W Pratiksha Hospital- Gurgaon

Hello,

 I am Dr. Aditi manudhane cataract, cornea and refractive surgeon. Aaj hum discuss karenge laser vision correction yani ki chashma hatane ki lasik surgery ki prakriya ke bare mein aur uski newest technology konsi hai uske bare mein. Agar aap chashma ya contact lens pehan rahe hain aur aap soch rahe hain ki aap isko hatane ke liye surgery karwana chah rahe hai to aapne agar kisi ko consult kiya hoga ya search kia hoga to aapko pata chala hoga iss prakriya ke liye bahut sare options available hai. Iss surgery ki alag alag technologies hai jo market mein available hain jinse ho sakta hai aapke mind mein bahut sara confusion ho ki konsi technology ke liye opt karna chahiye, kis technology ka ek se dusre mein faida hai, ye sab kuch hum iss video mein discuss karenge. Lasik ki technology samajhne se pehle aapko ye samajhna jaruri hoga ki chashma ka number akhir kyu aata hai. Jo aapki ankh hai usme roshni ki kirane jakar parde par ek point par focus karti hain jisse aapko clear dikhne lagta hai. Agar aapki ankh ka size normal ankh se thoda bada hota hai ya stretched hota hai to ye roshni ki kirane seedha parde pe na padkar thoda aage padhti hai jisse ki aapko minus ka number aata hai. To inn roshni ki kirano ko seedha parde par padhne ke liye aap chashma ya contact lens ka istemal karte hain.

Ab lasik ki prakriya mein aapki kali putli yani cornea mein ek flap uthaya jata hai aur laser dwara isko reshape kiya jata hai taki roshni ki kirane seedha parde par pade jisse ki aapko clear dikhe bina chashme ki madad ke. To iss prakriya mein ye jo cornea ka flap uthaya jata hai iss basis pe 2 major techniques hote hain: 1 hota hai blade lasik jisme ki iss flap ko ek microkeratome nam ke blade dwara uthaya jata hai aur dusra hota hai blade free lasik jisse eye lasik ke nam pe pramanit kiya gaya hai, iss prakriya mein jo aapka cornea ka flap hai use bhi femtosecond laser dwara hi banaya jata hai aur uthaya jata hai. Ab hum discuss karenge konse platforms ya lasik ki technologies dwara aapke number ko treat kiya jata hai, uspe basis pe different different types ke lasik hote hai.

Jaise ki standard lasik, uske bad aya SB care lasik yani ki thin flap lasik, fir aya customised platforms inme types hote hai Aspheric lasik, wavefront guided lasik, topography guided Lasik jisko contoura vision ke naam se jana jata hai aur jo latest technology ayi hai powered by eye-design refractive studio 2, usko kehte hai topo integrated wavefront guided Lasik. Uske alava laser vision correction ke aur tareeke hote hain jaise ki surface ablation aur smile jinke bare mein bhi hum discuss karenge. So sabse purani technology jo ayi thi vo thi standard lasik. Iss prakriya mein sirf aapke kali putli pe laser dwara aapke number ko hataya jata hai is prakriya mein kisi bhi tarah ka koi bhi customisation nahi kiya jata jisse aapki eye ki imperfections ya quality of vision ko improve kiya jaye. Standard Lasik ab outdated ho chuka hai, obsolete ho chuka hai, generally aaj ke taur pe koi bhi is procedure ko offer nahi karta. Iss prakriya mein jo startburst hai, glare ya halos ki problem standard Lasik mein jyada hoti thi aur iss kaarand ab naye platforms aane ke bad ye obsolete ho chuki hai. Fir aya SB care lasik yani ki thin flap lasik.

Normal lasik ki prakriya mein aapka jo cornea ka flap uthaya jata hai uski thickness 130 micron se leke 150 microns ke beech hoti hai. SB care lasik mein hum 90 microns tak ka flap bana sakte hai iska ye advantage hua ki niche jo aapki kali putli ke thickness bachti hai vo jyada bachti hai so technically aapke cornea ki integrity ya strength maintain hoti hai. Uske bad aaya customised platforms jinme hai Aspheric Lasik, wavefront guided Lasik aur topography guided Lasik yani contoura vision. Aspheric lasik aaj ke daur mein ek basic standard minimum mana jata hai, isse niche ke types nahi offer kiye jate kisi ko, ye ek standard basic procedure offer kiya jata hai. Aspheric lasik mein aapke cornea pe laser dwara aapka number to hataya hi jata hai lekin aapki jo cornea ki contour hai yani ki shape hai iss tarah laser fire kiya jata hai ki isko normal maintain kare, near normal maintain kare. To isse aapke cornea ki ek asphericity value hoti hai jo maintain ki jati hai. Aspheric lasik se jo standard lasik mein glare, halos ya starburst ki problem hoti thi vo nahi hoti hai. So, islye aapko vision to 6/6 aata hai lekin quality bhi behtar hoti hai.

Fir technology advance hue aur fir aya wavefront platforms. Wavefront guided Lasik mein aapki eye ke kuch measurements liye jate hain optical imperfections yani ki abrasions ko ek aberometer dwara measure kiya jata hai aur software mein aapke number ko to zero target kiya hi jata hai lekin inn optical imperfections ko bhi treat karne ke liye target karte hai. To iske kaarand jo aapki quality of vision aati hai vo bahut sharp aati hai aur contrast bhi behtar aata hai. Ab wavefront platforms ke alag alag nam hai jaise ki zyoptix nam se aata hai, custom q nam se aata hai, custom view lasik ke nam se bhi aata hai ya HD lasik ke nam se bhi ise jana jata hai. Fir aaya contoura vision yani ki topography guided Lasik, contoura vision 2016 mein launch kiya gaya. Iss prakriya mein main aapki jo kali putli yani cornea ki irregularities hai inko measure kiya jata hai aur number ko to hataya hi jata hai lekin inn irregularities ko bhi smoothen out kiya jata hai jisse ki aapki quality of vision enhance ho jati hai.

So, isilye isko topography guided technology ke naam se pramadik kiya gaya hai ye US FDA dwara approved hai. Uske bad jo latest technology aayi hai US FDA dwara pramanit ki gayi hai 2018 mein uska nam hai Eye design refractive studio 2.0 iss prakriya mein topography integrated wavefront guided lasik kiya jata hai. To isme aapke eye ke cornea ki topography ko bhi consider kiya jata hai aur aapke eye ke abrasions ko bhi consider kiya jata hai aur jab aap jyada cheezo ko measure karte hai to zahir si baat hai aap better treatment kar payenge. To isse jo quality of vision hai ya lasik ka experience hai vo pura enhance ho jata hai kyunki hum cornea ki irregularities ko to treat kar hi rahe hai aur hum ankh ke optical imperfections ko bhi treat kar rahe hai, eye design refractive studio software dwara. Ye vo hi technology hai jo NASA ne bhi apne web-telescopes mein istemal ki gayi hai. To zahir si baat hai agar NASA mein ise use kiya gaya hai aur effective paya gaya hai to vo hi technique jab aapke eye mein treat karne ke liye istemal ki jaati hai definitely ye ek safe hai aur ek advanced technique hai aur iske outcomes bahut hi promising hai.

Aaj ke daur mein major leading clinics jo hai USA mein iss technique ko offer kar rahe hain aur acchi baat ye hai ki ab ye technology India mein bhi aagyi hai. So, ab hum India mein bhi aapko ye technique ke liye treat kar sakte hain. Inn laser platform ke alava ek technique hota hai Smile jise hum kehte hai small incision lenticule extraction. Iss technique mein laser dwara aapke cornea mein do planes mein laser dekar ek lenticule banaya jata hai, ek chhote se incision dwara; is lenticule ko dissect karke nikala jata hai jisse ki aapki cornea flatten out ho jati hai aur aapka number hat jata hai. Aap samajh lijiye jaise ki agar ek koi sandwich ho aur usme beech mein cheese ka slice ho to agar aap us cheese ke slice ko sandwich mein se hata dete hai usi tarah Smile technique mein aapke cornea yani kali putli mein ek lenticule banaya jata hai laser dwara 2 planes mein aur usko hata diya jata hai incision mein se dissect karke taki aapki cornea flatten out hojaye. To effectively ye ek aspheric lenticule hai jisko hum fashion karke nikal dete hai. Smile technique se bhi visual outcome 6/6 aate hai aur ye US FDA dwara pramanit hai myopia yani ki minus number ko treat karne ke liye.

Jo ultimate vision outcome hota hai vo smile aur lasik dono mein 6/6 aata hai. Smile ko ek flapless technology ke naam pe jyada publicize kiya gaya hai, kuchh studies kehti hai ki kyunki isme technically 1 flap nahi utth raha hai to apne dry eye ki problems nahi hoti hain aur jo cornea ki integrity hai ya biomechanics hain unko maintain kiya jata hai but ab ye jo studies aa rahi hai recent mein vo mixed results de rahin hain, kuch studies keh rahi hai ki haan dry eye ki problem kam hoti hai, kuch studies ye keh rahi hai ki lasik aur smile dono mein hi agar dry eye ki problem hai vo almost same hoti hai aur cornea ki biomechanics mein bhi bahut fark nahi padta. Ek difference dono mein jo paya gaya hai vo ye hai ki lasik ka jo effect hota hai immediate wow factor aata hai, ek din ke andar aapko agale din hi clear dikhne lagta hai. Smile mein bhi ultimately vision 6/6 aati hai lekin jo visual recovery hoti hai vo 3 se 4 din bad aapko ekdum clear lagne lagta hai. Ultimate outcome lasik or smile dono mein 6/6 aata hai.

So, ek aur truly flapless technique agar aap chahenge aap karvana chahte hain to use hum kehte hain surface ablation. Ye hi true mayne mein ek flapless technique hai kyunki isme aapke jo cornea hai yani ke kali putli hai uspe surface pe ek layer hoti hai jise hum epithelium kehte hai. Surface ablation mein iss epithelium ko hataya jata hai, khured ke hataya jata hai aur uspe laser dwara aapke cornea ko reshape kardiya jata hai. Cornea ko protect karne ke liye laser ke bad ek contact lens yani ki bandage contact lens ko lagaya jata hai jo ye superficial layer hai jise hum epithelium kehte hain, jis ko hataya gaya hai ye 72 hours mein sadharan taur pe wapas regenerate ho jaati hai, regrow kar jaati hai jiske bad is bandage contact lens ko hata diya jata hai.

To kyunki aapke eye mein flap nahi uthaya gaya to aapke cornea ki integrity bhi maintain hoti hai aur ye truly 1 flapless technique hai. To friends aaj ke video mein humne discuss kiya lasik yani ki laser vision correction ki sari technologies ke bare mein, humne customised platforms ko discuss kiya jaise ki aspheric Lasik, fir contoura vision aur fir jo latest hai vo hai topo integrated wavefront guided Lasik yani ki eye design refractive studio 2.0 aur smile aur surface ablation ke bare mein. Aap apne doctor se discuss kar sakte hain ki aapke liye konsa technique best hoga lekin ye dhyan mein rakhna hai ki jaise jaise technology advance ho rahi hai always agar ye technology advanced hai to thodi expensive ho sakti hai lekin kyunki eye ki surgery ek bar hoti hai always better hota hai ki aap jo best technique hai ya jo advanced technique hai use opt kare kyunki surgery ek hi bar hoti hai aur best outcome hum chahte hai ki aye. To agar aapko iss prakriya ke bare mein aur koi doubts hai aap hume contact kar sakte hai niche diye gaye numbers pe aur agar aapko hamara video pasand aya to please ise like kare, share kare aur subscribe kare hamare channel ko aur hum jaldi ayenge aapke pass aur educational videos leke.

Thank you.

Hi,

I am Dr. Aditi Manudhane, Ophthalmologist and mai cataract, cornea and refractive surgeon hun. Aaj hum baat karenge keratoconus ke baare mein. Sabse pehle aap ko ye samjhna hoga ki keratoconus kya bimari hai. Kerato means cornea yanike humari kali putli hoti hai, oconus means tricone. Is bimari mein humari normal cornea uska aakar dheere dheere tricone ho jata hai. Ye bimari 10-15 years ke bachon mein shuru hoti hai aur 30-40 years ke logon mein bhi paayi jaa sakti hai. Keratoconus humare India mein bohut hi common hai. Iske kya karan ho sakte hain? Aapne dekha hoga ki bohut se logon ka number sthir nahi hota hai aur cylindrical number badalte rehta hai. Sabse pehla sign ki is patient ko keratoconus ki bimari hai ye humein kaise pata chalti hai. Agar number baar baar badal raha hai toh hum shak kkar sakte hain ki aise patient ko keratoconus ki bimari ho. Dusra common factor hai eye rubbing. Jo bache constantly aankhon ko rub karte hain ya fir baar baar allergy ki bimari hoti hai toh ye bada risk factor hai is bimari ke liya.

Jis bache ka number 1 se jyada ho aur baar baar badal raha ho, aise humein doubt hota hai ki ye bimari ho. Inki screening bohut jaruri hai. Ab mai aap ko btaungi ki is bimari ko diagnose kaise karte hain. Is bimari ko pakdane ke liya corneal topography ki jaanch ki jaati hai. Ismein humein putli ki motayi pata chal jaati hai aur uska curvature pata chal jaata hai. Ye isliya kiya jaata hai kyuki bimai jitni jaldi pakdi jaaye uska ilaj utna jaldi possible and successful hota hai. Aur bimari ko hum stabilize kar jaate hain. Jaise jaise bimari advance hot hai, iska treatment utna hi complicated ho jaata hai. Isliya jaruri hai ki bimari ko hum time se diagnose karen. Agar kisi patient ko keratoconus diagnose hota hai aur uski cornea ki motayi 400 microne se jyada hoti hai to hum ek parkriya karte hain jise cornea collagen crosslinking kehte hain. Ye treatment bimari ko apni jgha pe rok sakti hai. Is se cornea strong ho jaati hai and aage chal ke patla hone se ruk jaati hai. Is bimari ko yahi roka jaa sakta hai. Putli ki motayi agar 400 se kam hai toh hum cornea collagen crosslinking nahi kar sakte. Ek dusri parkriya bhi hoti hai jise hum intacs kehte hain.

Is mein plastic ki rings hoti hain. Jise hum laser ke through cornea min daal dete hain. Is se tricone ko flatten kiya jaa sakta hai. Patient ke number ko thoda kam kiya jaa sakta hai. Tisra option hai contact lens ka. Jab humne cornea collagen crosslinking kar di and bimari ko rok diya, toh patient ko achi vision dene ke liya specs ya fir contact lenses use karne pad sakte hain. Aise patients ke liya contact lenses ke bohut different options hote hain. Inhe hum RGP lenses advise karte hain. Jarurat padne par mini sclera lens bhi advise karte hain. Especially un cases mein jinmein cylindrical power bohut jyada ho. Aise in patients ki vision improve kar jaati hai. Advance cases mein agar cornea ke thickness 400 se kam ho jaati hai toh aise patients mein humein corneal transplant ki jarurat padti hai. Ye transplant bhi 2 types ke hote hain. Ek hai penetrating keratoplasty and 2nd is deep anterior lamellar keratoplasty. Keratoconus mein transplant ke options bohut ache hote hain. Deep anterior lamellar keratoplasty mein aage ke layers jo effect hue hain unhein replace karte hain. Last mein mai ye kehna chahungi ki aagr kisi ka bhi high cylindrical power hai aur vo stable nahi hai, badhta jaa raha hai toh is bimati ko rule out karna bohut jaruri hai. Kyuki jitna jaldi is bimari ko pakda jaaye uthna hi acha hai. Aur agar advance stage pe pata chale toh uske treatment option utne hi complicated hain.

Thank You!