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KAMRA Inlay Eye Surgery Arrives in the UK

Dave Allamby — Tue, 29 Nov 2011 09:54:14 +0000

The KAMRA Inlay is a breakthrough in correcting the need for reading glasses, and is now our primary treatment for anyone aged 45 upwards. You can read an article from yesterday’s London Evening Standard all about KAMRA. It features Karen who had the Keyhole KAMRA version, where no LASIK-type flap is created, and the inlay is simply inserted into a tiny pocket through a keyhole entrance. Unlike LASIK, there is no significant dry eye and the patient could even rub their eyes afterwards without risk of dislodging anything.

You can see the full article here: www.thisislondon.co.uk/standard/article-24014966-london-clinic-develops-10-minute-operation-to-freeze-failing-eyesight.do

You can learn more about KAMRA and presbyopia here at KAMRAvision.com

Daily Mail Laser Eye Surgery Article, 30-11-10. The truth?

Dave Allamby — Mon, 06 Dec 2010 12:48:39 +0000

You may have seen this article on laser eye surgery in the Daily Mail last week. The article describes the serious complications suffered by Lois Roberts following her laser eye surgery 3 years ago.

Yet, instead of the simple pain-free experience Lois was led to expect, the surgery to correct her short-sightedness left her in agony for days. Worse, three years on, she still has painfully dry eyes as a result of damage to the nerves that stimulate tears. Lois has to apply eye drops daily – which in itself is a problem, as long-term use can raise the risk of chronic eye inflammation. Dry eyes can also lead to serious infections and, ultimately, even loss of vision.

As well as dry eyes, Lois suffers from constant floaters and poorer night vision. ‘The floaters are like clumps of black lines and dots,’ she says. ‘I’ve been reassured they’re harmless, but they are incredibly annoying.’

How accurate was this piece? Sadly, not very much at all. Interestingly, Lois herself added the following comments on the online version of the article:

Hi all – I’m Lois from the article I just wanted to confirm that I do NOT regret having laser eye surgery. I was shocked when I saw a huge picture of myself saying that laser eye surgery has ruined my sight! This is not true. For me personally, I don’t find the dry eyes and floaters a big problem, yes they’re annoying but hey it’s worth it for me. Also, I would never EVER have had laser surgery after watching an advert on the tv! I had it done in Manchester, the same place as my father had his done very successfully around 15 years ago. I thought this article was going to look at the positive and negative effects of laser surgery. For me, it’s great to be able to surf and play sports without having to worry about whether I’d be able to put my contacts in. Anyway, I feel better now I’ve had a little rant! Thank you for some of the lovely comments!

- Lois, North Wales, 01/12/2010 11:04

Another reader, Andy, added his feelings on this:

Thankful that Lois has been able to put in a comment that counters the sensationalism of this article … But you do get what you pay for! … There are enough alternative, highly rated clinics out there with fantastic reputations that you can choose from. Do not undervalue your eyes – laser eye surgery IS surgery and should not be treated like buying anything else on the high street. Please do your research into laser eye surgery clinics and you will avoid the problems detailed in this sensationalist article.

- Andy, Guildford, Surrey, 01/12/2010 17:30

You should look around carefully before choosing the clinic and surgeon for your laser eye surgery. You get one pair of eyes, after all. If you are unlucky enough to need to wear glasses, laser eye surgery is a realistic option and safe in the right hands. The latter emphasis is important. For example, dry eyes occur in those who had dry eye before the procedure, and these patients should not have LASIK.

Laser Eye Surgery and Steep Corneas

Dave Allamby — Wed, 03 Nov 2010 14:19:35 +0000

Kate asked:

Hi,

I’ve been to consults at two clinics, one that does PRK, and the other LASIK (with a blade). Both clinics offered a similar quote and both said I was an ideal candidate for the surgery (I’m a healthy 23 year old female with mild astigmatism and the same prescription of -1.5 in both eyes since I’ve had glasses (2001). The only thing a out of the norm is that my corneas are a little steep (46). Is there going to be a benefit to me choosing one surgery over the other?

Cheers, Kate

Hi Kate

Thanks for your question. Easy prescription to correct, and quite stable, so no problems there. Yes, your corneas are a bit on the steep side, so that can introduce a small risk, but one that can be easily avoided.

You mentioned two clinics, one that offers/offered PRK and the other blade-cut LASIK. II do believe that in 2010 you have no reason to accept blade-cut laser eye surgery. Such a mechanical cut does bring a small risk of a buttonhole flap (flap with a hole) when the corneas are steep, and with 80% of UK clinics now offering femtosecond LASIK, please forget the blade option. It is a good sign if a clinic has invested in new technology, such as a femto laser.

PRK will give you very good vision, assuming the clinic is using a modern wavefront technique, but will take 4-6 days for the vision to settle, and you may need to be off work during this time. Your prescription is low, so no need to use MMC to prevent corneal haze. Even though your risk will be low, still, you should avoid excess UV light (bright sunlight) during the first few months, e.g. wear wraparound UV filtered sunglasses outside if the sun is bright. Sun-beds can be OK as long as you wear opaque eye-covers.

Your other option is to go to a clinic that offers the latest in femtosecond LASIK (Z-LASIK, i-LASIK). It is still possible to get a buttonhole with a femto laser, but it is pretty rare, and you can usually identify it before lifting the flap preventing complications.

LASIK Enhancements

Dave Allamby — Sun, 17 Oct 2010 14:34:02 +0000

Julie asked:

Dear Dave, I am about to get an enhancement surgery since my eye changed to -1.0 after just 10 months. I got the flap cut with the laser. I see that this type of cut heels quickly and I know doctor will not be using the cutting laser again, so how is he going to lift the flap? I’m terrified and thinking that I will be better off wearing glasses again. What do you think? Thank you

Hi Julie
We lift flaps manually, using a special instrument designed for lifting, which is usually a fairly simple process. It should be possible to lift a femtosecond flap at 10 months, but you wont know until it is tried. I had one patient that proved impossible to lift after 6 months, but that was unusual. You could opt for PRK enhancement with mitomycin, but I would opt normally to lift the flap first. You can discuss this with your surgeon before going ahead.
We are now hitting 100% for patients seeing 20/20 or better at my clinic, Focus, so enhancements are getting increasingly rare. If they do happen, it is usually for patients with very high myopia.
Best regards, Dave

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Laser Eye Surgery and Boxing

Dave Allamby — Sun, 26 Sep 2010 21:52:14 +0000

Winston asked:

I am 19 , with -6.25 in the left eye and -7.25 in right. I have been wearing glasses for about 9 to 10 ten years.
What would you recommend? I do boxing as well as other physical activity.

Is your prescription for your glasses now stable? Has it changed since last year? If not, you may well be suitable. In view of your boxing, you should consider having PRK (LASEK) instead of LASIK, to avoid risks from direct trauma to the LASIK flap, during sparring or matches. Although modern thin flaps created with femtosecond lasers do heal down well, this can take a year or so. Normal rubbing of course cannot move a flap, but a hard physical blow in the first months potentially could.

In view of your high prescription, we would use a drug called mitomycin at the time of PRK surgery to ensure a stable vision result for you. Mitomycin (MMC) will prevent haze scarring and weakening of your vision following treatment.

Laser Eye Surgery and Contact Lenses

Dave Allamby — Sat, 18 Sep 2010 11:30:54 +0000

Meera asked

Contact lenses can warp the corneal shape and so give false readings and inaccurate measurements, that are required to enter into the laser prior to treatment. So it is vital we have a stable cornea, free from warpage from lenses.

The time it takes the cornea to ‘unbend’ from a contact lens depends on the type of lens and the duration of wear in the case of hard lenses, in years:

For soft lenses, this will take about one week
For extended wear lenses, it will take about 2 weeks
For hard lenses, it will take 4 weeks for every decade of use (e.g if you have worn hard lenses for 25 years, it can take 10 weeks for the cornea to resume its normal shape)

So why do clinics recommend different times? Well, if you want to get a definitive answer at your consultation, you will leave your lenses out according to the guideline times shown above; the figures will be OK to use at your operation. If you come along for a consultation without leaving your lenses out for the full period, you may get a good idea of suitability, but sometimes a final answer cannot be given and you will have to come back for additional scans and measurements at some point, to get the final data to be used at your laser eye surgery.

One way of doing that is to do a provisional consultation, with your lenses not left out, and then later leave them out for the full period prior to the treatment, and repeat the tests on the day of surgery. However, your treatment may get cancelled or postponed if the readings are still not ideal. So it is a balance between convenience and certainty of decision.

Clinics may say to come along without leaving your lenses out, and so attract patients by avoiding the inconvenience of a lens-free period. This is fine, as long as the clinic makes it clear that a period of lens free vision will be necessary at some point. I agree, the varied lens-out times from various clinics can be confusing. However, the laws of bio-mechanics and the effect of wearing lenses on corneal shape do not vary between clinics. The above periods of lens-free wear will be needed at some point, either prior to consult or prior to surgery.

LASIK Re-treatment Rates; Post-op Dryness

Dave Allamby — Mon, 12 Jul 2010 13:34:43 +0000

Anne asked:

Hi Dave,
I am in contact with your clinic re: having Lasik. I just have a couple of questions:

1/ What is your re-treatment rate?
2/ How many dry eye cases are persistent/long-term?

Thanks, Anne

Anne, our enhancement rate is under 1% for short-sghted patients, and slightly higher for blended vision patients (distance plus reading correction).
Our “20/20 or better” rate is 99.4% for short-sighted patients up to -9.00D.

We have seen long-term dryness in a handful of patients, out of thousands of treatments. I find it is a rare problem when patients are properly screened, and treated pre-op if there is some dryness present. The way we keep these rates very low is by being vary careful on who we operate on, and excluding those with significant dry eye.

Suitability for Laser Eye Surgery

Dave Allamby — Sun, 11 Jul 2010 11:24:39 +0000

Faisal asked:
I am short sighted, wearing glasses for almost 15 years. Just wanted to know whether I am a suitable candidate for laser eye surgery or not. Thanks

Faisal,
Being short sighted and wearing glasses for many years is typical. You will need a full consultation to determine if you are suitable for laser eye surgery. Some of the main factors will be the scans of your corneas, prescription, corneal thickness, and eye examination.

LASIK and Keloid Scars?

Dave Allamby — Fri, 09 Jul 2010 16:41:20 +0000

Sally asked:

I am considering laser eye surgery but am prone to keloid scars. Would this be a problem?

My reply was:

Hi Sally
Keloid scarring should be no problem with LASIK laser eye surgery. I have done several patients with keloid and had excellent LASIK vision results. No problems with healing at all.
Best regards, Dave

Too Old for LASIK?

Dave Allamby — Thu, 08 Jul 2010 21:18:18 +0000

Anthony asked:

Hi Dave
I am 67 years old and currently use daily contacts. Left eye D + 1.50 Right D + 1.75, the left eye has a slight astigmatisum. I use + 2 reading glasses. I have been told that due to some mild furring around the edges of the cornea, expected at my age, I will need Intra – Ocular Lenses, one for long distance and one for reading. Also I have some dryness in both eyes, again expected at my age.
Do you think I am too old and would Z-Lasik be able to correct my vision in both distance and reading or just distance. I live in London so travelling to Wimpole Street is not a problem should I decide to have a consultation.

My reply was:
Hi Anthony, Certainly not too old, and I have done blended vision for patients in their 70s. All depends on the condition of your natural lenses and presence of any cataracts. Sometimes IOLs can be the better choice but not always. Your prescription is certainly in range of those I treat for correcting distance and near. Dryness can be assessed and treated if not too bad. If severe, would likely be a block to laser eye correction, but not to IOLs.

We can certainly have a look at consultation with one of my team as a first step. Price wise, the IOLs are the more expensive option, at £2,500-3,000 per eye, the latter being if you opt for multifocal lenses to help with reading and distance. Laser blended vision is £2,200 per eye, again correcting far and near.

Previous Laser Eye Surgery and Ageing

Dave Allamby — Tue, 06 Jul 2010 17:30:46 +0000

Peter asked:

I had laser eye surgery in 1995 for short sightedness. Long distance has become blurred e.g. night driving affected. Will naturally occurring long sightedness change this over time I’m 47?

Peter, you have become somewhat myopic (short-sighted) again, either through progression of your condition (can be associated with high amounts of near work, although that story is not straight-forward), or regression of your treatment, or both combined.
At 47, most people will be showing signs of presbyopia, or age-related loss of near vision. Your myopia will mask those symptoms if you are not wearing glasses or contact lens correction, and so in fact is of some benefit to you. Your presbyopia will have minimal effect on your distance vision though, and will not neutralize it. One option is to get one eye retreated to fix the distance and get a blended vision combination, and so see well for far and near. Will depend on your current prescription though.

Reading Glasses Surgery Cost

Dave Allamby — Sun, 04 Jul 2010 10:39:35 +0000

Liz asked:

Hello, I do not suffer with headaches etc but I do have to be at least a 12 inches away to be able to for example focus on the smallest words of this website. Any nearer and the words are out of focus but I can read them at a distance. How much would it be for you to correct this to at least 20/20 vision please? Many thanks, Liz.

Liz, you have presbyopia so reading vision is getting blurry, but the distance vision remains clear. This happens to everyone starting in their 40s. Sometimes only one eye needs to be treated if there is no distance glasses prescription, which is about 15% of presbyopic patients. Presbyopic treatments need to be performed very accurately and choice of surgeon (and technology) becomes even more important that in myopia correction (distance vision, short-sight). The cost at Focus is £2,200 per eye. Regards, Dave

Squint and Laser Eye Surgery

Dave Allamby — Fri, 02 Jul 2010 16:03:47 +0000

Terry asked:

I am thinking of laser eye treatment. I have a squint in my left eye and long vision. The consultant has told me the squint and vision will be corrected by the surgery. I will be having wavefront laser. Can you tell me if this will work? My glasses correct the squint and my vision,

Terry, There are different causes for squints. The laser correction itself will only change the focus of your eyes, but as some squints are linked to focusing of your vision, especially long-sight, the squint can be helped or removed through e.g. LASIK. You said your glasses correct your vision and the squint. If your glasses do NOT contain a prism to correct the misalignment of your eyes, then laser correction will likely do the same job as your glasses. The closest test is how your vision and squint is when fully correcting your focus with contact lenses, but glasses can perform a similar role. If your glasses contain a prism, then you will still need to wear glasses with a prism afterwards.

How Z-LASIK Works

Dave Allamby — Fri, 25 Jun 2010 20:40:29 +0000

I was recently asked by Kaz to explain the Z-LASIK procedure in more detail. Watch this video and in a second post I will run through why I consider Z-LASIK combined with the WaveLight excimer laser to be the ultimate in LASIK laser eye surgery.

This text will be replaced

Laser Eye Clinics’ Prices Vary Hugely

Dave Allamby — Sat, 25 Apr 2009 16:03:45 +0000

You are interested in laser eye surgery. You have been doing what everyone else does first, which is search through the websites of various laser eye surgery clinics including the big three chains: Ultralase, Optical Express and Optimax, plus independent clinics such as FOCUS Laser Vision, Centre for Sight, London Vision Clinic etc.

The first thing you notice is that some clinics outline some or all their prices, while others give a headline price and give more details after you contact the clinic directly. One very handy site that can help you get all that information quickly is www.lasik-eyes.co.uk where patients can post independent reviews of their experiences at all of the UK’s laser eye clinics plus the price they paid for surgery.

There is a huge variation in the prices paid at UK clinics. Prices paid for both eyes for laser eye treatment vary from around £1,500 up to over £6,000.

But what does this mean for you? What about quality? Do you get what you pay for? Or do prices not correlate well with the quality of the surgery, vision result or service?