America has been at the forefront of eye surgeries and technological advancements in eye surgery for the last 50 years. There are some of the most experienced and highly trained eye surgeons in the world are here.

You now have the opportunity to use one of these amazing eye surgeons and when it comes to something as important and delicate as your eyes you should only

use the best.

Lasik Laser Eye Surgery	Cataract Surgery	Corneal Transplant
	Glaucoma Surgery	Phakic Intraocular Lens

An estimated 90 million people have nearsightedness so severe that it cannot be corrected with Custom LASIK or other procedures. Most non-LASIK candidates can overcome their vision limitations with a phakic intraocular lens implant. This implant was designed to correct moderate to severe (5-20 diopters) degrees of nearsightedness. It is placed behind your cornea and works along side your natural crystalline lens. A phakic intraocular lens may offer high quality, high-definition vision and minimize your dependence on glasses or contact lenses.

What is a phakic intraocular lens (IOL)?

The phakic IOL is a micro lens placed behind your cornea. It is made out of PMMA, the same material used safely for the past 50 years in cataract surgery. “Phakic” means that your natural crystalline lens is left in the eye. Your natural lens helps your eye adjust between seeing objects that are near or far.

Who is a candidate?

Patients older than 21 years of age who pass a rigorous preoperative assessment and who have nearsightedness between 5.0 and 20.0 diopters of myopia and no more than 2.5 diopters of astigmatism may be candidates. The overall health of your eye will be determined along with the depth of the anterior chamber where the lens will be placed and the number of endothelial cells on the back of the cornea.

 Overview of the procedure

An outpatient treatment, the procedure takes around 20-30 minutes. One eye is treated at a time. The other eye can be treated within a few days. A small opening will be made in the peripheral iris by a special laser prior to the day of surgery in the doctor’s office to minimize glaucoma or elevated eye pressure.

On the day of surgery, eye drops will be given to reduce your pupil size. For better access to your eye, the surgeon will use an instrument to comfortably hold your eyelids open during the procedure. A local and/or IV anesthetic is given, so the procedure should not be painful. General anesthesia is usually not necessary but can be done if the patient desires. A micro incision is made in the cornea for the IOL to be placed into the anterior chamber (fluid filled space behind the cornea and in front of the iris or colored tissue of the eye). The lens is centered in front of the pupil and is gently attached to the iris without sutures by spreading the specially designed arms of the optic to hold a small amount of iris tissue. This will hold the lens in place.

The small incision is closed with microscopic stitches that dissolve on their own. A temporary shield will be placed over your eye to protect it during the time just after the procedure.

Frequently asked questions

 What is the difference between phakic IOL and LASIK?

Phakic IOL is specifically designed to provide precise vision correction for very nearsighted people who are not candidates for Custom LASIK. The corneal shape is not altered. A specially designed IOL is placed inside the eye to refocus light rays onto the retinal surface similar to glasses or contacts.

LASIK is an excellent procedure for people with lower levels of nearsightedness. The corneal curvature is altered to correct the nearsightedness and/or astigmatism.

How many patients have had the phakic IOL procedure?

The basic phakic IOL design has been successfully used in South America for 18 years and more than 750,000 phakic IOL procedures have been performed worldwide. In the United States , clinical studies of the phakic IOL procedure began in 1997 and approximately 1000 procedures have been performed as of January 2005. It was FDA approved in September 2004 after these clinical studies proved that the phakic IOL procedure is a safe and effective way to reduce your need for thick glasses and contact lenses.

Is the phakic IOL procedure painful?

Local anesthesia is used to numb your eye prior to surgery so most patients experience minimal discomfort during the procedure. Although some discomfort is normal during the healing process, the vast majority of patients experience little pain after the procedure. If you have specific questions or concerns, please discuss them with the doctor.

Can I see well up close and at a distance with a phakic IOL?

For patients 45 years or younger, you will be able to see at a distance and up close after surgery because your natural crystalline lens is left in place allowing natural adjustments to focus on near and distant objects. After age 45, you can expect to need reading glasses for close work just like other people who see well at distance at this age.

Will I be able to see or feel the phakic lens in my eye?

Once implanted, the lens is virtually undetectable. You and others close to you may be able to see the lens in your eye by looking very closely. Because the lens is placed behind your cornea inside the eye, you will not be able to feel it.

Does the lens require maintenance?

Unlike contact lenses, the intraocular lens does not require any maintenance. It is extremely important to attend all follow-up appointments and schedule annual exams with your surgeon to help ensure your long-term vision health.

Can the phakic lens slip or fall out?

Once implanted, the lens will not fall out. The lens is extremely secure because it is carefully attached to your iris. There have been rare occurrences of the lens becoming detached from the iris. If this occurs, you would notice a decrease in vision. The lens could then be easily reattached to the iris by your surgeon.

How long does the phakic lens last?

The phakic lens is designed to provide permanent vision correction. It will provide high quality vision as long as the eye does not suffer from other vision health problems such as cataracts or macular degeneration later in life. If cataracts develop, the lens would be removed at the time of cataract surgery and routine cataract surgery then performed by your surgeon.

What is the cornea?

The cornea is the clear front window of the eye that covers the colored iris and the round pupil. Light is focused while passing through the cornea and focused on the retina. If the cornea is injured it may become swollen or scarred, distorting the shape of the cornea. When light passes through an irregularly shaped cornea the light will scatter resulting in glare and blurred vision.

Once you and your doctor decide you need a corneal transplant, your name is put on a list at eye banks in California and Panama . The average wait for a donor cornea is two weeks but could be as short as 3 days or as long as one month. Comprehensive testing is completed to insure the cornea is free of any disease and is carefully checked for clarity. Other information that has been found critical to the success rate of corneal transplants is the cell count of the cornea and the number of days the cornea has been available.

The higher the cell count indicates a healthier and younger cornea which has been found to lower the chances of rejection. Unfortunately, doctors often accept as low as 1300 cell count and will use donor transplants at 14 days old. The surgeon SSI recommends for this surgery will only accept a minimum of 2500 cell count and will never use donor transplants over 6 days old. As a result his percentage of rejections is far below 5% where as the national average in the United States is 5%. Another crucial treatment is accelerated steroid therapy. If a transplant starts to show signs of rejection the first line of defense is always to increase the steroid dosage, which protects against rejection. New studies show that by using an accelerated steroid therapy, even before any signs of rejection, greatly reduce the rejection rate. This is our standard practice.

Surgery is often done on an outpatient basis. Either a local or general anesthesia is used, depending on your age, medical condition, and eye disease.

During the operation your doctor will remove the damaged cornea and complete any necessary additional work within the eye, such as removal of a cataract. Then the donor cornea is sewn into place with invisible micro sutures. When the operation is over, your doctor will place a shield over your eye and you will begin using eye drops that include antibiotics and steroids. Follow up appointments are scheduled for the one day and one week after surgery. Sutures are normally removed in 6 months to one year.

Signs and symptoms

Chronic glaucoma is often called “the silent thief of sight” because you have no warning sign, no hint that anything is wrong.

Glaucoma gradually reduces your peripheral vision, but by the time you notice it, permanent damage has already occurred and you will only be able to see objects that are straight ahead.

An acute attack of narrow-angle glaucoma produces sudden symptoms such as eye pain, headaches, halos around lights, dilated pupils, vision loss, red eyes, nausea and vomiting. These signs may last for a few hours, then return again for another round. Each attack takes with it part of your field of vision.

Other symptoms include headaches, blurred vision, difficulty adapting to darkness, or halos around lights. Chronic glaucoma normally develops after age 35.

Treatments

There are a lot of different ways to treat glaucoma. There is no cure for glaucoma yet but it can be controlled with drugs like eye drops or a pill that you take once a day. The five ways to treat glaucoma are:

• Laser Peripheral Iridotomy (PI)
• Argon Laser Trabeculoplasty (ALT)
• Glaucoma Drainage Device (Tube Shunt)
• Glaucoma Filtration Procedure (Trabeculectomy)
• Cyclophotocoagulation

Recovery usually occurs on an outpatient basis. Follow-up appointments to ensure you are healing properly are scheduled for the day after surgery, one week and fifteen days.

Laser Peripheral Iridotomy (PI) 

A Laser peripheral iridotomy (PI) is performed almost exclusively for patients with narrow angles , narrow angle glaucoma, or acute angle closure glaucoma . Aqueous fluid is made in the ciliary body of the eye, which is anatomically situated behind the iris . The aqueous fluid primarily escapes the eye by flowing between the lens and iris of the eye, and then drains via the trabecular meshwork , which is located in the angle of the eye (where the front clear cornea meets the iris, essentially). If the flow of aqueous fluid to the drainage angle (trabecular meshwork) is obstructed by a forwardly bowed iris, the patient is said to have narrow angles.

This condition may predispose one to an acute episode of angle closure glaucoma. If the angles are never acutely closed, but glaucoma is still present, the patient is diagnosed with narrow angle glaucoma.

Laser peripheral iridotomy involves creating a tiny opening in the peripheral iris, allowing aqueous fluid to flow from behind the iris directly to the anterior chamber of the eye. This typically results in resolution of the forwardly bowed iris and thereby an opening up of the angle of the eye.

The narrow or closed angle thus becomes an open angle! 

The laser peripheral iridotomy procedure is usually completed in the office or as a brief outpatient procedure. Prior to the procedure, the pupil is often constricted with an eye drop medication known as pilocarpine. The procedure itself is completed with the patient seated at the laser, and requires no sedation. Usually, a lens is placed on the eye after topical anesthetic drops are applied to better control the laser beam. The entire procedure only takes a few minutes. The lens is then removed from the eye, and vision will quickly return to normal. After the procedure, your eye surgeon may recommend anti-inflammatory eye drop medications for the next few days. A post-op visit will be scheduled.

FAQ’s

Does an ALT Procedure Reverse Glaucoma? Is it Always Effective?

In general, glaucoma is not reversed, or cured, by any procedure or medication. However, an ALT often works like a powerful medication, in terms of pressure reduction, without the potential side effects of medicines. Therefore, it may be used alone or in combination with medicines to treat glaucoma. The procedure isn’t always effective, although it will be effective in pressure reduction in the great majority of cases.

Does the Pressure Lowering Effect with an ALT last a Lifetime? 

In most cases, the pressure lowering effect with an ALT will last 3 to 5 years. If the initial treatment is effective, a second ALT, in which the opposite half of the trabecular meshwork is treated, may be appropriate.

Are there any Complications with an ALT?

The risks with an ALT procedure are rare, and when they do occur, are even more rarely serious. In general, the risks include post-operative inflammation, pressure spikes, and worsening of glaucoma. The latter complication is likely to be due to the underlying disease, and not the ALT procedure itself.

Is an ALT Procedure More Likely to be Helpful for Certain Types of Glaucoma?

Yes. ALT seems to work best in patients with primary open angle glaucoma , pseudoexfoliation (exfoliation) syndrome , and pigmentary dispersion syndrome (pigmentary dispersion glaucoma). It is also likely to be more efficient for patients who have significant pigmentation in the trabecular meshwork. This latter characteristic is determined by the ophthalmologist when examining the angle of the eye, in a diagnostic procedure called gonioscopy.

Argon Laser Trabeculoplasty (ALT) 

Argon laser trabeculoplasty (ALT) is a procedure which has been proven to be efficient for different types of glaucoma. The procedure has been used for many years and continues to be a powerful tool in for the treatment of glaucoma . ALT is often recommended when medical therapy alone is insufficient in controlling pressure and the progression of glaucoma. However, it has recently been advocated by some as primary therapy in the treatment of glaucoma, especially for those patients who have contraindications to glaucoma medications or, for any reason, are unable to use eye drops.

In the ALT procedure, the eye surgeon directs a laser beam into the trabecular meshwork, which is the primary aqueous (fluid) drainage region of the eye. The trabecular meshwork is located in the angle of the eye, approximately where the cornea meets the iris . In most cases, 180 degrees of the trabecular meshwork is treated with laser spots, which typically requires about 40 to 80 laser applications. The effect of the procedure is increased drainage of aqueous fluid out of the eye, thereby lowering the intraocular pressure.

The ALT Procedure 

The ALT procedure can be completed as an out-patient procedure. The procedure is completed with the patient seated at the laser, with topical (eye drop) anesthesia, and a lens applied to the surface of the eye to allow delivery of laser applications into the trabecular meshwork . This procedure is typically painless or results in only minor discomfort. After the procedure, the patient is typically treated with anti-inflammatory eye drops for a few days, perhaps in association with their usual glaucoma medications. Vision is minimally, if at all, affected, even on the day of the procedure. There is generally no discomfort after the procedure. Most patients are scheduled for a return visit within a week to re-evaluate.

FAQ’s

Does an ALT Procedure Reverse Glaucoma? Is it Always Effective?

In general, glaucoma is not reversed, or cured, by any procedure or medication. However, an ALT often works like a powerful medication, in terms of pressure reduction, without the potential side effects of medicines. Therefore, it may be used alone or in combination with medicines to treat glaucoma. The procedure isn’t always effective, although it will be effective in pressure reduction in the great majority of cases

Does the Pressure Lowering Effect with an ALT last a Lifetime? 

In most cases, the pressure lowering effect with an ALT will last 3 to 5 years. If the initial treatment is effective, a second ALT, in which the opposite half of the trabecular meshwork is treated, may be appropriate.

Are there any Complications with an ALT?

The risks with an ALT procedure are rare, and when they do occur, are even more rarely serious. In general, the risks include post-operative inflammation, pressure spikes, and worsening of glaucoma. The latter complication is likely to be due to the underlying disease, and not the ALT procedure itself.

Is an ALT Procedure More Likely to be Helpful for Certain Types of Glaucoma?

Yes. ALT seems to work best in patients with primary open angle glaucoma , pseudoexfoliation (exfoliation) syndrome , and pigmentary dispersion syndrome(pigmentary dispersion glaucoma). It is also likely to be more efficient for patients who have significant pigmentation in the trabecular meshwork. This latter characteristic is determined by the ophthalmologist when examining the angle of the eye, in a diagnostic procedure called gonioscopy.

Glaucoma Drainage Device (Tube Shunt) 

Glaucoma drainage devices, also known as tube shunts, are implanted devices that are designed to maintain an artificial drainage pathway for patients with glaucoma . This procedure is often chosen for patients at high risk of failure with a traditional glaucoma filter procedure (trabeculectomy). Such patients might include those with neovascular glaucoma , glaucoma associated withuveitis (iritis), prior history of failure with a filter procedure, and any patient with glaucoma under 30 years of age. All of these patients are at significant risk for failure of a routine glaucoma filter procedure due to greater inflammation and fibrosis (scarring), which might close off thedrainage canal .

Tube Shunt Implantation—The Procedure

Prior to surgery, your ophthalmologist may have you take eye drop medications to prepare your eye for surgery. These may be begun on the day of surgery, or even up to 3 days prior to surgery. Just prior to surgery, local anesthesia will typically be given to numb your eye for surgery. In young children, the procedure must be performed under general anesthesia.  Just prior to surgery, a local anesthetic is usually given unless the procedure is to be performed under general anesthesia. Your eye will be prepped in the operating room and sterile drapes placed to maintain a sterile field. An operating microscope will be moved into place. The surgeon will place a small instrument to hold the lids apart during the surgery.

A small incision is made in the conjunctiva , usually towards the top of the eye, however, the surgery may be performed in other quadrants of the eye. The surgeon will then make a tiny incision in the sclera of the eye and will fashion an opening for the drainage implant device. The drainage tube will be placed such that the opening of the tiny tube is inside the anterior   chamber of the eye where it is bathed in aqueous fluid.

The tube is sutured in place with the drainage device attached to the sclera of the eye. Most surgeons will place an absorbable suture around the tube at the time of surgery to prevent filtration through the device until a fibrous capsule has formed. As such, the device is not expected to function until about 3 to 8 weeks following the procedure. This technique is thought to prevent over-filtration. Once the tube shunt is securely sutured into the desired position, the conjunctiva over the device is closed with tiny sutures, which are considerably finer than human hair.

After Your Operation

As previously stated, the tube shunt device is not expected to function until 3 to 8 weeks following surgery. In the meantime, the glaucoma may be even more difficult to control than before. Some surgeons, therefore, create a separate glaucoma filtration site, which is expected to fail at approximately the same time that the tube shunt begins to function.

You will be instructed to use antibiotics , anti-inflammatory medicines, and probably glaucoma medications following the procedure. The actual medicines and dosing schedules will be carefully planned and reviewed with you by your eye surgeon or his staff. You may expect to use these additional medicines for up to two to three months after surgery to help prevent infection and control inflammation.

In general, you will likely be able to return to most activities within a day or two after surgery. Your eye may feel scratchy or have a foreign body sensation. This should usually resolve in the first one to two weeks. Your surgeon will instruct you as to strenuous activities.

FAQ’s

When Can I Expect the Final Results?

The efficacy of the tube shunt implantation usually won’t be known until at least 8 to 12 weeks after surgery or more. At that time, a new baseline level of pressure within your eye will usually be established.

Will My Glaucoma Be Cured with the Tube Shunt Device?

In general, glaucoma cannot be reversed. The damage which has ensued prior to surgery is essentially irreversible, since theoptic nerve does not regenerate. The best result that can be expected is a complete halt of the progression of glaucoma. This can only be known by following visual signs of the optic nerve and evaluating peripheral vision with visual field testing .

What are the Risks with a Tube Shunt Device?

The risks of this procedure include, but are not limited to, over-filtration (pressure too low in the eye), under-filtration (pressure remains too high in the eye), infection, bleeding, swelling of the retina , fluid under the retina (choroidal detachment), droopy eyelid, double vision, loss of vision, and even loss of the eye. In general, however, if your surgeon recommends a tube shunt implantation, he or she believes the benefits of the procedure far outweigh the potential risks.

Will I Still Need Medications After a Tube Shunt?

All patients will need eye drop medications to help prevent infection and inflammation after a tube shunt implantation, usually for the first two to three months. After that, use of glaucoma medications to further control pressures will depend on the outcome of surgery, i.e., the pressure in the eye.

Glaucoma Filtration Procedure (Trabeculectomy)

When glaucoma continues to progress despite the use of medication regimens and possibly laser treatments, a glaucoma filtration procedure (trabeculectomy) may be recommended. In general, a glaucoma filtration procedure is recommended when these other methods of glaucoma management have failed or have insufficiently controlled the progression of glaucoma. However, in some cases, a glaucoma filtration procedure may be recommended before other methods of treatment are attempted. This decision is based on the type of glaucoma, the degree that it has advanced, the general health of the patient and ability to comply with treatment regimens, and other circumstances. In a smaller proportion of patients, the glaucoma filtration procedure is combined with a cataract operation.

The Procedure 

Once the decision is made to proceed with a glaucoma filtration procedure, the surgery is scheduled. The procedure is completed in the operating room, usually under local anesthesia. Some ophthalmologists will complete the procedure under topical (eye drop) anesthesia. On the day of surgery, one should expect to have several eye drop medications applied multiple times to the eye for approximately one hour prior to the procedure. Finally, the eye drop anesthetics or local anesthetic is applied just prior to the procedure.  Once in the operating room, your eye will be “prepped” for surgery with sterilizing solutions. Usually, a semi-opaque sterile drape will be applied over the operative field, using a small instrument to hold your lids apart for the procedure. Your eye should be entirely comfortable during the operation. Your surgeon may recommend mild sedation during the procedure, and this is usually determined on a case-by-case basis.

The goal of the glaucoma filtration procedure is to create a new passageway by which aqueous fluid inside the eye can escape, thereby lowering the pressure. The escape route, however, is not directly to the external surface of the eye, as this would obviously allow access for bacteria inside the eye and thus, potential infection.

The filter, therefore, allows the drainage of fluid from inside theanterior chamber of the eye to a “pocket” created between theconjunctiva , which is the outermost covering of the eye, and the sclera , which is the underlying white anatomical structure of the eye. The fluid is eventually absorbed by blood vessels.  In many cases, medication to control scarring, and thus to help prevent closure of the filtration site, is applied to the eye during the operation or just afterwards. These medications, known as Mitomycin C and 5-Fluorouracil (5-FU), will be used in some cases and not others, depending on both surgeon and patient variables.

After Your Operation

In most cases, a patch and shield will be placed over your eye on the day of surgery. This is usually removed later that day or the day after surgery and eye drop medications are begun. Your surgeon will usually want to evaluate your eye on the day of surgery or on the first post-operative day. At that time, depending on pressure in the eye, your surgeon might elect to cut sutures on the flap of the filter to modulate the filtration process. This is often done with a laser while in the office. Antibiotic and anti-inflammatory eye drop medications are continued after surgery for up to 6 weeks or more.  In some cases, the surgeon will apply additional medicines (e.g., 5-FU) to further prevent scarring and failure of the filter. The exact regimen will vary from one surgeon to another as well as surgical outcome variables. Cutting of sutures may be completed up to several weeks after surgery, again depending on the degree of filtration noted at each office visit. The number of visits to your doctor after surgery may vary widely depending on circumstances. In general, follow-up visits after filtration procedures are quite frequent, as often as every day or two shortly after surgery, with office visits decreasing in frequency as healing progresses.

FAQ’s

Can glaucoma be cured with filtration surgery?

In general, glaucoma is rarely cured, but the progression of the disease may be greatly delayed with surgery, medicine, or laser procedures. If your surgeon has recommended a glaucoma filtration procedure, it is quite likely that your glaucoma is moderately or severely advanced. The goal of this procedure is to preserve your vision. This is usually, but not always, possible.

Does surgery eliminate the need for medication? 

You will certainly need medications after surgery, perhaps for the first 4 to 10 weeks. After the filter site of your eye has entirely healed, whether you will need glaucoma medications will depend largely on the pressure in your eye as well as your peripheral vision (based on a visual field test). In most cases, dependence on glaucoma medication is reduced, and in some cases, glaucoma medications are no longer required. Your eye surgeon will determine whether medicines are appropriate or not based on your final outcome with surgery.

Is there still pressure in the eye after surgery? 

Yes. However, after a glaucoma filtration procedure, the pressure may be too low or too high, depending on the degree of filtration. Your surgeon will use many techniques as well as medicines to modulate this effect after surgery. Once healing is complete, usually 6 to 8 weeks after surgery, a new “baseline” pressure is usually established based on the degree of filtration created by the combination of the surgery and subsequent healing.

Does a filter procedure have risks?

All surgical procedures have risks. Glaucoma surgery is no different. The primary risks include, but are not limited to, infection, bleeding, swelling in the retina , development of fluid under the retina ( choroidal detachment ), retinal detachment, droopy eyelid, double vision, loss of vision, and even loss of the eye. The likelihood of these risks is quite low, but you should discuss the risks, as well as the benefits of the procedure, with your surgeon. In general, if your eye surgeon recommends a glaucoma filter procedure for you, he or she believes that the potential benefits of the procedure far outweigh the potential risks.

Cyclophotocoagulation

Transscleral cyclophotocoagulation is a procedure for glaucoma that is performed on an outpatient basis. In this procedure, the ciliary body of the eye, which creates aqueous fluid, is treated with laser to decrease production of aqueous. This in turn reduces pressure inside the eye. The technology has been available for nearly 30 years.

The cyclophotocoagulation procedure is usually performed with local anesthesia. About 20 to 40 laser delivery applications are completed. After the procedure, the patient is usually started on both dilating and anti-inflammatory eye drop medications, and perhaps oral anti-inflammatory medications as well.

Cyclophotocoagulation is most often employed when other means of glaucoma treatment have failed to properly control high pressures. Many patients will require more than a single treatment. The procedure appears to have significant success and relatively low risk.

What is a cataract?

A cataract is a clouding of the eye’s natural lens. When the lens becomes cloudy, it interferes with the passage of light through the eye, resulting in a decrease in vision. The lens of the eye is similar to the lens of a camera. When the camera lens is not working properly you get a blurry photograph. When the lens of the eye becomes cloudy your vision decreases and things appear blurry.

What causes cataracts?

Most cataracts are related to the natural ageing of the eye. However, other factors can be involved. Some diseases, such as diabetes or glaucoma, or the use of certain medications, such as steroids, are thought to increase the chance of a cataract occurring. Often, a cataract only covers a small part of the lens; if sight is not greatly impaired there is no need to remove the cataract. However, if a large portion of the lens becomes cloudy, sight can be partially or completely lost until cataract removal occurs.

Who can have a cataract?

Cataracts can occur at any age. Most cataracts occur in people who are 60 years of age or older, although a smaller number of people develop cataracts between the ages of 45 and 60. Some cataracts occur in children at birth due to genetic disorders or if the mother had rubella (German measles). Cataracts due to injury can occur at any age.

What are some cataract symptoms?

If you have cataracts you may not realize it right away. Vision loss may be gradual, painless and hard to detect until significant loss has occurred. Depending on the nature and cause, a cataract can develop rapidly over a few months or slowly over many years. In older people, it is not unusual for cataracts to develop in both eyes but most of the time the cataract develops in only one eye at a time.

Some of the more common symptoms of cataracts include:

• Blurred vision
• Glare
• Fading or yellowing of colours
• Poor night vision
• Double vision in one eye
• Halos around lights

People with a cataract in only one eye may notice a loss of depth perception; this can cause problems in judging where stairs are and determining the distance of cars driving in front of them.

What cataract treatment is available?

Presently, there is no medication, eye drops, exercises or glasses to cure or prevent cataracts. Cataract removal surgery is the only way to remove a cataract. Cataract treatment is one of the safest and most common types of surgery. Cataracts cannot be removed with a laser, only through surgery. Cataract surgery involves two steps. The surgeon removes the lens, leaving behind the lens capsule (outer covering).

The surgeon will use sound waves to soften the lens and remove it through a needle. Your lens is then replaced with a clear plastic lens at the same time. This artificial disc, called an intra ocular lens, is placed in the lens capsule inside your eye. Once a cataract has been removed, light can once again pass undistorted through the cornea and the newly implanted artificial lens, to the retina in the back of the eye. However, you may still be required to wear glasses to see more clearly because the incoming light needs to be focused directly on the retina.

If your eye cannot do so on its own, eyeglasses provide that focus .Cataract surgery is best performed on one eye at a time, to enable you to use one eye while the other is healing. Recovery usually occurs on an outpatient basis. Follow-up visits are scheduled for the next day and one week after surgery. A one month follow-up visit with your optometrist at home is recommended. Your sight will usually improve within a few days, although complete healing may take several months.

When should the cataract be removed?

For the most part it is up to the patient to decide when they want to undergo cataract removal. This is very much an individual decision because each patient has different vision requirements. Questions concerning cataracts and the need for cataract treatment should be discussed with an accredited optometrist and/or an ophthalmologist.

After surgery

Shortly after surgery is completed, the patient may go home and resume almost all routine activities. However, it must be understood that complications may occur in all types of surgery. In cataract removal surgery, hemorrhage, infection, and swelling are all possible, but very uncommon. The chance of any significant complication is less than 1%. Cataract treatment surgery is among the safest and most successful procedure in the medical field.

About a year after surgery, approximately 20% of the patients who undergo cataract surgery develop a haze of the capsular membrane surrounding the lens implant. Should this occur, YAG laser treatment is recommended. The YAG laser is used to create an opening in the clouded membrane, which significantly improves the patient’s vision. It is one of the safest treatments used in ophthalmology. It is painless, requires no anesthesia or incision, and takes only minutes to complete.

Patients with near-sightedness, far sightedness and astigmatism can now reduce or eliminate their dependence on contact lenses and eyeglasses through LASIK (laser assisted in situ keratomileusi). South America many people are surprised to hear has always been at the forefront of technology for eye surgery. 30 years ago refractive surgery was first developed in South America and as a result the most experienced doctors in the world, who not only use the latest technology but actually help develop it, are there.

The newest innovation to LASIK is a diagnostic device known as Wavefront. Wavefront is an extremely accurate device that maps any imperfections of your cornea and as a result there is less scar tissue and an increased probability of seeing 20/40 or better. It also allows people previously denied LASIK, due to thin corneal walls, the opportunity to undergo this life changing treatment.

ARE YOU A CANDIDATE FOR LASIK?

Here is a quick checklist to see if you are a good candidate for LASIK eye surgery? Every individual is different and nothing can replace a thorough examination by your optometrist to qualify you as a candidate.

1. Are you 18 years or older?
2. Has your prescription stayed the same or had only a minor change within the last year?
3. Do you have a moderate prescription for myopia (near sightedness) or hyperopia (far sightedness)?
4. You have never had eye surgery before? ( e.g. cataract, glaucoma,)
5. Do you currently have cataracts? Or Glaucoma?
6. Do you have a medical condition which may interfere with the healing process?
   • Autoimmune or immunodeficiency
   • Uncontrolled diabetes
   • Degenerative disease of the cornea
   • Cancer
   • Lupus
   • Rheumatoid arthritis
7. Are you currently using any of the following drugs such as isotretinoin (Accutane 2 ) for acne treatment or amiodarone hydrochloride (Cordarone 3 ) for normalizing heart rhythm.
8. Do you have severely dry eyes?
9. Are you pregnant or nursing?

If you answered yes to questions 1-3 and NO to questions 4-9 you may be a good candidate for LASIK. Before you travel to receive LASIK it is very important that you visit your local optometrist and confirm your candidacy.

1-. Explanation of the procedure 

LASIK is a form of outpatient corneal surgery in which, under local anesthesia, a surgeon uses a specialized and precise flap-making instrument, called a microkeratome, to create a thin flap of corneal tissue. This flap is raised and laid back while still attached to the cornea. The surgeon then uses an excimer laser to remove a pre-determined amount of corneal tissue from the exposed bed of the cornea. The amount of tissue to be removed is calculated based on the pre-operative determination of the power of your eye. The flap is replaced and within minutes natural forces hold the flap down on the cornea. Usually, within a few hours, the surface epithelium (“skin”) of the cornea begins to grow over the cut edge of the flap to seal it into position. LASIK can be used to correct nearsightedness (myopia), farsightedness (hyperopia), and astigmatism.

2-. Understanding How Your Eye Works

In order to decide whether to undergo the Procedure, it is helpful to understand how the eye works. The eye is like a camera. The cornea is the clear, dome-shaped window that forms the front wall of the eye. The retina is the light-sensitive tissue in the back of the eye that connects to the brain. The retina acts like the film in a camera. The cornea at the front of the eye acts as a lens that focuses light onto the retina, producing an image on the retina that gets transmitted to the brain and interpreted as vision. The curve of the cornea determines the power of the corneal lens and whether the incoming light rays from distant objects focus directly onto the retina. When light does not focus directly on the retina, the eye has a refractive error. This means that with the appropriate “refractive correction” lenses, incoming light rays become focused onto the retina, producing clear vision.

• Myopia/Nearsightedness 

In the normal eye, the cornea focuses light rays directly on the retina, resulting in clear vision
without glasses or contact lenses. In myopia , or nearsightedness , the eye is longer than
normal. The light rays come together at a point in front of the retina, and are out of focus on
the retina. Distant objects are blurred, while nearby objects can be clear.

• Hyperopia/Farsightedness 

In hyperopia, or farsightedness , the eye is shorter than normal. The light rays come together
at a point behind the retina, and are therefore out of focus on the retina. Nearby objects can
appear blurry, while distant objects are clearer. Very farsighted patients will report that even
distant objects appear blurry.

• Astigmatism

In the normal eye, the cornea is curved the same in the horizontal and vertical directions, like
a baseball. When the light rays hit the cornea, they focus at a single point. In astigmatism ,
the curve of the cornea is not the same in the horizontal and vertical directions. The cornea
looks like a football, with a steep curve on one side and a flat surface on the other.
As a result, light rays entering the cornea do not focus at a single point, causing distorted
vision. Many people with myopia or hyperopia have some degree of astigmatism.

In all of these conditions, the person needs some type of corrective lens, such as glasses
or contact lenses to focus the light properly. LASIK is used to change the shape and curve
of the cornea in order to correct myopia, Hyperopia and astigmatism.

3-. WAVEFRONT-GUIDED TREATMENT –What is it?

As technology advances, additional treatment options become available to patients. One such procedure is wavefront treatment (also referred to as “custom ablation” or “custom treatment”).

Eyeglasses and contact lenses address what’s known as ‘low-order aberrations’, of which nearsightedness, farsightedness, and astigmatism are symptoms.

Wavefront treatment corrects additional visual imperfections called ‘high-order aberrations’ (e.g., halos, spikes, starbursts, some night vision problems, etc.), improving visual acuity and visual quality beyond that which is possible with eyeglasses or contact lenses, or other, less evolved laser eye treatments. These high-order aberrations are mapped, and a customized laser treatment plan is developed to correct them.

Wavefront treatment involves creating a sophisticated corneal map of the eye and then combining that with an analysis of the visual system of the eye using a Wavefront analyzer, or aberrometer, which studies the way the eye bends light rays, improving visual quality potential. A precise measurement of all the aberrations of the eye provides a broader treatment range and allows patients to be treated that might have otherwise been ineligible. The entire visual system is analyzed, from the corneal surface through the crystalline lens of the eye, all the way to the retina, which is at the back of the eye. This combined analysis is then applied directly to the cornea via laser treatment.

These steps represent a far more detailed assessment and treatment of the visual system than available previously, whereby visual imperfections are virtually eliminated. Wavefront treatment can be done in conjunction with either LASIK or PRK, allowing one the opportunity to potentially see 20/20 or even better.

4-. Chances of Success  

Chances of Success in LASIK

Chances of Success in LASIK of IUMO.

*A visual acuity of 20/40 of better is required to pass the driver’s license examination. It is therefore considered the legal “normal” visual acuity.

5-. The Process  

First step initial exam

If you wear contact lenses, it is a good idea to stop wearing them before your baseline evaluation and switch to wearing your glasses full-time. Contact lenses change the shape of your cornea for up to several weeks after you have stopped using them depending on the type of contact lenses you wear. Not leaving your contact lenses out long enough for your cornea to assume its natural shape before your and exam and surgery can have negative consequences. These consequences include inaccurate measurements and a poor surgical plan, resulting in poor vision after surgery. These measurements, which determine how much corneal tissue to remove, may need to be repeated at least a week after your initial evaluation and before surgery to make sure your measurements have not changed.

You should tell your doctor about your past and present medical and eye conditions and any medications you are taking including over the counter medications and any allergies you may have. You should have the opportunity to ask your doctor questions during this discussion.

Your doctor should perform a thorough eye exam and discuss whether you are a good candidate for Lasik and what the risks, benefits and the alternatives of the surgery are. You should know what to expect before, during and after the surgery and what your responsibilities are. Give yourself plenty of time to think about the risk/benefit discussion, to review any informational literature provided by your doctor, and to have any additional questions answered by your doctor before deciding to go through with surgery and before signing the informed consent form.

Second Step (Pre- procedure)

Contact Lenses

Contact lenses can “warp” the corneal surface, which changes the corneal curvature and leads to a measurement of your refraction that is not representative of your true refraction. In order to properly calculate the treatment to correct your refractive error, you will have to stop wearing contact lenses at some stage prior to surgery. The time interval that you must go without wearing contact lenses depends on the type of lens that you use and the length of time you have used them.

1. Soft contact lenses may not be worn for at least one (1) week prior to the pre-operative exam. Soft contact lenses may not be worn for at least one (1) week prior to the Procedure.
2. Soft toric lenses may not be worn for at least one (1) week prior to the pre-operative exam. Soft toric lenses may not be worn for at least one (1) week prior to the Procedure.
3. Gas permeable lenses may not be worn for at least four (4) weeks prior to the pre-operative exam (or 8 weeks if you have worn them for more than 20 years or 12 weeks if you have worn them for more than 30 years). Gas permeable lenses may not be worn for at least six (6) weeks prior to the Procedure.
4. True hard lenses (PMMA) may not be worn for at least twelve (12) weeks prior to the pre-operative exam. True hard lenses (PMMA) may not be worn for at least twelve (12) weeks prior to the Procedure.

Exceptions to the above rules exist and you can discuss these with your eye physician.

Your doctor will order blood tests to be performed.

Day before surgery and day of surgery

You should stop using:

• Creams or lotions
• Make-up
• Perfumes
• Hair products that contain alcohol such at hair spray or mousse

These products as well as debris along the eyelashes may increase the risk of infection during and after surgery. Your doctor may ask you to scrub your eyelashes for a period of time before surgery to get rid of residues and debris along the lashes.

Make sure you bring with you a pair of sunglasses, your eyes will be sensitive and irritated by light for the first 24 to 48 hours.

Avoid alcohol 24 hours prior to and 48 hours after your surgery, as this tends to dehydrate the tissues.

Wear comfortable clothing on your surgery day. Avoid clothing such as wool that may generate lint in the surgical suite. Wear minimal jewelry and bring only necessary personal items.

Before your surgery

You will be instructed to take off your shoes and jewelry. You will then be given a sterile hair cap, body garment (you do not take off your clothes) and foot coverings. You will then be led to a preparatory room where an assistant will begin treatment with numbing eye drops.

During Surgery  

The surgery should take less than 20 minutes. You will lie on your back in a reclining chair in an exam room containing the laser system. The laser system includes a large machine with a microscope attached to it and a computers screen.

Another numbing drop will be placed in your eye, the area around your eye will be cleaned, and an instrument called a lid speculum will be used to hold your eyelids open. A ring will be placed on your eye and very high pressures will be applied to create suction to the cornea. Your vision will dim while the suction ring is on and you may feel the pressure and experience some discomfort during this part of the procedure. The microkeratome, a cutting instrument, is attached to the suction ring. Your doctor will use the blade of the microkeratome to make a flap in you cornea.

The microkeratome and the suction ring are then removed. You will be able to see, but you will experience fluctuating degrees of blurred vision during the rest of the procedure. The doctor will then lift the flap and fold it back on its hinge, and dry the exposed tissue.

The laser will be positioned over your eye and you will be asked to stare at a light. This is not the laser used to remove tissue from the cornea. This light is to help you keep your eye fixed on one spot once the laser comes on. NOTE: if you cannot stare at a fixed object for at least 60 seconds, you may not be a good candidate for this surgery.

When your eye is in the correct position, your doctor will start the laser. At this point in the surgery, you may become aware of new sounds and smells. The pulse of the laser makes a ticking sound. As the laser removes corneal tissue, some people have reported a smell similar to burning hair. A computer controls the amount of laser energy delivered to your eye. Before the start of surgery, your doctor will have programmed the computer to vaporize a particular amount of tissue based on the measurements taken at your initial evaluation. After the pulses of laser energy remove the exact amount of corneal tissue, your eye is irrigated and then the flap is put back into position.

After Surgery 

Immediately after the procedure, your eye may burn, itch, or feel like there is something in it. You may experience some discomfort , or in some cases, mild pain and your doctor may suggest you take a mild pain reliever. Both your eyes may tear or water. Your vision will probably be hazy or blurry. You will instinctively want to rub your eye, BUT DON”T!! Rubbing your eye could dislodge the flap, requiring further treatment. In addition, you may experience sensitivity to light glare, starburst or haloes around lights, or the whites of your eye may look red or bloodshot. These symptoms should improve considerably within the first few days after surgery. You should plan on taking a few days off from work until these symptoms subside. You should contact your doctor immediately and not wait for your scheduled visit, if you experience severe pain, or if your vision or other symptoms get worse instead of better.

You will be given antibiotic eye drops and a lubricating eye drops to use in the weeks following your surgery.

Your doctor will then schedule a follow up visit for the following day to examine you eyes and test your vision. You should have another follow up exam three days after surgery, one month and three months.

If you choose to use your own eye care professional, your doctor will require pre- and post-operative forms. After your 24-hour post-operative appointment you will receive, via email or in person, your refractive surgical report and post-op form for your own eye care doctor.

Day of laser eye surgery (after your surgery) 

• The day of surgery should be a day of rest.
• Always be very careful about activities where the eye may be poked, rubbed or touched.
• Always avoid rubbing eyes. Rubbing is never a good idea – instead use lubricating drops for irritation.
• Avoid staring without lubricating the eyes.

24 hours after laser eye surgery.

• Take a bath instead of a shower .Avoid getting soap or water in the eyes.
• Restrict movement to light activities. Work should probably be avoided. Work at home is acceptable.
• Driving short distances after the eye examination is acceptable if adequate vision is confirmed at the post operative evaluation.
• Reading and watching television is acceptable as long as adequate eye lubrication is maintained.
• Flying in airplanes is acceptable but keep eyes generously lubricated (every 30 minutes) airplanes have very dry air.

48 hours after surgery

• Driving can be resumed if adequate vision is confirmed at post-operative evaluation.
• Shower, but continue to avoid any soap or water in the eyes.
• Apply face make-up but not eye make-up.
• Do office work.
• Use computers, but it is very important to keep eyes well lubricated.

Day 3 activities

• Exercise without risk to the eyes, e.g., treadmill, stair climber, stationary bike
• Sexual activity (avoid touching near the eyes)
• Playing with children (be careful)
• Drinking alcohol

Day 7 activities

• Applying eye make-up (avoid touching the eye)
• Jogging outdoors
• Rollerblading
• Relaxed bicycling, no mountain biking
• Playing golf
• Lifting weights

Activities for 1 month after surgery (maintain eye protection for 6 months following any eye surgery)

• Racquet sports – squash, racquetball, badminton (always wear eye protection)
• Swimming
• Scuba diving, snorkeling
• Sailing
• Sun tanning
• Motorcycling, dirt biking, mountain biking
• Parachuting
• Baseball, basketball, football, soccer, hockey
• Skiing

Activities for 3 months after surgery (maintain eye protection for 6 months following surgery)

Proceed with caution as these activities have a high risk of water being forced into the eyes.

• Water skiing
• Wind surfing
• Kayaking
• Surfing

6-.  When should You NOT have LASIK  

If you have any of the following situations or conditions, the risk of LASIK surgery may be greater than the benefit. You should consider NOT having LASIK surgery if you:

• Are pregnant or nursing. These conditions may cause temporary and unpredictable changes in your cornea that may interfere with the accuracy of the measurement of your cornea before the LASIK procedure.
• Have a collagen vascular (e.g., rheumatoid arthritis), autoimmune (e.g., lupus), or immunodeficiency disease (e.g., AIDS). These conditions affect your body’s ability to heal and may result in inflammation or swelling of parts of the body such as muscles, joints, and blood vessels.
• Show signs of keratoconus