About The Surgery
The Pre-Operative Consultation
For your first appointment to our centre there is a bit of preparation required of you. If you wear contact lenses they must be removed for ''true'' readings of your prescription to be obtained and for the health of your corneas to be viewed.
Please bring all of your previous spectacles and or contact lens prescriptions. This will help us enormously in giving you a highly accurate assessment.
Please remove soft/disposable contact lenses for at least one week prior to your consultaion. Hard contact lenses should be out of your eyes for at least 3 weeks prior to your first consultation at the Northern Laser Vision Centre. Failure to adhere to these guidelines can affect the results of your surgery.
During your initial consultation you will have your prescription checked without drops. At the second consultation drops will be used to dilate your pupils. Please keep this in mind, as you will not be able to drive home straight after your consultation.
You will have your corneas mapped, with the most sophisticated software available called ''Orbscan'', which maps the curvature patterns of your cornea, the size and shape and very importantly the thickness of your cornea. Some people who have thin corneas are not suitable for Excimer Laser.
From the Orbscan, calculations are made to determine an acceptable corneal thickness with regard to your prescription and hence the amount of tissue to be removed.
Your consultation just prior to surgery is always with your surgeon, with the measurements and assistance of the NLVC team. The surgeon will assess your measurements and you will have the opportunity to ask any questions at this time.
We will also check your retina (the back surface of the eye), for any weakness or abnormality which may need attention prior to any Excimer Laser treatment. The general health of your eye is also examined.
In some situations very high scripts will not ultimately get a ''perfect'' result, which would be totally independent from glasses. You and the doctor may aim for thinner glasses as a desired result of your surgery. The doctor can advise you regarding your predicted result according to your prescription.
You will always be given a very honest idea of what your individual expectations should be from the laser treatment. If there are any risks specific to you, you will be told prior to surgery. Also you will be told whether the you can expect to be free from using spectacles or whether you still may need them for certain circumstances, like reading for example.
After all pre-operative data is examined, the surgeon will recommend the best refractive treatment option to ensure the best outcome.
And One More Thing...
When you finally make your decision to proceed with Laser Vision Corrective Surgery, please consider the following:
- "Do I find spectacles/contact lenses a hindrance to my lifestyle?"
- "Am I prepared to consider and understand all the risks associated with this procedure?"
- "Have all my questions been answered regarding this procedure?"
If you can answer yes to ALL these questions then you are ready to go ahead with the treatment.
Surgery Day
For the day of the procedure you should be aware of the following issues:
- Try to organise somebody to pick you up once your surgery is finished. As you will be given a light sedative, you are not safe to drive yourself home. If this is difficult to organise, then please let us know and we will organise transport home for you.
- You must not wear eye make-up to the clinic on the day of your procedure.
- You should wear loose comfortable clothing.
- Keep in mind that the laser room is always kept at a low temperature. It is suggested that you don’t wear woollen jumpers or clothing with small fibres on it, to ensure the environment of the treatment area is totally particle free.
- It is preferred that you don’t wear perfume on the day, the strong vapour from the perfume can affect the laser power.
- Ensure you have signed an informed consent form if not done prior to this time.
- Organise payment of your account - which we request be done on the day of surgery.
If you are clinically suitable we will treat both eyes on the same day.
When you arrive on the day of your treatment you will be given a light sedative called ''Ativan'', this will help you to relax ,but you will remain awake.
After this medication has been given 20 minutes to take affect, you will then be prepared for the surgery. The eye area will be cleaned with antiseptic. You are then given shoe covers, a hair net and a gown to wear into the laser area.
In the Laser Procedure Theatre
Once you are lying on the table in the laser procedure theatre some local anaesthetic eye drops are put into your eye. The eye not being treated will be covered.
The anaesthetic eye drops will stop you from feeling any pain during the procedure, however it will not stop you from feeling any pressure on the eye during the procedure.
Once the procedure is to start, an eyelid retractor is put into the eye. This instrument holds your eyelids open and stops you from blinking. It can feel uncomfortable to start with but it is a sensation you will get used to.
At this point of the treatment the procedure will be performed and usually takes approximately 20 minutes.
What To Expect
Surgery times are scheduled at the time of your pre-operative consultation.
What you can expect:
- Upon arrival at the clinic, you will sign the consent form that was given to you at the assessment for your review. A surgical assistant will go over this with you and answer any additional questions you may have.
- Outstanding fees will be collected at this time.
- You will be prepared for surgery.
- You will be given a light sedative called "Ativan" that will help you to relax while remaining awake.
- The laser will be calibrated and tested for accuracy.
- Your vision correction profile will be entered into the laser computer by means of a zip drive transferring information from the CRS-Master (WASCA).
- You will enter the operating room and be asked to lie on the surgical bed.
- Anaesthetic eye drops will be placed into your eyes.
- One of your eyelids will be covered while a lid speculum is used to gently hold the other open.
- The surgeon will instruct you to look at a green flashing light directly ahead of you.
- You will see a red light in addition to the green light, feel a faint breeze of air and hear a buzzing noise that indicates that the laser is activated.
- The light will get blurry as the surgery progresses. This is normal.
- Laser treatment with the Carl Zeiss Meditec MEL-80 is very brief (5 – 30 seconds).
- The epiltelial flap is repositioned. NU-LASE Epilift flaps are protected with a clear contact lens that stays in place for approximately four days.
- Following surgery you will be instructed in regards to do’s, don’ts, use of drops, etc. and given an appointment for follow-up.
Following surgery your vision will be blurry and you will be light sensitive. It is important to use your drops as instructed. A 24-hour on-call telephone number will be given to you for problems or emergencies.
Post-op follow-up visits are as follows: Post-op day 4 (removal of bandage/contact lens), then one week later, at one month, at three months, six months and one year after your NU-LASE Epilift vision correction.
What are the risks involved?
Excimer Laser should always be considered as a surgical procedure and hence this treatment has possible side effects. It is very important that you are aware of, and understand, the possible side effects. This information is not intended to scare you, rather to make you an informed consumer.
It is important to keep in mind that these side effects and risks have a low incidence and the majority of patients only suffer side effects for a short time following their Excimer Laser treatment.
If there are any details relating to the risks and complications that you don’t understand, or if you would like further information, please raise them during your consultation.
The risks associated with Excimer Laser treatment are:
- Serious / Permanent Vision Loss: The percentage of this worldwide is very low and the Australian ratio of this is even lower due to the very high standard of equipment generally used in Australia.
- Regression: This is where the eye replaces some of the laser ablated tissue. It is uncommon after NU-LASE Epilift but more likely with Hyperopia than Myopia. You may need an ‘enhancement’ if this occurs. This is a very safe procedure when done using NU-LASE.
- Undercorrection / Overcorrection: This may often occur immediately after your treatment and can be deliberately done for some people, according to their refractive error. This is to allow for any predicted regression which may occur in Hyperopia regression and therefore ensure good vision is attained after the ‘settling down’ period. The majority of all regression occurs within the first six months. Again if necessary an enhancement procedure can be done very safely.
- Infection: This is very rare. You are started on antibiotic drops straight after your treatment as a prophylactic therapy. You actually have less chance of infection after Excimer Laser than you do getting a serious infection during a lifetime of contact lens wear.
- Pain or Discomfort after Treatment: This was a more significant problem with PRK. However, with NU-LASE Epilift it is considerably reduced, but may last up to 48 hours. You are given analgesics and sleeping tablets to make you comfortable during this period.
- Instability of Refraction: In early stages of healing, your refraction can frequently change. This usually resolves in about 1 month and is mostly due to dry eyes and tear film related problems.
- Haze: This problem should it arise, is managed with steroid eye drops for a short period of time. To date we have not seen any significant Haze effecting vision or causing vision symptoms with NU-LASE.
- Glare (Night Glare): Some patients suffer from this after treatment and it is often related to tear film problems or inflammation of the eye. Eye drops and sunglasses assist in making this condition manageable and often resolves in 3 months after treatment. We have found there is minimal night vision symptoms with NU-LASE and MEL80, the Eximer Laser.
- Decreased Contrast Sensitivity: This is often only a problem for people with careers such as artists and engineers. This is a compromise which must be considered, however the fourth Generation lasers and NULASE have reduced Contrast Sensitivity problems. Very few patients report any change.
- Induced Astigmatism / Decentration of Treatment: This is where the centering of the laser ablation has been inaccurate for some reason. However, at the Northern Laser Vision Centre the laser we use (Zeiss Meditec MEL 80) which has a sophisticated eye tracking device. The laser beam follows any small movement of your eye during surgery. If you move too much the laser actually cuts out until you are steady again.
- Loss of Best Spectacle Corrected Visual Acuity (BSCVA): BSCVA = The best vision you have prior to your surgery. In some instances that same vision may not be achieved with laser surgery. This can be due to irregularity of the eye surface or decentration of the optical zone. This is very uncommon but more likely with LASIK than with NU-LASE.
