What is Excimer laser?
Who are the candidates?
Therapeutical application of excimer laser – PTK
How does it look like, how long it lasts, what anaesthesia is applied?
How to plan examination if wearing contact lenses?

From the very beginning of work of Special hospital SVETI VID, this type of surgery is performed by experienced European surgeons-professors with more than 25 years of experience, on the laser of the latest generation!

It is the reason for thousands of operated patients to be satisfied and therefore they are the best recommendation for others to perform this intervention in SVETI VID on the highest level.

LATEST IN SVETI VID-WOW!!! LASER

Excimer laser – Schwind Amaris- SmartPuls/SmartSurf ACE touch free T-PRK

  • Painless
  • Prompt
  • Safe
  • Touch-free
  • Without flap making
  • Without side-effects

Dream of millions around the world is to get free from spectacles and contact lenses.

Dream of millions of parents around the world is to help their little ones, who have dioptry problems threatening to become amblyopia, to achieve, in early pre-school age, better visual acuity and to avoid visual impairments for the whole life.

Laser procedures at Sveti Vid provide comfortable and safe way of reaching these goals for children and adults.

It is the cutting-edge technology and revolutionary laser approach.
SmartPuls -SmartSurfACE, innovative technology with WOW effect, named for joyful exclamation immediately after the procedure – WOW!!!
Procedure does not require creation of epithelial flap, providing highest precision using rapid eye-tracker-tracking fine movements of the eye while controlling static and dynamic cyclotorsion and precise beam centration.
Exceptional speed of laser beam described like “fireworks“, shortens significantly time of the laser procedure, refining the corneal surface and results in fast visual recovery, painless, smooth and transparent surface of cornea (no haze) maintaining corneal quality, and comfort for a patient.
This atraumatic approach without incision or needle, practically touch-free, is effective, safe and certain treatment of refractive error, awaited for many years.
This procedure has advantage over LASIK which is accompanied with some degree of possible flap complications even several months and years after, and in comparison with older PRK methods gives ease without pain.
This laser procedure is used for therapeutic purposes as well (PTK), for corneal defects resulting from trauma, recurrent erosions, bullous keratopathy as an aftermath of traumatic cataract surgeries, corneal scars and so forth.

NEW – LASER NEWEST GENERATION
PROMPT, PAINLESS, TOUCH-FREE

What is Excimer laser?

Dream of millions becomes reality! Precision, predictability, safety, and pleasure of millions of treated patients in the world.

Excimer laser certainly takes great popularity among refractive procedures being the least invasive. For several decades it has been in practice, as a safe procedure in defined indications. It is controlled application of cold laser beam – “flying” laser beams, interchanging at the great speed in desired corneal zones to in advance planned model reshaping it and „polishing”. Laser changes corneal refractive power into desired one and corrects the error in refraction. Laser used in Sveti Vid is the most advanced, and in the world of ophthalmic technology has been awarded for quality, design, precision and safety. (Topmost laser procedures).

Dioptry range that can be corrected is defined by parameters determined by examination. One of essentials is corneal thickness and stability. Application is defined in range from minus 13 D nearsightedness to plus 4 D farsightedness (with astigmatism), providing that cornea is healthy and of sufficient thickness. The range of ability to treat thinner corneas is smaller. To preserve and maintain the health of cornea there is a limit, meaning that residual cornea (after laser) remains healthy, which is a safety factor for a patient and our imperative.

EXCIMER IN ADULTS

EXCIMER IN CHILDREN

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.

Excimer laser is used in the purpose of therapy of some corneal problems, not only as a refractive procedure. That is what we call PTK (phototherapeutic keratectomy). This method is used to ’’polish the cornea’’ in order to remove the superficial opacities, or corneal scars, to ’’regain’’ clear cornea. It is very often used in recidivant corneal erosion, to achieve better and faster reepitelization. In the case of bulos keratopathy, PTK will remove the subjective complains and irritations, pain, photophoby, tearing, with the eased epitelization. Combination of PRK + PTK will heal the cornea and correct refractive error, at the same moment.

Controlled by computer the application of “cold” laser beam has a target to “ reshape” cornea and changes its refractive power into desired. It is achieved by direct emission of laser beam to the superficial surfaces of cornea, touch –free trans PRK surface method –which by application of new, inovative technology SmartSurf ACE enables comfortable procedure and patient’s satisfying experience with WOW efect in visual acuity immediately after the procedure.

The highest degree of safety, corneal stability, impressively smooth surface of cornea during the procedure, long-lasting safety for a patient.

Procedure takes just a few minutes. Recovery is fast.

Great advantage over standard procedures, PRK, LASIK and lenticular procedures (SMILE).

LASIK (laser assisted in-situ keratomileusis), means combination of microsurgical and laser procedures. By microkeratom (special knife) or femtolaser the surface of cornea is cut to make a flap. The flap is lifted, and deeper layers of stroma are lasered. After that the flap is returned back to its position. This is an invasive method. Period of corneal recovery lasts longer than t-PRK. The instability of flap can last several months.

Possible risks with Lasik are:

flap complications – irregularity, decentration, button hole (rupture in the flap during the cuting of the flap), incomplete flap, uneven thickness of the flap, appearance of central haze and other.

With lasik caution is adviced and stoppage with sport activities even two months after for risks of flap complications.

That is why the method of choice for active sportsmen definitely is transepitelial PRK, or Lasek (superficial ablation).

LASEK (laser assisted subepithelial keratomileusis) is just like t-PRK, a variant of superficial procedures. It has excellent subjective to

lerance as non-invasive as LASIK. LASEK is especially comfortable for pediatric patients.

In all cases of laser correction topical anaesthesia with drops is used, except in children, where general anaesthesia and analgo-sedation is used. Sveti Vid gives the advantage to superficial laser techniques, T- PRK / SmartSurf ACE and LASEK, as safer and with excellent outcomes, predictability and stability of results. Before the procedure, comprehensive examination is done, for complete evaluation of the problem, the quality, curvature and changes of cornea which will exclude all risks.

It is recommended to stop wearing soft contact lenses a week before, and GP at least a month before the laser correction (as recommended a month break for each decade of wearing). The configuration and any changing of cornea should be followed on cornea topography and thereafter it reffers to refractive correction. Before laser correction, reports from complete eye examination are collected and risks are excluded for the safety of procedure.