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          

A direct mail advertisement by Optimax Laser Eye Clinics, which said ‘we’re the UK’s number one Laser Eye Surgery specialists’ has been banned by the ASA, according to the drum.co.uk. A complaint had been made by Optical Express about the advert, which also claimed that Optimax had ‘the best corrective vision treatment in the country’. Optimax said the ad was an oversight because they had been ensuring they were careful to avoid comparative and superlative claims in their advertising. Since the advertising Standards Authority did not receive any evidence to back the claims of being number one for laser eye surgery, or for having the best vision corrective treatment in the country, the regulatory body decided that the advert breached the CAP code on misleading advertising and substantiation. It said that the advert must not be shown again in that form. »crosslinked«

Cataracts develop as part of the aging process, so everyone is at risk eventually. According to a recent article from the American Academy of Ophthalmology, the risk factors include: Advanced age; Diabetes; A family history of cataracts; Extensive exposure to sunlight; Smoking; Obesity; High blood pressure; Previous eye injury or inflammation (swelling) in the eye; Previous eye surgery; Long-term use of steroid medication (especially combined use of oral and inhaled steroids). If you have any of these risk factors, and your vision is not as clear as it once was, then you may be developing cataracts. Visit your local optometrist as the first port of call for an eye health check and refraction. Cataracts are readily treatable with a local anaesthetic operation. Multi-focal implants are also available to restore both distance and near vision, reducing or eliminating your dependence on all glasses.

According to a news report in Cataract and Refractive Surgery Today, vegetarians may have a reduced risk of developing cataracts, based on a study in the American Journal of Clinical Nutrition. Researchers at the University of Oxford in England studied the lifestyle characteristics of 27,670 self-reported nondiabetic participants aged 40 years and more by using data from the Hospital Episode Statistics in England and Scottish Morbidity Records. Participants were asked to fill out dietary surveys between 1993 and 1999; their medical records between 2008 and 2009 were monitored to see if they developed cataracts. Almost 1,500 participants had cataracts during the follow-up period. The data showed that vegetarians and vegans were 30% to 40% less likely to develop cataracts than individuals who consume high amounts of meat. “There are many good reasons to follow a healthy diet, and our study suggests that lowering your risk of cataract can now be added to these,” lead author Paul Appleby, senior statistician, Cancer Epidemiology Unit at the University of Oxford, said in an e-mail to Cataract & Refractive Surgery Today. “How far individuals move along the path toward a plant-based diet is a matter of personal choice.” There was a strong relationship between cataract risk and dietary group. A progressive decrease in the risk of cataract was shown in those who consumed high amounts of meat—100 g (? 3.5 oz) daily—to moderate meat eaters (1.7- 3.4 oz), low meat eaters (> 1.7 oz), fish eaters (participants who ate fish but not meat), vegetarians, and vegans, with risk ratios of 0.96, 0.85, 0.79, 0.70 and 0.60, respectively. The authors point out that eating meat does not necessarily promote cataract formation, rather it is vegetables that may have protective nutrients that lower cataract risk. Additionally, vegetarians may practice other healthy behaviors that can contribute to a lower risk of developing cataracts. “There was no obvious explanation of our findings in terms of specific nutrients. It may be that diet group is simply a better marker of a healthy diet than the intake of any given nutrient,” Mr. Appleby said.

I had this interesting question from Sophie: Dear Mr. Allamby, My father has keratoconus, I believe he has had it a long time but was diagnosed officially at an eye test when he was 30 (he is now 50) will this affect my chances of laser eye surgery and would it be safe to proceed if I show no current symptoms (I am 21). Many thanks, Sophie Dear Sophie, Thanks for your question. Keratoconus (KC) is most often sporadic (not apparently inherited) but has been observed to run in some families. Typically it is first seen in adolescence. Around 80% of cases do not progress. As you are now 21, if you have KC there may well be changes in the corneas already so the best next step would be to see you for corneal scans. These are now very sophisticated at picking up even early changes of KC before they would affect your vision. We perform thin-flap femtosecond LASIK with our new Crystal Line Ziemer down to 500 microns central corneal thickness (CCT). Below that we would normally do PRK, and also PRK if there is any slight irregularity in corneal shape. However, it is the appearance on the scans that is more important in your case, and CCT is only one of the risk factors we look at when considering suitability. I am rather obsessed with safety, and any doubt whatsoever means I would advise against any treatment, even if you were very keen!

I had this interesting question recently from Kevin: Hi Doctor, Would you please advise if “zlasik” is still better and newer technology compared to “ilasik with iFS Advanced Femtosecond Laser”?  Thanks Hi Kevin, I prefer the Ziemer system (Z-LASIK). We have the brand new Ziemer LDV Crystal Line system, currently the only one in the UK, and it is a remarkable flap creation tool. It has a 33 times faster repetition rate than the latest iFS 150KHz model, with energy per pulse far lower, tighter energy focus and the shortest suction-on time. We can do both eyes safely and very accurately in around 6 minutes.

You may have seen this article on laser eye surgery in the Daily Mail last week. The article describes the serious complications suffered by Lois Roberts following her laser eye surgery 3 years ago. Yet, instead of the simple pain-free experience Lois was led to expect, the surgery to correct her short-sightedness left her in agony for days. Worse, three years on, she still has painfully dry eyes as a result of damage to the nerves that stimulate tears. Lois has to apply eye drops daily – which in itself is a problem, as long-term use can raise the risk of chronic eye inflammation. Dry eyes can also lead to serious infections and, ultimately, even loss of vision. As well as dry eyes, Lois suffers from constant floaters and poorer night vision. ‘The floaters are like clumps of black lines and dots,’ she says. ‘I’ve been reassured they’re harmless, but they are incredibly annoying.’ How accurate was this piece? Sadly, not very much at all. Interestingly, Lois herself added the following comments on the online version of the article: Hi all – I’m Lois from the article I just wanted to confirm that I do NOT regret having laser eye surgery. I was shocked when I saw a huge picture of myself saying that laser eye surgery has ruined my sight! This is not true. For me personally, I don’t find the dry eyes and floaters a big problem, yes they’re annoying but hey it’s worth it for me. Also, I would never EVER have had laser surgery after watching an advert on the tv! I had it done in Manchester, the same place as my father had his done very successfully around 15 years ago. I thought this article was going to look at the positive and negative effects of laser surgery. For me, it’s great to be able to surf and play sports without having to worry about whether I’d be able to put my contacts in. Anyway, I feel better now I’ve had a little rant! Thank you for some of the lovely comments! - Lois, North Wales, 01/12/2010 11:04 Another reader, Andy, added his feelings on this: Thankful that Lois has been able to put in a comment that counters the sensationalism of this article … But you do get what you pay for! … There are enough alternative, highly rated clinics out there with fantastic reputations that you can choose from. Do not undervalue your eyes – laser eye surgery IS surgery and should not be treated like buying anything else on the high street. Please do your research into laser eye surgery clinics and you will avoid the problems detailed in this sensationalist article. - Andy, Guildford, Surrey, 01/12/2010 17:30 You should look around carefully before choosing the clinic and surgeon for your laser eye surgery. You get one pair of eyes, after all. If you are unlucky enough to need to wear glasses, laser eye surgery is a realistic option and safe in the right hands. The latter emphasis is important. For example, dry eyes occur in those who had dry eye before the procedure, and these patients should not have LASIK.

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 Hi Kate Thanks for your question. Easy prescription to correct, and quite stable, so no problems there. Yes, your corneas are a bit on the steep side, so that can introduce a small risk, but one that can be easily avoided. You mentioned two clinics, one that offers/offered PRK and the other blade-cut LASIK. II do believe that in 2010 you have no reason to accept blade-cut laser eye surgery. Such a mechanical cut does bring a small risk of a buttonhole flap (flap with a hole) when the corneas are steep, and with 80% of UK clinics now offering femtosecond LASIK, please forget the blade option. It is a good sign if a clinic has invested in new technology, such as a femto laser. PRK will give you very good vision, assuming the clinic is using a modern wavefront technique, but will take 4-6 days for the vision to settle, and you may need to be off work during this time. Your prescription is low, so no need to use MMC to prevent corneal haze. Even though your risk will be low, still, you should avoid excess UV light (bright sunlight) during the first few months, e.g. wear wraparound UV filtered sunglasses outside if the sun is bright. Sun-beds can be OK as long as you wear opaque eye-covers. Your other option is to go to a clinic that offers the latest in femtosecond LASIK (Z-LASIK, i-LASIK). It is still possible to get a buttonhole with a femto laser, but it is pretty rare, and you can usually identify it before lifting the flap preventing complications.

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

Winston asked: I am 19 , with -6.25 in the left eye and -7.25 in right. I have been wearing glasses for about 9 to 10 ten years. What would you recommend? I do boxing as well as other physical activity. Is your prescription for your glasses now stable? Has it changed since last year? If not, you may well be suitable. In view of your boxing, you should consider having PRK (LASEK) instead of LASIK, to avoid risks from direct trauma to the LASIK flap, during sparring or matches. Although modern thin flaps created with femtosecond lasers do heal down well, this can take a year or so. Normal rubbing of course cannot move a flap, but a hard physical blow in the first months potentially could. In view of your high prescription, we would use a drug called mitomycin at the time of PRK surgery to ensure a stable vision result for you. Mitomycin (MMC) will prevent haze scarring and weakening of your vision following treatment.

Meera asked Contact lenses can warp the corneal shape and so give false readings and inaccurate measurements, that are required to enter into the laser prior to treatment. So it is vital we have a stable cornea, free from warpage from lenses. The time it takes the cornea to ‘unbend’ from a contact lens depends on the type of lens and the duration of wear in the case of hard lenses, in years: For soft lenses, this will take about one week For extended wear lenses, it will take about 2 weeks For hard lenses, it will take 4 weeks for every decade of use (e.g if you have worn hard lenses for 25 years, it can take 10 weeks for the cornea to resume its normal shape) So why do clinics recommend different times? Well, if you want to get a definitive answer at your consultation, you will leave your lenses out according to the guideline times shown above; the figures will be OK to use at your operation. If you come along for a consultation without leaving your lenses out for the full period, you may get a good idea of suitability, but sometimes a final answer cannot be given and you will have to come back for additional scans and measurements at some point, to get the final data to be used at your laser eye surgery. One way of doing that is to do a provisional consultation, with your lenses not left out, and then later leave them out for the full period prior to the treatment, and repeat the tests on the day of surgery. However, your treatment may get cancelled or postponed if the readings are still not ideal. So it is a balance between convenience and certainty of decision. Clinics may say to come along without leaving your lenses out, and so attract patients by avoiding the inconvenience of a lens-free period. This is fine, as long as the clinic makes it clear that a period of lens free vision will be necessary at some point. I agree, the varied lens-out times from various clinics can be confusing. However, the laws of bio-mechanics and the effect of wearing lenses on corneal shape do not vary between clinics. The above periods of lens-free wear will be needed at some point, either prior to consult or prior to surgery.

Trudi asked Hello Dave, I had my eyes lasered in Dec 2009. My prescription was SPH -4.50 & -5.00. My left eye (which had the worst prescription) is perfect! I have had enhancement surgery on my right though as a slight astigmatism remained. I had enhancement surgery (using the LASEK method this time round) 4 wks ago and the vision is not yet as good as it was after the first surgery, before the enhancement. I am beginning to think I should have lived with the result I had after the first surgery and been grateful. Do you think my eye will heal to at least what it was after the first surgery? Also, I have regular post-op check-ups with various different opticians (dependant on who’s in on the day of my app) and each tells a different story about healing and drops. I have been told that keeping the eyes wet with blink drops is *very important* to aid healing. I have also been told by another optician that I only need to put drops in when my eye feels dry. What is your view? Thanks. Trudi, for the lubrication, I would recommend regular instillation rather than just when they feel dry. The nerves are lasered during the treatment and see the eye is somewhat insensitive for a while, so you may not be aware of some dryness and so not lubricate. Aim for 4-6 times a day over the next couple of months. I prefer the preservative free version (you can buy e.g. Blink or Refresh over the counter at Boots) which will be less irritant with regular usage over an extended period. These are the ones in individual droppers. One vial should last you a day, one drop in each eye every 3-4 hours. For surface laser correction (PRK/LASEK) the full result can take months to fully settle and the vision is often a bit off at 4 weeks post-op. You should find it will settle more over the next 4-8 weeks.

Graeme just asked: Hi Dave, Two weeks ago I was treated with wavefront guided LASIK with Intralase by [clinic name deleted]. Although my vision was very good from the following day, I have had problems at night with severe starbursts, glare and halos around fluorescent lights (even indoors). I was told a couple of days ago that it will get better with time but since it’s hardly got better since day 1, I think there is a slim to no chance of this happening, especially as the eyes otherwise feel good with excellent vision. Also, I was told a number of times that I had very large pupils which is why I needed wavefront guided LASIK to prevent my night visiion being affected. In hindsight and reading further on the Internet (which I now realise I should have done much more of) . I guess I’m asking is there anything that I can do about this, anything I should ask them, e.g. pupil dilation, treatment area or anything like that to determine the reason for the starbursts and the fact that it hasn’t been done 100% correctly or I shouldn’t have been recommended as suitable? Or is there anything that can be done to improve it? I wouldn’t obviously want further surgery but I’ve seen on this page info about more modern lasers and larger treatment areas that you have used which almost eliminate night vision problems. Could this be an option? Although I have paid out £3000 so far and so wouldn’t welcome another big outlay especially without guarantees of success. My main problem is that come the winter I won’t even be able to get to work if my night vision remains as bad as this. I would be grateful for any suggestions or advice that you have. Graeme, it is still very early after your treatment, so I think the advice from your clinic to wait is correct. I would normally allow 2-3 months for the vision to settle fully before looking if anything else needs doing, especially if it was a particularly large prescription. So please be patient for now. Keep in contact with your clinic, and repeat testing at 4, 8 and 12 weeks post-op can help monitor your progress and relieve anxiety. You would want refractions and wavefront scans in particular, as night problems can arise from both low and high order aberrations. Low order means your prescription, but from your description your distance vision is excellent so not likely to be much prescription left – but you can confirm at your next visit. It can occur if the treatment zone was significantly smaller than the scotopic (dark conditions) pupil size but clinics and doctors are well aware of this and modern lasers can treat a wide area of the cornea. You can ask about your dark pupil size and the full optical zone used at your treatment, as well as the total treatment zone (including the blend zone that feathers the treatment edges outside of the full optical zone area). If the night vision problems persist, treatment is usually possible and will depend on the cause. Patience first though, as these symptoms can improve significantly yet. Give them the opportunity to assess and review your progress. Please let me know how you get on.

Ellie asked: Hi Dave, I got iLasik performed 4 weeks ago. Since then I got 3 exams and they show I still got -2 and -1,75 ( was -4,75 both eyes before the op) I also got very high pressure in the eyes – like 34-40…The doctor said it’s normal – comes from the eye drops and will go away, got new drops now, but still can not see clear, still got miopia that I can not watch TV or drive…is this normal? I was told with Lasik the sight is improved right after the surgery, I still can see as far as my nose…What is next? Thanks. Ellie, No not common at all in LASIK surgery, but it is possible. Under-correction of that degree is rare but it is feasible that it could happen. The high pressure afterwards could have led to some increased swelling in the cornea which would change the vision significantly. The pressure rise occasionally happens with steroid drops, and rapidly goes back to normal once stopped. As for what is next? You should wait around 12 weeks to let the eyes and corneas settle and ensure all swelling has resolved. You may find the myopia decreases more. If not, then the flaps can be easily lifted and eyes re-treated around 3 months post. Keep in contact with your clinic and let time pass to see how it settles. It’s still pretty early at 4 weeks. It’s normal for some patients to need an enhancement to finish off the result. Our own clinic rate is less than 1% for myopia, and it can vary between clinics – but we ALL perform enhancement procedures. Certainly must be disappointing as most patients see 20/20 or better the following day, and yours is a pretty big under-correction. Hang on though and I am confident that your end result should be good. Keep me informed of the outcome please. Regards, Dave

Omar asked: Good Afternoon Mr Allamby, I’m considering getting some treatment on my eyes, but am very worried about the long-term effect cutting the cornea can have. As i get older and my eyesight deterioates. will the my eyesight be worse off than if i had just kept wearing glasses? Omar, I think this is one of the most common worries that prospective candidates have when considering laser eye surgery be it LASIK or PRK. It is just over 20 years since we first performed PRK for short-sight, and just under 20 years for LASIK, so we have considerable experience of long-term results. The long-term outcomes have been excellent to date. Regression is seen in the London PRK study in 1-2% of patients, with a partial return to myopia, but not as bad as the vision had been before without glasses. Cutting the cornea (e.g. to create a flap or flap disc) has been around for decades. Lamellar cuts were made in the 50s, and the first mechanical keratome was first used in 1963. No long term problems were seen, except when too little thickness was left in the cornea. At my clinic, we use a high safety standard of leaving 300 microns in the corneal bed, after creating the flap with a femtosecond laser and using the excimer laser to reshape the cornea. The main worry is in excessive weakening of the cornea. However, the incidence of bending of the cornea through weakness in post-LASIK patients is the same as the incidence of bending from a disease known as keratoconus (KC). So in normal LASIK where all the safety parameters are observed, we are not sure if LASIK actually contributes to corneal bending post-operatively. The key here, as always, is rigorous screening pre-operatively and visiting a centre where you get sufficient time for your consultation. Some clinics do consultations in 30 minutes, or even less. Others (mine included) spend much longer. Focus consultations take at least 2 hours. Choose carefully.