SERVICES

LASIK


Browse through these pages to learn about how we have geared our processes and technology to achieve 2 key points for a successful LASIK - accuracy and safety.

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SHINAGAWA LASIK

Shinagawa Eye Centre has a long history of providing LASIK treatment in Singapore. Thousands of patients have had their procedures performed at our Centre since 2008. Get a review from a friend or relative who had their treatment done at our Centre and you will hear about our experienced doctors, advanced technology and our emphasis on having the human touch.


IS LASIK FOR YOU?

LASIK is a laser procedure, used to correct Myopia (Short-sightedness), Hyperopia (Long-sightedness) and Astigmatism; to reduce or eliminate a person's dependence on spectacles and contact lenses. Spectacles could impede those who lead an active lifestyle, especially in sports and games. As an alternative, this same group of people would look to contact lenses for clear vision.

Although contact lenses provide good vision to many people, it has its constraints such as dry eyes and eye allergy. When worn over a prolonged period, it can cause damage to the surface of the eyes due to the lack of oxygen. Furthermore, it can lead to infection of the cornea. In light of these constraints, LASIK is the solution.

As a good candidate for LASIK, you should:

  1. Have a stable spectacle power for at least one year
  2. Not have eye diseases such as keratoconus
    (weak protruding cornea)
  3. Have a suitable range of myopia and/or astigmatism
  4. Not be pregnant

PROCEDURES AVAILABLE

LASIK
The term LASIK is used when the method involves creating a cornea flap.

Conventionally, a blade instrument called Microkeratome is used to create the cornea flap. The flap created is then folded aside, to enable the Excimer laser to do the job of reshaping the cornea. The cornea flap is then put back to its original position.

IntraLase Method
The Microkeratome method has slowly been phased out over the years. These days, doctors will make use of the blade-free method to create the cornea flap. We have been using this method since 2008. Some have also called this the All-Laser LASIK. This is an expensive laser machine which uses an advanced femtosecond laser technology to achieve a more accurate, and safer flap-making procedure.

Because the IntraLase is empowered by computer control precision, it allows the surgeon to customise the depth, width, shape and location in creating a very thin cornea flap in order to customise to the needs of the individual patient.

The IntraLase laser creates air bubbles in the stroma of the cornea. Air bubbles create space and the flap is not lifted until the LASIK surgeon uses a special surgical instrument to lift the cornea flap. This means that the cornea is still intact after the IntraLase laser and the patient can blink normally and walk around normally without fear that the flap will dislodge.

There are several generations of the Intralase in use in Singapore. We have the 5th generation of Intralase - The iFS Intralase Laser available at our centre. This is the latest version of the Intralase. This version lasers 2.5 times faster than the previous generation (FS60), so it takes a much shorter time to complete the procedure. The cornea flap is also more stable and there is less inflammation as less energy is used.

Anaesthesia eye drops are applied

Intralase laser is used to create the cornea flap

The flap is folded to one side and the excimer laser applied to reshape the cornea

The cornea flap is repositioned

Epi-LASIK / PRK / LASEK / No-touch Epi-LASIK

Apart from the above methods in which a cornea flap is made, Epi-LASIK is a method that does not make any cornea flap. A specialised equipment is used to separate a thin layer of cells known as epithelium on the front surface of the cornea. The laser is applied and the thin layer of cells is then placed back over the cornea.

Another way to perform the surgery without the need for a cornea flap is to perform PRK (Photo Refractive Keratectomy), this method involves scraping off the epithelium. A variation of this method involves applying some alcohol over the cornea for a short period of time to make it easier for the cells to be removed, this method is known as LASEK.

Shinagawa Eye Centre has all the above methods but the preferred method to do the no flap technique is to use an even more advanced method: No-touch Epi-LASIK. This method utilizes the advanced Amaris laser to remove the epithelium. This means that there is no need to use any equipment to scrape the skin cells away, the laser does the entire procedure. This reduces surgery time and increases precision. There have been quite a few terms for this particular method of surgery, some call it Bladeless Epi-LASIK or Trans-PRK or Trans Epi-LASIK. The simple way to think of it is No Touch and No Flap.

Not everyone is suitable for this technique. It is important for you to go through an assessment of your eyes and our doctor will determine which method best suits your eyes.

There are some centres in the world that use Relex Smile. This is a less mature technology than LASIK. Unlike LASIK or Epi-LASIK, it cannot treat people with low amounts of short-sightedness and the procedure cannot be done again (enhancement) on the same eye if needed. This method is not truly flapless as it involves disrupting the layers of the cornea such that a small layer of the cornea can be removed through an opening on the side of the cornea.


Our Laser System

Schwind AMARIS laser

The AMARIS laser offers you the leading technology for your laser treatment - superior in all important aspects: Speed, precision, safety and comfort.


Minimum treatment time
The AMARIS works two to three times faster than other laser systems. It is extremely fast and corrects one diopter of myopia within 1.5 seconds, and eight diopters (800 degrees) are ablated within 13 seconds.


Eye tracking in six dimensions

The eyes can involuntarily move in all directions for milliseconds while fixating on the laser light. The AMARIS eye tracker monitors the position of the eye with approximately 1050 measurements per second and thereby compensates any deviation up to the sixth dimension.

Your eyeball can turn left to right and up and down; rotate around its own axis (cyclotorsion) or move up and down along the z-axis. The eye tracker of the AMARIS detects all these eye movements and compensates them.


Exceptionally fine laser beam
The laser beam of the AMARIS have an exceptionally small diameter of only 0.54 millimetres and are thus significantly smaller than others. Further-more they have a special shape. Your cornea becomes especially smooth with this fine beam, therefore allowing a better quality of vision.


Clinical results
A multitude of international clinical studies have documented the excellent treatment quality with AMARIS technology. Visual acuity of 100 percent or better was achieved in nearly all cases. A high percentage of treated patients could see better than before with glasses or contact lenses. The study results also show improved contrast vision.


SOFTWARE MODULATIONS AVAILABLE ON THE EXCIMER LASER

After the flap is created by the IntraLase or the cornea is prepared by the Epi-LASIK method, the excimer laser is applied to reshape the cornea. The following are software modulations available on our excimer laser: the AMARIS laser. Note that it is not the same laser as Intralase which is used to create the cornea flap.

Standard LASIK

This corrects vision problems such as Myopia, Hyperopia and Astigmatism. While this treatment method is available at our Centre, it is not often used. Instead, one of the following customised treatment is used, depending on the needs of the individual eye.

Wavefront-Optimised LASIK

Wavefront-Optimised LASIK is a laser technique which creates a more natural shape of the periphery of the cornea, thus reducing the chances of the night glare effect and improving quality of vision. Almost everyone will benefit from this treatment as the lasered cornea becomes smoother and more natural in shape.

Wavefront-Guided LASIK

Wavefront-Guided LASIK treatment can correct the "higher order" aberrations, therefore allowing an improvement in vision quality. Higher order aberrations are irregularities of the eyes that degrade vision quality. Those with a large amount of these aberrations will benefit from this treatment.


LASIK Xtra

LASIK Xtra refers to the combination of LASIK together with Corneal Collagen Cross-Linking.

Corneal Collagen Cross-Linking (CXL) is a surgical procedure used to strengthen a weakened cornea.

The Avedro KXL system

A newer system, the Avedro KXL system is now available for strengthening the cornea by cross-linking its collagen.


The Avedro KXL system

LASIK Xtra™ - better safety after LASIK

Besides cross-linking corneas with keratoconus (weak cornea disease), the Avedro KXL system has also been used in patients undergoing LASIK. This helps to minimise the weakening effects of LASIK on the cornea by strengthening it with cross-linking treatment. Corneas normally become thinner after LASIK because the excimer laser used removes tissue. This effect is more marked when higher degrees of spectacle power are treated. In a very small percentage of cases, this thinning causes the cornea to bulge forwards and become distorted in a condition called corneal ectasia.

The mechanics of LASIK Xtra™

Performing this addition to a normal LASIK procedure only adds an extra 3 minutes of time.

After the excimer laser has been used to reshape the cornea during a LASIK procedure, special cross-linking medication is applied to the cornea surface. The LASIK flap is replaced. The Avedro KXL system is then positioned over the cornea and the light is shone onto the cornea. This activates the medication in the cornea and cross-links the collagen fibres, making the cornea stronger.

Safety of LASIK Xtra™

The Avedro KXL is CE marked and thus approved for use throughout the European Union. It is also approved for use in Canada and Japan. Overall, cross-linking treatment did not affect the accuracy of the excimer laser in correcting spectacle power and the side-effects are similar to those who just had LASIK without cross-linking done.

LASIK Xtra™

  • A system to strengthen the weakened cornea by ultraviolet light induced cross-linking with riboflavin.
  • Based on established principles which have been in use with older machines for almost 10 years.
  • Improvements include much shorter duration of treatment, better precision with more consistent treatment effect and better safety.
  • Stabilises conditions like keratoconus and corneal ectasia.
  • Useful for LASIK in patients with high spectacle powers and pre-existing thin corneas as it helps to strengthen the cornea.

SIDE EFFECTS OF LASIK

As in all surgical procedures, there are some side effects that may occur after LASIK surgery. Although this surgery is very accurate; perfect vision cannot be guaranteed. Most of the problems after surgery are temporary and do not affect vision. Some of the side effects:

Dry eyes
Dry eyes after laser vision correction is common. This is easily treated with eye drops. This condition does not usually affect vision and will subside within 1 to 2 months.


Night Vision Problems
This refers to seeing glare and star-bursts when looking at bright objects in dim light, for example, headlights of cars at night. It occurs in those whose pupils dilate well in dim light and in those who need a high correction. Not all patients will have this side effect.

For those who observe this effect - it occurs in the early stages after treatment but will gradually diminish over the course of 3 to 4 months. Pupil size in dim light is measured before the surgery and you will be advised if you are at risk of observing this effect after surgery.


Under and Over-corrections
This is uncommon, usually in the range of 1 to 3%. For example, a person with 900 degrees of Myopia may be left with 50 degrees in a case of under-correction. If it does occur a top-up laser can be performed at 3 months after the first laser treatment.


Infection
Infections due to surgery is a rarity, compared to infections caused by contact lens wear. (Antibiotics are given during and after surgery to prevent such occurrence)

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