Durchführung der LASIK in 3 Schritten

1. Freilegen des Hornhautinneren

Mit einem Präzisionsmesser (Keratom) wird ein dünnes Scheibchen der Hornhaut teilweise eingeschnitten. Dieses Scheibchen (engl. flap") wird wie ein "Buchdeckel" weggeklappt. Wird anstelle des mechanischen Mikrokeratoms ein Femtosekundenlaser verwendet, so spricht man von der Femto-LASIK.

2. Der Laser wird angesetzt

Die darunterliegenden tieferen Hornhautschichten werden mit dem Excimer-Laser je nach Fehlsichtigkeit modelliert. Kurzsichtigkeit wird korrigiert, indem die Hornhaut im Zentrum abgeflacht wird. Bei Weitsichtigkeit wird die Hornhaut um das Zentrum ringförmig abgetragen. Eine bestehende Hornhautverkrümmung wird bei einer Korrektur der Kurz- oder Weitsichtigkeit mitbehandelt. Die Oberfläche der Hornhaut wird dabei so abgetragen, dass sie der Kugelform angenähert wird.

3. Wundverschluss

Das Hornhautscheibchen wird wieder zurückgelegt, haftet von selbst und schützt als körpereigenes Pflaster die Wunde.

Wann findet das LASIK-Verfahren Anwendung?

- Kurzsichtigkeit bis ca. -12 dpt.
- Weitsichtigkeit bis ca. +5 dpt.
- Hornhautverkrümmung bis ca. -/+5 dpt.

Über 90% aller fehlsichtigen Patienten sind für die LASIK Laserkorrektur geeignet. Die LASIK ist daher das am häufigsten angewendete Verfahren zur Korrektur einer Fehlsichtigkeit.

Was sind die Vorteile des LASIK-Verfahrens?

- Gute Vorhersagbarkeit innerhalb des Indikationsbereichs.
- Der Eingriff dauert nur wenige Minuten.
- Durch lokal betäubende Augentropfen ist die OP sehr schmerzarm.
- Bereits nach einigen Stunden erreichen Sie wieder ein gutes Sehvermögen.
- Viele Patienten kehren am nächsten Tag wieder in Ihr normales Alltagsleben zurück.
- Der natürliche Aufbau der oberflächlichen Hornhautschichten bleibt erhalten.
- Die Wundheilung verläuft im Hornhautinneren von selbst, langsam und gleichmäßig.
- Der Heilungsprozess verläuft in der Regel rasch und schmerzfrei.
- Der Patient erreicht schnell die volle Sehkraft.

Myopia (Nearsightedness) :  

What causes nearsightedness?

How is nearsightedness diagnosed?

How is nearsightedness treated?

Myopia Video

What causes nearsightedness?

The exact cause of nearsightedness is unknown, but two factors may be primarily responsible for its development:

a) heredity
b) visual stress

There is significant evidence that many people inherit nearsightedness, or at least the tendency to develop nearsightedness. If one or both parents are nearsighted, there is an increased chance their children will be nearsighted.

Even though the tendency to develop nearsightedness may be inherited, its actual development may be affected by how a person uses his or her eyes. Individuals who spend considerable time reading, working at a computer, or doing other intense close visual work may be more likely to develop nearsightedness.

Nearsightedness may also occur due to environmental factors or other health problems:

Some people may experience blurred distance vision only at night. This "night myopia" may be due to the low level of light making it difficult for the eyes to focus properly or the increased pupil size during dark conditions, allowing more peripheral, unfocused light rays to enter the eye.

People who do an excessive amount of near vision work may experience a false or "pseudo" myopia. Their blurred distance vision is caused by over use of the eyes' focusing mechanism. After long periods of near work, their eyes are unable to refocus to see clearly in the distance. The symptoms are usually temporary and clear distance vision may return after resting the eyes. However, over time constant visual stress may lead to a permanent reduction in distance vision.

Symptoms of nearsightedness may also be a sign of variations in blood sugar levels in persons with diabetes or an early indication of a developing cataract.

An optometrist can evaluate vision and determine the cause of the vision problems.

How is nearsightedness diagnosed?

Testing for nearsightedness may use several procedures in order to measure how the eyes focus light and to determine the power of any optical lenses needed to correct the reduced vision.

A phoropter and retinoscope are often used to determine the lenses that allow the clearest vision during a comprehensive eye exam.
As part of the testing, letters on a distance chart are identified. This test measures visual acuity, which is written as a fraction such as 20/40.

The top number of the fraction is the standard distance at which testing is performed, twenty feet. The bottom number is the smallest letter size read. A person with 20/40 visual acuity would have to get within 20 feet to identify a letter that could be seen clearly at forty feet in a "normal" eye. Normal distance visual acuity is 20/20, although many people have 20/15 (better) vision.

Using an instrument called a phoropter, an optometrist places a series of lenses in front of your eyes and measures how they focus light using a hand held lighted instrument called a retinoscope. The doctor may choose to use an automated instrument that automatically evaluates the focusing power of the eye. The power is then refined by patient's responses to determine the lenses that allow the clearest vision.

This testing may be done without the use of eye drops to determine how the eyes respond under normal seeing conditions. In some cases, such as for patients who can't respond verbally, or when some of the eye's focusing power may be hidden, eye drops may be used. They temporarily keep the eyes from changing focus while testing is performed.

Using the information obtained from these tests, along with the results of other tests of eye focusing and eye teaming, your optometrist can determine if you have nearsightedness. He or she will also determine the power of any lens correction needed to provide clear vision. Once testing is complete, your optometrist can discuss options for treatment.

How will nearsightedness affect my lifestyle?

Most individuals adapt well to wearing glasses or contact lenses. For those individuals who feel glasses affect their image or interfere with their activities, contact lenses, orthokeratology or refractive surgery may provide options to better meet their lifestyle and vision needs. In some cases, more severely nearsighted individuals may find the condition limits their choice of occupations.

How is nearsightedness treated?

Persons with nearsightedness have several options available to regain clear distance vision. They include:

- eyeglasses
- contact lenses
- orthokeratology
-l aser and other refractive surgery procedures
- vision therapy for persons with stress-related nearsightedness.

Eyeglasses are the primary choice of correction for persons with nearsightedness. Generally, a single vision lens is prescribed to provide clear vision at all distances. However, for patients over about age 40, or children and adults whose nearsightedness is due to the stress of near vision work, a bifocal or progressive addition lens may be needed. These multifocal lenses provide different powers or strengths throughout the lens to allow for clear vision in the distance and also clear vision up close.

Eyeglasses are frequently used to correct myopia.
A large selection of lens types and frame designs are now available for patients of all ages. Eye glasses are no longer just a medical device that provides needed vision correction, but can also be a fashion statement. They are available in a wide variety of sizes, shapes, colors and materials that not only correct for vision problems but also may enhance appearance.

For some individuals, contact lenses can offer better vision than eyeglasses. They may provide clearer vision and a wider field of view. However, since contact lenses are worn directly on the eyes, they require regular cleaning and care to safeguard eye health.

Orthokeratology (Ortho-k), also known as corneal refractive therapy, involves the fitting of a series of rigid contact lenses to reshape the cornea, the front outer surface of the eye. The contact lenses are worn daily for limited periods, such as overnight, and then removed. Persons with moderate amounts of nearsightedness may be able to temporarily obtain clear vision for most of their daily activities.

Nearsightedness can also be corrected by reshaping the cornea using a laser beam of light. Two commonly used procedures are photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK).

In PRK, a laser is used to remove a thin layer of tissue from the surface of the cornea in order to change its shape and refocus light entering the eye. There is a limit to how much tissue can safely be removed and therefore the amount of nearsightedness that can be corrected.

LASIK does not remove tissue from the surface of the cornea, but from its inner layers. To do this, a section of the outer corneal surface is cut and folded back to expose the inner tissue. Then a laser is used to remove the precise amount of corneal tissue needed to reshape the eye, and then the flap of outer tissue is placed back in position to heal. The amount of nearsightedness that LASIK can correct is limited by the amount of corneal tissue that can be removed in a safe manner.

People who are highly nearsighted or whose corneas are too thin to allow the use of laser procedures now have another option. They may be able to have their nearsightedness surgically corrected by implanting small lenses in their eyes. These intraocular lenses look like small contact lenses and they provide the needed optical correction directly inside the eye.

Vision therapy is an option for people whose blurred distance vision is caused by a spasm of the muscles which control eye focusing. Various eye exercises can be used to improve poor eye focusing ability and regain clear distance vision.

People with nearsightedness have a variety of options to correct their vision problem. In consultation with your optometrist, you can select the treatment that best meets you visual and lifestyle needs.

Hyperopia (Farsightedness)  

Hyperopia: Description

What are signs/symptoms of farsightedness?

How is farsightedness diagnosed?

Hyperopia Video

Hyperopia: Description

Farsightedness, or hyperopia, as it is medically termed, is a vision condition in which distant objects are usually seen clearly, but close ones do not come into proper focus.
Farsightedness occurs if your eyeball is too short or the cornea has too little curvature, so light entering your eye is not focused correctly.

Common signs of farsightedness include difficulty in concentrating and maintaining a clear focus on near objects, eye strain, fatigue and/or headaches after close work, aching or burning eyes, irritability or nervousness after sustained concentration.

Common vision screenings, often done in schools, are generally ineffective in detecting farsightedness. A comprehensive optometric examination will include testing for farsightedness.

In mild cases of farsightedness, your eyes may be able to compensate without corrective lenses. In other cases, your optometrist can prescribe eyeglasses or contact lenses to optically correct farsightedness by altering the way the light enters your eyes.

What are signs/symptoms of farsightedness?

Common signs and symptoms of farsightedness include difficulty in concentrating and maintaining a clear focus on near objects, blurred vision, eye strain, fatigue and/or headaches after close work.

How is farsightedness diagnosed?

Farsightedness can be effectively diagnosed in a comprehensive optometric examination. Common vision screenings, often done in schools, are generally ineffective in detecting farsighted people. This is because these individuals can identify the letters on an eye chart with little difficulty.

Astigmatism 

What causes astigmatism?

How is astigmatism diagnosed?

How is astigmatism treated?

What causes astigmatism?

Astigmatism occurs due to the irregular shape of the cornea or the lens inside the eye. The cornea and lens are primarily responsible for properly focusing light entering your eyes allowing you to see things clearly.

The curvature of the cornea and lens causes light entering the eye to be bent in order to focus it precisely on the retina at the back of the eye. In astigmatism, the surface of the cornea or lens has a somewhat different curvature in one direction than another. In the case of the cornea, instead of having a round shape like a basketball, the surface of the cornea is more like a football. As a result, the eye is unable to focus light rays to a single point causing vision to be out of focus at any distance.

Sometimes astigmatism may develop following an eye injury or eye surgery.

There is also a relatively rare condition called keratoconus where the cornea becomes progressively thinner and cone shaped. This results in a large amount of astigmatism resulting in poor vision that cannot be clearly corrected with spectacles. Keratoconus usually requires contact lenses for clear vision, and it may eventually progress to a point where a corneal transplant is necessary.

How is astigmatism diagnosed?

Astigmatism can be diagnosed through a comprehensive eye examination. Testing for astigmatism measures how the eyes focus light and determines the power of any optical lenses needed to compensate for reduced vision.

This examination may include:

Visual acuity - As part of the testing, you'll be asked to read letters on a distance chart. This test measures visual acuity, which is written as a fraction such as 20/40. The top number is the standard distance at which testing is done, twenty feet. The bottom number is the smallest letter size you were able to read. A person with 20/40 visual acuity would have to get within 20 feet of a letter that should be seen at forty feet in order to see it clearly. Normal distance visual acuity is 20/20.

Keratometry - A keratometer is the primary instrument used to measure the curvature of the cornea. By focusing a circle of light on the cornea and measuring its reflection, it is possible to determine the exact curvature of the cornea's surface. This measurement is particularly critical in determining the proper fit for contact lenses

. A more sophisticated procedure called corneal topography may be performed in some cases to provide even more detail of the shape of the cornea.

Refraction - Using an instrument called a phoropter, your optometrist places a series of lenses in front of your eyes and measures how they focus light. This is performed using a hand held lighted instrument called a retinoscope or an automated instrument that automatically evaluates the focusing power of the eye. The power is then refined by patient's responses to determine the lenses that allow the clearest vision.

Using the information obtained from these tests, your optometrist can determine if you have astigmatism. These findings, combined with those of other tests performed, will allow the optometrist to determine the power of any lens correction needed to provide clear, comfortable vision, and discuss options for treatment.

How is astigmatism treated?

Persons with astigmatism have several options available to regain clear vision. They include:

- eyeglasses
- contact lenses
- orthokeratology
- laser and other refractive surgery procedures

Eyeglasses are a common form of correction for persons with astigmatism.

Eyeglasses are the primary choice of correction for persons with astigmatism. They will contain a special cylindrical lens prescription to compensate for the astigmatism. This provides for additional lens power in only specific meridians of the lens. An example of a prescription for astigmatism for one eye would be -1.00 -1.25 X 180. The middle number (-1.25) is the lens power for correction of the astigmatism. The "X 180" designates the placement (axis) of the lens power. The first number (-1.00) indicates that this prescription also includes a correction for nearsightedness in addition to astigmatism.

Generally, a single vision lens is prescribed to provide clear vision at all distances. However, for patients over about age 40 who have the condition called presbyopia, a bifocal or progressive addition lens may be needed. These provide different lens powers to see clearly in the distance and to focus effectively for near vision work.

A wide variety of lens types and frame designs are now available for patients of all ages. Eyeglasses are no longer just a medical device that provides needed vision correction. Eyeglass frames are available in a many shapes, sizes, colors and materials that not only allow for correction of vision, but also enhance appearance.

For some individuals, contact lenses can offer better vision than eyeglasses. They may provide clearer vision and a wider field of view. However, since contact lenses are worn directly on the eyes, they require regular cleaning and care to safeguard eye health.

Soft contact lenses conform to the shape of the eye, therefore standard soft lenses may not be effective in correcting astigmatism. However, special toric soft contact lenses are available to provide a correction for many types of astigmatism. Because rigid gas permeable contact lenses maintain their regular shape while on the cornea, they offer an effective way to compensate for the cornea's irregular shape and improve vision for persons with astigmatism and other refractive errors.

Orthokeratology (Ortho-K) involves the fitting of a series of rigid contact lenses to reshape the cornea, the front outer cover of the eye. The contact lenses are worn for limited periods, such as overnight, and then removed. Persons with moderate amounts of astigmatism may be able to temporarily obtain clear vision without lenses for most of their daily activities. Orthokeratology does not permanently improve vision and if you stop wearing the retainer lenses, your vision may return to its original condition.

Astigmatism can also be corrected by reshaping the cornea using a highly focused laser beam of light. Two commonly used procedures are photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK).

PRK removes tissue from the superficial and inner layers of the cornea. LASIK does not remove tissue from the surface of the cornea, but only from its inner layer. To do this, a section of outer corneal surface is cut and folded back to expose the inner tissue. Then a laser is used to remove the precise amount of tissue needed and the flap of outer tissue is placed back in position to heal. Both procedures allow light to focus on the retina by altering the shape of the cornea.

Individuals with astigmatism have a wide range of options to correct their vision problem. In consultation with your optometrist, you can select the treatment that best meets your visual and lifestyle needs.

Cataract 

Causes of cataracts

How is cataract diagnosed?

How is cataract treated?

What causes cataracts?

Most cataracts are due to age-related changes in the lens. However, other factors can contribute to their development including:

Diabetes mellitus - Persons with diabetes are at higher risk for cataracts.

Drugs - Certain medications have been found to be associated with the development of a cataract. These include:
- Corticosteroids
- Chlorpromazine and other phenothiazine related medications

Ultraviolet radiation - Studies have shown that there is an increased chance of cataract formation with unprotected exposure to ultraviolet (UV) radiation.
Smoking - An association between smoking and increased nuclear opacities has been reported.

Alcohol - Several studies have shown increased cataract formation in patients with higher alcohol consumption compared with people who have lower or no alcohol consumption.

Nutritional deficiency - Although the results are inconclusive, studies have suggested an association between cataract formation and low levels of antioxidants (e.g. vitamin C, vitamin E, carotenoids). Further studies may show that antioxidants have a significant effect on decreasing cataract development.

Rarely, cataracts can be present at birth or develop shortly after. They may be inherited or develop due to an infection, i.e. rubella, in the mother during pregnancy.

A cataract may also develop following an injury to the eye or surgery for another eye problem, such as glaucoma.

While there are no clinically proven approaches to preventing cataracts, simple preventive strategies include reducing exposure to sunlight through UV blocking lenses, decreasing or discontinuing smoking and increasing antioxidant vitamin intake through consumption of leafy green vegetables and nutritional supplements.

How is cataract diagnosed?

Cataracts can be diagnosed through a comprehensive eye examination.

This examination may include:

Patient history to determine vision difficulties experienced by the patient that may limit their daily activities and other general health concerns affecting vision.

Visual acuity measurement to determine to what extent a cataract may be limiting clear vision at distance and near.

Refraction to determine the need for changes in an eyeglass or contact lens prescription.

Evaluation of the lens under high magnification and illumination to determine the extent and location of any cataracts.

Evaluation of the retina of the eye through a dilated pupil.

Measurement of pressure within the eye.

Supplemental testing for color vision and glare sensitivity.

Additional testing may be needed to determine the extent of impairment to vision caused by a cataract and to evaluate whether other eye diseases may limit vision following cataract surgery.

Using the information obtained from these tests, your optometrist can determine if you have cataracts and advise you on options for treatment.

How is cataract treated?

The treatment of cataracts is based on the level of visual impairment they cause.

If a cataract affects vision only minimally, or not at all, no treatment may be needed. Patients may be advised to monitor for increased visual symptoms and follow a regular check-up schedule.

In some cases, a change in eyeglass prescription may provide temporary improvement in visual acuity. Increasing the amount of light used when reading may be beneficial. The use of anti-glare coatings on clear lenses can help reduce glare for night driving.

When a cataract progresses to the point that it affects a person's ability to do normal everyday tasks, surgery may be needed. Cataract surgery involves removing the lens of the eye and replacing it with an artificial lens. The artificial lens requires no care and can significantly improve vision. New artificial lens options include those that simulate the natural focusing ability of a young healthy lens.

Two approaches to cataract surgery are generally used:

Small incision cataract surgery involves making an incision in the side of the cornea, the clear outer covering of the eye, and inserting a tiny probe into the eye. The probe emits ultrasound waves that soften and break-up the lens so it can be removed by suction. This process is called phacoemulsification.

Extracapsular surgery requires a somewhat larger incision in the cornea and the lens core is removed in one piece.
Once the natural lens has been removed, it is replaced by a clear plastic lens called an intraocular lens (IOL). For situations where implanting an IOL is not possible because of other eye problems, contact lenses and in some cases eyeglasses may be an option to provide needed vision correction.

As with any surgery, cataract surgery has risks from infection and bleeding. Cataract surgery also slightly increases the risk of retinal detachment. It is important to discuss the benefits and risks of cataract surgery with your eye care providers. Other ocular conditions may increase the need for cataract surgery or prevent a person from being a cataract surgery candidate.

Cataract surgery is one of the safest and most effective types of surgery performed in the United States today. Approximately 90 percent of cataract surgery patients report better vision following the surgery. without lenses for most of their daily activities. Orthokeratology does not permanently improve vision and if you stop wearing the retainer lenses, your vision may return to its original condition.

Glaucoma 

Causes of glaucoma

How is glaucoma diagnosed?

How is glaucoma treated?

What causes glaucoma?

There are many types of glaucoma and many theories about the causes of glaucoma.

The exact cause is unknown. Although the disease is usually associated with an increase in the fluid pressure inside the eye, other theories include lack of adequate blood supply to the nerve.

Primary open-angle glaucoma – This is the most common form of glaucoma. One theory is that glaucoma is thought to develop when the eye's drainage system becomes inefficient over time. This leads to an increased amount of fluid and a gradual buildup of pressure within the eye. Other theories of the cause of the optic nerve damage include poor perfusion, or blood flow, to the optic nerve. Damage to the optic nerve is slow and painless and a large portion of vision can be lost before vision problems are noticed. Other theories also exist.

Angle-closure glaucoma – This type of glaucoma, also called closed-angle glaucoma or narrow angle glaucoma, is a less common form of the disease. It is a medical emergency that can cause vision loss within a day of its onset.

It occurs when the drainage angle in the eye (formed by the cornea and the iris) closes or becomes blocked. Many people who develop this type of glaucoma have a very narrow drainage angle. With age, the lens in the eye becomes larger, pushing the iris forward and narrowing the space between the iris and the cornea. As this angle narrows, the aqueous fluid is blocked from exiting through the drainage system, resulting in a buildup of fluid and an increase in eye pressure.

Angle-closure glaucoma can be chronic (progressing gradually) or acute (appearing suddenly). The acute form occurs when the iris completely blocks the drainage of the aqueous fluid. In people with a narrow drainage angle, if their pupils become dilated, the angle may close and cause a sudden increase in eye pressure. Although an acute attack often affects only one eye, the other eye may be at risk of an attack as well.

Secondary glaucoma – This type of glaucoma occurs as a result of an injury or other eye disease. It may be caused by a variety of medical conditions, medications, physical injuries, and eye abnormalities. Infrequently, eye surgery can be associated with secondary glaucoma.

Normal-tension glaucoma – In this form of glaucoma, eye pressure remains within what is considered to be the "normal" range, but the optic nerve is damaged nevertheless. Why this happens is unknown.
It is possible that people with low-tension glaucoma may have an abnormally sensitive optic nerve or a reduced blood supply to the optic nerve caused by a condition such as atherosclerosis, a hardening of the arteries. Under these circumstances even normal pressure on the optic nerve may be enough to cause damage.

Risk factors

Certain factors can increase the risk for developing glaucoma. They include:

Age – People over age 60 are at increased risk for the disease. For African Americans, however, the increase in risk begins after age 40. The risk of developing glaucoma increases slightly with each year of age.

Race – African Americans are significantly more likely to get glaucoma than are Caucasians, and they are much more likely to suffer permanent vision loss as a result. People of Asian descent are at higher risk of angle-closure glaucoma and those of Japanese descent are more prone to low-tension glaucoma.

Family history of glaucoma – Having a family history of glaucoma increases the risk of developing glaucoma.

Medical conditions – Some studies indicate that diabetes may increases the risk of developing glaucoma, as do high blood pressure and heart disease.

Physical injuries to the eye – Severe trauma, such as being hit in the eye, can result in immediate increased eye pressure and future increases in pressure due to internal damage. Injury can also dislocate the lens, closing the drainage angle, and increasing pressure.

Other eye-related risk factors – Eye anatomy, namely corneal thickness and optic nerve appearance indicate risk for development of glaucoma. Conditions such as retinal detachment, eye tumors, and eye inflammations may also induce glaucoma. Some studies suggest that high amounts of nearsightedness may also be a risk factor for the development of glaucoma.

Corticosteroid use – Using corticosteroids for prolonged periods of time appears to put some people at risk of getting secondary glaucoma.

How is glaucoma diagnosed?

Glaucoma is diagnosed through a comprehensive eye examination.

To establish a diagnosis of glaucoma, several factors must be present: Because glaucoma is a progressive disease, meaning it worsens over time, a change in the appearance of the optic nerve, a loss of nerve tissue, and a corresponding loss of vision confirm the diagnosis.

Some optic nerves have a suspicious appearance, resembling nerves with glaucoma, but the patients may have no other risk factors or signs of glaucoma. These patients should be closely followed with routine comprehensive exams to monitor for change.

Testing includes:

Patient history to determine any symptoms the patient is experiencing and the presence of any general health problems and family history that may be contributing to the problem.

Visual acuity measurements to determine the extent to which vision may be affected.

Tonometry to measure the pressure inside the eye to detect increased risk factors for glaucoma.

Pachymetry to measure corneal thickness. People with thinner corneas are at an increased risk of developing glaucoma.

Visual field testing, also called perimetry, to check if the field of vision has been affected by glaucoma. This test measures your side (peripheral) vision and central vision by either determining the dimmest amount of light that can be detected in various locations of vision, or by determining sensitivity to targets other than light, and comparing it to others of similar age.

Evaluation of the retina of the eye, which may include photographs of the optic nerve, in order to monitor any changes that might occur over time.
Supplemental testing may include gonioscopy, a procedure allowing views of the angle anatomy, the area in the eye where fluid drainage occurs.

Serial tonometry may be performed. This is a procedure acquiring several pressure measurements over time, looking for changes in the eye pressure throughout the day. Other tests include using devices to measure nerve fiber thickness, and look for specific areas of the nerve fiber layer for loss of tissue.

How is glaucoma treated?

The treatment of glaucoma is aimed at reducing intraocular pressure.

The most common first line treatment of glaucoma is usually prescription eye drops that must be taken regularly. In some cases, systemic medications, laser treatment, or other surgery may be required. While there is no cure as yet for glaucoma, early diagnosis and continuing treatment can preserve eyesight.


Medications - A number of medications are currently available to treat glaucoma. Typically medications are intended to reduce elevated intraocular pressure. One may be prescribed a single medication or a combination of medications. The type of medication may change if it is not providing enough pressure reduction or if the patient is experiencing side-effects from the drops.

Surgery involves either laser treatment, making a drainage flap in the eye, inserting a drainage valve, or destroying the tissue that creates the fluid in the eye. All procedures aim to reduce the pressure inside the eye. Surgery may help lower pressure when medication is not sufficient, however it cannot reverse vision loss.

Laser surgery - Laser trabeculoplasty helps fluid drain out of the eye. A high-energy laser beam is used to stimulate the trabecular meshwork to work more efficiently at fluid drainage. The results may be somewhat temporary, and the procedure may need to be repeated in the future.

Conventional surgery - If eye drops and laser surgery aren't effective in controlling eye pressure, you may need a filtering procedure called a trabeculectomy. Filtering microsurgery involves creating a drainage flap, allowing fluid to percolate into and later drain into the vascular system.

Drainage implants - Another type of surgery, called drainage valve implant surgery, may be an option for people with uncontrolled glaucoma, secondary glaucoma or for children with glaucoma. A small silicone tube is inserted in the eye to help drain aqueous fluid.

Treatment for acute angle-closure glaucoma

Acute angle-closure glaucoma is a medical emergency. Several medications can be used to reduce eye pressure as quickly as possible. A laser procedure called laser peripheral iridotomy will also likely be performed. In this procedure, a laser beam creates a small hole in the iris to allow aqueous fluid to flow more freely into the front chamber of the eye where it then has access to the meshwork for drainage.

Lifelong treatment

There is no cure for glaucoma. Patients with glaucoma need to continue treatment for the rest of their lives. Because the disease can progress or change silently, compliance with eye medications and eye examinations are essential, as treatment may need to be adjusted periodically.

By keeping eye pressure under control, continued damage to the optic nerve and continued loss of your visual field may slow or stop. The optometrist may focus on lowering the intraocular pressure to a level that is least likely to cause further optic nerve damage. This level is often referred to as the target pressure and will probably be a range rather than a single number. Target pressure differs for each person, depending on the extent of the damage and other factors.

Target pressure may change over the course of a lifetime. Newer medications are always being developed to help in the fight against glaucoma.

Early detection, prompt treatment and regular monitoring can help to control glaucoma and therefore reduce the chances of progression vision loss.

Advantages 

Am I happy with my glasses & contacts lenses?

Wearing glasses and contact lenses can get in the way of leading an active life. Maybe these
scenarios sound familiar:

•Your glasses constantly slip while you're playing tennis

•Your contacts have popped out during a mountain biking or snowboarding adventure

•You have to swim, surf and scuba dive "blind" because you can't wear glasses or contacts in
the water

Have you ever thought about how much more fun—and success—you'd have if you could see without
glasses or contacts? If so, laser eye surgery may be the ultimate tool to enhance your lifestyle.

Contacts Are NOT The Long-Term Answer

Here's why:

• Contacts require meticulous cleansing to avoid infection.
• Experts consider the rate of infection higher with contacts than with corrective laser eye surgery
procedures.
• Contacts are expensive. A 25-year-old can expect to spend tens of thousands of dollars on
contacts over his or her lifetime—as much as FIVE TIMES the price of the typical LASIK
procedure2.

A track record of success

What kind of lifestyle compromises do you make because of your contacts? It's time to stop sacrificing
and start living your best life. The fact is, laser vision correction has never been safer or more
effective.

• Doctors have been performing laser vision correction procedures for over a decade, with 31.4
million procedures performed worldwide to date.3 It's the most common elective vision procedure
in the U.S.

• About 98% of mildly to moderately nearsighted patients participating in CustomVue clinical trials
submitted to the FDA could see 20/20 or better one year after treatment4.

You can keep wearing contacts for the rest of your life or opt for the corrective laser eye surgery
procedure. It's easier than ever to say goodbye to contacts for good.

References
1. Oregon Health & Science University (OHSU) Casey Eye Institute. Is LASIK Surgery Safer
than Contact Lenses?
2. Based on an estimated iLASIK Procedure fee of $5000. Source: Michael L. Stark, DO; Jeffrey
M. Ward, OD.
3. Market Scope Q1 2009 Quarterly Estimate.

Durchführung der Femto-LASIK in 3 Schritten

1. Der Femtosekunden-Laser wird angesetzt

Zur Vorbereitung der Laserung wird ein Fixationsring mit einem Kontaktglas auf das Auge gesetzt, über den computergesteuert Laserpulse (Femto-Laser) in einer vorausberechneten Tiefe einen Laserschnitt erzeugen.

2. Freilegen des Hornhautinneren

Die Laserpulse erzeugen kleine (10-30 Mikrometer) Gasblasen und trennen das Hornhautgewebe in einer optisch festgelegten Schichttiefe. Wie bei der LASIK wird jetzt der Hornhautdeckel mit einem feinen Instrument aufgeklappt.

3. Der Excimer-Laser wird angesetzt

Die darunterliegenden tieferen Hornhautschichten werden mit dem Excimer-Laser je nach Fehlsichtigkeit modelliert. Kurzsichtigkeit wird korrigiert, indem die Hornhaut im Zentrum abgeflacht wird. Bei Weitsichtigkeit wird die Hornhaut um das Zentrum ringförmig abgetragen. Eine bestehende Hornhautverkrümmung wird bei einer Korrektur der Kurz- oder Weitsichtigkeit mitbehandelt. Die Oberfläche der Hornhaut wird dabei so abgetragen, dass sie der Kugelform angenähert wird. Das Hornhautscheibchen wird wieder zurückgelegt, haftet von selbst und schützt als körpereigenes Pflaster die Wunde.

Wann findet das Femto-LASIK Verfahren Anwendung?

- Kurzsichtigkeit bis ca. -12 dpt.
- Weitsichtigkeit bis ca. +5 dpt.
- Hornhautverkrümmung bis ca. -/+5 dpt.

Über 99% aller fehlsichtigen Patienten sind für die Femto-LASIK Laserkorrektur geeignet. 50-60% aller durchgeführten LASIK-Operationen, die Dr. Bas täglich durchführt sind Femto-LASIK-Eingriffe. .

Was sind die Vorteile des Femto-LASIK Verfahrens?

Die Eigenschaften der Femto-LASIK entsprechen denen der LASIK. Durch Einsatz des Femtosekundenlasers bei der Präparation der Hornhautlamelle bietet die Femto-LASIK zusätzlich:

hohe Präzision:

Bei der Femto-LASIK werden mit dem Femtosekundenlaser homogene, gleichmäßig dicke Hornhautlamellen mit exakt reproduzierbarem Durchmesser erzeugt. Bei Mikrokeratomen sind Schwankungen der Lamellendicke von 50 µm die Regel – der Laserschnitt mit dem Femtosekundenlaser hat hingegen eine Toleranz von lediglich 5 µm. Darüber hinaus ist die mit dem Femtosekundenlaser präparierte Hornhautlamelle stabiler und lässt sich nach der Korrektur zuverlässig und präzise wieder an die alte Stelle zurücklegen.

hohe Sicherheit:

Durch die Präzision des Femtosekundenlasers werden schnittbedingte Komplikationen bei der Femto-LASIK eliminiert. Bei einem unvollständigen Schnitt kann man - da die Hornhaut gewissermaßen nur unterirdisch durchtrennt wurde - einfach neu ansetzen, ohne damit größere Komplikationen zu riskieren. Außerdem sind Infektionen nahezu ausgeschlossen, da bei einem Laserschnitt keine Keime übertragen werden können. Auch Epitheleinwachsungen werden praktisch nicht mehr beobachtet.

sehr gute Ergebnisse:

Durch die hohe Präzision des Lasers lässt sich das Ergebnis einer Femto-LASIK noch besser berechnen. Die Korrektur der Fehlsichtigkeit wird noch genauer als bei der LASIK.

Monovision Lasik: 

No Cure But A Reliable Workaround

There are currently no reliable and predictable surgery techniques to prevent reading problem.However, for many patients, monovision lasik  will reduce or eliminate the need for readers, bifocals, or trifocals.

The concept of monovision is very simple. One eye is corrected for near vision and the other eye is corrected for distance vision. The brain figures out which eye to use and when. How to achieve monovision varies, depending upon the patient's current eyesight.

The chief advantage of monovision is the freedom it can provide from reading glasses. After six to eight weeks the brain makes the vision changes automatically, without any conscious effort or awareness. Monovision makes it possible to repeatedly change the range of focus, without having to constantly remove or add corrective lenses.

Monovision Drawbacks

As with many good things, monovision comes with some disadvantages.Monovision does NOT maintain a perfect far and near vision, it only maintains a good vision and no need for using glasses in daily life. Patients should  form their expectations according to this way.  

People who are entering mid-life and are interested in monovision should discuss the matter with their doctor prior to undergoing surgery.

It is surprising how many patients adapt readily and happily to this vision option, however monovision is not for everybody and some people dislike its effect.

Kontaktlinsen

Corneale "Cross-Linking"-Verfahren

Cross-linking ist eine photochemische Vernetzungsmethode, die zur Stabilisierung der Hornhaut beiträgt. Die Behandlung hat die Vorteile, dass sie einfach durchzuführen ist, nicht lange dauert und dass auch zu einem späteren Zeitpunkt immer noch eine Hornhauttransplantation möglich ist.

Die Behandlung wird ambulant durchgeführt. Dafür wir die obere Hornhautschicht (Epithel) entfernt und anschließend Riboflavin auf die Hornhaut geträufelt und mit UV-Licht bestrahlt. Die Kollagenfasern werden dadurch dicker, das Gewebe fester. Nach der Operation haben Patienten etwa 2 Tage lang Schmerzen. Da in dieser Zeit das Epithel der Hornhaut nicht zugewachsen ist, sollten Patienten auf Sport verzichten. Das Auge ist insgesamt etwa 2 Wochen lang gerötet. Kontaktlinsen sollten erst nach etwa 4 Wochen wieder getragen werden.

Ringimplantate (Intacs)

Hier implantiert der Augenchirurg zwei hauchdünne bogenförmige Kunststoffsegmente am Rand der Hornhaut um diese zu stabilisieren und die Hornhautverkrümmung zu verringern. In unserer Klinik verwendet Dr. Bas ausschließlich das IntraLase-Verfahren für die notwendigen seitlichen Hornhauteinschnitte. Die Operation dauert ca. 15 Minuten und wird mit örtlich betäubenden Augentropfen durchgeführt. Nach der Operation spüren die Patienten Symptome wie Brennen oder Jucken der Augen. Den Patienten werden Augentropfen für die nächsten 30 Tage verschrieben.

Durchführung der LASEK

Bei der LASEK wird das Hornhautepithel (die oberste Deckschicht des Auges) mit Alkohol abgelöst und aufgerollt. Nachdem mit dem Excimer Laser die Hornhaut modelliert wurde, wird das Hornhautepithel wieder über die Behandlungszone gelegt und mit einer therapeutischen Kontaktlinse abgedeckt. Durch diesen "Deckel" aus Hornhautepithel erhöht sich der Komfort für den Patienten erheblich und er verspürt (ähnlich wie bei der LASIK) auch nach der LASEK postoperativ meist keine Schmerzen. Natürlich ist das sehr davon abhängig, wie gut der Epitheldeckel präpariert wurde. Eine schützende Kontaktlinse wird im Anschluß auf das Auge gesetzt.

Wann findet das LASEK Verfahren Anwendung?

- Kurzsichtigkeit bis ca. -6 dpt.
- Hornhautverkrümmung bis ca. -3 dpt.
- Bei Vorliegen einer dünnen Hornhaut, bei denen sich eine LASIK wegen des Schnittes verbietet
- Wenn Risikoreduktion die wichtigste Rolle spielt .

Was sind die Vorteile der LASEK?

Bei der Lasik muß das Auge angesaugt und ein dünner Flap (ca. 0,16mm) geschnitten werden. Dieses Schnittrisiko ist bei der LASEK nicht vorhanden. Da das Auge auch nicht angesaugt werden muss, kommt es ebenfalls nicht zu einer kurzfristigen Unterbindung der Blutversorgung am Sehnerv. Auch die anderen Komplikationen, die mit dem Flap bei einer Lasik zusammenhängen, gibt es bei der LASEK nicht.

Welche Nachteile hat die LASEK im Vergleich zur Lasik? Eine beinahe Schmerzfreiheit, wie nach einer Lasik, ist jedoch nicht gegeben. Das bestkorrigierte Sehvermögen wird nach einer LASIK 1 bis 2 Wochen später erreicht als nach einer Lasik.

Durchführung der Wavefront-LASIK

Im ersten Schritt wird im Rahmen der Wellenfront-Analyse (WaveScan) ein Laserstrahl durch das Auge auf die Netzhaut gesendet. Das Licht wird durch den Glaskörper, die Linse, die Pupille und die Hornhaut zurückgeworfen. Ein Sensor misst nun die Irregularitäten des reflektierten Lichts (Wellenfront) an über 50-250 verschiedenen Punkten und produziert eine präzise, dreidimensionale Landkarte der Hornhaut des Auges inklusive aller Irregularitäten bzw. Aberrationen. Mit Hilfe dieser Untersuchung können auch Aberrationen höherer Ordnung festgestellt werden, die z.B. Halos, Glare oder verschwommene Bilder verursachen können. Die gewonnenen Daten fliessen in eine mathematische Formel ein, die wiederum vom Chirurgen genutzt wird, um den Excimer-Laser zu programmieren.

Vorteile der Wavefront-LASIK

Auf diese Weise lassen sich auch Fehlsichtigkeiten korrigieren, die mit einer Brille nicht mehr verbesserbar sind. Die Wellenfront-Lasik soll besseres Kontrastsehen ermöglichen und das Sehen in der Dämmerung verbessern. Im Gegensatz dazu bringt die wellenfront-gesteuerte LASIK in Augen ohne signifikante Irregularitäten oder Aberrationen keinen Vorteil.

Besonderheiten der Wavefront-LASIK

Dr. Nusret Bas empfiehlt das Wavefront-Lasik Verfahren nur dann, wenn tatsächlich signifikant hohe Sehfehler höherer Ordnung (Aberrationen) vorliegen und wenn die Hornhaut des Patienten ausreichend dick ist.

Durchführung Monovision-LASIK

Die Durchführung der Monovision-LASIK entspricht der Durchfürhung des LASIK Verfahrens. Als Behandlungsoption wird jedoch in der Regel das dominierende Auge auf die Ferne eingestellt und das andere Auge für die Nähe. So kann in den meisten Fällen eine Brille für den Nahbereich entfallen.

Wann findet das Monovision-LASIK Verfahren Anwendung?

Die Monovision als Behandlungsform kommt vor allem bei älteren Patienten zum Einsatz, bei denen die Sicht auf Objekte in der Nähe nicht mehr scharf gestellt werden kann. Am dominanten Auge wird dabei die Fehlsichtigkeit vollständig ausgeglichen, so dass mit diesem Auge ein optimiertes Sehen in der Ferne möglich ist. An dem anderen Auge erfolgt hingegen nur eine teilweise Korrektur, d.h. eine gewisse Kurzsichtigkeit bleibt bestehen oder wird – bei vorheriger Weitsichtigkeit – herbeigeführt. Der Patient nutzt dieses Auge nun für die Nahsicht. Die so erzeugte Monovision erfordert vom Gehirn eine aktive Mitarbeit, da es die Differenz in der Wahrnehmung permanent verarbeiten muss. Nicht jeder ist für die Monovision-LASIK geeignet.

Was sind die Vorteile des Monovision-LASIK Verfahrens?

In den meisten Fällen kann somit im Alltag auf eine Brille im Nahbereich größtenteils verzichtet werden.

Vorbereitung

Kontaktlinsen beeinflussen die Hornhaut, deshalb sollten die Linsen in der Zeit vor der Behandlung nicht benutzt werden. Es emfiehlt sich auf weiche Kontaktlinsen ca. 2 Wochen und auf Hartlinsen sogar 4 Wochen vor dem Eingriff zu verzichten. Die Behandlung könnte sonst nicht zum optimalen Ergebnis führen.

1. Tag

Ankunft Istanbul Flughafen.

Unser freundlicher Fahrer wird Sie vom Flughafen abholen und zu Ihrem Hotel bringen.

Achten Sie beim Flughafen Ausgang auf das BLU Meditravel Logo.

2. Tag

Transfer vom Hotel zur Klinik.

Vor Durchführung der Operation finden folgende Untersuchungen statt:

Untersuchung der Hornhaut

Orbscan: Die Krümmung und die Form der Hornhaut wird untersucht - auch um festzustellen, ob mögliche Hornhauterkrankungen vorliegen.

WaveScan: Bei der WaveScan-Analyse misst man mit einem Aberrometer die individuelle Brechkraft des Auges an ca. 50 bis 250 Punkten. So entsteht eine dreidimensionale Landkarte des Auges, welche die Besonderheiten präziser erfasst als es herkömmliche Messverfahren können.

Untersuchung der Netzhaut

Dr. Bas untersucht persönlich die Netzhaut (Retina) des Auges mit einem Biomikroskob.

Untersuchung der Sehkraft

Dr. Bas untersucht Ihre Sehkraft mit und ohne Brille. Der Grad der Kurzsichtigkeit oder Weitsichtigkeit wird mit Hilfe des Autorefraktometers gemessen.

Abschließende Konsultation durch Dr. Bas:

Auf Basis aller vorliegenden Untersuchungsergebnisse wird unser Dr. Bas entscheiden, welches Augenlaserverfahren für Sie am Besten geeignet ist.

Durchführung der Operation:

Ihr BLU Mitarbeiter wird im Operationsraum an Ihrer Seite sein. Es wird Ihnen Schritt für Schritt erklärt, was während der Operation vor sich geht. Vor der Durchführung wird das Lasersystem kalibriert und alle medizinischen Hilfsmittel vorbereitet. Der Eingriff erfolgt in liegender Stellung in einem sterilen Operationssaal. Nachdem das Auge abgedeckt und mit einigen Tropfen eines örtlich wirkenden Betäubungsmittels gefühllos gemacht wurde, wird zwischen Ober- und Unterlid ein Lidsperrer platziert, um das Auge offen zu halten und Sie am Blinzeln zu hindern. Nun wird je nach Empfehlung des Arztes das LASIK, Femto-LASIK (IntraLASE), Wavefront-LASIk oder LASEK Verfahren durchgeführt.

Nach der Operation:

Nach der Operation werden Sie in einen abgedunkelten Raum geführt. Dort erhalten Sie auch Ihre Augentropfen - und auf Wunsch auch Schmerzmittel, falls Sie diese benötigen.

Abschließende Untersuchung durch Dr. Bas.

Transfer von der Klinik zum Hotel

3. Tag

Transfer vom Hotel zur Klinik

Nachuntersuchung durch Dr. Bas

Stadtführung (falls Gruppentermin gebucht wird)

4. Tag

Transfer vom Hotel zum Flughafen

Abflug

Vorteile gegenüber der Brille

- Brillen rutschen auf der Nase und können (gerade im Winter) leicht beschlagen
- Brillen stellen eine Behinderung bei sportlichen oder anderen Freizeitaktivitäten dar
- Brillen können beim Schwimmen in der Regel nicht getragen werden
- Bei starker Sehschwäche verkleinern Brillen das Gesehene
- Brillenränder begrenzen das Blickfeld
- Sonnenbrillen erfordern immer eine Anpassung der eingesetzten Brillengläser an die entsprechende Sehschwäche des Brillenträgers

Vorteile gegenüber Kontaktlinsen

- Nicht jeder Mensch kann sich an Kontaktlinsen gewöhnen
- Kontaktlinsen können tränende Augen oder allergische Reaktionen hervorrufen
- Kontaktlinsen können bei Heuschnupfen nicht getragen werden
- Kontaktlinsen können nicht rund um die Uhr getragen werden
- Kontaktlinsen müssen gewissenhaft gepflegt werden und können außerdem leicht verloren gehen

Fazit

Die modernen augenlaserchirurgischen Verfahren bieten aktiven Menschen ein neues Lebensgefühl.