Laser Eye Surgery in South Africa
The Excimer Laser
The modern method of using the Excimer Laser to correct refractive
errors is a breakthrough, which can benefit millions of patients who are
shortsighted or have other refractive errors. The technique has advanced
to a point where we can reliably predict that Excimer Laser treatment
will, in suitable patients, provide good vision without glasses or contact
lenses. For people who undergo Excimer Laser procedures, less dependency
upon corrective lenses is a major benefit.
Excimer Laser treatment is an elective procedure and, as with any form
of surgery, deserves careful consideration prior to proceeding. Please
contact us and we will answer any questions that you may have. We offer
a free screening test and we also have educational videos for you to watch.
If you are a good candidate for the Excimer Laser procedure, then the
decision to go ahead is entirely yours to make.
The Excimer Laser was originally developed for the manufacture of computer
microchips, where it was used to etch the circuits. However, its extreme
accuracy resulted in it being developed as an eye laser. It is now used
to re-sculpture the corneal surface of patients with refractive errors.
The Excimer Eye Laser is extremely accurate and removes only 0.25 microns
(1/4000 th millimetre) of tissue per pulse. During the re-sculpturing
the Laser gently "evaporates" tissue; there is no burning or
cutting involved. In most cases the Laser treatment takes only 20 to 45
seconds depending on how severe your refractive error is. The Excimer
Laser accurately re-sculptures the cornea to make the curve of the cornea
balance the length of the eye, light rays are then focused normally on
the retina.
In myopia the cornea is flattened (as shown above), whereas in hyperopia
the cornea is made more curved. With astigmatism the surface of the cornea
is re-sculptured to a regular curvature. This advanced surgical technique
using the Excimer Laser can accurately re-sculpture your cornea thus permanently
correcting your myopia or other refractive error - allowing you to be
independent or less reliant on glasses and contact lenses.
In the original method of treatment the Laser was used on the surface
of the cornea. This method is known as photorefractive keratectomy (PRK).
Although still sometimes used for low degrees of myopia and hyperopia,
PRK has been largely superseded by the Lasik method in which the Laser
treatment is applied under a protective corneal flap
This is a modern adaptation, using the Excimer Laser, of a technique
that has been in existence for almost 30 years. A thin protective corneal
flap is raised, rather like a trapdoor. The front surface of the exposed
cornea is resculptured by the Excimer Laser. At the end of the procedure
the protective flap is simply replaced. The Lasik technique leaves the
original surface of the cornea virtually intact, the mild healing process
results in minimal regression and no scarring. The Lasik procedure is
now regarded as the most advanced refractive surgery technique.
Who is suitable?
How can you find out if you are a good candidate for Excimer Laser?
Almost all patients with myopia, astigmatism, and hyperopia are suitable
for Excimer Laser treatment. Patients with presbyopia alone cannot be
treated by the Excimer Laser but may be suitable for Presby implants.
During the free screening test that we offer, we can give you a good
idea as to whether you are a possible candidate. However, before proceeding
with treatment, you will need a full eye examination to exclude any diseases
and contraindications.
The following tests will be performed and the following information
will be requested.
- How much myopia, or other refractive error, is present? A refraction
test will measure the amount of refractive error present.
- A measurement of your cornea is made by computerized corneal topography
that produces a contour map to show the curve of your cornea.
- What is the thickness of your cornea? An ultrasound probe is used
to measure the thickness of your cornea in microns.
- We will measure the size of your pupils in the dark. Your eyes will
be examined to determine that no other medical eye problems are present
which may interfere with the Laser procedure. A pressure test is also
routinely performed to exclude glaucoma.
- Is your refractive error stable?
- Personal information about allergies and other medical conditions
that may effect the laser treatment will be requested.
- Does your profession or occupation have a visual requirement?
- Do glasses or contact lenses satisfy your visual needs?
- What do you expect from the Excimer Laser procedure?
Please note: Realistic expectations and the ability
to follow instructions are essential for a successful result.
FREQUENTLY ASKED QUESTIONS
- What can I expect from Excimer Laser treatment?
The Excimer Laser is able to eradicate all or the majority of a patient's
myopia or other refractive error. With certain provisos, discussed below,
we can virtually guarantee that you will be able to function for the majority
of the day without the use of glasses or contact lenses. Patients become
independent of these optical aids and have more self-confidence doing their
normal day to day and sporting activities. Patients enthuse about being able
to wake in the middle of the night or in the morning and be able to see clearly,
or to be able to swim with clear vision.
It is important to realize that we all heal differently and it is unlikely
that both eyes will have "zero" readings after treatment - in fact
this situation occurs rarely in the normal population. The small refractive
error that remains is usually insignificant and does not require the use of
spectacles or contact lenses.
However, for fine visual tasks only, some patients do require a thin pair
of spectacle lenses - currently about 2% of our patients fall into this category.
When we enter the 40+ age group we begin to need help for close vision because
of presbyopia. This requirement to use reading glasses will happen regardless
of whether you have Laser treatment, or continue to wear contact lenses or
glasses.
In a few patients not all of the refractive error is eradicated and the
level of vision is inadequate. In these cases (about 5%) a repeat Excimer
Laser treatment, or enhancement, can be performed. The need for an enhancement
becomes manifest within the first few months. After this period the correction
stabilises and is permanent.
- How long has LASER been used?
The Excimer Laser was first used on a patient in 1986, and first became
available clinically in 1990. Dr. John Hill has been performing refractive
surgery since 1984 and Excimer Laser treatments since 1993. In 1994 he started
using the lasik procedure, and now uses this method almost exclusively.
- Is the procedure safe?
The Laser is constantly checked for accuracy and when used by an experienced
surgeon the risk of a serious complication is extremely low.
- Is the procedure permanent?
Yes, providing your refractive error was stable prior to treatment.
- How long does the procedure take?
About 10 to 15 minutes per eye.
- Is the procedure painful?
No. The anaesthetic drops numb all pain. Some sensation of pressure may
be felt, rather like when you press gently on your eye when your eyelids
are closed.
- Is there pain afterwards?
Normally there is only a slight scratchy feeling for a day or two. The
eyes may feel dry sometimes, for a week or so (especially in the mornings)
and we give you artificial tears to alleviate these symptoms.
- Are both eyes done at the same time?
Many patients request that both eyes are corrected at the same time. The
decision is yours.
- Are my eyes covered after treatment?
No, we do not cover your eyes. However, there is a small chance that you
will rub your eyes when you are asleep, so we give you clear plastic shields
to cover your eyes for the first night.
- Can I wear contact lenses after the treatment?
Yes, but they are very rarely required.
- Is there any follow up needed?
We normally see you within a day or two of your treatment and then again
1, 3, 6, and 12 months. This is done at no charge.
- Is there a fee for enhancements?
During the first year, when enhancements could be needed, no fee is charged.
- Will my eyes be more light sensitive after treatment?
Initially your eyes may be a little light sensitive and you may need to
wear sunglasses outdoors. This usually settles with a few days. However,
in a few patients this sensitivity persists for a month or more, for these
patients we prescribe additional eyedrops.
- I understand that night vision is a problem after laser
treatment.
With the older lasers that only treated a small area of the cornea, night
vision was a problem in some patients. What happens is that the pupil enlarges
at night and becomes bigger than the treatment area. Light rays then enter
the eye through the treated area and also around the edge, causing a "ghost" image
and glare. These subside to a large extent over a period of 3 to 6 months.
With the newer lasers the treatment area is much larger and these problems
are now uncommon.
However, if you require treatment for a large refractive error or if you
have large pupils at night you may notice these effects especially in the
initial period. We will measure your pupil size in the dark and will give
you an indication on whether this could be a problem. In a recent survey we
found that almost all patients found their vision to be better or unchanged
at night, this is because contact lenses or glasses can also cause these symptoms
and are, of course, not needed after laser treatment!
Laser Eye Surgery - Before and After Picture
Arranging Laser Eye Surgery
South Africa has an extremely high standard of medical care, not to mention beautiful scenery and a soothing atmosphere.
You can be reassured that you will be in the hands of a professional practitioner who is registered with all the appropriate medical bodies. We can offer an initial consultation in the UK before you travel to Cape Town.
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