical anesthetic and how is it given?
Eye surgeons and nurses are trained to administer topical anesthetic using numbing eye drops.
Before the Operation Day
Health Check: The Initial Patient Assessment
You will be asked about:
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General health and fitness
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Medical problems
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Chronic conditions
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Ocular problems
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Diabetes
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Your current medication
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If you are pregnant
SJH-EC-PI/frm 008 v1.0
Authors: Tanya Costa
Date: August 2016
Saint James Hospital – Eye Clinic
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Allergies
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Smoking
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Alcohol intake
The Day of the Operation
You will receive clear instructions about if you should stop eating or drinking.
You can continue to take most prescribed medication as normal, including up to and on the day of your
operation. If you are taking blood thinning agents, please inform your surgeon. If you have a cough or
heavy cold on the day of the surgery, your operation might need to be postponed.
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Please bring any medication you are taking with you to the clinic on the day of your operation so
that the surgeon and nurses can check them out.
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Do not wear any make up, eye creams or face creams
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Do not wear any perfume or after shave
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Wear comfortable loose clothing
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Have someone to accompany you after the surgery
In the clinic
You will be seen by your eye surgeon. Your eye surgeon will check and mark the eye/s that is being
operated on and discuss the operation with you. You will be asked to sign a consent form and your forehead
may be marked on the side of the eye to be operated on.
What happens next?
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You may be asked to put on a cap and plastic over shoes. You will keep your own clothes on and
you should wear comfortable clothing that is loose around the neck.
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Depending on the type of operation you are having the nurses may give you some eye drops. It is
sensible to use the toilet before you go to the laser suite, so that you can lie still comfortably
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The recovery area nurse will accompany you to the laser suite.
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Safety Checks – Nurses will ask you some questions to check who you are, and what
operation you are having. They will check again with you which eye is being operated on
and check your consent form. This is done to be in line with the latest guidelines issued by
the World Health Organization – Safe Surgery Checklist
SJH-EC-PI/frm 008 v1.0
Authors: Tanya Costa
Date: August 2016
Saint James Hospital – Eye Clinic
Can I have something to calm me down?
Our doctors and nurses are very used to helping people relax. Sedatives can sometimes make you very
sleepy and slow your breathing during the operation. Please discuss your wishes with your eye surgeon.
What happens in the Laser Suite?
You will be made comfortable on the operating table and the eye surgeon will then give you the eye drops
which numb the eye.
After the local anesthetic is given, your eye will be kept closed to prevent from anything touching and
damaging the surface of the eye.
The Operation
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The nurse will check that you are lying comfortably on the laser table and that your head is
supported.
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Your eye will be cleansed with a disinfectant solution.
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You will be swiveled underneath the Femtosecond laser and you will feel some pressure from the
device and in a few seconds, a flap is created.
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You will be swiveled back underneath the Excimer Laser, where laser blended vision will be done
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You will hear the noise of the laser machine and smell burning.
Can I speak during the operation?
It is best not to speak during the laser procedure, however if you want to say something, you will be asked
to move your hand gently and the eye surgeon will stop operating so that you can speak.
Will I see anything?
You will usually be able to see bright lights and you may see some movements during the operation. This
varies from person to person. You will not be able to see any detail.
What if I blink or move?
A small clip keeps your eyelids open so you do not need to worry about blinking. The laser has a tracking
device that allows the laser to follow the movements of the eye with precision.
After the Operation
A nurse will escort you back to the recovery area. Your eye may be covered with a transparent eye shield
until the following day to protect it and stop you from rubbing it whilst asleep. You will be discharged home
after some time. Before you go, the recovery nurse will give you written instructions about recovering from
your surgery, for example what activities to avoid. The nurse will tell you about any medication you need
to take and will show you how to put the eye drops if you are unsure. You will be asked to come back to
the clinic for further follow up appointments.
SJH-EC-PI/frm 008 v1.0
Authors: Tanya Costa
Date: August 2016
Saint James Hospital – Eye Clinic
Will I be in pain?
There will be no pain after LBV, however a sensation of foreign body or excess tears can occur during the
first few hours.
When can I drive?
You will need to ask your surgeon how long you should wait before driving, as it varies from person to
person.
Do I need to take special care?
You will receive individual instructions about the care of your eye, but you should think about the following:
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Avoid rubbing the eye for 4 weeks
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Do no use make up for 1 week
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Do not swim for 4 weeks
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After 1 week you are allowed to run, ride a bike, do aerobics, but wear sunglasses when outdoors
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Avoid strenuous contact sports for 2 months
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Wear sunglasses when in the sun for 2-3 months
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If you are a restless sleeper, wear an eye shield so you can’t rub your eye without knowing when
asleep
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Contact us if you notice worsening of your symptoms, for example if your vision gets worse, if you
develop new symptoms or if the eye becomes painful.
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Avoid very heavy lifting, strenuous exercise and swimming until you get the all clear from your
doctor.
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Take care in windy weather in case you get something in your eye. Sunglasses can give some
extra protection form dust and grit.
Risks and Complications
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The LBV procedure requires the use of sophisticated electrical equipment and thus as
with all electrical instrumentation, it is susceptible to system malfunctions that can be
beyond our control, nonetheless, Saint James Hospital - Eye Clinic will be taking all
necessary precautions and preparations to ensure patient safety.
The LBV procedure is done to reduce or avoid the wearing of spectacles or contact lenses.
LBV is a surgical procedure and like all surgery it is dependent on the doctor’s skill and is
not risk free. The doctor is required to make detailed records of consultation, treatment
SJH-EC-PI/frm 008 v1.0
Authors: Tanya Costa
Date: August 2016
Saint James Hospital – Eye Clinic
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and any advice given. Medical records are held by Saint James Hospital - Eye Clinic on
behalf of the doctor and the patient.
Possible complications:
 Regression of refraction
 98% of myopic / presbyopia patients can see 20/20 for distance and J5 for near
 95% of hyperopic / presbyopia patients can see 20/20 for distance and J5 for near
 97% of emmentropic / presbyopia patients can see 20/20 for distance and J5 for near
 In order to retain capacity of vision to see 20/20 for distance and J5 for near, there is
a 10%-12% probability that a touch up in either both eyes or in one eye will be needed
after approximately 5 -10 years
 The majority of patients will get accustomed to the corrected eye sight within 3 months.
A small percentage my need a period of 6-12months to get accustomed fully. In the
meantime, corrective glasses can be worn during this adaptation period so as to
relieve these symptoms
 Over or under correction
 Difficulties relating to fitting of contact lenses if needed
 Dry Eyes that might take some weeks to resolve, artificial tears will be prescribed
 Incomplete flap, treatment will be repeated after few weeks
Short term complications:
 Droopy eyelids
 Double vision
 Haze
 Induced astigmatism
 Glare or haloes
Serious complications are rare. Infection, though very uncommon, can occur and
fortunately can be treated with antibiotic medications but there may be scarring of the
cornea requiring a remedial retreatment or even surgery.
Corneal Ectasia is a very rare complication of flap surgeries, however since a high
precision thin flap is made with a femtosecond laser, the incidence of ectasia has been
completely minimized.
Discomfort and imbalance may be felt if only one eye is treated and headaches and
dizziness are not uncommon, together with the impairment of judging distances,
interference in reading, driving and sports.
Should an adverse event occur, such as intense pain, swelling, irritation, infection, it is
your responsibility to contact us immediately. Patients should stop taking medication or
ointment if an allergic reaction occurs. PATIENT MUST NOT RUB OR TOUCH THEIR
EYES after surgery.
Visual sharpness is measured by the smallest letter readable on the eye test chart using
lenses as necessary. The laser is programmed for very precise degrees of correction,
however everybody responds differently to the treatment, which can result in over or under
correction or induced astigmatism.
SJH-EC-PI/frm 008 v1.0
Authors: Tanya Costa
Date: August 2016
Saint James Hospital – Eye Clinic
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Since it is impossible to state every complication which may occur, this list remains
incomplete and is adjourned frequently so as to provide the patients with the latest results
coming from all over the world.
Secondary treatment to the same eye if necessary, may be possible, but it may carry
additional risks
SJH-EC-PI/frm 008 v1.0
Authors: Tanya Costa
Date: August 2016
Saint James Hospital – Eye Clinic