Refractive Surgery :Treatment, Procedure, Cost And Side Effects

There are vision problems which cannot be completely cured but rather improved using medical technologies. Refractive surgery helps in fixing vision problems through a series of laser treatments. Refractive eye surgery is a special type of eye surgery which is used to improve the refractive state of the patient eye and thus decrease or eliminate the dependency of the patient on the glasses or contact lenses. It is through this surgery the eye related vision problems are cured. Refractive surgery can include various methods like surgical remodeling of the cornea, lens implantation or lens replacement surgery etc. The refractive surgery thus helps in curing nearsightedness, farsightedness, astigmatism and presbyopia problems of the eye. Among the various types of refractive surgery LASIK surgery is the most popular one which is done through laser. Some of the available refractive surgeries are as follows:

1. LASIK Surgery: LASIK surgery is one the main type of refractive surgery. A surgery which is used to correct farsightedness, nearsightedness, and astigmatism. The working procedure is called in-situ keratomileusis, which aids in eye focus by reshaping the tissues below the cornea. This is done with the help of laser technology.
2. PRK: This is known as photorefractive keratectomy. It is very much similar to LASIK but it affects only the cornea surfaces.
3. Epi-LASEK: This is similar to LASIK, in which the surgeon uses an alcohol solution in the reshaping by separating the issue from the cornea.
4. LASEK: This is known as laser epithelial keratomileusis. The healing process is aided by contact lens and alcohol solution to separate layers of tissues.
5. Epi-LASIK: contact lens alone is used in the healing process for protection
6. PRELEX: this is known as presbyopic lens exchange. When the lens in our eyes loses flexibility, it is supported by a multifocal lens. It is also known by the name refractive lens exchange. Common people know it well by cataract surgery. A new lens, plastic or silicone replaces the eyes lens which is removed by cutting the edges of the cornea. It is used to support people having nearsightedness or farsightedness. Cataract surgeries are often combined with LASEK or LASIK surgeries.
7. AK: This is known as astigmatic keratotomy, abbreviated as AK. There are no laser techniques involved in this procedure. It is just a surgical reshaping through small incisions in the eye.
8. Phakic intraocular lens implants: The doctor makes incisions to place the new lens in your eye without removing your original lens. This is similar to PREFLEX and is useful for people having nearsightedness and farsightedness.
9. Intacs: This procedure also doesn’t involve any lasers, known as intracorneal ring segments (ICR) which will help to focus the eye. This is used for the treatment of nearsightedness. This is more beneficial to treat keratoconus, which is a condition in which cornea is shaped poorly and creates vision-related problems.

It is through various types of refractive surgeries the eye related vision problems are cured. The surgeries in detail are as follows:

1. In LASIK, a flap is made in the outer layer to get into reach of the underneath tissue. In the next step, a laser is used to reshape the underneath tissue of your cornea so that it can focus properly towards a light. The feature which makes LASIK different from others is the flap. Wavefront technology, a computer imaging technique is used to obtain a detailed picture of your cornea which can be used as the guide for the procedure.
2. Photorefractive keratectomy (PRK): It takes 10-15 minutes to treat both eyes in this treatment. The procedure is carried out under local anesthesia. The cornea surface cells are removed and reshaping of the cornea is done using the laser. At the end of surgery, a contact lens is placed to aid the healing process and reduce irritation. Computer imaging is used in this process.
3. Refractive Lens Exchange (RLE): At the edge of the cornea, a small cut is made to remove the natural lens. It is then replaced using a plastic lens implant. It is beneficial if your cornea is thin and you have dry eyes.
4. PRELEX, short for presbyopic lens exchange, is a procedure used for presbyopia, or loss of flexibility in your eye. The doctor removes your lens and replaces it with a multifocal lens.
5. Astigmatic Keratotomy (AK): More than one incisions are made by identifying the steepest part of the cornea. These incisions help the cornea to relax and brings a rounded shape which can help in reducing astigmatism.
6. Intacs: Small incisions are made in cornea and two crescent-shaped plastic rings at an outer edge. The cornea is flattened by the rings and the way the light rays get focused changed. This can treat nearsightedness, now these are replaced by laser techniques. This can fix keratoconus, a condition of the irregular shaped cornea which can cause the loss in vision and thinning of the cornea.

Following is the eligibility criteria for the refractive surgeries

1. He/she should be above 18 years of age
2. He/she should have contact lens prescription and stable eyeglass for more than 2 years
3. The vision should have remained stable over the past year
4. There should not be any history or findings of active corneal disease.
5. There should not be any medical eye problems like corneal ulcers, progressive thinning of the cornea, diabetic retinopathy, macular degeneration or glaucoma.
6. She should not be nursing or pregnant

Following are not eligible for the refractive surgery treatment:

1. Those who are at the age of 40 or above are prone to presbyopia. This is a part of aging. Gradually a difficulty grows to read close items and small sized letters. Refractive surgery may not be as effective over the age of 40.
2. Those who have high refractive errors. LASIK or other techniques may not be effective for those are having above average level of myopia or hyperopia. The above average levels are between -8 and -20 diopters. Implantable contact lens would be more suitable than refractive surgery.
3. Usually, eye disorders and other autoimmune disorders such as medical history of keratoconus in a family may not get successful results with laser surgery. People with diabetes may or may not be suitable depending on their health situation. They have to consult an ophthalmologist and get a confirmation for laser surgery.
4. Problems under the age of 20 keep on changing and are quite normal. If the prescription undergoes a change for 12 months before surgery, then they may not get expected results.
5. Persons who are having a clot in arteries and thus require heart treatment or are under blood thinners are not eligible for the treatment unless the doctor recommends them.

The possible side effects of the refractive surgery are as follows:

1. There are chances of reduced tear production which can cause dry eyes. This can reduce the quality of vision.
2. It might be difficult to see at night. Glares, halos, and double vision might be noticed. The ability to see things in dim light gets reduced after the surgery.
3. There are chances of under corrections and over corrections.
4. Uneven removal of tissues during the surgery can cause astigmatism.

In case the condition worsens it is advised to consult the doctor immediately.

Some of the post-treatment guidelines after refractive surgery are as follows:

1. Don’t wash your hair or take a shower for two days from the surgery
2. For the first few days, avoid non-sterile water for hair washing. It may get into your eyes
3. Keep soap out of reach for the eye when you are washing your hair.
4. Make sure that you don’t rub your eyes for a month
5. It is advisable not to drive until you are comfortable.
6. Wear the goggles or eyelids given by the doctor while sleeping for the first 10 days.
7. Make sure that tap water doesn’t get into your eyes for a week.
8. Avoid visiting lakes, pools for a month.
9. It is recommended to avoid eye make up for a month to prevent infection.
10. Don’t get your hair colored for at least a week.
11. Don’t exercise for at least three days.
12. When you start your exercise and sports activities, make sure that you wear eye protection.
13. Dark sunglasses would be helpful as your eyes will be sensitive towards sunlight for a while.
14. Stay away from dust and polluted environment for 10 days.
15. Wear sunglasses for a year as bright sunshine can cause scarring and irritation.

Eyes start to heal immediately after the surgery. One may start having improved vision within 24 hours post surgery. However, the entire recovery process continues for a longer period of time. A patient who has undergone Refractive surgeries generally takes 6-8 weeks to get back to a normal routine.

The price of the Refractive surgeries varies from place to place. It depends upon the quality of the lens you choose and the place where you are opting the surgery. On an average, it can cost you around Rs 20,000 to Rs 30,000 to get the procedure done.

The results of the Refractive surgeries can be considered as semi-permanent.

Refractive lens exchange and intraocular lens implants are the alternatives for the surgery. Else you can wear glasses to cope up with the vision-related problems.