Eye Health, Medicare Health & Travel Services

Eye Health

  • Excimer Laser
  • Cataract
  • Treatment of Refractive Error

EXCIMER LASER

Excimer Laser is the common method used for treating refractive errors such as myopia, hypermetropia and astigmatism. Excimer Laser treatment is currently done using two techniques.

  1. Surface treatment. (PRK-LASEK)
  2. Deeper treatment (LASİK)

This treatment method is preferred for low grade refractive errors and for those whose cornea is not thick enough for Lasik method.

This is the practice by which epithelium, the outermost layer of cornea, is scraped and laser is applied to the surface beneath.

After the procedure is over, contact lens is worn for a few days for a faster and easier healing of the surface and for reducing the discomfort. The sight will be a little blurry until the surface is totally healed (for 48-72 hours).

This is the most common method today because of its advantages such as applicability to high grade refractive errors, fast healing of the sight and shorter period of discomfort following the operation (6-8 hours).

Lasik method involves removal of a thin layer on the cornea surface, followed by laser application and replacement of the removed layer after the operation is over.

- Everyone over 18, there is no upper age limit unless cataract or nuclear sclerosis, which is the initial phase of cataract, is involved.
- The individuals whose glasses has not changed more than 0.50 diopter in the last two years.
- Those who have been found to have a suitable eye construction in the detailed examination and analyses and who are free from any eye diseases (keratoconus, cataract, glaucoma, diabetic retinopathy etc.) that may hinder the operation.
- Those with myopia up to 10.0 diopters.
- Those with hypermetropia up to 6.00 diopters.
- Those with astigmatism up to 6.00 diopters.
- Those with sufficient cornea thickness.
- Those free from rheumatism or connective tissue diseases.

Examination and surveys are done to check whether the eye is eligible for Excimer laser treatment and decision is made on the best suited and the safest laser method for the eye.

It is as important a stage as the laser operation itself.

Before the examination, the person must have spent 2 days without wearing soft lenses and two weeks without wearing the hard and gas permeable lenses.

This is for identifying the visual acuity and the degree of refractory error. Eye pressure is measured. Front and rear parts of the eye are examined in detail.

- Cornea, the transparent layer in the front eye, is topographically mapped (slope and elevation).
- Cornea thickness is measured using pachymetric method. Cornea thickness is one of the most important parameters when deciding for the type of laser to be used.
- Pupil diameter in darkness and in daylight is measured using pupillometer.
- Any irregularities in the transparent parts of the eye are analysed using wave front analysis method.

Results of the surveys and examinations are assessed together to identify whether the eye is suitable for laser and to decide on the method to be used.

Excimer laser treatment is a short-time method that gives no trouble to the patient. It does not require an empty stomach. The person is only asked to wear no eye make-up and avoid taking blood diluent drugs such as aspirin.

Upon entering the laser room, you will be asked to lie on your back on the special laser bed and your eyes will be narcotized with an eye drop only. After covering your eye with a sterile sheet, a special tool will be used to keep your eyes open for ensuring no blinking during the operation.

Eyes are not bandaged after the treatment.

About 30 minutes after the treatment, the patient is examined to check the condition and then sent home.

Lasik method gives a burning, stinging and watering sensation that starts sometime after the treatment and lasts about 6-8 hours. For the first day, you are advised not to drive, not to rub your eyes and avoid water contacting your eyes. Your sight will be almost recovered on the day after treatment.

In PRK method this takes about 2-2.5 days.

After treatment with Lasik method, various eye drops should be used for about 3 weeks. With PRK method, this period is extended to 6-8 weeks.

At present, people are in search of more comfortable lives. Many people feel themselves restricted with contact lenses and glasses and want to have a clear sight without them. Thanks to the big advancements in technology, Excimer laser refractive surgery is the most common and effective method that serves this purpose. In the last 10 years, there have been more than 50 million Excimer laser applications across the world.

Very satisfactory results are obtained from Excimer laser treatment applied by well-trained and experienced doctors using advanced technological equipment.

CATARACT

Cataract is an eye disease that causes the natural lens within the eye to lose its transparency, consequently leading to the impairment of sight. It is by 90% dependent on advanced age. But it may be seen in all age groups including babies. The light and images coming from outside can be clearly received by the visual cortex only if they are refracted first in the cornea, the outmost transparent layer of the eye, and then in the lens layer inside the eye. Under normal conditions, both of these layers are transparent. When transparency is lost, the lens becomes opaque, its color changes and turns it into something like an opal glass and the patient gradually loses sight. Cataract is the case in which the lens inside the eye shifts from transparency to opacity. It is among the top reasons of curable blindness.

Although there is no known cause, many risk factors can be counted including nutrition, ultraviolet beams etc. Depending on the lens opacity, patients first complain about nearsightedness or farsightedness.

The most important cause of cataract is old age. Besides ageing, it may be brought about by traumas, some other eye surgeries, some medicines and diabetes, as well as developing secondarily to eye diseases including uveitis and eye pressure. Factors such as vitamin C deficit and exposure to ultraviolet beams also accelerate cataract development.

Cataract may also be encountered during babyhood and childhood. The most important factor in congenital cataracts is infections, such as German measles, that mothers have during pregnancy.

- Gradual impairment of sight
- Light sensitivity, glare
- Diplopia
- Dyslexia
- Impaired night vision
- Fading or yellowing of colors
- Operation should be performed when a person has troubles in vision. No need to wait.
- Waiting makes the surgery more difficult.

Cataract has no medical treatment. Only surgery can cure it. Operation is based on removing the lens that has opacified and lost its transparency and giving the patient a clear sight. Before 1950’s patients had to use glasses (with about +10 diopter) after the surgery because the operation was completed without placing a lens in patient’s eye. Surgeries at present involve placing a lens in the eye and patients have a clear post-operative near and far sight by using glasses with very low diopter.

Colloquially known as laser-assisted cataract operation, the method is called phacoemulsification. This method is about using an ultrasonically vibrating needle to crush the cataract in the eye and remove it out. This surgery is shortly named as PHACO surgery.

In today’s advanced cataract surgeries; general or local anesthesia is applied only in special circumstances. Patients are prepared for the surgery with 4-5 drops of eye drop that narcotizes the eye. Patients must quietly lie on the back for about 10-15 minutes.

Phaco surgery starts by laceration of the cornea with a diamond knife at a depth of 2 mm and a special gel is fed into the eye. This gel is for protecting the inner eye tissues.

A circular piece is removed from the front capsule of cataract. The hard nucleus beneath is crushed using the ultrasonically vibrating needle named phaco and taken out of the eye.

This procedure is followed by clearing the soft sections between the capsule and the nucleus and the front capsule cells. Extreme care must be exercised meanwhile in order to protect the 50 micron lens capsule from being damaged. The capsule, totally emptied just like a transparent bag, is refilled with gel.

The foldable lens is inserted in the eye with a special injector. Then the gel is washed away from the eye interior using serum. The laceration is treated with serum, thus the incision is closed without stitching. The operation is over.

During the postoperative 3-4 weeks, cortisone and antibiotic eye drops and nonsteroid eye drops are used 4-6 times a day. Postoperative controls are scheduled for day 1, week 1 and month 1 (eye test).

- The function of eye is impaired or lost for both far and near sight.
- Eye pressure may increase.
- Amblyopia (lazy eye) may develop.
- Inflammations called uveitis may develop inside the eye.
- It becomes harder to diagnose and treat the problem inside the eye since the visual cortex and retina are not observable in the examination.

ataract surgery is recommended if the vision is blurred to the extent that the patient is unable to carry on the daily life (difficulty of reading, of watching television, of driving). There is no need to wait until the cataract is mature to perform the operation. Surgery decision is made by the ophthalmologist in consideration of the patient’s needs.

Lenses are inserted in the eye to stay for the lifetime. Therefore they must have maximum compatibility with the eye. Lenses must be able to prevent the opacification of the rear capsule of the lens that has remained intact during the surgery. The patients planning to undergo cataract surgery should discuss with the doctor in detail about the lens to be placed in the eye. They must inform their doctor if they want to have a multifocal intraocular lens that gives clear far and near sight without glasses. Because most of the doctors do not choose multifocal lenses if not especially requested by the patient and insert a standard monofocal lens instead. In that case, patients lose the benefit of having a clear near sight. The multifocal lenses we use require a bit more precision in the surgery than the standard cataract intraocular lenses.

It is out of question for cataract to redevelop. What is colloquially known as redevelopment of cataract is the opacification of the rear capsule of the lens which remains in place in support of the intraocular lens. If the rear capsule loses its transparency, it may be treated in a couple of minutes using YAG laser capsulotomy.

It is out of question for cataract to redevelop. What is colloquially known as redevelopment of cataract is the opacification of the rear capsule of the lens which remains in place in support of the intraocular lens. If the rear capsule loses its transparency, it may be treated in a couple of minutes using YAG laser capsulotomy.

The diopter of the intraocular lens is calculated before the surgery in order to make sure that the patient has a clear far sight after the operation. Patients often need to wear both near and far sighted glasses after the operation, with a lower diopter for nearsight. Postoperative glasses is generally prescribed after the first month following the surgery. If prescribed earlier, the diopters change in time.

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