AboutDr Anand Shroff, MD, FICS Expertise I am happy to answer any questions on eye care. My expertise is in Laser Eye surgery (LASIK, Epi LASIK), Multifocal Implants, Cataract, Glaucoma and procedures for Corneal abnormalities like Keratoconus - Corneal Collagen Crosslinking C3R
Experience OF LASIK, We are one of the first centres to use the wavefront guided LASIK or custom LASIK procedures and the only center in India using the most safest,accurate and fastest excimer laser in the world- 'The Wavelight Concerto, 500 Hz laser'. Doctors from various parts of the world train with me and few other experts in Germany each year on our wavefront procedures. Our centre is the first eye hospital to be awarded the highest certfication in healthcare- the Joint Commission International (JCI from USA) and is also the referral centre for our Wavelight Laser Technologies, Germany in India.
We have treated patients from 89 countries and this list keeps growing as more and more patients are getting increasingly aware of the benefits of treatment with advanced technology in laser eye surgery.
Organizations ASCRS [American Society of Cataract and Refractive Surgery]certified by USA- Joint Commission International
Publications http://www.shroffeye.org
Education/Credentials MD Ophthalmology and FICS [Fellow of the International College of Surgeons]
Awards and Honors please see http://www.shroffeye.org and www.lasikindia.in
Question QUESTION: There is one major difference in eye exams in places of my area before LASIK treatment. I've read that thorough eye structure exam has to be done when eye is dilated, using dilation drops.
However, this one place doesn't do that. Whole procedure (at that place it's Wavefront LASIK), tests included, is done at the same visit within hours. Their web page doesn't tell any specific use of dilation drops during exams either.
I'd like to know is that exam only for risk factors for eye diseases or is there something else involved due to quality of Wavefront procedure itself? Because I've heard a claim that then you can not fix all irregularities, since Wavefront analysis wouldn't be as good as it would be if dilation drop exam had been done.
I doubt this but I'd like to know for sure if they are just greedy; making a shortcut and be fast as possible for good income.
Thanks in advance!
-Ray
ANSWER: Dear Ray,
I can answer this based on my experience in wavefront surgery.
The answer may sound technical, but as the basis of your question is technical, I have tried to simplify it as much as I could.
We use one of the finest equipments in the world- The Wavelight Concerto 500 Hz laser system.
The wavefront analysis or the Aberrations or optical errors of the eye are measured and analyzed using an instrument called the 'aberrometer'.
In our center we dilate the eye for this test...reason?
There are limits imposed by the optics of the eye.
Improving the optics of the eye by removing aberrations increases the contrast and spatial detail of the retinal image. These effects are pupil-dependent. The larger the pupil in a diffraction-limited system, the higher the contrast and the crisper the edges of the retinal image.
The elimination of almost all optical errors from the optical system of the eye through wavefront analysis has been found to enhance the visual acuity to beyond conventional ‘normal vision’. Will it be possible to enhance the visual acuity of patients already enjoying 6/6 vision for the purpose of occupational needs?
Uncorrected refractive errors cause the retinal image to become blurred, reducing visual performance by decreasing contrast in the retinal image. The elimination of a sphero-cylindrical blur (lower order optical errors) by using spectacles, contact lenses or refractive surgery restores what is traditionally called ‘normal vision’. The goal, however, is to eliminate all traces of optical blur due to higher order optical errors (aberrations) of the eye which clinicians referred to as ‘irregular astigmatism’.
Hope this helps,
Regards,
Dr Anand Shroff, MS (OPHTH), FICS
www.shroffeye.org
Shroff Eye -Mumbai
---------- FOLLOW-UP ----------
QUESTION: Thanks for the answer,
However, it wasn't quite what i was looking for; Just to clarify, I do understand the technical side quite well or let's say "the idea" of how and what Wavefront guided LASIK can and should do and what the goals are there. Answer itself was quite nice explaining that side of the story.
Since the information is offered, I'll tell how it is done as they say. First of all, the same Wavelight Concerto 500Hz is used there. They say they can remove aberrations up to sixth level (first three are lower order aberrations to my knowledge?) and Wavefront analysis is up to 11th level of aberrations (higher order aberrations). Operational area of the cornea is up to 9 millimeters to obtain oblate shape of the eye (the ideal flat circle).
And they're making the aberrometer test without dilating the eye. It seems that there are different kind of aberrometers that are doing the Wavefront analysis. Is there a possibility that there is a aberrometer that can do a proper map for the whole operational are of the cornea without dilating, which results correcting higher order aberrations up to a point as said?
So I'd like to know that is there a possibility to do this properly just the way they are doing it since the claim was that they can't do it as well as it can be done due to Wavefront possibilities.
Obviously there is a difference and since this seems to go further to the used techniques with the aberrometer(s), let's hope You have some answers beyond the way things are done at Your clinic.
Again, thanks in advance!
-Ray
Answer Dear Ray,
Well firstly, I am glad that you will understand the technical jargon used. Secondly, the Wavelight Concerto or any other Wavelight machine for that matter, cannot utilize data from another company's aberrometer or wavefront analyser, as it will just not 'read' the data.
The Wavefront maps taken by the 'Aberrometer' of the 'Wavelight' has a software link to transport this data on the laser so that wavefront guided treatments can be done.
If the data from the wavefront analyser- Aberrometer is not used, then the treatments definitely are not Wavefront- guided.
Hence, the theory of using different aberrometers does not make sense as Wavelight has just one kind of aberrometer anyways!
Also, since I train over 120 eye doctors on the Wavefront analysis with the aberrometer, every year in Europe in our Wavelight Conference, I can speak about this confidently that one will not be able to get 'true' maps of the eye or simply put, maps of the eye at rest (after dilation), which is called cycloplegic refraction, unless you dilate the eye, whch is the accurate method of performing wavefront analysis.
Hope this helps,
Regards,
Dr Anand Shroff, MS (OPHTH), FICS
www.lasikindia.in
