1. Optometry Pathway Laser Refractive Surgery Charlotte Hazel

2. Patient Assessment - Summary 2 page questionnaire History Refraction Pupil sizes Orbscan Aberrometry Anterior Eye Fundus Assessment Pachymetry Counselling

3. History Questionnaire Health - exclusion criteria Pattern of spectacle and/or contact lens wear History Why surgery? Why now? Expectations? Visual Activities - work, sports, hobbies? Symptoms? -e.g. dry eye, CL intolerance

4. Refraction –Stability, e.g. young myopes –Cycloplegia for young hypermetropes Pupil sizes –Photopic and mesopic

5. Orbscan Topographer Contour map of the cornea Posterior AND Anterior surface Thickness Curvature information Is the cornea healthy and thick enough to perform treatment?

6. Orbscan tiff

8. Aberrometry Zywave® II Wavefront Aberrometer –Hartmann-Shack Principles –Up to 5th order –Personalised measure of refractive error –Wavefront guided treatment produces better quality of vision and less likely to induce night vision problems

9. Aberrometry tiff

10. Anterior Eye Blepharitis/ Lid disease Tear film assessment Cornea Pachymetry –Ultrasound –Bowmans to descemets membrane

11. Posterior Eye Usual fundus assessment Is the eye healthy?

12. Counselling Healing phase - symptoms, time-scale Potential side effects Effect on presbyopia - e.g. removing myopia Surgical/ Post-surgical complications Ensure expectations are realistic =Make sure what we can offer and what the patient wants are the same thing!

13. Counselling 2 What happens on day of treatment? –Before, during and after treatment What does the laser look like? Drops, eye shields, do’s and don’ts Initial preparation for nervous patients Patient understands what is involved

14. Thank-you!