What are the different types of laser eye surgery procedures available?

SMILE, LASIK & PRK/LASEK

The best option for you?

You have decided that you want to be free from spectacles and contact lenses and that laser eye surgery is the best option for you.

You will probably be trying to decide between the three best options: SMILE, LASIK or PRK/LASEK.

PRK, LASIK and SMILE

All three surgeries are trusted, safe, and effective ways to correct your vision. But which procedure is best? Lets tackle all three one at a time;

PRK/LASEK

PRK also known as LASEK is considered by many to be the first generation of laser vision correction. PRK can treat nearsightedness, farsightedness, and astigmatism.

During a PRK procedure, the outer layer of your cornea (also known as the epithelium) is gently removed using a manual instrument. Your surgeon then uses a cool excimer laser to reshape your cornea and correct your vision.

When is PRK a Good Option?



PRK is a good option for patients with thin or irregular corneas, patients who are predisposed to chronic dry eye, and patients whose jobs or lifestyles cause them to take a lot of direct contact to the eyes (Ex: Boxers and fighters). Thin corneas, dry eye, and high-risk occupations can cause a patient to not be a suitable candidate for LASIK (but still may be a great candidate for SMILE, which we’ll get to later).

PRK Downsides



The major downside with PRK is recovery time: PRK has the longest recovery period out of all three laser eye surgeries. It takes about a week for the cells on the outer layer of your cornea to grow back. It can then take anywhere from two to six weeks for the cells to smooth and allow for clear vision.

If you were to elect to have PRK done in both eyes at once (which is an option) a patient will typically need to take a week off of work or driving.

There is also a higher chance of post-surgery discomfort when compared to SMILE or LASIK.

LASIK

                                    

       
The majority of our new patients are most familiar with LASIK. This is because LASIK is the most commonly performed laser eye surgery in practice today.

LASIK can treat mild to moderate nearsightedness, farsightedness, and astigmatism.

During a LASIK procedure, a small flap of corneal tissue is created using a femtosecond laser and then folded back. Your surgeon will then use an excimer laser to reshape the underlying corneal tissue in order to correct your vision.

When is LASIK a Good Option?



In order to be a good candidate for LASIK, a patient needs to have an adequate corneal thickness. Since a flap is created during this procedure, a certain amount of corneal thickness is required and those with thin or irregular corneas may be unable to receive LASIK. Patients with thin or irregular corneas are typically better candidates for SMILE or PRK.

If a patient is predisposed to chronic dry eye symptoms, SMILE or PRK may be a better option. LASIK is known to run a higher risk for postoperative dry eye symptoms and can increase previously held chronic dry eye.

LASIK Downsides



LASIK is an extremely effective, safe, and trusted option. Its one downside is it is a more complex procedure than its successor, SMILE, because it uses two lasers and creates a flap during surgery. Because of this, there is a potential for flap-related complications post-surgery.

Flap-related complications include microscopic wrinkles called striae, irregular astigmatism, epithelial ingrowth, inflammation, and dry eye syndrome. Flap-related complications are rare and your chance of encountering these complications are greatly decreased by partnering with an experienced surgeon like Dr. Amir Hamid.

SMILE

SMILE  is the most advanced laser vision correction procedure to date. SMILE has been in practice worldwide since 2012.

One of the main differences between SMILE and its predecessors is it is a one-laser procedure. Unlike PRK and LASIK, there is no use of an excimer laser during a SMILE procedure. Instead, your surgeon will use a femtosecond laser to cut a tiny incision in the cornea and use it to remove a small piece of corneal tissue (called a lenticule). This reshapes the cornea and improves vision.


Less Invasive Surgery



SMILE is a less invasive laser eye surgery procedure than LASIK. During a LASIK procedure, your surgeon creates a flap that is 20mm in circumference. A PRK procedure creates an 8mm diameter surface removal. In comparison, SMILE creates only a 3mm corneal key-hole incision. This allows for more corneal stability post-surgery and less disturbance to corneal nerves during surgery.
Quiet, Odourless, and Blade-Free

During both LASIK and PRK, an excimer laser is used to reshape the cornea. During surgery, this laser makes a clicking sound and creates a noticeable odour. Since the excimer laser is not used during SMILE, the procedure is quiet and odourless.

No Flap-Related Complications



Because SMILE does not create a flap like LASIK, there is no risk of flap-related complications after surgery.

Safe, Accurate, and Fast Visual Recovery



Clinical trials for SMILE have found it to be just as safe and accurate as LASIK.

SMILE is considered the most significant advance in laser eye surgery technology in over 10 years. It combines the safety of traditional vision correction techniques with even greater comfort and potentially greater precision.



Which is Right for Me?



Ultimately, only a comprehensive eye exam and consultation by your surgeon can determine which procedure is the best for you. If you would like to learn if SMILE, LASIK or PRK is the best option for you contact info@dramirhamid.com for a free no obligation consultation.

About Dr Amir Hamid

My Trip to The Medicontur Premium Class in Budapest: Age Related Macular Degeneration and the Macula Lens

This week I was in Budapest to learn more about the Scharioth Macula Lens and how it can help patients who have sight loss from AMD.

Age Related Macular Degeneration (AMD)

AMD is a degenerative condition affecting the central part of the retina called the macula. This central sight loss profoundly affects reading ability and many other important tasks of daily living.

There are 2 main types of AMD: Dry and Wet
















Dry AMD 

The most common form of AMD has no available treatment to prevent development or progression. There is evidence that nutritional supplements can slow down progression. However, Dry AMD progresses slowly over many years leading to a blank patch in central vision.

Wet AMD

This form of AMD is rapidly progressive but can be treated with anti-VEGF injections. Despite this central vision loss may still occur.

Visual Aids

There are many visual aids to help patients to regain reading ability with the use of magnification. However, many of these aids can be bulky or not easily moved from location to location. Many patients are also not comfortable in displaying the fact that they have a visual disability in public.

The Scharioth Macula Lens (SML): The Magnifier in the Eye


Is an add on intraocular lens which acts as a magnifier in the eye. A scientific paper has been published in the respected Journal of Cataract and Refractive Surgery demonstrating its safety and efficacy.



In addition it is much more affordable than competing tecnologies available with significantly less invasive surgery with more rapid visual recovery.




In Budapest I listened and spoke to Prof Scharioth himself about the scientific basis of the lens, its development and safety profile but most importantly how satisfied his patients have been. I am convinced it has much to offer in the cases of motivated individuals who want to continue to maintain an active lifestyle.




I will now be offering the SML in London and the SE of England.

For more information about AMD:

http://www.rnib.org.uk/eye-health-eye-conditions-z-eye-conditions/age-related-macular-degeneration-amd

For more information about the SML:

http://www.medicontur.com/scharioth_macula_lens

www.dramirhamid.com

My Recent Interview at European Cataract and Refractive Surgery Conference in Copenhagen

I was recently interview at the ESCRS conference in Copenhagen. It is the premier international conference in cataract and refractive surgery and I was asked to discuss some of the research we presented at the conference.

I explained the different results we can achieve with different types of multifocal/presbyopia correcting lenses.

The peer reviewed publication can be found here:

http://www.scirp.org/Journal/PaperInformation.aspx?PaperID=69937

NHS Ethics Committee Approved Clinical Trial

 (Cataract Surgery and Premium Lenses)

Multifocal IOLs offer spectacle independence for patients undergoing cataract surgery. We are now able to offer £1000 off the total cost of bilateral cataract surgery in our private state of the art facilities in Harley Street.

We aim to provide surgery to the first eye by 16th of December 2016 at the latest. Recruitment for the trial will cease after this.

Patients will be randomised to receive bilateral implantation of one of two CE marked Trifocal Intraocular lenses during their cataract surgery.

For a free no obligation consultation please email info@dramirhamid.com

Dr Amir Hamid's Website

Interviewed this week for BBC - Symfony Lens

Those of you in the South East may have caught a TV interview I gave to BBC this week - discussing the benefits of the advanced new Symfony lens, introduced this summer at Optimax.

As I told BBC, the main benefit of this implantable lens technology is that it gives allows high-quality vision at all distances, which independence from spectacles.

The programme also interviewed one of my patients - Nicola Ellen, from Wingham, Kent, who was one of the first to be treated with the new lens, and who is delighted with her visual outcome.

On a more technical note, the new lens largely eradicates factors which can be present in traditional multifocal lenses - glare and poor colour contrast in certain lighting situations.

Introducing new Toric version of Symfony Lens.

This week I will begin implanting the new Toric version of the Symfony lens. These new lenses, released only a few days ago, mean that we can now treat patients with astigmatism, so now even more people can benefit from an extended range of good vision.

Our latest results with groundbreaking Symfony Lens - Published in leading eye surgery journal this month

CRST Europe: October 2014


Early Results With the Symfony IOL

This lens offers another option in presbyopia correction

By Amir Hamid, BMedSci, FRCOphth

 

Cataract surgery has evolved from a procedure devised to remove a cloudy lens to one that additionally aims to incorporate refractive solutions. Until recently, emmetropia for distance vision was the main goal, and many patients required reading glasses after surgery.

However, improved techniques and increased patient expectations have resulted in the quest for a simultaneous presbyopic solution.

Multifocal IOLs have been an excellent option in patients who desire spectacle independence. Specifically, the latest generation of trifocal IOLs provides excellent distance, intermediate, and near vision with high levels of spectacle independence and patient satisfaction.

 

However, several factors can still affect visual results and patient satisfaction. Chief among these are glare and halos and reduced contrast sensitivity. Another is the fixed focusing distances that these lenses afford.

 

EXTENDED RANGE OF VISION

In June 2014, the Tecnis Symfony IOL (Abbot Medical Optics) received the CE Mark. This IOL offers several advantages over traditional multifocal IOLs.One is its echelette design,which producesa unique pattern of light diffraction, elongating the focusing ability of the eye.The result is an extended range of vision.

Another advantage is that the Symfony compensates for image-degrading chromatic aberration between shorter blue and longer red wavelengths. It has been reported that correction of chromatic aberration results in a sharper focus of light.^1,2

This lens design therefore allows improved depth of focus, increased retinal image quality, and reduced visual disturbances (glare and halos) compared with traditional multifocals.

 

REAL WORLD RESULTS

My colleagues and I have compared the performance of the Symfony IOL with the AT LISA tri(Carl Zeiss Meditec).³We used a standard monofocal IOL (Tecnis) as a control. The defocus curve of the control provided a benchmark for the other two groups.

 

Each lens was implanted in one eye of 10 consecutive patients (20 eyes) who presented for cataract surgery or refractive lens exchange with no other ocular comorbidity. Both the Tecnis Symfony and the AT LISA performed well and similarly to each other, with all patients achieving 20/25 visual acuity or better and excellent levels of uncorrected near, intermediate, and distance visual acuities (Figure 1).

 

In terms of the defocus curves, the AT LISA had three distinct points of focus corresponding to near, intermediate, and distance vision, with a drop in vision between these points. By contrast, the Symfony had a smooth defocus curve up to approximately 2.50 D (Figure 2).

 

We also found that the Symfony provided better contrast sensitivity than the AT LISA tri and Tecnis monofocal IOLs (Figure 3).

 

CONCLUSION

Both the AT LISA tri and the Symfony IOLs are high quality lenses that produce excellent results in near, intermediate, and distance vision. The early results from our small group of patients, however, suggest that the latter provides an extended range of vision. Therefore, we have found that the Symfony IOL is another option in presbyopia correction with improved contrast sensitivity and reduced glare and halos.

 

Amir Hamid, BMedSci, FRCOphth, is Medical Director of UltralaseOptimax Eye Surgery Specialists in London. Dr. Hamid states that he has no financial interest in the products or companies mentioned. He may be reached at e-mail: amir.hamid@optimax.co.uk.

 

1.      WeeberHA, Piers PA.Theoretical performance of intraocular lenses correcting both spherical and chromatic aberration. J Refract Surg. 2012;28(1):48-52.

2.      ArtalP, Manzanera S, Piers P, et al. Visual effect of the combined correction of spherical and longitudinal chromatic aberrations. Opt. Express. 2010;18(2):1637-1648.

3.      Hamid A, SokwalaA, Patel V. Comparative visual performance of an extended range of vision IOL, trifocal IOL and monofocal IOL. [Data to be published].