A Guide to Refractive Laser Eye Surgeries

Femto-SMILE Surgery is the latest type of refractive surgery. This method is known as the least invasive treatment for correction of myopia and astigmatism. The major advantage of Femto-SMILE is that it does not involve cutting a flap on the cornea.

In Femto-SMILE, the surgeon creates two corneal incisions with the thickness of 110 to 130 microns. The incisions create a small, lens-shaped bit of tissue (lenticule) within the cornea. By removing the lenticule through a 2 to 4 mm keyhole incision, the shape of the cornea changes and the refractive error is corrected. This is the best choice for all patients with myopia and astigmatism.

In Femto-SMILE, a femtosecond laser is used to create a very thin disc of tissue (lenticule) inside the intact cornea, and unlike other refractive laser surgical procedures, there is no need for an excimer laser.

Femto-LASIK is the most commonly performed surgical procedure to correct refractive errors, especially astigmatism. In this technique a thin layer of the cornea (flap) with a thickness of 100 to 180 microns is removed using a femtosecond laser. Then the surgeon focuses the laser light on the cornea and reshapes the cornea to accommodate refractive error. After this step, the surgeon places the flap back into position. In Femto-LASIK The laser emits energy with a very short pulse duration that is on the order of 10–15 seconds. Because of using a femtosecond laser (the fastest laser used in ophthalmology), Femto-LASIK is a quick, high-precision and safe technique and has high patient satisfaction rate.

LASEK/PRK Laser Eye Surgery, LASEK is a modification of PRK, is an older technology that is still used by some patients and is suitable for them. In LASEK (PRK), which was common refractive surgical procedure before the invention of LASIK, the surgeon removes a very thin layer of the cornea surface with a laser or surgical blade and uses an excimer laser to apply computer-controlled pulses of light energy to reshape the cornea to correct the refractive error. At the end of the procedure, a bondage contact lens is applied on the eye.

LASEK/PRK Laser Eye Surgery

• PRK or LASEK eye surgery can be recommended for approximately 40% of patients with refractive errors. In fact, most patients with refractive errors can undergo LASEK/ PRK procedures except people with hyperopia (farsightedness) and hyperopic astigmatism.

• Full recovery from PRK/LASEK surgery takes 1-2 weeks, and the final visual outcome is achieved six months after surgery. PRK/LASEK procedures are used to correct myopia and myopic astigmatism. These procedures are performed using an excimer laser.

• People with thin corneas or people who are involved in martial arts or traumatic exercises are good candidates for PRK or LASEK.

Femto-LASIK Laser Eye Surgery

• Femto-LASIK surgery is recommended for approximately 40% of patients to correct refractive errors. All people with adequate corneal thickness can be suitable candidates for Femto-LASIK surgery.

• Due to the use of Femtosecond Laser, Femto-LASIK surgery is performed very quickly. The patient can return to normal work and life 2 days after surgery. Usually the eye recovers quickly after surgery.

• Femto-LASIK is recommended for the correction of hyperopia, myopia and myopic astigmatism. All people with refractive errors can be suitable candidates for Femto-LASIK surgery.

• Femto-LASIK surgery is performed using both of femtosecond and excimer lasers.

Femto-SMILE Laser Eye Surgery

• Femto-SMILE surgical procedure is recommended for approximately 20% of patients to correct refractive errors. Most patients with adequate corneal thickness, myopia and myopic astigmatism can be suitable candidates for Femto-SMILE.

• The patient can return to normal work and life 2 days after surgery. Full recovery from Femto-SMILE takes less than 2 months.

• Femto-SMTLE surgery is recommended for the correction of myopia and myopic astigmatism.

• This surgical procedure is performed using a femtosecond laser.

If you are a candidate for one of the LASIK procedures, including PRK/LASEK, Femto- LASIK and Femto-SMILE, at Noor Eye Hospital, please note the following:

1. You should be at least 18 years old.

2. Your vision should be stable for at least 12 months before undergoing refractive eye surgery.

3. You should have realistic expectations from refractive eye surgery.

4. You should NOT have uncontrolled diabetes.

5. You should NOT have connective tissue disorders.

6. You should NOT have a history of corneal herpes simplex.

7. You should NOT have intraocular inflammation.

8. You should NOT have glaucoma (blue water) or cataract.

9. You should NOT take some medications such as Roaccutane.

10. You should NOT be pregnant or breastfeeding.

Note: Your ophthalmologist will remind you of these points and more before doing refractive eye surgery.

1. Wash your eyelids and eyelashes the night before surgery.

2. Do not wear eye make-up 48 hours before surgery.

3. Wear comfortable loose-fitting clothing on the day of surgery.

4. Avoid wearing perfume or hairspray on the day of surgery.

5. Do not wear contact lenses 48 hours before surgery.

6. Take a sedative if you feel anxious.

Advantages, Disadvantages and Complications of PRK/LASEK:

• Post-Operative Eye Pain and Discomfort: In some cases, there is a possibility of considerable (tangible) eye pain and persistence eye discomfort for 3-5 days after surgery.

• Full Visual Recovery: Full visual recovery from PRK/LASEK surgery takes several months after surgery.

• Possibility of Post-Operative Infection: there is a very low possibility of post-operative infection usually within the first 3-4 days after surgery.

• Possibility of Displacement of the Corneal Flap: there is no possibility of flap displacement in PRK/LASEK procedures.

• Swimming Restriction: There is a swimming restriction of up to one month after PRK/LASEK procedures.

• Returning to Daily Activities: Most patients can return to their daily activities 3-5 days after surgery, but if your job needs sharp vision for detail, such as a surgeon, a bank employee, an accountant, etc., the recovery period will be longer.

Advantages, Disadvantages and Complications of Femto-LASIK Surgery:

• Post-Operative Eye Pain and Discomfort: After Femto-LASIK surgery, there is minimal discomfort for most people. It usually is not felt more than 2 hours.

• Full Visual Recovery: Most patients have a good vision after surgery.

• Possibility of Post-Operative Infection: There is a very low possibility of post-operative infection after Femto-LASIK surgery.

• Possibility of Displacement of the Corneal Flap: There is a very low possibility of flap displacement.

• Swimming Restriction: There is a swimming restriction of up to one month after Femto-Lasik surgery.

• Returning to Daily Activities: One day after surgery, the patient can return to the normal daily activity.

Advantages, Disadvantages and Complications of Femto-SMILE Surgery:

• Post-Operative Eye Pain and Discomfort: After Femto-SMILE surgery, there is minimal discomfort for most people. It usually is not felt more than 2 hours.

• Full Visual Recovery: The Visual recovery after Femto-SMILE is significantly longer as compared to other LASIK procedures.

• Possibility of Post-Operative Infection: There is minimal possibility of infection after Femto-SMILE surgery.

• Possibility of Displacement of the Corneal Flap: There is no possibility of flap displacement.

• Swimming Restriction: There is a swimming restriction of up to one month after Femto-SMILE surgery.

• Returning to Daily Activities: the patient can return to the normal daily activity 2 days after surgery.

Each refractive surgical procedure may have its own complications; however, according to the latest valid international reports, no serious eye problem has been so far reported as a post-operative Femto-LASIK complication. Noor Eye Hospital, as one of the best eye hospitals in Iran, with its experienced ophthalmologists, ophthalmic surgeons, staff and advanced ophthalmology equipment offers high precision Femto-LASIK, Femto-SMILE and PRK/LASEK surgical procedures.

Common post-operative complications of Femto-LASIK, PRK/LASEK and Femto-SMILE are as follows:

- Dry eyes

- Bright or dazzling lights

- Halos or glares around lights

- Night vision issues

- Blurry vision

- Sensitivity to light

Uncommon post-operative complications of of Femto-LASIK, PRK/LASEK and Femto-SMILE are as follows:

- Eye inflammation

- Corneal infection

- Irregular astigmatism

- Vision loss

- Significant vision regression

Femto-LASIK, PRK/LASEK, and Femto-SMILE are carried out very quickly and accurately using ophthalmic lasers. These laser surgical procedures are painless and are performed safely due to the measures taken by the experienced ophthalmologists and therapeutic team of Noor Eye Hospital; however, the cooperation of the patient during the surgery has a significant role in the outcome of the refractive surgical procedure. Thus, it is advisable to keep relaxed and pay attention to the instructions given by the ophthalmologist while operating, and pay attention to the items described below.

- During refractive eye surgery, including PRK/LASEK, Femto-LASIK and Femto- SMILE, look at the red or green flashing light and avoid moving your eyes and head.

- The laser treatment itself usually takes less than a minute, usually 10 seconds, depending on which type of laser is used. Therefore, do not move your eyes during the time you hear the sound of a femtosecond laser device used for Femto-LASIK and Femto-SMILE surgeries.

- Do not worry about blinking during surgery since your eyelids are opened by means of a tool; to avoid the unpleasant feeling it is better not to squeeze your eyelids and frown during surgery.

- Do not touch the surgical site because it causes eye contamination and infection.

- Your first post-operative appointment will be 24 hours after surgery.

- Carry out appointments at regular intervals during the first six months

- Over the first visit, your ophthalmologist assesses your visual acuity and examines your eyes.

- Avoid wearing contact lenses (therapeutic or cosmetic ones) for at least three months after surgery.

- Avoid wearing make-up, lotions and creams around your eyes for at least three days or more according to your surgeon's instruction.

- For high-intensity workouts like boxing, football, karate, etc. wait at least ten weeks after surgery.

- Avoid rubbing and scratching your eyes during the first weeks after surgery.

-It is normal to experience some fluctuations in your vision for several months after surgery. It may take 3–6 months for your vision to become stable, and during this period, you may experience symptoms such as discomfort driving at night, dazzling lights in the field of vision, and halos or glares around lights.

- To determine the need for a second LASIK surgery, you should wait until your vision becomes stable, during two consecutive visits and at least three months after the first surgery.