Before even looking at the actual laser, consider that we have laser application options onto the cornea. The type of procedure is dependent on whether the epithelium is included or not with laser ablation.

1. PTK - PhotoTherapeutic Keratectomy

The epithelium is manually removed, sometimes with the help of alcohol or a brush. The laser is then applied to the exposed stromal bed. The refractive equivalent of this procedure is a PRK, PhotoRefractive Keratectomy.

2. TransPTK - Transepithelial PhotoTherapeutic Keratectomy

With this procedure the laser is applied straight to the epithelium and then stroma without pause. The epithelium acts as a masking agent. The refractive equivalent of this procedure is a TransPRK (Transepithelial PhotoRefractive Keratectomy).

3. WetPTK

Fluid is used as masking agent to smooth the stromal bed. Usually done after one of the other therapeutic profiles, or after removal of the epithelium alone.

4. SCTK - Sequential Custom Thereapeutic Keratectomy

This is a combination of multiple Wavefront / Topography guided profiles. First, a TransPTK / PTK is done. Then a WetPTK to smooth the stromal bed. The eye is remeasured immediately. A new custom PTK profile is planned, and steps one and two are repeated. The process can be repeated a few times, usually 3 or 4 times, but even up to 5 times or more is possible, all in one setting.

We can either go through the epithelial (TransPTK or Transepithelial Phototherapeutic Keratectomy profiles), as well as directly onto the stroma (traditional PTK or Phototherapeutic Keratectomy) after epithelial removal. Both techniques have their merits and indications. Both techniques change shape on a “global” corneal scale. 

We can also laser onto a masking fluid, the so called WetPTK. With this technique, energy is applied to the masking fluid that has been added to the stromal bed, and the energy is dispersed laterally instead of straight down into the stroma. Small “localized” vertical ridges are smoothed with this technique.

I almost always perform the WetPTK after any therapeutic laser, to smooth the bed as much as possible. This has two functions: one, to improve the stromal irregularity as much as possible, but two, to give the epithelium a smooth pathway to close quicker. This means, I do two laser runs on the same eye at the same setting. The so called “Dry Run”, where I apply the calculated profile that will give me global reduction in stromal irregularity. And the “Wet Run” that will smooth the stromal bed of small and localized irregularities. I plan the Dry Run on the eye (within the planning file) that I am operating on, and the Wet Run on the contralateral eye (within the same planning file) so that I do not have to switch to a new planning file in between the two runs on the same eye.

Any depth can be planned, from 1µm upward. It is not only the depth that can be manipulated, but also the profile shape which we laser. Profiles include:

• Uniform. With this profile, a single depth is chosen across the entire profile, with a specific ablation zone size. Certain lasers can also position this specific profile where you would like onto the cornea. And again, certain lasers can change the shape to a circle, ring, or an oval shape of any orientation.

• Corneal Wavefront Optimized. This profile is based on the mathematical expression of the wavefront measurement of the cornea.

• Topoguided. This profile is based on the topographical expression of the front surface of the cornea.

• Ocular Wavefront Optimized. This profile is based on the wavefront measurement of the whole eye.

• Refractive. Traditional refractive profiles can also be used. Note that with therapeutics one can sometimes see very interesting refractive shifts that cannot be wholly calculated by the uninitiated prior to the laser.

Therapeutic laser techniques then combine the different profiles with the different corneal applications. The technique chosen is completely dependent on the pathology.

1. Irregularities

2. Opacities or Scars

3. Recurrent Corneal Erosions 

4. Corneal Dystrophies

5. Corneal Degenerations

6. Apical Syndrome

7. Keratoconus and Ectasias

Theatre Booking

• After your consultation with Dr Botha, you will return to Reception to make your refractive theatre booking. 

  • ALL procedures will be done at our practice, unless otherwise specified

• An exact procedure time cannot be provided at this stage but you will be given an approximate time period for planning purposes. 

  • The day before your procedure, we will contact you to communicate what time you will need to arrive at our practice. 

Payment and Medical Aid Authorisation

• Most medical aids in South Africa do cover up to a certain amount.  

  • The practice will phone your medical aid on your behalf. However, full authorisation remains the responsibility of the patient.

  • Please ensure that you receive a DETAILED AUTHORISATION from your medical aid.

    • The authorisation must be sent to accounts@drtcbotha.com.

    • This information is used to prevent co-payments, if possible.

  • If the full amount is not covered by your medical aid, this will be communicated to you before surgery.

  • If the cost of your procedure needs to be settled privately you will be informed beforehand.

What to Bring and How to Prepare

• Depending on your procedure, and whether it will involve one or both eyes, it may be necessary to arrange transport after surgery. 

  • This will be confirmed when you make your refractive theatre booking.

• NO CHANGE in eating and medication routines is necessary.

• Avoid bringing excessive accessories.

• Be sure to dress comfortably. The theatre gown provided to you on the day of surgery will be worn over your own clothes.

• Please do not wear any mascara or eye make-up on the day of surgery.

Anaesthesia, Eating and Drinking 

• The procedure is done under TOPICAL ANAESTHESIA. This means that drops are used to numb the eye/s.

  • The procedure is very quick. As a routine doing more than topical anesthesia is excessive.

• As the patient needs to be awake to fixate on a light and give certain feedback, no general anesthesia is used. 

  • If a patient is very anxious, then tablets are given to relax the patient. 

• You can eat and drink as normal before your procedure.

• NO PAIN is felt during the procedure.  

Admission Process

• Please arrive at Reception at the time provided to you the day before.

• You will be given a CONSENT FORM to read and sign before we begin the refractive theatre preparation process.

• One of our skilled Ophthalmic Assistants will then begin the procedure preparation process

Even though the procedure itself is usually quite short, the process surrounding the procedure can take some time. Preparation is also slightly different for each patient, therefore waiting times can vary. Please be patient during this process. We do the best we can to make the time in our practice as short and comfortable as possible.

Theatre Preparation

• Numbing drops will be used to prepare the eye/s for the procedure. 

• If you are feeling very anxious please communicate this to one of our Ophthalmic Assistants. 

  • Tablets can be provided to help you feel more relaxed.

Operation 

• Although the procedure is usually the same in its nature, variability in procedure type and techniques used will have different time factors. 

• You will be awake during the procedure as you will need to fixate on a light and provide certain feedback.

• The procedure should be comfortable for you. NO PAIN should be present during the procedure.

  • You can verbalize if there is any discomfort and we will immediately react to this. 

TransPTK Post-Procedure Information

• Walk out with eyes open (no shields are placed over the eye/s) with CONTACT LENSES IN SITU.

• DROPS will be prescribed. A SCRIPT will be provided immediately post-operation.

  • Drops are to be used until finished.

• You will receive a BAG with an APPOINTMENT CARD. This card gives the time of your post-operative consultation with Dr Botha the next morning.

• Major post-operative expectations / issues:

  • Day 1 + 2 pain and discomfort - pain tablets usually enough.

  • Day 3 usually much more comfortable.

  • Day 4 contact lens removal. If defects not healed, review again at Day 7.

  • Major fluctuations in vision first week.

  • Minor fluctuations in vision first month.

  • Dry eyes for weeks to months.

• REMEMBER: your spectacle/contact lens script will change with surgery.

  • The aim is to improve the vision with spectacles or contact lenses.

  • This means that there will be a time for about 10 days to 1 month after surgery that you do not have the correct spectacles/contact lenses to correct vision. This can be very disconcerting and uncomfortable.

  • DO NOT fixate on the refractive values as a guide for improvement, this is irrelevant. Corneal regularity is more important here.

  • The usual option taken is to see the optometrist at about Day 10 for soft contact lenses. Update of soft lenses is then possible at intervals as the refractive end-point shifts.

  • Spectacles or other forms of permanent correction usually only at 3 months, sometimes longer depending on the corneal pathology.

  • Your estimated recovery time will be discussed at length, please ask again if you missed it during the consult.