Cornea, Keratoconus, dry eye, and LASIK vs. PRK

The cornea is a transparent tissue that covers the colored part of your eye. It helps in focusing light onto the retina (the light-sensitive film at the back of the eye). Diseases of the cornea may change its shape and/or decrease its transparency, which can lead to many problems in sight.

Keratoconus is a slowly developing disease in which the cornea is gradually bulging forward, causing continuous worsening of sight. It usually starts at puberty, and stabilizes at the age of about 30-35 years. Many options are available for its treatment, as follows:

Keratoconus Treatments

Corneal Crosslinking

Corneal Crosslinking

Crosslinking aims to stop corneal weakening and thinning due to keratoconus.

Treatment involves applying (Vitamin B2) drops to the eye, then exposing the eye to (ultraviolet light) over a 30 minute period.

Crosslinking has shown to increase corneal rigidity, and stop the progression of keratoconus in over 90% of those who undergo the operation.

Hard Contact Lenses

Hard contact lenses

These lenses sit very tightly on the cornea and change its irregular shape to a more uniform one. This tends to improve vision.

The drawbacks include less patient's comfort, so he may require frequent visits to the optometrist to fit and change the prescription.

 

 
Corneal Rings

Corneal Rings by Femtosecond laser

Corneal rings, such as (Kerarings) and (Intacs) are an alternative treatment for keratoconus designed to improve patient's sight.

The procedure is performed under local anesthesia. During the operation, channels are made within the cornea and the rings are inserted into them to make the corneal shape more regular.

This procedure is designed to let you get better sight, although you may still need to use glasses and/or contact lenses. But, when using them, you will be more comfortable than before this surgery.

Laser Vision Correction Guided by Corneal imaging with Corneal CrossLinking
Laser Vision Correction Guided by Corneal imaging with Corneal CrossLinking

Laser vision correction has traditionally not been available for those with keratoconus. When the cornea is precisely imaged by what is called (corneal topography), it is possible to perform laser vision correction to improve the shape of the cornea and, in turn, improve vision. The laser vision correction procedure is combined corneal crosslinking to reduce the risk of progression of keratoconus.

This procedure is not the same as performing laser vision correction in the normal eye. The aim is to improve vision, not cure the disease.

Corneal Grafting

 

Corneal Grafting

In advanced cases, corneal grafting may be needed. This procedure replaces the patient's diseased original cornea with a healthy one. Patient may still need to wear glasses or contact lenses to enhance his/her sight, but with a better comfort. Corneal grafting is often followed by laser vision correction to improve vision even more.

Dry Eye Management

Punctal Plugs

If eye drops and gels fail to improve eye dryness, plugs are an easy alternative solution for this problem. It is done in the clinic without pain or side effects. Ask your doctor for more details

Nutritional Supplements

There is a growing evidence that omega-3 deficiency is linked to eye dryness.

Operations to get rid of your glasses

LASIK vs. PRK to get rid of your glasses

There is a layer on the surface of the eye called (epithelium), which is replaced by the eye every 7 to 14 days.

In PRK: the epithelium is removed, so the eye surgeon is able to change the shape of the permanent layer underneath. Following this, a contact lens is applied as a bandage to allow the epithelium to re-grow under the contact lens.

In LASIK: a thin cut (flap) is made in the cornea. This cut involves the epithelium and part of the corneal matter. Then, the eye surgeon is able to change the shape of the remaining layer underneath. This allows the surgeon a little doorway for re-shaping the permanent layer.

By returning the flap to its original position,it is only the edges of the flap that need to heal. Thus, the recovery time of LASIK is only a fraction of that of PRK.

Both surgeries are safe and effective, and carry a very high rate of patient satisfaction. Choosing between PRK and LASIK is a decision best made in consultation with a trained eye doctor who specializes in laser eye surgery. the choice depends on several factors, such as: corneal thickness - degree of sight problems that needs to be corrected - and severity of eye dryness. The good news is that our experience has shown that whichever you choose, you’re likely to be very pleased with the outcome.

Implantable collamer lens (ICL)

 

The ICL is a lens which is placed inside the eye to correct some sight problems. It has the potential advantage of being removable, and does not require the cornea to be modified as in LASIK. It is also more expensive than LASIK.

The ICL does not cause inflammation within the eye. It is one of several brands of lenses that go into the eye along with the natural lens to improve the vision as opposed to LASIK which works by changing the shape of the front surface of the cornea.

The ICL is most often used in high corrections or in cases where the cornea is too thin preventing LASIK. In cases where the ICL does not fully correct the vision, patient may need to undergo LASIK on top of ICL in order to "fine tune" the sight.

In summary, ICL is a good option for certain situations but, at this time, is used mostly for cases in which LASIK is not a good option.

Femtosecond Laser

This new type of laser can be used in many eye operations, such as cataract surgery, corneal-ring insertion, LASIK, and corneal grafting. It gives us a highly accurate and expected results than the older techniques.

Modern Procedures for Vision Correction

Advanced Femtosecond LASIK Technology
With this technology, we can do many procedures

ICL implantation

LASIK using Femtosecond laser vs. PRK

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