Laser Eye Surgery – A Patient’s Diary
What If I’m Not Suitable For Lasik
Author : Dr Japie Grové
Ten years ago you were simply told that you do not qualify for LASIK surgery – period.
That left you with the traditional options of either spectacles or contact lenses, quite disappointing for a young active person with a huge spectacle prescription and intolerance to contact lenses.
Fortunately alternative options have evolved very quickly over the last few years!
Why would you not qualify?
People who most often do not qualify would be someone with a high refractive error (big spectacle prescription) and a thin cornea. To do safe LASIK surgery you need to leave at least 250um of the corneal bed intact, anything less than that can lead to long term problems like ectasia. Other reasons that will disqualify you include cornea diseases like keratoconus, Pellucid degeneration of the cornea, previous trauma etc. Minor eye ailment like dry eyes, bleferitis or simple infections will not disqualify you from LASIK but, it is important to have your eyes in optimal condition before laser surgery. Your ophthalmologist will therefore prescribe some treatment before commencing with the laser procedure.
Should you not qualify for LASIK your ophthalmologist will give you one of the following options tailored to your specific eye condition.
Phakic Intraocular Lenses:
Phakic Intraocular Lenses(PIOL) are lenses that is implanted inside the eye –either on or behind the iris(coloured part of the eye).The natural lens of the eye is kept intact with the PIOL adding or subtracting to or from the strength of the eye’s own lens system (almost like a contact lens only inside the eye).PIOL’s most often used in South Africa include: ICL(STAAR), Artisan/Artiflex(Ophtec) and Cachet(Alcon).
The big advantage of PIOL’s is that you can treat much higher refractive errors than with LASIK. Prescriptions of between +12 and -23 are treatable with the thickness of the cornea not playing any role. Astigmatism can also be addressed by some of the PIOL’s. The procedure is quick painless and safe and once the PIOL is inside the eye the patient is not aware of it. The accuracy is very comparable to LASIK surgery. A big advantage of the PIOL is that it is easily reversible by simply removing the lens surgically.
Bioptics:
Bioptics is the term used for combining Phakic Intraocular Lenses with Laser treatment. The reason one would consider Bioptics is to correct very high spectacle prescriptions( up to -35)
The PIOL procedure is done first followed by a laser treatment(either LASIK or PRK) to correct what is left of the refractive error.
Clear Lens Extraction:
Also called a Refractive Lens Exchange, Clear Lens Extraction refer to the removal of the eye’s natural lens to replace it with an artificial lens with better focus. This option is usually reserved for patients where LASIK or PIOL’s are not indicated. Best suited patients are usually farsighted (Hyperopic) individuals. The surgery is exactly the same as for cataract surgery and done through a 2.2mm self sealing wound(no sutures necessary), recovery is quick and relatively pain free. The artificial lenses implanted can be either monofocal (one focus point) or multifocal(two focus points, both for near and distance vision).
Conclusion:
Although LASIK treatment is still the best way to deal with most patient’s refractive problems, other options in refractive surgery are increasing by the day. This widens the opportunity, to be spectacle independent, to patients who would previously not have qualified for any treatment.
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