Refractive Surgery

These new exciting technologies offer real alternatives for people who are dependent on glasses or contact lenses. As opposed to “patching the vision problem” these techniques actually “fix” the vision problem.

There are several approaches to restoring the focus of light onto the retina. Most procedures involve either flattening or steepening the cornea. This area of eye care is not that new (it has been around for over 20 years) and is not experimental (results are predictable and consistent). Millions of eyes have been corrected and freed of the need of glasses and there has not been one “blinded eye! The oldest technique was found by accident. Hard contact lens wearers found they could still “see” after they removed their lenses. The results were temporary but if this could happen by accident what would happen if we tried to permanently alter the shape of the cornea. A new field called “orthokeratology” was developed whereby contact lenses were purposely fitted to alter the cornea.

Shortly after this a surgical technique called “Radial Keratology” was developed to accomplish the same thing. This was more widely accepted because it offered instantaneous results. However, the procedure proved to be unstable in that many patients needed to return to glasses approximately 10 years afterwards. The eximer laser was approved in the USA in October of 1996. To date millions of procedures have been performed in the USA. The eximer however, has been in use worldwide for eleven years. Long-term results are excellent and unlike its surgical predecessor are stable. The original technique with the eximer laser was called PRK and the current more popular techniques are called LASIK. The difference between the two techniques is simply whether the cornea is sculpted on the top or in the middle.

The outcomes of both are excellent and almost all studies show over 90% of the patients seeing 20/25 or better. The advantage of the “middle procedure” is that, for most patients, the vision stabilizes within 12 hours and is absolutely pain free while the top method takes several days to stabilize and is uncomfortable during that “recovery time”. In order to perform this middle or LASIK procedure a piece of equipment, a microkeratome, is used to create a corneal flap. The flap is then moved and the eximer laser is turned on. After the laser is finished (average time is 30 seconds) the flap is placed back into its original position. Another technique for flattening the cornea is Kertac corneal rings. These plastic semi circles are implanted into the peripheral cornea. These rings currently have a very limited range and are not widely used.

Clear lens extraction or “cataract surgery” has been used for many years. It is very invasive but safe. An implant is selected to replace the normal crystalline lens of the eye, which will correct the patient’s vision. This technique is generally used on our elderly population and those patients with extremely high corrections. Another new technology is the implantable contact lens. A contact lens similar to regular contacts is placed inside the eye as opposed to placing the contact lens on the cornea. This is still being developed and I have no experience with this yet. Speaking of contact lenses, new materials are on the immediate horizon that will enable the patient to sleep with the lenses for 30 days at a time. These lenses are inexpensive and in clinical testing, are well tolerated.

I have included some links for anyone interested in learning more about these exciting techniques or please feel free to e-mail or call the office for more information or to discuss any questions that you may have.

http://www.lzr.com  

http://visx.com/