Toll-free phone number 1-888-400-3937
SASKATOON, SASKATCHEWAN, CANADA
P – 306.664.3937
F – 306.664.3927
saskatoon@horizonlaser.com
REGINA, SASKATCHEWAN, CANADA
P - 306.352.5277
F – 306.664.3937
regina@horizonlaser.com
www.horizonlaser.com
Horizon Laser Vision Center is an established refractive surgery clinic with facilities
in Saskatoon and Regina. We have a unique patient care system that involves you,
the optometrist, and the participating ophthalmologists. We provide the safest
technology at our center and the highest quality of care through this care system.
OUR MISSION
Our mission is to provide the highest quality care to our refractive surgery patients.
We aim to achieve this mission by providing the latest and safest technology in a top
quality facility, with the highest quality pre and post operative eye care.
OUR GOAL
Our goal is to provide a center of excellence for surgery and for continuing education
for both the doctor and the patient.
REFRACTIVE SURGERY: GENERAL INFORMATION
We feel it is important that the patient be educated fully on all aspects of the surgical
process so that they are properly equipped for informed consent. At Horizon the
patient has a refractive surgery assessment preoperatively to discuss procedure
options (iLASIK or PRK) and logistics.
Included in this package you will find all the tools you need to refer your patient to
Horizon Laser Vision Center. The information includes protocol on referrals, follow
up, patient fees and reimbursement. It will also provide you with important
information on patient selection and counseling.
We hope you find this book of use to you and your practice and we look forward to
working with you. Feel free to contact us anytime if you have questions or if you
have a situation with a patient where you an unsure of next steps.
REFERRAL PROTOCOL TO HORIZON LASER VISION CENTER
Determine if your patient is a good surgery candidate using the patient criteria provided. The choice
of which procedure is optimal will be determined at the refractive surgery assessment at Horizon Laser
Vision Center with our Consulting Optometrist, in consultation with the surgeons.
Before referral to Horizon, the patient will require a recent full examination which should include a
complete history including refractive history, complete medical history, a peripheral retinal
examination (either dilated fundus examination or Optomap imaging), a thorough review of macula
including when necessary macular OCT. Topography and pachymetry should be performed if
possible. Dry eyes should be treated and controlled before assessment at Horizon. Any other concerns
should be referred to the appropriate specialist and cleared before assessment at Horizon.
If the patient is in your chair for a regularly scheduled check and brings up the subject of laser surgery
we suggest you speak with them about refractive surgery and tell them you will forward their
information to Horizon.
You are not REQUIRED to have a separate visit for a laser consult with the patient’s contact lenses
off. You are not REQUIRED to perform a cycloplegic refraction in all cases. Cycloplegic refraction is
still required for all hyperopes but this can be performed at the time of the full examination or this can
be done at the clinic if this is more convenient for the patient. This does not preclude you from doing
any testing that you feel necessary for your screening and counseling of the patients including the
cycloplegic – use your clinical judgment to determine what is necessary to determine if a patient is a
good candidate.
Fill out (clearly and completely) both the PREOP ASSESSMENT and HISTORY forms at this visit.
FAX the forms to Horizon Laser Vision Center.
Inform the patient that Horizon will be contacting them within 24 to 48 hours to arrange their pretesting and refractive surgery assessment. Please ensure the patient is aware that all the necessary
appointments may not be on the same day – your patient may need to attend appointments on two or
three different days.
It is important to notify your patient that they will need to discontinue their contact lens wear for
accurate measurements at the time of the refractive surgery assessment at Horizon. Soft contacts
should have been removed for 2 full weeks, soft toric lens for 4 weeks and gas permeable/rigid lenses
for 4-6 weeks. This will help to promote corneal stability which is crucial to refractive surgery success.
Our optometric consultants will do the laser assessment at Horizon after the patient has been off
contact lenses for the appropriate time and as usual the surgeon will make the final determination of
patient suitability. The clinic will notify the referring doctor if a candidate is proceeding or is rejected.
Information regarding the visit to Horizon will be emailed/mailed directly to the patient from Horizon
Laser Vision Center. This will include information about the procedures done at Horizon and
financing information as well.
IF surgery is scheduled, follow up visits with the surgeon will be arranged by Horizon Laser Vision
Center. The ONE WEEK follow up visit with the optometrist will also be arranged by Horizon. All
other optometrist visits should made by your individual offices.
Treatment Range with the VISX STAR 4 EXCIMER LASER
MYOPIA
iLASIK
 -1.00 and greater sphere
 -0.50 to -6.00 cylinder
PRK
 -1.00 to -10.00 sphere
 -0.50 to -6.00 cylinder
The consulting optometrist will discuss treatment options with the patient and help
the patient better understand what procedure best suits their unique eye. Please
counsel your patients on both iLASIK and PRK procedures.
At Horizon, we perform about 90% iLASIK due to patient/surgeon choice. Please
note that PRK patients can sometimes have a more challenging/delayed healing
period.
HYPEROPIA
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+1.00 to +4.00 sphere
up to -4.00 cylinder
Mixed astigmatism can be treated and is quite successful. (eg: +2.00 –3.00 x 90)
CONTACT LENS WEAR
As contact lenses influence the corneal surface, great care should be taken to ensure
the cornea is stable before surgery.
We recommend prior to your patient’s refractive surgery assessment and prior to the
surgical procedure itself:
 Soft lenses: discontinue x 2 weeks minimum
 Toric lenses: discontinue x 4 weeks minimum
 Rigid lenses: discontinue x 4-6 weeks minimum
Often the biggest inconvenience for patients is the discontinuation of their lenses.
However, it cannot be stressed enough that it is imperative for a successful outcome.
MONOCULAR vs BINOCULAR TREATMENT

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Currently over 98% of patients elect to have a bilateral procedure
It is completely up to the patient, consulting optometrist and surgeon to decide
which is best for each individual.
iLASIK vs PRK
 While a patient’s prescription MAY make them a candidate for either
procedure….it is important to let the consulting optometrist and the patient make
the decision together based on a number of factors including risk vs. benefit,
expectation, k-readings and pachymetry.
iLASIK or PRK XTRA
XTRA is a 3-minute procedure used in conjunction with an iLASIK or PRK surgery
to add biomechanical strength to the cornea through accelerated corneal crosslinking.
During refractive surgery, changing the shape of the cornea affects the biomechanics
of the cornea. A change in biomechanics may cause the refractive effect to regress
and possibly necessitate an enhancement procedure. Adding biomechanical strength
through cross-linking has been shown to halt refractive regression in conditions
associated with weakened corneas.
The indications/protocols for CXL and “XTRA” continue to evolve and our
surgeons are advised to keep up with the current literature on the subject, and provide
appropriate counselling to the optometric consultants and patients prior to treatment.
Possible Indications for XTRA
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Young patients (under 30 years of age).
Patients with severe ocular allergies, due to the risk of heavy rubbing.
Completely normal corneas, with no one sign of Keratoconus, but family
history.
Thin corneas with complete normal preoperative evaluation (Risk of ectasia
has been ruled out).
High myopes (large resections)
Hyperopes
Retreatments
CORNEAL TOPOGRAPHY/ PENTACAM
Pentacam or topography is extremely useful both the pre- and post-operatively. If you
have a Pentacam, or access to one, we recommend:


Preoperative maps to rule out abnormalities.
Preoperative Pentacam maps to be done by HLVC at time of refractive surgery
assessment.
If you do not have access to one, Horizon’s Pentacam will be sufficient.
CORNEAL PACHYMETRY
Pachymetry or corneal thickness measurement is a determining factor in whether
your patient has iLASIK or PRK. A sufficient amount of corneal tissue must remain
untouched during the procedure and therefore an adequate amount of tissue must be
present initially.
Pachymetry is always performed by the clinic prior to surgery.
*If you have access to a pachymeter it is often helpful in higher myopes to
determine their suitability for refractive surgery.
PATIENT SELECTION
At Horizon we feel it is you, the eye care professional who is best able to judge if
your patient is a suitable candidate for laser surgery. It is our mandate to direct all
patients towards their own eye doctors. Here are a few guidelines for patient
selection:
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Patients should be over 18 years of age
Intelligent and motivated
Stable refraction for at least one year with less than 0.50 diopter change
Uncorrected acuity that is sufficiently reduced to ensure the risk/benefit ratio is
desirable
Have an understanding of the capabilities and limitations of the procedures
Realistic goals and expectations
CONTRAINDICATIONS
OCULAR
 Significant ocular pathology
 Severe dry eyes
 Recurrent iritis/uveitis
 Corneal anesthesia
 History of herpes simplex keratitis
 Keratoconus
 Glaucoma
 Marginal corneal dystrophies (eg: Terrien’s corneal dystrophy)
 Endothelial dystrophies
 Significant cataract development
 Monocular patients
 Unstable refraction
SYSTEMIC
 Significant history of keloid formation
 Active collagen vascular disease
 Long term insulin diabetics
 Immune compromised patients
 Thyroid eye disease
 Pregnancy and lactation
 Any systemic disorder or medication likely to affect healing
POSTOP MEDICATIONS AND FOLLOW UP VISITS
After surgery, all instructions and medications will be given to the patient before they
leave Horizon Laser Vision Center. They will receive a written copy of all
instructions. They will follow these instructions until seen by their optometrist at
ONE WEEK POSTOP. If you have any questions FEEL FREE TO CALL
HORIZON for guidance.
FOLLOW-UP ASSESSMENTS
Your patient will be seen at HORIZON 1-3 DAYS following surgery. With PRK the
time is usually 3 - 4 days and with iLASIK it is 1-2 days. If the patient has any
inflammation/delayed healing, the time could be extended by a day or two. This
however is not usually the case. The patient will then be seen by their optometrist at
1 WEEK postoperatively followed by 1 MONTH, 3 MONTHS, 6 MONTHS AND
12 MONTHS postoperatively. These visits are vital to your patients’ success and
happiness as well as to our statistics. It is imperative that these visits be kept.
At each of these visits a POSTOPERATIVE ASSESSMENT form must be filled out
by the optometrist and faxed to Horizon. These forms will be provided to you with
patient specific information provided on them at the time the surgery is scheduled.
This will save you and your staff from having to fill in this basic information. If you
feel the need for more frequent visits with your patient we can provide more forms.
The forms have space for questions to the surgeon and an area for his/her
response to your concerns.
Please fill them in as completely as possible to give HORIZON as much information
as possible for reviewing your findings. This allows the surgeons to respond to your
questions quickly and efficiently. Their answer will be clearly stated on the postoperative
form and faxed back to you.
MEDICATIONS for PRK
Each PRK patient is started on the same medications postoperatively. The normal
regime is as follows:
SURGERY DAY:
 Bandage Contact lens is inserted
 Dilute Tetracaine given for use if necessary.
1 DAY POST-OP:
 Zymar 1 drop QID
 Flarex 1 drop QID
 Voltaren 1 drop QID until gone (1 pkg given)
 ARTIFICIAL TEARS often for lubrication
DAY 3-4 POSTOP:
 Patient assessed by surgeon or optometrist
 IF epithelium is well healed ….bandage lens is removed
 Zymar 1 drop QID – to stop at one week.
 Flarex 1 drop QID
 Systane Ultra or other preservative-free lubrication is continued at least QID
 Pt instructed to see optometrist at 1 week but to call HORIZON if any
problems prior to that visit
1 WK POSTOP:
 Seen by optometrist
 Assess epithelial healing
 Fill in all areas of postop assessment sheet and fax to Horizon
 Any questions you may have will be answered quickly
 Follow up is made for 1 month after surgery date
Often you may wish to see the patient sooner than the required 1 month visit. Feel
free to do this to establish where the patient is refractively. This is often difficult to
do on the first visit. Then see the patient for all of the required visits 1 MONTH, 3
MONTHS, 6 MONTHS and 12 MONTHS POSTOP.
Taper Flarex as follows:

QID for one month,
TID for two weeks,
BID for two weeks,
OD for two weeks.
RETREATMENTS are NOT considered until the 6 MONTH mark. Stability is the most
important factor in retreatment. Patients must be completely off steroids before considered
stable.
MEDICATIONS for iLASIK
SURGERY DAY:
* Zymar QID
* Maxidex q1h for 3 days, then QID for 4 days
* ARTIFICIAL TEARS often
1 WEEK POSTOP:
* Medications are continued for one week and D/C at the optometrist’s one week
visit
* Occasionally a patient will be put on PRED FORTE due to an inflammatory
response postoperatively. HORIZON will direct the patient on how to take the
prescribed medications and notify the optometrist of any change in standard
regime.
Often you may wish to see the patient sooner than the required 1 month visit. Feel
free to do this to establish where the patient is refractively. This is often difficult to
do on the first visit. Then see the patient for all of the required visits 1 MONTH, 3
MONTHS, 6 MONTHS and 12 MONTHS POSTOP.
RETREATMENTS for LASIK are not considered until the 3 MONTH mark. Shifting can
occur until the 2-3 month time frame.
Updated July 2014
CO-MANAGEMENT AGREEMENT
I, _______________________________ agree to participate in the co-management of
excimer laser surgery patients with Horizon Laser Vision Center.
I agree that I will accept a fee of $300.00 /eye for iLASIK, $325.00/eye for PRK to cover
the post-operative assessments (1 week and 1, 3, 6 and 12 months following surgery or
any other necessary visits), related to the patient’s excimer laser surgery for 1 year
following the original and any enhancement surgeries which are included in the patient
fee for two years from original surgery date.
*For iLASIK, if the patient has a spherical equivalent of greater than -6.00 or +4.00, the OD and
surgeon will be paid an extra $50/eye. If the patient has a cylinder amount that is greater than 2.50 the
same will apply.)
I agree to not charge the patient any further fees for consultations directly related to their
refractive surgery, for 12 months following the original or enhancement procedure date.
DR._________________________________
ADDRESS: _____________________________________________________________
_____________________________________________________________
EMAIL: ______________________________________________________
SIGNATURE: _________________________________________
DATE: _____________________
103-728 SPADINA CRES. E. SASKATOON, SK. S7K 4H7 PH:(306)664-3937 FAX: (306)664-3927
110 - 1914 HAMILTON STREET. REGINA, SK. S4P 3N6 PH: (306)352-5277 FAX: (306)352-5202