Refractive Surgery > Dr. Steensma

$Refractive surgery$

Refractive surgery is an alternative to glasses or contact lenses

Refractive surgery is a way of improving your vision without glasses or contact lenses. It’s not for everyone, but is a valid option for those who don’t want to wear contacts or glasses. Refractive procedures have been around since the 1970's, but advances in instrumentation and techniques have only recently brought them to the forefront of modern care. There have been enormous improvements in the procedures in the last year. Your family optometrist an objective source of information about which procedure is or isn't best for you. Your family optometrist knows you and your needs much better than the surgeon.

Dr. Steensma will provide much of the pre-surgical and post-surgical care. Optometric participation is beneficial for the patient, the optometrist and the surgeon. For the patient, continuity of care is maintained and eye care becomes more convenient and accessible. Co-management affords Dr. Steensma the opportunity to maintain his role as primary eye care provider during and after the procedure. He will do the pre-op exam, observe the surgical procedure and then provide follow you care for a year after the surgery. The surgeon is allowed to work at his highest skill level doing surgery, not follow up visits.

LASIK (Laser In-Situ Keratomileusis)

LASIK is by far the most commonly done refractive procedure. It was originally developed for those patients with extreme amounts of nearsightedness, but has now become the preferred procedure for most people. It produces much better results than previous refractive surgery methods did.

Most patients after LASIK see well enough to function without glasses or contact lenses much of the time. About 90% see 20/40 or better and 50% see 20/20. Some people still need glasses when critical vision like night time driving is required.

The procedure:

You will be awake and alert during the entire procedure. Drops are used in your eyes so you don't feel any pain or discomfort.

A very thin flap of cornea is created with a special instrument. When the flap is folded back a laser is used to remove a microscopic amount of tissue. Then the flap is returned to its original position. The procedure only takes a few minutes.

The laser reshapes the central part of the cornea with an ultraviolet laser. The laser used is called an Excimer laser. Excimer is a contraction for the words "Excited Dimmer". What happens is closely bound molecules in a high energy state are subjected to an electrical discharge in a laser cavity producing a beam of ultraviolet light. The UV beam destroys the molecular bonds of the corneal tissue destroying tissue. The tissue destroyed is less than a hair thickness. There is very little heat created in adjacent tissue so the device is very precise.

When the cornea changes shape the light entering the eye is properly focused on the retina resulting in clearer vision.

After the procedure:

Almost everyone experiences a dramatic improvement in vision, often as soon as the next day

Prescription eye drops are used for 4-5 days after surgery. Vision is normally blurry for the first 6 hours. A clear plastic shield is taped over your eyes. It is removed the next day, but is used during sleep the first 3 nights after surgery.

Mild foreign body sensation for 1 to 2 days
Mild tearing for 1 to 2 days
Mild light sensitivity for 1 to 2 days
Mild dry eye sensation for 1 to 2 weeks
Minimal visual fluctuation Minimal halos around lights at night for the first month
Occasional halos around lights at night for the first three months
In some cases an enhancement procedure needs to be done for better vision. This decision is usually made at the 3 month follow-up.

The contraindications for LASIK are:

Any significant auto-immune disease
Uncontrolled vascular disease such as diabetes
Pregnant women or nursing women
Corneal disease
Patients with a history of keloid formation
Patients with a history of herpes eye infections
Patients with only one eye After surgery:

INTAC

The Intac© intrastromal corneal ring (ICR) is a fairly new procedure that is being used on patients with less than 3.50 D. of myopia and less than 0.75 D. astigmatism

The Intac© ring is surgically placed within the peripheral cornea. It changes the corneal curvature to eliminate myopia. Because it is in the peripheral cornea it does not damage the central cornea through which light travels into the eye. It can be surgically removed if necessary.

The procedure takes about ten minutes. Vision improves immediately with the surgery, but you may notice some glare for a few months. Most people can return to work and normal activities in two days.

Most patients achieve 20/20 vision with this procedure and some studies indicate that vision with this procedure is better than with other forms of refractive surgery.

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