Das gesamte IROC Team wünscht Ihnen besinnliche und harmonische Festtage und einen guten Rutsch ins neue Jahr 2018.

Die Augenklinik ist vom 23.12.2017 bis 07.01.2018 geschlossen.
Wir freuen uns, Sie im neuen Jahr wieder bei uns begrüssen zu dürfen.
The entire IROC team wishes you peaceful and pleasant Christmas and a happy new year 2018.

The Eye Clinic is closed from 23.12.2017 to 07.01.2018.
We are looking forward to welcome you again in the new year.
IROC Augenklinik Infocenter

Questions & Answers

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Questions & Answers

Zurich Eye laser

1.
How do I know that I am a candidate for an eye laser treatment?

This is probably the most frequently asked question which cannot be answered without a thorough examination. Therefore, we recommend that you arrange an appointment for a pre-examination for refractive surgery at IROC, so we can get familiar with your individual situation. Through many years of experience and the latest technology we can determine whether an eye laser treatment is possible and if so, which one is the most appropriate technique for you.

2.
Can all patients that wear glasses or contact lenses be treated by refractive surgery?

Most patients who wear glasses or contact lenses are suitable candidates for eye laser treatment. In particular, patients suffering from myopia experience an enormous increase in vision. But also in patients with presbyopia, far-sightedness and astigmatism very positive results are achieved. In severe cases of short-sightedness or far-sightedness an implantation of a special phakic intraocular lens might also have to be considered. The IROC ophthalmologists will work together with you to determine the most appropriate option individually for your vision.

3.
Is SMILE better than Femto-Lasik?

The hit rate for myopia correction is 90-95% for LASIK and only 75-85% for SMILE. Also, the glare is increased within the first months after SMILE. Possible benefits of SMILE are less dry eyes and reduced effect on the stability of the cornea (no flap). Whether these advantages offset the lower hit rate is something that must be decided individually in each case.

4.
Since when is IROC working in the field of eye laser treatments?

Professor Theo Seiler was instrumental in the development of refractive surgery. In 1987 he was the worldwide first person, that treated a human eye with photorefractive keratectomy (PRK), but also wavefront-guided PRK/LASIK and corneal crosslinking are on his account. Meanwhile, more than 20,000 eye laser surgeries have been performed at the IROC eye clinic in Zurich.

5.
Which lasers are used at the IROC?

Through close collaboration with industry (such as Ziemer, Schwind or Avedro), IROC is always supplied with the most recent developed products and technologies. At present, IROC uses the excimer laser "Schwind Amaris 1050RS", the femtosecond laser "Ziemer LDV Z8" and "Ziemer LDV Z2" as well as the UV irradiation system "Mosaic".

6.
How long does the procedure take?

You will be at IROC for about 1.5 hours on the day of surgery. For each eye, the entire procedure takes about 15-20 minutes although the actual laser ablation is performed in less than a minute each.

7.
Is an eye laser treatment painful?

Due to topically applied anesthetic eye drops, you will experience the entire procedure without any pain but fully conscious. This is necessary because your cooperation is required. After the operation it can come to itching or an increased tears flow. These are only short-lasting symptoms and are described by the patients as well-tolerable.

8.
What visual acuity can I expect after the procedure?

After a LASIK, as well as after SMILE, many patients notice an immediate improvement in visual acuity. This is increased remarkably within one day and increases slowly in the following weeks and months. The final result is at least as good as your preoperative visual acuity with glasses or contact lenses. After PRK, many patients report a marked improvement in visual acuity within one week, but the final result is only available 3 to 6 months after surgery.

9.
Can both eyes be treated in one day?

The latest and most advanced technologies allow the IROC eye clinic to treat both eyes in quick succession. However, the preconditions of the patient to be treated are also paramount here, which is why the procedure is coordinated with each patient individually.

10.
How long do eye laser results last?

Refractive surgery is a procedure with permanent results. International long-term studies over 20 years demonstrated, however, that you are still not preserved from age-related eye developments such as cataract or presbyopia, but also from an increase of myopia due to continuous eye growth.

11.
When can I get back to work and normal daily activities?

In the case of a LASIK or SMILE procedure, most patients can get back to work on the first day after the procedure. After PRK, the work can be resumed after about 3 days.

12.
Which risks have to be considered in eye laser treatments?

There are two main risks: On one hand, the surgery can lead to an infection of the cornea and, on the other hand, there is the risk of re-surgery. Fortunately, infections are very rare (less than 1 in 10,000 surgeries), but still presents a risk to the cornea. The risk of a re-surgery is relatively higher (2-5%) but can usually be performed without problems and further complications.

Cataract surgery

1.
What is the cataract?

Cataract is the progressive opacification of the lens of the eye. The main symptom of cataract is a slowly progressing, painless vision loss.

2.
How do I know if I need cataract surgery?

If and when the cataract surgery is necessary can only be determined after a detailed profound examination of your eyes by an IROC ophthalmologist. Usually cataract surgery is advised if you are restricted in your everyday life (e.g. visual impairment/increased blinding/glare while driving).

3.
Is cataract surgery at IROC more expensive than at a public hospital?

No. Despite the high-quality standards, costs at IROC eye clinic in Zurich are the same as in a public swiss hospital. Thus, when choosing a standard artificial lens, the entire cataract surgery is covered by the standard swiss health insurance. These services are uniform throughout Switzerland for all outpatient treatments. However, we do not recommend the implantation of a standard artificial lens, but an aspherical blue-filter artificial lens. This enables better optical imaging on the retina and possible protection against macular degeneration. To determine the individual asphericity of this premium lens for your eye, an additional examination is performed that will be charged with 300,- CHF per eye prior to the surgery. These costs are not covered by the standard swiss health insurance.

4.
Is a cataract surgery dangerous?

Every intervention involves certain risks. These are, however, reduced to a minimum by using the most recent technologies and devices and by the long experience of our ophthalmologists and ocular surgeons. After a thorough pre-examination, you will be informed and advised in detail about general and individual risks regarding your eyes.

5.
Is cataract surgery performed under general anesthesia?

In most cases, cataract surgery is performed under local anesthesia. This can be done for example via a syringe injection, which is placed next to the eye. You won't feel this at all, because we let you sleep briefly for the time of the injection. Alternatively, the procedure can also be performed under topical anesthesia or rarely under general anesthesia.

6.
Do I have to stop taking any medication prior to cataract surgery?

Yes, blood-thinning medications such as Tiatral, Marcoumar, Sintrom, etc. should usually be stopped 7 days prior to the surgery, "new" blood-thinning medications like Xarelto at least 24-36 hours prior to the surgery. Do not stop taking these medications yourself but discuss this with your family physician first. If you have recurrent bruises or if you suffer from persistent bleeding after minor injuries, this is also taken into account during the planning of the surgery.

7.
Is cataract surgery performed using a laser?

Yes, the high-precision femtosecond laser is used to produce the incision in the anterior surface of lens capsule because it increases safety compared to the manual technique. In addition, the actual cataract is also fragmented into small parts by the femtosecond laser, that are subsequently removed by an ultrasound pen.

8.
How much time do I have to schedule on the day of the operation?

Three hours in total. That includes the preparation time, the surgery and the follow-up time.

9.
Can I go home after the operation?

The operation is done on an outpatient basis. You can go home about 30 minutes after the end procedure.

10.
Do I need an accompaniment after the operation?

This is recommended. Due to the bandage after surgery you only see with the fellow eye, which limits your spatial vision.

11.
Will I have pain after cataract surgery?

Strong pain after cataract surgery is rare. In case it occurs, you can find the provided painkillers in your post-surgery kit. If pain persists you should contact the surgeon. In general, many patients report foreign body sensation after the surgery. This is normal within the first days after cataract surgery.

12.
Is my vision limited after cataract surgery?

During the first few days after cataract surgery a transient reduction in vision may occur. The surgeon will inform you about the expected healing course of your operated eye at the early-postoperative examination 1 day after the surgery.

13.
How long am I disabled to work?

By the rule, you are disabled to work for 1 week.

Keratoconus / Crosslinking / CXL

1.
What is understood by keratoconus?

Keratoconus is the progressive thinning and conical protrusion of the cornea of the eye. In most cases it is a hereditary disease.

2.
I am diagnosed with keratoconus. What can I do?

If you are diagnosed with keratoconus, be assured that our team of ophthalmologists is ready to take care of your case. In a preliminary examination, we want to get familiar with your personal situation and determine the next steps to offer you best-available therapy.

3.
What is meant by UV riboflavin crosslinking of the cornea?

Crosslinking of the cornea is achieved by a combination of UV-irradiation with administration of riboflavin eye drops (vitamin B2). The intensity of the UV radiation is chosen so that structures posterior of the cornea are not damaged. The currently most efficient technique is customized crosslinking.

4.
Why should I get keratoconus surgery on IROC?

Together with the University Eye Hospital Dresden, we have the longest experience worldwide using this method. In the past years, further developments of the method were investigated by IROC. The IROC eye clinic in Zurich is currently the only provider of customized crosslinking, which has been demonstrated in international studies to be the most efficient and safest crosslinking approach in keratoconus.

5.
What is the IROC opinion regarding Epi-on crosslinking?

Multiple studies from different research groups reported a significantly lower short- and long-term efficacy when using this technique. This is why we only don't use this technique.

6.
Will my health insurance cover the costs of the surgery?

In contrast to other countries (e.g. Italy, Norway, partly Germany), standard Swiss health insurances currently do not cover the costs for the crosslinking operation. In cooperation with a medical lawyer we have set the costs to CHF 2.300 as a lump sum for the operation.

7.
What are the risks of crosslinking the cornea?

IROC ophthalmologists will discuss possible risks and side effects together with you after the pre-examination. In general, the risks associated with this type of surgery are minimal if the pre-examination is carried out carefully. The complication rate is about 1%.

8.
How is the eye anesthetized?

On the day of the customized crosslinking procedure, the eye is only anesthetized via topical anesthetic eye drops. The entire operation is completely painless.

9.
Will I have pain after the customized crosslinking procedure?

During the crosslinking procedure, the superficial layer of the cornea, the epithelium, has to be removed. Bare corneal nerve endings induce pain, which is sometimes considerable strong within the first 48 hours after surgery. However, our ophthalmologists will provide painkillers to keep the discomfort on a minimum.

10.
Do I need an accompaniment after the operation?

You should be in company, as your vision will be limited after surgery and the use of public transport may be a risk. You should also not drive a car yourself.

11.
How long will I be unable to work?

The inability to work is usually 7 to 10 days.

12.
What are the long-term experiences?

So far, results of 15 years of experience have been published in international studies, reporting god long-term outcome of crosslinking.

13.
How will my vision be affected after customized crosslinking?

During the postoperative period (1-3 months) after the crosslinking you are much more sensitive to light (glare) and the visual acuity might be transiently reduced. Usually rigid contact lens can be used one month after the surgery again. Previously published studies report on an increased vision acuity after customized Crosslinking after 1 year.

Eyelid surgery

1.
How much time do I have to schedule on the day of the operation?

You should come to IROC eye clinic about 1 to 1.5 hours prior the scheduled surgery time. The surgery usually lasts between 1 and 1.5 hours. The follow-up time is another 2 hours, after which an early postoperative examination is carried out.

2.
Can I go home after the operation?

If the early postoperative examination shows no abnormalities, you can leave the eye clinic when you are accompanied. However, on the day of the operation, you are not allowed to drive or use public transport without assistance.

3.
Will I have pain after surgery?

Severe pain is rare after eyelid surgery. In case, you can find painkillers in the post-surgery kit. If pain persists you should contact the surgeon suing the provided phone number.

4.
Is my vison reduced after surgery?

Within the first 2-3 days after the operation, you will notice a reduction in vision, because ointment is applied to protect the cornea, which can affect the vision.

5.
How many days should I plan for the recovery?

Depending on the procedure, you will be unable to work between 2-7 days.

6.
Which kind of anesthesia is used?

In most cases, eyelid surgery is performed under local anesthesia and you won't perceive any pain. Here, a syringe injection technique the so-called "fractional injection" is used, which is barely noticed by the patient.

7.
Do I have to stop taking any medication prior to eyelid surgery?

Yes, blood-thinning medications, such as Tiatral, Marcoumar, Sintrom, etc. should usually be stopped 7 days prior to the surgery, "new" blood-thinning medications like Xarelto at least 24-36 hours prior to the surgery. Do not stop taking these medications yourself but discuss this with your family physician first. If you have recurrent bruises or if you suffer from persistent bleeding after minor injuries, this is also taken into account during the planning of the surgery.

Macular therapy

1.
What is meant by the term "macula"?

The macula is located at the central retina in the posterior part of the human eye. It has the highest density of photoreceptors of the entire retina. The macula is responsible for sharp vision.

2.
Which diseases of the macula are most frequently diagnosed?

The most commonly diagnosed macular disease is age-related macular degeneration (AMD). The other diseases of the macula that are commonly diagnosed and treated are diabetic macular disease (diabetic maculopathy) and macular disease resulting from retinal venous occlusion (macular edema following venous occlusion). However, there are numerous less-frequent other types of macular diseases.

3.
Can all macular diseases be treated?

Numerous diseases of the macula can be successfully treated today. Whether the diseased macula will benefit from a possible treatment must be clarified in a profound examination. After the initial diagnosis, the cause, the type and the stage of the disease need to be determined. In many cases, previously reduced visual acuity can be gained again under therapy, or at least further deterioration can be prevented. The earlier and the more consistent the treatment is, the better the long-term outcome of the diseased macula will be.

4.
What is age-related macular degeneration (AMD)?

Age-related macular degeneration (AMD) is the most commonly diagnosed macular disease. Beside hereditary cause, other factors like age of the patient play a crucial role in its development. In the course of getting older, the complicated metabolic mechanisms necessary for a good macular function can be disrupted. The layers that provide nutrients for the unrestricted function of the photoreceptor cells are not working appropriate and a consecutive accumulation of metabolic degradation products is causing tissue damage.

5.
Which forms of AMD are differentiated?

A distinction is made between "dry " and "wet" age-related macular degeneration (AMD).

6.
What characterizes the "dry" and "wet" form of age-related macular degeneration (AMD)?

Dry AMD very often has so-called "drusen" which are locally condensed accumulations of metabolic degradation products in the macular layers. In the context of further degenerative development, tissue atrophy can occur, including all layers of the macular structure. A late stage of dry AMD is characterized by an extensive tissue loss ("geographic atrophy"). In wet age-related macular degeneration (AMD), new vessels develop in the choroidal layer of the eye, which do not have the structure and characteristics of normal choroidal vessels. These new vessels can grow into retinal structures. They are permeable to fluid that may leak into the retina and they are prone to bleeding. If not treated appropriately, this exudative, wet form of AMD can lead to a fast-progressing loss of visual acuity.

7.
Can a dry form of age-related macular degeneration (AMD) turn into a wet, exudative form?

Yes. The dry form of the AMD can change into a wet, exudative form. This transition is usually accompanied by symptoms like visual deterioration.

8.
Which symptoms characterize the wet, exudative form of AMD, or the transition from a dry to a wet form?

Affected patients often complain about severely distorted or blurred vision in the centre of the visual field. Straight lines are no longer perceived as straight. In late stages of wet macular degeneration, as well as in late stages of dry macular degeneration, the patient sees a central dark spot of various sizes.

9.
Is there a self-assessment test for patients that detects a transition from a dry form of age-related macular degeneration (AMD) form to a wet, exudative form as early as possible so that an ophthalmologist can promptly be consulted?

Yes. This test is called Amsler test. The Amsler test is a very suitable test for the self-assessment of the macular situation of an eye. It is very simple, delivers quick results and yet is still surprisingly accurate. The Amsler grid is placed in reading distance (for example, about 30 cm). The test is done with reading glasses, unless you are able to read without glasses. The Amsler test is always performed separately for each eye (the fellow eye is covered), so that a conclusion about the macula of each eye can be made. For the test the eye has to fixate the black dot in the center of the panel. The test is conspicuous when the lines of the grid are not perceived straight but distorted or when line interruptions or whole area defects are noticed.

10.
Is there a therapy for every kind of macular disease?

Not every macular disease has an evidence-based treatment option. In the wet form of age-related macular degeneration (AMD), diabetic macular disease, and in macular disease following venous occlusion, intravitreal injection therapy of vascular growth inhibitory factors ("anti-VEGF") into the vitreous humor of the eye is in most cases a very efficient therapy. In these cases, the current condition of the affected macula can be stabilized or even improved.

11.
Is the therapy using intravitreal injections a one-time therapy?

No. The adequate treatment requires repetitive intravitreal injections. Regular monitoring of the macula with OCT examinations makes it possible to customize the rhythm of the intravitreal injections for each patient individually.

12.
Does age-related macular degeneration (AMD) lead to complete blindness?

No. Age-related macular degeneration (AMD) affects only the centre of the retina. In late stages of AMD, a central black sport of different sizes with the corresponding consequences for vision arises, including the loss of reading ability. The peripheral retina, which is responsible for the perception of the peripheral visual field, is preserved. This allows orientation of the affected patients in their spatial environment even in very advanced stages of macular degeneration.

13.
How can I find out more about macular diseases and their therapy?

We have put together a special brochure on macular therapy which informs you in detail about further steps. We are glad to answer all questions you may have about your macular problem after a profound macular examination.

Glaucoma

1.
How to diagnose glaucoma?

Initially, an ophthalmologic examination is necessary including the intraocular pressure, corneal thickness, optic nerve and inspection of the anterior chamber angle. In suspicious cases the measurement of the visual field and imaging of the optic nerve will be performed. At IROC eye clinic high-resolution laser scanning systems are used to image the optical nerve. This allows the detection of damages at very early stage. Only in comprehension of all examination results the kind and stage of the glaucoma can be determined. This is the most important step, which has the highest impact on the later treatment.

2.
Do certain risk factors exist?

Yes, the major risk factors are increased intraocular pressure of more than 21 mmHg and age. At an age of 40 the risk to suffer from glaucoma is 0.6%, whereas it increases to more than 7% at an age of 80. But also, the genetic background has an impact. The risk to develop glaucoma is 3-fold increased if a first-grade relative is affected by glaucoma. In addition, female gender, pigmented skin and low blood pressure are minor glaucoma risk factors.

3.
Are always both eyes affected by glaucoma?

Glaucoma is a bilateral disease that is likely to be asymmetric, meaning one eye is stronger affected. The progression of glaucoma is also different in each eye. That's why usually both eyes are treated.

4.
Does the blood pressure affect the pressure of the eyes?

Yes, but it is only a minor contributing factor. An elevation of blood pressure by 10mmHg results in an increase of 0.2 to 0.3 mmHg of eye pressure.

5.
Does the range of diurnal intraocular pressure fluctuations influence glaucoma?

Patients with diurnal changes of intraocular pressure of more than 5 mmHg are at greater risk of developing glaucomatous damage.

6.
Beside the use of pressure reducing eye drops, what are the different surgical options?

In general, there are two ways to reduce the intraocular pressure. The first mechanism is to increase the outflow of the eye. This can be achieved by an extension of the regular outflow pathways or by creation of a new alterative outflow channel. The only way to reduce the inflow into the eye is the destruction of the aqueous humor producing tissue of the eye.

7.
Is a laser treatment possible in glaucoma?

Intraocular pressure can be reduced by selective trabeculoplasty (SLT). Patients with elevated intraocular pressure, normal-pressure glaucoma or open-angle glaucoma can be treated using this laser-technique. The treatment with this low-energy laser at the drainage channel of the eye produces a reaction of the body without damaging any structures of the eye. The eye responds to the laser effects by releasing substrates that loosen junctions between the cells and allow greater passage of fluid. In addition, cells are attracted that clean the outflow pathway.

8.
Are contact lenses allowed if you have glaucoma?

In general, it is possible for glaucoma patients to wear contact lenses. In patients using eye drops to reduce the intraocular pressure, this it is not always the case and an ophthalmologist has to be consulted.

9.
Are refractive eye laser treatments (e.g. LASIK) possible in patients suffering from glaucoma?

During LASIK surgery, the intraocular pressure is elevated for a short time. Patients with advanced glaucoma may experience further damage during this phase. In general, LASIK surgery can be performed in glaucoma patients.

10.
Does a cataract surgery affect glaucoma?

In about a third of the patients that received cataract surgery the intraocular pressure is significantly reduced, which has a positive effect on glaucoma progression.

11.
Do cortisone derivates have an effect on the introcular pressure?

About 10% of all people react to cortisone (tablets, ointments, inhalations or eye drops) with an elevated intraocular pressure. The raise is dependent on dose, derivate and applied pathway.

12.
Is alcohol aggravating glaucoma?

No. Alcohol even lowers the intraocular pressure slightly.

13.
Does regular exercising affect glaucoma?

Yes. People who do sports tend to have lower intraocular pressures.