Refractive Procedures

Refractive surgery is an excellent solution to many vision problems; although it cannot guarantee perfect vision, refractive surgery can greatly reduce or eliminate one's dependence on glasses and contact lenses. Individuals consider the option of refractive surgery for a variety of very personal reasons, allowing them to more freely pursue their hobbies, sports activities, or career options:

• For frequent travelers with vision problems, breaking glasses or losing contact lenses while far from home can be a major concern. With refractive surgery, these fears are greatly reduced, and travelers do not have to pack as many "backup" items.
• Sports enthusiasts and professional athletes may find that glasses or contact lenses pose performance and safety issues.
• Parents often prefer the convenience of refractive surgery so they can focus on caring for their children, rather than worrying about searching for glasses in the middle of the night or at the swimming pool.

The best way to understand refractive surgery is to understand what causes poor vision to begin with. A "perfect" eye is completely round and bends light rays in such a way that every image that enters the eye appears in focus on the retina, or back surface of the eye. The retina is then able to process this information and send it along to the brain.

Unfortunately, few people have "perfect" eyes. Some eyes are too long, too short, or even the wrong shape altogether. This means that when an image arrives at the retina, it is out of focus and cannot be processed correctly. Below are some of the major categories of refractive errors and corrective procedures performed by Dr. Epitropoulos:

• Myopia
• Hyperopia
• Astigmatism
• Presbyopia
• Laser Vision Correction
• LASIK
• Custom LASIK with VISX® Star 4 ActiveTrak™ Excimer Laser
• Photorefractive Keratectomy (PRK)
• Astigmatic Keratotomy
• (CLE) with the AcrySof® ReSTOR® Lens

Myopia

Myopia, or nearsightedness, is probably the most common type of refractive error, affecting about one in four people in the United States. As sufferers of myopia can attest, they can see things up close (this may be as little as a few inches), but anything further away appears blurry or even indistinguishable.

A long eye is to blame for myopia; as light rays enter the eye, they focus on a point somewhere in front of the retina, causing a blurry image on the surface of the retina. For qualified candidates, Dr. Epitropoulos is able to correct this problem with one of several procedures, the most common being LASIK (and occasionally PRK), which serve to reshape the cornea, or front surface of the eye, and to fine-tune the eye's focusing capabilities.

For individuals who are not candidates for LASIK or PRK surgery, clear lens exchange (CLE) is another option for the treatment of myopia.

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Hyperopia

Hyperopia, or farsightedness, results from an eye that is too short, meaning that light rays reach the retina before they have the opportunity to converge into a focused image. Patients with this condition are able to see, with varying degrees of success, objects further away, but close-up items are blurry.

Because the natural lens of the eye can sometimes accommodate for the farsighted eye when younger, many people do not realize that they are hyperopic until they are in their 30s or 40s. Fortunately, Dr. Alice Epitropoulos can treat hyperopia with LASIK by steepening the cornea and therefore changing the point of focus. Farsightedness can also be corrected by removing the natural crystalline lens and replacing it with a lens implant. This is also known as a clear lens exchange (CLE).

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Astigmatism

Probably the most misunderstood of the refractive errors, astigmatism simply refers to a very common condition in which the eye curves more steeply on one side than the other, so that the cornea is oval or “football” shaped. Astigmatism causes light rays to focus at two different points in the eye which causes distant and near images to be blurred.

Usually occurring in tandem with myopia or hyperopia, the only treatment for astigmatism in the past was to prescribe glasses and contact lenses. Now, with the prevalence of such procedures as LASIK, PRK, and AK (astigmatic keratotomy), astigmatism can be eliminated.

Dr. Epitropoulos was the first in the country to offer AK patients a new take on the procedure. Her innovation has gained national attention and has been featured by both local and national news organizations. If you would like to find out more about your refractive error or schedule a consultation, please do not hesitate to contact the office of Dr. Alice Epitropoulos today.

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Presbyopia

When we are young, our eyes can quickly change focus from an object that is close to one that is farther away. This ability for accommodation is achieved when the eye's lens changes shape in order to change focus. As we age, the lenses in our eyes become less flexible, and therefore less able to accommodate for different focusing distances.

This condition, called presbyopia, is most noticeable when items up close become harder to see; menus and books have to be held farther away, and hobbies involving small details become harder to do. People who are nearsighted often find that they can compensate for early presbyopia by simply removing their glasses. However, eventually reading glasses or bifocals will become necessary for both nearsighted and farsighted people.

Another option for treating presbyopia is called monovision, which involves correcting one eye for distance and one eye for near. With this option sometimes only one eye needs to be corrected. Monovision can be achieved with either contact lenses or with Laser Vision Correction. When considering monovision as an option, Dr. Epitropoulos recommends that patients undergo a trial period with the contact lenses, as some people find it difficult to adapt to monovision.

For patients who are seeking an alternative to monovision, the AcrySof® ReSTOR® intraocular lens may be a good solution. As it replaces the faulty natural lens, an intraocular lens may eliminate the need for glasses entirely. To find out more about your options, and to see if you are an appropriate candidate for any of these procedures, contact the office of Dr. Epitropoulos today!

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Laser Vision Correction

Of all the technological advances made throughout eye care history, laser vision correction is perhaps the most exciting. Dr. Epitropoulos directs a cool laser beam of light from the computer-guided excimer laser to precisely and gently reshape the cornea. The excimer laser is revolutionary in its precision; rather than a continuous beam, the laser produces dozens of tiny pulses every second, each placed in exactly the right location. Both LASIK and PRK are made possible with an excimer laser, as is lasting vision correction. Dr. Epitropoulos offers a complimentary consultation to those interested in laser vision correction.

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LASIK

LASIK, which stands for laser-assisted in situ keratomileusis, is one of the most popular modern treatments for a number of refractive errors, including myopia, hyperopia, and astigmatism. LASIK has a number of benefits; aside from the short amount of time required for the procedure itself, the LASIK procedure allows for rapid healing with minimal discomfort. In fact, most patients see well enough to drive within 24 hours of their LASIK treatment.

Unlike surgeons in many "high-volume" LASIK centers, Dr. Epitropoulos conducts each LASIK exam personally to ensure the highest possible rate of success. She believes that the best way to ensure a successful outcome is for her to personally conduct a comprehensive eye exam. Once Dr. Epitropoulos determines the health of your eyes, she will give you an informed and honest opinion on your candidacy for LASIK surgery.

When preparing for a LASIK evaluation or procedure, please keep in mind that wearing contact lenses can affect the shape of the eye, even if removed immediately prior to the office visit. You should abide by the following guidelines: soft contact lens wearers should stop wearing them for one week prior to the final examination and surgery; users of gas permeable or hard lenses should stop wearing them for four weeks before the final examination and surgery.

During the LASIK evaluation, your eyes will be measured and photographed with a computerized instrument to assess the shape of your cornea. Dr. Epitropoulos will also take into account a number of medical considerations such as your prescription strength, corneal thickness, and general health. She will also talk to you about your individual needs in regard to your lifestyle and your expectations. To help you make the right decision, you may also choose to speak with someone who has had the procedure. Although LASIK is a wonderful option for most people, there are certain groups of people who are not good candidates for the surgery, including:

• People under the age of 21. Most people's eyes are still developing when they are younger, and Dr. Epitropoulos wants to make sure that the prescription has stabilized.
• People with such afflictions as lupus, Sjogren's syndrome, rheumatoid arthritis or other autoimmune conditions.
• People who have scarred corneas or a history of herpes infection in the eye.
• Women who are pregnant or nursing. Often, prescriptions will fluctuate dramatically during and after pregnancy. Women should wait until after they are done nursing before undergoing LASIK.

Once Dr. Epitropoulos finds that you are a good candidate for laser vision correction, she will make sure that you understand all the facts about LASIK and that your expectations are realistic. It will then be up to you to make the ultimate decision to go ahead with the procedure. You are the only person who knows the value that can be placed on reducing your dependence on glasses and contact lenses.

Laser vision correction takes only about 15 minutes to complete. First, your prescription is entered into the computer that controls the laser. After the eye is prepared and numbed with anesthetic drops, Dr. Epitropoulos will create a flap in the cornea using an extraordinarily precise instrument called a microkeratome. You may feel some pressure during this portion of the procedure. The laser is then positioned over the eye, where it will emit small, controlled bursts of energy. Depending on the desired outcome of the surgery, small amounts of corneal tissue will be removed in order to change the focus of the eye. For the duration of the laser's operation, Dr. Epitropoulos will closely monitor the eye through a surgical microscope; she can pause the process at any time. Once the desired prescription has been achieved, the flap is returned to its original position. The flap will self-adhere and does not typically require sutures. The major advantages of corneal flap creation are that healing is faster and that discomfort is greatly reduced.

The postoperative period after LASIK is just as, if not more, important to the success of the procedure. The best way to help the healing process immediately after LASIK is to go directly home and sleep (or at least keep your eyes closed) for about four hours. Your eyelids will help the corneal flap to continue the bonding process. After this time period, it is essential that you keep your eyes lubricated with the drops provided by Dr. Epitropoulos and follow all of her postoperative instructions.

Most people find that they can resume normal activities shortly after undergoing LASIK and return to work within a couple of days. Dr. Epitropoulos will make specific recommendations to you during your follow-up exams.

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Custom LASIK with VISX® Star 4 ActiveTrak™ Excimer Laser

Dr. Alice Epitropoulos always strives to keep up to date with the latest advances in vision correction technology. As a result, she is able to offer laser vision candidates such innovative technology as the VISX® Star 4 ActiveTrak™ Excimer laser, capable of providing CustomVue™ Wavefront™ LASIK.

Conventional LASIK corrects refractive errors such as myopia and hyperopia by sculpting the cornea into a standard shape; this would correlate with a prescription for glasses and contact lenses. While it sharpens visual acuity, this method is unable to correct "higher-order aberrations," or the small imperfections in a patient's eye that cause such undesirable effects as glare and halos around lights at night.

CustomVue™ LASIK performed with the VISX® S4 ActiveTrak™ Excimer laser changes all that. CustomVue™ could potentially correct vision to a level better than that achieved by glasses or contact lenses. Now, an individual "map" of the eye can be created by measuring the manner in which light beams are reflected back from the cornea. The results of this procedure are 25 times more precise than those of standard methods. This map is used to guide the laser, resulting in correction of both refractive errors and higher-order aberrations

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PRK - Photoreactive Keratectomy

PRK, or photoreactive keratectomy, is similar to LASIK in that a laser is used to reshape the cornea to change the way that it focuses. However, in PRK, no flap is created in the cornea. Instead, a thin layer of epithelial, or surface, cells is removed to expose the corneal tissue underneath.

Effective for patients with myopia and astigmatism, PRK is usually an excellent alternative for people who are not suitable candidates for LASIK, including those whose corneas are too thin to accommodate a flap.

Because there is no corneal flap to protect the treated area, patients who undergo PRK can expect to experience more discomfort and a slightly longer recovery period than those who undergo LASIK. Dr. Epitropoulos will likely place a bandage contact lens on the affected eye to protect it during the first few days after surgery. Once the healing period is over, however, PRK patients should enjoy the same amount of success and satisfaction as with other procedures.

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AK - Astigmatic Keratotomy

AK, or astigmatic keratotomy, is a procedure designed specifically to reduce astigmatism by "evening out" the curvature of the cornea. Dr. Epitropoulos achieves this by making a pair of microscopic incisions on the outer edges of the cornea. This causes the cornea to relax, or flatten out, in that area. AK can be performed alone or in conjunction with other refractive procedures.

Dr. Epitropoulos was the first in the country to offer AK patients a new take on the procedure. Her innovation has gained national attention and has been featured by both local and national news organizations. Her technique involves the use of an instrument known as the Terry Astigmatome. This device makes the procedure more accurate reducing error and improving consistency and results. While other ophthalmologists have used the device in the operating room, Dr. Epitropoulos was the first in the country to perform the procedure in the office. The procedure takes approximately 10 minutes and is performed with the patient sitting up at the slit lamp.

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Refractive or Clear Lens Exchange (RLE or CLE) with the AcrySof® ReSTOR® Lens

The first choice for many patients who wish to reduce their dependence on glasses or contact lenses tends to be LASIK or Custom Wavefront™ LASIK. Some patients, however, do not meet the qualifications for these procedures and must find an alternative corrective vision solution.

Many LASIK surgeons will recommend alternative laser eye procedures including PRK, LASEK, or Epi LASIK. All of these procedures reshape the cornea through the use of an excimer laser and are safe and effective in the correction of astigmatism, myopia (nearsightedness), and hyperopia (farsightedness). Unfortunately, patients over the age of 40 may not benefit from this procedure either.

Although Dr. Epitropoulos may be able to offer a level of vision correction in the early phases of presbyopia with monovision LASIK, as the presbyopia progresses it becomes increasingly difficult to effectively treat the problem of focusing up close with LASIK.

Because of this, many patients turn to another form of refractive surgery that can reduce their dependence on glasses and contacts for all vision distances (near, intermediate, and far). This option is clear lens exchange (CLE) with the use of a multifocal or accommodative lens implant to correct the vision defect.

Refractive or clear lens exchange (RLE or CLE, respectively) is an approach to vision correction that may be an excellent alternative for those who are not appropriate candidates for laser vision correction, such as presbyopic patients, or those who have prescriptions that are too extreme to be treated with LASIK.

How does the Acrysof® ReSTOR® Lens work?
As we perform daily activities such as reading, watching television or working at the computer, our eyes are constantly focusing on objects at varying distances - up close, far away and everything in-between. The ability to quickly change focus throughout this range of vision is called accommodation.

Unfortunately, this ability diminishes as we grow older, causing us to become dependent on bifocals or reading glasses. However, the AcrySof® ReSTOR® IOL was designed to provide quality vision, both near and far, by combining the strengths of apodized diffraction and refractive technologies. Before being used in the ReSTOR® IOL, apodized diffraction and refraction were originally developed to improve image quality in microscopes and telescopes.

The Clear Lens Exchange (CLE) Procedure
Clear Lens Exchange is performed in a similar manner to cataract surgery. It is performed in an outpatient surgery center with numbing drops much like LASIK. CLE involves the surgical removal of the eye's natural lens. This is usually accomplished by making a microscopic incision in the periphery of the cornea. The natural lens is removed by ultrasound. Then, a new artificial lens is inserted; this lens is custom-crafted according to an individual's prescription and in a majority of cases reduces or eliminates his or her dependence on corrective lenses.

CLE has been shown to effectively correct most refractive errors, including hyperopia, myopia, and presbyopia. One of the major advantages to undergoing CLE is that, as the patient ages, it is impossible for cataracts to develop, as this only occurs in natural lenses. Therefore, some of the most ideal candidates for CLE are older patients who show signs of cataract development.

The FDA-approved AcrySof® ReSTOR® lens offers the highest available level of independence from glasses. In fact, 80 percent of patients receiving the AcrySof® ReSTOR® lens in clinical trials reported that they never had to use reading glasses or bifocals. Many people say that they see better than they have for decades.

For more information on these procedures, and to find out which treatment is best suited to your individual situation, please contact the office of Dr. Alice Epitropoulos today. We will be happy to schedule a consultation with you to discuss the best treatment options for your eyes.

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Contact Us Today

For more information about your refractive options, please contact the office of Dr. Alice Epitropoulos via email or by calling 866-906-7763.

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Dr. Alice Epitropoulos included in NBC Channel 4's health team.

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Part of NHL Columbus Blue Jacket's ophthalmologist team