UNIVERSITE SAINT-ESPRIT De KASLIK

FACULTY OF ENGINEERING
Biomedical Engineering Department




Vision Anomalies & Laser Treatment


Prepared By:
SAWMA Antoine.

Under The Direction Of:
Dr. ATTIEH Charbel.



Fall 2012/2013
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1- Myopia
a- Description
b- Classification
c- Degree
d- Signs & Symptoms
e- Management

2- Astigmatism
a- Description
b- Types
c- Treatment

3- LASI K Treatment
a- Description
b- Procedure
c- Wavefront-guided LASIK

4- Other Vision Anomalies

5- Other Laser Treatments



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1- Myopia
a) Description
Myopia, commonly known as being short sighted. A condition of the eye where the light that
comes in does not directly focus on the retina but in front of it. This causes the image that one
sees when looking at a distant object to be out of focus but in focus when looking at a close
object.
Eye care professionals most commonly correct myopia through the use of corrective lenses,
such as glasses or contact lenses. It may also be corrected by refractive, though there are cases of
associated side effects. The corrective lenses have a negative optical power (i.e. are concave)
which compensates for the excessive positive diopters of the myopic eye.





b) Classification
Curvature myopia is attributed to excessive, or increased, curvature of one or more of the
refractive surfaces of the eye, especially the cornea. In those with Cohen syndrome,
myopia appears to result from high corneal and lenticular power.
Index myopia is attributed to variation in the index of refraction of one or more of the
ocular media.
Simple myopia, more common than other types of myopia, is characterized by an eye that
is too long for its optical power or optically too powerful for its axial length.
Degenerative myopia, or progressive myopia, is characterized by marked fundus changes,
such as posterior staphyloma, and associated with a high refractive error and subnormal
visual acuity after correction. This form of myopia gets progressively worse over time.
Nocturnal myopia, also known as night or twilight myopia, is a condition in which the
eye has a greater difficulty seeing in low-illumination areas, even though its daytime
vision is normal. Night myopia is believed to be caused by pupils dilating to let more
light in, which adds aberrations, resulting in becoming more nearsighted.
Pseudomyopia is the blurring of distance vision brought about by spasm of the ciliary
muscle.
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Induced myopia, also known as acquired myopia, results from exposure to
various pharmaceuticals, increases in glucose levels, nuclear sclerosis, oxygen toxicity or
other anomalous conditions.
Index myopia is attributed to variation in the index of refraction of one or more of the
ocular media. Cataracts may lead to index myopia.
Form deprivation myopia occurs when the eyesight is deprived by limited illumination
and vision range, or the eye is modified with artificial lenses or deprived of clear form
vision.
Nearwork-induced transient myopia (NITM) is defined as short-term myopic far point
shift immediately following a sustained near visual task.

c) Degree
Myopia, which is measured in diopters by the strength or optical power of a corrective lens
that focuses distant images on the retina, has also been classified by degree or severity:
Low myopia usually describes myopia of 3.00 diopters or less (i.e. closer to 0.00).
Medium myopia usually describes myopia between 3.00 and 6.00 diopters.
High myopia usually describes myopia of 6.00 or more.

d) Signs & Symptoms
Myopia presents with blurry distance vision, but generally gives well near vision. In high
myopia, even near vision is affected as objects must be extremely close to the eyes to see clearly,
and patients cannot read without their glasses prescribed for distance.

e) Management
Eyeglasses, contact lenses, and refractive surgery are the primary options to treat the visual
symptoms of those with myopia. Lens implants are now available offering an alternative to
glasses or contact lenses for myopic for whom laser surgery is not an option.
Occasionally, pinhole glasses are used by patients with low-level myopia. These work by
reducing the blur circle formed on the retina, but their adverse effects on peripheral vision,
contrast and brightness make them unsuitable in most situations.
For people with a high degree of myopia, very strong eyeglass prescriptions are needed to
correct the focus error. However, strong eyeglass prescriptions have a negative side effect in that
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off-axis viewing of objects away from the center of the lens results in prismatic movement and
separation of colors, known as chromatic aberration.
Glasses may have the potential to make the eyes worse, as they increase the accommodation
needed by the eyes to focus.
Glasses work by using optical lenses bringing the image a viewer closer so that it can be
focused by their myopic eyes. Large amounts of near work while wearing glasses can be very
detrimental to the eyes and can be a cause of worsening nearsightedness.
Laser treatment is also available for Myopia, LASIK.





2- Astigmatism
a) Description
Astigmatism is an optical defect in which vision is blurred due to the inability of the optics of
the eye to focus a point object into a sharp focused image on the retina. This may be due to an
irregular or toric curvature of the cornea or lens. The two types of astigmatism are regular and
irregular. Irregular astigmatism is often caused by a corneal scar or scattering in the crystalline
lens, and cannot be corrected by standard spectacle lenses, but can be corrected by contact
lenses. Regular astigmatism arising from either the cornea or crystalline lens can be corrected by
a toric lens.



b) Types
Regular astigmatism principal meridians are perpendicular.
With-the-rule astigmatism the vertical meridian is steepest (a rugby ball or American
football lying on its side).
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Against-the-rule astigmatism the horizontal meridian is steepest (a rugby ball or
American football standing on its end).
Oblique astigmatism the steepest curve lies in between 120 and 150 degrees and 30 and
60 degrees.
Irregular astigmatism principal meridians are not perpendicular.

c) Treatment
Astigmatism may be corrected with eyeglasses, contact lenses, or refractive surgery. The
planning and analysis of astigmatism treatment in corneal, cataract, and refractive surgery has
been outlined by the American National Standards Institute, and was originally described by
Australian ophthalmologist Noel A. Alpins in his Alpins method of astigmatism analysis.
Various considerations involving ocular health, refractive status, and lifestyle, frequently
determines whether one option may be better than another.
A further option is the Mini Asymmetric Radial Keratotomy (M.A.R.K.), a surgical
technique developed by Italian ophthalmologist Marco Abbondanza in 1994 and improved in
2005. It consists of a series of microincisions, which are made with a diamond knife, designed to
cause a controlled scarring of the cornea, which changes its thickness and shape. This procedure,
if done properly, is able to cure the astigmatism and the first and second stages of
the keratoconus, avoiding the need for a cornea transplant.
3- LASI K Treatment
a) Description
LASIK (Laser-Assisted in Situ Keratomileusis), commonly referred to as laser eye surgery, is
a type of refractive surgery for the correction of myopia, hyperopia, and astigmatism. The
LASIK surgery is performed by an ophthalmologist who uses a laser or microkeratome to
reshape the eye's cornea in order to improve visual acuity. For most patients, LASIK provides a
permanent alternative to eyeglasses or contact lenses. Major side effects include halos, starbursts,
night-driving problems, ectasia, and eye dryness.

b) Procedure
The LASIK procedure is performed by ophthalmologists, medical doctors who specialize in
surgical treatments of the eye. Here is an outline of the procedure:
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A soft corneal suction ring is applied to the eye, holding the eye in place. This step in the
procedure can sometimes cause small blood vessels to burst, resulting in bleeding or
subconjunctival hemorrhage into the white (sclera) of the eye, a harmless side effect that resolves
within several weeks. Increased suction causes a transient dimming of vision in the treated eye.
Once the eye is immobilized, the flap is created. This process is achieved with a mechanical
microkeratome using a metal blade, or a femtosecond laser that creates a series of tiny closely
arranged bubbles within the cornea. A hinge is left at one end of this flap. The flap is folded
back, revealing the stroma, the middle section of the cornea. The process of lifting and folding
back the flap can sometimes be uncomfortable.
The second step of the procedure uses an excimer laser (193 nm) to remodel the corneal
stroma. The laser vaporizes the tissue in a finely controlled manner without damaging the
adjacent stroma. No burning with heat or actual cutting is required to ablate the tissue. The layers
of tissue removed are tens of micrometres thick. Performing the laser ablation in the deeper
corneal stroma provides for more rapid visual recovery and less pain than the earlier technique,
photorefractive keratectomy (PRK). During the second step, the patient's vision becomes blurry,
once the flap is lifted. They will be able to see only white light surrounding the orange light of
the laser, which can lead to mild disorientation. The excimer laser uses an eye tracking system
that follows the patient's eye position up to 4,000 times per second, redirecting laser pulses for
precise placement within the treatment zone. Typical pulses are around 1 millijoule (mJ) of pulse
energy in 10 to 20 nanoseconds.
After the laser has reshaped the stromal layer, the LASIK flap is carefully repositioned over
the treatment area by the surgeon and checked for the presence of air bubbles, debris, and proper
fit on the eye. The flap remains in position by natural adhesion until healing is completed.
c) Wavefront-guided LASIK
Wavefront-guided LASIK is a variation of LASIK surgery in which, rather than applying a
simple correction of focusing power to the cornea (as in traditional LASIK), an ophthalmologist
applies a spatially varying correction, guiding the computer-controlled excimer laser with
measurements from a wavefront sensor. The goal is to achieve a more optically perfect eye,
though the final result still depends on the physician's success at predicting changes that occur
during healing and other factors that may have to do with the regularity/irregularity of the cornea
and the axis of any residual astigmatism. In older patients, scattering from microscopic particles
(cataract or incipient cataract) may play a role that outweighs any benefit from wavefront
correction. Therefore, patients expecting so-called "super vision" from such procedures may be
disappointed.

4- Other Vision Anomalies
a) Hyperopia, also known as farsightedness, longsightedness or hypermetropia, is
a defect of vision caused by an imperfection in the eye (often when the eyeball is too
short or the lens cannot become round enough), causing difficulty focusing on near
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objects, and in extreme cases causing a sufferer to be unable to focus on objects at
any distance.
b) Amblyopia, also known as lazy eye, is a disorder of the visual system that is
characterized by a vision deficiency in an eye that is otherwise physically normal, or out
of proportion to associated structural abnormalities of the eye. It has been estimated to
affect 15% of the population.
In amblyopia, visual stimulation either fails to transmit or is poorly transmitted through the optic
nerve to the brain for a continuous period of time.

c) Aniridia is the absence of the iris. Aniridia usually involves both eyes. It can be
congenital or caused by a penetrant injury. Isolated aniridia is a congenital disorder which
is not limited to a defect in iris development, but is a panocular condition
with macular and optic nerve hypoplasia, cataract, and corneal changes. Vision may be
severely compromised and the disorder is frequently associated with a number of ocular.

d) Aphakia is the absence of the lens of the eye, due to surgical removal,
a perforating wound or ulcer, or congenital anomaly. It causes a loss
of accommodation,hyperopia, and a deep anterior chamber. Complications include
detachment of the vitreous or retina, and glaucoma.
Aphakic people are reported to be able to see ultraviolet wavelengths (400 nm - 300 nm)
that are normally excluded by the lens. They perceive this light as whitish blue or whitish
violet.
e) Keratoconus is a degenerative disorder of the eye in which structural changes within
the cornea cause it to thin and change to a more conical shape than its normal
gradual curve.
Keratoconus can cause substantial distortion of vision, with multiple images, streaking
and sensitivity to light all often reported by the patient. If afflicting both eyes, the
deterioration in vision can affect the patient's ability to drive a car or read normal print.

5- Other Laser Treatments
Photorefractive keratectomy (PRK) and Laser-Assisted Sub-Epithelial
Keratectomy (or Laser Epithelial Keratomileusis) (LASEK) are laser eye surgery procedures
intended to correct a person's vision, reducing dependency on glasses or contact lenses.
PRK versus LASIK
Because PRK does not create a permanent flap in the deeper corneal layers
(the LASIK procedure involves a mechanical microtome using a metal blade or
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a femtosecond laser microtome to create a 'flap' out of the outer cornea), the cornea's structural
integrity is less altered by PRK.
The LASIK process covers the laser treated area with the flap of tissue which is from 100
to 180 micrometres thick. This flap can mute the nuances of the laser ablation, whereas PRK
performs the laser ablation at the outer surface of the cornea. The use of the anti-
metabolite mitomycin, which is referred as M-LASEK, can minimize the risk of post-operative
haze in persons requiring larger PRK corrections.
PRK does not involve a knife, microtome, or cutting laser as used in LASIK, but there
may be more pain and slower visual recovery. Unlike LASIK, PRK does not create the risk of
dislocated corneal flaps which may occur (especially with trauma), at any time after LASIK.
PRK versus LASEK
Although PRK and LASEK use basically the same technique, there are minor differences
between them. In PRK, epithelium is removed and the outermost layer below the epithelium is
treated with laser. In LASEK, epithelium is not removed, but an alcoholic solution is used to
cause the epithelial cells to weaken; the surgeon will fold the epithelial layer out of the laser
treatment field, and fold it back in its original place after cornea has been reshaped by laser.
[4]
If
the epithelial flap is not strong enough to be laid back in its original place, it will be removed,
and the LASEK procedure becomes a PRK procedure.



The End