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What is LASIK ?  asia information

LASIK Laser In-Situ Keratomileusis

LASIK is a surgical procedure to correct nearsightedness, farsightedness, and astigmatism that utilizes the Microkeratome to create a corneal "flap" of about one-third of the total corneal thickness. The excimer laser is then used to reshape the exposed middle layer of the cornea. The flap is finally put back to assume a new shape created by the excimer laser.


The History of LASIK

LASIK dates back to the year 1949, when the late Professor Jose I. Barraquer of Bogota, Colombia, came up with a method to change the curvature of the cornea to correct nearsightedness and farsightedness. The procedure, known as Keratomileusis, involves using an instrument (the "Microkeratome") to separate a layer of corneal tissue and carving it with a lathe. The corneal tissue is then sutured back to the eye. Keratomileusis proved to be a reasonably safe and effective procedure in trained hands. However, the complexity of the technique and its machinery prevented it from being widely adopted.

In 1983, Dr. Trokel was the first to recognize the potential of the excimer laser as a surgical instrument. It was first used in a procedure called Photorefractive Keratectomy, which utilizes the excimer laser to directly sculpt the cornea's outermost layers. PRK proved to be moderately safe and effective in the treatment of low refractive errors, but became more unpredictable in higher ranges.

The utilization of the excimer laser in combination with the microkeratome was proposed by Drs. Buratto and Pallikaris at about the same time in 1990. The resulting procedure, called Laser In-situ Keratomileusis, or LASIK, combines the accuracy of the excimer laser with the paucity of tissue reaction of keratomileusis, resulting in one of the most accurate vision correction procedures in history. It is also one of the least disruptive, enabling most patients to return to work the very next day..

The LASIK Procedure

The entire LASIK eye surgery procedure takes about 10 minutes and unlike other laser correction techniques, LASIK eye surgery patients experience less discomfort after the procedure in comparison to others and both eyes can be treated simultaneously.

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History Developments in the Excimer Laser Technology



The technology of the excimer laser has been continuously developed in many aspects, but the characteristics that can best categorize each generation of the excimer laser are those of the beam delivery system.

First Generation Excimer Laser

Excimer laser started off as a treatment for near-sightedness only. The procedure involves a laser beam projected in concentric circles of different sizes onto the cornea. The center of the cornea thus receives the most laser energy while the outer areas will, in a pre-calculated manner, receive less.  The effect will be a decrease in corneal curvature, there by correcting near-sightedness by refocusing the light on the retina. This type of treatment, however, is prone to problems due to the non-homogeneity of energy spread across the treatment area. This problem is magnified further when treating wider areas. As a result, the first-generation excimer laser is limited to a treatment zone of about 6mm, making night-vision complications common, especially for patients with large night-time pupil diameters.

Second Generation Excimer Laser

To overcome the limitations of the first-generation excimer laser, the second-generation ones are designed with laser energy output as a narrow slit. The laser is then scanned in the direction perpendicular to the axis of the slit, thus the name “slit-scanning laser”. The procedure did improve the problem of non-homogenous energy spread but the improvement was still limited. The maximum area of treatment remained limited to the 7 to 8 mm range.

Third Generation Excimer Laser

Excimer laser technology entered another phase with the use of computer-controlled scanning mirrors to scan tiny spots of laser energy over the treatment area. This technique is termed “flying spot laser” and is capable of producing extremely smooth surfaces as any unevenness within the spot cancels itself out as it is spread across a large area. The area covered by the spot can be as large as 12mm in diameter, so significant night vision problems are rare with this technology. In addition, the scanning mirrors are controlled by software, allowing third-generation lasers to create just about any treatment profile to cater to any degree of refractive errors.


Advantage of LASIK
  • LASIK makes permanent changes to correct refractive errors
  • Quick surgery and rapid recovery.
  • Minimal temporary side effects
  • Quick return of usable vision.
  • No injections, no suture. Only numbing eyedrops
LASIK and the Improvement of Your Quality of Life
  • LASIK can eliminate risks associated with long term contact lenses usage.
  • LASIK can make you more eligible for certain professions.
  • LASIK can increase convenience in everyday life.
  • LASIK can improve your performance in many activities, especially water and outdoor sports.
  • LASIK can improve your self-confidence

LASIK and the Improvement of Quality of Life

  • LASIK can eliminate risks associated with long term contact lenses usage.
  • LASIK can make you more eligible for certain professions.
  • LASIK can increase convenience in everyday life.
  • LASIK can improve your performance in many activities, especially water and outdoor sports.
  • LASIK can improve your self-confidence.

Who may be qualified for LASIK?

  • People who are at least 18 years of age and have had stable vision for at least one year.
  • People with no corneal diseases (i.e. severe eye dryness),other eye diseases (i.e. retinal degeneration) or any other complicating systemic problems which may affect the eye's healing process (i.e. SLE, Sjogren's, or other immune related deficiencies).
  • Women who are not pregnant or breastfeeding
  • People who have a complete and detailed understanding of the advantages and disadvantages of the surgery, and have realistic expectations of the outcomes.

Side-Effects and Complications of LASIK

These are adverse effects that may occur after LASIK. Although the risks of these side effects and complications are very small in LASIK, they have to be thoroughly understood and accepted by the patient before undergoing the surgery. During the preoperative evaluation by your surgeon, the relative risks of these problems can be discussed on an individual basis.

The noteworthy side effects and complications of LASIK are as follows:

Infection


Infections are very rare in LASIK, but they can damage the cornea if not resolved with early treatment. They are usually identified early and effectively treated with medications. The statistic of Lasik Center in Thailand shows as depicted in the following table:


Vision Correction Options Risks of Corneal Infection

Soft daily-wear contact lenses
(proper care)

1 in 2000 per year

LASIK

1 in 7000* procedures

LASIK Center in Thailand

1 in 12,000* procedures



Glare and Haloes

May be experienced, especially at nighttime. This condition may happen in the early stages after treatment, but will gradually diminish. Nevertheless, some cases may experience more severe glare and haloes than others, and some permanently (with a probability of less than 1%). People with high corrections and large pupils are more prone to get this problem.


Fluctuation of Vision

Fluctuating vision may be more prevalent in the early stages after treatment, but will also slowly improve.


Dry Eyes

As a result of surgery, a patient may not be able to produce enough tears to keep the eyes moist and comfortable. This condition may last the first few months or may be permanent. Intensive drop therapy may be required.




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