PAtient SeleCtion foR lASeR ViSion CoRReCtion

Patient Selection for Laser Vision Correction
Suitable Candidates:
n
Must be 18 years old
n
Healthy eyes
n
Stable prescription for at least one year
(i.e. change no greater than 1.00 D a year)
n
Acceptable corneal thickness and corneal curvature
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Realistic expectations*
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Clear understanding and acceptance of risks
*Realistic expectations means the following:
Attaining specific goal(s) — to enhance lifestyle, comfort, safety, career opportunity
Searching for perfection or guarantee is NOT suitable
Desire for immediate recovery is NOT suitable
Bad Candidates:
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Unstable prescription (i.e. change greater than 1.00 D a year)
n
Unstable, uncontrolled diabetes
n
Immunosuppressed patients
n
Auto-immune disorders
n
Pregnant or nursing mothers
n
Patients on Amiodorone
n
Systemic illness — wound healing problems
n
Use of any medication inhibiting tissue growth
1565 Carling Ave., Suite 110, Ottawa, ON K1Z 8R1 n 1-800-IN-FOCUS (1-800-463-6287) n 613-724-3937 n fax 613-724-6264 n www.focuseye.com
Hotel Dieu Hospital, 166 Brock St., Suite 325, Kingston, ON K7L 5G2 n 1-877-460-6029 n 613-542-5000 n fax 613-544-2632 n www.focuseye.com
Parameters:
Wavefront:
Myopia: -10.00 sphere, and up to +5.00 cyl
Hyperopia: +3.00 sphere, and up to +5.00 cyl
(limited by corneal curvature and thickness)
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Standard PRK:
Myopia: -1.00 sphere to –12.00 sphere and up to +5.00 cyl
(limited by corneal curvature and thickness)
Hyperopia: +3.00 sphere, and up to +5.00 cyl
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INTRALASE SBK:
Myopia: -1.00 sphere to -10.00 sphere and up to +5.00 cyl
(limited by corneal curvature and thickness)
Hyperopia: +3.00 sphere to +5.00 cyl
n
n
CLE:
All prescriptions
Age dependant (usually for ages 40 and older)
*Please note that the laser has capabilities to treat up to –16.00 myopia, +9.00 hyperopia
and +6.00 astigmatism. With very high prescriptions the outcomes with laser are not
favourable as the quality of vision is compromised. Limitations exist due to corneal
thickness and curvatures. A CLE procedure will give the patient a better outcome in
extreme cases.
Monovision:
n
Candidates for monovision are ages 40 and older.
n
Very low myopes may only need one eye treated.
n
For other patients, monovision means that one eye, usually the non-dominant eye,
will be left slightly undercorrected (if myopic), or overcorrected (if hyperopic).
n
Target for monovision ranges from -1.00 D to –1.75 D, depending on age.
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Reminder that if the patient cannot adjust, an enhancement procedure may be done
when prescription is stable — at no additional cost to the patient if within one year
of original procedure. They will however require reading glasses.
FOCUS EYE
CENTRE
Ottawa
1565 Carling Ave.
Suite 110
Ottawa, ON K1Z 8R1
(613) 724-3937
1-800-IN-FOCUS
(1-800-463-6287)
Preparing
for
your
laser vision
correction consultation
1. Carefully Review the Enclosed Materials
2. Make a List of Any Questions or Concerns You May Have
Both the Canadian Ophthalmological Society (COS) and the Canadian Society of Cataract
and Refractive Surgery (CSCRS) state that “careful patient selection [and pre-operative testing]
is the key to good outcomes following refractive surgery”. (COS News Release, Nov. 24, 2000).
Unlike discount centres, Focus insists that your initial consultation be performed by one of
our experienced eye doctors. Take advantage of your meeting with the doctor by preparing
a list of any questions or concerns you may have regarding laser vision correction prior to
your consultation.
Kingston
Hotel Dieu Hospital
166 Brock Street
Suite 325
Kingston, ON K7L 5G2
(613) 542-5000
1-877-460-6029
www.focuseye.com
3. Remove Contact Lenses at Least One Day Before Your Consultation
It is important that your eyes be allowed to return to their natural shape before having laser
vision correction. The following is the average length of time contact lenses must be removed
prior to surgery:
Type of Contacts­ Length of Time­
Disposable­
4 - 7 days­
Soft­
1 - 2 weeks­
Hard/Toric­
up to 8 weeks­
If you are interested in having surgery as early as possible after your consultation, please ensure
that you keep your contact lenses out for the period of time set out in the schedule above.
4. Bring Along Someone Who Can Help You in the Decision-Making Process
During the pre-operative examination and consultation, the doctor will describe in detail the
benefits, risks and different types of laser vision correction procedures. We strongly recommend
that you bring your spouse, partner, family member or friend to assist you in understanding the
information and making an informed decision. Your consultation will take approximately one hour.
5. Bring Along a Pair of Sunglasses
A-3 rev 11/09
As part of the pre-operative testing, your pupils will be dilated. You will be very sensitive to light
and your near vision may be blurry for about three hours or so afterwards. Although you will be
able to drive after your consultation, you will find it very helpful to wear sunglasses until your
pupils return to their normal size.
We look forward to meeting you and
helping you discover a world without glasses or contact lenses!
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FOCUS EYE
CENTRE
Ottawa
Wavefront-Guided Procedures
1565 Carling Ave.
Suite 110
Ottawa, ON K1Z 8R1
Every person’s vision is as unique as their fingerprint.
Focus Eye is committed to providing outstanding medical care and the best possible results.
This means using the gold standard in Laser Vision Correction technology: the WavePrint
System from VISX, Inc.
(613) 724-3937
1-800-IN-FOCUS
(1-800-463-6287)
Unlike traditional eye examination methods which provided information about only the corneal
surface of your eye, the WavePrint Map reveals the way your entire optical system processes
light. The WavePrint System thus provides a precise and more detailed analysis of your vision.
Kingston
Hotel Dieu Hospital
166 Brock Street
Suite 325
Kingston, ON K7L 5G2
Using this information, Focus doctors can more accurately assess whether you are a good
candidate for laser vision correction and the type of laser procedure which is best for you.
The WavePrint System allows Focus to give our patients the potential to see better than 20/20, to
see better than they do with their contacts or glasses. Depending on the results of your WavePrint
Map, your doctor may recommend a Wavefront-guided procedure as the optimal procedure for
you. Wavefront is recommended for all qualified patients. In a Wavefront-guided procedure,
information from the WavePrint Map is inputted into the laser. The result is a highly personalized
treatment that takes into account the unique, individual characteristics of your entire optical system.
(613) 542-5000
1-877-460-6029
www.focuseye.com
Wavefront-guided procedures are fully approved by Health Canada.
Recovery Time
Intralase SBK with Wavefront..........as little as 24 hours.
PRK with Wavefront..........................in most cases, patients are able to return to work
after 4 to 7 days. However, some patients may
need longer as healing is individual.
The
Benefits of Wavefront
In numerous clinical studies of Wavefront-guided procedures — both PRK and Intralase SBK — the
results have been excellent. This is consistent with the results obtained from the Wavefront-guided
procedures performed at Focus. With Wavefront, suitable candidates have an increased likelihood of:
•achieving 20/20 vision or better;
•obtaining better vision than they had with their glasses or contacts;
•achieving improved “quality of vision”. In studies where patients have had one
eye treated with Wavefront and the other treated using traditional procedures,
the majority of patients reported sharper vision with the Wavefront-treated eye;
A-5 rev 11/09
•avoiding possible night vision difficulties. For those candidates at risk of night
vision problems with traditional procedures, the risk is significantly reduced
with Wavefront-guided procedures.
Please do not hesitate to speak to any of our doctors
or education coordinators, if you have questions about
wavefront guided procedures at Focus Eye Centre.
your
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FOCUS EYE
CENTRE
Ottawa
1565 Carling Ave.
Suite 110
Ottawa, ON K1Z 8R1
(613) 724-3937
1-800-IN-FOCUS
(1-800-463-6287)
Kingston
Hotel Dieu Hospital
166 Brock Street
Suite 325
Kingston, ON K7L 5G2
(613) 542-5000
1-877-460-6029
www.focuseye.com
Questions &
answers
about
Laser Vision Correction
Q. What is LVC and Why Wavefront?
At the best clinics, Laser Vision Correction (LVC) in 2010 and beyond is an extremely refined
and precise procedure when done by an experienced surgeon in a quality clinic using the finest
techniques and technology. Focus possesses all of the above, including Wavefront-guided
Intralase SBK and PRK procedures.
Wavefront-guided Laser Vision Correction is our Standard of Care. Considered the gold standard
for Laser Vision Correction, Wavefront is a pre-operative, no-touch diagnostic procedure that
produces a computer generated map of any and all anomalies in the patient’s eye. Wavefront
guided Laser Vision Correction affords greater precision for the surgeon and better results for
our patients.
Q. What is Intralase SBK?
Intralase SBK is an advanced form of surface ablation that allows patients a visual recovery
time measured in hours rather than days.
SBK is a procedure comprising the removal and retention of the epithelial layer by the
femtosecond Intralase laser and the traditional excimer laser to correct the refractive error.
The term SBK refers to the part of the cornea where the cleavage plane is created (i.e. just
below the Bowman’s layer in the anterior part of the cornea). This prevents almost all the
potential complications of the traditional LASIK flap (e.g. decreasing the structural integrity
of the cornea, a 30-plus percentage incidence of dry eyes and susceptibility to trauma) while
providing post-operative comfort and rapid visual recovery.
Intralase SBK and PRK are both considered “extremely safe” procedures. The judgment of
our surgeons is that these are the safest means of providing Laser Vision Correction.
Q. What is PRK?
A-4 rev 09/09
PRK (Photorefractive Keratectomy) uses a cool beam from the Excimer laser to reshape the
surface of the cornea with a very short wavelength of light energy. Only a minute amount
of tissue is removed, normally less than 10% of the cornea. The structure of the eye is not
weakened and remains intact. PRK was first performed in 1987 and several million procedures
have been performed in countries around the world. Due to the results Focus Eye and its
patients are experiencing with Intralase SBK and PRK, our surgeons have made the decision
to no longer offer LASIK.
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Q. Will I become nearsighted again?
PRK and Intralase SBK procedures are essentially permanent corrections. Studies have shown results to be stable
once healing is completed, three to six months after the procedure. However, small amounts of regression can
occur. Instances of this are exceptional rare. Be aware that following LVC the human eye continues to undergo
the normal aging process. So while refractive corrections are permanent, the eye remains subject to age-related
issues such as cataracts and presbyopia, which occur independent of LVC.
Q. Who is a good candidate?
Most people who are nearsighted (myopic) or farsighted (hyperopic), with or without astigmatism, are eligible
for the procedure. To be considered a good candidate, your prescription must be stable (i.e. less than one diopter
of change over the course of a year). Normally, once you have reached your twenties, your prescription will have
stabilized. If you undergo the procedure when your prescription is unstable, you may regress from the desired
result. Also, women who are pregnant or who are nursing, are not good candidates for the procedure.
Q. What are the risks?
Laser Vision Correction is considered to be very safe. As with any surgical procedure, there can be complications
and these will be described by your eye doctor. Visual outcomes for both PRK and Intralase SBK procedures are
comparable. It is important to note that individual results may vary due to each person’s healing rate. For this
reason, less than 5% of patients (depending on their initial prescription) will need to undergo a touch-up
procedure following their initial, primary treatment. The data on patients who have had Laser Vision Correction
supports stable results with little, if any, regression. The risks and complications of both PRK and Intralase SBK
will be discussed in detail on the day of your consultation.
Q. Is there any pain?
There is no pain during the procedure. Freezing drops are administered before the procedure to alleviate any
discomfort. You may experience a scratchy sensation and may be sensitive to light for the first couple of days.
Should you have any discomfort, pain relief medication is available.
Q. Do I need to take time off work?
Every person’s healing rate is unique. Patients who have PRK generally return to work 4 to 7 days after the
procedure. Normal activities including sports may be resumed at this time. With Intralase SBK, some patients
see well enough to return to work within 24 to 48 hours.
Q. What can I expect after Laser Vision Correction?
After a laser procedure you can expect to see as well as you did with your glasses or contact lenses. For many
patients the procedure means freedom to participate in sport and leisure activities without the hassles of corrective
lenses or glasses. Others are motivated by the ability to see the alarm clock first thing in the morning. Whatever
your motivation, the procedure offers a new freedom.
Q. What is the Goal of Focus Eye Centre?
A-4 rev 09/09
Our goal is to provide a viable alternative to those nearsighted, farsighted and or astigmatic patients who are
motivated to reduce or eliminate their need for glasses or contact lenses. Making an informed decision with
reasonable expectations is an integral part of achieving this goal.
FOCUS EYE
CENTRE
Monovision
The human eye can focus on objects at different distances, similar to a camera, by automatically
adjusting its depth of focus through a process called “accommodation”. All humans naturally
lose their ability to accommodate over time, beginning gradually at age 42 and completely by
age 60. For individuals who are nearsighted, this is not a big problem as they can take off their
distance glasses and still see well up close. For individuals who are farsighted, the loss of the
ability to accommodate will result in the need for reading glasses or bifocals.
Ottawa
1565 Carling Ave.
Suite 110
Ottawa, ON K1Z 8R1
(613) 724-3937
1-800-IN-FOCUS
(1-800-463-6287)
So far the technology for refractive surgery has not yet come up with a reliable bifocal correction
on the cornea. Therefore, if you are over 42 and want to see both distance and near without
glasses then you will need monovision correction. This means that one eye is focused for distance
and one eye is focused for near vision. Normally the dominant eye is focused for distance.
Kingston
Hotel Dieu Hospital
166 Brock Street
Suite 325
Kingston, ON K7L 5G2
Although you may think monovision will leave you feeling “unbalanced”, almost all of our
patients adjust completely within one week to a month. After this initial adjustment period,
patients are not even aware which eye is being used — just that they can now see both distance
and near for most of their everyday vision needs. As patients get closer to age 60 they will need
magnifiers for very close work such as threading a needle or reading in bed.
(613) 542-5000
1-877-460-6029
www.focuseye.com
(At Focus Eye Centre, the majority of our patients over 42 years of age choose to have
monovision and the overwhelming feedback is that “it works”.)
summarize
monovision:
To
Advantages
•Ability to do most activities without glasses.
•Functional near vision without glasses (e.g. reading, writing and working on a computer).
•Retain peripheral vision and depth perception.
Disadvantages
A-6 rev 09/09
•May lose some stereopsis (near).
•After age 60 will need magnifiers for very close work (e.g. threading a needle).
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LIFETIME COMMITMENT
We stand behind our results
In order to be eligible for the Focus Lifetime Commitment program
the patient must:
• have had their initial Laser Vision Correction procedure at
Focus Eye Centre;
• have attended all of the required post-operative eye exams,
be compliant with drop regime, and follow all the necessary
post-operative instructions set out by the physician managing
the patient’s care;
• have had an annual eye examination with a Focus affiliated
eye doctor upon completion of the one year post-operative
period which must be documented and signed off by Focus
physicians; and
The patient is responsible for the cost of the annual eye
examination. Upon completion of their one year postoperative
review period, patients must consult their own eye doctor
if they encounter any problems with their eyes including
a reduction in their vision. Your eye doctor will advise you
whether an enhancement would be appropriate and, if so,
will refer you back to Focus Eye Centre.
CRITERIA FOR ENHANCEMENT
Patients are eligible for an enhancement if their residual refractive
error is +/- 1.00 with an Uncorrected Visual Acuity (UCVA) of
20/40 or worse and the enhancement is recommended by the
Surgeon at Focus Eye Centre.
If an enhancement is recommended by Focus Eye Centre it will
not occur until a minimum of 9 months from the original procedure
or at the surgeon’s discretion.
Patients who fall in the “High Myopia, High Hyperopia, and
High Astigmatism” category are guaranteed a maximum of 2
enhancement procedures per eye due to the severity of the initial
preoperative refraction. See the Additional Consent form for further
clarification.
If the patient requests a retreatment that falls outside the Criteria
for Enhancement as detailed in the Lifetime Commitment, this
retreatment will be subject to a fee.
BENEFITS
Focus Eye Centre will provide any necessary additional treatments
directly related to the patient’s initial Laser Vision Correction procedure at no charge provided it falls within the Criteria for Enhancement as detailed in the Lifetime Commitment.
However, if the recommended enhancement involves a procedure
which was more expensive than the original treatment method,
the patient will be responsible for an additional fee of up to
$1000 per eye.
Eye drops will be dispensed by Focus Eye Centre within the first
year only, or following an enhancement within the first year, or
at the discretion of the physician.
If the enhancement occurs within one year of the date of the
initial treatment, patients have the choice of having their post-
enhancement examination at Focus Eye Centre or with a Focus
affiliated doctor.
If the enhancement occurs more than one year from the date of
the initial treatment, patients are responsible for the cost of the
post-operative examinations if the examinations are not conducted
at Focus Eye Centre.
Focus Eye Centre’s co-management program for post-operative
care is only valid in Canada.
Patients residing outside of Canada are responsible for the cost
of all post-operative care.
RESTRICTIONS
Patients will be excluded from Lifetime Commitment Policy if
one (or more) of the following conditions are preexisting, and/or
present at the time of surgery or are conditions that occur after
date of surgery:
• Amblyopia, Strabismus, Ptergium
• Have had an initial and/or Retreatment surgery elsewhere
• Diabetes Type I or II, Auto-Immune disorders (ie. Lupus,
Crohns/Colitis, RA...)
• Glaucoma, Cataracts, Keratoconus, Corneal Dystrophy’s or
Keratitis
• Have had a trauma or injury to the eye
The Standard Enhancement Policy will apply for those patients
who are not eligible for the Lifetime Commitment Policy, whether
through restriction (s) as outlined above, or non-compliance of
the terms and conditions of the program.
The Standard Enhancement Policy is outlined below:
• Entitled to Retreatment(s) within 2yrs of their initial surgery.
• After this 2yr period a $500 Retreatment Fee (plus technology
fee if applicable) per eye will apply, conditional on Surgeon
Recommendation and Patient Compliance relating to PostOperative Care.
I have read and understand the conditions of the Lifetime
Commitment outlined above. I understand that should I not
qualify at the time of surgery, or do not meet the conditions,
I will be covered by the Standard Enhancement Policy as
outlined above.
Patient Name: Patient Signature:
Date:
Witness Name: Witness Signature:
Date:
1565 Carling Ave., Suite 110, Ottawa, ON K1Z 8R1 n 1-800-IN-FOCUS (1-800-463-6287) n 613-724-3937 n fax 613-724-6264 n www.focuseye.com
Hotel Dieu Hospital, 166 Brock St., Suite 325, Kingston, ON K7L 5G2 n 1-877-460-6029 n 613-542-5000 n fax 613-544-2632 n www.focuseye.com
C7 Rev. 01/11
Eligibility/Requirements
Surgeon Profiles
Dr. David R. Edmison, MD, FRCS(C)
Dr. Claude Ménard, MD, FRCS(C), CPSQ
Medical Director, Ottawa
Refractive & Corneal specialist
Dr. Edmison is the founder and Medical Director
of Focus Eye Centre and has been involved in
laser vision correction since 1992.
Dr. Claude Ménard is a long-serving and valued
refractive surgeon at Focus Eye Centre. He is also a
corneal specialist who has performed more than 200
corneal transplants and over 3,500 cataract surgeries.
He is a leader and pioneer in the field of refractive
surgery. Having performed over 30,000 Laser Vision
Correction procedures, Dr. Edmison is one of the most experienced
and respected laser eye surgeons in Canada.
Dr. Ménard is a member of many professional
associations including the Association des Ophtalmologistes du Québec
where he sat on the board of directors from 1996 to 2000.
Between 1996 and 1998, Dr. Edmison was the President of the
Canadian Society of Cataract and Refractive Surgery. He is also the
former Chair of the Department of Ophthalmology at the Grace General Hospital in Ottawa. Dr. Edmison is currently on staff at the Ottawa
Hospital, Riverside Campus, and the Hotel Dieu Hospital in Kingston.
At the Université de Sherbrooke, Dr. Ménard was professor of corneal
diseases for the residency program from 1988 to 1994 and associate
professor of Ophthalmology at the Faculty of Medicine from 1995 to
1996. Dr. Ménard was the Head of the Ophthalmology department
at the Centre Universitaire de Santé de l’Estrie in 1996.
Dr. Edmison has been part of a volunteer cataract-teaching program
run by ORBIS in Fuzhou, China, and conducted research for VISX
(now AMO), the leading manufacturer of excimer lasers. In addition,
he has published numerous articles in the area of ophthalmic surgery
and is frequently asked to lecture at international conferences.
Since 1999, Dr. Ménard has been the Head of the Department of
Ophthalmology at the Centre Hospitalier des Vallées de l’Outaouais
in Gatineau, Québec and is an associated member at the Centre Communautaire du Pontiac in Shawville. Dr. Ménard is actively involved in
ophthalmic research and regularly gives presentations across Canada.
“Since founding Focus, there’s not been a more exciting time to
be involved in laser vision correction. With the advancements of
Intralase SBK and Wavefront, the majority of our patients now
have even better vision than they had with glasses or contacts.”
Dr. Kevin Smith, MDCM, FRCS(C)
Dr. John Cheung, MD, FRCS(C)
Oculoplastic specialist
Medical Director, Kingston
Dr. Kevin Smith is an ophthalmologist, cataract
and oculoplastic surgeon, providing Blepharoplasty
(Eyelid Rejuvenation Surgery) to Focus Eye patients.
Dr. John Cheung is Medical Director of Focus
Eye Centre in Kingston. He is also an Assistant
Professor of Ophthalmology at Queen’s University
in Kingston, Ontario.
Dr. Smith is a Fellow of the Royal College of
Surgeons (Canada) in Ophthalmology and is
American Board Certified in Ophthalmology. A Montreal native,
he has been in private practice in Ottawa since 1992, averaging 500
cataracts and 500 oculoplastics procedures each year. He is currently
the Team Ophthalmologist for the Ottawa Senators Hockey Club.
Dr. Smith earned a B.Sc. in Mathematics, a Diploma in Management
and an M.D.C.M. from McGill University. His post-graduate training included: Rotating Internship, St. Mary’s Hospital, McGill University, 19851986; Residency in Ophthalmology, Chief Resident, University
of Western Ontario, 1988-1991; Fellowship in Ophthalmic Plastics
and Orbital Reconstructive Surgery, McGill University, 1991-1992.
Dr. Smith worked for the Department of National Defense, first as
a base flight surgeon in Portage, Manitoba (1986-1988) and then
as an ophthalmologist with the rank of Major at the National Defense
Medical Centre (1992-1997).
“It is a true pleasure to be able to extend Blepharoplasty treatments to Focus Eye patients. My association with Focus and
Everesr SurgiCentre is a professional union that makes sense,
as evidenced by the outstanding outcomes patients are seeing.”
A7 rev 11/09
“Focus Eye Centre is truly a leader in laser vision correction.
The results we are able to achieve for patients at Focus these
days are nothing short of impressive.”
Dr. Cheung graduated with honours from the
Faculty of Medicine at University of Toronto in 1995. He studied Ophthalmology at Queen’s University and then did further post-graduate
study in Ophthalmology at McGill University in Montreal. Dr. Cheung
is a member of the American Board of Ophthalmology and is a Fellow
of the Royal College of Physicians and Surgeons of Ontario.
Dr. Cheung has written several articles in the field of ophthalmology
and is the recipient of numerous academic prizes and graduate
scholarships including the R. Samuel McLaughlin Foundation Fellowship Award at McGill University and the Wilkinson Scholarship at
the University of Toronto for excellence in the field of Ophthalmology.
Dr. Cheung has been affiliated with Focus Eye Centre since 2000.
He has a stellar reputation for offering excellent care to his patients
and delivering superior results with both clear lens exchange and
refractive procedures.
“I’m very proud of Focus’s commitment to bringing the best
technology to patient care. In particular, I’m excited about
the great results we’ve been having with Wavefront technology,
and the positive effect it has had on the people we treat.”
1565 Carling Ave., Suite 110, Ottawa, ON K1Z 8R1 1-800-IN-FOCUS (1-800-463-6287) local (613) 724-3937 www.focuseye.com
Hotel Dieu Hospital, Suite 325, 166 Brock St., Kingston, ON K7L 5G2 1-877-460-6029 local (613) 542-5000 www.focuseye.com
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FAST
facts
A NEWS SERVICE FOR DOCTORS AFFILIATED WITH FOCUS EYE CENTRE
Intralase SBK
Workshop Updates
The response to Intralase SBK
has been quite positive from both
patients and Co-Managing doctors.
Intralase SBK with Wavefront now
encompasses 80% of all procedures
performed at Focus Eye Centre. Please
see below for a summary of discussion
points highlighted at the Spring 2009
Co-Management meetings, Monday,
April 27 and Wednesday, May 6. This
document is accessible via InSight
the secure dedicated website for
Co-Managing doctors.
Complications:
Haze: Difuse sub epithelial haze can develop
at the 1–3 month check-up. This is quite
common and does not affect quality of
vision and will fade overtime. Drops are not
required and the patient is not symptomatic.
Edema: Presents at the 24hr and may
be detected at the 1 week post-op visit.
Rarely persists after first week unless patient
is elderly or has a pre-existing corneal
condition.
Striae: Most patients undergoing Intralase
SBK have a bandage contact lens (BCL)
inserted after surgery. The use of the contact lens has resulted in far less micro-striae
and interface debris. The contact is typically
removed at the 24hr post-operative visit
at Focus. If significant striae are noted at
the one week Intralase SBK follow-up and
this is interfering with the quality of vision
the patient should be sent back to Focus
immediately. Please also notify Nancy Bast
(Co-Management Coordinator) of the
patient’s name so she can expedite the
process. Protective eye shields are to be
worn at night for the first week after surgery,
and are strongly recommended to prevent
striae. Patients are also advised to avoid
rubbing or squeezing eyes to prevent striae.
Flap dislocation: Although rare,
vigorous rubbing or a blow to the eye
may result in flap dislocation during the
first month post-op. Refer immediately
back to Focus for repositioning.
FAQs:
Interface Debris: Normal post-op
finding. Patients with pre-existing blepharitis
may have a higher incidence of interface
debris. This will gradually disappear over
2–3 months.
A:The Multiple (>1 micron) small
DLK: Usually detected at the 24hr post-op.
Due to the thickness of the flap, Pred Forte
(PF) Q2H has excellent penetration and DLK
typically resolves within the first week.
Transient Light Syndrome (TLS):
Extreme photophobia may develop
approximately one month post SBK. This has
been noted in less than 5% of our patients.
The course of treatment is to initiate PF QID
and to follow-up within 1–2 weeks, to make
sure photophobia symptoms have resolved
at which point drops can be discontinued.
Q:Why does the Intralase SBK flap
appear rough in comparison to
a LASIK flap?
explosions beneath the epithelium
coalesce together but still leave a
slightly irregular surface. Bonding
is enhanced because of this.
Advantages of the SBK flap include:
•Less risk during surgery (minimal
risk of Ischemic Optic Neuropathy)
•More tissue remains on the bed
— lessens occurrence of ectasia
•Re-growth of nerves faster
•Scarring / haze at edge of flap is
more common with SBK than LASIK
— patients are not symptomatic
•Less incidence of dry eyes
Epithelial In-growth: Very rare, can be
confused with interface debris. If presents,
please send patient back to Focus for
evaluation.
•Flap is plano increased safety
factor in the event flap is removed,
vision will not change, similar to
PRK vs. LASIK not perfectly plano
thinner in the middle
Regression: Percentages for myopes
same as PRK. Hyperopes show a significant
reduction in regression verses PRK.
•Less epithelial in-growth which
is problematic with LASIK
Retreatments: Stability dependent. On
average 6 months post-op. SBK retreatments
post PRK treatments epithelial tissue is not
as strong and recovery may take longer
(i.e. BCL X 48hours). PRK retreatment patients
are eligible for Intralase SBK enhancement
at an additional fee of $350.00 per eye.
Intralase SBK may benefit Hyperopes post
PRK due to reccurence of regression.
Dry eyes: Incidence of dry eyes reported
following SBK is considerably less than with
LASIK and the same, or slightly less than with
PRK. Most patients will discontinue artificial
tears 1–3 months post-op.When determining
patient candidacy, Intralase SBK may prove
advantageous for patients with pre-existing
dry eyes, or who are contact lens intolerant.
Ottawa: 1565 Carling Ave., Suite 110 n 1-800-IN-FOCUS (1-800-463-6287)
Kingston: Hotel Dieu Hospital, 166 Brock St., Suite 325 n 1-877-460-6029
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•Important to remember all flaps
will not look the same due to
individual healing differences
Q:Is striae a concern?
A:If vision is not impacted,
striae is not a concern
Q:Is flap debris normal?
A:If there is no inflammatory
response, debris is not centrally
located and VA is not affected,
no course of concern.
Q:Is corneal edema a common
finding post SBK?
A:1–2 weeks post- SBK patients
may report a “foggy” VA or halos
related to the edema.
613-724-3937 n fax 613-724-6264
613-542-5000 n fax 613-544-2632
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www.focuseye.com
www.focuseye.com
FAST
facts
A NEWS SERVICE FOR DOCTORS AFFILIATED WITH FOCUS EYE CENTRE
New Patient
Selection Parameters
for Hyperopes
“Having tracked statistical outcomes at Focus for years,
we have concluded that hyperopic patients over
+3.00 achieve best outcomes with CLE (Clear Lens
Exchange),” says Dr. David Edmison, Medical Director.
Please contact us at:
by email at
[email protected]
or by calling
613.724.3937
“Based on this data, we will be recommending this
procedure for those patients who otherwise qualify.”
This change is reflected in the updated Patient Selection
Parameters attached, in full, here.
We ask that you read this information closely, especially
as it pertains to hyperopes, and contact us by phone
or e-mail should you have any questions.
Ottawa: 1565 Carling Ave., Suite 110 n 1-800-IN-FOCUS (1-800-463-6287)
Kingston: Hotel Dieu Hospital, 166 Brock St., Suite 325 n 1-877-460-6029
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613-724-3937 n fax 613-724-6264
613-542-5000 n fax 613-544-2632
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www.focuseye.com
www.focuseye.com
FAST
facts
A NEWS SERVICE FOR DOCTORS AFFILIATED WITH FOCUS EYE CENTRE
InSight Comes Online
OD Intranet designed to bring best info to eyecare professionals
Focus Eye Centre prides itself on
the close working relationships
it has developed with ODs in the
local community. These relationships
date back to Focus Eye’s inception
15 years ago and will be maintained
well into the future.
These days Focus affiliated ODs
number upwards of 200 and offer
our laser vision correction (LVC)
centre a valued and valuable link
to the men and women who are
‘primary healthcare practitioners
of the eye’. As a means of further
our connection, as well as fostering
knowledge exchange between Focus
surgeons and ODs and those ODs
working in the community, we have
built an OD Intranet —– InSight
— accessible via Focus Eye’s main
website (www.focuseye.com).
The mission of InSight is to keep
Focus-affiliated ODs abreast of the
latest developments in laser vision
correction, particularly surgical
techniques and treatments being
used by Focus Eye.
“InSight is a natural extension of
what we do each and every day in
terms of connecting and conferring
with ODs,” says Nancy Bast,
Co-Management Coordinator at Focus. “We are also cognizant of
the fact that ODs are often the first
face a patient meets when they are
struggling with vision correction.”
“Often the best vision-care solution
is a pair of glasses or contact lenses.
However, many people find the
benefits of LVC too numerous
and positive to resist,” adds Bast.
surely become the industry standard
based on the outcomes it is delivering.
There have been more than 1 million
SBK procedures performed in the U.S.,
and the U.S. Navy, a long-time proponent of PRK for its fighter pilots, has
already moved to adopt SBK as their
standard of care.
“InSight is a natural extension of what
we do each and every day in terms of
connecting and conferring with ODs,”
InSight asks the question “Why Refer?”
and looks into the particulars of OD
Co-Management. It also delves into
industry-leading treatment issues
such as the data on Intralase SBK
(Sub-Bowman’s Keratomileusis), which
involves creating an ultra-thin corneal
flap of approximately 100 microns just
below Bowman’s layer with a femtosecond laser. Simply stated, Intralase
SBK combines the advantages of
PRK and LASIK, with recovery times
measured in hours rather than days.
The case for Intralase SBK is extremely
compelling, and one you’ll be hearing
a lot about in the coming days as doctors and patients alike adopt what will
www.focuseye.com
(613) 724-3937 1-800-IN-FOCUS
Two-way communication and 24/7
access are of paramount importance,
according to Nancy Bast, who points
out that InSight allows ODs to download pre- and post-operative forms.
“We are also encouraging our ODs
to send us their comments and questions about the work we do and the
ways in which we can better assist
ODs in the work they do.”
Whether it is an eye exam or troubleshooting an infection, performing
LVC or CLE, Focus and its affiliate
ODs share a common goal: getting
people their best possible vision in
the safest and most effective manner.
FA S T
facts
A NEWS SERVICE FOR DOCTORS AFFILIATED WITH FOCUS EYE CENTRE
Why Wavefront
Wavefront is a diagnostic technique
that produces detailed information
which is then programmed into the
laser prior to your patient’s procedure. Wavefront goes beyond treating nearsightedness, farsightedness
and astigmatism by detecting all
the irregularities that impact on
the path of light from the front of
the eye (cornea) to the retina at the
back, and then eliminating them.
PRK and PRK-WGA Low Myopia
3 MonthUncorrected Visual Acuity
100%
75%
59%
25%
0%
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95% 100%
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PRK
PRK-WGA
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123456 20/20 or better
123456 20/15 or better
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12345620/25 or better
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While our Standard laser vision
correction results are excellent,
Wavefront affords greater precision for the surgeon and better
results for our patients.
Our surgeons are recommending
Wavefront to candidates that fall
within the parameters. It is a
Standard of Care here at
Focus, and simply put, a better
treatment option.
94%
20/40 or better
PRK-WGA Low Myopia 3 Month
Uncorrected Visual Acuity
100%
“The majority of our Wavefront
patients have recorded better vision
than they were able to achieve before
their procedure — in many cases
20/15 or even 20/10. In addition,
patients also talk of an improved
‘quality’ of vision.“
— David Edmison,
MD, FRCSC,
Medical Director.
95%
91%
100%
Each patient outcome is as unique
as the individual’s fingerprint. But
Wavefront is not for everyone; it
depends on the results of the examination with the surgeon and consultation with the patient. The goal,
as always, is to identify and deliver
the best outcome for your patients.
75%
59%
50%
Who Qualifies
for Wavefront?
25%
Focus Eye Internal Results:
Highlights of Wavefront results
are as follows:
• 91% 20/20 Uncorrected
Visual Acuity or Better
at 3 months
• 50% 20/15 Uncorrected
Visual Acuity or Better
at 3 months
0%
>20/15
>20/20
>20/25
>20/40
PRK-WGA
The surgeons at Focus started using
Wavefront in late 2002, and since
that time have had extraordinary
results. Many patients are seeing
better than they ever could with
glasses or contacts.
www.focuseye.com
(613) 724-3937 1-800-IN-FOCUS
The patient parameters for
WGA are as follows:
• Myopia: -12.00 sphere,
and up to +6.00 cylinder.
• Hyperopia: +9.00 sphere,
and up to +6.00 cylinder.
• Minimum requirement
for pupil size: 5 mm.