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All you wanted to know about refractive surgery

Refractive errors occur when the shape of the eye prevents light from focusing directly on the retina, leading to blurred vision. Common refractive errors include Myopia (difficulty seeing distant objects clearly), Hyperopia (difficulty seeing close objects clearly), Astigmatism (blurred vision due to irregularly shaped cornea or lens) and need for reading glasses or Presbyopia. Refractive surgery helps correct these defects and takes away the need for glasses or contact lenses.

Laser Refractive Surgery for Refractive Errors

Introduction:


Laser refractive surgery is a safe and effective procedure aimed at correcting refractive errors. This surgical procedure utilizes advanced laser technology to reshape the cornea, improving vision and reducing or eliminating the need for glasses or contact lenses.

 

Types of Laser Refractive Surgery:

1. LASIK (Laser-assisted in situ keratomileusis):

  • Procedure:

    • A femtosecond laser creates a thin, precise flap in the outer corneal layer.

    • An excimer laser reshapes the underlying corneal tissue by removing a specific amount of tissue with high precision.

    • The flap is then gently repositioned and adheres naturally without stitches.

  • Benefits:

    • Offers the fastest visual recovery among refractive procedures.

    • Minimally invasive with minimal discomfort.

    • Suitable for correcting a wider range of refractive errors.

  • Considerations:

    • Requires sufficient corneal thickness for flap creation.

    • Potential for flap complications though rare (e.g., flap dislocation).

2. PRK (Photorefractive keratectomy) / Advanced Surface Ablation:

  • Procedure:

    • The epithelium (cornea's surface layer) is removed using an alcohol solution or laser.

    • The excimer laser ablates corneal tissue directly to reshape the cornea.

    • A bandage contact lens is placed to protect the healing surface.

  • Benefits:

    • May be preferable for some patients with thin corneas who are not candidates for LASIK.

    • Offers good long-term stability.

  • Considerations:

    • Slower recovery time compared to LASIK, with initial discomfort.

    • May experience temporary haze during healing (usually resolves within weeks).

3. CLEAR (Lenticule Extraction) such as SMILE / KLEX / SILK etc

  • Procedure:

    • A femtosecond laser creates a disc-shaped lenticule within the corneal stroma (middle layer).

    • A small incision is made in the cornea, and the lenticule is removed through this incision.

    • The remaining corneal tissue reshapes naturally, correcting the vision.

  • Benefits:

    • Minimally invasive with less disruption to corneal tissue compared to LASIK.

    • Quicker visual recovery than PRK.

    • May offer advantages for certain patients with dry eyes.

  • Considerations:

    • A newer technique with less long-term data compared to LASIK.

    • May not be suitable for all types of refractive errors.

4. Phakic IOL (ICL):

  • Procedure:

    • A customized intra ocular lens (phakic IOL) designed to correct refractive errors which are not amenable to laser refractive surgery 

    • This phakic IOL is placed inside the eye in front of the natural lens via a small incision.

    • The incision is self-sealing and does not require any stitches.

  • Benefits:

    • Minimally invasive with no impact on cornea.

    • Quicker visual recovery 

    • May offer advantages for certain patients with dry eyes or weak cornea

  • Considerations:

    • Intraocular surgery may have the risk of complications of lens changes / inflammation / raised eye pressure

    • May not be suitable for eyes with narrower space in front part of the eye
                 

 

Preoperative Evaluation:

 

Before undergoing laser refractive surgery, you will undergo a comprehensive eye examination to assess your candidacy for the procedure. This evaluation includes measurements of your refractive error, corneal thickness, pupil size, corneal tomography and overall eye health. Your surgeon will discuss your medical history and lifestyle to ensure that laser refractive surgery is suitable for you.

 

Procedure Overview:

 

1. Preparation: On the day of the surgery, prior to procedure numbing eye drops will be administered to ensure your comfort throughout the procedure. You may also be given a mild sedative to help you relax.

   

2. Creation of Flap (for LASIK): If you are undergoing LASIK, a specialized instrument called a microkeratome or a femtosecond laser will be used to create a thin flap on the surface of the cornea. This flap is then gently lifted to expose the underlying corneal tissue.

   

3. Corneal Reshaping: A computer-controlled excimer laser is used to precisely reshape the cornea based on your unique prescription. The laser emits pulses of ultraviolet light, removing microscopic amounts of corneal tissue to achieve the desired correction.

   

4. Flap Repositioning (for LASIK):  After the corneal reshaping is complete, the flap is carefully repositioned onto the cornea, where it adheres naturally without the need for stitches.

   

5. Postoperative Care: Following the procedure, you will be given instructions on how to care for your eyes during the initial healing period. You may experience temporary discomfort, light sensitivity, and blurry vision, but these symptoms typically improve within a few days to weeks.

 

Benefits of Laser Refractive Surgery:

1. Improved Vision: Laser refractive surgery can significantly improve your vision, reducing or eliminating the need for corrective lenses.

   

2. Quick Recovery: Most patients experience a rapid recovery and notice improved vision within a few days after surgery.

   

3. Long-Term Results: The effects of laser refractive surgery are usually permanent, providing lasting vision correction.

 

Risks and Considerations:

 

While laser refractive surgery is generally safe and effective, it's essential to be aware of potential risks and complications, which may include:

- Dry eyes

- Glare or halos around lights, especially at night

- Under-correction or over-correction of refractive error

- Flap complications (for LASIK)

- Infection

- Loss of vision (very rare)

 

Candidacy for Laser Refractive Surgery:

Not everyone is a suitable candidate for laser refractive surgery. Your eye surgeon will determine your eligibility based on factors such as your age, prescription stability, corneal thickness, and overall eye health. It's essential to have realistic expectations about the outcomes of the procedure and to discuss any concerns with your surgeon.

 

Conclusion:

Laser refractive surgery offers a safe and effective solution for correcting refractive errors and achieving clearer vision. By understanding the procedure, its benefits, and potential risks, you can make an informed decision about whether laser refractive surgery is the right option for you. Your eye surgeon will guide you through the process, from preoperative evaluation to postoperative care, ensuring the best possible outcome for your vision.

 

If you have any further questions or concerns about laser refractive surgery, don't hesitate to discuss them with your eye specialist Dr Rajesh Fogla @ Cornea Clinic, Apollo Hospitals, Jubilee Hills, Hyderabad.

 

For appointments –

Call Mr Bhaskar

+91 9866076750 / 8465076750  

Email us @ 

corneaclinic_hyd@apollohospitals.com 

rajeshfogla@gmail.com

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