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Refractive surgery to get rid of one’s spectacle power, has gained much popularity and acceptance in the recent past. This is foremost on account of technological advancements in this field that promise better safety, better accuracy and faster recovery. Refractive surgery is now a certified super speciality with fellowship courses that are available to train ophthalmologists to hone their skills in this field at top institutes.

Corneal Laser procedures are surface procedures, not intraocular surgeries; hence, the associated risks and complications are fewer. They essentially involve re-shaping the cornea by removing tissue from it with a laser. Corneal reshaping then allows the eye to focus rays of light on the retina and correct the refractive error. Refractive errors like myopia or short sightedness (minus numbers), hyperopia or long sightedness (plus numbers) and astigmatism (cylindrical numbers) can all be corrected with these surgical procedures. Health insurance policies provide coverage for these procedures when high refractive errors are being treated.

A normal corneal thickness and shape, which is tested with a scan called corneal topography, is mandatory to undergo this procedure. A minimum age criteria of 18-21 years and a stable refraction are also necessary. A quick 5-10 min procedure, without injection, without pain, no sutures, no eye pad, no bleeding makes the experience comfortable and appealing. Bladeless & flapless options like Relex SMILE or Femto – LASIK have made 100% safety a reality. High numbers upto -30D can also be corrected with customised phakic IOL options. Common side-effects can be postoperative glare, dryness, adaptation time to focus which usually recover in a couple of weeks. Long term complications are uncommon.

There are different laser surgeries at our disposal to achieve refractive error correction. The most advanced and latest procedures are lenticule-extraction based like ReLex SMILE- which are flapless, bladeless, without flap-associated risks and dryness. LASIK is a time-tested flap based procedure with many customisations and bladeless options available to achieve safe, effective and quick outcomes. Surface ablation which is a surface based laser procedure still has a place for correcting low refractive errors. Which procedure is suitable for an individual depends on multiple factors like the magnitude of error, corneal curvature and thickness, patients lifestyle and doctors preference. Phakic IOL options and lens based options like Presbyopic Lens Exchange are also offered when corneal laser procedure is not an option.

Spectacle freedom for admission in the army, navy, air force and police force or for adventure activities like scuba diving, trekking and sky-diving or professional demands of sportspersons, actors, and flight attendants have increased the demand for Laser Vision Correction. Freedom from contact lenses and associated eye dryness and allergies makes this one-time, permanent treatment a life changing alternative! Whatever the reason behind wanting it, the experience and reward it gives the patient are definitely fulfilling & worthwhile.

Do you know that people have spectacle power as high as -25 Diopters sometimes? But it’s even more astonishing that it can get fully corrected with an easy, 5 minute, painless surgery! If you didn’t know of this miracle, then read on, to know more about Phakic Intraocular lenses (IOLs).

Phakic IOLs are extremely thin lenses that are permanently placed inside the eye, behind the pupil, in front of the natural lens of the eye. They are a great option to correct high refractive errors, especially when patients are not eligible for laser vision correction, either because their number is more than 8-9 diopters or their corneal thickness is less than 470 µm or their corneal topography is abnormal.

Phakic Iols provide a reversible modality, wherein, the lens can be removed in case a circumstance demands it. The risk of a residual error remaining or power increasing again, is almost negligible. This procedure also has a ”WOW” factor wherein vision recovers fully in a matter of hours.

Not everyone is eligible for a Phakic IOL implant. A corneal topography map will help confirm whether there is adequate space in the eye to place the lens . After that, few more measurements are needed to determine adequate size of lenses. It takes a few days for customised lenses to get delivered. The procedure itself is simple, painless and without injection, with full recovery in 4-5 days time.

Phakic IOLs come in plus, minus and cylindrical powers with a wide range of sizes. Multiple brands now manufacture these lenses. These lenses are different from contact lenses which need daily insertion-removal and extreme care. These lenses are also different from IOLs/Intraocular lenses inserted after cataract surgery which replace your natural lens.

Phakic IOLs do not need any further care or long term restriction of activity. All routine or outdoor activities can be resumed few week after the procedure.

SWOJAS KULKARNI, with a refractive error of -27 Sph and -4 cylindrical error in both eyes underwent Phakic IOL implantation at Medilaser. He not just got rid of his thick glasses, but had a makeover in his personality. He now makes eye contact when he speaks and has also cleared his driving license test. High refractive errors can have limited peripheral vision and distorted vision due to thick lenses. We have performed more than 500 successful Phakic IOL implantations to change their lives for the better!

To know more about Phakic IOLs, contact us on 8805982871

Link: https://youtu.be/vtUcdHmth7I?si=vaixiOM-h6Jvo6xh

Laser refractive surgery involves reshaping the cornea, which is the frontmost transparent layer of the eye, with laser, to correct spectacle power. Over the years, this procedure has evolved to become safer, more accurate and predictable.

LASIK (Laser-Assisted In Situ Keratomileusis) is a time -tested procedure that has been around for more than 25 yrs. It involves creation of a thin flap of the cornea, followed by excimer laser ablation beneath the flap to correct power and lastly, repositioning the flap in place. It has great accuracy and fast recovery. Safety of the procedure has increased greatly with use of femtosecond laser (bladeless lasik) to create flaps rather than the conventional blade or microkeratome flap cutting.

Contoura is a customised type of lasik procedure that can benefit patients with irregular corneas. Topo- guided LASIK is available on multiple LASIK platforms; Contoura is the brand name of the Alcon platform. In this procedure, the laser ablation treatment is matched with the corneal map or topography of the patient to try and regularise an irregular cornea, eg. cases of previous decentered treatments.

ReLex SMILE (Small Incision lenticule extraction) is the first lenticule-based laser refractive procedure, made available by the Visumax (Carl Zeiss) platform since 2011. This is an all- femto procedure with no excimer laser ablation/ burning, no flap and only 2 mm incision. This is a true bladeless, flapless, painless procedure. With no flap creation, risk of dry eye is very less and the strength of the cornea is preserved better.  It can correct myopia of upto -10 diopters and cylindrical error of upto 5 D. It is most suited for people indulging in adventure activities and contact sports as the risk of flap displacement with LASIK is negated here.

SILK  (Smooth Incision Lenticule Keratomileusis) by J&J is one of many new lenticule platforms being launched for laser vision correction this year, after SMILE had monopoly for over a decade. SILK is a biconvex lenticule with smooth dissection and precise results. CLEAR (Corneal Lenticule Extraction for Advanced Refractive Correction) by Zeimer and ATOS by Schwind are other lenticule platforms that are based on the same surgical technique as SMILE. With more brands competing for supremacy, awareness and demand of these procedures is on the rise.

We, at Medilaser have been the pioneers in the field of lenticule surgery, in this part of the world; having performed more than 10,000 ReLex SMILE procedures since 2013. We offer all refractive solutions under one-roof and our skill and experience in this field is unmatched.

Spectacle use is quite commonplace in recent times. With increasing screen usage, there has been a recent pandemic of myopia in young children. And most would like to get rid of glasses for convenience, better vision and cosmesis.

The minimum age to get laser vision correction done is 18yrs, preferably 21 yrs. This is to ensure that the growth of the eyeball is complete and refraction is stable. Younger than 18 yrs, Laser Vision correction can be done with the understanding that if the eyeball grows further and number increases, a re-enhancement maybe needed. The ideal age is considered after 21 yrs because the cornea gets stronger with age. A young person has a more delicate or fragile cornea than someone older.

The choice of procedures for Laser vision correction is wide open from 18 or 21- 40yrs of age. Depending on the magnitude of refractive error and corneal topography parameters, patients may be advised Lenticule extraction procedures like ReLEx SmILE, SILK, CLEAR, ATOS or flap based LASIK procedures or surface ablation procedures. If patient is not eligible for corneal laser surgery on account of a high refractive error or abnormal corneal topography, Phakic IOL– ICL or IPCL may be advised for him. With these procedures, distance vision is corrected permanently but patients develop Presbyopia or need reading glasses after the age of 40yrs. If they do not opt for Laser vision correction, they would still develop Presbyopia and would need bifocals or progressives. Presbyopia is inevitable with or without Laser vision correction.

In the presbyopic age (>40yrs) the options for Laser vision correction are many and need to be customised to patient’s lifestyle and needs. Regular ReLEX SmILE or Lasik or ICL can correct distance vision in both eyes: however, patient will then need reading glasses- prescription of these increases with patient’s age from +1 to +2.50 progressively. If patient is willing to use glasses for near, he can get perfect distance vision in both eyes with regular laser vision correction.

If patient does not want reading glasses, options are presbyopic LASIK, monovision or presbyopic Lens exchange.

Presbyopic LASIK corrects the dominant eye for distance and intermediate while the non dominant eye is corrected for intermediate and near. This is called laser blended vision so as to not lose binocularity and depth perception. Here, each eye cannot see both far and near perfectly. But, together both distances can be managed comfortably. We usually give a trial with glasses to these patients to see if they will tolerate and be satisfied with the outcome. Not every patient is a candidate for presbyopic LASIK and patients are selected based on their lifestyle, needs and tolerance. Since, reading number progressively increases with age, enhancements for this laser are often necessary.

Monovision is the next option available for laser vision correction in the presbyopic age group. Monovision means correcting the dominant eye for distance and the non- dominant eye for near. Patients who do not drive or those who do not have detailed eye related work can opt for this option. With both eyes open, far and near objects are visible. However, depth perception or 3-D vision is lost with this option. Patient can use glasses only for activities that require binocularity or stereopsis like driving or threading a needle but can be spectacle free most of the time.

The last option in the presbyopic age group is PreLex (Presbyopic lens exchange) with a Trifocal or Extended depth of focus IOL. This is a permanent option with no cataract development or increase in reading number later. This option is great for those with hyperopia with Presbyopia. Hyperopic patients cannot see distance or near without glasses and are very happy with PreLex. In emmetropes, distance vision is perfect and they may not be happy with a compromise in its quality with multifocal lens. Even night vision and contrast sensitivity reduction can lead to dissatisfaction in emmetropes. Hence, patient selection and extensive counselling are of vital importance. Myopes again can be unhappy with the unaided near vision & reading distance that a multifocal IOL provides. PreLex, again is not for all. A refractive surgeon will carefully select the best option for the patient taking into account a multitude of factors and tailor- make his treatment plan after running many tests and counselling sessions. > 55 yrs of age, PreLex is the best permanent option as patient will not need cataract surgery after it.

There is also a category of patients, post- cataract surgery, who have glasses and don’t want them. A top-up Laser procedure like Relex SmILE or LASIK or surface ablation, can correct any distance residual power. If patient has a monofocal IOL placed at the time of Cataract surgery and later desires a multifocal implant, an additional, sulcus based multifocal IOL can be placed over the existing monofocal IOL to get rid of any distance as well as reading power that the patient may have.

“Bioptics” is a procedure where corneal laser and lens based surgical options are combined to get rid of spectacle number. Doing one procedure, does not close your doors for the next. Any refractive error can be treated at any age; but there isn’t one procedure across all age groups.  Procedures vary depending on the refractive error, patient’s age, surgeon’s comfort and patient’s lifestyle needs.