Excimer Laser

excimer-swind-amaris

Laser that emits very concentrated light in the ultraviolet (UV) region of the spectrum.

Excimer lasers are used, for example, in:

Ophthalmology — to vaporize part of the surface layer of the cornea and thus reshape the cornea to correct refractive errors from myopia(nearsightedness), hyperopia (farsightedness), and astigmatism.

An excimer laser uses a noble-gas halide. Excimer is a chemical term that refers to a substance formed by the joining of two atoms or two molecules of the same chemical composition in an excited state; it is an excited dimer.

The process through which visual impairments (myopia, hypermetric, and astigmatic) are corrected with completely computerized Excimer Laser devices that reshape the eye’s the transparent layer, cornea, can be briefly called “visual correction with Laser”.

When applied on the cornea tissue on the front region of the eye, Excimer laser causes breaking of the carbon bonds that hold the tissue in the cornea together, and thus makes the tissue evaporate and vanish. In Excimer laser, when the completely adjusted laser is directed to the requested points on the cornea, a certain part of the cornea can be planed. Thus, refractivity of the cornea changes and reaches the demanded value.

Treatment of refraction errors via Excimer laser method has been used for more than 25 years throughout the world, and for 22 years in Turkey. In the meantime, both laser devices and application methods significantly changed. With each new development, getting better and demanded results, providing excellent comfort for the patient, and reducing complications became possible. While it was initially applied with PRK method, Excimer laser has reached to Femto-Lasik procedure today.

Who can have Excimer Laser Treatment?

In a normal eye with no refraction issue, image of an object forms on the retina where the image is fully perceived.

*Myopic people: In myopic people’s eyes, the cornea surface is excessively concave or the length of the eye is more than the usual. These paints view far objects blurry since the image forms in front of the retina.
* Hypermetropic people: These are the patients whose corneas are smoother than the usual, and length of the eye is shorter than the normal. Thus, the image forms behind the retina. For hypermetric eyes, difficulties in seeing far objects are more severe than difficulties in seeing nearer objects.
*Astigmatism: When the surface of the eye is curved like an egg, there occurs problems with both seeing the far and seeing the near.
*Presbyopia: It is the difficulty of seeing near objects, which occurs as a result of eye lenses’ decreased elasticity due to ageing. It is more common with people over 45. As a result of natural ageing process, people over 45 years of age wear hypermetropic glasses or need a hypermetropic glasses in addition to their myopic glasses.
Myopia up to 10 numbers, hypermetropic up to 5 numbers, and astigmatism up to 6.00 numbers can be quickly corrected via the latest technology Schwind Amaris 750 H Excimer laser device at İzmir Private Ekol Eye Center. Additionally, thanks to presbymax technology, which delivers the best and the most satisfactory results in the world, near vision impairment can also be corrected.

Excimer Laser Application Procedures:

PRK: It is the initial procedure of Excimer Laser. Here, epithelium, a very thin live tissue on the cornea is rubbed out using a scraper called spatula. After about 9 mm of the cornea surface becomes completely epithelium-free, Excimer laser is applied. The eye regenerates the removed epithelium part on its own. Post-operation period is painful. For about 3 to 7 days, the patient may feel pain and stinging pain. Ease in vision may take as long as 3-6 weeks.

TPRK: In this technique, which is specific to Schwind Amaris Excimer Laser device, laser is applied directly on the cornea without removing the epithelium. In this method, stinging pain is less and eye healing is faster.

LASIK: Lasik is a surgical method developed for making the correction via Excimer laser painless and satisfactory. Lasik method has 4 important advantages:

1-) It is a less painful method compared PRK. Stinging pain and ache complaints after the surgery significantly decrease or diminish starting from the 2th day.
2-) Vision improves faster. The patient can have a satisfactory vision within 3-5 days.
3-) Return of the number and blurriness on the cornea, do not happen after the surgery.
4-) It can be applied to myopia up to 10 number.

There are mainly two steps in Lasik method:
1-) Producing corneal flap
2-) Excimer laser application

1st Step:
In Lasik method, eye specialist cuts off a thin and circular layer before applying Excimer laser. Then, this layer (corneal flap) is carefully folded backwards, leaving the central area of the cornea open. The important point is how flap removal operation is conducted. In classic Lasik method, microkeratome, a special precision blade, is used for this application.

2nd Step:
After the cornea flap is removed from the area and secured, laser is applied on the cornea bed. Then, the flap laying backward is put back into its place in a proper position.

IS LASIK PAINFUL?
LASIK technique is a completely painless method that and takes little time. When applied with microkeratome, a slight pain may be felt due to microkeratome’s hold of the eye while the incision is made. However, this pain is brief and slight, causing no disturbance. The type of anesthesia used for LASIK is the drop anesthesia. There is absolutely no operation requiring needle or stitching. After dropping several drops of anesthetic substance, operation on the eye can be carried on painlessly.

Vision improves rapidly after LASIK operation, thus, you can go to your home after 15 minutes of resting. A slight itching and light sensitivity is expectable, but none of them are severe. The patient may take painkiller in case of pain. Sight becomes satisfactory within 2-3 days.

Is the vision correction via LASIK safe?
In such a developed country USA, a corporation named FDA (Food and Drug Administration) confirms any kind of treatment after a very detailed examination. FDA confirmed PRK method in 1995, and LASIK method in 1999 as safe treatments.

Is LASIK completely risk-free?
Rate of complications, unwanted results, in LASIK method is extremely low. Almost all of the reported complications are related to the mechanic keratome incision applied during the corneal flap production.
Complications that may occur while the flap is removed with razor microkeratome during Lasik application are reported to be 2.2% in large ranges. However, thanks to experienced hands and advances devices, this rate of complication can drop below 1%. In Ekol Eye Center, the most commonly used and the least risky device, Schwind’s pendular microkeratome is being used.
Complications arising during the incising of the cornea in the desired thickness, order, and completeness may sometimes be serious and harmful to vision. But none of them resulted in loss of the eye.

FEMTO-LASIK:

femtosecond

The latest technological method Femto-Lasik is on the most important advancements in refractive surgery. This completely computerized system, which allows no mechanic intervention, makes the corneal incision required for Lasik without blades and with extremely reliable and peerless precision, using laser.
While Lasik method, which is applied on millions of people on the world, is quite reliable, it may cause some complications. Almost all of these complications are related to the first step of the procedure in which the flap is removed with the mechanic keratome. FEMTOSECOND laser technology resolved this problem completely. Flap incision, the first step in the procedure, is now done via computer-based lasers. In this way, it is possible to make flap incision appropriate to the desired thickness, desired diameters, and in desired region, and it is now possible to produce flaps with utmost accuracy and precision.

In methods in which the corneal flap is removed with the microkeratome blade, there might be an inflammatory reaction (DLK: Diffuse Lamellar Keratitis) between the flap and the cornea bed, albeit rarely. In case this reaction occurs, your cornea flap might require removal and cleansing, and you might need some additional medicines. In Femro-Lasik application, the rate of DLK cases is much more lower, and it causes less problems. Another rarely seen but unwanted case is the passing of the cornea under the epithelial flap, the outmost cell layer. This complication is also close to nonexistent (under 0.1 percent) in Femto-Latik method due to regular incision.

WHY DO WE SUPPORT FEMTO-LASIK APPLICATION? :
*Femto-Lasik eliminates the potential complications generated by mechanic keratome and provides extra safety for our patients.
* We are able to provide our patients having thin corneas with Lasik applications since we can remove flaps in desired thicknesses with femtolaser.
* Since we can remove thin flaps with femtolaser, we are able to apply Excimer laser on the patients having high refractory errors as well as on the patients having myopia up to 10.00 degree.
* Femtolaser renders the Lasik application completely a laser method from the beginning to the end.
* When the cornea flap removed via femtolaser is laid back once one after Excimer laser application, it generates a more suitable flap.
* Making flaps via femtolaser is painless and more comfortable since it puts less pressure on the cornea.
In Ekol Eye Center, we use Ziemer Z6+ Femtosecond laser device, which incorporates the latest technology in the world.

WAVEFRONT (EAGLE EYE) TECHNOLOGY:
In addition to refraction errors such as myopia, hypermetropic, and astigmatic, some eyes also have Aberrations, which are the optical irregularities depending on irregular spots on the cornea layer of the eye. Aberrations may reduce night vision and vision precision.

In this treatment, mostly known as Eagle Eye, irregularities on the cornea are detected and these spots are corrected with an extremely precise topography in addition to the treatments of myopia, hypermetropic, and astigmatic visions of the patient. This application provides the patient with night vision and vision precision better than the vision with eyeglasses.
At Ekol Eye Center, the irregularities detected with the latest technology Schwind Sirius Topography device are loaded into Schwind Amaris 750 Excimer device with the help of computers and treated under computerized supervision.

ASSESSMENT BEFORE EXCIMER LASER TREATMENT:
The tests performed before Excimer laser treatment, are very important. Risk-free and appropriate patients identified through these tests undergo Excimer laser treatment. 3D detailed maps of the cornea (cornea topography) will be sketched, the cornea thickness will be calculated at multiple points, and the cornea irregularities will be identified. There will be no contact with your eyes during these applications.

HOW IS MY VISION GOING TO BECOME AFTER EXCIMER LASER?
Almost all of research results show that vision precision without glasses becomes 60/100 with 99% possibility, and it becomes 100/100, with 80% possibility after the standard LASIK operation. With devices adopting Wavefront (Eagle eye) technology, these rates increase even further. Still, it is impossible to guarantee that the patient will never wear glasses again. Although, with the new technology our purpose is the complete treatment of refraction errors, your eyes might not be completely emmetrope (eye without refraction errors) depending on type and degree of refraction errors of the eye and some other structural factors. However, your vision will not be the same as before the surgery, and most likely you will carry on your life comfortably without wearing glasses. A very slight percentage of patients experience night vision problems. However, with Wavefront technology, these are very exceptional.

CAN MY NEAR VISION BE CORRECTED WITH EXCIMER LASER?
Although far vision problems have been corrected for about 25 years, presbyopia, the refraction error that requires wearing near vision glasses after the age of 45 could not have been treated with Excimer laser. However, there have been significant advancements to overcome this problem in recent years. Implanting certain materials inside the cornea for this correction has resulted in unsatisfactory effects and there have been some complications during operations. At some clinics, the patient’s eye lenses were removed and lenses correcting far and near vision were implanted despite the fact that the patient did not have cataract.
Today, the latest technology for correcting near vision with Excimer laser is PRESBYMAX. This is a technology that can only be applied with Schwind Amaris device. In this technique, only near vision impairments, or both near and far vision impairments can be treated. Treatment procedure is the same with Lasik treatment procedures mentioned above. In this procedure, the cornea flap is removed using mechanic keratome or femtolaser. This technology is still applied in Germany, France, England, Korea, China, Japan, and Russia.
Near vision of the patients treated with this technology improves significantly starting on the day one, but there might be slight decrease in far vision. After careful examination of the cornea and the diameter of the pupil, PRESBYMAX is applied to the patient group appropriate to this treatment. This treatment generates the best results for patients who require better near vision instead of a better far vision. One of the important advantages of PRESBYMAX is that this treatment can be undone if the patient is unsatisfied with the results. This brand new Excimer laser technology, which provides the most satisfactory results, is applied with Schwind Amaris 750 Excimer Laser device only at Ekol Eye Center in İzmir. This treatment can be performed mechanically by removing flap with Schwind Pendular Microkeratome, or under complete computer supervision, using Ziemer Z6+ Femtolaser device.

CAN EVERYBODY HAVE EXCIMER LASER TREATMENT?
LASIK may be dangerous in case of various systemic and eye related illnesses that may prevent the cornea from taking shape. Before LASIK, your eyes must be examined with latest technology, advanced devices. Additionally, it should be taken into account that Excimer laser is not appropriate for individuals under 18, pregnant women, breast feeding mothers, and people whose eye numbers are frequently changing. It is not recommended in case of eye illnesses such as cataract, keratoconus, dry eye etc. and systemic illness arising from diabetic and immune systems.

DURING THE OPERATION;
* In Excimer Laser method, anesthetics such as needles and narcosis are not used. Only an eyedropper is used to anesthetize the eye surface.
* Both Excimer laser operation and flap removal operation are short applications that take 1 or 2 minutes. With the new laser technology, laser exposure time usually lasts less than 1 minute. Considering the eye’s preparation for the operation, total operation duration is accepted to be 5 minutes per eye.
* You can communicate and talk with your doctor during the laser operation.
* We recommend you to relax and keep your eyes motionless. However, thanks to the eye traction system of advanced the Excimer laser devices, which are sensitive to the eye, the laser follows your eyes and apply the right amount of laser beam on the proper spot even if you move your eyes.

AFTER THE OPERATION:
* Your eyes will not be closed after the operation; you can return home immediately.
* It recommended spending several hours for resting.
* If you undergo lasik or femto-lasik treatments, you can carry on your life as usual on the following day. Wearing protective sunglasses might be beneficial since it helps to deal with light sensitivity that may occur during the first couple of days.
* Rubbing, pressing on, and itching your eyes are unfavorable.
* You should use the prescribed eyedroppers in the required manner.

FREQUENTLY ASKED QUESTIONS AND ANSWERS:
* Seeing that this is a very advanced technology, then why don’t most of eye specialistsundergo operations?
Answer: One of the most important reasons is that the eye specialist experienced enough to treat you, probably has both near vision problems and far vision problems due to his/her age. Since there is no treatment for the near vision impairments for years, far vision treatment is not appropriate for a group of experienced specialists.
Additionally, doctors who frequently perform eye surgeries may have problems using microscopes after the surgery, since they spend more time with microscopes compared to other people.  Another reason is that Excimer laser treatment is a based on choices. If a person is happy with his/her glasses, there is no need for that person to undergo this operation. Doctors, being accustomed to wearing glasses may not prefer surgery since wearing glasses do not cause a problem in their jobs.
However, there are many doctors who have undergone this operation as well.
* Does my eye number before the operation return?
Answer: This case was happening with the devices and techniques when Excimer lasers were being applied for the first time. However, today, especially in the Lasik method, such cases are exceptional.
* Can people who have undergone Excimer Laser treatment have cataract operation in the future as well?
Answer: This is another of the false-rumors. A person who has undergone Excimer laser treatment can have cataract operation just like a person who has not undergone laser treatment. Excimer laser treatment is performed without penetrating the eye, and it does not prevent having cataract surgeries, which are done by penetrating the eye.
* Does my eye number advance after the surgery? Can I have this operation once more?
Answer: Not having more than 0,25 change in eye number during the last year and being above 18 years of age are important criteria for the surgery. Some refraction errors that usually stop at age 18 may sometimes advance, though there is no turning back to the old eye numbers with the new Lasik methods. If there is a significant eye number change and exceptionally if the desired number cannot be accomplished, it is possible to redo the operation in a much easier way after 6 months following the first surgery.
* Is there any risk with the surgery? Do I lose my eye?
Answer: Risk is never zero with anything. As mentioned above, most of the complications regarding Lasik treatment occur while the cornea flap is removed with a blade. The rate of complication is 1% or below with an experienced surgeon. With Femto-Lasik, this rate is even smaller. None of these risks are untreatable. There is no possibility of eye loss or complete blindness under any circumstances.
* At which ages can I have Excimer Laser Treatment?
Answer: Patients anywhere from age 18 to age 65 can undergo this operation. However, 18 to 40 age-range is more appropriate for far vision treatments, and 40 to 65 age-range is more appropriate for near vision treatments.