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Improving vision in keratoconus

As global leaders in keratoconus treatment and improving vision in keratoconus, ELZA’s surgeons boast over two decades of experience, offering all these visual rehabilitation options.

ELZA’s medical director Prof. Farhad Hafezi officially is the most productive scientist on the topic globally, followed by ELZA’s Dr. Emilio Torres and Dr. Mark Hillen at numbers 2 and 5. ELZA’s surgeons are also in the top Expertscape global rankings for cross-linking.

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The goal: improving vision in keratoconus

The goal is to achieve better vision and visual acuity. “Visual quality” and “Visual acuity” do not mean the same thing. Visual acuity is purely a description of how small a letter patients can see on a vision test chart (it doesn’t matter if the letter is blurred or the patient sees three of them, the smallest sized letter the patient can read defines their score. “Visual acuity” says nothing about the quality of their vision.

Improvement of picture quality

There are two images below: the image on the left gives an example of good picture quality, and the arrow points to the 80% visual acuity line. The image on the right gives an example of poor visual quality, and again, the arrow points to the 80% visual acuity line. You can probably read both lines now, and the patient’s visual acuity would be 80% in both cases. However, you can see for yourself that the picture quality is completely different.

And this is the typical case in keratoconus: even if a certain visual acuity can be achieved, the quality can still be extremely poor. This is where the laser can help.

Before
After

Same visual acuity, different image quality.

What can I expect?

In most cases, there is an improvement in image quality with glasses. We cannot use your precious corneal tissue to both improve quality and acuity at the same time. This would require too much tissuen to be removed. So we rather focus on improving visual quality. The remaining diopters can be corrected with glasses or regular contact lenses.

Which possibilities exist?

There are several ways to enhancing vision after in eyes with keratoconus. These include special contact lenses, Femto-CAIRS, PACE customized cross-linking, and wavefront-guided transPRK with the excimer laser.

All options are highly customised, and which option – or combination of options – are best depends on each individual’s eye. Notably, contact lenses, Femto-CAIRS, and wavefront-guided excimer laser treatments primarily serve to improve visual quality rather than address progressive corneal ectasias.

Corneal cross-linking (CXL) is unique in its ability to halt ectasia progression. ELZA’s pioneering PACE customized cross-linking procedure not only strengthens the keratoconus to stop disease progression but also enhances visual quality simultaneously. But what approach is right for you?

We will briefly introduce the concepts, which you can choose to explore in greater detail if required.

Special contact lenses

For instance, significant improvement in visual quality can be achieved with special contact lenses, such as rigid gas permeable (RGP) or scleral lenses, which are custom-fitted. Typically, these lenses provide superior vision compared to glasses.

Learn more about special contact lenses.

However, wearing these lenses for extended periods, up to 18 hours daily, may cause discomfort and potentially lead to severe dry eye conditions. Reducing dependence on these special contact lenses is preferable, and surgical options can offer a solution.

Surgical Options

However, wearing these lenses for extended periods, up to 18 hours daily, may cause discomfort and potentially lead to severe dry eye conditions. Reducing dependence on these special contact lenses is preferable, and surgical options can offer a solution.

Femto-CAIRS

If we consider a “worst-case” scenario with a highly irregular cornea requiring substantial regularization, our initial strategy would be to employ Femto-CAIRS, as it has the potential for the most significant cone flattening. 

Learn more about Femto-CAIRS.

PACE

After achieving a stable corneal shape, we might consider PACE customized cross-linking and/or wavefront-guided transPRK for additional regularization. 

Learn more about PACE – customized cross-linking.

Wavefront-guided transPRK

Finally, in suitable corneas, we can perform wavefront-guided transPRK to “fine-tune” vision, aiming to reduce higher-order wavefront errors (aberrations) (e.g., blurring, ghosting, double vision) caused by the keratoconic cornea.

Learn more about PRK.

Summary

These highly individualized treatment approaches, whether involving one, two, or three steps, depend on the state of each person’s cornea: the shape, the thickness, the biomechanical strength, and other holistic factors we can determine together with our patients.

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Augeninstitut ELZA
4.8
Based on 109 reviews
powered by Google
mike
mike
09:02 04 Jan 23
Overall as a 50 year old, who wanted to continue to avoid wearing glasses and/or contact lenses, my goal was 100%... achieved with ELZA and Dr. Hafezi. I greatly appreciated the overall approach by Dr. Hafezi and his friendly and competent team in reviewing my vision at the start and following a comprehensive eye exam- the explanations of my options. For me I chose PRK in one eye for a monovision solution to correct short sightedness which was becoming more prevalent in night driving and sports such as skiing and cycling. PRK heals slowly but the outcome is worth the wait- and the cost- you use your eyes every waking moment- and for me I cannot see any reason not to pursue better vision with the ELZA team! A great quality of life enhancement!read more
Zuzana Fecko
Zuzana Fecko
21:48 31 Oct 22
Thank you so much, Dr. Torres and prof. Hafezi. 26 years I was only “dreaming” about the eye surgery due to possible... complications. I was worried ..Thank you for encouraging me to make a decision and thank you for your professionalism, explanations and great work!I wish you all the best, lots of success and only happy patients!read more
Serena Fazio
Serena Fazio
11:15 06 Mar 22
I have been to the ELZA clinic to have surgery for my miopy, as my eyes were rejecting the contacts and I was tired of... wearing glasses. From the first preliminary visit, to the actual surgery and post-surgery care Dr. Hafezi and all his collaborators have been extremely professional, considerate and helpful. All the steps of the (very short!) surgery were thoroughly explained to me in order to be as calm as possible, together with the medication plan and precautions to be aware of so that my eyes could heal in the best way possible. By following their exact instructions, the healing process has been very successful and smooth, and after about one week I was able to see perfectly. I absolutely recommend this team and their expertise!read more
Robin A
Robin A
11:43 16 Feb 22
Top experts and professional team. Highly recommended
Thunder Shiviah
Thunder Shiviah
14:05 23 Nov 21
After some research on local options I decided to go with ELZA since it stood out as the best. The operation and the... post-operation recovery went extremely smooth (something I was worried about with PRK). Now my vision is much better than I had hoped and I have no side effects such as dry eye or night vision problems. Thank you!read more
Thomas S.
Thomas S.
09:37 07 Jul 21
My left eye had to be operated on because of a cataract. As I had an Artiflex lens implanted a few years ago, it had to... be removed first before a modern lens could be implanted to correct the cataract. Prof. Hafezi treated me in an very competent and friendly manner. I am very happy with the result.read more
Selma A. Rahim
Selma A. Rahim
19:45 02 Jul 21
Dr. Hafezi.. the KING OF CXL🤴
Gianluca Ricci
Gianluca Ricci
12:46 10 Apr 21
Great team and service!
rehaneyecare
rehaneyecare
05:36 08 Apr 21
Excellent surgeon
Steven H.A
Steven H.A
16:13 11 Jan 21
Prof. F. Hafezi s expertise is enormous and he has a very pleasant and calm nature which gives the patient... security.Thank youread more
Online Commande
Online Commande
09:19 05 Dec 20
Totally creepy, very arrogant Prof.He just want your money.It may explain, why this Prof. is not in the center of the... city of Zürich and why he has been thrown away from University of Geneva.read more
Elena Churilova
Elena Churilova
10:06 17 Nov 20
At the moment, 3 months have passed since the moment I made laser vision correction in this clinic. and I can say that... I am happy that I chose this particular clinic and Prof. F. Hafezi. The entire staff of the clinic is very friendly, treats patients with sympathy and patience if they are nervous before surgery (my big gratitude to Aida Alili for all support and patience). The doctor Hafezi and other doctors of the clinic are very professional and ready to explain to you as many times as you need. I can only recommend!read more
Michele Aggiato
Michele Aggiato
18:17 10 Jan 20
The day I had Prof Hafezi checking my keratoconus I knew I was finally in the right place after years of searching for... a good ophthalmologist. Prof Hafezi recommended a surgery due to a drastic degeneration of my cornea. The surgery was performed by himself with the assistance of Dr Rodriguez, one more collaborator of Prof Hafezi’s team who got my full trust.read more
Ashley Faulkes
Ashley Faulkes
15:30 21 Mar 16
Professor Hafezi and the team at the ELZA Institute have done an amazing job of creating a first class eye clinic, with... cutting edge technology and support. I went there for a dry eye issue and other issues with my prescription, and they were easily able to help me and put me on the road to better vision! High recommend them to anyone in the Zurich/Aargau area.read more
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Augeninstitut ELZA
4.8
Based on 109 reviews
powered by Google
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