What are refractive errors ?

The human eye is like a camera. Cornea & lens are located at front of the eye, & work similar to
camera lens system. Light sensitive layer of the eye, ie Retina is located at the back of the eye
and is similar to camera film. In the normal eye, light rays of an image pass through the cornea
and lens, which helps focus the image directly on the retina to produce a clear image. This is a
perfect optical system.

When this image does not fall on the Retina, there is a refractive error, ie the power of the eye
is not perfect and corrective lenses have to be used to help focus the image onto Retina.
Myopia or short sightedness

Refers to a state of the eye, wherein the rays of light coming from a distant target, get focused at a point in front of the
retina. In this situation, minus powered glasses or contact lenses are necessary to focus this image onto the retina
Hyperopia or long sightedness

Refers to a state of the eye, wherein the rays of light coming from a distant target, get focused at a point behind the
retina. In this situation, plus powered glasses or contact lenses are necessary to focus this image onto the retina
Astigmatism or cylindrical power

Refers to a state of the eye, wherein the rays of light coming from a distant target, cannot focus at a single point on the
retina. In this situation special lenses of different curvature are required to focus the light onto the retina
How are refractive errors corrected?

Spectacles
or Glasses, contain lenses that alter the incoming rays of light to enable them to focus on the retina.

Contact lenses (soft or rigid) perform the same function as spectacles but are placed on the cornea. They provide improved
cosmesis and better quality of vision, especially for higher refractive errors.

Laser Refractive Surgery, LASIK is an exciting surgical procedure that is capable of correcting a wide range of nearsightedness
(myopia), farsightedness (hyperopia) and astigmatism.
LASIK is the acronym for Laser Assisted in-SItu Keratomileusis. LASIK is
currently the most commonly performed refractive procedure worldwide. LASIK has been performed internationally for approximately
two decades. It was first performed in clinical trials in the U.S. in 1991. It was officially approved in 1996 in the U.S. It is important to
note that the major components of the procedure have a long history. Ophthalmologists have been reshaping the cornea for over
50 years, creating a protective layer of tissue for over 35 years, and using the excimer laser since the 1980's.
Excimer laser treatment has brought more accuracy to corneal surgery and vision correction than ever before. One pulse of the
excimer laser removes 0.25 microns of tissue. This exquisite precision in tissue removal helps in reshaping the corneal contour and
correction of different refractive errors. Modern laser systems have the potential to produce the smoothest ablations & use radar
technology to track the eye's movement during treatment. They also have the potential to treat irregular astigmatism and link to
topography, & wavefront maps for customised laser treatment.

Wide variety of laser treatment options to choose from, including - Advanced Surface Ablation (PRK / Transepithelial PRK / LASEK/
Blade free Laser), Microkeratome assisted LASIK, Femtosecond laser assisted LASIK / FemtoLASIK / Blade free LASIK. The laser
procedure can be further customized to Wavefront Optimised / Topography Guided / Wavefront Guided / Q factor Guided
procedures. Presbyopic treatment options are also available to help improve near vision.
You can fix an appointment for
free counselling to know more
about this exciting LASIK
treatment.

Call Dr Fogla on 9866076750
to fix appointment for
free counselling on LASIK.
If you are at least 18 years old
and your glasses haven't
required a significant
prescription change, you may
be a candidate for LASIK
treatment.
If you are interested in this
exciting technology to
improve your vision, please
send us your prescription
details and we'll gladly discuss
your treatment options
Are You Eligible for LASIK?

While most patients are eligible for LASIK, not everyone is.

An ideal candidate for refractive surgery
  • Must be at least 18 years of age with stable refraction for 6 months.
  • No associated eye disease.
  • No active connective tissue disorders.
  • Must discontinue contact lens wear prior to refractive surgery, (soft lens 2 days, RGP lens 2 weeks)

Eligibility also depends on the amount of refractive error, the curvature and thickness of the cornea and a
number of other factors that an ophthalmologist must evaluate.
Proper patient selection is vital for successful refractive surgery and a satisfied patient.
Did you know that Tiger Woods
underwent LASIK procedure in
both eyes in 1999, following which
he won four golf championships
Others who have had LASIK
Cindy Crawford
Brad Pitt
All these procedures are absolutely painless and are performed as outpatient procedure using topical anesthetic eyedrops. The
entire procedure lasts for only 10 –15 minutes and you will be awake during the entire procedure.
During the treatment you are required to look at a fixation light while the laser is performed and you will also hear the noise of the
laser machine during the treatment. The actual laser treatment only lasts for 2 - 20 seconds.
Following the treatment you can return home immediately. However you should make arrangements for a friend or relative to take
you home after the procedure.

Will my vision improve immediately ?
There is a considerable improvement in unaided vision following the treatment.  Following LASIK this improvement is noted right
after the procedure and is perfect the next day. Following surface ablation the vision also improves immediatly post procedure,
however it takes 2-3 days for complete surface healing. A slight fluctuation of vision may occur over the next few weeks as the
healing process continues and the tear film stabilizes.

What are the possible side effects ?
Usually most patients are quite comfortable following LASIK. There is mild - moderate amount of discomfort following advanced
surface ablation on day 1, which reduces subsequently. There may be transient light sensitivity, glare & foreign body sensation,
or dryness in the treated eye.
A slight undercorrection or overcorrection can rarely occur while treating higher refractive errors (especially with higher powers
over).
Kenny G
Nicole
Kidman
Hear what our patients have
to say
We feel it is of extreme importance
that you meet the surgeon who
performs the procedure prior to
making an informed decision on
whether to have the surgery.

The corneal surgeon will discuss
the risks and benefits of LASIK
with you and will try to tell you what
you can expect.

Laser refractive surgery is such a
precise procedure that there is no
room for compromise during
treatment at our center. Our
standards are very high and we
believe in delivering what we
promise.
Email  dr_fogla@yahoo.com or  call us  +919866076750
Will I need to wear glasses or contact lenses after the procedure ?
These procedures are designed to allow you to discontinue the use of corrective lenses for routine daily work. In over 98%
patients there is no need for any glasses or contact lenses. However very rarely in some patients with higher refractive errors,
corrective lenses of minimal residual power may still be required following the treatment. This residual refractive error can often be
corrected by a second refractive procedure (enhancement).  Sometimes the surgeon may choose to leave behind minimal amount
of refractive error in one eye to allow near vision in individuals above the age of 40. This is called Monovision

When can I resume normal activities ?
You can return to work after 3 days if advanced surface ablation has been performed. Following LASIK you can return to work the
following day. While most activities can be resumed, it is better to avoid swimming, contact sports etc at least for a one month
duration.

Are the results of LASIK permanent?
LASIK permanently removes corneal tissue to reshape the eye in order to improve refraction. The physical results are permanent.
However, you should be aware that since the eyes can still change with time, LASIK does not prevent presbyopia or affect this
condition once it does occur.

Should I undergo LASIK ?
Ophthalmologists all over the world have been reshaping the cornea using the excimer laser since the 1990s. LASIK has been
performed internationally for approximately  two decades now. Laser refractive surgery when performed by a qualified, cornea
specialist, does promise reducing one's dependence on contacts or glasses. For many people, this will allow them to more freely
pursue their hobbies, sports activities or career options.
Dr Rajesh Fogla DNB, FRCS, MMed  has been performing LASIK treatments since 1998. He has received formal training in corneal disorders and laser treatment at
Sankara Nethralaya, Chennai. He was the first surgeon to introduce LASIK in Sri Lanka in 2002. He has published several papers in international journals on
LASIK treatment, and has delivered lectures on the same topic on numerous occasions both national and international symposiums. He has worked with the
Summit Omnimed, Summit Apexplus, Wavelight 200Hz ,Wavelight 400 Hz, & Wavelight EX 500 Laser systems, and used the Hansatome, Amadeus 1 & 2, SKBM,
and Moria microkeratomes. With 18 years of laser experience, and having treated over 10,000 eyes, you can depend on Dr Fogla to ensure perfect and safe
outcome following laser treatment.

Dr Fogla is available in the clinic on weekdays between 9am to 5pm.

For more information on correction of refractive errors with laser treatment call us or send us an email to schedule an appointment
Wavelight Allegretto Eye Q laser
500th installation in 2005 at
Cornea Clinic Apollo Hospitals, Jubilee Hills
Hyderabad 500096, India

Over 6000 cases performed successfully since then
And now the laser has been upgraded with the new
Wavelight EX 500 laser system
Cornea Clinic at Apollo Hospitals is equipped with the most advanced Laser systems currently available in the world.

Wavelight EX-500 Excimer Laser from Alcon, is the fastest laser system, which treats 1 diopter of power in just 1.3 seconds. It has a
sophisticated eye tracking system to ensure perfect delivery of laser pulses during treatment. Online pachymetry allows accurate
measurement of corneal thickness during treatment which increases the safety of the procedure. Treatment can be customized
based on topography or wavefront maps (none of these are possible with lenticule extraction procedures such as SMILE or Relex)

Ziemer Z6 femtosecond laser system allows creation of corneal flaps for LASIK in a gentle and easy manner. Unlike other
femtosecond laser system which work at microjoules of pulse energy, the Z6 works with nanjoules of pulse energy which makes it
very gentle on the cornea, and separation of corneal layers occurs with relatively much more ease.
      How is the procedure performed ?

Laser in situ keratomileusis (LASIK)

This procedure involves first creating a thin flap of cornea with an instrument called
the microkeratome or femtosecond laser. Followed by lifting of the flap and laser
treatment to reshape the cornea. The flap is then repositioned in its original place.
Improvement in vision is noted within 15 - 20 minutes post procedure.
The beam profile of
Wavelight laser removes lesser amount of corneal tissue per
diopter of correction, thus making the treatment more safe for your eyes.
Customized ablation also ensures that you do not experience any glare or halos
during the night while looking at bright lights.
Multiple options for customized treatments, such as wavefront optimized, wavefront
guided, topography guided, Q factor guided treatments. Such treatment modalities
are far superior when compared to those with other laser system. Lenticule
extraction procedure (SMILE/Relex) have an accuracy of 5 microns.. which is almost
0.5 diopters of power, compared to this the Excimer laser has the precision of 1
micron. Currently Excimer laser procedures are US FDA approved, whereas
lenticule extraction is not, (under investigation)

Advanced Surface Ablation (ASA)

This procedure involves direct application of excimer laser treatment on the corneal
surface without creating a flap. The corneal epithelium is removed prior to
application of laser pulses and at the end of procedure a bandage contact lens is
placed. The corneal epithelium usually heals in 3 days. Moderate discomfort is
experienced on Day 1. Procedure is planned for low powers, thin cornea, or specific
post operative professional requirements. The results are similar to Customized
LASIK if not better.

Other Options

In case the preoperative evaluation tests reveal that you are not a good candidate
for laser refractive surgery, there are other options.
Phakic IOL such as the Staar Visian ICL is a US FDA approved implant which can be
easily placed in front of the natural lens to correct a wide range of refractive errors.
The surgical procedure is painless and takes 10 minutes to perform. Visual
improvement is noted immediately post procedure.
Tel 91 40 23607777,  Fax 91 40 23608050 ,24 hours emergency services call 1066
Cornea Clinic - Eye Department - Apollo Hospitals, Jubilee Hills, Hyderabad 500096, Telangana,  INDIA
Cornea Clinic - toll free number 1600 345 1066, other numbers 91 40 23607777 ext 6333
Cornea
Lens
Retina
LASIK Article in "The Nation"
Newspaper...patients perspective
Cornea Clinic
Center for Innovative Corneal Surgery
Center for Innovative Corneal Surgery