Refractive surgery is any procedure that changes the focusing power of the eye in order to reduce the need for glasses or contacts. The cornea is the clear part of the front of the eye and is responsible for two-thirds of the focusing power needed to see clearly. As technology has advanced, the number of options available to patients to reduce their dependence on glasses and contacts has increased.
Corneal refractive surgery
Refractive surgery is either corneal or lens-based. Corneal procedures are performed with a laser and are divided into flapless procedures and flap procedures.
Surface ablation is the original flapless surgery. It involves the removal of surface epithelial cells, followed by laser removal of a very specific amount of corneal tissue in a predetermined pattern. Due to the removal of the surface cells, which act as a protective layer for the eye, this procedure is slightly more uncomfortable and has a slower recovery period than other laser procedures.
The next advancement in laser refractive surgery came with the creation of a flap by the laser. Once the flap has been created, the surgeon carefully lifts the flap and performs the ablation or tissue removal within the corneal tissue itself. This reduces the amount of haze that can develop with surface ablation. Since the flap gives access to the tissue, the surface cells don’t have to be removed allowing quicker recovery and less discomfort.
The newest advancement involves a flapless laser procedure where the laser precisely sculpts a disc of tissue within the cornea that is then freed and removed from the surrounding tissue by the surgeon. This technique is performed deeper within the corneal tissue, which provides more stability compared with flap surgery. The incision is about 75% smaller, which means that fewer nerves are impacted by the laser – allowing for a quicker recovery period and less dryness.
Lens-based refractive surgery
Laser procedures are not for everyone, which is when a lens-based surgery becomes the best option. Sometimes the cornea is too thin or the eyeglass prescription is too large, and tissue removal might result in an unstable cornea and poor vision. In these cases, there are two options: a custom lens or a refractive lens exchange.
A custom lens can be made based off the patient’s prescription and placed into the eye. This lens sits between the iris, colored part of the eye, and the lens. Unlike laser surgeries, this procedure doesn’t permanently change the eye and can be removed at any time. This option, however, will not correct presbyopia, which is a challenge with near vision that normally begins to present in an individual’s early forties. As long as the patient doesn’t mind using reading glasses, this implantable lens can be used in patients up to forty-five.
The second lens-based surgery is a refractive lens exchange. This procedure is designed for patients who struggle with near vision and are not candidates for any of the previous surgeries. The lens of the eye is replaced with an artificial lens before cataracts begin to develop. The most common lens exchanges involve multifocal lenses that give the patient an extended range of vision encompassing distant, intermediate, and near vision. Once the lens has been exchanged, patients can expect great vision for the rest of their life on condition that no other eye diseases or unforeseen trauma occur.
Understand your options
At your refractive surgery evaluation, your surgeon and their associates will evaluate your eye health and discuss the options that will give you the best outcome for your eyes. Several refractive solutions exist outside of LASIK, so consult with a professional who is aware of the latest advancements in refractive technology. Your vision is too important to settle for a solution that might not be specifically designed to meet the needs of your individual eyes!
