Excellence in Laser Vision Correction

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Richard Dorsey
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1 Excellence in Laser Vision Correction In collaboration with

2 The Laser Vision Eye Centre Bringing together leading Ophthalmologists, state of the art facilities and world class technology giving you life changing vision. Hampshire based Laser Vision Eye Centre offers the best laser vision correction locally by providing a surgeon-led service. From your initial appointment right through to your final check-up, you have the peace of mind that an expert is with you every step of the way. Inside this booklet 3 - The Different Procedures 4 - Quality Care at Laser Vision Eye Centre 6 - Leading Experts in Vision Correction 8 - Your Vision Explained 10 - LASIK 11 - SMILE 12 - ASA (Advanced Surface Ablation) 13 - Presbyond 14 - Your Questions Answered

LASIK The most popular Laser Vision Correction

SMILE The latest development in Laser Vision Correction.

for thinner corneas or specialist treatments, such as

3 LASIK The most popular Laser Vision Correction procedure, with rapid painless visual recovery. SMILE The latest development in Laser Vision Correction. A flapless pain-free procedure, ideal for getting active rapidly. ASA ADVANCED SURFACE ABLATION Laser Vision Correction for thinner corneas or specialist treatments, such as keratoconus PRESBYOND The solution to age-related need for reading glasses, developed exclusively by Zeiss

4 Quality care at Laser Vision Eye Centre Whether you are struggling to see objects in the distance (short-sightedness) or close up (long-sightedness) or now need reading glasses (presbyopia), Laser Vision Eye Centre can improve your vision. Laser Vision Correction has been a treatment option for over 25 years and is the world s most frequently performed elective procedure. It is a great alternative to glasses or contact lenses which can be costly and frustrating. At Laser Vision Eye Centre we provide the latest Laser Vision Correction procedures, including SMILE and Presbyond. Expert Eye Surgeons With over forty years combined experience you couldn t be in better hands. Specialists in corneal surgery, Mr Anderson & Mr Konstantopoulos will be with you every step of the way, from the pre-surgery consultation to your final appointment. World Class Technology Offering a range of laser eye correction procedures, including LASIK, SMILE, ASA (Advanced Surface Ablation) and PRESBYOND, we use the most advanced technology and equipment. This ensures the best outcome for you and your needs. The Nuffield Health Wessex Hospital is conveniently located off junction 12 of the M3. With ample free on-site parking there is no need to worry about getting to your appointment. Convenient Locations Laser Vision Eye Centre provides clinics in convenient locations: Southampton Winchester Basingstoke Guildford 4

5 Transparent Pricing Our prices are transparent which means there are no hidden extras. Interest free credit is available. Terms & conditions apply. Screening Appointments Find out whether you are suitable for treatment without charge or obligation

$Leading experts in vision correction As recognised experts in corneal and refractive surgery our experience is what sets us apart.$ $David Anderson Aris Konstantopoulos David and Aris are: UK trained Fellows of the Royal College of Ophthalmologists Fellowship trained in Cornea and Refractive Surgery University$

6 Leading experts in vision correction As recognised experts in corneal and refractive surgery our experience is what sets us apart. We are researching, teaching and paving the way for the future in Laser Vision Correction. David Anderson Aris Konstantopoulos David and Aris are: UK trained Fellows of the Royal College of Ophthalmologists Fellowship trained in Cornea and Refractive Surgery University Hospital consultants treating complex corneal and refractive conditions Actively involved in research and regularly speaking at national and international meetings; they have published more than 70 articles Leading the Cornea fellowship programme at University Hospital Southampton NHS Foundation Trust, training future consultants 6

7 David Anderson Consultant Ophthalmologist - PhD FRCOphth MB BS CCST David Anderson has been a practicing Ophthalmologist for over 25 years. He is an internationally recognised expert in Laser Vision Correction, corneal transplantation and corneal and cataract surgery. He specialises in the treatment of patients with complex corneal and refractive conditions. David qualified from St Thomas s Hospital in 1989, completing a period of specialist undergraduate training at Harvard Medical School in Boston. After early positions in London he completed his higher surgical training in Southampton leading to his inclusion on the specialist register of Ophthalmic Surgeons. David has taught and led the Fellowship programme at Southampton for 10 years as well as teaching surgeons internationally in wavefront-guided laser techniques. He is head of cataract surgery at University Hospital Southampton, Hon, Senior lecturer at University of Southampton and regularly publishes and presents research findings at national and international ophthalmology conferences. He examines Ophthalmologists internationally for the European Board of Ophthalmology and has advised both NICE and NIHR. David lives locally and enjoys spending time with his wife and children, playing and watching sports and enjoying the arts and travel. Aris Konstantopoulos Consultant Ophthalmologist- MB ChB MSc FRCOphth CCT PhD Aris Konstantopoulos is a Consultant Eye Surgeon at University Hospital Southampton NHS Foundation Trust, where he specialises in treatments of the cornea, corneal surgery and cataract surgery. Aris graduated from the University of Glasgow in 1999 and completed his core ophthalmology training in hospitals of the Oxford and Wessex Deaneries. This was followed by 2 years of advanced training in Cornea and external eye disease at University Hospital Southampton. Aris carried out novel research on corneal imaging using optical coherence tomography at the University of Southampton. His research has been presented widely within the UK and internationally, and led to the award of a PhD degree. Following this, Aris specialised further by carrying out a Fellowship in Cornea and Refractive surgery at the Singapore National Eye Centre and Singapore Eye Research Institute, one of the most prestigious and influential eye institutions in the world. He studied refractive surgery with pioneers of Laser Vision Correction and SMILE, including Professors Donald Tan and Jod Mehta, and conducted research on new applications of femtosecond lasers. Aris remains an honorary research fellow at the Singapore Eye Research Institute

$Understanding the different types of refractive errors will help you and your eye surgeon decide together which procedure is best.$

8 Your vision explained At Laser Vision Eye Centre we provide the treatment that is most appropriate for your eyes and most suitable to your needs. Understanding the different types of refractive errors will help you and your eye surgeon decide together which procedure is best. Myopia - short-sightednes In myopia the eyeball is longer than required for the power of the cornea. Light is focused in front of the retina, resulting in blurred distance vision but clearer near vision. Laser Vision Correction sculpts the shape of the cornea so that it matches the length of the eye. This results in light rays focusing on the retina and clear vision. Hypermetropia - long-sightedness In hypermetropia the eyeball is usually shorter than required for the power of the cornea. Light is focused behind the retina, resulting in blurred distance and near vision. When young, the lens of the eye can compensate for this mismatch but with age the lens loses this ability, resulting in increasingly blurred vision. As with myopia, Laser Vision Correction sculpts the shape of the cornea so that it matches the length of the eye. 8

9 Astigmatism In astigmatism the surface of the cornea is not a perfect sphere; some areas (meridians or axes) of the cornea are more curved and have a higher power than others. Light is not focused at one point on the retina but two, resulting in blurred vision. Laser Vision Correction sculpts the cornea so that it has a uniform power. If myopia or hypermetropia are also present, these are corrected with one procedure. Presbyopia Presbyopia is a normal development above the age of 40 years; with age the lens inside the eye gradually loses its ability to accommodate and focus, resulting in blurred near vision. This is why most people find that in their 40s they require reading glasses. PRESBYOND Laser Vision Correction can compensate for these changes of the lens without surgery inside the eye. Using wavefront information, sculpting of the cornea with excimer laser results in an increased depth of field and improved near vision without the need for glasses. We offer a comprehensive range of treatments: 1. LASIK 2. SMILE 3. ASA (Advanced Surface Ablation) 4. PRESBYOND We provide an extensive and in depth eye assessment. Based upon this, your refractive error and needs we can decide which procedure will work best for you

10 LASIK The most popular Laser Vision Correction procedure, with rapid painless visual recovery. What is LASIK? LASIK is the most commonly performed Laser Vision Correction procedure to reduce or eliminate the need for glasses or contact lenses; it can correct short-sightedness, long-sightedness and astigmatism. The Procedure A femtosecond laser is used to create a thin layer on the corneal surface, called the flap, which is lifted by the surgeon. An excimer laser is then used to sculpt the cornea, correcting the underlying refractive error. Finally, the flap is repositioned and smoothened in place with no need for stitches. The entire procedure is painless, although a feeling of pressure on the eyes may be noticed for less than 30 seconds. Each procedure typically takes 5-10 minutes. Recovery In the initial recovery period some gritty sensation and sensitivity to light may be experienced, this typically lasts hours. We advise no contact sports for one month. The recovery is fast. However some care and attention will be required following the procedure. Before discharge we will provide you with drops to help keep your eyes moist as well as prevent infection and inflammation. You will continue to administer these at home for the next few weeks. You should arrange for someone to drive you home where you should rest for the remainder of the day. 1 A femtosecond laser is used to create a thin corneal layer, called the flap, which is then lifted by the surgeon 2 The excimer laser resculpts the surface of the cornea, correcting the refractive error 3 The flap is finally repositioned and secured in place without the need for sutures 10

SMILE The latest development in Laser Vision Correction. A flapless pain-free procedure, ideal for getting back to activities rapidly. What is SMILE?

11 SMILE The latest development in Laser Vision Correction. A flapless pain-free procedure, ideal for getting back to activities rapidly. What is SMILE? SMILE stands for small incision lenticule extraction. This is the latest development in Laser Vision Correction. Although relatively new in the UK, it was a natural evolution of femtosecond lasers in refractive surgery and has a 10 year track record. SMILE reduces or eliminates the need for glasses or contact lenses by correcting short-sightedness and astigmatism. The Procedure With SMILE no flap is created and the epithelium (surface of the cornea) is not removed. The first part of the procedure involves the laser creating a lenticule within the corneal tissue. The lenticule, a disc shaped tissue approximately 6 mm in width, is then removed by your surgeon in the second part of the procedure; this is achieved through a small 2-4 mm keyhole. SMILE results in a change in the shape of the cornea, correcting the underlying refractive error. This is all done using one laser. Similar to LASIK and ASA (Advanced Surface Ablation), the procedure is painless, with only a small pressure feeling; SMILE typically lasts 5-10 minutes for each eye. Recovery By day 1, 80% of the visual correction is noticeable, with the full improvement achieved gradually over the next few weeks. Healing time and the ability to see clearly are a lot quicker with SMILE than with ASA, and similar to LASIK. The absence of a flap allows the treatment of high myopia, thinner corneas and eyes with mild to moderate dryness. Finally, there is no risk of trauma related flap complications, so activities and swimming can be resumed sooner than after either LASIK or ASA. SMILE combines the advantages of LASIK and ASA. A minor gritty sensation and sensitivity to light may be experienced for the first 24 hours. Although care will be needed for a longer period, return to swimming, heavy exercise and contact sports can be achieved sooner than LASIK, as no flap has been created. Before discharge we will provide you with drops to help keep your eyes moist as well as prevent infection and inflammation. You will continue to administer these at home for the next few weeks. You should arrange for someone to drive you home where you should rest for the remainder of the day. 1 A refractive lenticule and small incision are created inside the intact cornea - all in one step 2 The lenticule is removed through the incision with minimal disruption to the corneal biomechanics 3 Removing the lenticule changes the shape of the cornea, thereby achieving a refractive correction

ASA ADVANCED SURFACE ABLATION Laser Vision Correction for thinner corneas or specialist treatments, such as keratoconus. What is Advanced Surface Ablation (ASA)?

12 ASA ADVANCED SURFACE ABLATION Laser Vision Correction for thinner corneas or specialist treatments, such as keratoconus. What is Advanced Surface Ablation (ASA)? ASA is a routinely performed Laser Vision Correction procedure to reduce or eliminate the need for glasses or contact lenses; it can correct short-sightedness, long-sightedness and astigmatism. It differs to LASIK as it does not involve the creation of a corneal flap. Instead, the most superficial self-healing layer of the cornea, the epithelium, is removed; the excimer laser then sculpts the cornea, correcting the refractive error. ASA can also be used for specialised, customised treatments in order to improve the vision in patients with keratoconus or corneal scarring. ASA is usually performed if the cornea is too thin for LASIK or the creation of a flap is undesirable, such as when hobbies or occupation risk eye injury. Most of these patients can now be treated with SMILE, a new flapless keyhole procedure that is available at Laser Vision Eye Centre. The Procedure In ASA the most superficial layer of the cornea, the epithelium, is removed and the excimer laser then sculpts the cornea, correcting the refractive error. The entire procedure is painless, although a feeling of pressure on the eyes may be noticed at times. Similar to LASIK, it typically lasts 5-10 minutes for each eye and around 30 minutes for the whole procedure. Recovery A key difference between ASA and LASIK or SMILE is that following ASA the gritty sensation and sensitivity to light are more pronounced and last longer - typically 3-5 days. The improvement in vision is also slower, taking up to 1 month to stabilise. However, the final vision is not inferior to LASIK or SMILE. Before discharge we will provide you with drops to help keep your eyes moist as well as prevent infection and inflammation. You will continue to administer these at home for the next few weeks. You should arrange for someone to drive you home where you should rest for the remainder of the day. 1 Dilute alcohol weakens the epithelium that is then removed to expose the underlying cornea 2 The excimer laser resculpts the surface of the cornea, correcting the refractive error 3 A protective contact lens is placed on the cornea to minimise post-operative discomfort and assist healing 12

13 The solution to age-related need for reading PRESBYOND glasses, developed exclusively by Zeiss. What is PRESBYOND? Presbyond laser blended vision is a treatment for people who have age-related need for reading glasses, known as presbyopia. As we age the natural lens inside our eye loses its flexibility, resulting in loss of the ability for near focusing. The effects of this are usually seen after the age of 40. Presbyond can be combined with correction of other refractive errors, such as short-sightedness, longsightedness and astigmatism The Procedure The procedure is almost identical to LASIK; it is painless, although a feeling of pressure on the eyes may be noticed at times. It typically lasts 5-10 minutes for each eye and around 30 minutes for the whole procedure. Presbyond uses excimer laser to sculpt the cornea and focuses the dominant eye for distance and the non-dominant eye for near sight. It is different to traditional monovision or micro-monovision, as the sophisticated wavefront laser profile expands the depth of focus for each eye. This improves your vision whether you are reading a book or driving a car, reducing or eliminating the need for glasses. Recovery Most patients will see clearly by the following day. In the initial recovery period there may be a gritty sensation and sensitivity to light may be experienced, this typically lasts hours. Care and attention will be needed however for a longer period. A period of adaptation is required to adapt fully to the treatment. We advise no contact sports for a month. Before discharge we will provide you with drops to help keep your eyes moist as well as prevent infection and inflammation. You will continue to administer these at home for the next few weeks. You should arrange for someone to drive you home where you should rest for the remainder of the day. 1 A femtosecond laser is used to create a thin corneal layer, called the flap, which is then lifted by the surgeon 2 The excimer laser resculpts the surface of the cornea, correcting the refractive error 3 The flap is finally repositioned and secured in place without the need for sutures

Your questions answered There is a lot of information to take in when considering a life changing procedure. Here are some of the questions we are asked regularly when we meet our patients.

14 Your questions answered There is a lot of information to take in when considering a life changing procedure. Here are some of the questions we are asked regularly when we meet our patients. Is Laser Vision Correction painful? Laser Vision Correction is not painful. A pressure feeling is typically experienced during the surgery but not pain. After LASIK or SMILE, a gritty sensation and sensitivity to light may be noticed for the first hours after the surgery. After ASA, the gritty sensation and sensitivity to light are more pronounced and typically last 3-5 days; however, with the use of appropriate drops and oral pain relief, these can be controlled. Can Laser Vision Correction cause blindness? Laser Vision Correction is carried out on the surface of or within the cornea, i.e. not inside the eye. As a result, the chances of going blind following laser treatment are negligible. However, poor vision may be caused if an infection were to develop following the procedure; the risk of this occurring is approximately 1 in Even in this very unlikely event, a corneal transplantation could be performed and restore good vision, usually to driving standards. Is my prescription too high for Laser Vision Correction? Laser Vision Correction is most commonly performed on patients with mild to moderate myopia (near sightedness), hypermetropia (far sightedness) or astigmatism. However, with our expertise and the range of procedures we offer, levels as high as -12 D of myopia or +6 D of hypermetropia can be safely treated. Suitability of such high treatments will depend on a variety of factors that will be assessed for on examination, such as corneal thickness and pupil size. These high treatments may also be combined with collagen crosslinking, a procedure that can improve the long-term outcome. What happens if I blink or move during surgery? Your vision will not be compromised, and your eyes will not be damaged if you blink, cough, sneeze or generally move during Laser Vision Correction. The excimer laser tracks the movement of your eyes and stops treating when your eyes are not aligned perfectly. 14

15 The femtosecond laser holds your eye with a gentle vacuum; it is very difficult for you to blink or move the eyes during laser treatment. Rarely, one in several hundred cases, if movement does occur, we may need to modify the planned treatment or complete the surgery on another day; this will not compromise the health of your eyes or your final visual result. Who reviews my progress after the laser treatment? At each visit, a team of practitioners, such as a nurse and an optometrist, and Laser Vision Eye Centre surgeons, David or Aris, will review you. You will typically be reviewed at 1-2 days, 1-2 weeks and 3 months after your Laser Vision Correction. What are the risks of Laser Vision Correction? Two large studies with over 500 patients, commissioned in the United States, reported on the symptoms and satisfaction of patients with LASIK. Their key advantage was that on-line questionnaires were conducted in private before and after surgery, without the treating surgeon being present or influencing answers. Concluding from these studies: - Driving level vision (6/12 or better) without glasses or contact lenses may be achieved in % of eyes - 6/6 vision, also called 20/20 vision, without glasses or contact lenses may be achieved in % of eyes - if 6/6 vision without glasses is not achieved, a top-up laser treatment (called enhancement) may be performed (and at no additional cost at Laser Vision Eye Centre) - the percentage of patients with dry eye symptoms decreased following LASIK in these 2 studies; less than 3% of patients developed new symptoms of severe dry eye. - the risk of poorer vision than before surgery was 2 in a thousand; however, all eyes achieved driving standards. As detailed above, other risks include the risk of infection of the cornea; this is approximately 1 in Can laser treatment affect the future health of my eyes? Laser Vision Correction does not affect the future health of your eyes and does not increase the risk of eye conditions, such as cataract, glaucoma or age-related macular degeneration. When a cataract does develop naturally later in life and cataract surgery is required, special considerations will be required to calculate the power of the intraocular lens. It is important to keep for future reference a record of your prescriptions and eye scans prior to laser treatment. Is Laser Vision Correction permanent? The change in the shape of the cornea and the Laser Vision Correction are permanent. Small changes develop over the first few months until the cornea stabilizes, but we anticipate them and take them into account when performing the laser treatment. Thereafter, minimal change can develop; this is most usually not related to the laser surgery and is caused by changes in the lens of the eye during the fifth decade of life and beyond. Am I too old for Laser Vision Correction? Laser Vision Correction can be carried out at any age. Indeed, at the Laser Vision Eye Centre we can compensate for presbyopia, i.e. the need for reading glasses, by performing PRESBYOND Laser Vision Correction; this treatment has been developed exclusively by Carl Zeiss. However, with increasing age the status of your lens inside the eye can change and develop early ageing changes - dysfunctional lens syndrome. If these changes are detected, alternative surgery to laser treatment may be recommended. We also recommend you read the Royal College of Ophthalmologists guidance on refractive surgery which can be found at : rcophth.ac.uk/patients/refractive-surgery/ More individualised detailed information can be found in our consent forms which will be provided at your consultation

16 Laser Vision Eye Centre Limited. Registered in England No

CATARACT & LENS SURGERY CATARACT SURGERY

GENERAL INFORMATION CATARACT & LENS SURGERY CATARACT SURGERY WHAT IS A CATARACT? A cataract is not a growth, but rather a clouding of the normally transparent and flexible lens of the eye. This condition