The management of

myopia in Laser-Assisted
in situ Keratomileusis
(LASIK)
What is LASIK?
• Procedure that uses a
laser to correct
nearsightedness,
farsightedness, and/or
astigmatism
Nearsightedness

 Myopia
 Image focused in front of
retina
 Eyeball axis too long
 Refractive power strong (+
3.00 etc.)
 Distance object appear blurry
 Cornea steeper
Farsightedness
 Hyperopia
 Image focused at back
 of retina
 Eyeball axis too short
 Refractive power weak
 ( -3.00 etc)
 Trouble seeing object
 that are close up
 Flat cornea
 Astigmatism

 Abnormal curvature
of the cornea

 Cause 2 focal points

in 2 different location

 Both near & far object blurry

How Does LASIK Correct
Refractive Error
 Glasses Contact lens

To treat Refractive Error

PRK Refractive LASIK

(Photo Refractive
Surgery (Laser In-situ
Keratectomy) Keratomileusis)

Non corneal Epi-LASIK

interventions
 Optical Treatment
SPECTACLES
• A minus correcting lens whose secondary
focal point coincide with the far point ofe
the eye is placed at the spectacle plane

• Artificialy place the far point of infinity

Advantage of Spectacle
Correction

Easy

Safe

inexpensive
Problems Caused by high Minus lenses

Lens Weight and Thickness

Minification

Field of View

Edge reflection and concentric

rings 11
Contact lens
• Soft contact lens
• Hard contact lens :
• Non Gas-permeable
• Rigid Gas-permeable
 Comparative Advantages of Soft and
Rigid Gas-Permeable Contact Lenses
• Soft Contact Lenses : • RGP Contact Lenses:
 Immediate comfort  Clear and sharp quality of vision
 Shorter adaptation period  Correction of small and large
 Flexible wear schedule amounts of astigmatism, as well as
irregular astigmatism
 Less sensitivity to environ
mental foreign bodies, dust  Ease of handling
 Variety of lens types (eg,  Acceptable for patients with dry
disposable lenses, lenses eye, ocularsurface disease, and
replaced frequently) similar disorders
 Ability to change eye color  Stability and durability
 Ease of care
SURGICAL TREATMENT
Non corneal intervention
• (A) REMOVAL OF CLEACR LENS
• We know that an aphakic eye is strongly
hypermetropic
• If an eye with an axial myopia of -24D is
deprived of its lens it will become
emmentropic without any correcting lens
• Note :
• Whenever surgery on clear lens is
contemplated the eye is examined
thoroughly for abnormalities like Raised
IOP, Vitrous and retinal degeneration etc.
Non corneal intervention
• (b)PAHKIC INTRAOCULAR LENSES
• An IOL of appropriate power is implanted
inside the eye without touching normal
crystaline lens thus without disturbing
accommodation
• Method can be used to correct both
myopia and hypermetropia
• Phakic IOL types :
• PC IOL
• Anggle Supported IOL
• Iris claw lens
 LASIK
 Create a corneal tissues flap
 Lasering onto deeper cornea beneath
flap
 More predictable, does not cause much
discomfort
 PRK
 Epithelial cells removal using alcohol
Treat cornea surface with Excimer laser
to flatten it
 Painful, up to 48 hours
 Epi-LASIK
 Epithelial cells removal
 Using plastic blade
 Without alcohol
LASIK PROCEDURE
1. CORNEA prepared for
microkeratome

2. A THIN FLAP IS CREATED WITH

THE USE OF THE MICROKERATOME

3. CREATING A FLAP

4. THE FLAP IS LIFTED UPWARDS AND

FOLDED BACK TO EXPOSE THE
INTERNAL PART OF THE CORNEA
CALLED STROMA

5. LASER IS APPLIED TO RESHAPE THE

CORNEA TISSUE

6. LASER FINISHED

7. REPLACED THE FLAP

8. THE FLAP BACK IN PLACE

 Advantages of LASIK
Minimal or no postoperative pain

Recovery of vision is very early as compare to PRK

No risk of perforation during surgery and rupture of

globe due to trauma like PRK

No residual haze unlike PRK where subepitelial

scorring may occur

LASIK is effective in correcting Myopia of -12D

 Disadvantage of LASIK

• Expensive
• Recuires greater surgical skill than Rk and
PRK
• Flap related complications
• Intraoperative of flap amputations
• Wringkling of flap on repositioning
• Posoperative flap dislocation/subluxation
• Ephitelization of flap-bad interface
• Irreguler astignatism
 Suitable Candidate
 18 years and above
 Have had stable refractive prescription
for at least ONE year
 Healthy cornea
 Healthy eye that is free from any
diseases
 Good general health
 Must not be pregnant or nursing
 Absolute general health contra-
indications

Auto-immune disease e.g. RA,SLE, Thyroid disease.

Immune suppression – HIV or immune suppression drugs.

Pregnancy-wait 6 months after giving birth or cessation of breast feeding.

Systemic steroids

Amiadarone

5-Hydroxy-tryptamine e.g. sumatriptan – there is an increased risk of vascular

occlusion when the intraocular pressure is raised during treatment. 24
 Relative general health contra-
indications

Tricyclics or lithium-based

Diabetes

Active atopy

Epilepsy

History of frequent fainting

Hepatitis B and C 25
 Absolute ocular health contra-
indications

Diabetic retinopathy

Glaucoma
Corneal thinning dystrophies e.g. keratoconus• Herpatic ocular
disease
Sjoِ gren’s syndrome

• Fuch’s endothelial dystrophy

Unstable refractive error

Visually significant. 26
 Relative ocular health contra-
indications

Dry eye – in some patients their condition may be

temporarily worse after Treatment.

Blepharitis – all signs of blepharitis must be absent

prior to treatment as it may induce postoperative
inflammation.

Nystagmus – not all lasers have a tracker that can

keep up with the involuntary eye movements
associated with nystagmus. 27
 Limitation
 Result is not guaranteed

 Additional procedures, spectacles or CLs

may be required to achieve adequate vision

 Will not prevent from developing

naturally eye problems such as glaucoma,
cataract or RD
 Do’s and Don’ts
 Do considering wearing sunglasses, as you
may find yourself unusually sensitive to
light
 Do try to follow the post op instructions
strictly
 Don’t participate in contact sports
 Don’t rub your eyes
 Don’t wear eye make-up for a few days
Good practices to follow
Follow-up care
• Day 1
• Day 4 (Epilasik/PRK)
• One week
• One month
• Three month
• Six month
• A year
• As needed
What to expect after surgery
Diagnostic Tools
AC Master

To measure corneal
thickness in every point
Specular Microscope

To measure central
cornea thickness

To measure cornea
endothelial cells
Corneal Topography

Provides detailed information

about corneal surface

Essential in assessing the

suitability of the patient’s eye
for treatment
Wasca Analyzer

Measuring the optical

aberrations of the eye
Retinal Camera

Fundus Examination
Visante OCT

Scanning the anterior segment

of the eye
Cirrus OCT

Scanning the posterior segment

of the eye
Pre-operation
Assessment
 The purpose of the pre-operative
assessment :

 To determine by physical measurement whether it is

possible to correct a patient’s individual refractive error
on their eyes.

 To determine by examination whether the ocular health

is adequate for surgery

 To identify if there is any increased risk of complications

specific to that patient.
 Patient Counseling
 Fully understands the treatment
 Benefits
 Alternative methods
 Understand the potential risks and
complications
 Management and outcomes
 Dispelling the myths
Instructions for treatment day
1. Read/fully understand consent form
before arriving the clinic
2. Come accompanied
3. Bring sunglasses
4. Do not return to work