Refractive surgery refers to a group of procedures
which are designed to improve or correct vision for patients who are glasses dependent. Those
patients may be short sighted for example or long sighted or they may have astigmatism,
which is where the shape of the front of the eye of the cornea is a little irregular in
such a way that they need some correction in their glasses to improve the vision. It
also incorporates group of patients who may find that they’re getting blurred vision
as they get older from ear work so they start to need reading glasses.
Refractive surgery is generally regarded as being something where you operate on the cornea
and most people have heard of LASIK, for example, which is very commonly performed for patients
who are younger and want to get rid of their glassed for distance.
LASIK is one procedure of a great many and in fact, refractive procedures can involve
not just surgery to the cornea but inside the eye and in recent years, the advance of
technology such as intraocular lenses that allow those different degrees of focus, have
come on the scene and really expanded the range of options available to those sorts
of patients. But for younger patients who may have very high glasses prescriptions,
there are other options where one might for example put a lens inside the eye in addition
to their natural lens so that they maintain accommodation and the ability to focus the
near and distance. There’s no perfect solution to a refractive
problem, but by choosing the patient carefully and ensuring they are properly counselled
and that any problems are managed effectively, one can make sure that most goals are met
and the patient achieves the aim of being as glasses independent as possible.
Laser eye surgery involves reshaping the cornea. The cornea is the clear window at the front
of the eye that does actually most of the focusing power of the eye. For younger patients
who are maybe short-sighted or longsighted, laser eye surgery is used to reshape the cornea
and refocus the light at the back of the eye. That’s being done for a number of years
now and is generally a very safe procedure and very effective for that category of patients.
It’s also used in older patients, but the downside is that as we get older, the eye
changes. So the ability to focus for near diminishes in our forties and fifties. Laser
eye surgery that has been conductive when you were younger doesn’t necessarily provide
that near vision that you need when you’re older.
The alternative is to either reshape the cornea, to refocus the light for near for one eye
or it may involve going inside the eye to remove the lens that is no longer able to
provide that near vision for you and replacing it with a clear plastic lens that maybe we’ll
give you a degree of what we call multi-focality. That means that the lens will provide you
with some distance vision, some intermediate vision for maybe looking at your computer
and maybe some near vision so that you can read without your glasses. Of course, going
inside the eye does involve a degree of risk but with modern cataract surgery techniques
and an experienced surgeon, the risks to the eye are extremely low.
In short, laser eye surgery can be used at any age, but generally is more effective and
simpler to perform in patients who are younger where the results of surgery are such that
they will still retain this ability to accommodate for near that is lost as we get older. And
as we get older, maybe it’s better to move to a procedure where we can remove the lens
that is no longer able to provide that near vision and replace it with the lens that will give
you degree of flexibility in terms of achieving glasses independence.
So every eye is different and every patient is different. Their needs are different. With
the huge array of options available to patients, now, it’s no wonder that the business of
trying to choose a solution for you is often very fraught and confusing. I often suggest
that you find a surgeon that you trust and that you’re happy with and that has the experience
to manage and guide you through the process of coming to a solution to your eye problem.
They also need a skill set that permits them to handle any complications that might occur
as a result of the surgery because most complications if they’re handled effectively and corrected
correctly can result in a good outcome. For laser eye surgery, there are a number
of options available. These include slightly older procedures where we just remove the
top layer of the cornea which is called the epithelium and then resculpt the cornea with
the laser and then apply contact lens whilst the surface heals over in 7 to 14 days. In
the last 10 to 20 years, a procedure called LASIK has come along which allows us to create
a flap in the front of the cornea which is then lifted and then the laser is then applied
to the cornea to reshape it and that flap is then replaced. The advantage of that is
that it permits a more rapid recovery of vision and the patient is more comfortable in the
immediate few days after procedure. In recent years, another procedure has come
along called SMILE which involves removing tissue from within the body of the cornea
to reshape the cornea. That is thought to have said advantages in terms of retaining
some strength in the cornea and also combining that with a more rapid recovery of vision.
Overall, there are a number of techniques available to a refractive surgeon to reduce
patients’ dependence on glasses and they have varying degrees of risk attached to them
and severity of risk. But overall, the risk is very low with modern techniques and an experienced surgeon.