Dr. Cha:
Checking my hair.
Dr. King:
I put goo in my hair. How is it? It looks great. Did I flatten with BIO today? I tried to do minimal BIO .
Speaker:
What’s BIO?
Dr. King:
That’s the headset we use for retina.
Speaker:
I think your hair looks great.
Dr. King:
Nah. I can’t trust you people
Speaker:
Did you forget a piece? No, I didn’t forget a piece because we have the ICL to go in here.
Dr. Cha:
Does this fit in here like those grooves?
Dr. King:
It does
Dr. Cha:
Just like that. Wow. Is that what the sulcus actually looks like? There’s no groove, right?
Dr. King:
No Dr. Cha, the only groove there is is by the zonules.
Dr. Cha:
Every time I see it, I’m like, is that groove supposed to be there?
Dr. King:
Where’d you go to school again?
Speaker:
Look, I didn’t do good in anatomy either.
Dr. Cha
I’m more of an optics guy.
Dr. King:
I still think it’s Galilean.
Dr. Cha:
It’s kind of flat actually.
Dr. King:
It’s a piece of plastic. Hi. Welcome to Days of Our Eyes. I’m Dr. King.
Dr. Cha:
And I’m Dr. Cha
Dr. King:
Today we’re gonna talk about refractive surgery. What is it? What types are available? We even brought our high tech props. Keep watching, learn more. What is refractive surgery Dr. Cha?
Dr. Cha:
Hi. So refractive surgery, .
Speaker:
Hello. Hi, I’m Dr. Cha.
Dr. Cha:
Refractive. Right? We kind of broke it down in some of our previous videos. Check it out. Refraction is bending of light. So reflection is bouncing of light, refraction is bending. And when we think of the eye
Dr. King:
We spared no expense here at AVI for your learning.
Dr. Cha:
Yeah. So light reflects or bounces off of objects and enters our eye, and it has to be refracted in a certain way so that it actually makes sense. The information coming in is an image when we have refractions when you go to see your your eye doctor, optometrists or ophthalmologist to get refractive for glasses or refracted for contact lenses, that’s what those different lenses in the phoropter, the big old pair of binoculars,
Dr. King:
Which is better. One or two? Yeah. Three. Four.
Dr. Cha:
That’s the active refracting. We’re literally bending light with different lenses so that it matches your kind of visual system so that you’re able to see. So a refractive surgery is that process that correction for your vision, but in a surgical manner, you know, more or less a permanent fashion.
Dr. King:
Basically, we’re gonna do surgery on the eye to correct the refractive powers so that everything is in focus without the aid of something outside the eye. There’s a lot of ways to do refractive surgery. You hear about all of ’em. LASIK, PRK, RK, nobody talks about that one anymore, but think of it this way. There are two parts of the eye that refract the light, that focus the light to land on the retina. So the ultimate goal is to get a clear image on the retina in the back of the eye. The two parts of the eye that help do that are the cornea out front. I call that the windshield of the eye and the lens in the middle. That’s where we get cataracts and stuff like that. These two have to work together to focus the light. So when we do surgery, we want to alter one of these things to correct the refraction, to give the eye the refraction that we found.
So we can either work on the cornea or the lens inside. The most common one you’ve heard about is LASIK. LASIK is a laser procedure that reshapes the cornea to correct the vision to work in sync with the lens and focus line on the eye. We use a different laser to make a flap, lay that flap back, laser the cornea into a shape. I think of it as when an artist creates a sculpture, they take one form and custom chisel it into a new form that we want to correct the vision. So we laser it in a predetermined pattern based on the topography. So everything we do at our practice is customized. Mm-Hmm. and reshape the cornea with the laser, then lay that flap back down so the patient can see pretty much right away. And then that flap just has to heal. So the advantage to that is you get off the table and you can see pretty much right away, it sharpens up a little bit after a few days, but you get almost instant vision correction.
So that’s what LASIK does. It’s a flap and a laser
Dr. Cha:
SMILE. Instead of making a large flap, we actually make a small incision a small opening in the, that really thin front layer of the eye, that windshield, the cornea, and then we actually take out a small piece of tissue instead of kind of reshaping it with the chisel is almost like what’s a good way to, like, what’s a good analogy? Like liposuction?
Dr. King:
Yeah. Kind of . Yeah. There’s a specific laser for SMILE that creates what they call a lenticule, a lens. All right. So our contact lens is a certain shape. We put it on the eye. What this does is creates a lens shape within the layers of the cornea. Then we can make a small incision and just pull that lens out and the top layer kind of falls down and the cornea assumes the new shape.
Advantage, no flap, less disruption to the corneal surface. We’re gonna get into a little more detail on each type of procedure and offer some pros and cons. Why would you have SMILE over LASIK? Who’s a better candidate for something else? What are the limitations? We’re gonna go over that in subsequent episodes. So we have LASIK, we have SMILE. Now we can talk about PRK. PRK has been around as long as lasik. It uses the same laser as LASIK. The difference is with PRK instead of making a flap on the cornea, so we’re still working on the front of the eye. Instead of making a flap on the cornea, we actually just remove the top layer. Sounds a little creepy, but it’s really effective. What that allows is we don’t have to remove as much tissue, then we use the laser, then we put a bandage contact lens on there and let that top layer grow back and heal. Little longer recovery time with that one. That’s why it didn’t gain so much popularity, but it works fantastic. The results long term are as good or better as any other procedure. It’s just a longer recovery time. So that was an earlier procedure, but we still do it in certain cases today. So I PRK is like LASIK with a longer recovery flap-less lasik.
Dr. Cha:
Yeah. Flap plus lasik. No, the front part of the eye one, it is the most sensitive part of your body, but with all those nerve endings your body prioritizes it to heal fast as well. Yes. Because it, it recognizes how important the sense of sight is.
Dr. King:
That’s, that’s the advantage to corneal surgeries. It’s, it’s the fastest healing tissue in the entire human body. So when we do something to the cornea, it heals in days, not months. That’s, that’s a big deal. That’s why we’re able to do most of these procedures. Yep. So we have LASIK with the flap, we have SMILE with the lenticule. And we have PRK without the flap.
Dr. Cha:
Yeah.
Dr. King:
That’s the corneal stuff. Then what about what say the cornea’s got issues, we shouldn’t touch it. What about in here? What can we do with the lens? What can we do with the lens? Dr. Cha? sorry, I just had to
Dr. Cha:
No, we use classes in contacts traditionally we’re adding something to the system, EVO ICL or implantable columnal lens a lot of times even to make it a little bit easier to understand is that almost like an implantable contact lens? Right. We are adding something into the eye instead of on top of or in front of the eye to be able to fix your prescription. It looks a lot like this. Yeah. It’s clear and we pretty much yeah. Implant what you would need in front of the eye into the inside the eye. Of course, not one-to-one. The numbers are completely different. And we take a lot more care to make sure that the numbers are as precise as we can get it.
Dr. King:
So that’s a little newer procedure. I mean, it’s been around a long time, don’t get me wrong. The idea is we can take advantage. There is space in between the iris and the lens, and we’re talking microns, but in the eye microns, thousands of a millimeter. That’s a big deal to us. We measure everything in microns. This allows us to really customize and get a lens inside the eye. Advantage to that we’re not messing with any tissue. We haven’t disrupted any tissue on the outside. And if you don’t like it, take it out. So it is reversible. Yes. Okay.
Dr. Cha:
Unlike the corneal procedures we just talked about
Dr. King:
Yes. All corneal procedures are permanent, non reversible. So it offers several advantages and it’s becoming more and more used actually. It’s as the safety and efficacy has improved. These lenses are gaining in popularity. So the last one, we’ve changed the cornea three different ways. We put a lens in there, but what if we don’t want to do that? Or what if somebody needs more than one focus, they need distance and near now, then we can actually do a refractive lens exchange. RLE as we call it, that’s where we take your natural lens and remove it and then put a new lens in. This is not to scale, obviously also known as the alien lens . Anyway in the eye. And it, there are different lenses we can use that allow us to restore multi focusing, multi distance focusing , something like that. This is akin to a cataract surgery. The same basic rules are followed for an RLE as a cataract surgery, but we’re again changing the lens inside the eye, and we’re fixing the system to focus the light on the retina and restore clear vision without the use of any devices outside the eye. And that’s a brief overview of the, of the ideas, the places that we can correct vision in the eye. Front and middle, all about focusing it on the back.
Dr. Cha:
The goal of any refractive surgery is to optimize vision. A lot of our patients, when they come for cataract surgery, they say, oh, I want my 20 year old eyes back. We, we don’t have a time machine.
Dr. King:
I want my 20 year old waist back.
Dr. King:
Not Happening.
Dr. Cha:
Right. We have microscopes, we have lasers, we have scalpels, but we don’t have a time machine in our office.
Dr. King:
Believe it or not, these are not mutually exclusive. There are times when you can use a combination of things depending on your individual case. At Alliance Vision Institute, we have built an entire practice around any surgery possible to make people see better. That’s the whole vision and mission of our practice. And there are times that we’ve had to use two of these procedures together to complete a refraction correction for a patient. But it works. And the idea is you do a full assessment. You figure out the health of the eyes, what’s best for the patient’s, ocular health and vision. Put those together and we can really improve quality of life. Well, that’s our overview of refractive surgery options. Tune into subsequent episodes and we’ll kind of get a little more in depth for each, each option at each episode. Limitations, risks, benefits best fits. And we hope you like what you saw. If you do hit subscribe, keep following us. In the meantime, drop a question in the Dropbox if you want to. And I’m Dr. King.
Dr. Cha:
And I’m Dr. Cha.
Dr. King:
See you next time on Days of Our Eyes.