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As with all refractive procedures, an exhaustive ocular examination is performed to ensure LASIK as the best procedure for our prospective patient. Further, to get the most accurate measurements, we like to have our patients out of their soft contact lenses 3 days and their RGPs 4-6 weeks prior to getting pre-operative measurements. Also, to minimize post-operative complications, it’s important to be very sensitive to surface dryness. A thorough evaluation of the meibomian glands and tear film (TBUT, anesthetized shirmers, flurouscein and lisamine green staining and LipiView meibomian gland imaging) is very important in detecting any tear film abnormalities
Pre-op measurements: VA (with and without correction, distance and near), manifest refraction, cycloplegic refraction, pupil size (photopic and scotopic), IOP, slit lamp exam, endothelial cell count (if any guttata are seen), Oculus Pentacam, ORA (Ocular Response Analyzer), Wavefront Analysis, and a dilated fundus exam (See: Diagnostic Technology Advances Tab for description of these instruments). While all these pre-operative measurements are very important, it is equally important to take into consideration the patient’s dominant eye, age, occupation, goals and expectations. Also, we like to have a good discussion with the patient regarding how they use their vision on a daily basis. With this information, we can tailor the best, safest refractive surgery procedure to meet their goals and expectations allowing them to perform these daily activities with less dependency on their glasses or contacts.
During the pre-operative examination it is important to not only get the appropriate measurements (Refraction, Topography, Corneal thickness, Wavefront, Cycloplegic refraction and Tear film assessment), but this is also an important time to set appropriate patient expectations and discuss the different types of ICL technologies. . The pre-operative examination is also a critical time to prepare the ocular surface when appropriate with plugs and/or prescription dry eye medication prior to surgery to maximize outcomes and minimize risk.
We use the Visian ICL (implantable collamer lens) at Vance Thompson Vision. The ICL is placed in the posterior chamber, behind the iris and does not require the natural lens to be removed. This procedure is recognized as an alternative to corneal refractive surgeries like LASIK.
The Verisyse ICL is a similar implantable lens, made of medical-grade polymethylmethacrylate, or PMMA. The Verisyse ICL is placed in the anterior chamber, in front or your iris. of the lens. Both lenses are FDA approved for the correction of nearsightedness.
Follow-up Regimen: 1 Day, 1 Week, 1 Month, 3 Months, 6 Months, 1 Year.
1 Day Post-op:
Tests to Perform: visual acuity, refraction, slit lamp exam
The day following surgery is when most patients feel their vision has improved a lot. Most patients are not only comfortable, but drive to their 1 day post-op exam and go back to work this day. Your patient can have some dryness on this visit. If so, artificial tears and possibly night time ointment can be added at this stage. Of course, punctal plugs (temporary or permanent) are also an option. Diffuse lamellar keratitis (DLK) will sometimes be seen at this time. If so, notify us and then we can determine whether to increase steroids or consider a potential lift flap and interface rinse. If there are any flap striae, we should also be notified for a potential lift and smooth. Subconjunctival hemorrhages can be noted at this visit. We are not too concerned with this, as these will usually resolve within the first few weeks.
1 Week Post-op:
Tests to Perform: Visual acuity, refraction, slit lamp exam
This is when your patient will typically start tapering their drops. If your patient is not correctable to the preoperative visual acuity, and you can see some striae, it would be appropriate to have our surgeon smooth the flap. Evaluate the flap edge for epithelial ingrowth. This is another time DLK can be observed, and we should be notified.
1 Month Post-op:
Tests to Perform: Visual acuity, refraction, slit lamp exam, IOP (if applicable)
Patients sometimes complain of photophobia at this visit due to a rebound inflammation. This can usually be remedied with a steroid qid for 1 week.
3 Month Post-op:
Tests to Perform: Visual acuity, refraction (if considering enhancement), slit lamp exam, IOP (if applicable).
This is typically the earliest we will want to consider an enhancement. Although we would prefer to wait until the six month post-op exam. We also want to see a stable refraction before considering an enhancement. If we are considering an enhancement, then a cycloplegic exam, corneal thickness and topography must also be performed. Before considering an enhancement it’s also important to assess the tear film. In many situations, if a person has not achieved their target following LASIK, it is secondary to an underlying dry eye. If we are going to consider an enhancement, we want to ensure that there’s a minimum of 400 microns of total corneal tissue and at least 300 microns of untouched corneal tissue under the flap before we will consider re-lifting the flap, as well as the duration of time since their primary procedure. If we are uncomfortable with lifting the flap, we will perform a PRK enhancement instead of a LASIK enhancement.
6 Month Post-op:
Tests to Perform: visual acuity, refraction, slit lamp exam, IOP (if applicable)
If we are considering an enhancement, then a cycloplegic exam, corneal thickness and topography must also be performed. We also want to a stable refraction at this point before considering an enhancement.
1 Year Post-op:
Tests to Perform: visual acuity, refraction, slit lamp exam, IOP