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Lec Ref Surgery

The document outlines a course on clinical refraction and instrumentation in optometry, focusing on refractive surgery and its associated procedures. It details patient selection criteria, contraindications, preoperative evaluations, and various refractive procedures for correcting myopia, hyperopia, and astigmatism. Additionally, it highlights the learning outcomes for students, emphasizing their understanding of refractive surgery and patient evaluation.

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Amna Shahid
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5 views41 pages

Lec Ref Surgery

The document outlines a course on clinical refraction and instrumentation in optometry, focusing on refractive surgery and its associated procedures. It details patient selection criteria, contraindications, preoperative evaluations, and various refractive procedures for correcting myopia, hyperopia, and astigmatism. Additionally, it highlights the learning outcomes for students, emphasizing their understanding of refractive surgery and patient evaluation.

Uploaded by

Amna Shahid
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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CLINICAL REFRACTION &

INSTRUMENTATION(OD-146)
BY

Doctor of Optometry

MAIMOONA REHMAT
Lecturer
DOVS-FAHS
The University of Lahore
COURSE DESCRIPTION

• After studying this course, students will have


basic knowledge regarding refraction and
advance instruments regarding optometry.
REFRACTIVE SURGERY
LEARNING OBJECTIVES
After the lecture student will get to know about:
• Refractive surgery
• Selection criteria for the patient
• Pre evaluation
• Different refractive procedures
OPTIONS TO CORRECT A REF.ERROR
• Glasses
• Contact Lenses
• Refractive Surgery
REFRACTIVE SURGERY

Range of procedures aimed at changing the refraction of


the eye by altering the cornea or lens, the principal refracting
components.
PATIENT SELECTION CRITERIA

• Age 18-22 years or older

• Stable refraction for at least one year

• Suitable refractive error


CONTRAINDICATIONS
Absolute contraindications:

• Corneal abnormalities (e.g., keratoconus, thin cornea,


corneal ulceration)

• External eye disease (e.g., blepharitis, atopy/allergy, dry eye


syndromes)

• Pregnancy
• Significant cataract
CONT..
• Uncontrolled diabetes mellitus

• Uncontrolled glaucoma

• Uncontrolled systemic autoimmune disease

• Unrealistic patient expectations


CONT..
Possible contraindications (consider with caution)

• Abnormal wound healing

• Controlled diabetes

• Glaucoma

• History of herpetic keratitis

• Systemic autoimmune disease (e.g sicca syndromes)


PREOP EVALUATION
• History
• Visual acuity distance and near
• Use of contact lenses must be discontinued.
• One to two weeks for soft lenses, and three to four weeks for
hard lenses so that the corneal surface can stabilize,
allowing for accurate preoperative measurements.
• Corneal topography
CONT…

• Corneal thickness i.e pachymetry

• Cycloplegic refraction

• Subjective refraction

• Current spectacle correction

• Pupil dilatation under mesopic and scotopic conditions


CONT..

• Ocular motility

• Gross slit lamp examination

• TBUT

• Counselling
REFRACTIVE PROCEDURES
Different refractive procedures are done to correct
• Myopia
• Hypermetropia
• Astigmatism
MYOPIA
• PRK
• LASEK
• LASIK
CONT…
• SMILE SMall Incision Lenticule Extraction
• uses a femtosecond laser to create a small, lens-shaped bit
of tissue (lenticule) within the cornea.
• Then, with the same laser, a small arc-shaped incision is
made in the surface of the cornea, the lenticule is extract
through this incision and discards it
CONT…

• Clear lens extraction:


gives very good visual results but carries a
small risk of RD.
CONT…

• Iris clip: implant is attached to the iris


• Phakic posterior chamber implant: is inserted
behind the iris and in front of the lens.
HYPEROPIA

• PRK
• LASEK
• LASIK
CONT…
• Conductive keratoplasty:
Involves the application of radiofrequency energy to the corneal stroma.
Burns are placed in one or two rings in the corneal periphery using a probe.
The resultant thermally-induced stromal shrinkage is accompanied by an
increase in central corneal curvature.
CONT…
• Laser thermal keratoplasty:
With a holmium laser can correct low hypermetropia.
Laser burns are placed in one or two rings in the corneal mid-periphery.
ASTIGMATISM
• PRK
• LASEK
• LASIK
• Limbal relaxing incisions/arcuate keratotomy
• It involves making paired arcuate incisions on
opposite sides of the cornea in the axis of the
correcting ‘plus’ cylinder (the steep meridian).
PRK…
CONT..

PRK is able to correct myopia up to 6 D


Astigmatism up to 3 D and low hypermetropia.
CONT…

Complications:
• slow-healing epithelial defects
• corneal haze and haloes
• poor night vision
• regression of refractive correction.
LASEK

• Laser assisted sub epithelial keratectomy(LASEK) is


an adaptation of PRK.
• In LASEK the epithelium is first detached and peeled
back, excimer laser applied and then the flap
repositioned.
• LASEK works well with low corrections
• Patients with very thin corneas.
LASIK..LASER ASSISTED INSITU
KERATOMILEUSIS
CONT…
• It can correct hypermetropia of up to 4 D
• astigmatism of up to 5 D and
• myopia of up to 12 D
CONT..
COMPLICATIONS:

• Tear instability
• Wrinkling , distortion or dislocation of the flap.
• Subepithelial haze with resultant glare especially at night.
PRESBYOPIA
• Lens extraction… Implantation of a multifocal, bifocal IOL
• Conductive keratoplasty
• Laser-induced monovision
• Laser to the crystalline lens ..research going on
REFERENCES
• Clinical Ophthalmogy by Kanski
•
LEARNING OUTCOMES
Students have learnt:
• Refractive surgery
• Selection criteria for the patient
• Pre evaluation
• Refractive procedures
THANK YOU!

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