Refractive (LASIK & Phakic lens) Eye Surgeries, a best alternative for Glasses or Contact lens

If you are having glasses (Refractive Errors) like Nearsightedness (Myopia), Farsightedness (Hypermetropia) and/or Astigmatism (Cylinder power) and Reading glass (Presbyopia), and don’t want to wear them, and are not comfortable with Contact lens, then Refractive (LASIK) eye surgery can help you. Refractive surgical procedures, typically performed by an expert Ophthalmologist (Refractive Surgeon), change the curvature of your cornea by Excimer or Femtosecond laser, to make you independent of Glass or Contact lens. Not everyone is a good candidate for the Refractive surgery, your Ophthalmologist will evaluate your eyes and health, to recommend which of the procedures available may be right for you.

Refractive Eye Surgeries (Laser & Lens) are very popular looking at its safety & success rate.  Dr Alpa Atul Poorabia, Consultant, Refractive, Cornea and Cataract Surgeon, answered various questions related to LASIK surgeries in order to explain the procedure.

Question: What should I do, if I am interested in getting rid of Glasses (Or Contact lens)?

Answer: If someone is interested to become glass free, you need to undergo a suitability test, which is called Corneal Topography which is also known as Pentacam, Orbscan II or 3, Cirrus, Galilei etc. Also, Aberrations on the cornea are measured.  Based on all these, the Refractive Surgeon guides the patient about best procedures for the patient.

If you are wearing contact lens then, at least one week before, you need to stop contact lens and then visit an Expert Refractive Eye Surgeon for suitability test.

Question: IF I am not suitable for surgery, does that mean that my eyes are abnormal and if so, what should I do to improve it?

Answer: If you are not suitable for Laser Refractive Surgery, then your eyes are not abnormal or diseased or problematic, but the Laser Refractive Surgery is not safe for your eyes, as it can lead to some serious sight threatening complication either immediately or in the future. In that case there is a possibility that no further change be feasible, nothing can be done to change it.

Question: If corneal thickness is not good enough or Laser Refractive surgery is not suitable, then which technique is the best?

Answer: Permanent contact lens/Phakic lens is the option available when a patient is not suitable for Laser Refractive Surgery, provided the patient is suitable for that.

Question: Is it a compulsory surgery?

Answer: Refractive Surgery is absolutely not a compulsory surgery but a pure cosmetic surgery for those people who don’t want to wear glasses or contact lens.

Question: What are the various Refractive Surgery options available for those who wants to get rid of glasses or contact lens?

There are two types of Refractive surgeries, Cornea based solutions (Laser Refractive Surgeries), and Lens based solutions (Phakic lens/Permanent contact lens- ICL/IPCL/EYECRYL/Toric lens).

Question: Which are different types of Laser Refractive surgeries (Corneal) or Cornea Based Solutions?

Answer: There are basically three Laser Refractive procedures (Corneal).

• Surface Ablation (PRK, LASEK, EpiLASIK),
• LASIK (Blade/Microkeratome LASIK, Blade free/Femto Lasik),
• ReLEx Procedure (ReLEx FLEx & ReLEx SMILE)

In Laser Refractive procedure (Corneal), ultrathin layers from the cornea are removed by Excimer or Femtosecond Laser, to reshape the Cornea. Cornea has power and reshaping will change the power of the cornea. It is changed in such a way that now cornea will be able to focus rays on the retina without any help of glass or contact lens. Also the patient will be able to see without any glass or contact lens.

Question: How is Surface Ablation done?

Answer: In Surface ablation procedure, first layer of cornea, called Corneal Epithelium is removed, either mechanically (PRK), by applying Alcohol (LASEK) or removed by sharpener (EpiLASIK), or by Excimer Laser (TransPRK) and then ultrathin layers are removed by the Excimer Laser to reshape the cornea. Corneal epithelium which was removed regrows in couple of days.

Question: What is LASIK Surgery and how does LASIK surgery done?

Answer: In LASIK (Laser in-situ Keratomileusis) procedure, Cornea is split/divided either by Microkeratome (Blade LASIK) or by Femtosecond Laser (Blade free or Femto LASIK) with a hinge at one place. After that the upper part/flap is lifted like the page of a book. On the lower exposed corneal stroma, Excimer Laser is applied to reshape the cornea by removing ultrathin layers, after which the flap is repositioned.

Question: What is ReLEx SMILE procedure and how it is done?

Answer: IN ReLEx SMILE procedure, a Refractive corneal lenticule (formed by ultrathin layer from corneal stroma) is created by Femtosecond Laser, separated and removed through small access incision. That’s why it is known as flapless procedure.

Question: What are Lens based Refractive Surgeries?

Answer: Lens based solutions mean Phakic lens/Permanent contact Lens implantation. In this surgery, artificial lens, which has power, is positioned in front of natural lens, inside the eye. It can be Spherical or Toric Phakic lens. E.G.  Staar (ICL, T-ICL), IOCare (IPCL, T-IPCL), Biotech (Eyecryl- Spherical and Toric)

Question: which is the best & safest surgery as there are many surgical options?

Answer: All Refractive surgeries are safe and best, provided the patient is suitable for surgery. But every technique has their own pros and cons. Depending on suitability test, your Refractive Surgeon will discuss options with you, as some patients are suitable for all options and some will have limited options (Surgery) to select.

Question: Will the surgery solves the issue permanently or will my glasses come back?

Answer: It is generally a permanent solution to become glass free or independent of glass in most patients. But age induced changes will be there in future, like reading glasses, cataract etc. Generally speaking, Glasses won’t come back, provided surgery is done with ideal parameters like, the patient is more than 18 years of age and there has been no change for the last two years in refraction/power (means power has stabilized).

Question: What are the side effects of the Refractive Surgery?

Answer: The most common side effect across all Laser Refractive surgeries, is Dry Eyes, which takes a couple of weeks to settle down. Occasionally some minor complains like night time glare, colored haloes around the light. Phakic Lens surgery also has same side effect, like glare/circles and haloes around the light.

Question:  Finally, when will I be able to  lead a normal life after refractive surgery?

Answer: Normally most of the patients are comfortable by 1 week and maximum by 2 weeks. In LASIK and SMILE surgery, next day onwards, and in Surface Ablation after 1 week, patient is allowed to read or work on computer, but comfort slowly comes about a couple of days. Face wash and head bath are allowed, but for 3 weeks, patient should be careful with their eyes.  Driving a vehicle, is generally allowed after 1 week, but night driving should be avoided until one feels comfortable in night light.

For those who do not want to wear glasses or not want to get burdened with contact lenses, then Refractive surgeries are the best option.  As explained above, one is advised to seek advice from an expert Ophthalmologist to get best results.

The article is prepared by Dr. Alpa Atul Poorabia, Consultant, Ophthalmologist, Apollo Spectra Hospitals, Kondapur, Hyderabad.