Detailed Treatment Information
Contact Lens Fitting
Treatments
Contact Lens Fitting
The clinic provides an extensive contact lens fitting service. We can provide soft lenses, RGP lenses, multifocal and toric contact lenses. The clinic also provides a specialist contact lens fitting service for keratoconus and post corneal graft patients.
During your contact lens fitting appointment the optometrist will perform a sight test and check the health of the front of your eye (your cornea, lids and conjunctiva). They will take a detailed history and discuss with you the many options available to you with regards to contact lenses. Together you will decide which is the best option for you based on their recommendations. (more…)
Corneal Cross Linking Keratoconus Treatment
Treatments
Corneal Cross-Linking (CXL) with Vitamin B2 (Riboflavin) Treatment
Keratoconus is a condition affecting about 1 in 2000 people where the collagen fibres in the cornea are relatively loosely arranged and not tightly bound to one another as it would be in a healthy cornea. The result is that the fibres can slip over one another and cause a steepening (cone) of the lower half of the cornea. This leads to a reduction in vision, an increase in astigmatism and the introduction of aberrations that reduce the quality of vision. (more…)
Cataract Premium IOLs
There have been some very exciting advancements in Intra-ocular Lens (IOL) technology that now make different options available to you when you undergo cataract surgery.
Cataract surgery requires the implantation of an IOL (intra-ocular lens) to restore vision. There are many options available to choose from in order to improve your vision. (more…)
Cataract Possible Complications
What are the potential complications of cataract surgery?
Cataract surgery has become a very safe procedure and hence the surgery is indicated today when you feel that it is impacting on your quality of life. Like all other surgery, it has potential complications. Most people have no complications during or after surgery, but it is important for you to understand the possible risks involved. (more…)
Cataract Post Operation
What happens after the operation?
You are required to come in to the Wellington Eye Clinic the next morning to ensure that everything looks good. Your vision will still be blurry but this improves every day. The eye will also be red possibly and this clears over a few weeks. There is a gritty sensation that also improves on a daily basis.
You will have a very detailed sheet with explicit instructions of exactly how to use your eyedrops over the recovery period. Some of the drops are used for 1 month following the surgery.
You are seen again 5 to7 days later at the clinic to ensure that the healing is going according to plan.
At the 1 month visit after the surgery, the vision is tested for spectacles. Depending on what you selected initially in terms of targets, you may require glasses for reading or for distance or for both. You will be sent back to your optician in order to get the glasses made up.
Cataract Choosing IOL
How do I know what IOL to choose?
Your doctor will guide you through this process depending on your individual needs and preferences.
IOL Measurements
The Wellington Eye Clinic uses the gold standard for determining IOL power, namely the IOL Master from Zeiss. It has greatly increased the accuracy of the IOL to give the intended visual outcome. It is a non-touch test that takes just a few minutes. We have a 2nd device called the Biograph that appears to be even more accurate and versatile than the IOL Master so between the 2 measuring devices, we will have the most accurate IOL power calculation currently available anywhere in Ireland. For very dense cataracts where neither of these devices can work, we have an A-Scan for biometry to determine IOL power.
Cataract Surgery Operation
What happens before my operation?
You will be seen by your surgeon on the day of surgery again to go through any last questions you may have and to sign your consent form.
Once you have settled down in the ward, the nurses will start placing eyedrops in the eye to dilate the pupil and prepare your eye for surgery. These drops may sting your eye for a few seconds and is nothing to be worried about.
You will be one of a number of people on the theatre list so there may be a waiting period before you are brought to theatre.
What happens in theatre?
The nursing staff in theatre will help you from your trolley onto the operating table. You will be connected to a heart monitor and a blood pressure monitoring device. You will be aware of pressure on the upper arm when the unit takes your blood pressure. The anesthetist will place a small canula into your hand or arm to provide a line for medication if it is needed. Directly before the surgery starts, the area around the eye is cleaned with antiseptic solution. Medications used include some sedatives, eye pressure reducing medications and antibiotics. You are then draped in sterile linen that covers the whole body including the head and there is oxygen supplied under the drapes so that you will not feel short of breath at all. Once the operation begins, you will be aware of a bright light. You will not feel any pain but may feel very light pressure on occasion. The surgeon will be talking to you all the time and you can communicate any concerns freely during the procedure.
What happens after the operation is over?
You are taken back to the day care unit where you will be given something to eat and drink. The eye will have a shield over it to protect it and keep you from rubbing it accidentally. As soon as you have eaten and feel comfortable, you will ready to go home. If you chose general anaesthesia instead, then it will normally be around 2 to 3 hours before you are ready to go home. The nurses will ensure that you have fully recovered from the anaesthesia before discharging you from their care.
Cataract Extraction Overview
Treatments
Cataract Presentation
For a short presentation on cataracts please see our video presentation – the presentation contains no images of surgery.
The Kamra Inlay from AcuFocus
The answer to improving your near vision and becoming less dependent on reading glasses: The Kamra inlay from AcuFocus
This revolutionary technology to improve your reading vision is another first in Ireland for the Wellington Eye Clinic and for the moment, is exclusive to the Wellington Eye Clinic.
It is actually very simple and utilizes an optical principal that has been known for thousands of years but that has only relatively recently been adapted for use in ophthalmology. (more…)
Presbyopia Treatments
Presbyopia
Presbyopia (The need for reading glasses around 42 – 45 yrs of age)
As the natural lens inside the eye ages, so it becomes less flexible. This results in difficulty focussing up near (e.g. reading) in the early to mid-forties. People with normal distance vision now need reading glasses for near work. Those who wear contact lenses now need reading glasses over the contact lenses and those that have always worn glasses now need bifocals or progressive or multifocal / varifocal glasses. So presbyopia is something that affects everyone.
Surgical procedures for presbyopia
There are a number of treatment options that we can offer to overcome the effects of presbyopia:
1. Laser vision correction:
a) Monovision
b) Advanced Monovision
2. Conductive keratoplasty (CK) Read more…
3. Intra-ocular lens surgery
a) Monovision
b) Multifocal IOL’s1a) Monovision with laser vision correction (LASIK or LASEK)
This has been used at the clinic for the past 10 years or more with great success. More than 6000 patients have enjoyed the benefits of monovision here at the Wellington Eye Clinic. It is a concept based on a principle used by contact lens practitioners for more than 40 years already. The one eye (usually the dominant one) is corrected for distance vision while the non-dominant eye is corrected for near vision. With this combination you find that you are now able to see far and near without the use of glasses and 80% of presbyopes find that monovision provides a good solution for them. If one finds that the monovision is not satisfactory, then the reading eye can be re-treated in order to make it good for distance vision.
1b) Advanced monovision is a new concept and the only clinic in Ireland that can offer this is the Wellington Clinic. The principle is similar to Monovision described above except for a single difference that results in a better quality distance vision in the reading eye. With normal monovision, the reading eye cannot see well in the distance and this difference between the two eyes can be a reason why monovision does not work for everyone. With advanced monovision, the reading eye is corrected for near but with the use of a laser profile called “Custom-Q” the asphericity of the cornea can be changed in such a way that even though the eye has been modified for reading vision, it still retains good distance vision. This results in less “difference between the 2 eyes” and less of a compromise in terms of visual quality.
2. Conductive Keratoplasty (Read more…) is a technique of advanced monovision that is performed without the use of a laser. Radio frequency is used to modify the shape of the cornea in order to improve reading. This procedure is typically used for the person with perfectly normal eyesight who has suddenly found that their reading vision is becoming less good. This would normally be around the mid-forties. The non-dominant eye is treated with CK by applying 8 or 16 spots of radio-frequency energy to the peripheral cornea under topical anaesthesia. The procedure is incredibly safe and effective and the improved reading visionis usually noticed as soon as the following day. Like with advanced monovision described above, the distance vision (in the reading eye) remains good even though reading has been improved. With both eyes open the patient finds that they now can read while the distance vision is still good.
3a) Intra-ocular lens surgery with monovision lens implants
Here the natural lens is removed and replaced with artificial lens implants. In the one eye the vision is corrected for distance vision and the other eye is corrected for near. This has been used for more than 10 years at the clinic with great success.
3b) Intra-ocular surgery with multifocal lens implants
Here the natural lens is replaced with multifocal lens implants. That means that each lens / eye has both distance and near vision. This sounds ideal and better than monovision but the reality is that the multifocal lenses only work well for perfect candidates. If you have astigmatism or any intra-ocular pathology the results are less good.
As you can see from the choices above, there is a solution for presbyopia now that is likely to suit you. Your consultant can guide you in this choice once your examination has been completed and your visual requirements established.
Before presbyopia surgery is performed, a contact lens trial simulating the expected outcome of surgery can be done to show the patient first hand what the effect of surgery will be. This way a truly informed decision can be made to assess suitability for a particular procedure. Contact lens trials cannot be performed on patients that are contact lens intolerant or those who have refractive errors that contact lenses cannot adequately correct.
Clear Lens Extraction
Treatments
Clear Lens Exchange (CLE) / Refractive Lens Exchange (RLE)
There have been some very exciting advancements in IOL (intra ocular lens) technology that now make different options available to you.
CLE / RLE surgery requires the implantation of an IOL (intra-ocular lens) to restore vision. There are many options available to choose the power of the IOL in order to provide a specific visual performance:
Single focus IOL’s: these IOL’s have focus at one point only
If both eyes are targeted for zero, then you will not require glasses for distance vision but you will require glasses for near vision.
If both eyes are targeted for reading (-2.00), then you will not need reading glasses, but you will require glasses for distance vision.
If one eye is targeted for distance (zero) and the other for reading (-2.00), you then have “Mono-Vision” and may find that you are now totally free of glasses. Not everyone can do monovision, but it works very well for the great majority of patients.
Premium Single Focus Implants
These lenses are the ideal for many CLE / RLE patients. The single-focus lens implants give patients the best possible clarity at one distance, either for far away, intermediate or up close. Glasses will be necessary for some activities.
Alcon AcrySof IQ Lens Implant
The IQ Lens Implant, for patients without astigmatism, gives the best potential for quality vision, typically for distance only. The AcrySof IQ lens is a single-piece yellow acrylic IOL with a patented surface modification that treats spherical aberration and the refractive error. These lenses are more difficult to manufacture, but their optics are better. Plus, while all currently available artificial lenses filter UV light, the AcrySof IQ lens implant filters both UV and blue light, which more closely mimics the abilities of a natural youthful lens.
Premium IOL’s:
Alcon AcrySof Toric Lens Implant
The Toric Lens Implant, for CLE / RLE patients with astigmatism, corrects both conditions simultaneously. The lens incorporates an optical design that corrects for pre-existing astigmatism in CLE / RLE patients, resulting in significantly improved distance visual outcomes.
Multifocal IOL’s
Traditional lens implants are monofocal of single-focus lenses, meaning they offer vision at one distance only (far, intermediate, or near). The new multifocal lens implants offer the possibility of seeing well at more than one distance, with less dependence on glasses than the standard mono-focal lens implant. These premium lens implants are available for select patients who meet specific criterion set by the Wellington Eye Clinic ophthalmic surgeons.
Alcon AcrySof ReSTOR Lens Implant
The ReSTOR Lens Implant uses apodized diffractive technology — a design that responds to how wide or small the eye’s pupil might be — to best provide near and distance vision, but objects at intermediate distances may still be somewhat out of focus. No lens can promise you perfect vision or that you will never have to wear glasses ever again. But in FDA studies with this lens, 80% of patients reported that they never wore glasses after the procedure. When patients did need to wear glasses, most often it was for intermediate distance, for example: piano music, computers that sit further away, top shelves at the supermarket.
There is a newer ReSTOR IOL recently launced (+3.00 add instead of the previous +4.00 add) and this IOL has greatly improved the intermediate vision (like for seeing a computer screen). This version of the ReSTOR lens is the IOL that we now recommend for patients requiring mulitfical lens implants.
Recently a new ReSTOR lens has been launched that has greatly improved the intermediate vision (like PC’s) too. This is the +3.00 add version and is the IOL that we recommend when patients want multifocal implants.
Personalised Attention to Your Particular Needs
Each of these advanced technology implantable lenses uses a slightly different optical design to help you achieve your goal of clear vision. The best way to determine which lens is the best choice for you is by coming in for a thorough eye examination. Once our doctors have measured and examined your eyes, we can discuss your lifestyle and vision needs, and discuss which procedure will help you see your best. Your surgeon at the Wellington Eye Clinic will make his recommendation for you based on your specific physiology and specific requirements.
Cost structure
Premium IOL’s require a lot more technology and expertise to manufacture and are therefore more expensive than single focus IOL’s. The difference in cost is quite significant with premium IOL’s adding € 750 to the cost of surgery (for each eye).
You should therefore ask yourself the following questions to help you decide which IOL is best suited for your needs:
Do I want to see better?
Yes -> Go ahead and book in for the surgery
No -> Do not book in for the surgery at this time but rather wait until you want to see better
Do I want to see better without the use of glasses?
Yes -> Consider using a premium channel IOL
No -> You can book in for surgery with a regular IOL
Am I prepared to pay extra to be less dependent on glasses for distance and near vision?
Yes -> Go ahead and book in for the surgery with a premium channel IOL
No -> You can book in for surgery with a regular IOL
Your doctor will help you decide which premium channel IOL is best suited to your needs.
Is it the toric IOL (that simultaneously corrects astigmatism) ? Or
Is it the multifocal IOL (that gives you distance and near vision without glasses) ?
Important:
In order for the premium channel IOL’s to give you the best results that they possibly can, their predictability in terms of providing the correct IOL power is paramount. You may therefore need “fine-tuning” with corneal laser surgery after the IOL surgery to provide you with the best visual performance. For those patients that have had premium channel IOL implants, the laser surgery is complimentary. The Wellington Eye Clinic will provide this approximately 4 to 6 weeks later at no additional cost to you. This serves to encourage our surgeons to make sure that the initial IOL calculations are as accurate as can possibly be. Our goal is to have you delighted with your vision following the surgery.
Phakic Lens Implants
Treatments
Phakic Lens Implants
This is a procedure whereby an artificial lens is implanted into the eye in front of or behind the pupil. The eye’s own natural lens is left undisturbed.
This technique is used in patients who wish to eliminate the need for glasses or contact lenses and whose refractive error is so large that it falls beyond the scope of laser surgery. It is possible to enhance one’s result with laser surgery should a small residual refractive error be present.
Phakic Lens Implants: ARTISAN®/ARTIFLEX® lenses
An ARTISAN®/ARTIFLEX® lens is a “contact lens” that is implanted in the eye. Therefore, you will no longer be dependent on spectacles or contact lenses.
This special lens is one of the most modern methods of refractive surgery and is being used more and more on a worldwide level.
The objective of this leaflet is to inform you about an ARTISAN®/ ARTIFLEX ® implantation.
ARTISAN®/ ARTIFLEX® lenses
Nowadays people from all around the world prefer not to be dependant on spectacles or contact lenses. They face problems while wearing these or they feel that they no longer fit in a modern lifestyle. For these people refractive surgery could be a solution.
The ARTISAN®/ ARTIFLEX® lens is one of the most modern techniques of refractive surgery. This lens is a reliable, well performing alternative for the popular laser treatments.
What is an ARTISAN® or ARTIFLEX® lens?
An ARTISAN®/ ARTIFLEX® lens is an implantable lens that is implanted in the eye by an eye surgeon. The lens will stay there permanently and therefore you will be able to see clearly all the time; your glasses or contacts will not bother or limit you any longer. It seems as though you have no “refraction problem” any more. The lens needs no maintenance and can stay in your eye for the rest of your life.
The lens is available for nearsightedness (-1 to –23,5 diopter) and farsightedness (+1 to +12 diopter);
If you should need to replace the lens for any reason, this can be done without any problem in most cases. The lens can be implanted in patients between 18 and 60 years of age, who meet certain conditions. The lens is available for shortsightedness (-3 to –23,5 diopter) and long-sightedness (+1 to +12 diopter); the cylinders (astigmatism) can also be corrected with the ARTISAN® lens. The ARTISAN®/ ARTIFLEX® lens offers no solution for presbyopia (the need for reading glasses after age ± 42 to 45 years) except for the use of monovision (where one eye is corrected for distance / zero and the other for near vision / -2.00).
The treatment with ARTISAN®/ ARTIFLEX® lenses
The ARTISAN®/ ARTIFLEX® lens is a small “contact lens” that’s not placed on, but in the eye. The lens is positioned in the anterior chamber in front of the iris. It will stay here for the rest of your life.
Only a specially trained surgeon can do the treatment. First you are given a general anaesthetic after which a small incision is made in your cornea. The lens is inserted through this opening in the anterior chamber. When the lens is positioned exactly in front of the pupil it is fixed to the iris with two clips on each side of the lens.
After the treatment you will be able to see immediately (blurry initially) but your vision is at its best after about one to three weeks in most cases. The treatment takes ±30 minutes and with the standard care before and after the surgery the total stay at the hospital is about two hours.
The second eye is often treated when the wound in the first eye has healed; this would usually be two to three weeks after the first eye.
The ARTISAN® / ARTIFLEX® lens is a unique product
The lens is developed by Prof Dr Jan G.F Worst, eye surgeon from The Netherlands. He’s the founder of this unique method to attach a lens in the eye with two clips on the Iris.
The clips are meant to fixate the lens and they’re attached when the lens is centralized in front of the pupil where it remains permanently. The Iris will not be damaged in any way although a triangular incision is made at the 12h00 position to avoid high pressure from building inside the eye. If necessary the lens can easily be detached to be replaced or removed.
The lens material
The ARTISAN® lens is made of Perspex (PMMA), an artificial material that’s completely accepted by the human body. This became clear when pilots of the 2nd World War walked around for several years with pieces of this material in their eyes due to shattered cockpits.
The ARTIFLEX® lens is partly made of a flexible material.
The development of the ARTISAN®/ ARTIFLEX® Lens
The unique fixation concept was introduced in 1978 by Prof. Dr Worst under the name “Worst Iris Claw Lens” and used in cataract patients to replace the opaque natural lens. The ARTISAN® lens was implanted worldwide in hundreds of thousands of eyes.
The indications were extended; from cataract to near- and farsightedness. In 1986 an ARTISAN® lens was implanted in an eye to correct nearsightedness, without the presence of cataract. The natural lens that normally is removed in cataract patients remained in the eye. It was a great success and the name was changed from WORST IRIS CLAW into ARTISAN®. In 1992 an ARTISAN® lens was developed for farsightedness and in 1999 a ptoric lens was developed that could correct astigmatism as well.
The safety and efficacy of the ARTISAN® lenses was and will always be controlled in the most accurate way. A significant number of clinical trials are finalized in Europe and the USA of which the results are so positive that they were published in several ophthalmic journals.
The ARTISAN® lens is being implanted everywhere in the world for the correction of nearsightedness, farsightedness and astigmatism.
The ARTIFLEX® lens is the latest model based on the ARTISAN® Iris Claw principle. Because of its foldable optic the ARTIFLEX® lens is suitable for small incision surgery, resulting in quick visual recovery. The lens is available for the treatment of Myopia.
Why choose ARTISAN® / ARTIFLEX® lenses?
With an ARTISAN® / ARTIFLEX® lens in your eye you:
- have no problems with steamed up glasses
- have no irritations caused by dry air, sand or dust
- won’t spend time on maintenance (as with contact lenses)
- won’t be afraid of losing your spectacles.
Why this kind of refractive surgery specifically?
Other kinds of refractive surgery also offer the above-mentioned advantages. Why do people who wear glasses or contacts often choose the ARTISAN® / ARTIFLEX® :
The procedure is reversible
When desired the lenses can always be replaced or removed. In this process the central part of the cornea that is responsible for a clear vision, remains untouched.
Proven: safe and effective
The ARTISAN® / ARTIFLEX® lenses have been subject of extended research. The results proved without exception that the lenses are safe and effective in the treatment of refractive disorders.
High refraction correction
The lens has an enormous range. This means that people with high refractive errors (+12 to -23,5) and/or cylinders can profit from this kind of refractive surgery too.
Considerations
ARTISAN® / ARTIFLEX® lenses can improve the quality of life of people who wear spectacles or contact lenses. Still it’s extremely important that you consider a couple of things, before taking the final decision. We have listed a few items for you:
- Risks
- Results
Conditions
You are a candidate for ARTISAN® / ARTIFLEX® lenses when you meet the following conditions:
- Your refractive error is between: -3 and –23,5 diopters with or without cylinder error +1 and +12 diopter with or without cylinder error.
- You’re between 18 and 60 years of age.
- You’re in good health.
- You don’t have other eye diseases.
- Your refraction has been stable for at least one year.
- You are not pregnant or breast feeding.
- You are convinced you want to undergo this procedure.
If you meet these conditions you are a candidate for the pre-examination. Here you will learn whether your eyes are suitable for the ARTISAN® or ARTIFLEX® lenses.
Risks
In every medical intervention there is a small risk factor to consider. This also applies to the ARTISAN® or ARTIFLEX® lens where there can be complications in spite of the best intentions to offer a flawless treatment. Because we are dealing with a healthy eye, apart from the refraction, it is essential that you consider the risks before making a decision.
The risks could be:
- Infection
- Temporary elevated eye pressure
- Dislocated Artisan Lens
Most of these complications can be treated post-operatively, but this is not always the case. Your quality of vision can get worse. Your consultant can inform you about the risks.
The results after a ARTISAN® / ARTIFLEX® lens implantation
The objective when implanting an ARTISAN® or ARTIFLEX® lens is to make you totally independent of your glasses. But as with all kinds of refractive surgery this will not always be the case. In the end the required diopter will be between 0 and 1. There can be several reasons for this; the diopter can be affected for instance when suturing the incision. With a diopter between 0 and 1 you will not be limited in daily life; you won’t be dependant on your glasses or contact lenses anymore. A slight correction might be needed if you demand a high level of visual acuity in your job or while driving or your result can be fine-tuned with laser treatment.
Cases of glare or halo’s in the dark.
After an ARTISAN® or ARTIFLEX® implantation you might be bothered by glare or halos at night. People who wear glasses or contact lenses are familiar with this phenomenon. It has to do with rays or light that reflect on the rim of the lens. Because the pupil is larger in the dark, these reflections sometimes enter the eye. The majority of people adapt to this after a while and don’t consider it to be a problem.
The procedure
- You have a consultation with a consultant and learn all about the implantation.
- With the aid of a clinical examination it is determined if you are suitable for a lens implantation
- Special tests are performed (Endothelial Cell Count / IOL Master measurements).
- You return within the following year for a number of check ups
Pre-examination around an ARTISAN®/ ARTIFLEX® implantation.
To determine whether your eyes are suitable for a lens implantation your eyes will be screened thoroughly. A so called pre-examination is of great importance in order to avoid possible risks so in this way you can take a well thought out decision.
It’s important to remove:
- Soft contact lenses one week prior to the examination
- Hard lenses two weeks prior to the examination
What can you expect from such a pre-examination?
During this examination you’ll be invited to tell the doctor about the condition of your eyes and your health in general. Then the desired correction will be determined very accurately after which some additional measurements will be performed like: the length of your eye, your pupil diameter and your eye pressure. It is also important to have a “close look” at your eye with the slit lamp in order to carefully characterize possible disorders. Not only superficially but also inside the eye. This test is painless but your eyes can be somewhat irritated afterwards.
When all the appropriate information is analyzed the consultant will make the final decision as to whether your eye is suitable for a lens implantation.
Informed consent
If your eyes are suitable for a lens implantation and you are convinced to have this treatment then you will be asked to sign a consent form. The declaration will state that you:
- Give permission to have this treatment and that this is your free will
- Have been informed sufficiently concerning the treatment
- Have been informed sufficiently about the possible risks and the advantages and disadvantages of lens implantations
After signing this consent you can make an appointment to have the first eye treated.
The treatment
A treatment with ARTISAN®/ ARTIFLEX® lenses will only happen if the pre-examinationshows that your eyes are suited for this and if you meet the other conditions.
It is a day treatment where we will treat one eye at a time. A nurse will meet you when you arrive. The nurse puts drops in your eyes in order to reduce the pupil size and he/she will explain the procedure with you and help you to prepare for surgery.
After you are asleep under general anesthesia, a little cut is made in the sclera / cornea through which the lens is inserted in the anterior chamber. When the lens is right in front of the pupil it is attached to the Iris. A little fold of Iris is pushed into the clips of the lens. In this way the lens will stay in its place. The small incision is sutured and the surgery is over.
After the procedure, which lasts about 30 minutes, the eye is covered with an eye patch and you are taken to the recovery room. A nurse again looks after your well being and will inform you of what you should and shouldn’t do until the next day when you come back for the first check up.
The following day you will have the first check up
The day after the treatment you’re allowed to take off the eye patch yourself. After this you will be asked to put some eye drops in the eye so that the consultant is able to do his check up in a clear eye later that day. You will be able to see with the eye immediately but your vision of course will not be perfect.
Rules after the treatment
You can go about your daily life again if and when you feel able to. One or two days of rest should be sufficient before getting back to your activities.
In order to let the eye heal properly and to avoid complications it’s important to follow certain rules for the first few days after the treatment:
- For up to 1 week after the treatment you should sleep with an eye patch, in order to avoid rubbing your eye and to avoid contact with any bedding materials.
- You should put drops in your eyes for the first three weeks after the surgery to avoid inflammatory reaction.
- For the first few days after the surgery you should avoid doing things that increase the pressure on your eye.
- For the first few days after the treatment you will receive tablets and drops to avoid any increased eye pressure.
- You are not allowed to wear make up the first week after surgery.
- You are not allowed to go swimming for the first 2 weeks after surgery.
The end calculation
About 6 weeks after the implantation your sight will reach the optimum level. Your consultant will check your vision at this stage and decide whether further laser surgery is necessary to further fine-tune your vision.
After check-up
During the first year after the treatment some post check-up will take place. If you need more check-ups than the standard, this is possible.
Refractive Surgery
The ARTISAN® or ARTIFLEX® lens implantation is one of the most modern methods of refractive surgery. It’s a safe and effective way that is being used worldwide. But there are other treatments available. If you consider other surgical methods for replacing glasses then it’s important to know the advantages and disadvantages of the more commonly used techniques.
At this moment in time the LASIK and PRK/LASEK solutions are also very popular. These are techniques whereby the curvature of the cornea is modified with a laser.
Cachet Phakic IOL
The Cachet lens corrects myopia from –6.00 to –16.5. At the moment it does not correct hyperopia or astigmatism.
Benefits of the Cachet Phakic Lens over other phakic IOL’s:
The main benefit is the incision size. The lens can be inserted into the eye through a tiny 2.3mm non-stitch incision making the surgery relatively quick, very safe and providing excellent results with the same “wow-factor” as LASIK. When you leave the operating theatre you can already see the difference and by the next morning you are typically seeing well already.
Any residual refractive error can be treated with laser surgery afterwards if necessary.
With so many choices it becomes difficult to know which procedure and which lens is most suited to you. The surgeons at the Wellington Eye Clinic will discuss these options with you and together determine which procedure provides you with the best risk-benefit and cost-benefit ratios.
On occasion, the choices will be between LASIK, LASEK, Artisan IOL and Cachet IOL.
This table aims to help you determine which procedure is most suited to you.
Conductive Keratoplasty (CK)
Treatments
Conductive keratoplasty (CK)
Derived from the Greek words for aging eye, presbyopia refers to age-related refractive changes in the eye that occur when the lens of the eye (which focuses light on the retina) hardens and loses elasticity.
As presbyopia develops, typically starting at age 40 to 45, focusing on objects that are up close becomes increasingly difficult —and so people with presbyopia typically reposition reading material in an effort to see it clearly i.e. they hold it further away from them and it feels like their arms are getting shorter. It’s noticeable at first when the ambient light is low and can be remedied in the early stages by using a brighter light by which to read. Eventually, older adults need reading glasses to bring near objects into focus.
Although there is no way to restore the elasticity of the lens, carefully calibrated changes in the cornea can compensate. But until now, the only alternative to reading glasses for people with presbyopia has been the excimer laser surgery, or LASIK, that corrects one eye for close vision and adjusts the other eye for distance vision, a technique known as monovision.
Although this approach can work well for presbyopia, the LASIK procedure requires cutting a flap in the cornea (the transparent front window of the eyeball) and may sometimes lead to dry eye and other potential complications.
Recently, the Food and Drug Administration (FDA) approved a technique called conductive keratoplasty (CK), a minimally invasive procedure that does not pose the problems related to the LASIK flap.
CK appears to be a relatively safe and effective treatment to cope with presbyopia, but there are several caveats for anyone considering the procedure if you have presbyopia. Many people with presbyopia are not candidates for CK; the procedure may have to be repeated in a few years because the corrective effect is not permanent; and complications, though rare, can occur.
Who Is a Candidate for CK?
CK is suitable for people over 40 who have presbyopia. They should have had relatively good distance vision most of their lives, and do not have eye diseases. People who are nearsighted (myopic) or farsighted (hyperopic to an extent greater than +1.00 diopters) are not good candidates. Because CK employs radio waves that may interfere with the operation of electronic equipment, anyone wearing a pacemaker should not undergo this procedure.
People older than 55 are not necessarily good candidates for CK because they may be developing cataracts and because their aging corneas may not respond in quite the same way as those in the 45- to 55-year-old group. People who have astigmatism (an asymmetric curvature of the cornea that can affect vision) would be far better off undergoing LASIK, which can treat both astigmatism and farsightedness simultaneously.
Somebody who has already had LASIK to correct either nearsightedness or farsightedness or astigmatism could later (around age 45yrs) undergo CK for coping with presbyopia.
How CK Is Done?
In CK, an ophthalmic surgeon uses a tiny, hair-thin probe to apply radio waves to the outer cornea in a circular pattern. The radio waves shrink small areas of collagen to create a constrictive band that increases the overall curvature of the cornea, thereby improving near vision. CK is performed using a topical anesthetic in an operating theater in a clinic. People can usually return to work or their normal activities the day after the procedure.
CK is generally performed in one eye only—usually the non-dominant eye — to improve close-up vision. The other eye, which is left untouched, provides most of the distance vision. The effect is similar to the monovision achieved by LASIK for presbyopia. Some people adapt well to monovision, while others do not. There is a very important difference however between contact lens or LASIK monovision and the monovision provided by CK. In the case of the first two procedures, the eye that is used for reading does not see well in the distance and this can bother some patients. In CK monovision however, the reading eye still has good distance vision too and therefore most patients are unaware of any loss in their quality of distance vision with both eyes open.
Usually, before patients undergo CK, we suggest they get the feel of monovision by using a contact lens to simulate slight nearsightedness in one eye. If they say, ‘Oh, this is just fabulous,’ we know they’ll be a good candidate for CK. But not everybody can adapt to monovision.
Most presbyopia patients notice improvement in their near vision immediately, but it usually takes several weeks for the eyes to reach their final level of vision correction. After one year of follow-up, according to clinical data submitted to the FDA during the approval process, 98% of patients who had undergone CK could read newspaper-sized print unaided with the treated eye.
Other Factors to Consider before CK Is Performed
Durability. Experts estimate that many patients will require re-treatment after about 3 to 5 years to restore the initial correction. A problem with CK is that the heat that shrinks the corneal collagen can sometimes induce a temporary effect. As the aging of the eye continues, the corneal collagen relaxes and the corrective effect weakens over time.
Potential complications of CK. Thus far, there have been no reports of serious, sight-threatening complications. Some presbyopia patients may initially experience such problems as double images, halos, blurry vision, and a slight overcorrection of their near vision after the procedure, but these side effects typically disappear in several weeks. In a small percentage of patients, the procedure has induced astigmatism. Many patients experience some loss of depth perception after CK.
CK can work very well for the patient who has been properly selected, but it is not the miracle cure for presbyopia. It does not lead to a return of the dynamic ability to focus at near distances. Much like excimer laser surgery, it creates monovision to allow some improved performance without the need for reading glasses.
Precautions after CK. Patients will have to apply antibiotic eyedrops for a week after the procedure to reduce the chance of infection. In addition, for 1 week after undergoing CK, all patients must avoid getting contaminated water (such as water from swimming pools, lakes, or spas), soap, or sweat in their eyes, and women must avoid applying eye makeup. It is also recommended that patients avoid rubbing their eyes for 2 weeks following the procedure.
Cost. CK typically costs about €1,500, and the expense is not covered by medical insurance because CK is considered a cosmetic procedure.
Custom LASIK / LASEK
Treatments
CUSTOM LASIK / LASEK
At the Wellington Eye Clinic we have the greatest selection of customization options available anywhere in Ireland.
Custom LASIK is the ability to treat prescriptions on an individual basis. Each patient has a unique corneal curvature, a unique corneal asphericity as well as a unique wavefront pattern that is as unique as a fingerprint.
We can therefore offer customization of a treatment based on:
| Wavefront: | A-CAT | |
| Topography: | T-CAT | |
| Corneal Asphericity: | Custom-Q (also called F-CAT) | |
| Monovision: | The only viable solution currently (using laser technology) that can address both distance and near vision issues for the presbyopic patient (older than 42 to 45 years of age) |
A device called an Aberrometer is used to measure how light is being bent and refracted through the cornea and onto the retina. It measures the entire optical system of the eye. This measurement is called a wavefront map. This is one way of customizing a treatment as is called A-CAT. A-CAT LASIK uses the wavefront map to outline a specific treatment pattern that is unique to the patient. The goal with Custom LASIK is to optimize the quality of vision for each unique patient.
A 2nd device called a Topolyzer analyses the corneal surface and contours (topography) and we have the ability to use this information to drive a CUSTOM LASIK procedure too. This is called T-CAT and again is designed to deliver better quality vision.
The 3rd way in which we can customize a treatment is with the use of the Custom-Q mode. This gives the surgeon more control over the final asphericity of the cornea ensuring better vision in all conditions, from bright sunlight to low light conditions at dawn & dusk or in really dark conditions such as country roads on a dark night.
The final way in which we can customize treatments is with the use of MONOVISION. This technique works well for patients who are already presbyopic (they need reading glasses or Bifocals / Varifocals) and wish to be entirely free of glasses after surgery. Here the dominant eye is corrected for distance vision and the non-dominant eye is corrected for near vision and this is a very good compromise for a large proportion of patients. During your assessment, the suitability of monovision will be explored.
As the Wavelight Allegretto is the most advanced laser available and the only laser to have been built right from the start for CUSTOM procedures, it is also the only laser currently ready to accept data from the Pentacam device to add another custom procedure to our options. The Wellington Clinic will be one of the first clinics in the world to use Pentacam-guided procedures in the latter half of 2006. The Pentacam has very quickly established itself as the premium device to obtain corneal information of visual significance. The Topolyser is the gold standard for overall topography of the cornea with especially good information from the peripheral cornea. The Pentacam is the new gold standard for topographical information especially from the central cornea (hence the visual quality)
It is very reassuring to know that we have so many options to enhance your visual outcome but it is important to realize we would still do around 70% of our procedures using the “standard” method. As you now know, nothing about this “standard” procedure is standard either as in its most basic mode, the laser still delivers a wavefront-optimized profile.
When one considers the various options available it becomes imperative that you are discussing your options with a qualified ophthalmologist.
WAVEFRONT-Optimised LASIK
Treatments
WAVEFRONT-Optimised LASIK
Most patients undergoing laser surgery in the past were very happy with their daytime vision but were aware of lesser quality vision at night or at dawn or dusk. The reason is that all lasers had less effect in the peripheral parts of the cornea and an oblate shape was created that increased glare at night. The Wavelight Allegretto is the only laser that compensates for this by increasing the number of shots in the periphery in order to create a prolate shape. This leads to increased quality night vision.
The diagram demonstrates how a perfect sphere has spherical aberration. For this reason, the human cornea is not perfectly spherical, but rather aspheric. It is steeper in the centre and flatter in the periphery. The Allegretto laser attempts to maintain this relationship between central steepness and peripheral flatness.
EFFECTS OF CORNEAL CURVATURE ON ABLATION PROFILE
The Allegretto Wave compensates for the reduced energy absorption in the periphery with more spots.
Result: True, large optical zone and ability to create a prolate cornea shape
The Problem
A Perfect Sphere
Even a perfect sphere has spherical aberration with the peripheral rays being refracted more than the central ray.
The normal corneal curvature is asperical i.e. steeper at the apex and less steep (flatter) at the periphery.
After regular laser surgery with any laser other than the Wavelight
This treatment has increased the spherical abberation with the peripheral rays being refracted even more than before.
After wavefront-optimised laser surgery (Allegretto Standard treatment)
This treatment has reduced the spherical aberration with the peripheral rays being refracted less than before and all the rays intersecting at the same point.
The Treatment
Wavefront-Guided Treatments
Wavefront-Guided (Customised) treatments are designed to correct higher order errors or aberrations.
This treatment has reduced the spherical aberration with the peripheral rays being refracted less than before and all the rays intersecting at the same point
Wavelight Wavefront Analyser
The Wavelight Wavefront Analyser uses visible light to map the wavefront aberrations as opposed to all other systems that use infrared light. An image is projected into the eye through a dilated pupil (after getting drops) and then the image at the back of the eye is photographed through the central, aberration-free part of the cornea. This photograph is then compared to the image that was projected by software and a digital map is produced of the wavefront. The data is then transferred to the laser to do a customised treatment.
The Technology
This technology can only work if the resolution of the laser is very good. The success of the procedure relies on good diagnostic data (the wavefront map) and the ability to transfer that treatment profile to the cornea (the laser).
Spot size
- Smallest spot size available (0.95mm)
- Increases resolution (accuracy/smoothness)
- Other lasers may claim smaler spots, but they are measuring at a different point within the beam profile
- This is the smallest spot size currently available with any laser system.
The smaller the spot size the higher the resolution (like drawing with a crayon as opposed to using a fine pencil).
The smaller spot size however needs a faster repetition rate to allow the same treatment to be done in the same time. The Allegretto is so fast, that despite having the smallest spot size, it is still the fastest laser available. It treats one diopter every five seconds.
View videos explaining how Laser Eye Surgery works on YouTube from our video library.
LASEK
Treatments
LASEK/P.R.K
It is likely that everything that you have heard up until now has been about LASIK. This literature is to inform you about a different procedure, called LASEK. It is unfortunate that the names selected for these two procedures are so similar as it leads to confusion.
LASIK is the procedure of choice for most people that are suitable – it is almost pain-free, offers a very fast visual recovery and both eyes can be treated at one sitting. These features just described explain why LASIK has become such a popular and commonly performed procedure.
During a LASIK procedure, a flap is made with the use of a machine called a “microkeratome”.
The laser ablation is then applied underneath this flap. Once the laser has been completed, the flap is replaced.
In the event that your cornea is too thin, then it becomes impossible to make a flap and do the laser ablation, as it would leave too little residual corneal thickness. This is where LASEK is primarily indicated, as it is a procedure that saves corneal thickness.
It works in the following way:
No mechanical flap is fashioned. Instead, a flap of epithelium (the very thin layer of cells that covers the surface of the cornea) is gently lifted by the surgeon and rolled to one side to facilitate laser treatment. The level of laser treatment is now at 50 microns beneath the surface as opposed to 160 microns beneath the surface that is usually the case with LASIK.
This difference in the level at which the laser ablation is applied, has saved 110 microns of tissue and this can be crucial in certain individual cases. It needs to be remembered that the higher your refraction, the more tissue that needs to be removed. There are therefore cases where LASIK would simply not be possible due to the existing corneal thickness and the amount of tissue that needs to be removed. In these specific cases, LASEK allows the procedure to go ahead as it saves 110 microns of tissue.
How does it differ from the patient’s perspective?
The procedure itself is very similar except that with a LASEK there is no pressure feeling during the procedure. It also lasts for approximately 10 minutes per eye.
A Bandage Contact Lens is routinely placed on the eye for 4 or 5 days following the procedure. This implies that you will have the contact lens in permanently for these 4 or 5 days, including sleeping with the lens in at night.
There is some discomfort for the first day after surgery and this improves quite steadily to the point that on the 2nd post-operative day, the eye is already quite comfortable.
It takes longer before the vision is fully recovered. With LASIK, the vision is normally very good by the very next day. With LASEK, the vision takes longer to recover. Once the contact lens is removed on the 5th day, the vision is normally around 80% of what it is going to be eventually. The final visual acuity is achieved at approximately 1 month after the procedure although the quality of vision continues to improve for up to 6 months afterwards.
Typical questions and answers concerning LASEK
Is it safe?
The procedure is very safe as there is no flap. Very few complications occur with LASIK, but when they do, they are almost invariably flap related. There is no flap with LASEK.
How does it differ from PRK?
(PRK was the procedure of choice some 5 to 10 years ago) With PRK the surface cells were removed and discarded. The cells then regenerated over the next 4 to 5 days. This explained why the procedure hurt more than the newer procedures and why the vision took longer to recover. With LASEK, the cell layer is placed back into position and held in position with the use of the bandage contact lens. This has resulted in more comfort and a quicker visual recovery. LASEK can almost be described as a marriage between PRK and LASIK.
Why is LASEK not the procedure of choice considering the fact that there can be no flap-related complications?
This is a very good question that has no simple answer. It is an excellent procedure and theoretically, it is safer than LASIK. On the other hand, LASIK performed by experienced surgeons very rarely has any complications at all.
The biggest reason that almost everyone still chooses LASIK, is the fact that the procedure has such a small “inconvenience factor” – it is almost pain-free, both eyes can be treated together and the visual recovery is very fast. These features mean that the average person is out from work for just a couple of days and after these initial days, is functioning as well as they were before the procedure with the only difference now that they are without their glasses.
With LASEK, there is more discomfort (although much less than with PRK), there is a period of anything up to a number of months before the 2nd eye is treated where a contact lens needs to be used to achieve a balance between the 2 eyes. Another option is to change the one lens in the glasses to accommodate the treated eye’s new prescription.
In the past number of years, the number of patients electing to do LASEK to both eyes on the same day has increased dramatically and at present, 95% of patients treat both eyes on the same day. This is most likely due to the fact that with the new modern bandage contact lenses that are worn for 5 days after LASEK, the visual recovery is faster and the discomfort less than before.
So basically, it comes down to convenience on behalf of the patient.
Can enhancements be done?
Enhancements (fine-tuning or adjustments) can be done but unlike LASIK, where they are relatively simple, here they are an exact replica of the initial procedure again. So where LASIK patients generally do not mind having enhancements done as they know the recovery is very quick, LASEK patients are less inclined to have enhancements done as they know that their vision is going to be blurred for longer, the recovery is slower and the discomfort factor higher. An interesting fact however is that LASEK patients need enhancements less regularly than LASIK patients (5% vs. 10% on average)
In what other situations may LASEK be indicated rather than LASIK?
a) In any situation where access to the eye with the microkeratome may be difficult (e.g. very deep-set eyes)
b) LASEK tends to induce less dry eye than LASIK, so is sometimes used when tear production is inadequate and cannot be improved sufficiently to allow LASIK
c) When the patient requests it – remember that refractive surgery is always elective. This means that you always have the final say concerning whether you want to do any procedure at all and to choose which procedure you prefer.
LASIK
Treatments
LASIK
LASIK changes the shape of the cornea to improve the way light is focused or ‘refracted’ by the eye.
First, a thin layer of the cornea is lifted back. Then, ultraviolet light and high energy pulses from the excimer laser reshape the internal cornea. By adjusting the laser, it is possible to treat high levels of nearsightedness, astigmatism and moderated amounts of far-sightedness. After the tissue has been reshaped, the flap is replaced in its original position. Healing is rapid and does not require stitches.
Bilateral Simultaneous LASIK(PDF)
Instructions following LASIK (PDF)
Implications of LASIK surgery(PDF)
Treatments
Laser Eye Surgery is the first treatment most people look to when they want to free their lives from glasses or contact lenses. While in the majority of cases Laser Eye Surgery is the most effective option, it is only one of several “refractive surgeries” existing today which can dramatically improve eyesight. On top of its frontier Laser Eye Surgery practice Wellington Eye Clinic also offers the most extensive range of alternative eyesight surgeries available anywhere in Ireland. It is only following a comprehensive two-hour assessment with our eye surgeons that we will know which of our treatments, if any, are most suited to your specific eye condition.
Refractive Surgery
Refractive Surgery is used to correct Refractive Errors, including Myopia, Hypermetropia, Astigmatism, and Presbyopia. As mentioned there are several different types of refractive surgery offered at the Wellington Eye Clinic all of which enable you to see without glasses or contact lenses. They are:
Laser Eye Surgery
Laser Eye Surgery is the most effective treatment available for improving eyesight and removing the need for glasses or contact lenses. The Wellington Eye Clinic offer several variations of Laser Eye Surgery which are explained in more detail in the links to the right.
Cataract Surgery
Clouding of the lens of the eye is called cataract. It leads to a loss of contrast initially with loss of vision eventually. The only treatment at present is surgical removal of the cataract with simultaneous intraocular lens implantation. This surgery is performed on a day case basis under local anaesthesia.
On top of our vast refractive practice the Wellington Eye Clinic also offer a series of other services.
Treatment of Glaucoma
Damage caused by this serious condition can be prevented through regular visits to your Ophthalmologist who can make a diagnosis at an early stage. In the Clinic this condition is treated medically and surgically as is required in each individual case.
Specialist Contact Lenses
At the Clinic we have a specialist contact lens practice.
Emergencies
Emergencies, such as injuries to the eye, are catered for by phoning the Clinic where you will be given an immediate appointment. The Wellington Eye Clinic is recognised for its high quality eye care and treatment.
Children
All children should have their eyes checked by an Ophthalmologist before the age of two years. This is especially important if there is a history of squint or “lazy eye” in the family. If the family history is positive or the child shows signs of ocular defect, examination should be performed sooner rather than later. Many of the conditions, which lead to loss of vision in children, can be prevented if they are diagnosed on time.
Custom LASIK/LESEK
CUSTOM LASIK / LASEK
At the Wellington Eye Clinic we have the greatest selection of customization options available anywhere in Ireland.
Custom LASIK is the ability to treat prescriptions on an individual basis. Each patient has a unique corneal curvature, a unique corneal asphericity as well as a unique wavefront pattern that is as unique as a fingerprint.
We can therefore offer customization of a treatment based on:
| Wavefront: | A-CAT | |
| Topography: | T-CAT | |
| Corneal Asphericity: | Custom-Q (also called F-CAT) | |
| Monovision: | The only viable solution currently (using laser technology) that can address both distance and near vision issues for the presbyopic patient (older than 42 to 45 years of age) |
A device called an Aberrometer is used to measure how light is being bent and refracted through the cornea and onto the retina. It measures the entire optical system of the eye. This measurement is called a wavefront map. This is one way of customizing a treatment as is called A-CAT. A-CAT LASIK uses the wavefront map to outline a specific treatment pattern that is unique to the patient. The goal with Custom LASIK is to optimize the quality of vision for each unique patient.
A 2nd device called a Topolyzer analyses the corneal surface and contours (topography) and we have the ability to use this information to drive a CUSTOM LASIK procedure too. This is called T-CAT and again is designed to deliver better quality vision.
The 3rd way in which we can customize a treatment is with the use of the Custom-Q mode. This gives the surgeon more control over the final asphericity of the cornea ensuring better vision in all conditions, from bright sunlight to low light conditions at dawn & dusk or in really dark conditions such as country roads on a dark night.
The final way in which we can customize treatments is with the use of MONOVISION. This technique works well for patients who are already presbyopic (they need reading glasses or Bifocals / Varifocals) and wish to be entirely free of glasses after surgery. Here the dominant eye is corrected for distance vision and the non-dominant eye is corrected for near vision and this is a very good compromise for a large proportion of patients. During your assessment, the suitability of monovision will be explored.
As the Wavelight Allegretto is the most advanced laser available and the only laser to have been built right from the start for CUSTOM procedures, it is also the only laser currently ready to accept data from the Pentacam device to add another custom procedure to our options. The Wellington Clinic will be one of the first clinics in the world to use Pentacam-guided procedures in the latter half of 2006. The Pentacam has very quickly established itself as the premium device to obtain corneal information of visual significance. The Topolyser is the gold standard for overall topography of the cornea with especially good information from the peripheral cornea. The Pentacam is the new gold standard for topographical information especially from the central cornea (hence the visual quality)
It is very reassuring to know that we have so many options to enhance your visual outcome but it is important to realize we would still do around 70% of our procedures using the “standard” method. As you now know, nothing about this “standard” procedure is standard either as in its most basic mode, the laser still delivers a wavefront-optimized profile.
When one considers the various options available it becomes imperative that you are discussing your options with a qualified ophthalmologist.
Technology
Technology at The Wellington Eye Clinic
Why Technology Matters
The safety and effectiveness of laser eye surgery are primarily a result of two inputs: the expertise of the consultant and the quality of the technology used during the surgery. The Wellington Eye Clinic can proudly state that it provides a world class standard on both fronts, unmatched anywhere else in Ireland. (See more on our Consultants).
The Most Advanced Technology Available Worldwide
The Wellington Eye Clinic uses the most advanced lasers currently available for performing LASIK anywhere in the world. The Alcon’s WaveLight Refractive Suite at the Wellington Eye Clinic is the only such “refractive suite” in Ireland and one of only five in the world currently.
This allows the Wellington Eye Clinic to provide the fastest laser combination in Ireland which ensures a safer and more effective treatment for the patient. This means a better vision for you, achieved through a quicker recovery time.
How the WaveLight Refractive Suite Works
Below you will see a step-by-step explanation of how the suite works to produce the best possible results attainable for you. However please ask the surgeon about any aspects of the features of the laser technology at the Wellington Eye Clinic that are of particular interest to you during your consultation and beyond.
The WaveLight Refractive Suite consists of the fastest combination of lasers available anywhere in the world to perform a LASIK procedure; The EX500 is a 500 Hz excimer laser and the FS200 is a 200 kHz Femtosecond laser.
The treatment times are faster, and hence safer, than with any other laser combination. A flap (See Glossary (1)) is created in around 6 seconds with the FS200 and the EX500 excimer laser completes the reshaping of the cornea in less than 2 seconds per diopter (2).
The WaveLight EX500 is a very small 0.9mm flying spot laser with a 500 Hz repetition rate. This laser takes 10 – 20% of the time that most other lasers do to do similar treatments. Together with the Tscherning wavefront analyzer or through its in-built prolate (3) profile enhancement, the EX500 produces superb clinical outcomes.
The ablation profile (4) used is more optically natural than previous lasers. This is just one of the ways that the Wellington Eye Clinic is different from any other eye clinic in Ireland.
This laser produces aspheric/prolate corneas (remembering that prolate is better than oblate (5)), to help reduce any induced higher-order aberrations (6), (7), especially spherical aberrations (8). This ensures the best visual quality in all lighting conditions. The WaveLight Allegretto EX500 excimer laser has a wide diameter treatment zone, thereby making night vision problems very unlikely.
The very latest WaveLight technology is to be found at the WEC.
Some of the enhanced safety features found on the EX500:
- Online pachymetry to ensure safety – this measures corneal thickness while the laser is working.
- 6-D active cyclo-rotational eye tracker ensuring that the eye is always in the correct position and that the eye is immediately recognized by the laser.
- The FS200 is the world’s fastest Femtosecond flap maker. It can also make channels for Intacs (9) for keratoconus (10) and do corneal transplant surgery.
- The flap parameters can be controlled on the laser’s computer.
- The 2 lasers are networked resulting in a higher degree of customization and safety than ever before.
Learn more about the Alcon Wavelight Refractive Suite
Scanning Spot Wavefront Optimized Laser
This latest generation laser system is the first laser specifically designed for Custom LASIK. There are a number of very unique features of this laser system: It is a scanning spot laser which has a larger treatment zone. The large treatment zone reduces the problem of glare at night. The rapid laser pulse rate fires at a speed that is much faster than standard lasers. The rapid pulse rate reduces the treatment time thereby reducing corneal dehydration and promotes faster healing. It has an advanced eye tracker (11) for greater accuracy and eliminates the problem of patient movement during surgery. The eye tracker automatically locks on the pupillary centre making the procedure less anxiety provoking for patients. This laser is equipped to perform Wavefront-optimized treatments, resulting in less induction of corneal distortions and spherical aberrations. When needed, this laser can perform different customized procedures to reduce higher order aberrations like spherical aberration and coma. These include profiles like wavefront-guided, topography-guided, Pentacam-guided and Custom-Q. There are some advanced treatment profiles in the pipeline that the laser is already programmed to do that will be coming online within the next year.
While patients of the Wellington Eye Clinic have enjoyed the benefits of standard LASIK and PRK since 1990, the latest technology, namely Custom LASIK, is now available. We, at the Wellington Eye Clinic, are the first (and only) clinic in Ireland to use this advanced laser with outstanding results.
True Optical Zones
The small spot creates the desired contour of the correction profile with utmost precision, thereby minimizing the total overall ablation depth. Combining a wavefront optimized ablation profile with small laser spots allows for the creation of a large effective optical zone (12) with a very small transition area.
The WEC has additional lasers too in the form of the 2nd fastest laser in Ireland. This is the WaveLight Allegretto Eye-Q 400 Hz laser.
We also have various microkeratomes (13) and will always use the technology most suited to your eyes.
We have raised the bar once more by investing in the best technology to ensure the best outcomes for our patients.
GLOSSARY
Flap – The flap that is created as part of the LASIK procedure
Diopter - A unit of measurement used to describe the degree of refractive error with respect to nearsightedness, farsightedness and astigmatism.
Prolate – Having the polar diameter greater than the equatorial diameter; being steeper in the centre.
Ablation profile – The shape of the area of the cornea treated by the laser
Oblate - Having the equatorial diameter greater than the polar diameter; being flattened at the centre
Aberrations – Imperfections causing a failure to produce a good image
Higher order aberrations - Refractive errors, other than nearsightedness, farsightedness, and astigmatism that cannot be corrected with glasses or contact lenses.
Spherical aberrations - Optical effects that occur due to the increased refraction of light rays when they strike near an edge of a lens, in comparison with those that strike nearer the centre. Spherical aberration affects the sharpness of an image.
Intacs - Corneal implants which are half-rings that reshape the curvature of the cornea from within, enhancing the natural shape of the eye to correct mild to moderate nearsightedness and improve keratoconus.
Keratoconus - Abnormal cone-shaped protrusion of the cornea of the eye affecting 1 in a 1000 of the population
Eye Tracker – A device which realigns the Laser to any changes in the position of the eye
Optical Zone - The central area of the cornea that performs a majority of the refractive functions of the eye
Microkeratome - The instrument a surgeon uses to create a flap in the cornea during a LASIK procedure
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Wellington Eye Clinic
Level 2, Suite 36,
Beacon Hall,
Beacon Court,
Sandyford,
Dublin 18
T: + 353 1 2930470
E: info@wellingtoneyeclinic.com
