9/18/2013
Refractive Surgery Refractive Surgery FAQs. Help your doctor with refractive surgery patient education Corneal Intraocular
Bill Tullo, OD, FAAO, LASIK Phakic IOL Verisys Diplomate Surface Ablation Vice-President of Visian PRK Clinical Services LASEK CLE – Clear Lens Extraction TLC Laser Eye Centers Epi-LASIK Cataract Surgery AK - Femto Toric IOL Multifocal IOL ICRS - Intacs Accommodative IOL Femtosecond Assisted Inlays Kamra
The OD’s role in Refractive Surgery Refractive Error
Determine the patient’s interest Myopia Make the patient aware of your ability to co-manage surgery Astigmatism Discuss advancements in the field Hyperopia Outline expectations Presbyopia/monovision Presbyopia Enhancements Risks Make a recommendation Manage post-op care and expectations
Myopia Myopic Astigmatism
FDA Approval Common Use FDA Approval Common Use
LASIK: 1D – 14D LASIK: 1D – 8D LASIK: -0.25D – -6D LASIK: -0.25D – -3.50D PRK: 1D – 13D PRK: 1D – 6D PRK: -0.25D – -6D PRK: -0.25D – -3.50D Intacs: 1D- 3D Intacs: 1D- 3D Intacs NONE Intacs: NONE P-IOL: 3D- 20D P-IOL: 8D- 20D P-IOL: NONE P-IOL: NONE CLE/CAT: any CLE/CAT: any CLE/CAT: -0.75D - -3D CLE/CAT: -0.75D - -3D
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Hyperopia Hyperopic Astigmatism
FDA Approval Common Use FDA Approval Common Use
LASIK: 0.25D – 6D LASIK: 0.25D – 4D LASIK: 0.25D – 6D LASIK: 0.25D – 4D PRK: 0.25D – 6D PRK: 0.25D – 4D PRK: 0.25D – 6D PRK: 0.25D – 4D Intacs: NONE Intacs: NONE Intacs: NONE Intacs: NONE P-IOL: NONE P-IOL: NONE P-IOL: NONE P-IOL: NONE CLE/CAT: any CLE/CAT: any CLE/CAT: -0.75 -3D CLE/CAT: -0.75 - -3D
Mixed Astigmatism FDA Approved LASERS
Alcon – Allegretto FDA Approval Common Use B&L – Zyoptix AMO – VISX CustomVue LASIK: 1D – 6D LASIK: 1D – 4D Nidek – EC5000 PRK: 1D – 6D PRK: 1D – 4D Zeiss- Meditec Mel 80 Intacs: NONE Intacs: NONE P-IOL: NONE P-IOL: NONE CLE/CAT: -0.75D - -3D CLE/CAT: -0.75 - -3D
VISX CustomVue Platform Eye Tracking & Iris Registration
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LASIK & Surface Ablation Types of Corneal Ablation Mechanical Microkeratome Conventional Spherical treatment Program laser with spectacle Rx Induces significant spherical aberration Rarely performed Wavefront Guided – Custom Uses patient’s aberrometry to guide treatment Induce less spherical aberration compared to conventional ablations Increase Quality of Vision Prolate – Optimized Age-related prolate pattern Induce less spherical aberration compared to conventional ablations Increase Quality of Vision
Mechanical Microkeratome Femtosecond Lasers
Intralase iFS Ziemer LDV Femtec 2010 Perfect Vision Zeiss VisuMax Technolas Victus
Femto Second LASIK Flap Intralase iFS
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Inverted Bevel-In Side Cut Angle Elliptical Flap with Inverted Side Cut
Provides better wound healing for enhanced biomechanical stability of the post LASIK cornea 1,2 Significantly stronger flap adhesion post-operatively for improved wound healing 3x more force required for iFS™ laser (150° side cut) vs. microkeratome during flap lift 2 Virtually effortless flap lift, replacement, and positioning for maximum flap stability 3,4 Significantly reduced flap gutter 3 1. Prof J Marshall, PhD. Data on file, AMO Development, LLC. 2. Prof M Knorz, MD. Presented ASCRS 2008. 3. P Binder, MD, A Chayet, MD. Presented ASCRS 2008. 4. A. Chayet, MD. Data on file, AMO Development, LLC.
Corneal Nerves – Dry Eye Advantages of Femtosecond Flap
Independent specific diameter Safer Less complications Independent specific thickness Less loss of BCVA Better flap centration More gain of BCVA Biomechanically stronger Variable hinge size/location Lower risk of keratectasia Beveled edge Better Efficacy Smooth evenly hydrated Induce less HOA stromal bed Smoother beds Conserve tissue Even hydration Faster visual recovery Planar shape Better Low Contrast vision
Femtosecond Laser flap vs. Microkeratome Patient’s Experience
What I tell patients about Femtosecond Laser flaps: Key points to discuss with your patients : Less flap-making risk Risk of enhancement Less long-term consequences if problems Presbyopia More precise Use of antibiotic and steroid More 20/20’s-better Visual outcome predictability Reduce the risk of infection and inflammation Better low contrast [night] vision Dry eye Thinner flaps More tissue left Expectations for surgery day: Less dryness – Corneal sensation returns faster with femtosecond flap compared Mild oral sedative and numbing drops to keratome flap Pressure feeling during flap creation Vision may grey or black out Burning smell
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Who is a candidate for Lasik? Contraindications for LASIK
18 and older (preferably 20-21+) Keratoconus No eye disease Irregular Astigmatism Nearsighted, farsighted, & astigmatism Monocular Patients Stable prescription Amblyopic patients must have BCVA 20/40 or Not seeking correction for primarily near vision better Out of Contact lenses- critical for good outcomes Severe Dry Eye 2 weeks for soft lenses Exposure Keratopathy One month per decade of wear for hard/RGP Pacemaker Until the cornea and RX are stable
Common Concerns Common Concerns
Dry Eye Pregnant/Breastfeeding No current symptoms, stable RX 3 normal cycles and stable RX Previous ocular Herpetic infection Some surgeons consider this an absolute Diabetes contraindication No retinopathy, stable RX, stable/low A1C No occurrence for 6-12 months Pre-treat with oral Acyclovir Autoimmune Conditions Corneal Scar Concern about DES Consider PRK depending on placement Rheumatoid Arthritis = contraindication EBMD or Recurrent Corneal Erosion HIV Consider PRK Need blood work
LASIK Post-Operative Care LASIK Post-Operative Care
TYPICAL MEDICATION REGIMEN: Patient Instructions during Post Op: Antibiotic -Vigamox/Zymaxid qid X 1 week For 1 week - Steroid - Lotemax/FML/Pred Forte q2h x 2 days No Swimming or using hot tubs qid X 5-7 days No Makeup Artificial Tears qid X 1 month No Sports Restasis bid x 1 month No Rubbing or squeezing the eye (some say 1- 6 months) Avoid dirty environments and wear sunglasses Use the fox shield at night Protection of the flaps Kick boxing and karate should wait 3 months Fox shield QHS x 5-7 days Scuba diving 1 month Sunglasses outdoors for 1 week Limited physical activity
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LASIK Post-Operative Care LASIK Post-Operative Care
Common Early Clinical Findings : POST-OP EXAM SCHEDULE Day 1 Visual recovery is quite rapid with LASIK – usually- Day 3-5 20/25 or better day 1 VA varies with amount of myopic correction Months 1, 3, 6*, and 12* VA recovery is slower with Hyperopes – Takes one week to get to good VA, one month to get Enhancements: to great VA (similar to PRK) Post op schedule the same as a – Usually No “wow” effect on the 1 day post op. Age, refractive error, and ocular surface primary procedure conditions will also contribute to the healing rate
Subconjunctival Hemorrhages Patient RS
31 year old male 3 hours S/P uneventful LASIK OU Patient phones office with complaints of discomfort OU “My right eye became very uncomfortable about an hour after I got home and the vision is much better currently in my left eye.”
What do you tell patient? LASIK vs. PRK
LASIK 1. Go back to sleep the eye should feel better in the Faster recovery, vision functional in a day, great in a week morning Less discomfort (burning/stinging/tearing 2-3 hours) 2. Take another vicodin, that should help the pain Less post-op meds Fewer post-op visits 3. It is normal to have pain after LASIK, just increase Can treat higher Rx* the artificial tears until the pain goes away PRK 4. RTO now Less invasive (no flap) Vision usually functional in a week, great in a month No flap complications Can treat low to moderate Rx
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Surface Ablation = PRK Surface Ablation Procedure Procedure Why PRK? Patient’s fear of “the flap” Hobby/Job with a high risk for trauma Increased understanding of high risk corneas Improved pain management Use of Mitomycin-C Enhancement of previous Lasik procedure You can perform PRK on your own patients in Oklahoma!!
Surface Ablation Surface Ablation
PRK - Epithelium removed: PRK – Photorefractive keratotomy Mechanical debridement (scrape) Transepithelial removal (laser) LASEK – Alcohol assisted with epi-flap Chemical Debridement (alcohol) Epi-LASIK – mechanical microkeratome Brush (Amoil’s Brush ASA – Advanced Surface Ablation -hybrid LASEK Epithelial flap produced by alcohol Same laser as PRK Epithelium replaced over ablation area Bandage CL No difference in discomfort or visual recovery
Brush LASEK
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LASEK – Discard Flap Surface Ablation POST-OP KITS
Antibiotic (Zymaxid or Vigamox)* Steroid (Flarex, FML, Pred Forte, Durazol) NSAID (Acular LS, Bromday) Lubricants (PF) Fox Shields Sunglasses Post-op Instructions Bring their post op bag for each follow up!!!
* May be Rx’ed separately
Surface Ablation – Patient Instructions Surface Ablation Vision Expectations
20/40-20/80 Day 1 No makeup for 1 week 20/40-20/200 Days 2-4 No swimming or hot tubs for 1 week 20/30-20/80 Day 4-5 No exercise for 1 week Avoid dirty environments for 1 week VA rapidly improves 2-3 days after removal of BCL as You may shower, but avoid rubbing the eye epithelium thickens and smoothes and/or getting water or chemicals in the eye Functional Vision at day 5-6 Expect to have driving vision Good vision at 1 week to 10 days Excellent vision at 4-6 weeks Healed at 6 months
Surface Ablation Post-Operative Visits Surface Ablation Post-op
Antibiotic x 1 week or until BCL removed 4th generation fluoroquinolone Daily , until the Epithelium is filled in and the Possibly add Polymyxin B/trimethoprim contact lens is removed Steroid (often a soft steroid) fluorometholone or loteprednol etabonate 1- 2 weeks after epithelium is healed fast tape r: QID x 1 week, TID x 1 week, BID x 1 week, qday x 1 week slow taper: QID x 1-4 weeks, TID x 1-4 weeks, BID x 1-4 weeks, qday x 1-4 weeks Months 1, 3, 6 , Some surgeons prefer to start with Pred and taper to soft steroid NSAI Enhancement if needed at 6 months or later 2-4 days for pain control if needed Dry eye management Artificial tears qid for 1-6 months Cyclosporine 0.05 %
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Surface Ablation POST-OP REGIMEN Surface Ablation Bandage Contact Lens
During Epithelial Healing Remove when epithelium is 100% closed Antibiotic & steroid qid until epithelium healed usually at day 4-5 NSAID 2 days then D/C This may delay epi healing, but makes the eye feel better. It can be used up to 4 days, but try to D/C If falls out – RTO quickly and if you think the patient is still using it, Do NOT let patient re-insert lens confiscate the bottle D/C antibiotic once epithelium is healed Topical anesthetic drops (only as an escape from pain, Let patient know that VA immediately after BCL potentially can delay healing) removal may be worse or no change Vitamin C 500mg bid
Surface Ablation POST-OP REGIMEN Surface Ablation Post-Operative Care
Steroid PAIN… Fast taper Slow Taper Onset of pain as early as 30 – 60 minutes after leaving the center . 4 x day for 1 week 4 x day for 1 month 3 x day for 1 week 3 x day for 1 month Patients should be advised of variability of discomfort level 2 x day for 1 week 2 x day for 1 month 1 x day for 1 week 1 x day for 1 month But often day 2 and 3 are worse than day of surgery
Lubricants frequently (PF preferred)
Pain Control Patient MA
Cold (Ice packs) S/P PRK x 3 day Topical NSAID I woke up this AM and my left eye hurts A LOT Topical Anesthetics* No pain last night in either eye Bandage Contact Lenses Feels like a broken contact lens in my left eye Oral Medications Vision is blurry in both eyes NSAID Steroids Narcotics
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Questions for MA What do you tell MA?
1. Go back to sleep the eye should feel better in a Did the bandage contact lens fall out? few hours 2. Take another vicodin, that should help the pain 3. It is normal to have pain after PRK, just increase Is the left eye having mucus discharge? the artificial tears until the pain goes away 4. RTO today Is the vision worse in the left eye?
Phakic IOLs – 2 Types
Anterior Chamber Verisyse Iris clip
Posterior Chamber Visian Between iris and crystalline lens
Verisyse/Artisan Phakic IOL Worldwide Experience • Current design in use for 15 years • Over 100,000 myopic, hyperopic, and toric lenses implanted worldwide by more than 5,000 physicians to date • Myopia -3.0D to -23.5D • Foldable lens, toric lens and hyperopic lens available in Europe
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STAAR Visian® ICL (Implantable Collamer Lens FDA approval December 2005 ) Quality of Vision Cosmetic Appearance Rapid Recovery Removable US FDA Approval Correct Myopia 3D - 16D Reduce Myopia 16D - 20D Toric and hyperopic lens available internationally
Visian - Simplicity Visian - Cosmetic Appearance
A 15 minute out-patient procedure Can typically be done with oral sedation and topical anesthesia (IV sedation if necessary) Footplates rest in ciliary sulcus requiring no sutures
Patient cannot see the Visian ICL. . Reflection from the Verisyse lens is apparent
Visian - Rapid Recovery Visian - Removable
Injector inserted through 2.8 – 3.5mm incision If patient is unhappy with vision, lens can be easily Some pressure felt during surgery removed (very flexible) No sutures Body does not recognize the ICL as foreign, so the Very little discomfort immediately after surgery lens does not erode into any structures Mild FBS and halos for few days Halos improve with time
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Phakic IOL - Patient History and Qualifications Phakic IOL - Contraindications
Patients under age 21 History of: Careful questioning and gauging expectations Iritis Progressive refractive History of contact lens wear Synechiae error Pigment dispersion D/C soft lens for 3 days Cornea/Endothelial Pseudoexfoliation D/C rigid lens for 3 weeks pathology Previous corneal/refractive Bilateral sequential vs bilateral simultaneous Glaucoma surgery? Narrow AC angle Keratoconus? Cataract or capsular opacification
Phakic IOL - Exam and Testing Phakic IOL - Exam and Testing
Manifest and cycloplegic refraction Anterior chamber depth Unaided and aided visual acuities Intraocular pressure (IOP) Keratometry or corneal topography Biomicroscopy-dilated and undilated Gonioscopy (grade 2 or greater) Ophthalmoscopy-dilated Pachymetry-corneal thickness Horizontal white to white- Pupil size in normal and mesopic conditions (6mm UBM / caliper / Orbscan / Pentacam or under mesopic) Endothelial cell count
Visian - Working Space = Anterior Chamber Visian - Peripheral Iridotomy
Depth Necessary to avoid pupillary block Myopes: Mean ACD = 3.8 mm Laser Argon pre-treatment in some cases YAG only in most patients Hyperopes: Mean ACD = 3.3 mm* Not yet FDA Approved Placed in mid-periphery (large >0.5mm) One or two (if 2 then place at 10:30 and 1:30) Need minimum of 2.8mm to perform safe Performed one-week prior to surgery surgery Post-op Pred-Forte qid
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Phakic IOL - Patient Selection
25 – 45 yr old Myopia -3D to -20D Thin corneas Irregular topography Dry Eye Large pupils Visually demanding
Post-op Day 1, 7 and month 1 &3 Visian - Post-op Care Uncorrected Visual acuity IOP is critical Over-refraction Dry Refraction (Day 7 & beyond) A/C exam for inflammation Biomicroscopy Evaluate the vault of the ICL ICL Vault (Vault .5 to 1.5 ct) PI Patency .5-1x corneal thickness is ideal Inflammation Under .5 observe for anterior capsule haze Over 1.5 observe for narrowing angle Tonometry Dilate for crystalline lens evaluation Evaluation of crystalline lens DFE at 3 month and annual
Visian - Post-op medications
Follow normal cataract routine
First 2 weeks: NSAID, steroid, antibiotic TID Next 2 weeks: NSAID and steroid BID
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Visian - Slitlamp Exam Phakic IOL - Summary
Ideal procedure for pre-presbyopic high myopes Ideal procedure for thin corneas Surgically similar to cataract surgery Post op care similar to cataract surgery
ICL vault
Lens Surgery Lens Surgery - Pre Operative Orders
Cataract Surgery Begin 4-7 days before surgery: Medically necessary (20/50 or worse BCVA) Patient typically pay 20% co-pay Topical Antibiotic Patient pay premium fees for MF & toric IOL Topical NSAI Lid Hygiene RLE – Refractive Lens Exchange Not medically necessary Patient pays all fees
Systemic Health Considerations Lens Surgery
Clearance by PCP required Unilateral nd st Full eval including EKG must be within 30 days of 2 eye usually done 1-4 weeks after 1 eye procedure Performed in hospital or Ambulatory Surgical Center (ASC) Some surgeons no longer require routine preoperative medical testing
The Value of Routine Preoperative Medical Testing before Cataract Surgery: Oliver D. Schein, M.D., M.P.H., Joanne Katz, Sc.D., Eric B. Bass, M.D., M.P.H., James M. Tielsch, Ph.D., Lisa H. Lubomski, Ph.D., Marc A. Feldman, M.D., M.P.H., Brent G. Petty, M.D., and Earl P. Steinberg, M.D., M.P.P. for the Study of Medical Testing for Cataract Surgery: N Engl J Med 2000; 342:168-175 January 20, 2000
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Cataract Surgery Preparation Cataract - Pre-operative Testing
Contact Lens Removal Uncorrected and Best Slit lamp D/C RGP 1 to ? Months..check stability Corrected VA Biomicroscopy (monocular and Tonometry Helpful to change patient to soft lens if considering binocular) Dilated retinal exam referral within 6 months Pinhole VA Binocular Status Manual Keratometry D/C soft lens….1-2 weeks …surgeon dependent EOM’s Topography Pre-op Medications Pupils Tomography Topical NSAID Manifest Refraction IOL Master – A-scan OCT* Topical Antibiotic Cycloplegic Refraction Lid hygiene
Informed Consent Cataract - RISKS
Risks Blindness Refractive Surprise Benefits Endophthalmitis Dryness Alternatives Retinal Detachment NVD’s/Dysphotopsia Medications Corneal Secondary Cataract Decompensation Standard Orders CME
Cataract Surgery Cataract Surgery
Anesthesia Anesthesia Topical (tetracaine, proparacaine,lidocaine) Sub-tenon’s block Advantage – low complication Advantages – safe, total EOM akinesis Disadvantages - none Disadvantage – no EOM akinesis, discomfort General Anesthesia Retrobulbar (lidocaine, bupivacaine) Advantages - No pain, total sedation Advantage – total EOM akinesis Disadvantages - Complications, Cost Disadvantage – possible globe perforation (long eyes) Intracameral – added when discomfort NPO …no food or drink after dinner day before surgery
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Cataract - Pre-op Medications Cataract Surgery - Types
Pupil Dilation ECCE – Extracapsular Cataract Extraction 1% cyclopentolate + Scleral incision 5-8mm remove lens and capsule – AC IOL 2.5% phenylephrine Dosage 1-2 drops x 10-15minutes 1 hour prior to surgery ICCE – Intracapsular Cataract Extraction Scleral Incision Corneal Incision – modern approach PC IOL intracapsular placement PC IOL sulcus placement AC IOL
Cataract Procedure IOL
Incision 1 Piece Anterior Capsulorrhexis Plate Optic-Haptics Hydrodissection/Hydrodelineation Phacoemulsification Ultrasound & Aspiration 3 Piece IOL insertion Optic and 2 Haptics
Surgery – IOL Choice IOL Calculations
Monofocal Biometry – Axial Length Distance Vision – will need glasses for NV & IV A-scan Monovision Immersion (no corneal compression) Toric – correct astigmatism IOL Master (optical no touch) Multifocal Reduce need for reading glasses Corneal Curvature May increase symptoms of night glare/halos Keratometry – manual Accommodative Auto-keratometry Distance and Intermediate vision Topography/Tomography Most still need glass for reading Accommodative Toric Astigmatism correction Distance and intermediate vision
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IOL Calculation - Formulas Cataract Post Operative Care
SRK/T Axial Length >22.01mm Antibiotic Holladay II NSAID Axial Length < 22.00mm Steroid K’s flatter than 42.00D K’s Steeper than 47.00D Hoffer Q Axial length < 22.00mm
Cataract Post Operative Care Cataract Post Operative Care Antibiotic Medication Antibiotic Medication Most Commonly used are the 4 th Dosing TID or greater generation fluoroquinolone class of Do Not Taper antibiotics Typical Order: Resistance in older classes Vigamox Oph Sol 5ml Ex: Vigamox (moxifloxacin) 1gtt OD TID 2 weeks Zymaxid (gatifloxacin) Besivancec(Besifloxacin)
Cataract Post Operative Care Cataract Surgery & Blepharitis NSAID Medication - Dosage
Pre-treat Prolensa qd Lid Scrubs Sterilid Acuvail BID OcuSoft Azasite Nevanac TID Patients at Risk – MRSA Carrier Acular LS QID Polytrim Solution Voltaren QID Mupirocin gel to lid margin 5 days bid (http://en.wikipedia.org/wiki/Mupirocin)
17 9/18/2013
Cataract Post Operative Care Cataract Post Operative Care NSAID Medication Topical Steroid Treatment of postoperative inflammation and reduction of Pred-forte 1% ocular pain in patients who (Prednisolone Acetate) have undergone cataract surgery. 1 Durezol 0.05% (difluprednate) Typical Order: Lotemax (Loteprednol Prolensa Etabonate) 1.7ml x 2 (twin pack) 1gtt OD “QD” 14 days beginning day before surgery
Cataract Post Operative Care Postoperative Visits Steroid Medication
24-36 Hours Prednisolone Acetate 1% Typical Order: 7-14 Days Pred-forte 1% Oph Sol 3-4 Weeks 5ml 8-12 Weeks 1gtt OD TID 2 wk then BID for 2 wk
Visit #1 24-36 Hours Visit #2 7-14 Days
History History UCVA UCVA Pinhole VA Autorefraction Slitlamp Biomicroscopy Dry/Wet Refraction* IOP Slitlamp Biomicroscopy Instructions to patient IOP Instructions to patient
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Visit #3 3-4 Weeks Visit #4 8-12 Weeks
History History UCVA UCVA Autorefraction Autorefraction Dry/Wet Refraction Dry Refraction Slitlamp Biomicroscopy Slitlamp Biomicroscopy IOP Corneal SPK A/C Cells/Flare DFE IOL Position Capsule Clarity Instructions to patient IOP Instructions to patient
Early Complications - Significant Early Complications – Less Urgent
Wound Leak – flat chamber Wound leak – normal chamber Ocular Hypertension Ptosis Endophthalmitis Diplopia Iris Prolapse/Vitreous in wound Corneal Edema IOL dislocation/vaulting Hyphema Retinal/Choroidal Detachment Hypopyon Pupillary Capture
Late Complications PCO – Posterior Capsular Opacification
Ocular Hypertension/Glaucoma This is an outpatient procedure and involves no incision. Ptosis/Diplopia Using the laser beam, the Corneal Edema/Decompensation physician makes an opening in the clouded capsule to let light Late Hyphema through. Chronic Uveitis After the procedure the patient remains in the center for an PCO – Posterior Capsular Opacity hour to be sure that pressure in the eye is not elevated. CME – Cystoid Macular Edema An eye examination for any complications should follow at 1 week.
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Types of Premium IOLs available IOL – Astigmatism Correction
Toric IOL – AcrySof Toric (Alcon) Toric (Staar)
Premium IOL – Multifocal ReZoom (AMO) ReSTOR (Alcon) Tecnis (AMO) Accommodating – Crystalens HD & AO (B&L)
Phakic IOL – Verisyse (AMO) Visian (Staar)
STAAR ToricIOL Alcon ToricIOL
Multifocal IOL’s - Alcon ReSTOR & AMO Tecnis
Introducing the Crystalens AO
AMO Tecnis Good distance and Near vision Intermediate vision may be reduced Poor vision in dim light
Accommodating IOL Crystalens Femtosecond Laser Cataract Surgery
• More predictable and potentially safer procedure Perfect capsulotomy sized/shaped/centered Near focus achieved by anterior Gentle break-up of the clouded lens (phacoemulsification) movement at hinges Perfect water-tight incisions Astigmatism correction Also available with astigmatism correction
MK-00251 Rev A
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Manual vs. Femtosecond Cataract Surgery Femto Cataract Video
Manual Surgery Femto Surgery
MK-00251 Rev A
Future Presbyopia Correction AcuFocus TM KAMRA Corneal Inlay
Overall diameter: 3.8 mm Designed to improve near vision in patients with Presbyopia Easily implanted Minimal impact on distance vision Removable
Central aperture:1.6 mm
AcuFocus™ KAMRA - How it Works The AcuFocus™ KAMRA - Procedure
The small aperture created by the AcuFocus™ Topical anesthetic eye drops ACI 7000 blocks the unfocused light on the Flap created retina The AcuFocus™ ACI 7000 is inserted and centered The flap is closed Takes less than 30 minutes - start to finish Blocks unfocused light
Allows focused light into the eye
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Thank You!
Sponsored by TLC Laser Eye Centers
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