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The UK Guide to Laser Eye Surgery

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The UK Guide to Laser Eye Surgery The UK Guide to Laser Eye Surgery 1 Contents 4 About the authors 5 Professor Dan Reinstein, MD MA(Cantab) FRCS(C) DABO FRCOphth FEBO, PGDip CRS, CertLRS 9 Mr Glenn Carp, MBBCh (WITS), FC Ophth (SA) (WITS), PGDip CRS, CertLRS 13 Mr Alastair Stuart, BMBS, FRCOphth, PGDip CRS, CertLRS 16 How the eye works 18 Myopia - Short-sightedness 19 Hyperopia - Long-sightedness Your eye 20 Presbyopia - Ageing eyes 21 Astigmatism 22 Understanding visual acuity - What does 20/20 mean? 24 Understanding prescriptions 26 How does laser eye surgery work? 30 Common misconceptions about laser eye surgery 34 Safety considerations of laser eye surgery is like a 34 How safe is laser eye surgery? 36 How is safety measured? 38 Questions to ask when considering laser eye surgery 44 Alternative treatment options 54 Questions about technology 56 Topography and tomography camera 56 Pachymetry 59 Very high-frequency digital ultrasound 60 Pupillometry 61 Wavefront aberrometry 62 Tonometry 64 Quality of vision measurement 66 Night vision simulation 67 Contrast sensitivity testing 68 Ocular dominance and tolerance assessment 68 Microkeratome 70 Femtosecond laser 71 Excimer laser 72 Active eye tracking 73 Wavefront-guided treatment 74 Customised wavefront optimised treatment 76 Frequently Asked Questions 92 Glossary 4 About the authors 5 Professor Dan Reinstein MD MA(Cantab) FRCS(C) DABO FRCOphth FEBO, PGDip CRS, CertLRS Professor Reinstein is the founder of • 1997: Refractive Surgical Fellowship Professor Reinstein London Vision Clinic. He is internationally under laser eye surgeons Zaldivar, is a recognised renowned for his expertise in laser eye Arbelaez, Chacon, and Barraquer surgery, and is one of the few full-time (Clinica Barraquer, Bogota, Colombia) international Ophthalmic Surgeons in the UK to have expert in laser dedicated his entire professional life to the • 1999: Fellowship in Cornea, External field of refractive surgery. Disease and Refractive Surgery (University refractive surgery of British Columbia, Canada) Professor Reinstein completed his undergraduate education at Cambridge Professor Reinstein is recognised as one of (1981 to 1984) and went on to earn his the world’s preeminent laser eye surgeons. medical degree from Cambridge University A pioneer in his field, he is the co-inventor - an M.B. B.Chir (1989). He has received of the Artemis Insight 100 - the world’s extensive post-doctorate fellowship sub- most accurate corneal scanner, which specialty training, first in corneal surgery allows London Vision Clinic to safely treat and then in laser eye surgery, including: even very high prescriptions. He was also instrumental in the development of • 1991: Research Fellowship in PRESBYOND® Laser Blended Vision and Ophthalmic Epidemiology (Institute of ReLEx SMILE - two treatments which Ophthalmology, London) have dramatically increased the range of prescriptions that can be treated, and • 1994: Fellowship in Ophthalmology (The brought the benefits of laser eye surgery Weill Medical College, Cornell University, to thousands of patients who would New York) previously have been found unsuitable. • 1996: Residency in Ophthalmology Continued on the next page (Mount Sinai School of Medicine, New York) 6 About the authors About the authors 7 Professor Reinstein is on the General Professor Reinstein is an experienced Professor Reinstein is the former Chief Professor Reinstein has appeared Medical Council’s Specialist Register research scientist and has made major Professor Reinstein Medical Officer of a group of 60 laser eye frequently in the media as a laser in the UK and is a board-certified contributions to the field. To date, he: has appeared surgeons across 30 clinics throughout eye surgery specialist. His television ophthalmologist in the USA and Canada. North America. During his tenure, the appearances have included This Morning, He holds professorships in New York • Has published over 175 articles in peer frequently in group grew to become the largest provider BBC Breakfast, and SKY News. He has also (Columbia University Medical Center), reviewed medical journals and over 180 the media as a of laser vision correction in the world been featured in publications ranging from Paris (Centre Hospitalier National articles for the ophthalmic press (performing over 100,000 procedures The Times and The Sunday Times to GQ d’Ophtalmologie des QuinzeVingts, laser eye surgery per year). and Harper’s Bazaar. Université de Paris VI) and Ulster • Has written or contributed to over 40 specialist (Biomedical Science Research Institute, book chapters He later joined the team at Carl Zeiss Professor Reinstein had PRESBYOND® University of Ulster). He is recognised Meditec, where he helped to develop Laser Blended Vision LASIK with Mr Carp world-wide as an expert in therapeutic • Has delivered over 550 lectures at the MEL 80 excimer laser – this was a in 2016. refractive surgery, and is frequently professional meetings on five continents revolutionary technological development, approached by other surgeons regarding and became the benchmark for the his knowledge in this area. • Has presented or published over 280 industry as a whole. Professor Reinstein scientific papers or abstracts remains the lead medical consultant to Carl Zeiss and, more recently, was a major • Is the editor for the Therapeutic contributor to the development of the Refractive Surgery section for the Journal VisuMax femtosecond laser and the MEL of Refractive Surgery 90 excimer laser. • Has published the textbook The Surgeon’s Guide to Small Incision Lenticule Extraction (SMILE) • Is the course director for the biannual 4-day training course on Forefront Refractive Surgery • Has trained 13 refractive surgery fellows 8 About the authors 9 Mr Glenn Carp MBBCh (WITS), FC Ophth (SA) (WITS), PGDip CRS, CertLRS Mr Glenn Carp is a distinguished and On completion of his training, Mr Carp has extremely skilled ophthalmic surgeon, who Mr Carp continued as a consultant undergone one of has undergone one of the most extensive ophthalmologist at the St John Eye training programs of any laser eye surgeon Hospital in Johannesburg. His areas of the most rigorous in the UK. Born and educated in South specialist interest included glaucoma and training programs Africa, he qualified as a doctor in 1996 retinal surgery, and he also held a part time in Johannesburg; he began his career in post at the Johannesburg Eye Hospital as for any laser eye Ophthalmology as an Ophthalmic Senior a private consultant. Following this tenure, surgeon in the UK House Officer, followed by a year spent Mr Carp left South Africa to develop his as a Research Officer in Ophthalmology expertise in the United Kingdom, at the University of the Witwatersrand in through fellowship training in corneal South Africa. and refractive surgery. Mr Carp is on the General Medical Since moving to the UK, Mr Carp has Council’s Specialist Register in the UK, practised at several leading hospitals, and is also a fellow of the College of including the Western Eye Hospital, Surgeons in Ophthalmology (South Africa). Maidstone General Hospital, Preston Royal In 2000, he began his specialist registrar Hospital, and Worcester Royal Hospital. training at the St John Eye Hospital in He was selected for a prestigious one Johannesburg - Africa’s largest eye hospital. year fellowship in Cornea and Anterior He has won several awards for excellence Segment Pathology and Surgery at in his field including the Tetski Patterson London’s Western Eye Hospital under the Award for clinical research and the Elli guidance of Miss Melanie Corbett, and Dahan Registrar of the Year Award, which later undertook an 18-month fellowship in recognised outstanding performance over Laser Refractive Surgery at London Vision his specialist training program. Clinic under the guidance of our founder, Professor Dan Reinstein. Continued on the next page 10 About the authors Interpret 11 image as Mr Carp is a member of many professional Mr Carp is a regular attendee at both organisations including: national and international congresses around the world. He has been delivering • The European Society of Cataract and presentations at the ESCRS congress for Refractive Surgery (ESCRS) over a decade, and is regularly invited to give lectures on ophthalmology to medical • The British Society for Refractive Surgery students, optometrists, and ophthalmic (BSRS) nursing teams. Mr Carp is also a Zeiss vision appointed expert and speaker for both • The Medical Contact Lens and Ocular congress symposia and training courses. Surface Association (MCLOSA) (Council He has also been responsible - alongside member) Professor Reinstein - for the training of five other clinical fellows at London Vision • The Ophthalmological Society of South Clinic in refractive surgery. Africa (OSSA) As well as being a talented and dedicated refractive laser eye surgeon, Mr Carp is • The South African Society of Cataract and recognised internationally as an expert on Refractive Surgeons (SASCRS) keratoconus and corneal cross-linking. Mr Carp had his own laser eye surgery with • The South African Society for the Professor Reinstein in 2006, and recently Prevention of Blindness - providing returned the favour in April 2016. cataract surgery to poor communities • United Kingdom & Ireland Society of Cataract & Refractive Surgeons (UKISCRS) 12 About the authors 13 Mr Alastair Stuart BMedSci Hons, BMBS, PGDip CRS, Cert LRS Mr Alastair Stuart has undergone multiple He has won several awards for With 14 years of fellowships on top of his training to excellence in his field including: training including become an eye surgeon, in order to become a top refractive specialist in his • The trainee prize at the London School of 3 sub speciality field. Ophthalmology in 2012 fellowships, Mr Following his graduation from Nottingham • The South West Thames trainee prize in Stuart is one of Medical School in 2008, he completed 2016 the few surgeons his two-year foundation jobs at Queen’s Medical Centre. • The best video prize at the UKISCRS to have completed meeting in 2015 From this point on, Mr Stuart decided formal refractive to dedicate his training to the field of • The best paper in refractive surgery at the surgery training.
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