Laser and cataract surgery, done in a morning

Helder Oogkliniek has rooms in the Gardens and on Meade Street in George. A screening takes about two and a half hours, surgery takes a morning, and you go home the same afternoon.

Book a screening

The practice, and who walks in

Helder is a private eye practice with rooms at 22 Hof Street in the Gardens and on Meade Street in George. Four ophthalmologists work between the two, with the same theatre lists, the same lenses and the same follow-up protocol in both towns, so a farmer from Uniondale is not sent to Cape Town for something he can have done an hour from home. Most people who walk in are somewhere between forty and eighty. Some have worn spectacles since standard three and have had enough of them. Some have just been told at the licensing department that their eyes are the reason they failed the test. We bill medical aid on the cataract side and we quote in writing for laser, because nobody should have to guess what an operation costs.

What a screening morning involves

You come in without contact lenses — two weeks out for hard lenses, three days for soft — and you keep two and a half hours free. We map the shape and thickness of the cornea, scan the retina, measure the pressure and then dilate the pupils, which is the part nobody warns you about. You will not be allowed to drive afterwards, so bring somebody or book a lift. At the end of it a surgeon sits down with you and says one of three things: laser suits your eyes, a lens exchange suits them better, or leave them alone for now. The third answer is more common than people expect, and it costs the same R950 as the other two.

Theatre day, and home by two

We operate on Tuesdays and Thursdays in our own day theatre in the Gardens, and on the first and third Wednesday of the month in George. You are booked onto a morning, not a whole day. Laser takes under ten minutes an eye. A cataract with a lens implant takes about fifteen. You are awake for it, the eye is numbed with drops, and there is nothing to feel beyond a bright light and some pressure. An hour in the recovery room, one last look at the eye, and you go home with drops and a plastic shield to sleep in. We see you the next morning, at a week and at a month. Most people are back at a desk on day two and driving again by the end of the first week.

What we operate on, and what each one is for

Eight procedures between the two rooms. Which one suits your eyes is a decision for the screening, not for a web page.

LASIK

The flap procedure most people mean when they say laser. Usable sight by the next morning, and the eye settles over about a month.

TransPRK surface laser

No flap at all — the laser works on the surface of the cornea. Sorer for three days, and the right answer for a thin cornea.

Cataract surgery

The clouded natural lens is taken out and a clear implant put in its place. Fifteen minutes an eye, and the second eye a fortnight later.

Multifocal and toric lenses

Implants that handle distance, reading or astigmatism at the same time. We go through the trade-offs before you pick one, not after.

Refractive lens exchange

For over-fifties whose cornea rules out laser. The natural lens is replaced early, which also means a cataract can never form later.

Cross-linking for keratoconus

Riboflavin and controlled UV to stiffen a cornea that is thinning. It does not give sight back; it stops the thinning going further.

YAG capsulotomy

The film that clouds behind an older lens implant, cleared in three minutes in the rooms. No theatre, no shield, no time off work.

Dry eye and pre-op treatment

Half the people who come in for laser need their tear film sorted out first. Lid treatment, punctal plugs and a proper diagnosis.

Said at the one-week check

I drove myself to this appointment. Forty-one years of spectacles and I drove here without them on my face.

Marius Nel · George

The cataract went through Bonitas and there was nothing for me to pay in. Home before lunch, reading the Burger the next day.

Ntombi Jantjies · Woodstock

Dr Adams told me my cornea was too thin and to come back at fifty for a lens instead. I trust a practice that turns work away.

Hendrik du Plessis · Oudtshoorn

Four questions we answer every day

Does it hurt?

Not while it is happening. The eye is numbed with drops, you see a light and feel some pressure, and that is all. Afterwards a LASIK eye is gritty and waters for a few hours. A surface laser eye is genuinely sore for about three days and we send you home with something for it. A cataract eye is usually just scratchy for one night.

What does it cost, and will medical aid pay?

Cataract surgery is a prescribed minimum benefit, so most schemes cover the surgeon, the anaesthetist and the theatre; a premium multifocal lens carries a co-payment we quote before you agree to it. Laser is not covered by any scheme in South Africa. The screening is R950 and laser starts at R14 500 an eye. You leave the screening with the whole number in writing, including the follow-up visits and the drops.

Am I too old, or too young?

Under twenty-one your prescription is usually still moving and we will ask you to come back. From twenty-one to about forty-five, laser is normally the right conversation. After that the lens itself is ageing and a lens exchange often makes more sense than reshaping the cornea. For cataracts there is no upper limit at all — our oldest patient last year was ninety-one.

How long am I off work, and when can I drive?

LASIK: back at a desk on day two, driving once we have checked the eye at a week. Surface laser: four to five days at home, and plan for it. Cataract: most people drive after the one-week check. You may not drive yourself home on the day of a screening or a procedure, because your pupils will be dilated and everything will look washed out for a few hours.

The four people you will actually see

Dr Annelie BesterOphthalmologist · refractive

Trained at Groote Schuur, then a cornea and refractive fellowship in Melbourne. She runs the Tuesday laser lists in the Gardens.

Dr Sipho MabasoOphthalmologist · cataract

Twenty-two years and somewhere past nine thousand cataracts, a good number of them on outreach lists in the Karoo.

Dr Riaan AdamsOphthalmologist · George rooms

Holds the Meade Street rooms and the George theatre days, and is the one who will tell you not to have laser if you should not.

Sr Farieda KamaldienRefractive co-ordinator

Takes every screening measurement herself and answers the phone afterwards. She is the person who gets you onto a list.

Not sure which one you need?

That is what the screening is for. Two and a half hours, R950, and a straight answer at the end of it.

Book a screening

Nothing is booked off this form — we phone you back first. Gardens: 22 Hof Street, Cape Town · 021 424 7780 George: 14 Meade Street · 044 873 2215 Consulting Mon–Thu 08:00–16:30, Fri 08:00–13:00. Theatre Tue and Thu. rooms@helder.co.za