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HUNTER STREET EYE SPECIALISTS THOMSON, SUMICH, LIM & ASSOCIATES

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Frequently Asked Questions

 

What is LASIK?

Laser Assisted In-Situ Keratomileusi (LASIK) is the most widely accepted method of correcting refractive errors in vision.  It reduces people’s dependence on their glasses or contact lenses, and involves reshaping the central part of the cornea, using a cool laser beam, to remove or reduce the need for spectacles and/or contact lenses. 

The cornea is the clear part at the very front of your eye. It is made up of 5 layers and is on average 520 - 530 microns thick. Imagine the cornea as a 520 page textbook with 5 different chapters - a 100 to 120 micron thick circular flap with a hinge is created using the IntraLase. The IntraLase is an advanced 100% blade free femtosecond laser that creates a perfectly circular planar flap and helps prepare an optimal corneal surface below the flap for superior visual outcome, particularly when used with wavefront guided procedures.

The surgeon lifts the flap and the Excimer Laser alters the shape of the third layer of the cornea called the stroma. The flap is re-positioned to cover the newly contoured stroma and quickly adheres without the need for stitches or other artificial methods of tissue adhesive. Not all patients can undergo LASIK. In fact, on average, 1 in 5 people are not suitable for the procedure. Only by having a thorough eye examination will you be able to assess suitability.

Am I suitable for LASIK?

To be suitable for LASIK you should:

  • be at least 20 years old
  • have had reasonably stable vision for at least 1 year – that is, no significant change in the strength of glasses or contact lenses required to see clearly
  • have good eye health

Note that the LASIK procedure cannot be performed on pregnant patients. If you are not suitable for LASIK, there is a good chance that you may be eligible for alternative refractive procedures to enhance your vision.

How long will the initial consultation take?

The initial consultation takes about one and half hours. It involves a comprehensive eye examination, after which Dr Sumich will discuss with you your suitability for LASIK or other vision correction procedures.
The examination will also determine your ocular health and reveal any existing conditions. If any of these conditions are present, you will receive a recommendation for their treatment and management. The initial consultation involves a comprehensive eye examination, after which your test results will be discussed with you, including your suitability for LASIK or other vision correction procedures. The examination will also determine your ocular health and reveal any existing conditions such as keratoconus, uveitis, glaucoma, cataract, macular degeneration and diseases of the retina. If any of these conditions are present, you will receive a recommendation for their treatment and management. Perfect vision can be achieved in many, but not all of our patients.  As with any medical procedure, there are risks of which you need to be aware. These will be explained to you in detail at the time of your consultation.

Does LASIK hurt?

LASIK is essentially a painless procedure for most people. A local anaesthetic is given to you in the form of eye drops - which is very effective in numbing the eye prior to the procedure. You may feel a sense of pressure from the eyelid speculum (the instrument to help stop you from blinking) but no pain. After LASIK most patients will temporarily experience some light sensitivity, eye irritation and watering of the eyes. Most patients after 2 – 4 hours symptoms would have eased. Less than one in 50 patients reports any pain and “pain” is usually relieved by paracetamol.

What do I need on the day of the procedure?

Depending upon the procedure itself, there are varying preparations to make. A general guideline of these preparations is as follows.

  • A friend or family member should accompany you to the clinic and take you home on the day of the
  • Perfumes and deodorants should not be worn
  • Avoid having a heavy meal prior to the procedure   

How long will it take?

The laser reshapes the cornea in less than 60 seconds each eye, in most cases. You will be in theatre for 15 to 20 minutes, but you will need to be at the centre for approximately 2 – 3 hours to ensure all pre- and post-operative checks are carried out.

What will happen during my procedure?

On the day of the procedure, you will recline in a comfortable chair and be given anaesthetic drops in each eye. The doctor will ask you to focus on the light above you before commencing the procedure. You need not worry about making slight movements during the procedure as the VISX Star S4™ tracks your eye movement in three dimensions and adjusts appropriately for changes.

After the procedure, anti-biotic eye drops will be administered and clear plastic shields will be placed over your eyes. These must be worn until waking the following morning to prevent accidental rubbing, but will allow you to see with only minimal restriction. 

What if I blink or move my eye during the procedure?

We use a small device called a speculum to prevent you from being able to blink during the procedure – this little device is very effective in keeping your eyelids open from start to finish. We also use the VISX Star S4 which employs an active 3-D eye tracker which detects even microscopic eye movement and can redirect the laser beam as required. VISX Star S4 system is the FIRST one of its kind in Australia to track your eye movements during the procedure in three dimensions. Although the human eye can move at a rate of 15 – 20 times a second the VISX Star S4 technology tracks your eye at a far greater speed. The effect of tracking the eye to improve safety depends not only on the frequency of tracking but the speed with which the laser adjusts to the movement of your eye. The VISX system we utilize at Hunter Eye is used in more than 60% of all Laser procedures worldwide and is the only one of its kind employed in Australia.

Will I be awake during the procedure?

Yes, local anaesthetic drops are used and the LASIK procedure takes only minutes. You will be offered some minimally sedating medication by mouth before the procedure to further relieve any anxiety you may have. The procedure is virtually painless and your eyelids are kept open for only a short period of time each.

What will my vision be like immediately after the procedure?

Although your vision will not be crystal clear, you will be able to see well enough to be able to go home and carry on with most activities of daily living. You should not drive, however, until you have been examined by our staff the following day.

Will my eyes be covered after the procedure?

No, not totally. Clear shields are to be worn over your eyes overnight that does not impede sight.

Is LASIK safe?

Over 10 million cases have been performed worldwide in the past 15 years and the LASIK procedure has a proven safety record and is considered to be very safe.

Nevertheless, people interested in having the procedure need to keep in mind that it is not possible to exactly predict the level of vision that will occur after surgery. This is because, like any surgery, the healing characteristics of the eyes vary from person to person. However, based on the clinical measurements obtained at the consultation, the surgeon will be able to fairly closely indicate the expected result.

What is the risk of a complication?

LASIK is a very safe procedure but like all surgical or medical procedures there is a risk of complication. These are rare, individual and usually minor if they occur. To reduce the risk to a bare minimum, as with any medical procedure, you must ensure that the surgeon is experienced, is a corneal specialist and that s/he utilizes the latest state of the art technology. All known complications will be thoroughly discussed with you at your complimentary consultation.

Are there any long term side effects of LASIK?

Lamellar surgery, the procedure of creating the flap has been performed for over 40 years and we have follow-up results. The excimer laser has been used on the cornea for over 20 years and the LASIK procedure has been around for 17 years and there have been no long term severe side effects documented. There are rare cases of corneal ectasia, a forward bulging of the cornea, but this is occurs when inappropriate surgery is performed upon inappropriate eyes. This is why it is important to thoroughly assess the eye as a whole which is all done at your consultation with Dr Sumich.

Is LASIK permanent?

This is highly dependant on personal differences and will be variable according to your particular conditions and your age. Once corneal tissue is removed and the cornea has been re-shaped it remains permanently modified in a vast majority of cases. There can be occurrences of regression in the first three months, which can be corrected with an enhancement procedure.

Near vision will, however, normally deteriorate with age in all people during their forties. This deterioration is called presbyopia and occurs in all people regardless of whether they do or don’t have surgery, were short-, or long-sighted, or started with normal vision.

A laser procedure will neither cause nor protect you from unrelated eye diseases such as cataract or glaucoma or unexpected refractive error change that would have occurred without the procedure anyway.

When will I be able to drive and return to work?

Even though you will feel that your vision is good enough to drive we suggest that you wait at least a day or two after your procedure before driving. Depending on your occupation, you may be fit for work the day after surgery. We will discuss this with you on the day after surgery at your check up.This will vary from person to person depending on the degree of visual error you had corrected and the type of work you do. Most patients can see well enough to drive a car the next day and usually patients go back to work the day after that.

What should I do after the procedure?

It is always better to have somebody to accompany you before and after the procedure for a bit of support and try not to have any activities planned for the rest of the day. We advice that you take it fairly easy for a couple of days after your procedure but Dr Sumich is always on hand to advice you when you can resume normal activities.

What restrictions are there after the procedure?

  • No swimming for 1 week
  • No eye make up for 1 week
  • Avoid rubbing your eyes for 2 weeks
  • No Body contact sports for 1 month

Are all excimer lasers the same?

No, not at all! The first generation lasers were called 'broad beam' lasers. A laser beam the size of the area treated was used. The results were satisfactory and still today a few of this type of laser is manufactured and modified to work a little like the latest generation spot lasers. Broad beam (of the older style) lasers suffered from a problem of less smooth treatments and specific corneal irregularities known as 'central islands'.

Dr Sumich has chosen to use VISX Star S4, the laser used in over 60% all laser procedures word wide. By incorporating Variable Spot Scanning technology we can provide you with increased accuracy and safety with reduced risk of error and complications. The VISX Star S4 is versatile as it increases the treatment range so we can now treat higher refractive errors regardless of whether you are myopic, hyperopic or astigmatic. VISX Star S4 allows for increased accuracy by being able to vary the size of the beam spot giving Dr Sumich greater flexibility and allow for faster smoother treatment with precise corneal shaping. Recovery time is reduced because far less tissue is removed and smoother shaping achieved thus improving your visual outcome.

The VISX Star S4 incorporates ‘customised wavefront-guided treatments’. It’s called the Wave Print system and is exclusive to the VISX brand. Essentially, the system allows the surgeon to take a ‘fingerprint’ of your cornea to map out any abnormal contours that are unique to your eye and cater for them during your procedure. It allows the surgeon to accurately asses whether you are a good candidate for LASIK and what your visual results are likely to be, a uniquely tailored treatment for your eyes and reduces risk of problems with night vision such as night glare.

A vision assessment will help determine whether WavePrint (in conjunction with LASIK) will be beneficial to you. The VISX Star S4 does not require your pupil to be dilated before your procedure. When the pupil is not dilated, it is easier for you to accurately view the fixation light during surgery and also allows the surgeon to centre the laser beam more accurately on your eye. For you this means that in comparison with other lasers the surgeon will increase accuracy to be able to centre over to your line of sight.

Iris registration and 3 dimensional tracking - No other laser can do this. Dr Sumich believes in always using superior technology because this is the only way, together with experience, in achieving optimal results.

Are all Eye Surgeons the same?

No, the level of experience of the individual surgeon is a major consideration and we encourage you to do your homework. Because there is no formal certification for this procedure, it is important to select a surgeon with extensive experience and who has the right qualifications. Dr Sumich performs over 500 eye procedures yearly and has more than 10 years experience. He is an independent surgeon with no quota or sales target so he is under no pressure to “book” in everyone who walks in the door.  

Is there a risk of losing my sight entirely?

As with any procedure whether its brain surgery or having a tooth out there is a risk - this risk is extremely remote. LASIK is a surface procedure and the risk of complications is lower than that of internal eye surgeries such as cataracts or retinal surgery. You are more at risk of getting a serious eye infection wearing contact lenses than from laser eye surgery.

What is Monovision?

As we age, the natural lens inside our eye becomes less flexible and is no longer able to focus the eye on close work. This normal condition is called presbyopia and occurs in most people between the mid-forties and about 55 years of age.

Monovision is a term used when a refractive procedure is used to adjust each eye for a different purpose – it isn’t a different procedure. It is when one eye is adjusted in order to enable the patient to read items at close range, while the other eye is adjusted for distance via a refractive procedure such as LASIK, PRK, refractive lensectomy etc. The procedure generally better suited to those patients who have needed reading glasses as their eyes have aged. The aim of this procedure is to provide patients who are of presbyopic age (43 years or older) with the ability to achieve good distance vision as well as the convenience of having good near vision, simultaneously.

What if I am not suitable for LASIK – what other options do I have?

The LASEK and PRK procedures are generally used to treat the same conditions as for LASIK, but in corneas which are abnormally shaped, have a fragile surface or are considered too thin for safe LASIK. Visual results from these procedures are comparable to LASIK. As with LASIK the laser used is the VISX Star S4 the main difference is the part of the cornea that is re-shaped is the outer most layer rather than the central cornea as with LASIK.

LASEK - Laser Assisted Epithelial Keratomileusis is a procedure where a very thin layer of corneal cells called the epithelium is set aside and the laser is then applied. The cells are then returned at the completion of the procedure. Unlike the LASIK procedure, a microkeratome (the instrument used to create a corneal flap) is NOT used, and the Excimer Laser is applied directly onto the cornea (front part of your eye) after removal of surface eye cells.

A contact lens is then placed over the eye to protect it over the course of several days and assist healing. 

PRK – PhotoRefractive Keratectomyis a similar procedure to LASEK, however, cells are not returned to the surface of the eye after the laser is applied. The corneal epithelium layer is removed. The front surface layer of the cornea (epithelium) is gently lifted away from the rest of the cornea. This exposes the corneal 'bed' which is now ready to receive the energy from the laser beam.

A contact lens is then placed over the eye to protect it over the course of several days and assist healing. 

Refractive Lensectomy – The term clear refractive Lensectomy means removing the natural lens of the eye and replacing it with a man made IOL (intraocular lens) while it is still free of any opacities. This procedure is reserved usually for those who are outside the range of traditional laser refractive procedures.

I am confused about all these names – LASEK, PRK, ASLA, NuLasik, EpiLASIK, Bladeless Laser, Intralase - what are they and how do they differ from each other?
Essentially, LASEK, PRK, ASLA, NuLasik, EpiLASIK  and Intralase are all “Bladeless Laser”- all these procedures reshape the cornea just as LASIK does and utilize the same excimer laser to do so. The main difference is which layer of the cornea is being re-shaped and how thick/thin the flap is.

It is very confusing and at Hunter Street Eye Specialist we will advise you on your very first consultation which procedure will suit your eyes the best. With all these confusing jargon be assured that we will tailor the surgery to suit your eyes.

ASLA, PRK – Advanced Surface Laser Ablationand Photo Refractive Keratectomyare exactly the same procedure a thin layer of corneal epithelium is removed, the excimer laser is then used to reshape the cornea and a bandage contact lens is placed on the eye/s for a few days to aid healing.

LASEKLaser Assisted Epithelial Keratomileusis is a procedure where a very thin layer of corneal cells called the epithelium is set aside and the laser is then applied. The cells are then returned at the completion of the procedure. Unlike the LASIK procedure, a microkeratome (the instrument used to create a corneal flap) is NOT used, and the Excimer Laser is applied directly onto the cornea (front part of your eye) after removal of surface eye cells.

A contact lens is then placed over the eye to protect it over the course of several days and assist healing. 

EpiLASIK, NuLasik – are essentially the same procedure - an Epi-Lift Epi-Keratome is used to create a thin flap instead of a microkeratome that is used in LASIK. The EpiLift Epi Keratome is a separator which is used to mechanically separate the epithelium (the front layer of cornea) from the stroma (the middle layer of the cornea). As with LASIK & PRK the excimer laser is then used to reshape the cornea after which the flap is then returned.

INTRALASE – Creates a flap for LASIK procedure.

LASEK and PRK procedures compared to LASIK procedures
LASEK and PRK can be considered safer than LASIK from one viewpoint as there is no need to create a corneal flap. 

On the other hand, vision takes longer to return to optimal standards and a slightly greater degree of discomfort can be expected in the days following the procedure when compared to LASIK. Certain eyes are better suited to a particular procedure and Dr Sumich will discuss with you all the pros and cons of these procedures and there is no pressure to have any surgery.

Hunter Street Lasik Laser Eye Specialists are located in Parramatta. We are an eye clinic specialising in Lasik Laser Eye Surgery, Advanced Cataract surgery, Laser Vision Correction and Lasik eye procedures. Hunter Street Laser Eye Surgery is located in Parramatta Sydney Australia