MEDICAL REASONS:
Contact lens intolerance because of frequent iritations, redness, dryness, trauma and corneal changes for reasons of long-term contact lens wearing. Inability to achieve full glasses correction, for reasons of high dioptrical or cylindrical value-astigmatism (inadequate, unrealistic image, uncomplete acuity with glasses).
PROFESIONAL REASONS AND LIFE CHOICES:
When a standard glasses or contacts correction is unacceptable or hindering, or prohibiting achievement of certain professions, or causing difficult socialisation even social exclusion, especially in children.
PATIENT MOTIVATION FOR BETTER REFRACTIVE CORRECTION
Patients with moderate and high refractive error, or great difference between eyes (anisometropia), are especially motivated for refractive procedures, for reasons of “barely craming” into glasses these dioptrical values, or they are having different or unrealistic images. These refractive errors make them absolutely dependent on glasses, because without glasses they are unable to move even in familiar surroundings. ”First thing I do when I wake up is to search for glasses without which I feel lost” – most common sentence used when they come to seek help. For these people, laser procedure gives completely new and realistic view at the world.
REALISTIC EXPECTATIONS
Patients must have realistic expectations. Laser is correcting the dioptry, not reconstucting the sight. If amblyopia is present in adult age as a consequence of inadequate correction in childhood, it is not realistic to expect visual acuity of 100 % after laser. The sight will be better, the image sharper and patient is obtaining better quality in respect to maximally corrected acuity with standard aids. For this reason, in pediatric patients, at pre-school age, in special indications, when threatened by amblyopia because of limitations of standard correction, laser correction is used as a METHOD OF CHOICE (excimer laser in children). This will create optimal conditions for development of visual function. If it is delayed till the age of 18 or 20, and the refractive error had not been adequately corrected with glasses or contact lenses, since childhood, amblyopia will remain. Dioptry will be corrected with laser, but without improving amblyopia. Amblyopia that was „missed” in childhood can not be repaired in adult age.
AGE
Laser procedures can be used at any age, in adults and children. For each and every patient there is a method of choice, in respect to the age, medical indication, professional choices and life habits. Laser corrects diopters for distance.
At the age of 50, with disappearance of accommodation, it is better to apply surgical procedure of implantation of multifocal intraocular lenses, by which one is set free from dependency of both glasses for near and for distance (multifocal trifocal implant).
Laser refractive procedures have been used for many years already, in pre-school children, before ending the process of visual development. Excimer laser in children is used in all situations when full correction is not possible to achieve by conventional ways. These are: -high refractive error, mono- or binoculary, -accommodative strabismus, -significant difference in refraction between eyes, -children with special needs. In such cases laser correction is the only solution for managing visual development. At the age of high school, for reasons of interest and dedication to sports, laser correction is used as well in lower refractive errors, as the most comfortable method of correction in demanding situations. Economical reasons motivate patients as well, for laser treatment is a procedure for a lifetime whereas conventional aids require continuous expences through life.
Laser corrects only existing dioptry, and does not stop the trend of increase.
Non-stable dioptry IS NOT A DETERRENT for laser procedure, after which the acuity and comfort are better.
In case that diopty after laser changes (non stable, high diopter, high hyperopia, hormonal disbalance, metabolic disbalance), laser refinement can be performed (enhancement). We always advise to wait at least a year for diopter to „stabilize” thereafter to enhance if need be.
HEALTHY CORNEA
Cornea must be healthy. Dioptrical range to be refracted, is defined by quality and thickness of cornea and pupilary size. These parameters present a limit up to which we can safely go in “removing diopters”. Special analysis of cornea (corneal topografy, corneal and ocular wave-front screening) reveal details about cornea and define a treatment model. These analysis also enable early detection of keratoconus. If the cornea is preserved, laser procedure could be done in combination with a corneal cross-linking (CCL or CXL) – „protective” procedure that will ”fortify” cornea , and increase its stability, lessening degree of disease progression.