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Wednesday / June 19.
HomemiophthalmologyAustralian First: The Newest Laser Treatment

Australian First: The Newest Laser Treatment

It’s been 12 weeks since Ricki Kerr became the first person in Australia (and one of the first in the entire world) to have the laser eye operation PresbyLASIK performed… and she couldn’t be more satisfied.

Sydney mother of three Ricki is one happy person!

“Not only have I stopped tripping over objects,” she jokes. “I can now park my car properly.”

According to the very first PresbyLASIK practitioner in Australia, Dr. Patrick Versace, of the Vision Eye Institute, the “revolutionary technique” has the potential to eliminate or at least reduce reliance on glasses for thousands of people suffering from the age-related condition known as presbyopia.

Ricki says she started wearing glasses about 15 years ago, and when she wasn’t wearing them, “I couldn’t tell the conditioner from the shampoo. Then I started to fall over. I used to trip over things a lot and I also noticed I had a problem parking the car. My depth perception was out which is probably why I was falling over. It was getting to a stage that my husband was getting very worried about all my injuries caused by my constantly tripping over things, so I knew something urgent had to be done,” says the 54-year-old.

PresbyLASIK has been described as a groundbreaking technique using laser technology to reshape the cornea of the eye, allowing the brain to merge near, middle and long distance vision from each eye. According to the very first PresbyLASIK practitioner in Australia, Dr. Patrick Versace, of the Vision Eye Institute, the “revolutionary technique” has the potential to eliminate or at least reduce reliance on glasses for thousands of people suffering from the age-related condition known as presbyopia. Ricki hadn’t had her eyes checked for years so, at the urging of her concerned husband she went to see an optometrist, got a referral to an ophthalmologist and asked him about laser treatment because she knew some people who had had it done successfully.

“The ophthalmologist Dr. Versace agreed I was a candidate for laser treatment and explained the choices I had”.

Those choices were either to replace her current lenses, have standard Lasik and continue to use reading glasses, Monovision surgery (laser treatment with one eye for far and the other for near), or have Laser Blended Vision – PresbyLASIK.

“Dr. Versace explained that with Laser Blended Vision, both eyes are refocused but one is preferentially set for clear distance vision whilst the other is biased more for near vision. The blending of vision between the eyes would create more natural balance” says Ricki.

“I went back to the Vision Eye Institute three times and that’s when Dr. Versace explained the new PresbyLASIK technique and told me I would be a perfect candidate. Dr. Versace explained that Laser Blended Vision was a new technique to create monovision without the compromises”.

The Prodedure

Ricki says PresbyLASIK is a quick and pain-free procedure which involves only a little discomfort.

Explaining the entire procedure, Ricki says: “When you go in they give you some Valium. You lie on the laser table and they put something on your eye to keep the eyeballs still. It lasts about 40 seconds while the laser machine creates a flap so they can get underneath the cornea. Then the table swivels and you go into the second machine and you can see five lights. For me they were really blue and the laser must have taken 20 seconds and the minute that happened I could see those lights perfectly clearly.

“When you finish they give you sunglasses and medication (antibiotic and steroid eye drops) to take home, and suggest you go home and have a sleep.”

The next morning Ricki says she could see perfectly, apart from the fact that there was some irritation and her eyes were runny.

“But I could see. I was blown away. It was fantastic. My husband was stunned with how my vision had improved and how I was no longer tripping over, and more to the point… I can now park my car. It’s changed my life for the better. My husband says I walk around much more confidently now”.

Ricki says she still wears glasses on occasions because she does a lot of reading and computer work, but she can now go to a restaurant and read a menu and tell the difference between the conditioner and shampoo glasses-free.

“I can’t tell you the difference it’s made. It’s fabulous,” she declares.

Last Frontier

Dr. Versace is extremely pleased with this latest technique for treating presbyopia, describing the treatment of the age-related problem as “the last frontier of refractive surgery,” Dr. Versace explains.

“We are still looking for a good treatment for presbyopia. Even though your eyes are perfectly normal, it’s a natural part of the ageing process for the lens in the eye to no longer be able to change the focus of the eye. We have quite a few treatments we are able to use for it… and PresbyLASIK is the latest one of them.”

He says eye surgeons have been doing laser refractive surgery for more than 20 years and there’s been a burning desire ever since to work out how doctors can treat near vision as well as distance vision through laser refractive surgery.

“Historically, what we would do is Monovision… make one eye for distance and one eye for up close. For example, if you’ve got a 50-year-old patient who is myopic, then maybe he or she is -2. We can treat their eyes and make both their eyes perfect with laser refractive surgery and they’d see very well, but they’d still need reading glasses.

“We could modify our laser surgery and treat one eye so that it’s clear for distance and the other eye so that it has near vision.
That’s called mono vision.

“The brain steps in and works out how to use the optics. Optometrists do this a lot with contact lenses. They’ll deliberately leave one eye with near vision and your brain can sort it out.

“But the problem is that it won’t work for at least 40 per cent of patients because they suffer some form of blurring.

“It happens because with mono vision, we’re creating two focal points. We’re creating one eye with a sharp focus for distance and the other eye with a sharp focus for about an arm’s length. With those sharp focus points, there are no overlaps between the eyes. We don’t have fusion of vision.

“Our visual system is designed for the brain to take information from both eyes and fuse the images, and then the brain creates a three dimensional image from that. This is how we judge depth.”

Expanding Focus

“With PresbyLASIK, we’re still doing laser refractive surgery, but Zeiss has developed software which allows us to actually expand the depth of focus with each eye.

“Instead of creating one eye with a sharp focus for distance and one with a sharp focus for near… we are actually expanding the range of focus of each eye. So you still have one eye that sees better preferentially for near and one for far, but because we have expanded the depth of focus for each eye, the brain can now fuse vision from each eye much better over a broader range. This blending of the vision significantly reduces the perception of blur and increases patient acceptance. It means we can take pretty much anybody – there’ll be some who still won’t be suitable – and get them to have functional vision without glasses,” Dr. Versace.

Dr. Versace says PresbyLASIK is a quick, non invasive procedure similar to LASIK only using different software and making a different shape on the cornea.

From the patient’s perspective, the surgery and the procedure are identical. It takes about 15 minutes for both eyes.

“It’s non-intrusive because it works on the outside of the cornea. It’s not actually penetrating the eye. It’s also pain free. There’s a bit of pressure during surgery, wateriness and some irritation the night of surgery. By the next morning most patients can drive and function because they’ve got vision,” he says.

And how is it that Dr. Versace was the first person in Australia to perform this technique on Ricki Kerr?

“Well, the patient was in the right place at the right time and my relationship with Zeiss brought about the fact that I became the first in Australia to perform PresbyLASIK. I’ve been doing laser refractive surgery with LASIK since it started in Australia about 15 years ago. I’ve had a relationship with Zeiss for the last few years and I’ve been one of their reference doctors”.

Asked how far medical science can go when it comes to vision correction Dr. Versace puts it this way: “We’ve come to learn that by manipulating some of the higher order aberrations in the eye – that is if you’re short sighted or have astigmatism, these are lower order aberrations. These are basic aberrations that distort your vision.

“There’s a whole series of more subtle aberrations – the higher order aberrations – which have a more subtle impact on vision. For example some people see well by day, but at night their vision is not sharp.

“If we selectively alter some of the higher order aberrations, we can modify the depth of focus with the eye and that’s what we’re doing with PresbyLASIK.

“So it’s based on wavefront treatment and it’s selectively modifying spherical aberrations to increase depth of focus. Isn’t that clever?”

Clever is an understatement. As Dr. Versace points out, that very same wavefront technology is also used in astronomy and in the design of the telescope, neutralising distortion and allowing the viewer to see the planets through the atmosphere.

Electric Lens
“One of the other approaches we take with treating presbyopia is for patients having cataract surgery or lens replacement surgery. When we do a cataract operation we remove the natural lens from the eye and replace it with an artificial lens.

“With the standard operation, we put a lens in the eye and patients see very well, but they still need reading glasses afterwards.

“There are a whole lot of lenses we can now use. For example, we often use multi focal lens implants after cataract surgery to allow patients clear vision for both distance and near vision.

“The latest version of this is now being designed and it’s actually an electrical lens that goes into the human eye. This lens is like a sandwich. It’s got a layer of optical materials and an electrical layer like a pixelated layer.

“When you pass an electrical current through it, it changes the focusing power of the lens – very elegant. So you can take an electrical current that can be sourced from the ciliary muscle that controls the focus. The muscle can produce the power to control the lens.

“It means you put that inside the eye and when you look at something up close, it sends a signal to the muscle, the muscle generates electricity, electricity goes to the lens and the lens focuses for near vision. This is what’s coming.

“To answer the question of where we are going in optics…they sky’s the limit”.