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Refractive Surgery

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Refractive Surgery: A Comprehensive Guide

Refractive surgery encompasses various procedures aimed at correcting vision by reshaping the cornea, reducing or eliminating the dependence on glasses or contact lenses. Common refractive errors that can be corrected include myopia (nearsightedness), hyperopia (farsightedness), astigmatism, and presbyopia.

These surgeries use advanced laser or micro-surgical techniques to reshape the cornea, improving how light is focused on the retina. Understanding the indications, different procedures available, possible risks, and what to expect can help potential candidates make an informed decision.

Indications for Refractive Surgery

Candidates for refractive surgery typically include individuals who:

  • Have stable vision for at least a year
  • Are over 18 years old (in some cases, 21 years is preferred)
  • Have moderate to high refractive errors that can be corrected with surgery
  • Have corneal thickness and shape suitable for the selected procedure
  • Are free from significant eye diseases such as keratoconus, severe dry eye, glaucoma, or cataracts
  • Do not have autoimmune diseases that could affect healing (e.g., lupus, rheumatoid arthritis)
  • Are not pregnant or nursing, as hormonal changes can temporarily alter vision
  • Have realistic expectations regarding the outcomes, including the possibility of needing enhancement procedures

Preoperative Preparation

Proper preparation before refractive surgery is essential to ensure the best possible outcomes and minimize complications. The following steps are typically recommended:

  • Comprehensive Eye Examination: A detailed assessment by an ophthalmologist will evaluate corneal thickness, refractive error, pupil size, tear production, and overall eye health.
  • Discontinue Contact Lens Use: Contact lenses alter the cornea's shape, so patients are advised to stop wearing them before surgery—2 weeks for soft lenses and 4 weeks for rigid gas permeable (RGP) lenses.
  • Discuss Medical History: Patients should inform their doctor of any medical conditions, medications, or allergies that may impact healing.
  • Avoid Eye Makeup and Creams: To reduce the risk of infection, patients should avoid eye makeup, creams, and lotions around the eyes for at least 24–48 hours before surgery.
  • Hydration and Rest: Staying well-hydrated and getting adequate rest can help the eyes recover more efficiently.
  • Arrange Transportation: Since vision will be blurry immediately after surgery, patients should arrange for someone to drive them home.
  • Follow Pre-Surgery Instructions: Some patients may be prescribed antibiotic or lubricating eye drops before surgery to prevent infections and maintain ocular surface health.

Options for Refractive Surgery

There are several types of refractive surgery, with the most common being TransPRK, Femto LASIK, and SMILE. Each technique has its unique advantages and considerations, and the choice depends on factors such as corneal thickness, lifestyle, and specific vision correction needs.

1. TransPRK (Transepithelial Photorefractive Keratectomy)

  • Procedure: TransPRK is an advanced form of PRK where the excimer laser removes the epithelium (outermost corneal layer) and then reshapes the underlying cornea in a single step. Unlike traditional PRK, no mechanical tools or alcohol solutions are used.
  • Advantages:
  • No flap creation, reducing the risk of flap-related complications such as displacement or wrinkles
  • Suitable for patients with thinner corneas who are not eligible for LASIK
  • Reduced biomechanical weakening of the cornea compared to LASIK
  • Economical
  • Disadvantages:
  • Longer recovery time (vision may take a few weeks to stabilize)
  • More discomfort and sensitivity in the first few days
  • Requires prolonged use of medicated eye drops to aid healing
  • Cannot be done for higher powers
  • Ideal for: Low to moderate myopes, Athletes, military personnel, and individuals at higher risk of eye trauma, as there is no risk of flap dislocation.

2. Femto LASIK (Femtosecond Laser-Assisted In Situ Keratomileusis)

  • Procedure: This two-step procedure involves creating a thin corneal flap using a femtosecond laser, then using an excimer laser to reshape the underlying cornea. The flap is then repositioned without the need for stitches.
  • Advantages:
  • Quick recovery with most patients experiencing significant vision improvement within 24–48 hours
  • Minimal post-operative discomfort compared to PRK
  • High precision and customizable treatment options
  • Disadvantages:
  • Risk of flap complications (e.g., displacement, epithelial ingrowth, or wrinkling)
  • Higher likelihood of post-surgical dry eyes compared to SMILE or PRK
  • Not suitable for individuals with thin corneas or those at risk of corneal trauma
  • Ideal for: Individuals with moderate to high refractive errors, provided they have sufficient corneal thickness.

3. SMILE (Small Incision Lenticule Extraction)

  • Procedure: A femtosecond laser creates a thin lenticule (disc-shaped piece of tissue) within the cornea, which is removed through a small incision, reshaping the cornea without the need for a flap.
  • Advantages:
  • Flapless and minimally invasive, reducing the risk of dry eyes and flap-related complications
  • Faster healing with less discomfort compared to PRK
  • Maintains better corneal biomechanics, making it suitable for patients with higher prescriptions
  • Disadvantages:
  • Limited treatment range (less effective for high hyperopia, High Astigmatism or very low refractive errors)
  • More expensive
  • Enhancement procedures, if needed, can be more challenging
  • Ideal for: Patients with myopia and astigmatism seeking a minimally invasive option with quicker recovery and fewer risks of dry eye.

Postoperative Care and Instructions

Following refractive surgery, adherence to post-operative care is crucial for optimal healing and vision outcomes. Key instructions include:

  • Use Prescribed Eye Drops: Antibiotic and anti-inflammatory drops help prevent infection and reduce inflammation.
  • Avoid Rubbing or Touching Eyes: This is especially important after LASIK to prevent flap displacement.
  • Wear Protective Eyewear: Sunglasses help reduce light sensitivity, and protective goggles may be required during sleep.
  • Limit Screen Time: Reducing screen exposure minimizes strain and dryness in the first few days.
  • Avoid Water Exposure: No swimming, hot tubs, or direct water contact (including shower water) for at least 1–2 weeks.
  • Avoid Makeup and Eye Creams: These can introduce bacteria and irritants during the healing period.
  • Follow Activity Restrictions: Avoid strenuous activities and contact sports for at least a month.
  • Attend Follow-up Appointments: Regular check-ups ensure proper healing and early detection of any complications.

Conclusion

Refractive surgery offers a life-changing opportunity for vision correction. Understanding the different options—TransPRK, Femto LASIK, and SMILE—and their risks and benefits helps individuals make an informed choice. Consulting with an experienced ophthalmologist is crucial to selecting the best procedure based on eye health, lifestyle, and personal needs. With proper preoperative evaluation and postoperative care, most patients achieve excellent visual outcomes and long-term satisfaction.

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