Olympia HSA Medical Series LASER EYE SURGERY A COMPLETE GUIDE FOR CANADIANS 1 Optimal Healthcare and “Life“ Benefits HEALTH SPENDING ACCOUNTS Olympia’s Optimize your Health Benefits All-in-one and make Claims online Benefits Program TRAVEL MEDICAL INSURANCE Protect yourself and your family on your next vacation EMERGENCY MEDICAL INSURANCE Prepare for life’s unexpected emergencies CATASTROPHIC DRUG INSURANCE Coverage for when prescription drug costs get out of hand DIALOGUE TELEMEDICINE SERVICES Discover how to use Olympia HSA to pay Consult with medical professionals on your for your laser eye surgery. phone anytime Share This Ebook www.olympiahsa.com 2 Imagine vision improvements that could translate into driving without glasses or playing sports without INTRO contact lenses. That’s become a reality for many of the millions of people worldwide who have elected to have laser eye surgery. This popular surgery is seen as a safe and effective way to correct vision problems and enhance lifestyles. Basically, it all comes down to the shape of the eye. Any variations in shape, including length, can result in vision problems. By using a laser to change the shape of the cornea, surgeons can correct refractive errors and improve the eye’s ability to focus on objects. Laser eye surgery can correct vision problems such as near-sightedness, far-sightedness and astigmatism, providing candidacy requirements are met. And cutting- edge advancements in laser technology means a wider range of candidates can be treated. While the idea of improved vision is a compelling one, the wide range of procedures, associated costs and laser eye surgery providers can seem overwhelming. The purpose of this guide is to provide an overview of laser eye surgery and to shed some light on the options available. 3 Intro 3 Geting started 5 LASIK 7 PRK 9 Keratoconus Treatment 11 Laser Epithelial Keratomileusis 14 Epi LASIK 15 Cataract Surgery 16 Artificial Lens Procedures 18 Monovision, Laser Blended Vision Correction and Corneal Inlay for Presbyopia 21 Laser Eye Surgery Results and Recovery 23 Laser Eye Surgery Cost 27 Conclusion and Additional Resources 29 TABLE OF CONTENTS TABLE 4 The first step in the process is an assessment that will help the surgery provider GETTING determine whether or not a patient is a candidate for laser eye surgery. It is also geared STARTED towards helping potential patients decide whether laser eye surgery is right for them. The preoperative assessment, which is normally complimentary, differs amongst providers. During this initial appointment, which can last between two and three hours, surgeons and clinic staff will gather patient information, including medical history, as well as answer questions and provide information through patient counseling. Eye testing is also a key component of the process. The eye specialists could be examining criteria such as current vision prescription, corneal thickness, pupil diameter, as well as both general and eye health. If a patient is deemed eligible for laser eye surgery, the provider will recommend and outline a surgical procedure and review pricing. Laser eye surgery is considered an elective surgery and is not covered by provincial health care plans. However, it is an eligible expense under a health spending account. Clinics normally have a contact lens policy in place which means that contact lenses must be removed for a certain amount of time before appointments. This allows the cornea to return to its natural shape and ensures accurate test results. 5 There are a few factors that will exclude a patient from having laser eye surgery: • Certain medical diseases • Certain eye injuries and diseases or disorders • Candidates should be a minimum age of 18 • Have a vision prescription that has been stable for at least a year and that falls within an admissible range • Pregnant or nursing women are not eligible for surgery Recent advancements in laser technology have opened doors so that a wider range of candidates can turn to laser eye surgery as a vision correction option. 6 TYPES LASIK can be used to correct nearsightedness (myopia) farsightedness (hyperopia) and astigmatism. Myopia and hyperopia are refractive errors that are caused by variations in OF LASER the shape of the eyeball. Astigmatism is a result of an irregular-shaped cornea, which is the EYE transparent outer portion of the eye surface. Surgeons can use the two-step LASIK procedure in different ways, specialized for each SURGERY patient, to correct refractive errors. Generally, the process involves reshaping the cornea to improve the way that light rays focus on the retina (the light-sensitive, back portion of the eye). LASIK First, surgeons use either a bladed instrument called a microkeratome or a laser to create a Laser-Assisted In Situ precise flap of the cornea. This hinged flap, which is still attached to the cornea, is raised. Keratomileusis Next, surgeons will use an excimer laser to reshape the cornea by accurately removing corneal tissue. The preoperative eye exam determines how much tissue should be removed for each patient. An advanced technology, custom wavefront LASIK, is available that allows surgeons to further refine the standard LASIK procedure and enable more precise vision corrections. LASIK, which is an outpatient surgical procedure, takes place under local anesthetic. The surgery itself is considered painless and takes only a matter of minutes per eye. After surgery, the natural healing processes of the eye take over to help seal the flap of the cornea. Although LASIK surgery is considered safe, there are risks involved: • Poor night vision due to halos • Double vision and regression • Bright light sensitivity • Rarely - infection or weakening of the cornea • Dry eyes 7 TYPES In photorefractive keratectomy (PRK), surgeons remove the thin surface layer of the cornea (called the epithelium). Like LASIK, PRK can be used to correct nearsightedness, farsightedness OF LASER or astigmatism. PRK differs from LASIK in that it doesn’t involve cutting a flap in the cornea. EYE After the epithelium is removed, PRK surgeons will then use an excimer laser to reshape the cornea by removing a predetermined amount of tissue. Either standard PRK or custom SURGERY wavefront PRK can be used at this stage of the process. Custom wavefront PRK is an enhanced version of standard PRK that allows surgeons to further customize the procedure for patients and can improve the outcome of laser vision correction. PRK The actual treatment time, including preparing the eye and the laser process, is roughly 30 Photorefractive minutes. During that time, the laser is used for only a few minutes per eye. Keratectomy Healing time is longer with PRK than with LASIK since it takes about three to five days for the epithelium to grow back. During this time, patients are fitted with contact lens ‘bandages’ to protect the cornea and help it heal. The surgical process itself is considered painless. However, patients can expect some pain during the healing process. PRK can be used on patients with high vision prescriptions or whose cornea is too thin or too soft to withstand the creation of a flap. It can also be recommended for people who participate in activities, such as boxing or martial arts, which put them at risk of getting hit in the eye. 8 Although PRK surgery is considered safe, there are risks involved: • Poor night vision due to halos • Increased bright light sensitivity • Double vision and regression • Hazy vision (normally clears up after healing) • Rarely - infection or weakening of the cornea 9 TYPES In recent years, laser eye surgery has been combined with a process called corneal collagen cross-linking or CXL, to treat a progressive eye disease known as keratoconus. This disease, OF LASER which often emerges when people are in their late teens or early 20s, causes the normally EYE dome-shaped cornea to bulge into a more cone-like shape. SURGERY The irregular shape results in blurred vision that, as the disease progresses, becomes increasingly difficult to correct with glasses or contact lenses. Traditionally, some people with keratoconus would have had to consider a corneal transplant Keratoconus to curb the effects. But recent advancements in keratoconus treatment are offering new hope for diagnosis and treatment of the disease. Treatment Using a technique called corneal collagen cross-linking, or CXL, surgeons are able to strengthen the cornea, helping it to retain its natural shape and resist bulging. The CXL Process • Anesthetic drops applied to numb the eye • Surface skin of the cornea is polished • Riboflavin drops are applied to the eye • 10 and 30 minutes of UV-A light • Bandage contact lens worn for several days Riboflavin drops, combined with the UV-A light, act on the cornea to strengthen it. Recent advancements in corneal collagen cross-linking are reducing the riboflavin soak time as well as the UV-A light exposure time. 10 CXL can be combined with laser eye surgery to improve vision quality with glasses or contact lenses for people with keratoconus. Before the CXL process, surgeons can use a standard laser vision correction process to reshape the cornea and help improve overall vision by reducing myopia, hyperopia or astigmatism. A more advanced laser eye surgery option, CXL combined with T-PRK, has also recently become available. Using state-of-the-art imaging technology, surgeons are able map out and improve corneal irregularities in people with keratoconus prior to CXL treatment. Treatments for keratoconus, including laser eye surgery combined with CXL, will not normally eliminate the need for glasses or contacts in people with the disease. The goal of these procedures is to improve vision quality and to slow or prevent the progression of the disease. 11 LASEK is a newer procedure in which the surface layer of the cornea (epithelium) is cut with TYPES a fine blade and loosened with alcohol drops.This thin, hinged layer is raised and pushed OF LASER to the side, allowing surgeons to use a laser to reshape the cornea.