– Many patients after the Lentivu® treatment tell us the same thing: I waited unnecessarily, I could decide earlier … Their observations and experiences are the most satisfying part of my work. We talk to the ophthalmologist Dr. Aleksandra Wlaź from the Optegra clinic about the fact that the laser beam does not hurt and often changes human life.
Doctor, contrary to common myths, laser vision correction (LKW) is not a technical novelty, but has a long history dating back to the 80s. The best evidence of the latest revolution in refractive surgery is the Lentivu® procedure. What is behind the mysterious name?
Lentivu® is a method of laser vision correction available at Optegra Clinics. It covers the full diagnostic and therapeutic process, from the qualification process, through SMILE (Small Incision Lenticule Extraction) surgery, to comprehensive postoperative care.
What distinguishes Lentivu®, or actually SMILE surgery, from other methods of laser treatment of vision defects?
First of all, low invasiveness, safety and quick rehabilitation after surgery. SMILE can be described as an endoscopic procedure. Some people even say that it is a “keyhole” procedure – through a very small incision not exceeding 3.5 mm in width, we remove the lenticula specially designed by the laser (hence the name Lentivu®), causing the shape of the cornea to change and thus correcting vision defect. The procedure itself has a beneficial effect on the biomechanics of the cornea. It should be remembered that most of the biomechanical strength of the cornea lies in its anterior layers, which remain intact during the SMILE procedure. In addition, it reduces the number of cut nerve and collagen fibers, which in turn significantly reduces the risk of dry eye after the procedure.
What type of laser is used during the SMILE treatment?
Femtosecond laser. It is a type of laser that produces ultra-short pulses (10-15 s) of high intensity. The accumulated energy produces thousands of tiny plasma bubbles, thus the femtosecond laser precisely separates the tissue, and we can safely and painlessly change its shape without mechanical cutting of the cornea.
At Optegra clinics, we perform SMILE treatments using the Zeiss Visumax femtosecond laser. The whole procedure is one-step, using one type of laser. The Visumax laser was the first and for many years the only laser registered for the SMILE procedure. The first procedure was performed by Walter Sekundo in 2006, and since 2011 the laser has been commercially available in the world. So far, over 4 million SMILE treatments have been performed in the world, and the results prove the very high safety, effectiveness and stability of this LKW method.
Which patients will benefit the most from the Lentivu® treatment?
The Lentivu® treatment is the best option for young, active shortsighted people. We can correct myopia from -0.5 to -10.0 D with astigmatism up to 5 D, with a spherical equivalent to -12.5 D. Research has been underway on the use of SMILE in the treatment of hyperopia for several years, and I think that in the near future SMILE will also be commercially available for correction “plus” defects.
The SMILE treatment induces very little spherical aberrations, and thus gives a very good quality of vision and a low risk of “halos”, which is important especially in young people with a wide pupil. Due to the lower risk of postoperative dryness, it may be indicated in patients at increased risk of dry eye syndrome. A small interference in the biomechanics of the cornea makes this procedure safer than others in the case of a thin cornea.
From the patient’s point of view, SMILE provides the fastest visual rehabilitation, practically on the second day after the surgery, patients see well (of course, it is not the final acuity, and the quality of vision stabilizes up to a year). And what is important, there is no pain during or after the procedure. You can return to many daily activities on the second day after the treatment.
Are there any contraindications to the Lentivu® treatment?
Maybe I’ll start with the fact that Lentivu®, and more specifically SMILE, is a surgical procedure. Therefore, proper qualification and appropriate preoperative diagnostics are essential. It is necessary to perform a number of specialized tests, assessing, inter alia, the thickness of the cornea, its shape, the presence of other ophthalmic diseases, as well as the width of the pupil and the number of preoperative aberrations in the optical system. Thus, the SMILE procedure is a safe and effective procedure, but only with appropriate pre-, intra- and postoperative procedures.
That is why in Optegra clinics we attach so much importance to the entire diagnostic and therapeutic process, which we call Lentivu ®. When it comes to contraindications, the most important are: keratoconus, active severe autoimmune disease (e.g. visceral lupus) or severe dry eye syndrome. However, it should be emphasized that we approach each patient individually and often appropriate preparation for the operation allows it to be carried out safely.
Many users of our portal are women, so I will ask if laser correction is possible during pregnancy or while breastfeeding? Can I give birth naturally after the LKW treatment?
Laser vision correction procedures are contraindicated during pregnancy and up to 4 months after breastfeeding. It is primarily about hormonal fluctuations that affect refractive results. Laser vision correction treatments are not a contraindication to natural childbirth.
What about hormonal contraception in the perioperative period?
Hormonal contraception is not a contraindication to the Lentivu procedure. However, we want the hormonal balance to be stable in the perioperative period, so you should not stop, start or significantly change the hormonal preparations used up to 6 months before the procedure.
You said that the correct qualification for the procedure is essential. How is the qualifying visit for the Lentivu® treatment going then?
A qualifying visit for the Lentivu® treatment takes place at the Optegra Clinic, where a team of specialists, i.e. a doctor, optometrist and nurse, conduct a number of specialist examinations. In addition to the standard ophthalmological examination, imaging examinations of the anterior segment of the eye are performed, which are rarely available in a standard ophthalmology clinic. For the accommodation paralysis, we use eye drops that dilate the pupil so that the assessment of the refractive error is not disturbed by the patient’s accommodation tension. In addition, we carefully assess the circumference of the retina, often during such a thorough examination we recognize other diseases that the patient did not know about before.
I read that the qualifying visit includes as many as 24 examinations …
True, but they are all painless. We have a very well-equipped qualifying clinic and, if necessary, we also perform additional tests, such as: OCT, i.e. optical coherence tomography of the cornea or retina or the measurement of corneal endothelial cells.
What is the day of the surgery like and how much time will we spend at the Optegra clinic?
The procedure itself, along with the preparation of the operating field, takes about 10-15 minutes for both eyes, while the laser procedure takes only about 24 seconds. On the other hand, the time that the patient will spend in our clinic is obviously longer and amounts to approx. 3 hours. This time includes re-performing the most important examinations, including re-checking the visual impairment, changing the patient into a protective gown, and planting a drop in the preparation room.
Before the procedure, we always talk to the patient again and discuss with him the consent form for the operation, which the patient signs in the presence of the surgeon. We also present him with a detailed plan of the procedure, “step by step” discussing what the patient may feel during the procedure itself. However, after the procedure, the patient rests, waiting for all documents. In our clinics, before leaving Optegra, the nurse discusses with the patient how to use the drops and what rules must be followed in the days following the procedure. The patient receives a mobile phone number to the surgeon’s doctor, so he has the possibility of direct contact with the operator. On the second day after the surgery, he reports to us for the first checkup.
You said that one of the advantages of Lentiv® is quick rehabilitation. We really do not have to worry about long, excluding from working life, convalescence?
In no case. The patient returns to his daily activities as quickly as possible among all available LKW methods. Of course, we recommend that you limit your work at the computer in the first days after surgery, but after a week you can do makeup and return to moderate sports activities such as cycling, jogging or yoga. Greater physical exertion, in which eyes are tightly closed or sweat can get into them, is possible after a month.
How about driving a car? When will I be able to drive?
It is very different in this case. Often visual acuity is good, but the quality of vision may not be quite suitable for driving a car yet. Most patients can drive after just a few days, but this always requires individual judgment.
We still have air travel …
After a week, you can board. Of course, there is air conditioning in the plane and the air is more dry, so you need to use moisturizing drops more often.
What do patients say after? Can modern vision correction change our lives?
Patient experiences and observations are the most rewarding part of my job. Many of them are surprised that the procedure itself takes so little time and the improvement in vision occurs so quickly. They often tell us that they regret having waited so long to perform the procedure. I think that the best advertisement for Lentiv® are satisfied patients who often bring their family members, friends and colleagues to us.
In our society, visual impairment is often underestimated. However, for many it is a serious problem – they do not want to wear glasses, they have problems with contact lenses tolerance, after which complications are extremely dangerous. Patients after Lentiv® undergo amazing metamorphoses, often their motivation is the desire to change jobs, i.e. they change their entire lives. For me, as a surgeon, it is a great joy and satisfaction to be able to participate in this.
Is it true that, since the pandemic, more and more people are interested in modern vision correction?
I think so. First of all, we now have more time to take care of ourselves and our health. Secondly, the last two years of the pandemic – remote work and remote learning, have exacerbated ophthalmological problems, and in the near future may affect the incidence of visual impairment.