Questions And Answers

Op. Dr. med. Akın Akyurt

Op. Dr. med. Akın Akyurt

What is PresbyMAX ?

PresbyMAX is the name of the new generation laser technique used to treat the deterioration of near vision occuring after 40 years of age. It is carried out with the Amaris excimer laser device developed by the German company Schwind. This method has been used in the West for a long time and was first introduced to our country by us, because of the high cost of investment.

Who can this procedure by used for ?

This treatment is suitable for approximately 85% of persons over the age of 40.

So what can be done for patients who wear glasses for distance ?

Let’s say the patient is 50 years of age, he can’t see close up and for the distance, he uses astigmatism glasses. This is where PresbyMAX comes into play. The person’s distance glasses are reduced to zero. It does not matter whether there is myopia, hyperopia or astigmatism. With this laser system, both close-up and distance are clear.

Let’s use another example: A 47-year-old patient has 2 degrees of myopia, but because he has myopia he can see close-up without glasses. What happens if this person receives the laser treatment

A good and very crucial question. If this person only receives the classic excimer laser treatment he will be able to see distance without wearing glasses but he will no longer be able to see close-up, as he could before the surgery, and will have to wear reading glasses. But if the excimer laser had been applied using the PresbyMax method, this patient would have net vision both for distance and close-up, without the need for glasses.

So myopia patients no longer have to fear losing the benefits of the net near vision when they undergo laser surgery?

Yes, exactly.

What is the maximum age for this treatment ?

There is only a minimum age. It can be applied to all patients over the age of 40 with suitable eye structures, who have not yet developed a cataract.

What about people who have already had laser eye surgery in the past?

PresbyMAX can easily be applied to patients who have had their distance vision corrected by laser surgery but still need to wear glasses for near vision. As long as these patients pass the suitability test, the results are exactly the same as other patients.

What is the suitability test?

Before treatment, all candidates for PresbyMax, who have trouble with near vision, must pass the conformity test. This tests whether the eye structure is suitable for such a laser treatment. It obtains the thickness of the cornea as well as providing a map of the corneal surface. It is a simple 5-minute process.

Is the PresbyMAX method suitable for patients who have had cataract surgery and have to wear glasses for near vision ?

The PresbyMAX method can be applied to people who have previously undergone cataract surgery. With this treatment, these patients can easily become free of the need to wear reading glasses. If they have to wear glasses for distance this will, of course, be corrected in the same session.

Is the effect of PresbyMAX permanent or for a specified period ?

It is permanent if distance vision with myopia, hyperopia and astigmatism are corrected during the same session. However, if the correction is for close-up only then 6-7 years later near vision begins to decline slightly. Then we have two options. Since the patient will still be able to carry out daily activities such as, read cell phone messages and see the time on a watch, we can either do nothing or, if they need to see in great detail close-up, then PresbyMax can be applied again.

Is there a risk in this process?

No one in the world has been blinded by the application of excimer laser. All over the world for about 30 years so far, 35 million people have received excimer laser. This treatment has proved itself to be successful. PresbyMAX is carried out with excimer laser. Very rarely, a corneal membrane wrinkling or what we call DLK, a sterile reaction or an infection can occur but any of these problems can be easily solved simply with droplets or by rinsing the cornea with a solution.[/et_pb_accordion_item][et_pb_accordion_item title=”What is excimer laser treatment and how long has is been used ?” _builder_version=”4.0.5″ hover_enabled=”0″]Excimer laser has been applied as a treatment method for about 25 years. It has been actively used in the treatment of eye problems for 20 years. Especially since 1995, it has been much favoured by eye surgeons. It is estimated that the number of eyes around the world which have undergone laser treatment is around 20 million. In the United States 1 million eyes per year are treated with this method.

Can this treatment be applied to every patient?

Of course, laser treatment cannot be applied to every patient. Before treatment, detailed measurements are needed and the results should be carefully evaluated by an experienced eye surgeon. If these measurements detect no problems, then the details of laser treatment can be explained to the patient and applied. If there are any problems detected then laser treatment should not be carried out.

Today laser treatment can be used for patients with all refractive errors such as myopia, hyperopia and astigmatism. If the structure of the eye is suitable, patients with -10.00 myopia, +5.00 hypermetropia and astigmatism up to 6.00, can be treated successfully.

For laser treatment, the cornea layer should be of regular structure and of sufficient thickness. The detailed eye examination prior to laser treatment will also check the suitability of all the layers of the eye, other than the cornea.

It is important to have a corneal topography prior to laser treatment, this provides a map of the eye so that diseases of the cornea, which may interfere with laser treatment, can be ruled out.

To receive laser treatment the patient must be over the age of 18 and their spectacle prescription should be stable, not progressing. Excimer laser should also not be applied to patients with problematic retinas or patients with cataract.

Are there different types of laser treatments?

With photorefractive keratectomy (PRK) treatment the corneal epithelium, the outer layer of the cornea, is removed and the laser is applied directly to the layers below. Even if the cornea is very fine in places PRK is a very safe method, but it is not recommended for cases with very high myopia and hypermetropia. The disadvantage is that the 3-4 days following laser treatment can be painful.

However, the Trans-PRK method (a more advanced version of PRK) keeps the corneal epithelium intact and involves no scraping or touching of the eye in any way (no touch technique). Compared to PRK, the Trans-PRK postoperative period of pain is shorter and the patient’s vision reaches the desired level within 1 month.

With LASIK treatment a very fine layer (a flap) is lifted and folded back using a system of automated blades, and the laser is then applied to the area under this flap. Once treatment is completed this flap is folded back into its original place. There is no pain after the treatment, the eyes may only sting and water for 2-3 hours. Vision starts to become clear immediately and full recovery is achieved in 1-2 days. Successful results can even be achieved in cases of Myopia up to 10 dioptres.

IntraLASIK laser therapy is different from standard LASIK treatment only in the way in which the flap is lifted. With IntraLASIK treatement it is lifted by laser rather then automated blades. This may be more suitable for certain patients according to their eye structure. Thus it is possible to treat patients who, due to the extremely flat or thin cornea, are not suitable for LASIK treatment.

Popularly known as the eagle eye, the Wavefront Lasik / IntraLASIK application measures the passage of light from the front surface of the eye to the back of the eye as well as optical aberrations, and a unique laser treatment is created for each eye. These aberrations cannot even be corrected using glasses or lenses, but when the wavefront technique is used the most appropriate treatment for one’s own eye structure is realized. With this method, vision acuity is maximized and at the same time night vision problems are minimized.

Does laser treatment have no risks?

At the end of the day, the excimer laser is a surgical treatment. As with any surgical treatment, there are some risks, even if they are rare. However, if based on preliminary examinations the structure of eye shows to be suitable for laser treatment, then thanks to today’s advanced laser technologies, the development of treatment-related problems are very low. In the hands of an experienced ophthalmologist, the chances of laser treatment-related problems occurring are almost impossible.

Can treatment-related problems develop in later years after treatment?

The medium-and long-term results of this treatment have been closely monitored by many bodies, both domestic and abroad. If suitability test results are good, and the patient’s age and dioptres are suitable then no problems are experienced in later years.

Does laser treatment completely correct my dioptres? Will my dioptres return after laser treatment?

After excimer laser treatment patients can see as well without glasses as they could see before with glasses. A refractive error of 0.5 dioptres and below remaining after laser treatment is regarded as a complete success. If laser treatment is applied when a patient’s dioptres are still increasing then the patient may have to use glasses again. For this reason, the dioptres should not have increased for at least one year.

Can someone who has undergone laser surgery have cataract surgery in the future?

Someone who has undergone laser eye surgery can go on to have any type of eye surgery, including cataract operations, in the future. Laser treatment is not an obstacle.

How can I find out what is the right type of laser for me?

The pre-compliance testing carried out before laser treatment will identify whether you are suitable for laser treatment and also which is the ideal laser technique for you.

What is the duration of laser surgery?

Laser surgery lasts approximately 5-10 minutes.

Is pain experienced either during or after laser surgery?

No pain can be felt during any laser technique. After IntraLASIK and LASIK surgery, where a flap is created, a short-term stinging and burning sensation may occur a few hours after the operation. With PRK, where the laser is applied after removing the surface of the eye, pain can last for 2-3 days, but with Trans-PRK where the eye is un-touched, the corneal epithelium is not manually removed, but instead, laser technique is applied, the pain only lasts for 1-2 days. Also to reduce the pain felt after laser treatment, protective contact lenses can be used.

Do people who have undergone laser surgery experience eye dryness?

There may be a feeling of dryness in the eye for a short period after laser surgery. This can be resolved by using artificial tear drops and with time there will no longer be a need for these drops.

Can laser surgery be used for eyes with low dioptres?

If glasses are always worn and you no longer want to use glasses, then laser surgery can be applied for any dioptres, as long as the structure of the eye is suitable.

Is astigmatism corrected with laser surgery?

Laser surgery eliminates myopia, hyperopia, and astigmatism.

What happens if the patient is over the age of 40-45 and uses glasses for both distance and near vision or uses glasses for distance but can read without glasses?

This is when PresbyMAX comes into play. The prescription for distance becomes zero. Myopia or hyperopia are not important, and neither is astigmatism. At the same time near vision is corrected. So Presbymax patients over the age of 40 no longer need glasses for distance and can also see clearly close-up. That is, if the structure of the eye is suitable for Presbymax.

A patient over the age of 40 with myopia had the following concern: “If I undergo laser for distance vision then my near vision will apparently deteriorate, whereas now I can see close-up without glasses “. Is this concern now misplaced?

If you are a person over the age of 40 and undergo classic laser surgery for the correction of myopia you will be able to see distance clearly but will now be unable to see close-up without wearing glasses, even though this was possible before surgery. But if excimer laser is applied using the PresbyMax method, nearsightedness will be corrected and close-up vision will be clear without the need for glasses.

What is important after laser treatment ?

After laser treatment clear therapeutical contact lenses should be worn. These will be removed the next morning during the check-up. Thus there is no need to bandage the eyes after treatment.

• Prescribed eye drops should be used from day one.

• In the first two days after treatment you should not rub your eyes or shower.

• After 24 hours, you can return to your normal life.

• Complaints of a stinging feeling and tearing in the first few hours are normal.

When can you return to everyday life after laser treatment?

A patient can go to work the day after laser treatment. At the start, the sun’s rays may be uncomfortable, wearing sunglasses will reduce this discomfort. Mild sports and social activities such as walking and cycling can be done. You can go on a plane. To protect against possible infection you should not go in a swimming pool or the sea for about 20 days. No eye make-up should be applied for a month.

Can laser surgery be done for the second time?

If your vision has not been completely corrected or a new dioptre has occurred then, according to the suitability of the corneal thickness and surface, laser treatment can be undergone again.

Can excimer laser be applied to patients with cataracts?

If the patient has cataract then excimer laser cannot be applied, the patient must first undergo a cataract operation. If the structure of the eye is suitable during the cataract surgery multifocal intraocular lenses can be inserted, thus after the operation, the patient will be able to see both near and distance without wearing glasses.

If the cornea is too thin or the refractive error is too high, what can be done?

In this case, there is no chance of excimer laser treatment and so intraocular lens applications come into play. After detailed diagnostic tests the most suitable type of lens, according to the patient’s eye structure, is determined and then, either removing the natural lens or leaving it intact, the intraocular lens is inserted into the patient’s eye. With this often applied method, patients with the thin cornea and high refractive error can be free of the need to wear glasses.