VisuMax ReLEx SMILE

SOFT CONTACT LENS HOLIDAY

Soft contact lens (SCL) users are required to discontinue the use of SCLs for at least one (1) week before the refractive screening. Hard contact lens and Rigid Gas Permeable (RGP) users are required to discontinue the use of RGPs for at least four (4) weeks before the refractive screening. Contact lens holidays allow the surface of the cornea to recover to its natural state, thereby increasing the reliability of the results of the diagnostic screening. Kindly wear your prescription eye glasses during this contact lens holiday. Please coordinate closely with our staff if you wish to move the tests to an earlier or later date.

OCULAR LUBRICATION

Kindly apply over-the-counter preservative-free lubricating drops hourly to both eyes during waking hours for at least 1 week prior to the surgery. This will make you feel comfortable with instilling topical medication to your eyes after surgery.

SMILE SUITABILITY SCREENING

After complying with your refractive surgery pre-screening instructions, you are now ready to proceed with your VisuMax ReLEx SMILE screening. It usually takes an average of three (3) hours to complete a refractive surgery screening. Your eyes will remain dilated for 6-8 hours after the procedure, therefore it is recommended that you don't schedule anything important for the rest of the day. After reporting to our clinic, our staff will escort you to the laser diagnostic room where the process will begin.

OCULAR HISTORY AND EXAMINATION

PERSONAL INFORMATION

Your personal information will be logged into the hospital records.

CLINICAL HISTORY

Clinical history taking will be performed. Your ophthalmic history, medical history, and family history will be reviewed. Please take note of all the medications that you are currently taking.

PRESCRIPTION GLASSES

Please hand over all of your prescription eyeglasses so our optometrist can record the power.

VISION AND REFRACTION

Your visual acuity will be taken with and without your current prescription eyeglasses. Automated refraction, manual/manifest refraction, and dilated/cycloplegic refraction will be done. All these measurements are critical in determining your best potential visual acuity.

SLIT LAMP BIOMICROSCOPY

Your eyelids, eyelashes, and the anterior segment (conjunctiva, cornea, pupil, iris, and lens) of your eye will be examined with a slit beam of light. This examination is performed to search for lid and lash conditions, corneal diseases, pupil and iris abnormalities, and lens status.

OCULAR SURFACE EVALUATION

Fluorescein dye applied to your eye will be used to examine the ocular surface for signs of dry eye disease. Your tear break-up time (TBUT) will be measured. In some instances, the use of a Rose Bengal or Lissamine Green dye strip may be necessary.

APPLANATION TONOMETRY (Haag Streit Goldmann)

A topical anesthetic, proparacaine, will be instilled into your lower eyelid pocket in order to numb your eye. A fluorescein dye and a cobalt blue filter will be used to measure your ocular pressure. Your eye pressure will be correlated with your corneal thickness. This examination is used to screen for glaucoma.

OCULAR DIAGNOSTIC TESTS

PUPILLOMETRY (Oasis Medical Colvard)

An infrared pupillometer will be used in a dark room to check for pupil size at night. This will assist us in selecting an appropriate optical zone for the best night vision. This examination is performed prior to pupil dilation.

OPTICAL BIOMETRY (Zeiss IOL Master)

Your ophthalmic 'time capsule' will be taken to secure your pre-refractive surgery corneal curvature and eyeball length. This will be useful once you have cataract surgery in the future. This examination is performed prior to pupil dilation.

SPECULAR MICROSCOPY (Topcon)

This measures endothelial cell density (ECD). Low ECD is a risk factor for refractive (corneal and cataract) surgeries that can be missed without the use of a specular microscope. This examination is performed prior to pupil dilation.

CORNEAL TOPOGRAPHY (Zeiss Atlas Pathfinder)

The corneal curvature is measured using this diagnostic test. It will show the flat and steep areas of your cornea. This helps in screening for keratoconus, which is a contraindication to laser refractive laser surgery. This examination is performed prior to pupil dilation.

SCHEIMPFLUG ANALYZER (Oculus Pentacam)

This is an improved version of a corneal topographer. It has the benefit of giving refractive surgeons more information on the curvature and thickness of the cornea. It is very useful in identifying even early keratoconus. This examination is performed prior to pupil dilation.

ABERROMETER (Zeiss WASCA)

Think of this as a super automated refraction machine. Traditionally, our refractive errors are determined using an autorefractor, phoropter, or trial lens. These are able to determine the amount of myopia, hyperopia, and astigmatism. However, our eyes as an optical system have higher wavefront measurements that are of consequence to the quality of our vision. The wavefront aberrometer measures how a wavefront of light passes through the cornea and the crystalline lens, which are refractive components of the eye. Distortions that occur as light travels through the eye are called aberrations, representing specific vision errors. This examination is performed before and after pupil dilation.

OCT MACULA (Zeiss Cirrus OCT )

A special photo of the macula is taken with this machine. The macula is responsible for the central 30 degrees of functional vision. So, a fully functioning macula will allow us to see the face of an individual who we are looking at. If this is diseased, we will see a central obstruction in vision. This examination is performed before or after pupil dilation.

OCT OPTIC NERVE (Zeiss Cirrus OCT)

A special photo of the optic nerve is taken with this machine. The optic nerve may be damaged because of glaucoma. Early detection is possible with this diagnostic test. This examination is performed before or after pupil dilation.

DILATED FUNDUS EXAMINATION

Dilating ophthalmic drops will be instilled into your lower eyelid to make your pupils dilate. It usually takes around 30 minutes to achieve full pharmacologic pupillary dilation. Dilation will allow us to examine your retina for congenital/acquired posterior segment diseases. We can see retinal tears/holes, macular degeneration, and optic nerve diseases, among other things. The presence of any posterior segment condition may disqualify one from having refractive laser surgery. Dr. Roque performs this at the end of the refractive surgery screening process.

REFRACTIVE COUNSELING

Dr. Roque will evaluate the results of your refractive surgery screening and determine if your eyes are fit to undergo refractive surgery. At this time, you will be able to ask all your questions about the possible surgical options. If you are accompanied by a decision-maker prior to surgery, you may have this person join you for this session.

SMILE Surgery Day

You have completed your refractive surgery screening and have been found to be an excellent candidate for refractive surgery. These are general guidelines for you to remember on the day of surgery.

• We suggest that you sleep early the night before surgery.
• We require no diet restriction prior to the surgery. You may have your regular meals up to 2 hours before surgery. You may have a complete meal immediately after surgery.
• Please arrange for someone to be with you after surgery. You may only be released to a responsible adult.
• On the day of surgery, please shampoo your hair and take a full body bath. We want you to feel fresh and clean.
• Wear something warm and comfortable. The laser room is very cold.
• Do not apply any eye and facial makeup. Do not apply any hair gel. Do not spray on any perfume.
• Please arrive at the St. Luke's Medical Center Global City Vision Laser Center 1 hour prior to surgery. This will give our laser room staff adequate time to assist you. It will also provide you sufficient time to relax before your pre-operative preparation 30 minutes before surgery.
• Kindly keep the rest of your day free.
• If you have any questions or are uncomfortable about your surgery, please call +639178442020 or +639989982020 before the surgery date.

SMILE POST-OPERATIVE INSTRUCTIONS

General guidelines:

• DO NOT rub your operative eye or squeeze your eyelids tightly immediately following your procedure.
• Wear the protective goggles at bedtime or naptime for seven days following ReLEx SMILE surgery.
• Use your best judgment when exercising. We strongly recommend headbands for seven-day sweat control and goggles for contact sports for up to a month.
• It is ok to shower or bathe; however, avoid getting water into your eyes for two weeks after surgery.
• Avoid smoky or dusty rooms or areas with chemical vapors for two weeks following ReLEx SMILE surgery.
• DO NOT wear make-up or apply lotion around the eyes for two weeks following ReLEx SMILE surgery.
• DO NOT swim or dive in pools or the ocean for one month after surgery.
• Some eye drops may sting for up to 2 minutes or cause temporary blurred vision.
• DO NOT drive unless you feel safe and confident with your vision.

Surgical discomfort: Use the medication as prescribed by Dr. Manolette Roque.

Diet: Regular diet on the day of surgery.

EYE DROPS

How to use eye drops:

• Wash your hands before administration of eye drop medications.
• DO NOT touch the eye dropper or let the dropper touch your eye.
• Shake the eye drops well before using.
• Tilt your head back, gazing upward, and pull down on your lower eyelid, making a pouch.
• Place the dropper directly over the eye and administer a prescribed number of drops.
• Look downward and gently close your eyes for 1 or 2 minutes.
• Try not to blink or rub your eyes.
• DO NOT rinse the eye dropper.
• WAIT 5 minutes between every new type of eye drop medication administered.

Report any of the following to your doctor:

• Uncontrollable nausea or vomiting
• Worsening vision
• Development of rash
• Excessive pain, not relieved by pain relievers

For Emergencies: Call us at St. Luke's Medical Center Global City MAB 217 at +639178442020 or +639989982020 from 8 am-5 pm, Mondays to Saturdays. After clinic hours, please proceed to the St. Luke's Medical Center Global City Emergency Room. We have Board-certified ophthalmologists on duty to evaluate and assist you. They will call up and update Dr. Manolette Roque.