With the opening of the Department of Refractive Surgery, since 2015 Sistina Ophthalmology together with the University Clinic Svjetlost in Zagreb, has enabled laser vision correction using state-of-the-art equipment, experienced staff and precise diagnostics.
Prof. Dr. Nikica Gabric, the founder and manager of Svjetlost, is an ophthalmic surgeon who first performed laser correction in the region, which he himself underwent. Over the past 19 years, only the “Svjetlost” Clinic in Zagreb , more than 45,000 eyes underwent laser correction and in the other 3 clinics in Split, Sarajevo, Banja Luka, including 13,000 eyes in Sistina Ophthalmology in Macedonia.
For patients who are not good candidates for laser vision correction due to a too high diopter, possibility of intraocular lenses (ICL) implantation is available. Our refractive surgeons are permanent lecturers and instructors at the most prestigious European Congresses of Ophthalmology and educators in the field of refractive surgery (Bosnia and Herzegovina, Serbia, Montenegro, Macedonia and Kosovo).
Refraction defects of the eye (diopter)
Diopter represents an optical imperfection of the eye, i.e. the inability of the eye to sharpen the image. You are short-sighted if you see clearly the objects in close proximity, while the distance is blurred (for example, you do not recognize a person coming towards you, you can not drive without glasses or watch TV). In this case the image focuses in front of the retina (inner coat of the eye sensitive to light stimuli) and you need negative diopter value in order for the image to focus directly on the retina and to be sharp.
You are farsighted if you do not see clearly distant nor close objects (for example, you do not recognize a person coming towards you, you can not drive without glasses or watch TV, but you also have blurred vision when reading, working on a computer, writing messages on your phone – your eyes strain or you have headaches working at short distance). In this case the image focuses behind the retina and you need positive diopter value in order for the image to focus directly on the retina and to be sharp.
You have astigmatism if both close and distant objects are blurred and have a shadow. Astigmatism refers to an irregular curvature of the cornea.
Laser eye correction methods
Laser vision correction refers to procedures performed by laser cornea remodelling (transparent front part of the eye) with the purpose of removing or decreasing the diopter value, eliminating optical aids and improving visual acuity. Today there are several methods of vision correction, and the basic division is based on the depth of the cornea at which the operation is performed (the surface of the cornea -PRK, middle of the cornea – LASIK).
Fast, safe and painless path to perfect vision
Nowadays all types of operations are fully computer-controlled by precise software programs. Modern lasers can remove one diopter value in less than 2 seconds. Systems used for tracking the eye of a patient during the operation (tracker) allow a precise delivery of the laser beam to an exact place regardless of the micromovements of the patient’s eye during the laser procedure. Because of the perfect precision and fast software systems all of the procedures performed today are 99% safe. The selection of the method nowadays depends solely on the characteristics of the eye, the value of the diopter and the lifestyle of the patient.
Modern lasers can correct diopter values from -10.0 to +6.0 as well as ±6.0 astigmatism diopter value, which means that circa 95% of people are candidates for surgery. People with diopter values higher than those stated above, also have a solution for vision correction by implantation of the most sophisticated lenses into the eyes with equally good results, and in some cases even better results than laser vision correction.
LASIK (Laser in Situ Keratomileusis) is the most commonly performed type of surgery for vision correction. LASIK is the most common choice of surgeons due to its high accuracy, excellent and long-term stable postoperative results, the complete absence of pain (both during the surgery and in the postoperative period) and a very rare occurrence of complications.
LASIK procedure is a two step operation. The first step is the forming of the flap (flap on the cornea), and the second is the remodeling of corneal surface using excimer laser.
LASIK with microkeratome (standard LASIK)
This is the first developed LASIK method which, besides good technology, also needs an experienced hand of a surgeon to form the flap (the lenticule on the cornea) with the help of microkeratome. Microkeratome is an automated electric knife used for the forming of the flap on the cornea. In the last 25 years the quality, speed, precision and efficiency of mechanical microkeratome has been constantly improving, which led to a significant increase in safety and precision of the surgery. Last generations of microkeratome that we use in our clinic allow very precise forming of flap on the cornea, regular edges and predetermined thickness and shape. The procedure lasts only a few minutes and does not create any discomfort to the patient.
PRK method (Photorefractive keratectomy)
Photorefractive keratectomy (PRK) is the oldest laser procedure for the remodeling of the cornea which has undergone a series of improvements over the years. The remodeling of the cornea with an excimer laser in PRK method is performed on the corneal surface after removing the epithelium (the renewable superficial layer of the cornea).
The operation is suitable for people with negative diopter values, with astigmatism up to 3.0 diopters, in mild irregularities of the cornea, in cases of a thin cornea and corneal scars.
Other vision correction methods: phakic lenses implantation
People with extremely high diopter values (over -10.0 or +6.00) or corneas (transparent front part of the eye) that too thin or irregular (diagnosed during examination) and because of it laser vision correction would expose them to the risk of complications have an option of phakic lens implantation (Implantable Collamer Lens-ICL, or iris claw-Verisyse, Veriflex) into the eyes.
Phakic lenses are implanted into the anterior eye segment (in front of or behind the pupil), without removing the natural lens and they function as a contact lens in the eye but the patient does not feel them and does not have to take care of them.
The operation is performed through small incisions which usually do not even need to be sutured. Surgery is almost completely free of complications and extremely harmless for all structures of the eye (no structure of the eye is removed). It is especially suitable for young people (between 20 and 50 years) who still have the possibility of eye accommodation, i.e. the adjustment of image focus both at distance and at proximity. Also, the procedure is reversible, i.e. the lens can be removed from the eye (the eye returns to its preexisting diopter) without additional damages (in case of an increase in diopter and the need for implantation of more powerful lenses or the arrival of new significantly better and more advanced technologies).
There are several types of these lenses (Implantable Collamer lens-ICL, or iris claw- Verisyse, Veriflex) which enable the treatment of diopter value range from -23 to +21 diopter as well as 6 cylinder of astigmatism.
Implantable Collamer Lens (ICL)
Lenses are implanted behind the pupil (in the posterior eye chamber between the iris and the natural lens). At the moment, they are considered the best solution for people who are not suitable candidates for laser vision correction, and have a diopter range from -0,5 to -18.0 and from +0.50 to +8.0 they also correct astigmatism up to 6.0 diopter. Compared to other generations of phakic lenses, they have better optics and are more suitable for people with a large pupil diameter. Also, due to lens position inside the eye, it has been observed that in patients with a large negative diopters it significantly improves visual acuity compared to glasses and contact lenses. It is made of biocompatible material and it does not cause immunological eye reaction, and it also has anti-reflective and UV protective properties.
Lenses are implanted in front of the pupil onto the iris. They give excellent quality of vision for people with high diopters, and are now being implanted in cases where diopter value is greater than the diopter range of ICL phakic intraocular lenses as well as in people with a weak supporting eye apparatus which is unable to keep the lens behind the pupil. Lenses exist on the market for more than 20 years and have on their side the greatest world experience which indicates excellent results and procedure stability.