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    Recent Advances in Laser Refractive Surgery

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    KPJConference
    Laser refractive surgery has become a common and successful procedure, with over 50 million performed globally. New technologies like femtosecond lasers and ReLex Smile procedure allow for safer, more precise corrections with quick visual recovery and fewer side effects. Studies show over 95% patient satisfaction following laser surgery. Proper patient screening and experienced surgeons can achieve highly predictable and reproducible results in improving vision and quality of life.

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    Recent Advances in Laser Refractive Surgery

    Uploaded by

    KPJConference
    407 views24 pages
    Laser refractive surgery has become a common and successful procedure, with over 50 million performed globally. New technologies like femtosecond lasers and ReLex Smile procedure allow for safer, more precise corrections with quick visual recovery and fewer side effects. Studies show over 95% patient satisfaction following laser surgery. Proper patient screening and experienced surgeons can achieve highly predictable and reproducible results in improving vision and quality of life.

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    Current trends in Laser Refractive Surgery

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    Laser refractive surgery has become a common and successful procedure, with over 50 million performed globally. New technologies like femtosecond lasers and ReLex Smile procedure allow for safer, more precise corrections with quick visual recovery and fewer side effects. Studies show over 95% patient satisfaction following laser surgery. Proper patient screening and experienced surgeons can achieve highly predictable and reproducible results in improving vision and quality of life.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    407 views24 pages

    Recent Advances in Laser Refractive Surgery

    Uploaded by

    KPJConference
    Laser refractive surgery has become a common and successful procedure, with over 50 million performed globally. New technologies like femtosecond lasers and ReLex Smile procedure allow for safer, more precise corrections with quick visual recovery and fewer side effects. Studies show over 95% patient satisfaction following laser surgery. Proper patient screening and experienced surgeons can achieve highly predictable and reproducible results in improving vision and quality of life.

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    Centre for Sight

    Current trends in Laser


    Refractive Surgery
    Dr. Choong Yean Yaw
    MBBS(Mal), FRCS Ed, M.Med(Spore), Am(Mal)

    Cornea and Refractive Surgeon


    Medical Director
    Pusat Pakar Mata Centre for Sight
    KPJ 24-6-14

    Centre for Sight

    More common terms

    LASIK
    PRK/ASA/Lasek
    All laser Lasik/Femtosecond Lasik
    Relax Smile

    KPJ 24-8-14

    Centre for Sight

    Lasik

    Elective operation, reserved for patients who want to reduce or


    eliminate a dependence on eyeglasses or contact lenses
    More than 50 millions procedure performed
    As with any surgery, LASIK has potential risks, complications
    and side effects
    Less than 1%
    well trained surgeon
    proper preop evaluation and assessment
    reliable equipment

    KPJ 24-8-14

    Centre for Sight

    Satisfaction after laser refractive


    surgery?

    K. Soloman et al. LASIK World Literature Review Quality of Life and Patient Satisfaction.
    Ophthalmology Volume 116, Issue 4, Pages 691701,
    April 2009
    309 database articles
    An average 95.4% of patients were satisfied with their
    outcome
    One of the most successful elective surgeries

    KPJ 24-8-14

    Centre for Sight

    EXCIMER LASER

    Argon Floride laser


    Cold laser
    Smooth ablation
    Cause no damage to surrounding tissue

    KPJ 24-8-14

    Centre for Sight

    Disadvantages of Excimer laser

    Subject to inconsistency
    differences in corneal hydration
    laser fluence projection
    reflection losses
    temperature and humidity in the laser room
    other environmental factors

    KPJ 24-8-14

    Centre for Sight

    What has changed?

    Improvement in predictability, accuracy & reproducibility


    Reduction in side effects
    Reduction in complications

    Better diagnostic equipments


    Better laser platform
    Better understanding of corneal biomechanics
    Digestion of data from numerous scientific papers
    Improved treatment profile

    Treatment to improve patients suffered side effects from previous surgery

    Femtosecond laser
    Not affected by environment factors
    KPJ 24-8-14

    ASA/PRK

    Centre for Sight

    Advantages

    Effective, predictable
    Safe
    Thin cornea
    Epithelial basement membrane dystrophy

    Disadvantages
    Discomfort
    Slower visual recovery
    Haze
    Incidence reduced with newer technology
    Mitomycin C

    KPJ 24-8-14

    Centre for Sight

    LASIK
    Laser Assisted In Situ Keratomileusis

    KPJ 24-8-14

    Centre for Sight

    LASIK

    Advantages
    Rapid Visual Recovery
    Pain Free
    Early Stability

    Disadvantages

    Higher rate of vision threatening complications


    Additional Step of Flap Creation
    Additional Step of Flap Repositioning
    Potential Posterior Segment Complications
    Dry eye
    KPJ 24-8-14

    Centre for Sight

    Flap creation

    Microkeratome
    Long tract record
    Improvement in design
    and safety profile

    KPJ 24-8-14

    Centre for Sight

    Flap Creation

    Femtosecond laser
    Safer for new/inexperience surgeon
    Gaining popularity due
    to surgeon preference

    KPJ 24-8-14

    Centre for Sight

    ReLex Smile (latest technology)

    Refractive Lenticule Extraction


    Latest technology in refractive surgery
    Femtosecond-only laser vision correction
    No flap, minimally invasive, key hole surgery
    Potentially changing the way how refractive surgery is
    performed now

    KPJ 24-8-14

    Centre for Sight

    Relex Smile

    Advantages

    Minimally invasive
    Flapless, no risk of flap displacement
    Painless
    Less dry eye
    Stronger cornea architecture1,2

    Disadvantages
    New procedure
    Limitation of only correcting shortsightedness and astigmatism
    1. Di Wu et al.Corneal biomechanical effects: Small incision lenticule extraction versus femtosecond laser-assisted laser in situ keratomileusis. J Cataract
    Refract Surg 2014; 40:954-962.
    2.Abhijit Sinha Roy et al. comparison of biomechanical effects of small incision lenticule extraction laser-assisted laser in situ keratomileusis. Finite element
    analysis. J Cataract Refract Surg 2014; 40:971-980.

    KPJ 24-8-14

    Centre for Sight

    Results

    Studies showed comparable results to Excimer laser1-4


    FDA clinical trial completed in June 2014, expected approval
    in 2016

    1. Kazutaka Kamiya et.al. Early clinical outcomes, including efficacy and endothelial cell loss, of refractive lenticule extraction using a 500 kHz femtosecond
    laser to correct myopia. Journal of Cataract & Refractive Surgery, Volume 38, Issue 11, November 2012, Pages 1996-2002
    2. Rupal Shah et.al. Results of small incision lenticule extraction: All-in-one femtosecond laser refractive surgery. J Cataract Refract Surg 2011; 37:127137
    3. Anders H. et.at. Efficacy, safety, predictability, contrast sensitivity, and aberrations after femtosecond laser lenticule extraction. J Cataract & Refract
    Surg, Volume 40, Issue 3, March 2014, Pages 403-411
    4. Marcus Blum et.al. Five-year results of refractive lenticule extraction. J Cataract & Refract Surg, Volume 40, Issue 9, September 2014, Pages 1425-1429

    KPJ 24-8-14

    Centre for Sight

    Are you a suitable candidate?

    unhappy with glasses or contacts


    motivated to improve his or her
    uncorrected vision
    short sightedness up to 12.00

    long sightedness up to +5.00 D


    Astigmatism up to 5.00 D

    KPJ 24-8-14

    Centre for Sight

    Ideal candidate

    Satisfy the following criteria :

    Be at least 18 years of age


    Have had stable vision for at least one year (stable refractive
    prescription of + 0.5 Diopter)
    Healthy cornea
    Healthy eye that is free from any diseases
    Good general health
    Must not be pregnant or nursing
    KPJ 24-8-14

    Centre for Sight

    PREOPERATIVE EXAMINATION

    Visual acuity (ucva, bcva)


    Refraction (manifest, cycloplegic)
    Pupil size
    Anterior segment examination
    (ruled out endothelial changes)
    Posterior segment examination
    Corneal topography
    Corneal thickness

    KPJ 24-8-14

    Centre for Sight

    Change of lifestyle

    Able to see the clock when waking up


    Looks confidence in front of the mirror without optical
    aids
    No more hassle of cleaning up contact lenses
    No more misty vision when
    taking hot meal
    Coming out from air-con room

    KPJ 24-8-14

    Centre for Sight

    Change of lifestyle

    Enjoy fullness in sports, outdoor activities


    No hassle of wearing multifocal glasses

    KPJ 24-8-14

    No worry of optical aids in


    any disaster scenarios

    Centre for Sight

    Laser Refractive Surgery

    In general

    Highly predictable
    Highly reproducible
    High safety margin
    Various options to suit different need
    Side effects or complications are minimal with well trained
    surgeon
    Exciting technology (Relax Smile) is NOW available!

    KPJ 24-8-14

    Centre for Sight

    Conclusion

    LASIK is not a cosmetic procedure


    It improves the function of the eye
    It can be life changing

    Continuous improvements in laser technology and


    surgical techniques have made LASIK safer and more
    effective year after year
    There are now new and better treatment options for
    many of the non-permanent side effects
    KPJ 24-8-14

    Centre for Sight

    Thank you
    KPJ 24-8-14

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