EN | 华语 | BH   #13-03 Camden Medical Centre, 1 Orchard Boulevard, Singapore 248649   (65) 6738 2000
 
   
   
  (65) 6738 2000
   
 
 
 
 
 
 
 
 
 
             
 
 
 
 
     
 
Vision Correction Surgery

At Eye and Retina Surgeons, we offer a comprehensive refractive surgery practice to deal with the whole gamut of refractive errors. These are :

  1. Myopia or short-sightedness; far and away the commonest refractive error seen in Singapore
  2. Astigmatism or ‘san guang’; the second most common refractive error seen here.
  3. Presbyopia or ‘lao hua yan’; the common inability to read in those above 40
  4. Hyperopia or long-sightedness; uncommon.

LASIK has stood the test of time in terms of its success rate and efficacy and we offer it in several modes. It is basically an operation in which a corneal flap is raised and then an excimer laser is used to reshape the cornea underneath after which the flap is replaced. This is like carving a contact lens on the eye.

Before a patient even gets to the operating room though, much important work needs to be done as part of the pre-operative assessment. Only in this way can we assess if a patient’s eye is suitable for Lasik vision correction. This establishes the safety/benefit profile.

An accurate refraction to determine your refractive error is carried out by our fully qualified optometrist before and after pupillary dilatation. Other important measurements are also carried out: the most important of these is corneal topography and we have two systems available to do this, the ORBSCAN II from Bausch and Lomb and the PENTACAM from Oculus. Corneal topography shows us the contours and thickness of the cornea so that an optimal treatment plan can be formulated by our doctors. Wavefront measurements using the Zywave aberrometer are also available. Finally a careful examination through the dilated pupil is made to exclude cataract and other retinal problems like retinal holes or detachments. If your LASIK surgeon does not do this, ask him to! Myopic individuals have a higher risk of thin retinas with holes or retinal detachments and it is an essential pre-LASIK examination. We have seen many patients over the years who have had these problems picked up during a thorough pre-LASIK assessment. These retinal problems need to be repaired before LASIK is considered.

Type of LASIK

The eye surgeon will review and check the numbers and plan the type of LASIK: essentially there are five types of LASIK:

  1. Standard plano-scan LASIK: this is the tried and tested, most reliable and predictable LASIK procedure and is suitable for most people who have nice, thick corneas and ‘normal’ levels of myopia (eg under -6 or 600 degrees). It is also the most economical method.
  2. Aspheric LASIK is the latest iteration in LASIK treatment modalities. It gives better quality vision and yet saves on the amount of tissue used.
  3. Tissue-saving LASIK is a very useful form of LASIK because it allows patients with thinner corneas to have full myopic/astigmatic treatments and yet retain enough cornea for structural safety and for possible enhancement LASIK.
  4. Wavefront LASIK is useful in selected patients who have high levels of pre-existing aberrations in their visual system.
  5. ReLEx SMILE is the 3rd generation of laser vision correction. It is based on the flapless SMILE procedure (small incision lenticule extraction) and hence reduces the risk of flap related complications. This offers the potential for fewer transected corneal nerves and more preservation of tissues with consequent reduced incidence of dry eyes.

The LASIK procedure itself is a quick painless procedure that takes less than 10 minutes per eye. We recommend doing both eyes consecutively on the one occasion. We find that in so doing, patients adapt better during the recovery period as the eyes are balanced.

There are two ways of making a LASIK flap. The tried and tested microkeratome which uses a very high quality blade to make very predictable flaps, and the newer femtosecond laser method which uses a laser to create the flap. Each method has its advantages and disadvantages with specific indications according to each individual’s eye condition and characteristics. We will assess each patient and advise them on the suitability of each of these two methods for their LASIK procedure.

After the procedure, a patient can go home after half an hour or so. When the anaesthetic wears off an hour or two later, the eye may feel uncomfortable, scratchy, itchy, uncomfortable and may water a lot. This is normal and eye drops are given to counter this. In most cases, by the time evening comes around, the pain has settled and patients are able to go out for dinner or watch television. It is also good to try and nap an hour or two after surgery.

How is LASIK Performed

The flap is first created and lifted to one side

Laser energy is then applied for a few seconds to a minute, to reshape the exposed surface of your cornea

ReLEx SMILE

Small Incision Lenticule Extraction


ICL phakic intraocular lens in the eye

The implantable contact lens is a type of phakic intraocular lens (PIOL) used in the correction of eyes with high refractive errors, especially if the cornea is thin. PIOL are artificial lenses which are implanted in front of the natural lens of the eye and functions as a “contact lens” within the eye affording high quality (high definition) vision. PIOLs are especially useful in certain patients who are not suitable for which laser refractive surgery like LASIK. At Eye & Retina Surgeons, the Visian Implantable Collamer Lens (ICL; Staar® Surgical Company, USA) is available for patients who require phakic intraocular lens implantation.

The Visian Implantable Collamer Lens (ICL; Staar® Surgical Company, USA) is a one-piece foldable phakic intraocular lens which is implanted just in front of the natural crystalline lens as a day surgery procedure. This PIOL requires a sutureless sub-3 mm corneal incision for insertion allowing fast visual rehabilitation and eliminating the need for hospital admissions. The Visian ICL is able to correct myopia of -3.0 D to -20.0 D (US approval). Toric models of this PIOL are also available. Toric models are able to correct both myopia and astigmatism simultaneously, eliminating the need for subsequent procedures to correct astigmatism.

 
WHO MAY BENEFIT FROM KAMRA OR INTRACOR?
  • Presbyopic persons dependent on reading glasses.
  • Above the age of 40.
  • Good distance vision without the need for glasses or contact lenses.
  • Persons that have myopia, astigmatism or hyperopia, in addition to presbyopia, maybe considered after a comprehensive evaluation.
  • Good general and eye health with no pre-existing conditions like cataract or glaucoma.
  • Persons who had cataract surgery with an intraocular lens implant can be considered.
  • Persons who had LASIK surgery are not currently eligible to undergo either the KAMRA or INTRACOR procedure until further studies validate the safety and efficacy of these procedures for this group.

To put it simply, presbyopia is the loss of near vision, notably affecting people above the age of 40. Before this age, a person’s eye is able to focus on both far and near objects to see a clear image. However, as we age, our eyes lose their ability to focus on close objects due to the stiffening of the natural lens. As a result, reading becomes difficult and near objects look blurry.

Using a pair of reading glasses is a quick way to improve near vision, but it does nothing to help you see far objects. Putting glasses on and off just to be able to see near and far objects can be tedious, but this can be solved by KAMRA or INTRACOR.

Both the KAMRA and INTRACOR procedures have already obtained the CE Mark.

KAMRA corneal inlay

KAMRA is done by implanting a corneal inlay in a 15-minute day surgery procedure under topical anaesthesia. A corneal flap is created with a femtosecond laser, just like in a LASIK surgery. The KAMRA corneal inlay is placed on the cornea and centered over the pupil. The corneal flap is then replaced over the KAMRA inlay without stitches.

This procedure effectively creates a pinhole effect just like a camera lens uses a smaller aperture to increase the range of focus (depth of field). The small aperture created by KAMRA reduces the blur and thus improves near vision with minimal effect on distance vision.

About a third the diameter of a contact lens and 5 microns (0.005 mm) thick, the KAMRA corneal inlay looks like a black ring. There is a tiny aperture or hole in the centre of the inlay. It is made of a biocompatible polymer material manufactured to strict quality standards.

INTRACOR laser

INTRACOR is a laser procedure done on the eye to correct presbyopia. It is performed with a femtosecond laser on the cornea.The laser treatment is applied within the cornea to induce a change in the shape of the cornea, without the need to cut a flap of the cornea as in LASIK surgery. This small change in shape of the cornea confers a multifocal effect to the eye, allowing it to see better for near without significantly affecting the distance vision.

INTRACOR is performed in a 10-minute day surgery procedure under topical anaesthesia. Unlike KAMRA, there is no need to implant any medical device in the cornea.

KAMRA or INTRACOR reduces your dependence on reading glasses but may not totally eliminate the need for them. You may still need glasses for reading very fine print or in dim light. The amount of time it takes to see an improvement in near vision varies. Some see better in a few days. For others, it takes several months. Limiting usage of reading glasses after the procedure could result in faster results.


INtracor – image courtesy of Technolas

SUPRACOR

SUPRACOR is one the latest treatments available for correcting presbyopia. Like conventional LASIK, it is an all laser procedure that uses a femtosecond laser to first create a thin corneal flap and then uses an excimer laser to reshape the cornea. The main difference is while conventional LASIK corrects only for either distance or near vision, SUPRACOR corrects for both distance and near vision simultaneously. This has the potential to allow patients with presbyopia to see far and near without using multifocal or reading glasses.

It is a new and improved form of presbyopic LASIK which causes less visual distortion compared to previous methods of presbyopia correction with a laser. SUPRACOR is performed in a ten minute outpatient surgery procedure under topical anaesthesia

SUPRACOR can treat patients with myopia and hyperopia who are now presbyopic because of age. It is also able to treat patients who have had LASIK done before and even patients who had cataract surgery.

  Surgical Services
Cataract Surgery
Corneal Surgery
Glaucoma Surgery
Vision Correction Surgery
Medical Retina Services
Oculoplastic and Aesthetic Services
Vitreo-retinal Surgery