Department
of Ophthalmology
Refractive Surgery Services at the UPMC Eye Center
To schedule a refracive surgery evaluation, call the UPMC Eye Center
at 412-647-2917. Debbie Holliday, our refractive surgery coordinator,
will walk you through the process.
At the UPMC Eye Center, refractive surgery procedures are performed
by Dr.
Deepinder Dhaliwal, Dr.
Francis S. Mah, Dr. Alexa Lu, and Dr. Viki Christopoulos.
Read
an ABC News article on refractive surgery featuring Dr. Dhaliwal.
Refractive surgery refers to procedures whose aim is to reduce or
eliminate the need for glasses or contact lenses. Most refractive
surgical procedures make some permanent alteration to the corneal
shape so that the magnitude of myopia, hyperopia, astigmatism or presbyopia
is reduced or eliminated. There are some procedures that involve the
lens inside the eye and not the cornea. Some of these options are
better for patients with extreme refractive errors. Your surgeon at
the UPMC Eye Center will determine which procedure is appropriate
for your particular situation. Each of these techniques entails a
permanent adjustment to the eye and cannot be reversed once completed.
The doctors at the UPMC Eye Center:
- are highly qualified ophthalmologic surgeons with fellowship training
in cornea and external diseases, certified by the American
Board of Ophthalmology
- teach various laser vision correction techniques to ophthalmologists
in training
- have a history of involvement in clinical trials which aim to improve
the outcomes of refractive surgery, putting us on the cutting edge
of technological advancements in the refractive industry
Our laser vision correction facility contains state of the art equipment
that is maintained to scrupulous standards. Our refractive team is dedicated
to making your procedure as safe as possible, and we only perform surgery
on those persons whom we feel have an excellent chance for a favorable
outcome. In addition, we strive to make this as pleasant and relaxing
an experience as possible.
Surgical Options
There are a host of vision correction options available at
the UPMC Eye Center, depending on your refractive error, ocular health,
and individual visual needs. The procedures we offer include the following:
Excimer Laser Procedures
The UPMC Eye Center has a comprehensive laser suite which includes
YAG, Excimer, and Argon/Tunable Dye lasers. Procedures commonly
performed in our laser center include treatments for diabetic retinopathy,
retinal detachments, and angle closure glaucoma, as well as phototherapeutic
keratotomy and refractive surgery procedures, including LASIK.
- LASIK (Laser In-Situ Keratomileusis )
LASIK is a popular refractive procedure in which excimer laser energy
reshapes the corneal surface (the clear surface of your eye). This
changes the way light bends through the cornea and can correct low
to moderate of myopia, hyperopia, and astigmatism.
In this procedure, a thin, superficial flap of cornea is created with
an instrument called a microkeratome. This flap is then reflected
away while the laser gently works on the underlying cornea. Once this
is completed, the flap is carefully replaced, allowing rapid healing
without the need for stitches. During the procedure the eye is numbed,
and so cannot feel pain. However, after the surgery, there is minimal
discomfort, and it is not uncommon to have a day or two of foreign
body sensation. The entire procedure takes approximately 10 to 15
minutes per eye.
While you are likely to experience an almost immediate improvement
in your vision, visual acuity tends to improve over the course of
1 to 2 months after the procedure. While perfect vision cannot be
guaranteed after LASIK, most studies show that 95 percent of patients
attain 20/40 vision or better. Read
more about the LASIK procedure.
The UPMC Eye Center offers an advanced approach to LASIK called
the IntraLase Method. The IntraLase
Method is a 100 percent blade-free approach to creating the
corneal flap, the thin flap of tissue that the doctor folds back
in order to perform a LASIK procedure. Traditionally, doctors have
used an instrument called a microkeratome for the creation of corneal
flaps. The microkeratome is a hand-held device that houses a blade
that moves across the eye, cutting the corneal flap as it goes.
While LASIK is extremely safe, if complications do occur, the microkeratome
is most often the cause. The IntraLase Method, by contrast, enables
the doctor to create the corneal flap without a blade ever touching
the eye. In addition to the added safety provided by IntraLase,
studies have shown that patients experience better quality of vision
overall, particularly in terms of their ability to see well in low
light such as at dusk or at night.
- Custom LASIK
Custom LASIK works similarly to LASIK, but differs in that it
corrects for the inherent optical aberrations in your individual eye.
There are many reasons besides refractive error that an eye does not
see well. These are termed aberrations, and have to do with the way
that a photon of light bounces around inside the eye before settling
on the retina. With Custom Wavescan technology, we can create a fingerprint
of these aberrations and then feed this data into the laser's computer.
During the procedure, the laser sculpts compensatory topological changes
on to the cornea. Custom LASIK can therefore not only correct for
your refractive error, but also increase the clarity of your vision
by eliminating many optical aberrations of the eye.
- Photorefractive Keratectomy (PRK)
This was the first procedure to use an exicmer laser instead of a
surgical blade to change the shape of the cornea. The laser energy
is applied in the central 5-9mm of the cornea to remove microscopic
layers of superficial cells without damaging any adjoining cell
layers. Usually between 5 and 30 percent of the central corneal
thickness is removed (or ablated), depending on the severity of
your initial refractive error. The precision of the laser allows
your surgeon to create very specific refractive modifications
with very little damage to the eye. In PRK, there is no flap of
tissue created as with LASIK or LASEK, so it is often an option
for patients for whom a flap cannot be safely created or for whom flap
safety is questionable (military pilots or divers, for example).
After PRK, it is not unusual for patients to experience some discomfort
similar to the feeling of having a foreign body on the eye’s
surface. Unlike LASIK, in which you can expect a very quick improvement
in your vision, after PRK vision is usually blurry for two or three
days until the corneal surface heals. You can expect that your vision
will improve for the next several weeks, and may not stabilize for
a month or two.
Incisional Procedures
- Intacs - Intrastromal Corneal Ring Segment
Intacs are used to treat patients with keratoconus to restore a more
normal shape to the cornea. Intacs are two tiny plastic inserts that
are inserted under the edge of your cornea during a brief outpatient
procedure. They are a flexible alternative to laser vision correction
because the inserts can be replaced with a different prescription
if your visual needs change, or can be removed entirely, returning
your vision to its pre-operative levels. You cannot feel Intacs once
they are in place, and are no more visible to observers than contact
lenses. They are FDA-approved for people with low amounts of myopia
and/or astigmatism and who have corneas thick enough for the procedure.
After Intacs, some patients are able to see without needing contact
lenses.
Thermal Procedures
- Conductive Keratoplasty (CK)
CK is an exciting new advancement in vision correction for patients
who have presbyopia,
which impairs their ability to read. After age 40, our eyes begin
to lose the ability to focus on near objects because the lens inside
the eye loses the flexibility needed to focus on things like a newspaper.
Conductive keratoplasty can change how the eye focuses light by reshaping
the surface of your eye (the cornea), allowing one to see at both
distance and near, producing what doctors call “blended vision”.
To produce this reshaping, CK uses a revolutionary technology that
employs radiofrequency energy instead of thermal laser energy. The
energy is applied to your eye in a circular pattern, avoiding your
pupil entirely. There is no cutting of tissue involved, enhancing
the safety profile of the procedure. Your physician can determine
if you are an appropriate candidate for CK. Often only one eye undergoes
the procedure, but if you are farsighted, sometimes both eyes are
treated.
Lens Implant Procedures
- Clear Lens Extraction - Refractive Lens Exchange
For some patients with extreme amounts of myopia or hyperopia, for
whom no other refractive procedures are safe, it is possible to perform
a ‘clear lens extraction’. This surgical procedure is
functionally performing cataract surgery on an eye that does not yet
suffer from this age-related lens change. Once the cataract is removed,
a small, plastic intraocular lens is put in its place. The power of
this lens is calculated to fully correct your refractive error. Traditional
intraocular lenses correct distance vision only, and mandate the use
of reading glasses for near tasks. Newer, state of the art intraocular
lenses exist that act as ‘bifocals” and allow for near
vision as well. Like all procedures, it is possible that one will
still require either distance or reading spectacles after the procedure.
The surgery for a clear lens extraction is more complex than many
of the other refractive procedures. Your doctor will be happy to discuss
the risks involved.
- Phakic Intraocular Lens (IOL)
This is a relatively new procedure targeted for patients with excessive
amounts of nearsightedness. In this surgery, a tiny intraocular lens,
similar to those used for cataract surgery, is placed inside the eye
next to the natural lens. The power of this intraocular lens combined
with the natural crystalline lens will correct extreme myopia. Since
the natural lens remains in place, the ability to focus for near tasks
is retained. Because this procedure is fairly new, the potential risks,
which include cataract formation, corneal decompensation, and glaucoma,
are still being assessed.
Refractive Options for Patients with Cataracts
Cataract
surgery has undergone tremendous technological advances throughout its
history. Every year, millions of patients choose to have both their
vision and their lifestyles restored, thanks to this life-changing medical
procedure.
Intraocular lens (IOL) technology has taken a giant leap forward. For
many patients, the objective is no longer to simply restore distance
vision with a monofocal lens. Today, patients may choose to enhance
their vision with an IOL that may provide a full range of vision, thus
minimizing dependence on glasses, including reading glasses or bifocals.
At the UPMC Eye Center, we offer the AcrySof ReSTOR intraocular
lens. With this revolutionary lens, most patients can read a book or
menu, work on the computer, drive, and play golf or tennis with increased
freedom from glasses.
As with any surgery, our doctors provide detailed information regarding
the benefits of the AcySof ReSTOR lens, helping patients decide
if this is the right choice for them.
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