LASER

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FEMTOLASIK: THE FLAP IS ALSO CUT BY THE LASER

(LATEST TECHNOLOGY)

 

   The cornea is de frontside of the eye. In most of the lasertreatments the lasik method is the most applied. With this treatment we first make a thin flap in the cornea. This used to be done with a sterile knife driven by a little motor: a “microkeratome” .
 After opening the flap with a spatula, the cornea is irradiate with the laser, so the laser can grind.
 The flap is then folded back .


 WHAT IS FEMTOLASIK ?

  InIndsfksjlqdIOInsdjflsdjlfIn femtolasik the flap is made by a femtoseconde –laser. Such laser does the same as a microkeratome. The flap that is made by the femtoseconde laser is thinner than the flap made by the microkeratome. The advantage is that a thicker cornea is left for the actual treatment with the excimer laser, a higher degree of myopia can be treated on a safe way. We must leave 250 µ cornea! The flap is also cut evenly, so the change is smaller that there still stays astigmatism after the treatment. The laser can also take greater account of the shape of the cornea, so the femtoseconde laser can make, on an even safer way, a flap. This makes the risks by cutting a flap again reduced: less likely to have a small flap er a hole in the flap.

Although the results of the mechanical microkeratomes is good, with the femtosecond method the probability of infrequent complications is reduced. Thus, there are fewer re-operations needed. A step forward in terms of safety and precision. However: because of the high purchase and maintenance costs there are only a few laser clinics who have this device.
 

SYNONYMS

Lasik without microkeratome = lasik without knife= all-laser-lasik = ultra-lasik

 
PROPERTIES OF THE FEMTOSECONDE LASER
The femtosecond laser is a laser that emits light in infrared ( 1053 nm) .
With ultra–short impulses (billionths of one second: a femtosecond) little zones( 1/100 mm) of the cornea are irradiated at a predetermined depth.
The femtosecond laser does not work on the surface like the Excimer laser .
The irradiation of the cornea with the femtosecond laser gives rise to a special phenomenon ” photodisruption”.
There is a small bubble, without heat transfer to surrounding tissue, that way the surrounding tissue is will not get damaged .
Because the laser pulses juxtaposition creates a layer of thousands of tiny air bubbles to the desired depth.
This creates a flap in the cornea that can be opened.
 
FEMTO LASIK TREATMENT PROCESS: VARIOUS STAGES

a) the flap is made by the femtoseconde laser

-A special device is placed on the eye, for the centration of the laser. This device puts less pressure on the eye compared to the classic micro-keratome so the risk on eyedamage is smaller.

-The laserbeam in the holder is controlled by the computer: The laser gives a puls that exactly at a certain depth in the cornea, the stroma, gets. The computer makes that the points are shot next to each other, so the upper layer is separated from the bottom via air bubbles that are arising: a flap is created.

b) the lasik-procedure

-The flap is opened with a spatula

-The excimerlaser is used to grind the cornea-bed so they get the right strength.

-The flap is put back on place 
 
ALL THE  BENEFITS OF FEMTOSECOND LASER:
Ø       It allows us to determine the thickness of the flap individually. When you set a certain cutting depth it will be much more accurate, when you cut with the laser. With the micro-keratome the cutting depth is only an approach with a standard deviation of 20 to 30 micron! With patients who have a very thin cornea we recommend femtolasik .

Ø       The femto lasik makes it possible to cut corneas with an abnormal curvature with reduced risks. The corneas who are to much bend or to much plane have more risk on a loss flap (“ free – cap”) or a whole in the flap ( “ button hole”) with cutting with a classic keratome. The  “bad flap” is put back and the eye recovers very fast, so after 1 month it is possible to cut a new flap. With femtosecondlaser you almost never get bad flaps.
 
Ø       While making the flap there is less pressure on the eye, so the change on damaging is low. Especially with high myopic patients, they have a thinneer cornea.

Ø       Less risk on damaging and wrinkling of the flap because the keratome cuts the flap and rolls the flap in the cutting device. 

Ø       When putting back the flap on the cornea, the flap sucks itselfs on to the cornea, so the chance that the flap loosens is low.

  Ø       Better eyesight, with the femtosecond laser there is less tendency to astigmatism or other aberrations

Ø       The laser can't jam, a micro-keratome can. Moving parts can blockade sooner or later,  by oxidation or dirt. 

 Ø       In femtolaser there is no garbage. With a micro-keratome parts of the blade or motor   kunnen er delen van het mesje of de motor head can loosen, by friction. This leads to white dust particles under the flap, this can lead to an inflammation or visibily reduce! 

Ø        Because the laser incision is so small there is almost no scar. 
 
THE DISADVANTAGES ARE:
Ø       The operation takes longer because the cut-time is longer than with the classic microkeratome and because the opening of the flap takes longer.

Ø       A slower recovery of the vision because a laserincision leads to a certain degree of edema. 24 to 48H this disappears. Most patients can drive the car and do computerwork the day after surgery.

Ø       Specific complications of the femtosecond laser (these complications almost never appearance anymore with the new generation of  femtosedond laser ! ) :

- the idiopatic inflammatory syndrome: because of an unknow reason sometimes a temporarty inflammation can excist after cutting the flap with the laser. With custom inflammatory drops this will disappear in a few days. With the new generation lasers (like our laser), that create many little bubbles, you don't get this problem.

- the peripheral epthelial invasion: with a flap cut by laser, epithelial cells can grow under the flap easily because the cutting edge isn't so sharp as with the micro-keratome.

 
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