No touch laser eye surgery

Although ‘no touch’ TransPRK and LASIK both produce excellent results, there are some differences in the benefits of each. The following are the advantages of ‘no touch’ TransPRK when compared to LASIK:

• There is less risk of dry eyes
• There is less risk of developing a rare condition called ectasia
• It doesn’t require a flap and therefore there is no chance of having flap complications
• It is touchless: No suction, no flap and no incision

LASEK is a very safe procedure, and a good option for many patients. That being said, it does have some downsides when compared to SMILE or LASIK procedures:

• With LASEK laser eye surgery, recovery is slower and accompanied by some pain or discomfort. It’s for this reason that Dr. Arbabi prefers not to use it if he can opt for SMILE or LASIK, however it is still a safe and effective procedure for those who are not suitable for newer laser surgery techniques.

If you and Dr. Arbabi decide that No touch laser isn’t the right procedure for you, you still have options when it comes to improving your vision:

• Continue using your glasses or contact lenses
• Other types of laser eye surgery such as SMILE or LASIK
• ICL implant
• Refractive Lens Exchange

With 30 years track record of ground-breaking improvements in Laser eye surgery technology and over 40 million procedures performed world-wide, laser eye surgery is one of most popular and most successful elective surgeries in the World. The overwhelming majority (over 95% according to Royal college of ophthalmologists*) of laser sight correction patients report that they are satisfied with the results and describe it as a life-changing procedure.

However, like any other surgery it has some risks. Fortunately, in most people even if a complication occurs it tend to be mild, short-term and either resolves by itself or treatable. treatable. However, a small percentage of patient can experience long term and serious complications that may cause eye discomfort or visual problems. The chance of a serious complication is about 1% in general and probably less than 0.3% with an expert and experienced surgeon. According to some large studies**, in 0.6% of patients the vision was worse by 2 or more lines on the visual chart compared to vision before surgery.

Some people are at higher risk of complications than others. In the rare event of a complication, Dr. Arbabi is a fully qualified corneal consultant (many LASIK surgeons are not corneal consultants) which means he has the knowledge, expertise and equipment to promptly deal with any complications that may occur, increasing the likelihood of success.

Risks vary among patients. That’s why Dr. Arbabi will perform a comprehensive assessment and discuss what does this means in your particular case. You will also read through his consent form and patient information pamphlet. So that you will have all of the information you need to decide if this is the best route for you.

Glasses are the only vision correction option which are risk free. All other vision correction options including contact lenses have their own risks. The following are potential risks of laser eye surgery:

• Dry eyes is the most common side effect. About 30 to 40% of patients can experience some degree of dry eye symptoms. The reassuring part is these symptoms tend to be mild and resolve in overwhelming majority of patients. If you were going to get dry eyes it tends to be worse in the first 3 months and then resolve over next 6 to 12 months. Although, persistent and severe dry eye symptoms are rare, especially if you did not have pre-existing dry eyes before laser surgery, they may still occur in about 2% of people. So, there is a very small risk that you may have to live with dry eye symptoms or require permanent eye drops. In a very small subset of patients, dry eye symptoms may be debilitating and may affects all day-to-day activities.
• The second most common symptom is experiencing some sort of visual disturbances such as glare, halos around light, star bursts and decreased quality of vision. This can be particularly troublesome in low light conditions and may affect night time driving. This complication used to be to be more common with the early laser technologies. However, with modern flying spot laser technology and new algorithms this is far less common now. These symptoms occur in about 20% but tend to resolve spontaneously in most people. Rarely, they may need additional treatment or repeat laser surgery to resolve. In a very small number of cases, these symptoms may not resolve or be treatable and may cause permanent symptoms. In PROWL study***** 1% of patients had visual symptoms that significantly affected their day to day activities.
• Third most common symptoms side effect is under or over correction so your glasses prescription is not quite close to zero. About 5% of patients may require enhancement, which means repeat laser treatment to smooth out any remaining near-sightedness, far-sightedness or to correct any irregularity of the corneal surface. The chance of requiring the repeat laser is higher in certain patients such as those with higher glasses prescription. The repeat laser is usually suitable and highly effective in majority of patients to correct the residual glasses prescription. However, a very small percentage of patients may not be suitable for enhancement and hence may still need glasses or contact lenses after surgery or have to have other types of surgery. Therefore, it is important to understand that it is not always guaranteed to be glasses free.
• It is important to have realistic expectations. Laser refractive surgery is highly effective in reducing or eliminating the need for glasses in most people. However, there is no always guarantee that you will be completely glasses-free. At the very least, you should expect to play sports and socialise comfortably without glasses but some patients may still require glasses for certain activities such as reading small print or driving at night.
• Another important point to realise is that it is normal to require reading glasses from around the age of 45 with good uncorrected distance vision. This normal aging process of the eye is called presbyopia. This process explains why people who have never required glasses in the past, start to wear glasses for reading and near work once they get in their 4th decade of life and beyond. This process is not altered by the laser eye surgery. If you have laser eye surgery before this age, you are very likely to require glasses for reading once you in 4th decade of life and beyond. There are, however, effective treatments available to reduce spectacle dependence for older patients such as PRESBYOND Laser Blended Vision, Refractive Lens Exchange or monovision.
• The results of laser eye surgery are intended to be lifelong, but a small percentage of patients may experience a partial return to the vision that they had before surgery (Regression). They may once again become longsighted, short-sighted or have astigmatism.
• One of most serious complications is corneal Ectasia. In this condition, the inner corneal layer becomes weaker causing corneal thinning and irregularity of eye surface which leads to poor vision. This condition is similar or may be identical to another condition called keratoconus which occurs 1 in 2000 of general population who never had laser eye surgery. The risk corneal ectasia after laser eye surgery is generally lower than in general population due to diagnostic pre-treatment test which highlights those patients who are at a higher risk. This condition used to be more common with early LASIK technique when a microkeratome was used than it is now with advanced femtosecond LASIK which is blade-less. A study by NICE estimated the risk of ectasia was 0.2% but highlighted that most of the affected eyes may have been selected inappropriately for LASIK treatment. Which means they should not have had laser as they were at high risk and this should have been picked up by the treating surgeon before surgery. This used to be the most dreaded complication which usually required a corneal transplant. However, over past decade, there is a treatment called collagen cross linking which is very effective if the condition is diagnosed and treated early.
• Another serious complication is corneal infection. This is estimated to occurs in about 1 in 4000 cases. Again, if this is diagnosed and treated early it can usually lead to good visual outcome but it has potential to causes significant corneal scaring and may require corneal transplant. If you are a contact lens wearer, your risk of getting a serious corneal infection is higher than it is with laser eye surgery******. With laser eye surgery, the risk of infection if it occurs tend to happen in the first few days to weeks or rarely months post-surgery. However, with CL the risk of infection is always there for as long as you wear CL.
• With LASIK there is a small added risk of complication because of the LASIK flap. However, with the use of modern bladeless femtosecond lasers, flap related complications are significantly lower compared to the first-generation LASIK which used a microkeratome blade to create the flap. Potential complications with flap surgery include flap misalignment, epithelial ingrowth, inflammation (abnormal healing) or infection. These may require another procedure or intensive treatment with drops. In rare cases, flap surgery can lead to a permanent decrease in vision and may require a corneal transplant.
• Another rare but extremely serious condition is called corneal neuralgia where the corneal nerves become hypersensitive. It can cause burning, stinging, and light sensitivity. However, in some patients it can causes excruciating and debilitating pain which may be difficult or impossible to treat and may require strong painkiller tablets as well as many drops.
• Corneal infection or inflammation may lead to corneal haze or corneal scaring which can be minimal and not troublesome or could causes significant visual loss. About 1 in 5000 (0.02%) of patients may need corneal transplant as a result of these complications or if they develop other complications such as corneal ectasia. Corneal transplant is a major surgery, but, if required, a good level of vision can normally be restored in most people although glasses or contact lenses are likely to be required after surgery.
• On rare occasions, one of the devices used in surgery may malfunction. In this case, surgery will be postponed or stopped altogether. In most cases the treatment can still be restarted and completed but in some instances the surgery may need to be changed, for example from a LASIK to LASEK or from SMILE to a LASIK or LASEK. If the type of treatment needs to be changed, Dr. Arbabi will discuss it with you before proceeding.
• The risk of blindness is exceedingly rare and the risk is lower than wearing contact lenses. The risk of blindness is estimated to be 1 in 5 million. If through an extremely unfortunate and unlikely series of events, a laser eye procedure was to cause blindness, it’s highly unlikely that you would lose vision entirely. So, even in that 1-in-5-million scenario, it’s improbable that you would lose your sight entirely. To put that in perspective, the chance of someone in the UK dying by falling out of bed is 1 in 2 million*** and the chance of getting struck by lightening in the UK per year is 1 in 1.2 million****. This means an individual is four times more likely to get hit by lightning every year in the UK than losing sight in one eye because of laser eye surgery.

References: * https://www.rcophth.ac.uk/wp-content/uploads/2018/07/Patient-Info-LVC-May-2018.pdf
**Sandoval HP, Donnenfeld ED, Kohnen T, et al. Modern laser in situ keratomileusis outcomes. J Cataract Refract Surg. 2016;42(8):1224-1234.
***https://www.mirror.co.uk/news/weird-news/scientists-calculate-odd-ways-die-282884
****https://www.researchgate.net/publication/223811436_Deaths_and_injuries_caused_by_lightning_in_the_United_Kingdom_Analyses_of_two_databases
*****Summary of study can be found on the EyeWorld (American Society of Cataract and Refractive Surgery) website: https://www.eyeworld.org/article-ascrs-responds-to-fda-prowl-studies
******Masters, J., Kocak, M. and Waite, A., 2017. Risk for microbial keratitis: Comparative metaanalysis of contact lens wearers and post-laser in situ keratomileusis patients. Journal of Cataract & Refractive Surgery, 43(1), pp.67-73.

Results from 67, 000 treated eyes*

• Very high success rates with over 99% of patients having better vision than driving standard without glasses
• The glasses prescription after laser surgery was 1D or less in 99%
• 99% of patients were satisfied with the laser eye surgery
• In only 0.6% of patients the vision was worse by 2 or more lines on the visual charts

PROWL 1 and PROWL 2 studies**

were two of largest studies looking at patient reported outcome from LASIK surgery. This was a collaboration between military and non-military ophthalmologists in USA in conjunction with the FDA (Food and Drug Administration). This study found below results:

• Over 96% of patients had 20/20 or better vision without glasses
• More than 95% of participants were satisfied with their vision following LASIK surgery.
• 28% of patients developed mild dry eyes after LASIK but in 65% of patients who had dry eyes before surgery had no dry eyes after LASIK.

Reference:
*Sandoval HP, Donnenfeld ED, Kohnen T, et al. Modern laser in situ keratomileusis outcomes. J Cataract Refract Surg. 2016;42(8):1224-1234.

**Summary of study can be found on the EyeWorld (American Society of Cataract and Refractive Surgery) website: https://www.eyeworld.org/article-ascrs-responds-to-fda-prowl-studies

Most people who have had laser eye surgery describe it as a life-changing procedure, and, according to the Royal College of Ophthalmologists, over 95% of them are satisfied with the results. However, the fear of laser eye surgery is the biggest barrier stopping many patients from having this safe, simple, and painless procedure. It is common for all of us to be anxious about any surgery but when you look at the facts and statistics you soon realise this is the safest elective surgery in the world with very few risks.

• Visualise the benefits: If after careful thinking you cannot see any clear benefit of laser eye surgery and you are happy with glasses, then there is no need for surgery. Glasses, after all, are 100% risk free.
• Choose an excellent surgeon who has access to the latest laser technologies rather than relying on a well-known organisation. Ensure the surgeon is a fully certified and qualified refractive surgeon who will listen, understand and address all your concerns. With the right surgeon and laser technologies, the risk of any serious complications becomes extremely low.
• Some people may find meditation helpful to put things into perspective and balance the risks and benefits.
• Educate yourself about the procedure: The more you know the less you fear. This is the best way to deal with any fear. In this website Dr. Arbabi provides an ample amount of content including YouTube educational videos to help patients understand the full picture. Below are some important facts about laser eye surgery
  • Laser surgery is painless. Your eyes will be numbed with special anaesthetic eye drops. Your eye may feel a little bit irritable and light sensitive, but this usually subsides very quickly.
  • The laser part of the laser eye surgery lasts only a matter of seconds. However, the full procedure may take about 10 to 15 minutes as we get you ready and comfortable on the laser bed.
  • If you are anxious about being awake during surgery, we can give you Valium (diazepam) to help you relax. It is not often that a patient needs this, as Dr. Arbabi will talk to you throughout the procedure and constantly reassure you that everything is OK. If you are too nervous to get the procedure, we can cancel, and you will get a full refund.
  • Laser eye surgery is the most common type of vision correction treatment with over 50 million LASIK surgeries world-wide.
  • Over 100,000 Laser eye surgeries are performed every year in the UK*
  • The chances of going blind are exceedingly rare. While any form of surgery carries some risk, laser eye surgery is an extremely safe and low-risk procedure. Click here for a closer look at the statistics; you’ll see that the chances of blindness are very slim.

*References: https://www.rcophth.ac.uk/standards-publications-research/refractive-surgery-standards/