Diva Lasik Refractive Center
NORMAL VISION:In the normal eye, in order to see clearly, rays of light pass through the cornea, pupil and lens of the eye. A sharp and clear image is focused directly on the retina.
MYOPIA:In a myopic person the cornea is too steep or the eye is too long and the focal point is in front of the retina resulting in blurred distance vision. Myopia is often hereditary. Because the eyeball grows with age, myopia tends to progress, usually stabilizing by the time you are 20 years old.
HYPEROPIA:For the hyperopic person the focus of the eye is behind the retina. Initially objects that are near seem blurred and distant vision is clear. However, with age, objects at all distances become blurred.
ASTIGMATISM:Astigmatism occurs when the cornea is not completely round but shaped more like an egg. Light that enters the eye focuses on more than one spot on the retina resulting in blurring of vision for distance.
- Contact Lenses
- Refractive surgery
- Implantable Contact Lens(ICL)
- Phakic IOL
- Clear Lens Extraction
- Conductive keratoplasty
- Astigmatic keratotomy
- Limbal relaxing incisions to correct astigmatism
All of the above options are available at DIVA Refractive / LASIK Centre
At Diva, patients are expertly guided to choose the procedure which is best for them. Our senior and experienced consultants have the knowledge, experience and ability; and are trained in all the above procedures.
We work as an Institute of excellence and have COMPLETE EYE CARE UNDER ONE ROOF. We provide complete solutions for refractive surgeries for all the patiets.There must be few centres to provide total expertised solutions to remove the numbers of glasses.
- Millions of eyes are treated the world over every year
- LASIK is approved by NASA for astronomers
- It is the safest method in which there is no pain, no injection, no dressing.
- Patient can resume his/her work from the very next day.
- Contact lens intolerance
- Cosmetic reasons, social (eg.marriage)
- "Tired of wearing glasses"
- Lifestyle activities that are inhibited due to glasses or lens wear such as outdoor sports like golf, football, water sports or hiking.
- Some occupations such as stage artistes, actors
- In some careers such as Merchant Navy, Army, Police and Airways enrollment, it is a requirement to have 20/20 or 6/6 vision.
- We have a highly experienced surgical team for refractive surgery, led by Dr. Dipan Desai who was the President of Cataract and Refractive surgery in India.
- We have been doing LASIK since 1993.
Our Machines:At Diva, LASIK is performed by the Schwind ESIRIS Laser System, a German machine which was awarded the Medical Design Excellence Award and best 100 innovations of the year in 2008.
Pre-LASIK evaluation is very accurately and swiftly performed by the ORK wavefront analyser, keratron scout topographer and ultrasonic pachymeter. We are the only centre in Ahmedabad which can perform Customized Corneal Wavefront correction because we have the Computer, Corneal topographer and aberrometer all on one platform and they are interlinked with each other.
During LASIK, the Carriazo Pendular Microkeratome ensures creation of the most Stable and Safest flaps possible in the world, with even thickness and sharp edges. This is not possible with other microkeratomes. Alternatively, flaps can be made with Femtosecond laser with the advantage of having an even thickness flap. Only the Carriazo Pendular microkeratome because of its design it has the same standard deviation in the thickness profile of the flap. The cost with the femtosecond laser flap making more than doubles as two lasers are now involved and femtosecond laser requires another space, also the patient has to get up from one operation table to the other.(that is from femto to excimer laser table)
SCHWIND ESIRIS laser machine has the fastest eye tracking facility. Hence, if the patient moves his/her eyes due to anxiety during surgery, the machine moves the whole laser system according to the movement of eye. If patient moves his eyes excessively then the machine stops firing automatically
- The Excimer Laser is an ultraviolet Laser working at the wavelength of 193 nanometers. It is a phenomenally accurate cutting tool with sub micron precision. Each pulse of the laser removes 1/4 of 1 micron of tissue (1000 micron = 1 millimeter). The Excimer laser gently reshapes the cornea bringing rays of light to focus on the retina.
- The SCHWIND ESIRIS Laser System provides immense safety with excellent clinical results because of the integration of the ORK platform, Excimer Laser & the Carriazo Pendular Microkeratome
- At DIVA LASIK procedures are performed in a zero bacteria operation theatre ( laminar flow).
Pre- LASIK Evaluation:
Tests done before LASIK :
- Detailed cycloplegic refraction
- Slit lamp examination
- Corneal Topography
- Aberrometry for wavefront aberrations
- Corneal Pachymetry
- Schirmer's test to rule out dryness
- Dilated fundus examination
1) WAVEFRONT HARTMAN SHACK ABERROMETER
- Most reliable
- High resolution
- Measures aberrations of the complete eye
- Measuring up to 1452 sampling points
2) OPTIKON KERATRON SCOUT - CORNEAL TOPOGRAPHERTo asses the aberration of cornea
- To asses the shape of cornea
- To treat complicated cases
- To treat previously treated cases
- To treat irregular aberrations
- To measure corneal thickness
THE LATEST CARRIAZO PENDULAR MICROKERATOME
This ensures most Stable and Safest flaps possible in the world (patented)
CARRIAZO PENDULAR MICROKERATOME: is used at DIVA to make the flap of cornea during surgery. This Pendular microkeratome works like the pendulum of a clock. Hence it cuts an even thickness and sharp edged flap of cornea. (Other microkeratomes applanate the cornea and cut a flap with a thick periphery and thin centre leading to greater chances of flap related complications like button holing of flap, incomplete flap etc) It is also well suited for small and deep eyes.
Alternatively, flaps can be made with Femtosecond laser with the advantage of having an even thickness flap. Only the Carriazo Pendular microkeratome because of its design it has the same standard deviation in the thickness profile of the flap. The cost with the femtosecond laser flap making more than doubles as two lasers are now involved and femtosecond laser requires another space, also the patient has to get up from one operation table to the other.(that is from femto to excimer laser table) It is equivalent to femto second laser in terms of safety and smoothness of flap.
Even thickness and sharp edge of flap Thin in centre and thick in periphery
SCHWIND ESIRIS EXCIMER LASER MACHINE:Our SCHWIND ESIRIS Excimer laser machine has the latest German technology . They have been pioneers in excimer laser refractive solutions in the world. This machine and technology has won numerous awards, including one the best 100 innovations of the year, and medical design award.
- 0.6 mm. flying spot laser beam
- Ablates 0.55 microns / laser pulse
- 1.50 microns / laser pulse by the second-best machine
- Hence smoothest profile on cornea achieved
- Spade versus chisel !
- Time is not important !
- 200 Hz Scanning / Flying Spot Laser
- Ensures that energy is dispersed extremely evenly
- Less thermal effects in the tissue
- Good results with regard to a better visual acuity
- 0.8 mm spot diameter
- Optimized Gaussian beam profile for smooth surfaces
- No grooves and ridges (compared to flat top profile)
- Small spot diameter ensures a regular ablation profile
- Optimal for customized ablation
- 330 Hz High Speed Eye-Tracker
- Fastest eye-tracking system on the market
- SCHWIND ESIRIS laser machine has the fastest eye tracking facility. Hence, if the patient move his/her eyes due to anxiety during surgery, the machine moves the whole laser system according to the movement of eye. If patient moves his eyes excessively then the machine stops automatically. Many a times the competition will say that we have the fastest excimer laser to decrease operative time. What is essentially required is that you must have a matching spee of excimer laser delivery and tracking mechanism.( in a music system you need a good tape deck,amplifier and speakers. If earthier of the three components are not upto standard then the final music output will be according to the worst component of the system.)
- The Heart of the System
- Single Platform allows Customised Corneal Wavefront
- Takes less time
We are the only centre in Ahmedabad which can perform Customized Corneal Wavefront correction because we have the Computer, Corneal topographer and aberrometer all on one platform and they are interlinked. Through high end mathematical calculations the ORK platform is able to select corneal wavefronts from other created wavefronts of lens,vitreous and retina. This gives us the ability to do advance retreatments of complications such as decentred treatments etc. of other lasik centres.
The SCHWIND ESIRIS Laser System provides immense safety with excellent clinical results because of the integration of the ORK platform, Excimer Laser & the Carriazo Pendular Microkeratome
- Age of the patient should be over 18 years
- Refraction (numbers) should be stable.
- Adequate Corneal thickness
- No pre-existing serious eye problems such as cataract and keratoconus.
- Range of refractive errors which can be corrected
- Myopia (minus number) up to -14.00 D
- Hyperopia (plus number) up to +6.00 D
- Astigmatism up to ± 6 D
However, this opinion may vary for various ophthalmologists based on their experience, expertise & other factors
SIMPLE LASIK:During the simple LASIK procedure, the cornea is made flat in myopic patients and steep in hyperopic patients. Preoperatively the cornea is prolate in shape ( steep in centre and flat in periphery). With the conventional LASIK treatment the cornea becomes oblate ( flat in centre and steep in periphery) shape. Hence there are higher chances of induction of higher order aberrations. This increase in post-operative higher order aberrations affects the patient's quality of vision. Patients may have complaint of glare and halos after Simple LASIK surgery.
ASPHERIC LASIK:Normally the shape of the human cornea is prolate (steep in the centre and flat at the periphery). When doing simple LASIK we flatten the central cornea (make it oblate). However, in Aspheric LASIK we shave off the corneal tissue from the periphery and make it like the original shape (prolate). This is known as Aspheric LASIK treatment. This was invented by our company. (SCHWIND ESIRIS LASER SYSTEM.)
The advantages are:
- Cornea made more physiological (natural)
- Better night driving
- Less halos
- Increase in contrast sensitivity
WAVEFRONT LASIK:When a ray of light passes through the different structures of the eye, it bends and affects the quality of vision (eg. Glare, halos around light etc). This is due to 'aberrations'. Along with refractive errors, these aberrations can also be corrected if wavefront technique is utilized. The aberrations are detected by an instrument called the aberrometer (ORK Wavefront analyzer) and then both the refractive error and higher order aberration details are fed in the Laser machine. The Laser machine then ablates the cornea in a way that these defects are removed.
The advantages of Wavefront LASIK are:
- Better quality of vision
- Better contrast sensitivity
- Can correct irregular astigmatism
- Reduces chances of night vision disturbances , halos and glare
- Greater predictability of the surgical outcome,
- Greater safety and efficacy.
There are two technologies to correct the aberrations of the eye, Ocular and Corneal Wavefront Correction.
Ocular Wavefront technology will correct aberrations of the whole eye. The disadvantage, however, is that with age-related changes, the aberrations of the lens will change. Hence some aberrations may be re-introduced some years after LASIK.
Customised Corneal Wavefront technology corrects only corneal aberrations. The advantage of this technology is that the cornea is not affected by age. Hence aberrations will not be re-introduced even later in life.
The corneal wavefront correction is undoubtedly the best and scores over Ocular wavefront corrections for the following reasons:
- Cornea has maximum refractive power of +42 diopter. When there is more refractive error (number) there will be more wavefront aberrations in the cornea which need to be corrected.
- The lens, vitreous and retina change with age and thus ocular wavefront correction changes over time. These wavefront changes decrease quality of vision rather than neutralizing it.
- We are operating only at cornea, we do not alter other structures in the eye.
At DIVA we are able to offer this Customised Corneal Wavefront technology. Ours is the only centre that corrects corneal wavefront as we have corneal topography, aberrometry and computer interlinked and on the same platform. This allows the machine ORK platform to deduce which are the corneal wavefronts and allows us to achieve correction of only corneal wavefronts. Other machines have topography and aberrometry machine separately attached with computer, thus not allowing corneal wavefronts to be separated from other wavefronts of the eye.
As our ORK platform has aberrometry, topography and computer interlinked, we can do TAG LASIK (Topography, Aberrometry guided LASIK).
What are aberrations?The optical model of eye can be compared to a camera. The eye has four surfaces (media) that can change the path of light.
|1. Cornea||Lenses in front of camera|
|4. Retina||Roll of camera|
When a ray of light passes through the optical system of eye it bends (changes path). These changes and distortions are known as spherical aberrations of the eye.
The measurement of these spherical aberration is known as Aberrometry which is measured by a very sophisticated machine known as an Aberrometer. This aberrometer can measure up to 100th order higher order aberrations as this was highest technology used by NASA TO OBSERVE STARS.
The human eye can see only up to 6th order spherical aberrations such as order 1 spherical, order 2 cylinder. The spherical aberrations above these, i.e. 3rd., 4th, 5th and 6th, are known as HIGHER ORDER ABERRATIONS with names such as trefoil, coma, quadrifoil, hexafoil etc... When these higher order aberrations are corrected, it is known as Wavefront correction.
The higher order aberrations cannot be corrected by glasses, contact lenses, Simple LASIK, Aspheric LASIK or intra ocular lenses.
Step 1: A thin flap of the cornea is made using an instrument called Microkeratome.
Step 2: The flap is lifted and exposed area is resurfaced using the laser beam.
Step 3: The flap is replaced carefully
The entire procedure is performed without injection and takes only about 12 to 15 minutes for both eyes. During the procedure the patient will see three red lights. The patient is asked to look at only the blinking red light in the centre.
Advantages of LASIK surgery:- Freedom from glasses and contact lenses
- Fast visual recovery
- Minimal side effects
- Minimal or absence of pain
- Faster healing
- Safest form of refractive surgery
- As patient enters greet and take file .Allot the Easy Launger.
- Take informed consent Do pre Op examination.
- Redness / Watering / Discharge / Pain
- Which Medications are using being used?
- Allergy to which medicines?
- Put plastic sheet over pillow & kidney tray on side.
- Patient to be in supine position.
- Put Paracaine eye drop
- Wash eye with 5% Betadine solution in 10 ml syringe. & with normal saline in 10 ml syringe.
POST OP INSTRUCTIONS (as given by staff):
- Make patient comfortable
- Provide Tea & Biscuits at appropriate time.
- Request relatives to bring medicines.
- Give post op instructions in details about hygiene & use of medicines mark medication with marker.
- Do not touch eyes without washing hands, start putting only one drop at a time as indicated. The second eye drop can instilled after 5 minutes .After putting any eye drop (1/3 will stay in eye and 2/3 extra eye drop which come out of eye, are to be cleaned with the Sterile cotton (How to prepare is giving below)
- The patient must start taking tablets as advised by us from 1/2 hour after surgery & to start putting eye drop as advice.
- PREPARATION OF STERILE COTTON to clean eye every day for 10 days. Make cotton ball (1*1 inch). This is done by allowing the cotton balls to boil in a vessel ("tapeli") of water for at least 15 minutes. And use this cotton to clean the eye during dressing or other time of day. When drop are instilled.
- Wear dark glasses soon after surgery. Wash the goggles every day with soap & water. They can be worn at night time too for 5 days to prevent jarring of eyes during sleep or advised by doctor .This provides a complete protection for 24 hours from injury BODYBATH is allowed from next day .HEAD BATH can be had after 4 day but do not allow water to enter the eyes .You can shave and comb hair from next day of surgery.
- There are no restrictions for DIET .One can have normal food from the day of surgery.
- You may START WORK on a modest scale after 2 days.
- You may watch television or read from the same or next day.
Other Important POST OP INSTRUCTIONS:
- DO NOT rub or touch your eyes and DO NOT squeeze your eyes
- Follow the eye drop doses. The eye drops should be put in exactly as instructed, preferably by someone else. Hands must be washed prior to instilling your eye drops,. Shake the eye drop bottle before use. Artificial tears may be used as often as required.
- Try to rest the whole day. For 6 to 8 hours after the procedure expect irritation, redness, tears, light sensitivity and slight swelling. For the most part of the day your vision will be hazy.
- It is important that you protect your eye for the day.
- The next morning the functional vision is usually restored. However as the healing is happening in the line of sight, there may be some days when the vision is slightly fuzzy and other days when it is very clear. This fluctuation typically lasts about 7 to 10 days
- Avoid swimming for 3 months
- If you experience severe discomfort, pain, discharge or sudden haziness of vision, call your doctor immediately.
- Detailed written instructions, eye drops and protective eyewear required for the immediate post-procedure period will be provided by us.
- Don't splash water in your eyes for 15 days.
- Don't drive till your vision is clear and you are comfortable.
- Protective eye wear for 1 month is recommended for all contact and racquet sports where a direct blow to the eyes is a possibility.
- Please visit us for follow up visits as advised.