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LASIK Alternatives

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If LASIK laser vision correction is not an option for you, there are other options that may better suit your individual eye conditions and your lifestyle. We encourage you to read the information provided below and to schedule a free consulation to discuss your vision correction options.

Visian ICL

Toledo LASIK & Cataract Now offers a solution for patients that suffer from High Myopia or High levels of Nearsightedness!

About Visian ICL™

Introducing a solution for patients with high amounts of nearsightedness. The Visian ICL™ is a revolutionary refractive lens that can correct vision up to –15 diopters of nearsightedness.

The Visian ICL™ procedure has been repeatedly improved through years of rigorous studies and continued refinement. This lens is a posterior chamber implant that is situated behind the iris and in front of the natural crystalline lens. It is also known as a Phakic IOL. The surgery is performed on an outpatient basis, which means that a patient has surgery and leaves the same day.

The Visian ICL™ is made with Swiss precision from Collamer. Collamer, a collagen copolymer is a proprietary biocompatible material formed from pure collagen and a hydrophilic copolymer with a UV absorbent chromophore. This material has been used to treat the eye for over 15 years now and considered very safe.

What Happens During Visian ICL™ Surgery

Prior to the surgery a surgeon will make two microscopic holes in the iris. Your eye will be numbed with a light, topical or local anesthetic. Once the eye is numbed the surgeon will make 2 side port incisions and one main temporal incision that is critical to the insertion process. Next the surgeon will insert the ICL through the main temporal incision and place the lens behind the iris and in front of the crystalline lens. This insertion procedure is typically performed one eye at a time. There is very little discomfort and normally no pain associated with the procedure. Some drops or perhaps oral medication may be prescribed and a visit is usually scheduled the day after surgery. Patients will be advised to arrange for someone to drive them to and from surgery.

Your solution for Implantable Contact Lenses in Toledo, Ohio. Call us today for a FREE patient consultation to determine if The Visian ICL™ is right for you. If you have been told by an eye doctor in Cleveland that you are NOT a candidate for LASIK eye surgery then the Visian ICL also known as the Implantanble Collamer Lens could be the best vision correction alternative. You can rest assured that the doctors at Toledo LASIK & Cataract will provide you only with the best options for correcting your vision. Whether this be LASIK, laser vision correction, PRK, The Visian ICL or even the Crystalens we simply provide the most robust vision correction option in Ohio. Call us today! Your source for Visian ICL in Toledo.


Refractive Lens Exchange

As our eyes age they often develop a condition known as presbyopia, which typically means that glasses or contact lenses will be needed to read. Presbyopia is vision condition that cannot be cured with laser vision correction. Fortunately, there is an alternative to glasses or contacts, a Refractive Lens Exchange.

Refractive lens exchange allows patients to reduce or even eliminate the need for reading glasses and presbyopia through an advanced multifocal intraocular lens. At Toledo LASIK & Cataract we offer ReStor, ReZoom and Crystalens, which are used to replace the natural lens of your eye during the refractive lens exchange.

LASIK concentrates on correcting the shape of the cornea, while Refractive Lens Exchange replaces the natural lens of your eye with an advanced multifocal or accommodating intraocular lens (IOL), allowing clear vision at every distance. An additional benefit to the refractive lens exchange is that you'll never have to worry about cataracts because the multifocal IOL will remain clear as your eyes age.

As our eye ages they often develop a condition known as presbyopia which typically means that glasses or contact lenses will be needed to read. Presbyopia is vision condition that cannot be cured with laser vision correction. Fortunately, there is an alternative to glasses or contacts, a Refractive Lens Exchange.

During the Refractive Lens Exchange procedure at Toledo LASIK & Cataract, our doctors will make a small incision in the edge of the cornea. A small probe is inserted through the incision to gently dismantle and vacuum out the damaged lens. The multifocal intraocular lens implant is then inserted into place. The entire Refractive Lens Exchange procedure is completed within a half an hour, and improvements in vision are seen quickly.

Refractive Lens Exchange is ideal for older patients who have hyperopia or myopia and are looking to decrease their need for glasses. If your interested in learning more about Refractive Lens Exchange please contact Toledo Cataract & LASIK at 419-346-2020 for more information or to schedule your appointment.


Premium Lens Options

Have you been told that you are a candidate for cataract surgery?  You now have an important decision to make.  Advanced technology now affords you the option to upgrade your cataract surgery by electing to to use premium intraocular lenses (IOLs).  These new lenses allow people to see near far and all distances in between with less or even no dependence on glasses and contact lenses!  Click on the links below to learn about these advanced lenses and scheule a consultation to learn more.  Dr. Wiley will review all the details and help determine the lens that is best for you you.

Good News to Medicare Patients!

Medicare and most insurance carriers allow for the use of premium intraocular lenses during cataract surgery.  this means that your surgery will be coverered by insurance, but there will be an additional fee that is not covered for the premium lenses themselves as they are considered an elective part of the surgery and not medically necessary.


Cross Linking (CXL)

Corneal collagen cross-linking is a technique that was first used in 1998 to treat patients with a disease called keratoconus. In keratoconus, the cornea (the front clear window of the eye) can become weak, thin, and irregularly shaped. Instead of keeping its normal round shape, corneas with keratoconus can bulge forward into the shape of a cone causing poor vision. CXL is now being performed for patients with this condition in approximately 450 centers throughout the world. Through a research study, our practice is now able to provide this investigational treatment to our patients using advanced technology for cross-linking.

What is keratoconus?

Keratoconus is a common disease that occurs in approximately 1 in 750 Americans. In this condition, the cornea becomes weak, progressively thinner, and irregular in shape which can cause high levels of astigmatism. Instead of a normal, relatively round shape resulting in clear vision, the cornea in keratoconus can become cone shaped. This can interfere with the ability to see clearly. Often keratoconus patients first require glasses, then contact lenses, and, if the condition progresses to a severe level, a corneal transplant may be required.

What is astigmatism?

Astigmatism means that the front surface of the eye (the cornea or clear window in front of the eye) is less round and more irregular in shape so the image won’t focus clearly on the retina in the back of the eye. This can result in poor vision and glare.

What does CXL do?

Normal corneas have crosslinks between its collagen fibers that keep it strong and able to retain its normal shape. In keratoconus, the cornea is weak with too few cross-links or support beams. This weakened structure allows the cornea to bulge outwards. The cross-linking procedure adds cross-links or “cross beams” to the cornea, making it more stable, holding its shape and focusing power better. These new cross-links help strengthen the cornea which stops the thinning process and further loss of vision.

Can CXL be performed for everyone with keratoconus?

To qualify for the CXL study, patients must be at least 12 years old and their corneas cannot be too thinned or too scarred for the procedure. During your consultation, we will determine if CXL might an option for you. Our practice offers a complimentary, no-touch, painless screening test to see whether CXL might help you.

Should your relatives be tested?

As you may know, keratoconus is a condition that often runs in families, so it’s important to arrange a screening for all family members of patients with keratoconus. If caught early, there is a good chance that CXL can halt the progression of keratoconus and prevent the need for uncomfortable contact lens wear and/or corneal transplant.

How effective is CXL?

Many research studies have shown that CXL may prevent further vision loss in over 95% of patients and improves vision in 60-81% of patients treated. 1-11

Is CXL like LASIK?

No. LASIK is a procedure that reduces or, in some cases, may even eliminate the need for glasses or contact lenses by removing corneal tissue. The CXL treatment does not remove tissue. The purpose of CXL is to prevent further deterioration of vision for most patients and to potentially improve vision. Patients will typically require a lower eyeglass prescription or can have an easier time being fit with contact lenses.

Can CXL prevent the need for corneal transplant?

Many studies have shown that CXL can often prevent the need for a corneal transplant and allow patients to wear contact lenses or glasses more comfortably and safely again.1-11

Can a corneal transplant be done after CXL?

If CXL does not prevent the need for a corneal transplant, then a corneal transplant can generally be performed.

Can I have CXL if I already had a corneal transplant?

Each patient and each patient’s eyes are different. In some cases CXL can be performed after corneal transplantation.

What’s the difference between a corneal transplant and CXL?

CXL is an in office procedure that does not involve surgical incisions into the eye or stitches. It is a relatively non-invasive procedure that is done with vitamin drops and light. Corneal transplants are performed in an operating room, involving incisions into the eye and a lifelong risk of rejection of the corneal tissue.

How long does CXL treatment last?

Based on CXL study results over more than a decade, the beneficial effects of CXL appear to last for many years and there is evidence that this strengthening effect may be permanent.

Is CXL new?

Corneal collagen cross-linking has been performed since 1999. The results and safety profile of CXL have been very positive in numerous studies throughout the world. In fact, by September of 2006, CXL had been approved by all 25 European Union nations. CXL procedures are now routinely performed on patients as young as 10 years old in Europe to prevent the development of keratoconus.

Does CXL need to be repeated?

In many studies, the majority of patients responded to a single vitamin and light CXL treatment and did not need to have the procedure repeated. CXL can often be repeated when treatment is not effective.

How is CXL performed?

The CXL treatment is an outpatient procedure performed in the doctor’s office using only numbing eye drops and a mild sedative like a Valium tablet. You’ll need to lie flat on your back in a reclining chair and look up at a soft blue light during the treatment. The epithelium, a thin layer of clear, protective tissue (like skin) that covers the cornea is removed for the CXL procedure. Next, vitamin eye drops (riboflavin) are used in the eye and you will be asked to look at a special blue (ultraviolet) light while lying comfortably on a reclining chair. It’s generally easy to look at this light because your eyes are numb and we use drops so your eyes won’t feel dry.

What is the transepithelial (or epi-on) CXL technique?

In this less invasive CXL treatment, the surface skin layer (epithelium) of the cornea is not removed so the recovery is much faster than the traditional CXL technique. This less invasive technique can only be done on corneas that are thicker than 400 microns12,13. Your surgeon will be able to determine if you might be a candidate for transepithelial CXL treatment.

How long does the procedure take?

If two eyes are being treated at once, the procedure takes approximately an hour and a half. If only one eye is being treated at a time, the procedure takes approximately one hour.

Does the CXL procedure hurt?

No. The cross-linking procedure is painless. Anesthetic eye drops are used to avoid any discomfort during the procedure. Some patients have some discomfort after the procedure and your surgeon can tell you whether you are or are not likely to do so.

Can I have one eye treated at a time?

Yes, your doctor will discuss the advantages and disadvantages of treating one eye or two eyes at a time.

When is the best time to have CXL?

As with most conditions, prevention of a problem is better than treatment of a problem. The best time to treat keratoconus is before astigmatism has become severe and vision has been lost. This does not mean that people with very poor vision from keratoconus cannot be helped by CXL. However, the results of CXL for patients with advanced keratoconus have not been as good as for patients with early disease.

If CXL works for me and stops my vision from getting worse, can I have laser vision correction or Intacs afterwards?

Some patients may be able to have an excimer laser treatment (PRK) or Intacs to improve their vision without glasses after they have healed from the CXL procedure.

Do I have to stop wearing contacts before having CXL?

We recommend that you stay out of contact lenses for a week or two if possible before your consultation visit to see if you might benefit from the investigational CXL procedure. This can vary based on how difficult it is for you to see without your contacts. We often suggest patients not wear their lenses for 3 days before their CXL procedure.

When can I resume wearing contact lenses?

Most patients can return to wearing contact lenses 2 to 6 weeks after having the cross-linking procedure depending on whether you are a candidate for transepithelial CXL. Your surgeon will determine how long this might take in your case.

Will I need new glasses or contacts after CXL?

Because cross-linking often improves vision, patients find that their old contacts or glasses are too strong for them and they need to be refit with new, glasses and/or contact lenses. Most of the time, patients can wear their old glasses until several months after the procedure when their doctor will prescribe new ones. Because the effects of CXL occur slowly, patients don’t generally have to change their glasses very often.

When will I notice any improvement in my vision after CXL?

With the traditional CXL procedure, most patients find that immediately after the cross-linking treatment, their vision is actually worse than it was before the procedure. This usually goes on for roughly 3-6 weeks. Patients may start to notice positive effects 4-8 weeks after the procedure and may experience major improvement in vision at least 3-6 months after the investigational procedure. In some studies patients’ vision and astigmatism were still continuing to improve five years after the cross-linking procedure2 so visual improvement is a long process. With the less invasive transepithelial CXL, some patients found their vision improved as early as several weeks after treatment.

When can I exercise and return to my usual activities after CXL?

We want to help you be able to work or do other things you need and want to do as quickly as possible. Based on the type of CXL procedure, your doctor can tell you when you can return to your usual activities. With traditional CXL, most people can usually do so after 5-7 days. With transepithelial CXL, most people return to their usual activities the next day.

Does insurance cover CXL treatment?

Because of the regulatory environment in the US, this procedure is investigational so CXL treatment is not covered by insurance.

Cost of being in the study

You will be charged for the procedure and will still have to pay for the costs of your regular medical care. Since this procedure is investigational, insurance plans typically do not cover the costs for participating. Financing is available to help our patients pay for this investigational procedure. To find out more about costs, ask the study doctor or staff. For more information about keratoconus, and/or our diagnostic screenings and treatments, please call our practice and ask to speak with a CXL coordinator or visit our website.

References:

1. Wollensak G, Spoerl E, Seiler T.; Riboflavin/ultraviolet-a-induced collagen crosslinking for the treatment of keratoconus. AJO 2003 May;135(5):620-7
2. Raiskup-Wolf F, Hoyer A, Spoerl E, Pillunat LE.; Collagen crosslinking with riboflavin and ultraviolet-A light in keratoconus: long-term results. J Cataract Refract Surg. 2008 May;34(5):796-801.
3. Coskunseven E, Jankov MR 2nd, Hafezi F.; Contralateral eye study of corneal collagen cross-linking with riboflavin and UVA irradiation in patients with keratoconus.
J Refract Surg. 2009 Apr;25(4):371-376
4. Grewal DS, Brar GS, Jain R, Sood V, Singla M, Grewal SP.; Corneal collagen crosslinking using riboflavin and ultraviolet-A light for keratoconus: one-year analysis using Scheimpflug imaging. J Cataract Refract Surg. 2009 Mar;35(3):425-32.
5. Spoerl E, Mrochen M, Sliney D, Trokel S, Seiler T.; Safety of UVA-riboflavin cross-linking of the cornea. Cornea. 2007 May;26(4):385-9.
6. Trattler W, Rubinfeld R, Corneal Collagen Cross-linking; Cataract and Refractive Surgery Today; September 2009
7. Caporossi A, Mazzotta C, Baiocchi S, Caporossi T. Long-term Results of Riboflavin Ultraviolet A Corneal Collagen Cross-linking for Keratoconus in Italy: The Siena Eye Study. Am Journal of Ophthalmology 2010:149:585-593 www.ajo.com/article/S0002-9394(09)00808-3/abstract
8. Raiskup-Wolf F, Hoyer A, Spoerl E, Pillunat LE. Collagen crosslinking with riboflavin and ultraviolet-A light in keratoconus: long-term results. J Cat Ref Surg. 2008
9. Vinciguerra P, Albè E, Trazza S, Seiler T, Epstein D. Intraoperative and postoperative effects of corneal collagen cross-linking on progressive keratoconus. Arch Ophth. 2009
http://archopht.ama-assn.org/cgi/content/abstract/127/10/1258
10. Daley, R. Cornea
Cross-linking vision improvement evidence mounts. Eyeworld, 2010. http://www.eyeworld.org/article.php?sid=5268&strict=&morphologic=&query=Daley, R. Corneal%26%238232%3BCross-linking vision improvement evidence mounts.
11. Rubinfeld RS, Trattler WB, Martin NF, Adi MA and The CXL-USA Study Group: Answering Your Patients’ Questions About Cross-Linking; Advanced Ocular Care. March 2010:25-28
bmctoday.net/advancedocularcare/2010/03/article.asp
12. Boxer Wachler BS, Pinelli R, Ertan A, Colin CKC. Safety and efficacy of transepithelial crosslinking (C3-R/CXL), J CATARACT REFRACT SURG - VOL 36, Pgs 186-187, JANUARY 2009
13. Pinelli R, El Beltagi T, Leccisotti A. Update on Corneal Crosslinking. Cataract and Refractive Surgery Today October 2008: 67-69. http://www.crstodayeurope.com/Issues/1008/1008_19.php

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