keratoconus

Keratoconus: how to protect your eyes from a gradual drop of vision

by Blogs

this condition is one of the  most popular chronically or slowly progressive ocular conditions that takes years to affect and impair a person’s vision. In this condition the cornea, the clear window at the front of the eye loses its natural spherical contour, and becomes thinned out ,bulging out at weak points and assuming a conical shape. This abnormality of shape and contour affects the bending of light rays at the corneal interface , causing irregular bending and defocus of these rays when they fall onto the retina, leading to drop of visual clarity and acuity. The condition affects one or both eyes with varying degrees, and the average age of affection is between 15 -25 years . 

What causes keratoconus?

The actual cause is unknown yet, but  research has shed light that a deficiency of certain building enzymes within the corneal stroma.  

The wear and tear that is constantly repaired by these enzymes is slowed down, causing excessive accumulation of diseased collagen fibers and oxygen free radicles, leading to weakening of the corneal stromal bridges, and hence weakness  and forward bulge of the cornea. 

Research has also linked the condition to certain hereditary factors and genetic conditions, which highlights the importance of family history in this condition. 

In addition, excessive unprotected exposure to sunlight and constant eye rubbing have also been implicated. Also, the misuse of poor-quality contact lenses has also been added to the predisposing factors. 

Available treatment options:

At the early stages of the disease , glasses and/or rigid contact lenses (Rose -K, RGP) can be used to treat the condition according to your doctor’s decision. 

As the condition worsens however, your ophthalmologist or eye surgeon may resort to corneal collagen cross linking or intracorneal ring implantation. 

What are the common symptoms for keratoconus?

Patient’s with this condition notice that their vision becomes gradually blurred and unclear with frequent change of their glasses prescription.

 This subtle symptom may progress over years or months and may affect both eyes and one eye more than the other .

 the most common early symptoms include 

  • Blurring of distant and near vision despite wearing the proper optical correction
  • Straight lines appear bent or skewed at different angles
  • Increased sensitivity to ,light and increased sense of haloes around the light 
  • Redness and swelling of the eye

Later symptoms become more ominous and include 

  • Increased blur and visual distortion that does not respond to  any form of optical correction
  • Intolerance to contact lenses
  • Progression of myopia and astigmatism

What are the various surgeries that can be used to treat the condition?

Corneal collagen cross linking:

 this procedure uses ultraviolet light rays and concentrated vit B2 eye drops to create and strengthen the interconnecting bridges between the collagen fibers in the corneal stroma, making it stronger and less liable to bulge. 

The vitamin B2 drops are instilled onto the eye over a period of 30 minutes, this is followed by further 30 minutes of ultraviolet exposure. 

intracorneal ring implantation

 these semicircular devices made of PMMA are inserted into tracks created within the stroma of the diseased cornea and help to restore visual clarity and acuity by flattening the cones and increasing corneal thickness therefore creating a smoother refractive surface and regular light refraction onto the retina.

Corneal implantation

 if the cornea is severely thinned out or damaged you might need to have it partially or fully replaced by  donor tissue. This surgery restores the natural anatomy of the cornea and may provide best visual outcomes for some cases

Not all keratoconus patients have the same condition or follow the same treatment protocol, or  respond to the same treatment modality, each treatment option is specifically tailored according to the presented case 

elmoatassem-lasik-img-1

FemtoLASIK surgery in Egypt

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What is the FemtoLASIK operation in Egypt?

The femtoLASIK procedure is different from the normal LASIK procedure in that the treating physician does not use the traditional blades and surgical instruments that are used to create a flap on the outer surface of the cornea, and instead uses two types of lasers, one to create the flap and the other to correct the error.  femtoLASIK procedure in Egypt is also known as the blade-free lasik procedure.

Are there any conditions for femtoLASIK procedure?

Before deciding to perform any operation, your ophthalmologist will first examine your eyes and ask you a series of very important questions  to make sure that you are  ready for the procedure. Similarly, the indications for the procedure are not very different from the conditions for normal LASIK procedure, i.e. every patient that is  eligible for the normal LASIK operation is qualified. Regardless of the patient’s readiness, some medical studies have shown to prefer femtoLASIK over traditional LASIK, to avoid its possible complications as a result of the use of a bladed  microkeratome on the surface of the eye.

What is the mechanism for femtoLASIK?

In the femtoLASIK procedure, the doctor uses a type of ultra rapid laser known as the femtosecond laser to create  a thin outer flap of corneal tissue, then uses another type of laser known as eximer laser  to reshape the corneal tissue under this flap to correct the patient’s eyesight, and then elevated flap is returned to its original state after the corneal tissue is treated beneath it.

Advantages of using femtoLASIK

Recently laser operations in the field of ophthalmology have gained a wide reputation and popularity among doctors and patients alike, and have become one of the most important methods used in the treatment of visual problems and freedom from glasses and contact lenses ,  because  of its multiple features,

The most important of these features are:

  • The high speed and precision of the femtosecond laser, which makes it a safe alternative to microkeratome blades used in normal LASIK operations, and avoids complications of traditional treatments.
  • FemtoLASIK is completely painless, an important feature that is not available in many other therapeutic modalities.
  • Laser technology gives greater control precision, and accuracy than other means.
  • High-speed laser technologies also allow meticulous control of the thickness of the surface corneal flap, providing better chances of correcting vision with never before seen results and accuracy
  • The femtosecond laser allows the doctor to deal with each case with high individuality and custom tailor the treatment according to your needs, giving you the maximal visual results, and does not have to generalize one method of treatment for everyone.
  • Another important feature of femtoLasik is that it absorbs relatively weak corneal fish conditions without fear of bad complications.
  • With the development of laser techniques, the risk of scars on the surface of the cornea or eye exposure to corneal nerve injury and dry eye caused by microkeratomes  has decreased, classifying it as a safer technique.

Tips after the FemtoLASIK procedure

After the procedure, the patient is advised to abide by some recommendations and instructions to complete the success of the operation and achieve the desired results, the most important of which are:

  • Be careful not to expose the eye to dust and wind for at least three days.
  • Be careful not to be exposed to extreme lighting, sunlight and high heat sources.
  • Make sure that water does not enter the eye for at least three days.
  • Be careful not to expose the eye to the radiation of electronic devices and smartphone screens for one to three days after the procedure.
  • Take the recommended treatment from your doctor regularly and seriously as these eyedrops very important for the success of the surgery.

What is the cost of the FemtoLASIK operation in Egypt?

As is known in the medical field in general, the cost of any operation varies greatly according to the hospital fees, the procedure done, materials used, as well as the skill, experience, and knowledge of the treating doctor and his scientific qualifications and the balance of his previous successful operations.
The cost of the Lasik operation

What is the difference between the FemtoLASIK procedure in Egypt and the FemtoSMILE?

FemtoLASIK surgery in Egypt:

As mentioned  earlier, the femtoLASIK procedure is different from the normal LASIK in that the your ophthalmologist does not use the surgical blade in the femtoLASIK procedure to remove the surface flap from the corneal tissue. In this  procedure a type of laser known as the femtosecond laser is used instead. In another type of laser vision correction, the femtoSMILE, the corneal flap is not created or elevated at all, but the femtosecond laser work is done directly without the need to separate corneal layers, and this is the difference between the two procedures femtoSMILE and femtoLASIK.

The LASIK procedure is divided into two main parts:
  • Phase 1: The laser-designed eye phase, by removing a thin flap from the corneal surface of the cornea using a microkeratome blade in normal LASIK operations, and using femtosecond lasers again in femtoLASIK.
  • Phase 2: The next stage of the elevation phase of the surface flap, after which the lasik device is used to adjust the degree of curvature of the cornea and its  thickness, in order to correct the error.

FemtoSMILE surgery

This  modern technique is used in the treatment of myopia in which femtosecond laser  is used to separate a thin part of the corneal stroma called the lenticule and then the doctor removes this part through the pocket incision at the edge of the cornea through a partial thickness incision without the need to raise a flap at all

femtoSMILE is used in the treatment of myopia in the following cases

  • In cases where the thickness of the cornea is lower than necessary to allow lasik or femto lasik operations.
  • femtoSMILE  is also used in cases where myopic errors are too high to be corrected using lasik or femtoLASIK.

When is the femtoSMILE better than the femtoLASIK?

Only the attending physician can determine the optimal or best treatment method for the patient, and in some cases it is better to use femtoSMILE instead of femtoLASIK according to doctor’s experience, knowledge and skill.

The doctor will make the decision to use femtoSMILE instead of femtoLASIK when the following conditions are met:

  • low corneal thickness  .
  • Highly curved cornea.
  • High degree of myopia.
  • Low astigmatism

When the patient’s condition allows the use of femtoLASIK or femtoSMILE evenly, which is better?

In some cases, the possibility of using the two procedures is equivocal: femtolasik and femtosmile, i.e. the patient is ready for any of the two operations according to the results of the examinations and images  performed by the doctor,The cost of the femtoSmile surgery in Egypt

The femtoSMILE procedure 

  • The femtoSMILE is minimally invasive and safe procedure, where the laser machine touches the outer surface of the cornea at a very light degree.
  • The device then separates a very fine slice of the internal corneal tissues called a lenticule , opening a very small incision of about two and a half millimeters at the side of the cornea.
  • The doctor then extracts the thin layer lenticule from the inside of the cornea, corrects the defects of the surface of the cornea and the degree of curvature
  • Immediately after the surgery, the patient’s vision maybe blurred, and the vision gradually returns after the effects of the surgery subside and the patient begins to follow the doctor’s instructions for a safe and successful  recovery plan.

Post-FemtoSMILE

After the femtoSMILE, the doctor gives some recommendations and instructions to the patient, the most important of which are:

  • Rest your eye for up to a week, and do not engage in any stress-prone contact sports  or focused activity, such as reading.
  • Do not expose your eyes to excessively bright lighting, refrain from looking at electronic screens and smartphones, and refrain from watching TV as well, until the doctor allows you to do so after the necessary follow up. 
  • Do not expose the eye to dust, smoke and heat for a week or more as decided by your ophthalmologist.
  • Refrain from using make up powders and cosmetics until the doctor allows the you to do so.
  • Make sure that water does not enter the eye when washing the face or bathing at least during the first week.
  • Do not expose the eye to sunlight, and protect the eye when you leave the house during the day by wearing sunglasses.
The cost of intracorneal ring implants in Egypt

The cost of intracorneal ring implants in Egypt

by Blogs

Treatment of keratoconus with intracorneal rings

The treatment of keratoconus with intracorneal rings is one of the most effective ways to treat the condition, and is done by placing half-circle or full circle segments of rings into tunnels created in the corneal. 

Mechanism of treatment of keratoconus with rings

  • Topical anesthesia is first instilled to numb the eye and prevent any discomfort
  • The rings are implanted at the periphery of the cornea  so that the center of the cornea remains free without being touched. They are implanted in carefully constructed tunnels , which can be either created manually or by femtosecond laser 
  • The rings are inserted into the cornea.
  • They aim at  reducing irregular astigmatism by supporting the base of the cone and flattening the bulge
  • These rings can be removed if necessary, but in such a case, the cornea will return to shape before surgery.

Advantages of the implantation of keratoconus rings

  • The main purpose of treating keratoconus with rings is to restore the shape of the natural eye and allow the patient to tolerate  contact lenses.
  • This type of treatment is fairly good, especially for people who do not want to have a corneal transplant keratoplasty in Egypt.
  • This treatment can improve vision c=and can be accompanied by eyeglasses

What are the steps of the operation?

  • Before starting this procedure, anesthetic eye drops are applied first.
  • After that, the doctor applies the eyelid speculum, which essentially keeps the eye open during the procedure.
  • The doctor creates a tunnel inside the cornea, by laser or manually.
  • The rings are then inserted into the cornea
  • Then, at the end of the procedure, the doctor applies drops and a plastic shield for protection.

Cost of implanting intracorneal rings for  keratoconus in Egypt

In Egypt it is considered a common operation, it varies in cost and depends on several main factors which are the type of tunnel creation procedure used in the operation, the hospital and doctor fees, and the cost of the rings and their type. 

What are the conditions for implanting intracorneal rings?

  1. There should be  no opacity (scar) on the surface of the cornea (cornea must be clear).
  2. The corneal thickness should be within normal limits 

What are the expected results after the procedure?

  • Vision is expected to begin to improve in the week following the procedure by 50%  but may fluctuate for several days until it stabilizes, and most people can return to work one or two days after the treatment.
  • Additional procedures may be used to  complement procedures such as corneal stabilization and other techniques.
  • It may be done more than once with various ring sizes and positions to accommodate the changing corneal parameters .

What are the rings used to treat keratoconus?

implantation of PMMA rings or ring segments, where they act as stents, and  are installed to adjust and stabilize the degree of corneal curvature.

These rings are made up of one or  two semicircular sections, implanted in the cornea, on outside the optical zone, and there are also full segment  rings, the type of ring is chosen according to the condition of each patient. 

These rings are made of solid materials ,PMMA, by installing them in the cornea, they make changes in the shape of the cornea and reduce the bulging cone and provide stability.

What cases require a  corneal transplant?

There are many cases in which corneal transplantation is used in Egypt.

  • Advanced keratoconus. 
  • extreme thinning of the cornea.
  • Scarring or swelling of the cornea, caused by infection or injury.
  • Corneal ulcers and scars , including those caused by infection and not responding to treatment.

It is known that

  • Corneal transplantation contributes to restoring vision, reducing pain, improving the appearance of damaged or sick cornea, or improving its appearance.
  • Most corneal transplants are successful, but corneal transplantation has complications, such as rejection of the donor cornea, so post-operative car and follow up are essential.

The cost of corneal transplantation in Egypt

Results of corneal transplantation

  1. Most people undergoing corneal implants at least partially regain their sight, depending on the cause of the surgery and the patient’s health and eye condition.
  2. Close follow up is needed  because there is a possibility of complications and rejection of the cornea even after years after corneal transplantation, and corneal rejection can often be controlled by medications.
  3. You may need to correct your vision after surgery, and it may take several months for your vision to improve.
  4. When the transplanted  cornea fully heals and recovers – several weeks to several months after surgery, you doctor will make some adjustments that can improve your vision.

Some of these are :

  • Correction astigmatism: meaning that stitches that held the  cornea in place in the patient’s eye can lead to corneal irregularities and astigmatism, causing blurring of vision at some points.

Part of this may be corrected by removing some stitches and tightening others .

  • Correction of other vision problems:  Refractive errors, such as myopia hyperopia can be corrected by wearing glasses, contact lenses or laser eye surgery in some cases.

What is the cost of intracorneal ring implants in Egypt?

The cost of intracorneal ring implant in Egypt using the femtosecond laser device also varies according to the doctor’s skill, experience , knowledge. In addition to the  specifications of rings used in the surgery and whether they will be inserted manually or by Femtolaser which is currently used in Egypt and  is considered to have guaranteed and safe results.

Best Eye Surgeon in Egypt

A lot of skill knowledge and experience is needed and is imperative  for the diagnosis of keratoconus in its early stages  and its modalities of treatment, including the type, placement and thickness of the rings, and whether additional surgeries will be done. The best option for you is to look for the best eye surgeon ophthalmologist  specialized in keratoconus surgeries known for their efficiency and guaranteed results.

 Hence comes Dr. Ashraf Hassan Soliman consultant of keratoconus and corneal surgery, cataract and glaucoma  surgery, refractive surgery and laser vision correction on the top of the best ophthalmologists and  as the best doctor for the treatment of keratoconus in Egypt.

1018_Uveitis

What is uveitis?

by Blogs

What is uveitis?

Inflammation of the line lining of the eye


What are its symptoms?

  • Pain and redness in the eye
  • Redness of the eyes may not appear in children.
  • Blurry vision.
  • Sensitivity to light.
  • Shadows, interlacing lines, or points that float in the field of view

How dangerous is it?

There are types:

  • An acute anterior is one of the simplest types and one of the lowest in terms of complications.
  • Chronic posterior may cause serious complications if not treated.
  • Medium and medium severity.

What are the causes?

Most of the time it is due to an imbalance in the immune system, but sometimes the cause is a microbe.

Strabismus-678x446

The evolution of strabismus surgery

by Blogs

An exciting development has occurred in strabismus surgeries in recent years, including, for example, strabismus surgeries without the use of any surgical sutures, which prevents any problems during surgery and the surgery is completely safe, as well as the patient does not feel any inconveniences after surgery and returns to his activities immediately.

It is also possible to perform strabismus surgeries using surface anesthesia drops and not to resort to general or local anesthesia, which increases the accuracy of controlling the angles of the squints using modern surgical methods with which the patient does not feel any pain, which increases the accuracy and success of the surgical procedure.

Note that strabismus surgeries are considered one-day surgeries, and the eye is not covered after the operation, and the patient returns to his activities immediately after surgery.

Multifocal lenses2

Multifocal lenses treat cataracts on eyes

by Blogs

With the proliferation of electronic devices and cell phones, the eye problems associated with them have increased. With age, the natural lens of the eye loses its ability to clarify the image, which is known as white water on the eyes, but it has become accompanied by other visual defects such as myopia, farsightedness and medial vision.

In the past, the only options available to patients were either monofocal or bifocal lenses, but eyeglasses are still often required for certain activities. With the development of modern technologies, one of the most recent methods of treating cataract on the eyes is Trifocal IOL.

What are multifocal lenses for treating white water on eyes?

Trifocal lenses are the most advanced lenses for treating cataracts, as they are implanted in the eye during a cataract or lens replacement procedure.

It is a bifocal lens (Bifocal), but it was designed with the addition of a different feature in it that makes the main goal of it to provide a clear vision of the near, medium and far distances for the patient with cataract on the eyes.

What is the difference between multifocal lenses and other lenses for treating cataracts?

1- Monofocal lenses.

The most common type of lens used to treat cataracts. Unlike your natural lens, this lens features a single fixed distance focus. It means treating patients with farsightedness only, but after the operation you will need glasses for reading or watching closely.

2- Bifocal lenses.

Like bifocal eyeglasses, this one has areas that help you see things at different distances (far and near only). It may take several months for your mind to adjust for your vision to appear normal.

3- Multifocal Lenses.

Trifocal lenses work by gathering light entering the eye from near, medium, and far distances, focusing it on a single focal point on the retina. As a result, it can see objects at various distances, providing close, middle and far vision through a single lens.

This type of lens is the latest in the world of intraocular lens implantation, and it substitutes for the use of eyeglasses.

Toric IOLs are the latest in multifocal lenses

Toric lenses are eye lenses that correct astigmatism as well as nearsightedness or farsightedness.

Immediately before cataract surgery, the surgeon places temporary markers on the patient’s cornea that determine the location of the most curved meridian at the front of the eye, and then implantation of the (Toric IOL) lens during cataract surgery is performed on the eye, the surgeon rotates the lens so that the existing marks are aligned. On the lens with marks on the cornea to ensure proper astigmatism correction.

What are the advantages of multifocal lenses for treating white water on eyes?

Unlike monofocal and bifocal lenses, the design of multifocal lenses includes a third focal point (middle distance) as well as near and far distances; This is what a person requires to do daily activities such as:

  1. Reading.
  2. Cooking, cleaning and ironing.
  3. Work on the computer.
  4. Shopping.
  5. Watching TV.
  6. Leadership.
  7. Work in the garden.
  8. Doing sports.

What are the disadvantages of multifocal lens implantation for cataract treatment?

Multifocal implantation, like many modern technologies, suffers from some disadvantages, which is that patients suffer from the appearance of some bright rings around lights at night. While the patient does not see it during the day. Therefore, if you are a practitioner of night professions, Prof. Ahmed Al-Mu’tasim advises that you consult your doctor about the compatibility of the process with your profession and your daily routine.

What to expect after implantation of multifocal lenses?

After lens implant surgery, patients stay in the hospital under observation for one or a few nights. And with the use of modern surgical methods; The patient can leave the hospital on the same day. The patient is instructed on how to use eye drops that contain antibiotics to prevent infection, which he should use for 3 weeks after the operation. The patient is provided with eye drops to prevent eye infection.

Who are the candidates for multifocal lenses?

  • People over the age of 55 who rely heavily on glasses.
  • Astigmatism patients.
  • Patients with vision disorders such as myopia or hyperopia.
  • Those with age-related eye diseases such as cataracts.

However, not all candidates are suitable for all types of lenses, for example; Sometimes, the best visible results are achieved after a cataract operation with a different type of lens.

For example, you may have astigmatism in one eye than in the other. In this case, your eye surgeon recommends using an IOL lens in that eye only.

An eye surgeon can fully evaluate your specific needs during a pre-operative exam, and help you choose the best type of lens for a successful result and better vision.

Femto ring

FemtoRing steps and advantages for treating keratoconus | Professor Dr. Ahmed El-Moatassem

by Blogs

The femto-ring process is considered a major breakthrough in the treatment of keratoconus with femtolizer technology, but it has become an ideal alternative to corneal grafts and corneal transplants, and has contributed in an unprecedented way to helping keratoconus owners stop the deterioration of the condition of the cornea and restore the strength of vision.

The femto-ring process is done by implanting medical rings to stabilize the corneal fibers, to reduce or eliminate myopia or astigmatism in patients with keratoconus, so that their normal vision can be restored, and there is no need for a corneal transplant.

Femto-rings for treating keratoconus

What is the femto-ring?

It is a minor surgery to reshape the corneal surface from a conical shape to a flat, natural shape, by installing specialized plastic rings that support the corneal fibers.

Stabilizing corneal microsurgery, previously used as a form of refractive surgery to treat low levels of myopia, has then received FDA approval for its use in treating keratoconus.

In this surgery, semi-circular plastic rings are used, which are inserted into the middle layer of the cornea to change the shape and location of the formed cone, eliminate some or all of the complications caused by keratoconus, and provide a good view of the various details.

However, eyeglasses may still be needed to achieve better vision, and LASIK can be performed after femto-ring to completely correct vision defects.

How does femto-ring help treat Keratoconus?

The normal shape of the cornea changes in patients with keratoconus, it becomes more curved forward (takes the shape of a cone), and this results in weak vision, and this condition deteriorates the more it is left without treatment or early intervention.

Keratoconus

And when these semi-circular rings are installed, they add volume at the edges of the cornea, and reduce their position in the middle, so they tighten and make them flat as closely as possible to the natural cornea, and this improves the strength of vision immediately.

What is the history of FemtoRing or laser corneal rings fixation?

2001: Some major medical companies manufactured specialized corneal implants to treat severe myopia.

2003: These rings received international recommendations for their use in the treatment of keratoconus due to their impressive results in tightening the corneal surface and improving vision.

2004: The FDA approved the keratoconus treatment for keratoconus.

Since that time, until now, femto-ring, or laser corneal ring fixation, has proven highly successful in treating keratoconus and some vision problems at the same time.

When is a femto-ring procedure performed for keratoconus patients?

In the past, patients had to wait a long time to reach a late stage, when it was possible to risk a corneal transplant to treat keratoconus, but now the femto-ring procedure to treat keratoconus is safely performed in the early stages.

And most of the cases that need femto-ring surgery are:

  • Intermediate or advanced keratoconus.
  • People with keratoconus who suffer from severe nearsightedness.
  • People with keratoconus who suffer from astigmatism.

What are the steps of the femto-ring process?

This procedure involves using local anesthetic drops to numb the eye, and using a clamp to keep the eye open at all times. A semicircular ring or two is placed in the deep layers of the cornea through a small incision made with the laser beam. The FemtoRing to stabilize the cornea takes about 15-20 minutes.

The three basic steps for this procedure come in this order:

Step 1: A single small incision is made on the surface of the cornea with a laser.

Step 2: A centering instrument is placed on the surface of the eye for several minutes to help stabilize the eye and ensure correct alignment of the insertion ring. During this time, the layers of the cornea are separated at the outer edge where the rings will be placed.

Step 3: The small hole in the cornea is closed.

Follow-up visits are often needed to monitor the healing process and evaluate the visual benefits of the surgery. In some cases – even after the success of the operation – there may still be a need for medical glasses or LASIK operations to completely correct vision defects in some cases.

When does vision improve after FemtoRing?

The patient can go home on the same day, with a commitment to apply antibiotic drops and soothing eye drops that are prescribed by the doctor. The patient notices a significant improvement in vision from the first day, and it continues to improve for a period of 1 to 3 weeks.

What are the advantages of the femtogenic ring for treating keratoconus?

In fact, we can skip the word “surgery” to describe this procedure due to its extreme simplicity. And because it is completely done without any scalpel, it completely takes less than 10 minutes. Among the advantages of the femto-ring process:

1- It saves you from corneal grafts or difficult corneal transplants.
2- The cornea is raised instead of falling down, to prevent the deterioration of the condition of the cornea.
3- Helps improve eyesight and treat nearsightedness and astigmatism.
4- It has a high success rate, and it is considered a completely safe process.

Professor Ahmed El-Moatassem is considered one of the first surgeons to perform FemtoRing for more than 15 years in Egypt, the United States of America and the UAE. He is currently traveling between Egypt, Iraq and the UAE to assist various cases of treating keratoconus successfully in less than ten