Laser

Myopia and other refractive abnormalities such as hyperopia, astigmatism and presbyopia are corrected with glasses, contact lenses or laser.

What is refractive abnormality?

Refractive abnormality is the inability of the eye to focus the image of an object on the retina, so that we do not see clearly. Refractive errors include myopia, astigmatism, hyperopia and presbyopia. One person can have one or more refractive errors, or only myopia and another patient can have myopia and astigmatism, while another has hyperopia and presbyopia.

The strongest refractive part of the eye is the cornea, and its curvature determines whether the image will form on the retina or not. In refractive surgery, we use the laser on the cornea to change its shape, and relieve the patient from the need to wear corrective glasses. With the laser we can correct all refractive diseases.

What is myopia, astigmatism, hyperopia and presbyopia?

Myopia, hyperopia, astigmatism and presbyopia are refractive diseases.

Imagine that the eye is like a camera. The front glass (the anterior transparent part of the eye) is called cornea, then the diaphragm called iris (the brown or blue color), further behind is the lens, and at the back part of the eye is the film of the eye, i.e. the retina, where the rays are focused (see figure)

Myopia

Patients with myopia cannot see clearly far.

Myopia is the refractive abnomality of the eye, in which light rays are not concentrated in the retina, as is normal to see clearly, but in front of it.

Myopia is due to increased length of the eye (larger eye than normal) or greater curvature of the cornea or increased strength of the lens of the eye.

But it may be due to diseases such as diabetes and cataracts that increase the refractive power of the lens.

An essential element of any surgical procedure, especially cosmetic surgery, is providing the patient with sufficient time for information.

Hyperopia

Patients with hyperopia can not see clearly, far and near either. It is because the eye is smaller and the rays are focused behind the retina.

Astigmatism

Patients with astigmatism see images warped and blurred, particularly for distant objects. Vision problems are most pronounced in the evening or in dark conditions where the lights are intense (night driving). It is because the curvature of the cornea is not smooth.

Presbyopia

Patients with presbyopia cannot see clearly nearby. It’s because the lens after 40 years old loses its elasticity and can’t focus on the retina objects that come close, like the letters of a book.

Myopia and other refractive abnormalities such as hyperopia, astigmatism and presbyopia are corrected with glasses, contact lenses or laser.

What are the symptoms of refractive diseases?

Refractive abnormalities can be manifested by blurred vision, headache, dizziness and diplopia. They can also create wrinkles on the sides of the eyes or in the mesophyron, since in their effort to see.

The myopus is unable to see clearly the objects that are far away and half-closes the eyes to do better.

To correct the aesthetic problem of wrinkles Dr Trakos applies Botox or Dysport to the eye muscle sphincter, while to treat the cause of these (myopia) requires Laser. Aesthetic Ophthalmology is the field of Ophthalmology that concerns the aesthetics of the eyes and the periocular area. Both wrinkles and the distorted shape of the eyes are aesthetic problems. So, if an eye has 2 degrees myopia and the other eye 5 degrees, and the patient wears glasses, the lens of glasses that corrects the eye with 5 degrees will make it look smaller than the other eye resulting in asymmetry and aesthetic problem.

Do insurance companies justify lasers for the correction of refractive errors?

Refractive errors create functional and aesthetic problems. Insurance companies treat the correction of refractive errors as aesthetic problems and categorize laser as aesthetic interventions, and usually do not justify such interventions.

The paradox of course is that patients with high myopia, that is from 6 degrees and above have significantly increased chances of developing glaucoma, maculopathy and cataracts.

Why choose Dr. Trakos?

Dr. Trakos’ contribution to the field of anterior segment and cataract surgery, as well as to the treatment of vision problems, has changed the lives of many people by improving their sight and quality of life

What Laser techniques are there?

There are 3 laser techniques: LASIK, PRK and Femtosecond laser.

Imagine the cornea as a book that has 550 pages.

At LASIK ( Laser Assisted in Situ Keratosmileusis) we lift the cover, send a laser beam, remove for each degree of myopia 10 pages, and close the cover again. The creation of the cover is made with a mechanical microkeratoid blade (traditional LASIK), in order to create an incision in the highest layers of the cornea and can separate the cover from the rest of the cornea. For a patient who has 5 degrees myopia 50 pages will be removed and 500 pages left from the book, resulting in permanently change the curvature of the cornea, focus the objects on the retina, and clearly see the patient without glasses or contact lenses, which remains constant in time. The whole process takes about 10 minutes and the laser each lasts a few seconds.

In PRK, no cover is created, but the surface part of the cornea called epithelium is removed, and the laser beam falls directly onto the cornea, and the required pages are evaporated. At the end a therapeutic lens is placed to help heal the epithelium in the next three to four days.

Vision has ups and downs for a few days. The protective lens is removed in 3-7 days when the cornea is completely healed.

The operation is performed with anesthetic drops and is painless.

The PRK method is applied to patients with thin cornea thickness who do not meet the criteria to make LASIK, as well as to patients with mild myopia, hyperopia and astigmatism.

Evolution of this method is the Trans PRK, in which the laser beam falls on the surface of the cornea in the safest, fast and effective way with the latest technology of the Swind Amaris 1050 RS. So healing is faster, and it’s the only technique where no one and no tool touches your eye.

In the Femtosecond laser, a laser is used to create the cover, so that it lifts off the rest of the cornea and the laser beam falls. This method corrects your vision using laser from the beginning to the end of the surgery. No blade or scalpel will touch your eyes, as is done in other techniques.

The name Femtosecond came from the number of pulses per second (pulse/sec) that this laser works with.

These lasers emit in the infrared zone of the spectrum and in combination with the extremely short action time and the very small energy achieve the photodisruption of the tissue to which they fall (cornea, crystalloid lens, etc.) which occurs in the form of a bubble and which is ultimately the force by which the FEMTOSECOND LASER intersects the tissues.

It is the most modern method of Ophthalmology in refractive surgery. This corrects myopia, astigmatism, hyperopia and presbyopia with maximum accuracy and safety.

It is even safer than other techniques, and the quality of postoperative vision is better than any other method. So you can correct your vision in the most gentle way and benefit from the most innovative technology available today in refractive laser surgery.

The experience gained to date after many millions of laser treatments showed that the majority of patients:

during the operation they did not feel pain
they got excellent eyesight without glasses
they are more satisfied with the result than they expected
they see better than their preoperative eyesight with glasses
would choose this method again and recommend it unreservedly to others

What are the Advantages of the Femtosecond technique?

Femtosecond LASIK has an extremely low effect on the eyes: the procedure lasts only a few minutes in each eye. Laser eye contact time is minimal
The method is comfortable and painless.
The method helps in difficult cases: thanks to the extremely high frequency of laser operation, the layers of the cornea are separated precisely creating an extremely thin flap.
The method is additionally effective in patients who were not candidates for refractive surgery with laser: this includes patients with extremely high myopia or thin cornea.
No inflammations: the Laser energy used in this method is almost 100 times less than in other Laser procedures. So this technique is milder for corneal tissue and prevents temporary inflammation and eye reaction.
Fast results: The time of vision restoration is significantly shorter than other techniques. Patients can usually see with ease in just a few hours.
Less side effects: This method using state-of-the-art Laser machines allows the surgeon to enlarge the treatment zone, thus reducing the risk of undesirable side effects such as dry eyes, decreased night vision or haloes (light rings surrounding point sources of illumination).

What are the steps of the Laser technique?

The 4 steps of the technique are:

Step 1: Preoperative examinations

Your doctor performs a series of tests to ensure that your eyes are suitable for laser vision correction. Detailed examinations are then carried out, the data ofwhich are analyzed to create an accurate three- dimensional image of the surface of the eye. From this image the computer configures the most appropriate laser therapy to correct your refractive error.

Step 2: Create a flap

A few minutes before laser treatment, anesthetic drops are instilled. An eyelid is placed to keep the eyes open and prevent blinking during treatment. The highest layer of the cornea is then separated by the laser and folded.

Step 3: Sculpting the cornea

The excimer laser sculpts the corneal tissue within seconds with a millimeter accuracy. After the end of the treatment, the flap that had previously been folded is repositioned and which heals very quickly. The whole process takes only a few minutes. Immediately after the treatment you can open and close your eyes as normal.

Step 4: Easy postoperative care.

In some cases, if necessary, the eyes are protected for a day with contact lenses. Special eye drops accelerate healing. During the first hours after surgery you should not rub your eyes. Also, for a few days you should avoid activities with sports (football, basketball, swimming).

In treated eyes there are no visible signs of surgery. Even an ophthalmologist, during an examination, is likely not to notice it.

What refractive diseases are corrected with the LASIK technique?

The LASIK technique is suitable for correcting the following refractive errors:

myopia
hyperopia
astigmatism
presbyopia

Also, a patient can have myopia and astigmatism and presbyopia or all of the above and all the conditions can be corrected together in one time.

How is presbyopia corrected?

Presbyopia is corrected with Femtosecond Laser, with which we create Monovision. That is, we make the patient see well away with one eye, the dominant one, while the other eye, the non-dominant one, we make it slightly myopic so that he sees better for close. So the patient sees well and far and near. This method is called Monovision.

Can everyone do Laser?

A candidate for a laser of Myopia is considered to be one who:

He/She is 20 years old.
Has stable refraction for at least six months before surgery.
Has sufficient corneal thickness.
Does not suffer from eye diseases such as keratoconus, glaucoma, cataracts, etc.
Does not suffer from autoimmune diseases and does not receive immunosuppressive drugs.
It is also not recommended to treat myopia during pregnancy or breastfeeding.

Some patients think that their myopia has not stabilized and continues to grow. But if, for example, they have been examined by different ophthalmologists in the last two years, and once they have removed their contact lenses 2 days before the examination, and the other time a few hours before the examination, and there may be a mild punctate keratitis from contact lenses or dry eye, then different measurements of myopia will be found. So it is not the case that their myopia has not stabilized. So you can have these patients successfully Laser-do.

How is Preoperative Control performed?

Preoperative control of a candidate for laser myopia, hyperopia, astigmatism or presbyopia is very important for success in refractive surgery.
During the pre-operative evaluation, all the data required to enable Dr Trakos to answer the question of whether the candidate can undergo refractive surgery are collected.

During the pre-operative examination for myopia lasers performed:

Taking personal and family history. When taking the medical history, present and past diseases, allergies, past surgeries and medications or conditions that may potentially affect corneal healing are recorded in detail and accurately.
Taking an ophthalmological history. After taking the medical personal and family history, the ophthalmological history is taken. Among other things, he is asked if he had ever worn contact lenses. Contact lenses can alter the shape of the anterior surface of the cornea. It is recommended to avoid the use of contact lenses both during the preoperative control and before surgery.
Control of visual acuity. The determination of the exact refractive error of the candidate for laser myopia during the preoperative examination determines the amount of the corneal layer which must be removed in order to achieve the desired postoperative effect. For this reason, Dr Trakos and the staff of the EYE LID Ophthalmology Center apply all safety protocols with the tests for the determination of refractive error, and the machines that are used are regularly tested for their proper functioning.
Control of cortical reflexes and pupil diameter. Measurement of pupil diameter in scotopic conditions is carried out as when the scotopic pupil exceeds the photodegradation zone in diameter, the likelihood of visual disturbances occurring at night increases.
Intraocular pressure. The measurement of intraocular pressure is done after refraction and topographic imaging of the cornea, so that the possible deformation of the anterior surface of the cornea by contact with the flattener does not affect the preoperative measurements. Refractive surgery is contraindicated in patients with uncontrolled glaucoma, patients who need multiple medications or surgery to control intraocular pressure, or patients with advanced glaucoma, significant papilledema and associated scotomas in visual field examination.
Slit lamp. Slit lamp examination is an integral part of the preoperative control. An overview of the eyelids reveals the existence of blepharitis or other pathology. In addition, the quality of the tear composition is checked. The anterior chamber and the iris should be thoroughly examined.
Corneal topography. Corneal topography is a valuable tool that gives us three-dimensional maps of the anterior and posterior surface of the cornea and diagnoses abnormalities such as keratoconus and pellucid marginal degeneration.
OCT Anterior segment scan. The CT scan gives a thorough analysis of the entire cornea (corneal elements, qualitative analysis of the anterior and posterior surface), anterior chamber and intraocular lens.
– Corneal pachymetry. The thickness of the cornea is a crucial factor when sorting patients for laser myopia. Corneal pachymetry is essential in choosing a method for correcting any refractive errors. Corneas with low central thickness are excluded from LASIK correction due to the risk of developing ectasia.
Dry eye control. All patients are subject to quantitative and qualitative tear control and especially candidates for LASIK.
Endotheliometry. With this method, a precise quantitative and qualitative determination of the endothelium of the cornea is made. It helps in cases of patients with high corneal thickness to diagnose endothelial cell pump malfunction.
Informing the patient. Once the full patient check is completed and it is determined that it meets the safety criteria for undergoing refractive surgery, the patient is fully informed and the consent form is completed by the patient.

Why should I use a laser of myopia, astigmatism or hyperopia with Dr. Nikolaos Trakos?

In order to get the best results in a refractive surgery, the 20-year experience of Dr Nikolaos Trakos should be combined with the best possible technology. The more perfected the method and the more modern the technology, the better the result will be.

Dr. Nikolaos Trakos performs laser surgeries with the SCHWIND AMARIS 1050RS machine, with a peak irradiation frequency of up to 1050Hz and a sublimation speed of just 1.3 seconds per diopter, carrying out each refractive operation with top safety and speed. So if a patient has 4 degrees myopia, it is removed within 5 seconds.

The Laser AMARIS has 7D Eye Tracker for top tracking of the eye’s saccadic movements and predictive technology for calculating the placement of each separate shot! So if a patient move their eyes, the machine has a tracking system, and by following the micro-movements of the eye, it targets the right spot with the highest accuracy.

Dr. Nikolaos Trakos uses the most innovative technology in laser refractive surgery for myopia, astigmatism, hyperopia and presbyopia, superior in all important areas such as safety, accuracy, speed and comfort, which is ideal for the correction of your refractive problem.

What makes the difference to the AMARIS Laser, the flagship of refractive lasers worldwide?

1) Absolute superiority to speed
The Amaris 1050RS, with 1050 tiny pulses of light per second, is 3 times faster than other lasers, correcting a degree of myopia in just 1.3 seconds. Patients benefit from the short duration of refractive surgery, have less stress and the cornea is exposed for a very short time so as not to dehydrate, and healing is done faster.

2) Automatic two-level energy setting for fast and “soft” tissue removal
The Amaris computer algorithm regulates an ideal ratio between the total number of pulses of the laser and the energy it delivers. 80% of refractive surgery is done with high energy efficiency to minimize its duration and the remaining 20% with lower energy resulting in an excellent smooth surface. The combination of the two energy levels results in tissue economy and an extremely smooth corneal surface in the shortest time.

3) “Smart” thermal energy distribution control in the cornea.

Absolute respect for the surrounding tissues during refractive surgery. The pulses of the laser are distributed in such a way that they are never in the same place, so that there is time to cool the cornea even at the high operating speed of Amaris. This dynamic and optimized pulse distribution ensures smooth and fast healing.

4) The world’s fastest eye tracker with control of eye movements in 7 dimensions.

With 1050 measurements per second, the Amaris eye tracker locks into the pupil, detects and controls its movements in 7 dimensions, compensating for any deviation in a time of three milliseconds (3msec). This ensures absolute accuracy in pulse positioning, excellent safety and results.

5) Unique stability of microclimatic conditions around the cornea.

The practical application of pioneering innovation in refractive surgery. The laser’s unique particle suction system creates stable microclimatic conditions around the cornea with a thin stream of air at a distance of 40 mm. Particles that would probably express the energy of the laser during refractive surgery are effectively removed and dehydration of the cornea is avoided

6) The “No-Touch” refractive, non-invasive surgery, without touching a human hand.

Further improvement of the Amaris algorithm for superficial refractive surgery led to the unique Trans-PRK where even the corneal epithelium is removed by laser. No tool touches the eye and refractive surgery is performed with infinitely greater accuracy and ease. From the patient’s point of view, this translates into a minimum stay in the operating room, faster recovery and restoration of vision.

The technological superiority of the Amaris 1050RS laser serves perfectly the refractive surgery candidate while covering vital needs of the ophthalmologist surgeon.

Dr Nikolaos Trakos and the EYE-LID Ophthalmology Center it is at your disposal for the control, measurement and correction of refractive laser interventions, such as myopia, astigmatism, hyperopia and presbyopia.