Refractive surgery refers to a group of procedures which are designed to improve or correct vision
for patients who are glasses dependent. Those patients may be short sighted for example or
long sighted or they may have astigmatism, which is where the shape of the front of the
eye of the cornea is a little irregular in such a way that they need some correction
in their glasses to improve the vision. It also incorporates group of patients who may
find that they’re getting blurred vision as they get older from ear work
so they start to need reading glasses. Refractive surgery is generally regarded as
being something where you operate on the cornea and most people have heard of LASIK, for example,
which is very commonly performed for patients who are younger and want to get rid of their
glassed for distance. LASIK is one procedure of a great many and
in fact, refractive procedures can involve not just surgery to the cornea but inside
the eye and in recent years, the advance of technology such as intraocular lenses that
allow those different degrees of focus, have come on the scene and really expanded the
range of options available to those sorts of patients. But for younger patients who
may have very high glasses prescriptions, there are other options where one might for
example put a lens inside the eye in addition to their natural lens so that they maintain
accommodation and the ability to focus the near and distance.
There’s no perfect solution to a refractive problem, but by choosing the patient carefully
and ensuring they are properly counselled and that any problems are managed effectively,
one can make sure that most goals are met and the patient achieves the aim of being
as glasses independent as possible. Laser eye surgery involves reshaping the cornea.
The cornea is the clear window at the front of the eye that does actually most of the
focusing power of the eye. For younger patients who are maybe short-sighted or longsighted,
laser eye surgery is used to reshape the cornea and refocus the light at the back of the eye.
That’s being done for a number of years now and is generally a very safe procedure
and very effective for that category of patients. It’s also used in older patients, but the
downside is that as we get older, the eye changes. So the ability to focus for near
diminishes in our forties and fifties. Laser eye surgery that has been conductive when
you were younger doesn't necessarily provide that near vision that you need when you’re
older. The alternative is to either reshape the cornea,
to refocus the light for near for one eye or it may involve going inside the eye to
remove the lens that is no longer able to provide that near vision for you and replacing
it with a clear plastic lens that maybe we'll give you a degree of what we call multi-focality.
That means that the lens will provide you with some distance vision, some intermediate
vision for maybe looking at your computer and maybe some near vision so that you can
read without your glasses. Of course, going inside the eye does involve a degree of risk
but with modern cataract surgery techniques and an experienced surgeon, the risks to the
eye are extremely low. In short, laser eye surgery can be used at
any age, but generally is more effective and simpler to perform in patients who are younger
where the results of surgery are such that they will still retain this ability to accommodate
for near that is lost as we get older. And as we get older, maybe it's better to move
to a procedure where we can remove the lens that is no longer able to provide that near
vision and replace it with the lens that will give you degree of flexibility in terms of achieving
glasses independence. So every eye is different and every patient
is different. Their needs are different. With the huge array of options available to patients,
now, it’s no wonder that the business of trying to choose a solution for you is often
very fraught and confusing. I often suggest that you find a surgeon that you trust and
that you're happy with and that has the experience to manage and guide you through the process
of coming to a solution to your eye problem. They also need a skill set that permits them
to handle any complications that might occur as a result of the surgery because most complications
if they’re handled effectively and corrected correctly can result in a good outcome.
For laser eye surgery, there are a number of options available. These include slightly
older procedures where we just remove the top layer of the cornea which is called the
epithelium and then resculpt the cornea with the laser and then apply contact lens whilst
the surface heals over in 7 to 14 days. In the last 10 to 20 years, a procedure called
LASIK has come along which allows us to create a flap in the front of the cornea which is
then lifted and then the laser is then applied to the cornea to reshape it and that flap
is then replaced. The advantage of that is that it permits a more rapid recovery of vision
and the patient is more comfortable in the immediate few days after procedure.
In recent years, another procedure has come along called SMILE which involves removing
tissue from within the body of the cornea to reshape the cornea. That is thought to
have said advantages in terms of retaining some strength in the cornea and also combining
that with a more rapid recovery of vision. Overall, there are a number of techniques
available to a refractive surgeon to reduce patients’ dependence on glasses and they
have varying degrees of risk attached to them and severity of risk. But overall, the risk
is very low with modern techniques and an experienced surgeon.