Laser Vision Correction:

Tips and Trics for Success

Setiyo Budi Riyanto, MD

Director, JEC @ Menteng

Past President Of INASCRS
Head of Cataract & Refractive Surgery Service JEC
Cataract & Refractive Surgery Consultant
 I Have No Financial Disclosure
For any Maters in This Presentation
Laser Vision Correction
Modern surgical lasers are able to alter the curvature and focusing power of the
front surface of the eye (the cornea) very accurately to correct short sight
(myopia), long sight (hyperopia), and astigmatism.

Three types of procedure are commonly used:

• Surface laser treatments (PRK, LASEK,
TransPRK)
• LASIK,
• ReLEx SMILE.
SUCCESS IN LASER VISION CORRECTION

Key Point for Success :

PATIENT Happy and No Complain • Education to patient
• Patient selection
• Complete pre Surgery analysis
SURGERY SAFE AND NO COMPLICATION
• Good and safe Surgery (Surgery
Technique) - Learning Curve
SURGEON Happy and NO Stress • Good management complication
Patient Education

Decrease of Visual Acuity

REFRACTION ERROR: ORGAN DISORDER OF EYE GLOBE :

• Myopia • Cornea
• Hypermetropia • Lens
• Astigmatism • Glaucoma
• Vitreus
• Retina
• Optic Nerve

LASER VISION CORRECTION

 Correction for Refraction Error:

NON SURGERY :
• Spectacles / Glasses
• Contact Lens

R
e SURGERY:
f • Radial Keratotomy
r
a • Phakik IOL
c • Clear Lens Extraction + IOL ( Refractive Lens Exchange)
t
i
v
e
S
u LASER VISION CORRECTION :
r
g
• PRK / LASEK / TRANS PRK
e • LASIK (Laser Assisted Insitu Keratomileusis)
r • ReLEx SMILE (Refractive Lenticule Extraction, SMall Incision Lenticule Extraction)
y
 LASER Vision Corretion:

PRK Simulation
Laser Type: Excimer Laser

LASIK Simulation
Laser Type: Excimer Laser

ReLEx SMILE Simulation

Laser Type: Femtosecond Laser
 LASIK
( Laser Assisted Insitu Keratomileusis )

Correction for Refraction Error:

* Spherical (Myopia/hypermetropia)
TOPOGRAPHY CORNEA * Astigmatism (Cylindris)
* Corneal Irregularity

ABEROMETRY CORNEA Wavefront - Guided LASIK

Custom Ablation
Visual Acuity

E a g l e Vision
 PRK / TRANSPRK / LASIK ?

Pre Op Cornea

OZ TZ

Target Cornea

Smoothly linked to
peripheral cornea
PRK / TRANS PRK LASIK RELEX SMILE

FAST RECOVERY
Slow Recovery FAST RECOVERY
NO FLAP
NO FLAP NO PAIN

PAIN NO HAZE NO PAIN

HAZE FLAP NO HAZE

Patient Selection :
Indication of Lasik :
• > 18 yo ( LASIK )
• > 40 yo ( PRESBY-LASIK )
• No Pregnance
• No Autoimun Disorder
• Refraction Error:
• S + 1 00 D s/d + 4 00;
• S – 0.50 D s/d - 14 00 D;
• C - 0.50 s/d - 5 00 D
• 14 days remove Soft Contact Lens
• 30 days remove Hard Contact Lens
• No Dry Eyes

SBR
Patient Selection :
Indication RELEX - SMILE:
• > 18 yo ( LASIK )
• No Pregnance
• No Autoimun Disorder
• Refraction Error:
• S – 0.50 D s/d - 10 00 D;
• C - 0.50 s/d - 5 00 D
• 14 days remove Soft Contact Lens
• 30 days remove Hard Contact Lens
• NO Dry Eyes

SBR
Patient Selection :

Contra-Indication of PRK/LASIK/SMILE :

• Eye Infection
• Keratoconus
• Thin Cornea
• Pregnance
• Severe Dry Eyes
• Glaukoma
• Retina Disorder
Patient Preparing (Pre Lasik/Smile):
• Best Subjective Refraction

• Corneal Analysis :
Corneal Thickness
Corneal Map

• Normal IOP

• Clear Cornea

• Normal Retina
CORNEAL THICKNESS
CORNEAL ANALYSIS
Corneal Analysis :
Normal Cornea
 Keratoconus Cornea

SCHWIND SIRIUS SCHWIND SIRIUS

Keratoconus screening Keratoconus screening

KPI % -> Keratoconus classification:

0% - 50% = Normal ("green)

50% - 75% = Suspect Keratoconus ("yellow")
(a rather normal eye with changes typical of an initial ectasia in the posterior corneal surface)
75% - 100% = Keratoconus ("red")
or Abnormal („blue“)
Irregular Cornea
Post Surgery Analysis

DECENTERED ABLATION
DECENTERED ABLATION
IRREGULAR ABLATION ( POST LASIK)
 LASER VISION CORRECTION

Trans PRK LASIK RELEX SMILE

 COMPLICATION / DIFFICULT CASES

Suction Lost Black Spot

Smile Retreat
Take Home Message :
Tips and Tricks for Success In LASER VISION CORRECTION:

• Education to patient

• Patient selection

• Complete pre Surgery analysis

• Good and safe Surgery (Surgery Technique)

• Good management complication

 THANK YOU
FOR YOUR ATTENTION