Refractive Surgery
Refractive Surgery is a surgical procedure performed to correct the refractive state of the eye or spectacle power of the eye.
Some facts about Refractive Surgery:
- Dependency on glasses or contact lenses can be eliminated by Refractive Surgery.
- Various methods of surgical remodeling of the cornea, lens implantation or lens replacement can be included.
- Excimer lasers is the most common method to reshape the curvature of the cornea.
- Common vision disorders such as myopia, hyperopia, presbyopia and astigmatism can be treated with refractive eye surgeries.
- Refractive surgery is a good option for you if you want to decrease your dependence on glasses or contact lenses.
- If you are free of eye disease and are are ready to accept the inherent risks and potential side effects of the procedure, then you can go for the procedure.
- The best option of Refractive Surgery for you can be decided after a thorough examination and discussion with your ophthalmologist.
- Your lifestyle and vision needs should be discussed with your ophthalmologist to determine the most appropriate procedure for you.
- Refractive Surgery is not recommended for people with certain eye diseases involving the cornea or retina and pregnant women.
- Patients who have medical conditions such as diabetes, uncontrolled vascular disease, glaucoma or autoimmune disease are also not suitable for refractive surgery.
- Additional thinning of the cornea because of refractive surgery may contribute to advancement of the disease resulting in the need for a corneal transplant.
Types of Refractive Surgery:
The refractive procedures can be classified as Corneal procedures and Lens based surgery.
Corneal procedures:
Corneal procedures include laser assisted power correction and can be either Photrefractive Keratectomy, Flap Based Procedure or Refractive Lenticule Extraction.
Photrefractive Keratectomy(PRK):
The the top most layer of the cornea also known as epithelium will be removed carefully in this procedure. Excimer laser delivery which reshapes the corneal surface will be done to correct the refractive power of the eye. A contact lens is placed for a few days to support the healing of the eye as the epithelium is very thin and usually takes three days to grows back.
LASIK (Flap Based Procedure):
A flap will be created in the superficial layer of the cornea in two methods.
Microkertome assisted LASIK is also known as BLADE LASIK as a small specialised blade will be used to dissects the flap at the accurate depth.
Femtosecond laser assisted LASIK is also known as FEMTO LASIK in which a specialised laser is used to create a flap precisely at the desired depth. The flap is lifted and the residual bed is then treated with Excimer laser after creating it. The flap is reposited back in place, on the corneal bed at the end of the procedure and patient is discharged with medication.
Refractive Lenticule Extraction:
Only the nly Femtosecond laser will be required in Refractive Lenticule Extraction to create a lenticule within the layers of the cornea. This lenticule can then be extracted either by Femtosecond Lenticule Extraction or Small Incision Lenticule Extraction (SMILE). The shape of the cornea can be altered and the refractive power can be corrected by extraction of this lenticule. It is popularly known as blade-less, flap-less refractive surgery as the surgery does not need Excimer laser, Microkeratome blade or flap.
Lens Based surgeries:
The eye intraocular procedures are involved in Lens Based surgeries to correct the spectacle power. It can be either Implantable Collamer Lens (ICL) or Refractive lens exchange.
Implantable Collamer Lens (ICL):
An artificial implantable contact lens will be placed in front of the natural crystalline lens in the eye during Implantable Collamer Lens (ICL). ICL are very different from disposable contact lenses that are used routinely as these are made of biocompatible material known as collamer.
Refractive lens exchange:
The natural crystalline lens of the eye will be removed and is replaced by an artificial intraocular lens (IOL) of the correct power during Refractive lens exchange.
There is no need of cataract surgery in the future as the natural lens from the eye will be extracted using Ultrasonic energy. It is known as ROBOTIC Refractive Lens Exchange when Femtosecond laser platform is used to assist in refractive lens exchange procedure.
Preparation for Refractive Surgery:
- Special Investigations like corneal topography, Anterior segment Optical Coherence Tomography (ASOCT) will be performed to evaluate the shape, thickness and curvature of the cornea and other dimensions of the eye before refractive surgery.
- A decision regarding the available options of refractive surgery for the patient will be taken after acquiring all the details.
- A review is required for all medications and supplements you are taking as you may need to stop taking certain medications or supplements before or after your Refractive Surgery.
Procedures for Refractive Surgery:
- You will either be given a sedative to help you relax and a local anesthetic to numb your eye, or to put you to sleep on the day of your Refractive Surgery.
- Surgery will be done on one eye at a time.
- The duration of time spent in surgery varies person to person depending on their health condition.
Recovery from Refractive Surgery:
- Eye drops or oral medications will be prescribed immediately after Refractive Surgery and during recovery to help control infection, swelling and pain.
- Eye drops can help prevent cornea rejections by suppressing the immune system.
- Wearing eye protection such as eye shields or glasses will help protect your eye as it heals.
- Avoid rubbing or pressing your eye.
- You need to visit your eye doctor regularly in the year after surgery to monitor your progress and look for complications.
