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Laser Treatments

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There are many factors to consider when determining whether you are a candidate for eye laser surgery. These factors depend on various parameters such as the health of your eyes, your general health, your age, and the type and degree of your vision defect.Here are the characteristics sought in an ideal candidate for eye laser surgery: It is generally recommended that candidates be at least 18 years old. This ensures that the eyeglass or contact lens prescription is stable for several years. An unstable eye prescription means that the laser correction may also change over time. Whether the surgery is applicable depends on the degree of myopia, hyperopia, and astigmatism. There are certain limits for each technology. For example, SMILE technology may not be recommended for very high myopia. Adequate thickness of the cornea ensures that the integrity of the cornea is preserved during laser correction. A thin cornea can make some laser procedures risky. Laser surgery may not be suitable for individuals with eye diseases or disorders such as dry eyes, keratoconus, glaucoma, and cataracts. Laser surgery may be risky for people with systemic diseases such as diabetes, rheumatoid arthritis, lupus, or those taking medications that weaken the immune system.

1. LASIK (Laser-assisted in situ keratomileusis): In LASIK, a thin flap (lid) is created from the surface of the cornea. This is done either with a device called a microkeratome or, in newer techniques, with a femtosecond laser. Once the flap is lifted, the excimer laser focuses on the tissue beneath the cornea and vaporizes it. This action of the laser changes the shape of the cornea, correcting vision defects. Once the shaping process is complete, the corneal flap is placed back in its original position. This flap acts as a natural band and heals quickly. 2. PRK (Photorefractive keratectomy): In this procedure, the epithelium, the outermost layer of the cornea, is completely removed. This can be done with an alcohol solution or a spatula. The excimer laser is then applied directly to the cornea, changing the shape of the cornea. The epithelium heals naturally as it grows back into the treated area. This process can take longer than LASIK and is usually associated with more discomfort. 3. LASEK (Laser-Assisted Subepithelial Keratomileusis): In LASEK, the epithelial layer is not completely removed; instead, it is softened with an alcohol solution and lifted as a flap. The cornea is then shaped using an excimer laser. Finally, the epithelial flap is placed back in its original position. 4. SMILE (Small Incision Lenticule Extraction): A femtosecond laser is used to create a small, lens-shaped tissue (lenticule) inside the cornea. The created lenticule is removed through a small 3-4 mm incision. SMILE has become a very popular technique, especially in the treatment of myopia, and offers a less invasive approach to the cornea.

Each laser technology has refractive error limits that it can treat. These limits may vary depending on the laser equipment used, the patient's eye structure, the thickness of the cornea and other factors. It should also be noted that these limits may change over time depending on technological developments. Here are the generally accepted limits of frequently used laser technologies: LASIK (Laser-Assisted In Situ Keratomileusis): Myopia: It is generally used for myopia ranging from -1.00 D to -10.00 D. Hyperopia: It can be used for hyperopia ranging from +1.00 D to +4.00 D. Astigmatism: It can be used for astigmatism ranging from ±1.00 D to ±6.00 D. PRK (Photorefractive Keratectomy): Myopia: It is generally used for myopia ranging from -1.00 D to -8.00 D. Hyperopia: It can be used in hyperopia cases from +1.00 D to +3.00 D. Astigmatism: It can be used in astigmatism cases from ±1.00 D to ±4.00 D. LASEK (Laser Epithelial Keratomileusis): Myopia: It can be used in myopia cases from -1.00 D to -8.00 D. Hyperopia: It can be used in hyperopia cases from +1.00 D to +3.00 D. Astigmatism: It can be used in astigmatism cases from ±1.00 D to ±4.00 D. SMILE (Small Incision Lenticule Extraction): Myopia: It can be used in myopia cases from -1.00 D to -10.00 D. Astigmatism: It can generally be used in cases of astigmatism from ±1.00 D to ±5.00 D. (The SMILE method is generally not recommended for hyperopia.)

Laser refractive surgery involves a series of procedures that aim to change the refractive power of the eye to reduce or eliminate the need for glasses and contact lenses. The most common refractive surgery methods are LASIK, PRK, LASEK, and SMILE. Here is a general comparison of these techniques: LASIK (Laser-Assisted In Situ Keratomileusis): A microkeratome or femtosecond laser is used to cut the top layer of the cornea into a temporary flap. Then an excimer laser is used to shape the corneal tissue underneath. Advantages: Fast recovery time. Low pain. High success rate. Results: Excellent vision is achieved for most people. PRK (Photorefractive Keratectomy): The surface layer of the cornea (epithelium) is removed and the cornea is shaped with an excimer laser. Advantages: No risk of flap complications in LASIK. May be more suitable for patients with thin corneas. Results: Similar results to LASIK, but recovery time is longer. LASEK (Laser Epithelial Keratomileusis): Epithelium is manipulated using alcohol and cornea is reshaped with excimer laser. Advantages: Similar to PRK, but epithelium is preserved. May be suitable for patients with thin corneas. Results: Similar results to LASIK and PRK. SMILE (Small Incision Lenticule Extraction): A small lens (lenticule) is created inside the cornea using a femtosecond laser and this lenticule is removed through a small incision. Advantages: No flap is created in the cornea, which reduces the risk of complications. The risk of dry eyes is lower. Results: Similar results to LASIK.

Eye laser surgery, like any surgical procedure, has some potential side effects and complications. Some of these side effects may be temporary and improve over time, but some may be permanent. The right patient selection, preoperative evaluation, and the knowledge and skill of an experienced surgeon can minimize the risk of these side effects. However, it is important to keep in mind that every surgical procedure carries some risks. Here are the most common side effects: Dry Eyes: Many patients experience temporary dry eyes after surgery. This can be caused by decreased tear production and cutting of the nerves that cause dry eyes. It can usually be managed with artificial tear drops or other treatments, but in some cases it can be permanent. Visual Disorders: Problems such as ring glare, reflections, or double vision may occur. These types of symptoms are usually more noticeable during night driving. Under or Over Correction: Sometimes the surgical procedure does not fully correct the refractive error in the eye, or it corrects it too much. This may cause the patient to still need to wear glasses or contact lenses. Astigmatism: Astigmatism may develop after the surgery or existing astigmatism may worsen. Flap Complications (Especially in LASIK): If the flap does not fit properly, wrinkles or shrinkage may occur in the tissues underneath. Rarely, microscopic dirt or air bubbles may form under the flap. Abnormal Growth of the Surface Epithelium (Especially in PRK and LASEK): The epithelium, the surface layer of the cornea, can grow beyond its normal outer borders. Infection: Although rare, there is a risk of infection after any type of eye surgery. Vision Loss: In very rare cases, laser refractive surgery can cause permanent vision loss. Wavy Vision: Some patients perceive a wavy or distorted image due to an irregular corneal surface. Night Vision Problems: Some patients may have poor vision at night.
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