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After performing cataract surgery, in a large percentage of patients, usually occurs opacity of the membrane used as support by the intraocular lens. This loss of transparency will cause a qualitative and quantitative reduction in vision, and can occur over months or even years after surgery. Treatment is painless, done in an outpatient basis, using anesthetic drops after pupil dilation.
Exam used to obtain information on the color perception that the person has. The two exams performed are Ishihara and Farnsworth-Munsell D-15. Suitable for evaluation of visual impairment in genetic ocular abnormalities (color blindness) or acquired ocular abnormalities (drug toxicity, among others).
The exam is non-invasive (no need for contrast injection) and can be repeated whenever necessary. There is no need for pupil dilation. The exam duration is from 5 to 20 minutes.
Used for the diagnosis of diseases such as glaucoma, retinal and central nervous system diseases.
The patient fixes his sight at a central point, keeping it from moving, and through a bell ring informs what is happening.
Evaluates central and peripheral visual field, identifying changes or reduced visual sensitivity.
Computerized topographers measure millions of points on about 95% of the corneal surface. Most of them are based on the principles of Placido disk, which uses the cornea as a reflective mirror, projecting a series of rings on it. These rings are captured, analyzed and codified into colors, generating curvature maps. We use in our hospital the high definition topographer E300, by Medmont.
Computed topography is an excellent tool to confirm the diagnosis of keratoconus, in the evaluation of patients eligible for laser treatment, or in intraocular lens implants, even when the characteristic signs are still not observed. The position of the apex and the progression of the disease can be seen when analyzing the colored maps.
Suitable for refractive surgery or cataract surgery candidates, patients with keratoconus and other corneal alterations. Simultaneously provides anterior and posterior corneal curvature measurement (topography); pachymetric mapping; anterior chamber 3D analysis; corneal diameter measurement; anterior chamber angle evaluation; I-S index calculation, which helps in keratoconus diagnosis; corneal and crystalline lens density measurement, and pupil measurement.
Exam performed in the high resolution topographer Keratron Scout 2000, by Optikon, provides information on the optical defects of the cornea that affect vision but are not directly related to the cylindrical or spherical diopters. It is possible, therefore, to know the types and strength of optical aberrations present in the examined cornea, enabling the planning of customized treatments.
Exam where images of the fundus are obtained after injection of sodium fluorescein substance. Suitable for detailed evaluation of retinal diseases such as diabetic retinopathy, age-related macular degeneration, venous obstructions and hereditary diseases.
Sodium Fluorescein is a dye which, injected to the vein arm, reaches the fundus blood flow after a few seconds. Thus, consecutive images are obtained for several minutes, with the presence of dye in the ocular fundus. Images are scanned into the computer and then printed.
Exam that provides images of the eye fundus. It is used to document and monitor retinal, choroidal and optic nerve disorders.
The pupil is dilated in advance with eye drops to obtain suitable images. The exam duration is from 5 to 10 minutes.
Also known as specular microscopy, it is a photograph taken through the Specular Microscope CEM-530 and enables the visualization of endothelial cells, the innermost layer of the cornea. It is a computerized exam, with no contact, that estimates the cell density, size and shape of these cells, and the presence of deposits, showing the vitality of the endothelium. The specular microscope that we have enables the evaluation of the corneal center, 8 paracentral points and 6 peripheral points.
This exam can be requested in the presence or suspicion of corneal degenerative diseases and as a preoperative exam for cataract, glaucoma, corneal transplant and refractive surgery, to assist the surgeon assess surgical risk.
The VERION® Image Guided System is a high-tech device that allows the surgeon to customize cataract surgery according to each patient, enabling a safer and more accurate surgery. The VERION® Image Guided System, including the VERION® Reference Unit and the VERION® Digital Marker, was developed to assist in: Improving clinical efficiency; Increasing the accuracy of toric and multifocal lenses; Optimizing refractive outcomes; Minimizing data transcription errors.
The VERION® Reference Unit performs the main eye measurements for patient diagnosis, such as keratometry dynamics, position and diameter of the corneal limbus, white-to-white horizontal distance, pupillometry, corneal reflex position, eccentricity of the visual axis, among others. These measures will guide the surgical procedure, allowing better planning for the surgeon. Next, the VERION® Reference Unit generates a digital high resolution image of the patient’s eye as a reference, capturing reference points of the episcleral and limbal vessels, and iris. This “eye fingerprint” is used to: Record and track the eye during the surgical procedure; Provide a visual reference of all incisions, capsulotomy and lens positioning.
Data generated by the VERION® Reference Unit is sent to the VERION® Digital Marker, which with its advanced image processing features, allows instant access in real time to reference points overlaid digitally, to increase the accuracy in each step of cataract surgery, enabling better alignment and positioning of the intraocular lens (IOL).
One of the most modern and advanced equipment for evaluation of the optical system, OPD Scan III is a single workstation with multiple features. It measures objective refraction, and the measured refractive error can be used as a reference when prescribing corrective lenses such as glasses and contact lenses. Corneal curvature, measurement and the anterior segment shape (topography and tomography) can be used as a reference when selecting the base curve of contact lenses or refractive power of intraocular lenses. It evaluates areas of the anterior segment for better selection of phakic intraocular lenses for cataract surgery. Accurately evaluates corneal power with one of more accurate existing topographers, with 33 rings of blue light. It also enables to evaluate individually ocular astigmatism: corneal, internal and total. The size of the pupil of the patient’s eye, as well as measuring the diameter and center may be used as a reference for selecting multifocal intraocular lenses. Wavefront aberrations can be used, for example, to quantify the components of irregular astigmatism or simulated views showing how the visual acuity optotypes are seen by the patient with vision correction. Allows separate evaluation of corneal aberrations, internal and total, as well as corneal asphericity. Accurate evaluation of the actual position of toric intraocular lenses, enabling better rotational control.
Therefore, this technology allows accurate and detailed examination of the cornea and the entire optical system, providing the physician greater accuracy in the diagnosis and treatment of each case, as well as facilitating the planning of refractive and cataract surgery.
Type of luminous energy used for several ophthalmic treatments. Pulses of Nd: Yag Laser act upon tissues causing what is known as photo disruption. The applications of the Nd: Yag Laser are usually painless. In this case, just one or two drops of eye anesthetic will be used.
Application of high power laser light, which generates controlled photocoagulation of the outermost layer of the retina. Suitable for treatment of retinal diseases such as diabetic retinopathy, venous obstruction and retinal rupture, among others. The laser’s action on the retina aims to cauterize the capillaries (small blood vessels), inhibiting the growth of new blood vessels and enhancing adherence to avoid its detachment.
Retinal photocoagulation, is generally performed with the use of anesthetic eye drops. In case of eye pain, a peribulbar anesthesia (around the eye) can be performed for greater comfort. The patient should be accompanied on the date of the photocoagulation procedure. The pupil is dilated in advance for suitable treatment. The duration of application varies from 5 to 30 minutes.
This exam is performed using laser digital retinal scanning. It is the best technology and process currently available for fundus exams. It generates digital images in HD to document the fundus (retinography) in wide angle (200°) from the posterior pole to the peripheral retina.
This equipment allows for further evaluation of the retina (up to 80% higher) when compared with traditional retinography. This enables studying the peripheral retina, sometimes impossible to be documented with other equipment. It also enables sequential exams for future comparisons, as well as greater convenience and flexibility in the exam, as it is not necessary to dilate the pupil, providing greater comfort to the patient.
Exam performed to evaluate the whole retina. It is performed after pupil dilation and gives the ophthalmologist a stereoscopic vision in 3D which allows the doctor to check for retina alterations.
Generates an image of a virtual sagittal cut of the cornea. It is possible to measure the thickness of different locations of the cornea with precision in few microns (thousandths of a millimeter). Corneal scars and degenerations are located accurately and when interpreting the image, the surgeon can plan with more safety the appropriate treatment. In a patient who has previously undergone a corneal surgery, OCT allows the surgeon to view the Lasik flap and residual stromal (the remaining cornea under the flap) or measure the exact depth of intracorneal rings inserted in keratoconus patients.
OCT may be required before or after the following surgeries: LASIK, PTK, implant of intracorneal ring, lamellar keratoplasty (DALK, DSEK, DMEK), penetrating keratoplasty. It also helps in surgical planning for the treatment of corneal opacities.
Exam that evaluates ocular motility disorders and the eye’s sensorimotor disorders. Suitable for a range of patients including complaints suggesting binocular vision disorders and patients with common or restrictive strabismus. Also called Orthoptic Test. The patient must take the exam WITHOUT pupil dilation.
The optical biometry examination is performed at Sadalla Amin Ghanem Eye Hospital using the most advanced equipment today, IOL Master® 700. This device, manufactured by Zeiss in Germany, increases the accuracy of calculating the intraocular lens for cataract surgery, using optical interferometry associated with optical coherence tomography (OCT) to optimize refractive outcomes. It is possible to verify the axial length of the eye, the anterior chamber depth, corneal diameter and also the central keratometry. This equipment greatly reduces the chance of unexpected results in diopters after surgery.
Retinographies of the optic nerve are taken to provide depth perception and obtain better control of glaucoma’s progress or to observe cases that could develop glaucoma. Photographic record of optic disc or papilla changes. Photographs taken with intense white light, to record shape, contours, relief, size, color and excavation of the optic disc, signs also analyzed during “check-up” of patients with glaucoma. It can also be requested in case of ocular hypertension, papilloedema, papilledema, inflammation of the optic nerve (optic neuritis), head tumors benign as melanocytoma and malignant as melanoma. In order for the exam to be performed, it is usually necessary to dilate the patient’s pupil using eye drops. The exam is relatively quick (total 5 to 10 minutes). There is no need for fasting.
The subnormal vision test is indicated for patients with low vision as long as no eye treatment can provide them with improved visual acuity. The test is aimed at the adaptation of optical aids (magnifying lens, magnifying glass, monocular), non-optical (convergence, enhancement, lighting) or electronic resources (electronic magnifiers and similar products) to improve the visual quality of the patient for certain activities. The test is performed without dilating the pupil, usually the patients make at least two visits to complete the test and it is desirable to bring resources that they already use in an attempt to improve the activities of their daily routine. In specific cases the exam can be performed with pupil dilation. The doctor and the examiner should be consulted in such cases.
Exam that measures the visual acuity of babies, preverbal children or patients who do not report their vision, at any age.
Cards containing, on one side, white and black stripes with varying width but with the same contrast pattern, and on the other side a flat pattern, are presented to the child.
The stripes follow a mathematical calculation of “cycles per cm”, therefore, the more cycles per cm, the smaller are the stripes, indicating better vision. Thus, the sight will be attracted by the stripes and the child will focus their gaze up to a limit, observed by the examiner by a central hole, which will determine how much the child sees and if it is within or below the normal range for that age.
The test is performed without the pupil dilation and the optical correction (glasses or contact lenses) when prescribed.
Ultrasonic Biometry is usually performed when cataract is very advanced and it is not possible to measure by optical biometry.
Corneal thickness measurement. Used in preoperative evaluation of refractive surgery, glaucoma, some cataract cases and corneal diseases. No pupil dilation is required for the exam, it uses only a drop of anesthetic drops in each eye, as the instrument probe lightly touches the cornea. If the patient uses soft contact lenses and the exam’s intent is an evaluation for refractive surgery, he or she needs to refrain from using the lenses for at least one week before the exam. If the patient uses rigid lenses, the recommended period without lenses is two weeks. The exam provides immediate results.
It is requested when the doctor can’t see the fundus due to opacities of the cornea, lens or vitreous, or when he or she needs a view from the back of the eyeball. It also assists in the diagnosis of tumors, vitreous hemorrhage, intraocular foreign bodies, retinal displacement and phthisis bulbi. It is a semiologic method of great importance, always indicated when there is a need to evaluate the internal conditions of the eyeball and orbit. In this exam, a probe emits ultrasound waves (sounds with frequencies higher than the upper audible limit of human hearing) that reflect echoes when in contact with the ocular structure of the patient. The exam can be performed by module A, which is the unidimensional acoustic representation in which the echoes are represented as vertical oscillations. Or by module B, where the acoustic representation is two dimensional, allowing the panoramic vision of the eye and orbit and analysis of shapes and structures.
It is an exam indicated for patients with low visual acuity whom will undergo cataract surgery. It evaluates the visual potential before surgery and it must be performed after pupil dilation.
It is estimated that about 95% of patients worldwide achieved, after laser surgery, 20/20 (100%) to 20/30 (85%) vision, without glasses. However, this does not mean that all of them ended up with excellent quality of vision, because the conventional Excimer Laser corrects only myopia, hyperopia and astigmatism, technically called refractive errors or low-order aberrations. But the eye is as unique as each person’s fingerprint. This means that, although some people have exactly the same level of refractive error (myopia or hyperopia and astigmatism), they may have their own exclusive imperfections in one or both eyes, technically called higher-order aberrations. Such imperfections interfere with quality of vision, especially at night and in dimmed light environments, even if vision after surgery reaches 20/20. Thanks to the Wavefront technology, the new Excimer Lasers are able to provide customized vision correction, reducing those visual aberrations.
Beyond Wavefront guided customized surgery, our Excimer has a system of delivering customized laser pulses based on the analysis of the corneal anterior surface of each patient. This system is named Topography Guided Customized Ablation. It allows laser corrections to be performed on patients who had been submitted to cornea transplant, had ocular trauma in the past, or underwent previous eye surgery which resulted in high astigmatism, myopia or hyperopia
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