Refractive Surgery For Vision Correction - Types Of Procedures And Risks
Albany (NY): Refractive eye surgery is any eye surgery used to improve the refractive
state of the eye and decrease or eliminate dependency on glasses or contact lenses. This can include various methods of surgical remodeling of the cornea or cataract surgery. The most common methods today use excimer lasers to reshape curvature of the cornea. There is a risk of infection, pain, night glare problems with all laser refractive surgery.
Lasik & Excimer Laser Surgery: LASIK (Laser-Assisted In Situ Keratomileusis) involves the creation of a corneal flap that can be created with a blade or a laser. LASIK is one of the most frequently performed healthcare procedures in North America. It can correct myopia, hyperopia and astigmatism.
Procedure includes numbing your eyes with drops and using a tool to hold your eyes open and keep them from blinking. When you are ready, the doctor will perform your LASIK eye surgery. The doctor will use a device to create a flap in your cornea. Then the doctor will ask you to look at a light to keep your eyes fixed as the laser reshapes your corneal tissue. The corneal flap will then be replaced over your eye to adhere. You should not feel any pain, but you will feel uncomfortable pressure from the eyelid holder. It takes about five or ten minutes to operate on each eye. Serious complication of laser vision correction is Corneal Ectasia (or keratectasia). This is a serious side effect that occurs when your cornea becomes steeper and begins to bulge after surgery.
Phakic IOL: Phakic Intraocular Lenses (IOLs) are lenses that can be surgically placed inside the eye; they resemble the IOLs that are implanted during cataract surgery, but differ from traditional IOLs because they dont replace the original lens in the eye. Phakic IOLs are currently being used to correct for nearsightedness in cases where the cornea is very thin or the nearsightedness is moderate to severe. Phakic IOL Options are:
1.The Verisyse phakic IOL is a plastic lens implanted between the cornea and the iris. The surgeon inserts the lens through a small incision and clips the new lens to the iris.
2.The Visian Implantable Collamer Lens (ICL) is a lens made in part from collagen, which is biocompatible, and then implanted behind the iris. The lens unfolds itself after its inserted, and the incision is so small that it doesnt need sutures.
Clear Lens Extraction & Replacement: Clear lens extraction is essentially premature cataract surgery. The clear natural lens of the eye is removed and a man-made implant of a better power is placed within the eye. Risks are similar to those with cataract surgery. Many lens implant options are available. Clear lens extraction is typically considered cosmetic and is not covered by insurance.
Standard Lens Replacement: A standard intraocular lens, or IOL, is a monofocal lens. A monofocal lens can focus light rays at distance or near but not both. Typically vision is optimized for distance and reading glasses are necessary for near tasks. This is the first kind of lens that was developed, which means it has the longest and best-documented history of all the lenses.
Toric Intraocular Lens: Toric IOLs can correct astigmatism if it is present. Astigmatism can be caused by the shape of the cornea or the shape of the lens. These monofocal lenses are used to improve the quality of distance vision and reduce dependency on glasses for distance only.
Mutifocal Intraocular Lens: A multifocal IOL has different zones within the lens that allow you to focus on objects that are near or far away. This type of lens is used to reduce dependence on glasses at BOTH distance and near.
Accommodation Intraocular Lens: An accommodating IOL can actually shift position, in much the same way the original lens does. This type of lens is used to reduce dependence on glasses at BOTH distance and near.
Crystalens is an accommodating intraocular lens that, unlike a standard IOL, can treat both a person's cataracts and presbyopialoss of near and intermediate vision. With this lens the induction of glare or halo is less common however there may be more dependence on reading glasses for near activities. Crystalens uses the eye muscle to flex and accommodate in order to focus on objects in the environment at all distances. Crystalens dynamically adjusts to your visual needs.
Conductive Keratoplasty: Conductive Keratoplasty (CK) is a method for improving farsightedness. CK utilizes radio-frequency waves to steepen the cornea. A tiny probe is used to place 8 to 32 spots in a concentric ring pattern on the peripheral cornea. The heat from the wave shrinks your eyes collagen fibers in each spot touched by the probe, and the fibers pull the cornea into a new shape. It is fast (about three minutes per eye) and has a quick recovery time. You can probably go back to work the next day.
You should understand that your eyes are going to continue to change as you age and the effects of the CK treatment are not permanent in many cases. You will probably still need to have reading glasses eventually, but it will be postponed.
Astigmatic Keratotomy / Limbal Relaxing Incision: Astigmatic Keratotomy (AK) and Limbal Relaxing Incision (LRI) are procedures in which partial thickness incisions are made in the peripheral cornea to relax astigmatism. They are most commonly used in conjunction with multifocal and accommodating IOLs to reduce coexisting astigmatism. This procedure is done at the same time as the lens implant surgery.
by: Dr. Robert L. Schultze
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