Laser eye surgery
FAQ
Unfortunately not. The need to wear glasses for reading or for close-up work – presbyopia – for all those over the age of 40 is not an actual ailment of the eye. It simply is the natural ageing process whereby the eye’s ability to focus clearly on close objects progressively worsens. This ability decreases gradually from childhood and manifests in the eye’s near point (the closest point at which an object can be brought into focus by the eye) getting further away. At around the age of 40–45 the distance of the eye’s near point moves roughly 35–40 cm from the eye and the patient begins to experience difficulties. For the time being, laser eye surgery is not a reliable tool to remove presbyopia and this is why it is recommended in such cases to undergo refractive lens replacement surgery.
No, it is not. However, it is advisable to carry out a specialised strabological examination prior to laser eye surgery in patients with strabismus. This is because there exists a connection in-between the position of the eyes and dioptre errors. The removal of a dioptre error in some specific cases could result in worsening of strabismus or rarely also the onset of the very unpleasant diplopy (double vison). It is not advisable to go through laser eye surgery in patients where there is such risk.
Lazy eye is a disorder in vision sharpness which is caused by strabismus, anisometropia (a higher dioptric error difference between the eyes) or other ailments of the eye. Any hinderance in the normal functioning of the eye in childhood can result in permanently weakening the eyes. This is the reason why children often wear an eye patch on the better eye so that the worse eye learns to function properly. Sometimes the eye remains permanently weaker (lazy eye) and is incapable of achieving sharpness like a healthy eye despite using corrective aids (glasses, contact lenses). This in itself also limits the reach of refractive eye surgery. The refractive eye surgery may reduce the dioptre error but cannot eliminate amblyopia so that the eye would see normally. To date, there is no known method of removing amblyopy in adults.
We do not perform refractive procedures on patients under the age of 18. There is no other age limitation. It is advisable to take into account though that in patients at around the age of the onset of in presbyopia (over the age of 40) the elimination of near-sightedness will inevitably mean the need to wear glasses for reading or for close-up work. With increasing age there also is the increasing probability of the onset of one of the eye ailments where it is not advisable to go through with eye surgery (for example cataract or glaucoma).
This depends largely on the problem the patient is experiencing with his/her eyes as well as on the thickness of the cornea. What laser eye surgery actually does is evaporating a given layer of the cornea tissue and thus thinning it. For the procedure to be safe and for the eye to not be weakened by the surgery, the cornea must not be made too thin. The thickness of the cornea is a key factor in deciding how many dioptres it is safe to eliminate.
It is possible to eliminate short-sightedness up to some −9 dioptres. In patients with a high dioptre error and thin cornea it is advisable and safer to carry out only a partial dioptre removal or potentially opt for a different method altogether. The possibilities of removing dioptre errors in far-sighted patients are more limited. Laser eye surgery is recommended only in cases where the dioptre error is lower (up to some +dioptres). Where a higher dioptre error is present it is advisable to opt for a different method (phakic lens in younger patients and the extraction of a clear lens in older patients).
The surgery is carried out with the patient being fully conscious, however anaesthetic eye drops are administered into the eye before the procedure to desensitise it. As such all laser eye surgeries are entirely painless.
The post-surgery healing process having undergone procedures of the LASIK type is usually very straightforward and without complications. Most patients have none or minimal difficulties (temporary burning sensation, eye dryer than usual, temporary photo-phobia) within the first 3‒4 hours post-surgery. In most cases it is not even necessary to apply contact lenses. The eye is protected using a bandage throughout the first night post-surgery and the quick and painless healing process enables patients to return to their normal day-to-day activities as well as work one day after the surgery.
Following a surface procedure of the PRK type a segment of the cornea remains exposed and as such is sensitive. The healing process which takes 3‒4 days is often accompanied by increased photo-phobia and some pain (a feeling of a presence of a foreign body in the eye or the eye having been scratched) as well as irritation of the eye. The pain is reduced by covering the eye using a bandage and by applying curative contact lenses together with administering eye drops or using painkillers temporarily.
It is standard procedure to carry out LASIK eye surgery on both eyes on the same day. Where the surface procedures are concerned – PRK or LASEK – it is recommended to wait at least 1 month between the two surgeries. The reason for this is a slower and more painful healing process. It is not advised to undergo surgery of the second eye before the first eye has fully recovered and stabilised.
We do not carry out surgeries on the day of the pre-surgery examination. One of the reasons is the rather intensive dilation of the pupil which is absolutely essential for the thorough examination of the retinal periphery. After such dilation the pupil takes several hours to get back to normal – reacting optimally to light.
For the surgery to be a success it is essential for the dioptre error to be stabilised (for it to not have deteriorated over at least 6 months). In higher dioptre errors, far-sightedness or astigmatism it is impossible to guarantee that the error will not return or progress post-surgery.
For the procedure to be a success and for the eye to not be weakened, care must be taken that the cornea is not rendered too thin by the surgery. In such cases (higher dioptre error, thinner cornea) it is recommended to perform only partial dioptre error reduction. The final result is also largely dependent on the individual post-surgery healing of the retinal tissue.
One of the main advantages of the LASIK method is excellent post-surgery stability. It is possible to correct residual post-surgery error using glasses or sometimes (thickness of retina permitting) it is possible to repeat the procedure.
This type of eye surgery is not covered by any Czech health insurance policy neither is it covered by any regular health insurance elsewhere in Europe.
Given that the procedure is not covered by health insurance policies, patients are not entitled to sick-leave. As such, the good news is that the post-surgery healing process is very quick and so is the return to work.
When the surgery is carried out at a time when the dioptre error of the eye is completely stabilised it is not necessary to repeat it. In case that the patient insists on going ahead with the surgery despite the fact that his/her dioptre error is not entirely stabilised, it is possible to make an agreement to undergo an additional procedure in a few years’ time. It is important to add though, that these are rare individual cases.
The eye continues in its natural ageing process even once laser eye surgery was undergone and as such it is natural to expect presbyopia to set in after the age of 40. This natural ageing of the eyes cannot be stopped or removed and as such it is impossible to apply life-timer guarantee on laser eye surgery.
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