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

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

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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Here is a recent question I was asked on whether LASIK is suitable for thin corneas:

“Dear David, I wrote a while ago to ask whether Z Lasik gave greater scope to those of us with thin corneas for having Lasik as opposed to Lasek or PRK. At the time, I didn’t know what my actual measurement was – I have since had my notes from my previous check and they read L 465, R 473. However, reading recent posts on your blog I see that you do not recommend any ‘flap cutting’ to anyone with a corneal thickness measurement of under 500. I suppose what I’m asking, is if that is completely set in stone? Does Z Lasik not allow you to consider previously borderline cases?“,

And another question on the same topic:

Hi Dave,
I have myopia of -6.5 and -2 for astigma. I have a corneal thickness of 490 micron. I went for 2 different consultations. One surgeon recommend that i should do PRK because he said that it is safer than iLasik (intralase) due to zero flap create. The other doctor recommended me to go with Intralase because he said that it is possible. I know that both procedures are safe. But i am just a bit concern in the long term. Also, what is the down side of having intralase over PRK or the other way around?

Average central corneal thickness is 530-540 microns. Many surgeons, myself included, don’t cut LASIK flaps in corneas less than 500 microns, although there are surgeons who will. In the first question, this person had very thin corneas (465 and 473 microns) and in my opinion should NOT have LASIK. In the second, the corneas are thin at 490 microns, but not excessively so.

It is true that being able to create very accurate LASIK flaps with the new femtosecond lasers (e.g. Ziemer, Intralase, Zeiss) leaves more tissue behind and so allowing larger treatments. More on this topic in my next post.

The choices can seem bewildering! You want to have laser eye treatment e.g LASIK and now you need to choose the clinic for your surgery.

But which one?

There are over 100 clinics in the UK, although 75% of those are made up of only three large business laser chains: Optical Express, Optimax and Ultralase. The other 25% are mainly owned by doctors and optometrists, who practice from their centres.

80% of UK centres have adopted the advanced blade-free femtosecond lasers, and so now offer blade-free LASIK (a.k.a all-laser LASIK, Intralase, Z-LASIK). These include:  FOCUS Laser Vision , Optimax, Optical Express, Ultralase, Moorfields Eye Hospital and Centre for Sight.

20% of UK centres have not yet invested in this technology, and only offer bladed LASIK, where a device containing a short blade is used to cut the LASIK flap. These centres include Advance VisionCare and Accuvision in London

Having your laser eye treatment with a blade free femtosecond method has rapidly become the standard of care for UK LASIK laser eye surgery.

Overall all laser eye surgery prices are increasing or set to increase. The cost of new technology to give you better and safer surgery is very high and needs to be constantly updated. Even though FOCUS have the UK’s best prices, you will find the trend everywhere will be up.

For example, laser clinics used to need one laser at a cost of £1/3 million. Now they need two to offer blade free dual laser LASIK, total cost £2/3 million and treatment prices are no different on average to back in 2000.

In a nutshell it costs a lot to do this type of treatment and costs are only increasing. The benefit of that though: highly accurate treatments with better safety than ever before.

At FOCUS, we made a decision to buy the very best technology and to bring that to the UK at the lowest price so that more people could afford to get fantastic levels of surgeon, service and technology, all without compromise. That is not hype. It is just what we have wanted to do.

But all of that does cost and has to be paid for. And no government bail-outs for anyone in healthcare! Unlike some banks we have to be prudent, cautious and look after our customers without risk so that we will be here next week, next month and next year.

Price wars in the US a few years ago meant cheaper surgery at first. Then bankrupt clinics closing with people having to pay all over again in order to get their aftercare. Not a good result for patients in the end.

You may see some special offers following these recent economic changes until things level out and then improve again. You may want to take advantage of those, as longer term costs will go up.

How to different laser eye surgery clinics charge for treatment? It can be confusing to understand different prices and messages from various clinics.

For LASIK pricing, there are two common ways to charge. The first is 1 price for all prescriptions – in effect the lower prescriptions are subsidising the higher more difficult cases. The second method, used by ourselves and some others, is to charge based upon the prescription.

So the easier the treatment and the simpler the case, the less that patient pays – and vice versa. This seems the fairer way overall.

Also, younger patients (who are mainly short sighted) generally have less money and so can more easiy afford to have laser eye treatment with FOCUS, as their prescriptions come in at a lower rate. Long sighted treatments are more complex (we specialise in these, unlike most clinics) and are more expensive. These patients are typically in the 40s and 50s and often can often afford a bit more.

I know it sounds rather like Robin Hood(!) but this allows more people to get a superb level of treatment with a very experienced surgeon, with lots more time in a relaxed clinic, away from a high-volume quick turnaround setup. For example, one of the laser chains has surgeons performing up to 40 laser eye procedures per day. At this level, the chances of the surgeon making a mistake increases. For any of us, if we are rushed at work we cannot do our best. We believe it is better to have fewer patients and spend more time.

I really have tried to make top-end ‘Harley Street’ laser eye treatment available to more people, hopefully in a fairer way (we are actually next door on Wimpole Street). I wish everyone with glasses could afford to come for treatment but, if you see my next post, this is not likely to happen.

Live video of Paul Ross having his laser eye surgery on the ‘This Morning’ TV show.

Fern Britten and Philip Schofield interview Paul Ross and Dr. Dave Allamby about laser eye surgery.

THIS is a question I often get asked. It’s a very good question.

Preview post…

Some new research from Professor John Marshall has helped shed light on this key topic and is something that everyone who is thinking about LASIK laser eye surgery needs to know.

Check back next week for my post on this topic…

A new lens to help reading vision has received approval from the American Food & Drug Administration (FDA), according to manufacturers Bausch & Lomb, based at Rochester in New York state.

These lenses are inserted inside the eye during a procedure very similar to that used for cataract surgery. The natural lens is removed and replaced with an artificial intraocular lens (IOL). The traditional IOL has a fixed focus and is unable to replicate the natural flexibility of the young human lens that allows us to zoom in on near objects to have clear close vision, e.g. reading a newspaper print.

Accommodating lenses are designed to mimic the natural zoom ability to not only provide clear distance vision but also to restore good near vision. This loss of near vision with age is called ‘presbyopia‘ and affects 20 million people in the UK alone.

The Crystalens HD is designed for enhanced depth of focus and features something called “proprietary optical focus,” B&L stated in a press release. This optical ability is claimed to be capable of improving near vision without reducing distance or intermediate vision. In the research study from B&L, 125 eyes were implanted with the new Crystalens HD. These patients had a visually significant cataract (usually age related clouding of the lens inside the eye), less than 1 D of corneal astigmatism, and the potential for best corrected visual acuity of 20/25 or better in both eyes. Of this study population, four out of five patients (80%) had vision of J2 (equivalent to small ingredients lists on food packets) or better at 4 months. B&L said it plans to begin sending out the Crystalens HD in early July.

You can see more information in the first featured article above on how laser eye surgery is now used to correction problems with reading vision.

Most people start to need reading glasses after the age of 45 and previously were not eligible for laser eye treatment. All that has changed with advances in technology. FOCUS Laser Vision has been very active in this increasingly popular area of laser eye correction.

WaveLight AG, based in Erlangen, Germany [who make the excellent Allegretto eye laser] increased its sales for the first nine months of 2007/8 accounting year by 31% to €65 million. The previous year’s turnover was €49.5 million for the same period.

The company’s market position in the U.S. has also expanded. In the worldwide sales-strong US market, which has been of great importance for WaveLight for the refractive surgery area, the company exceeded the turnover of the comparable period in the previous year by 66%.

WaveLight make the Allegretto Eye-Q 400 Hz excimer system for laser eye surgery. You can see the FDA results for the WaveLight laser versus other systems here.

Let’s look at the second of Carlo’s questions on laser eye surgery:

My name is Carlo and I have recently discovered this great blog. I would like to ask a couple of questions regarding eye surgery:
Question: Is it true that the LASIK procedure has not been approved for air-force pilots and astronauts in the US but PRK and LASEK has?

No, this is not true.

LASIK was approved for use on consumers a decade ago and reportedly more than 11 million LASIK procedures have been performed in the US. This means LASIK laser eye surgery is the most-common American elective surgical procedure.

NASA has approved LASIK for use on pilots, mission and payload specialists who face extreme and often physically demanding conditions in space. The all-laser LASIK technologies, using a blade free femtosecond laser approach, have also been cleared for U.S. military personnel, including most recently Air Force pilots.

“NASA’s approval is further evidence that today’s LASIK exceeds all established standards of safety and effectiveness,” said Steven Schallhorn, M.D., retired captain of the U.S. Navy.

Though LASIK has been around for a long time, concerns about the harsh environment in aviation prevented its use. To date, aero-medical professionals have been cautious of employing the procedure on military pilots who often encounter environmental extremes such as high altitude, dry air, wind exposure and “G” forces. In space, other conditions further add even higher levels of concern due to the very high level of precision needed during flight and space walks.

Defense Department’s research into laser vision correction included the following results:

# In a study of different methods to create the LASIK flap, 370 naval personnel underwent bilateral (both eyes) wavefront-guided LASIK with either the femtosecond laser (blade free) or microkeratome blade. One week after surgery more than 76 percent of femtosecond laser patients achieved an uncorrected visual acuity of at least 20/16 (better than 20/20) compared to only 58 percent of microkeratome patients

# In an evaluation of 785 pilots, 89% of Navy aviators evaluated their ability to land on an aircraft carrier as moderately to significantly better after laser eye surgery. None said it was worse after treatment

# A separate study determined that over 90 percent of marksmen had improvement in marksmanship skills after laser eye surgery; an impressive finding given the visual precision of marksmen

LASIK, particularly blade free femtosecond LASIK, appears to have established itself as a very effective and reliable procedure. The move from blade to laser blade free has allowed another significant improvement in results (now targeting better than 20/20 as a standard of care) according to the above research findings.

You can still read Rick’s story about his treatment with me, online at the Daily Mail’s website. Rick talks about the whole process in a very interesting article from Rachel Kaufman.

Follow the link below to read the full article.

www.dailymail.co.uk/health/article-404859/New-laser-surgery-cured-long-short-sight.html

Advanced Medical Optics Inc. in Santa Ana, announced on Wednesday that the Food and Drug Administration (FDA) has approved a new laser for use in laser eye correction. The iFS femtosecond laser is set to be at the centre of AMO’s iLasik products for laser vision surgery. The laser has an increased speed of 150kHz, up from the existing 60kHz.

However, competitor Ziemer from Switzerland recently launched its own femtosecond laser offering more than 1000kHz speed, integral to its Z-LASIK offering. Click here for a discussion blog post comparing iLASIK and Z-LASIK.

AMO has pushed into laser vision correction, including its $800 million buy of Irvine, California-based IntraLase Corporation last year. The iFS laser uses technology from IntraLase. The femtosecond laser is used to create a corneal flap which is the first step in laser vision surgery. Advanced Medical’s lasers have been gaining market share over traditional metal blades. The laser is due to be shipped to U.S. laser eye surgeons in the third quarter, according to Advanced Medical Optics.

Tags: Z-LASIK, iLASIK, AMO, FDA, femtosecond, eye, laser, surgery