How Can I Get Rid of Glasses or Contact Lenses?

The eye is an organ that basically resembles a camera. Rays from the external environment pass through the refractive surfaces of the eye, such as the cornea (the outermost transparent layer) and the lens, and are focused in the macula (yellow spot) region of the retina, which is responsible for sharp vision. The focusing of the rays in a different place is called a refractive error.

Refractive errors can be examined in 3 different groups as myopia, hyperopia and astigmatism. Apart from these, the decrease in near vision caused by the decrease in the ability of the eye lens to focus near over the age of 40 is called presbyopia. This condition is not an eye disease but a natural part of the aging process.

BREAKING (FOCUSING)

Defects and Treatment Methods

1 MYOPIA

Farsightedness

Myopia, defined as the inability to see far away clearly, is the result of the rays coming into the eye focusing in front of the retina. It most commonly develops when the anterior-posterior axis of the eye is longer than normal. It is a structural feature and genetic inheritance is common. It usually starts at school age and increases as the growth process continues. The development of cataracts at an advanced age can also change the refractive properties of the lens and cause myopia.

2 HYPERMETROP

Nearsightedness

In general, it is nearsightedness. It occurs when the rays coming into the eye are focused behind the retina. In contrast to myopia, here the eye structure is smaller than normal. Structural and hereditary characteristics are the most common causes of hyperopia. Untreated hyperopia increases the risk of lazy eye in children. For this reason, all children before school age should have an eye examination.

3 ASTIGMAT

Blurred near and distance vision

It is caused by the different refractive power of the cornea in different meridians. Astigmatism is an eye condition that causes blurred vision at any distance. It may be structural or it may occur as a result of degenerative diseases, infections and traumas that can cause changes in the corneal layer.

4 PRESBIOPIA

Age Related Near Vision Impairment

Over 40 years of age, it is a problem of nearsightedness. The lens inside our eyes has a structure that can change shape. Thanks to this special ability, the intraocular lens swells and increases its refractive power when objects are close and we can see nearby objects clearly. After the age of 40, the eye begins to lose this ability gradually and nearsightedness called presbyopia begins.

EXCIMER LASER

Refractive errors can now be treated permanently with today’s technology.

This treatment, which has been safely applied all over the world for more than 30 years and has eliminated the dependence of millions of people on glasses or contact lenses, is performed with a device called Excimer laser. Excimer laser is a device that produces ultraviolet light at a wavelength of 193 nm using Ar F gas. The laser beam generated here eliminates the targeted tissue in the desired thickness and width, so that a permanent change occurs in the cornea layer located at the outermost part of the eye and the treatment of myopia, hyperopia or astigmatism is realized. Femtolasik is the most commonly used method for this purpose.

LASIK

It is the most commonly used method in the treatment of focusing defects. Patients who are over 18 years of age and have not changed their glasses number in the last 1 year are candidates for this treatment.

In order for Lasik to be applied, the number of glasses and the structure of the eye must be appropriate. For this purpose, all candidate patients undergo a detailed eye examination as well as a series of tests showing the properties of the corneal layer. LASIK can treat myopia up to 12.0 degrees, hyperopia up to 6 degrees and astigmatism.

It is important to stop wearing contact lenses before Lasik. Patients who wear soft lenses should not wear lenses for at least one week and those who wear hard lenses for at least three weeks.

Who is not eligible for Lasik?

Pregnant and lactating mothers.

Those with severe dry eye.

Those with corneal thickness below a certain limit.

Diabetics and people with rheumatic diseases.

Those with conditions such as cataract, glaucoma, infection in the eye.

Application

In the LASIK method, the cornea layer, which is the outermost layer of the eye, is first numbed with 1-2 drops of anesthetic drops. Thus, the patient does not feel any pain during the intervention.

To prevent involuntary lid movements, an instrument called a speculum is placed on the lids. Then, a smooth surface is provided in the eye with a vacuum ring and an incision of approximately 0.12 mm is made in the corneal layer with a tool called microkeratome. The flap is removed and Excimer laser is applied to the underlying corneal tissue. Finally, the flap is placed in the same area and the operation is terminated. All these procedures are performed in an average of 5 minutes for both eyes and no pain is felt during this process.

The eyes are not closed after LASIK, it is recommended to rest the eyes as much as possible on the same day. Eye drops are used for an average of 1 week. During this period, it is not recommended to swim in the sea or pool, apply eye make-up and rub the eyes vigorously.

Advantages

The most important advantage of LASIK treatment is the comfort it provides to the patient. In patients with appropriate eye structure, LASIK can effectively correct even high spectacle degrees.

Recovery is extremely fast and the patient can have a good quality vision within hours after the treatment. Pain, watering and stinging problems disappear within 12 hours at the latest and 1 week of medication is sufficient after the treatment.

The LASIK procedure is usually completed in as little as 15 minutes. No pain or soreness is felt thanks to local anesthesia with eye drops.
Many patients can return to their daily life the day after surgery. Generally, clear vision starts within 24-48 hours.
Thanks to LASIK treatment, the use of glasses or contact lenses is largely eliminated. It provides serious convenience in areas such as social life, sports and business life.
In individuals with appropriate eye structure, LASIK provides lifelong permanent vision correction. Reversal of refractive errors is very rare.
Thanks to the measurements made with advanced devices, personalized laser applications are made. This ensures maximum success.
It is applied safely and precisely with the new generation Femtosecond and Excimer Laser systems. It is performed without damaging the outer structure of the eye.

Complications

LASIK treatment is a treatment that takes place in the outermost layer of the eye. Therefore, it does not damage the structures inside the eye.

In addition, very rarely, some problems may occur during the removal of the flap from the cornea, as well as problems such as infection, inflammation, allergy and inadequate correction of the degree after the treatment. These problems can be minimized with the experience of the physician applying LASIK treatment and the quality of the laser device used. The quality of the Excimer laser device, especially the FDA approval, should be questioned before having LASIK. Alcon ALLEGRETTO WAVELIGHT EX 500, which is used in our hospital, has a speed of 500 Hz and is one of the fastest laser systems in the world.

It can treat 1 diopter eye defect in less than 1.5 seconds. Thanks to the eye tracker system at a speed of 1050 Hz, laser treatment is extremely safe.

FEMTOLASICS

The most important step in LASIK treatment is the creation of a valve called a flap from the upper part of the cornea.

Femtosecond laser technology has been used in recent years to create the flap. Femtosecond laser is a device that can create incisions of the desired depth, width and shape in the tissue. FS 200 Femtosecond laser is the fastest and safest technology developed for this purpose.

People who have been diagnosed with cataract and decided to undergo surgery.
Patients who want to be treated with advanced technology.
Individuals who expect the highest performance from their intraocular lenses.
Patients with astigmatism who want it corrected during surgery.

Femtolasik Treatment

What are the Advantages?

Thanks to this device, the complications that could be seen in previously used microkeratome systems are almost eliminated.
Femtosecond laser can be used to create flaps specific to the person's refractive error.
The results are more successful especially in the treatment of hyperopia and astigmatism.
Corneal biomechanics are better preserved in femtosecond laser flaps.
Since it can lift flaps of the desired thickness, Lasik can be applied especially in patients with limited corneal thickness.
Since the flap interface is smoother, less aberration (light deviation) develops after Laser treatment.
Femtosecond flaps have less risk of dry eye development, which is observed especially in elderly patients.
In addition to creating flaps with femtosecond laser systems, corneal implants can be inserted, keratoplasty (corneal transplantation) and astigmatic keratotomy procedures can be performed.

Surface Treatments

PRK-LASEK-NO TOUCH

LASIK (the method applied by removing the flap from the cornea) is the standard treatment for the treatment of refractive errors with excimer laser all over the world. However, the corneal structure of each patient may not be suitable for this treatment. In such cases, surface treatments should be preferred.

The biggest disadvantage of these treatments, which have the same long-term results as LASIK when the appropriate method is selected, is the long recovery time and corneal haze called haze may occur in high corrections. Surface treatments, which have been used less frequently in recent years with the widespread use of femtolasik treatment, are still a highly effective and safe treatment alternative, especially in the correction of low numbers.

Waverfront Treatment

In laser treatment, a laser correction is performed based solely on the patient’s degree of spectacle. In wavefront treatment, the wavefront device measures the light scattering in the cornea, lens and nerve layer in detail and organizes a treatment scheme according to this measurement.

The treatment scheme calculated in the wavefront device is transferred to the laser device and thus personalized laser treatment is performed. Wavefront treatment is a method that should be preferred in patients with high sequential aberration rate in the measurements made before Excimer laser treatment.

Lenticule Removal through Small Incision

It is a method of creating a lenticule in the corneal stroma with femtosecond laser and removing it mechanically. It can be used in the treatment of myopia and myopic astigmatism.

Compared to LASIK, the refractive results are similar and postoperative dry eye is less common because the incision is smaller. Disadvantages include a lower success rate in the presence of high astigmatism and the inability to treat refractive errors such as hyperopia, hyperopic astigmatism and mixed astigmatism.

Phakic Lens

It is a preferred method for people between the ages of 20-45 whose corneal structure or degree of refractive error is not suitable for Excimer laser treatment.

There are 2 different types of phakic lenses that can be worn in the anterior or posterior chamber.

Fixed to the iris
Settled in Sulcusa

Individual characteristics such as endothelial count and anterior chamber depth must be appropriate for these lenses to be fitted.

Refractive Lens Exchange

Over 45 years of age, it is a method used in the treatment of myopia, hyperopia, astigmatism and presbyopia (near focusing difficulty due to old age). Thanks to the Toric (which corrects astigmatism) and Multifocal (which provides both near and far vision) lens technologies, which have developed especially recently, we are able to offer our patients a life without glasses.

REFRACTIVE SURGERY

Curiosities

Does pain occur during and after laser treatment?

Laser treatments are performed with the help of numbing eye drops. No pain is felt during the operation. Since the procedure takes place in a very short time, about 5 minutes per eye, the operation is over before most of our patients realize what has happened.

Postoperative discomfort (stinging, burning, watering, blurred vision) in lasik treatment lasts about 5-6 hours. In other words, patients can easily fulfill their daily activities when they wake up one day later.

Things to consider before laser treatment?

Patients who wear hard contact lenses should stop wearing them 3 weeks in advance and those who wear soft contact lenses 1 week in advance. It is recommended to wear comfortable clothes, no make-up or even perfume on the day of surgery.

Is laser treatment safe?

Excimer laser treatment has been practiced all over the world for about 25 years. During this period, we have not encountered serious complications that would require us to stop this treatment. Especially with the help of recently developed diagnostic devices, the results are very satisfactory if the appropriate patient is selected and the right treatment is applied at the right time.

What should be done after laser treatment?

Immediately after the treatment, patients are given 2 eye drops containing antibiotics and cortisone and asked to use them every hour. After one day, the doses are reduced and these drops are used for one week. For 1 week, it is important not to swim in the sea or pool and not to rub the eye.

Can a more perfect treatment emerge in this period of continuous technological development?

This was a question that always confused me as an ophthalmologist and caused me to wait for Excimer laser. However, the results we have achieved at the point we have reached now are so satisfactory that I thought that there was no end to waiting and that I had to catch up with the technology somewhere and I had this treatment 8 years ago. I am extremely pleased with the decision I have made now.

Is laser treatment an obstacle to future cataract surgery?

Before the cataract operation, a measurement called biometry is performed to calculate how many intraocular lenses will be implanted. Corneal curvature (slope) is important in biometry. Since excimer laser treatment permanently changes the corneal curvature, there were difficulties in intraocular lens calculations for a while. However, with the new formulas developed in the last 4-5 years, this problem has now been overcome. Therefore, all eye surgeries, including cataract surgery, can be performed safely after Excimer laser treatment.

Is there a difference between femtosecond Lasik and normal Lasik?

Femtosecond laser is a method that creates a flap (a piece of tissue removed from the upper part of the cornea), which is the most important stage of Excimer laser treatment. It can also be used in corneal ring applications and kerotoplasty (corneal transplantation) surgeries. This Nobel Prize-winning laser technology creates a very smooth incision in the cornea with infrared pulses in a quadrillionth of a second. Complications that can be seen in standard keratomas during flap formation are almost non-existent in this system, making it a safer method. There are publications reporting that refractive surgery using femtosecond laser gives better visual results compared to treatments with standard keratomas.

In conclusion, Excimer laser surgery is a plastic surgery. It is not a mandatory procedure. Therefore, when surgery is decided, it should be performed with the safest possible method. Excimer laser treatment with femtosecond laser flap creation is the safest method for today.

Is it possible to get the number back after laser treatment?

It is not possible for the entire corrected number to come back, but 5 out of 100 patients may have numbers that require glasses. In this case, which is usually encountered in high number corrections, it is possible to re-laser from the same area if the corneal structure allows.

Is it possible to cure astigmatism?

Since the introduction of excimer laser treatment, it is possible to treat astigmatism up to number 6.

Will the treatment fail if I move my eye during laser?

Thanks to the eye tracker systems in excimer laser devices, the slightest movements of the eye are detected and the treatment is directed to the right area. When there is a movement that the device cannot follow, the treatment is stopped. Therefore, it is not possible to have a bad result due to the patient’s non-compliance.

Is no touch therapy a newer and more successful treatment?

No touch or transepithelial PRK is a treatment that has been available since the beginning of Excimer laser applications and is included in the group of surface ablations.

What is done here is to somehow remove the epithelial layer on the outermost part of the cornea and apply the Excimer laser directly. The epithelium can be removed by scraping, with the help of alcohol or with special devices developed for this purpose, or it can be removed with Excimer laser.

The results of the treatments in the surface ablation group are the same in terms of predictability, safety, stability and there is no difference in terms of complications that may occur in the studies. Surface ablations are currently preferred only in patients with low corneal thickness due to the long rehabilitation period and less predictable refractive results compared to LASIK, especially at high numbers.