Refractive Laser Surgery

internal image of eye showing beam of light going through to the retina

What is Refractive Laser Surgery?

Refractive laser surgery is a surgical procedure performed to correct refractive errors and improve vision. The main objective of the refractive laser surgery is to eliminate or reduce the need for contact lenses or eyeglasses.

Refractive errors are common vision problems in which your eyes are not able to focus clearly on an object. It occurs when light rays from an object do not focus correctly on the retina (light-sensitive inner back layer of the eye). Blurred vision is the most common symptom of refractive error, while impairment of vision may occur in severe cases. You may also experience other symptoms such as headache, squinting, double vision, or eye strain.

Types of Refractive Errors

Refractive errors are classified as follows:

  • Myopia or nearsightedness: Light rays are focused in front of the retina, thereby causing distant objects to appear blurred.
  • Hyperopia or farsightedness: Light rays are focused behind the retina and cause nearby objects to appear blurred.
  • Astigmatism: Irregularly curved cornea (dome-shaped front part of the eye) causes light rays to get distorted, affecting distant and near vision.
  • Presbyopia: Age-related difficulty in focusing on objects at arm’s distance.

Who is a Good Candidate for Refractive Laser Surgery?

Refractive laser surgery is not a good option for everyone. To qualify for laser eye surgery, you should meet the below-mentioned qualifications:

  • You should be at least 18 years old.
  • You should have had stable vision for at least 1 year.
  • You should have had the same contact lenses and eyeglasses prescription for the last 2 to 3 years.
  • You should not be pregnant or nursing.
  • You should not have a history of active corneal disease.
  • You should not be diabetic or have glaucoma or other eye conditions.

Preparation for Refractive Laser Surgery

Most refractive laser surgeries are performed on an outpatient basis and take less than an hour, so you will not require an overnight stay in the hospital and can go home the same day. In general, the preparation for surgery involves the following:

  • A complete eye exam is performed prior to scheduling surgery.
  • Do not apply eye makeup for at least 2 days prior to surgery.
  • If you are using contact lenses, do not insert them before surgery.
  • A general health assessment is reviewed to check for any active health conditions.
  • A review of all the medications and supplements you may be taking is discussed.
  • You should arrange for an escort as you will not able to drive home yourself post surgery.
  • A written consent will be obtained from you after the surgical process has been explained in detail.

Procedure and Types of Refractive Laser Surgeries

Refractive errors can be treated with various types of refractive laser eye surgeries. In general, all vision correction surgeries involve reshaping the cornea with the help of anaesthetic eye drops to numb the eyes and a speculum to keep the eye open. Some may require the replacement of the natural lens of the eye. Based on your eye examination, your eye doctor may recommend any of the following surgeries to improve your vision: 

LASIK (Bladeless) 
Laser-assisted in-situ keratomileusis is a laser surgery useful in correcting vision abnormalities such as nearsightedness, farsightedness, and/or astigmatism. During a LASIK surgery, a flap is made in the outer layer of the cornea. This flap provides access to the underlying tissue of the cornea, which is reshaped in order to make the cornea focus light onto the retina. The flap can be made using a blade or a laser beam. Bladeless LASIK has been associated with faster recovery. 

PRK 
Photorefractive keratectomy (PRK) is a laser surgery useful in correcting mild-to-moderate nearsightedness, farsightedness, and/or astigmatism. During PRK surgery, an excimer laser is passed over the corneal surface to reshape the cornea. Wavefront Technology may be used with PRK.

LTK
LTK (laser thermal keratoplasty) is a technique for reshaping your cornea to assist you to see better without corrective lenses or glasses. This is a procedure that utilises a holmium laser to gently heat certain areas of the cornea in order to shrink the outer part of the cornea to make the central cornea steeper.

Bioptics 
Bioptics is a combination of two techniques, LASIK and lens implantation, which are used to correct extreme refractive errors. Your doctor may suggest bioptics if you have farsightedness greater than +4 dpt or nearsightedness greater than -8 dpt. The first procedure involves creating a corneal flap and implantation of a lens in addition to your own lens. The second procedure of LASIK is performed around 6 weeks to 3 months after lens implantation. The flap created is lifted and laser is used to make fine corrections to the refractive error.

Postoperative Care and Instructions for Refractive Laser Surgery

Postoperative care and instructions will include the following:

  • You should wear an eye shield for several nights to protect your eyes from rubbing.
  • Anti-inflammatory and antibiotic eye drops are prescribed to minimise the risk of infection, dry eye, or inflammation.
  • You must avoid dusty environments or wearing eye makeup for at least a week.
  • Contact sports, bathtubs, and swimming should be avoided for at least a week.
  • Call your doctor immediately if you experience pain, discharge, or redness in the eye or any other problems.
  • Strictly adhere to the scheduled follow-up appointments to monitor your progress.

Risks and Complications of Refractive Laser Surgery

Refractive laser  eye surgery is a relatively safe procedure; however, as with any surgery, there are risks and complications that could occur, such as:

  • Infection
  • Dry eyes
  • Blurred vision
  • Eye sensitivity
  • Corneal scarring
  • Excessive corneal thinning
  • Overcorrection or undercorrection
internal image of eye showing beam of light going through to the retina
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