Home Therapies Refractive surgery: eye surgery instead of glasses

Refractive surgery: eye surgery instead of glasses

by Josephine Andrews
Published: Last Updated on 251 views

The term refractive surgery refers to all eye operations that change the refractive power of the eye. In this way, the doctor can correct or at least improve ametropia such as long-sightedness or short-sightedness. Here you can read everything you need to know about the individual procedures, what risks they entail and which patients refractive surgery can help.

What is refractive surgery?

Refractive surgery is an umbrella term for various surgical procedures in which the ophthalmologist changes the refractive power of the eye. The point of attack is either the lens or the cornea of ​​the eye . Ametropia such as nearsightedness and farsightedness can be compensated for or at least improved by refractive surgery. Refractive surgery is therefore an alternative to glasses and contact lenses in the treatment of ametropia .

When is refractive surgery performed?

Light entering the eye is refracted by both the cornea and the lens and then passes through the vitreous humor to the retina . This is where the image of what is seen is created. The refractive power of the cornea and lens must be precisely matched to the length of the vitreous body, otherwise various ametropia will occur, which can be treated with refractive surgery:

  • Short-sightedness (myopia): The vitreous humor is too long, causing distant images to appear blurry. The patient can see nearby objects well.
  • Farsightedness (hyperopia): The vitreous humor is too short, causing nearby images to appear blurry. However, the patient can see objects in the distance clearly.
  • Farsightedness ( presbyopia ): The deformability of the eye lens decreases with age. That’s why most people over the age of 45 need reading glasses.
  • Astigmatism ( astigmatism ): The cornea is irregularly curved. As a result, what is seen appears distorted.

exclusion criteria

The methods of refractive surgery are not suitable for every patient. The following circumstances or pre-existing conditions rule out eye surgery:

  • Patient is younger than 18 years
  • very thin cornea
  • Glaucoma ( glaucoma ) with pronounced visual field damage
  • chronic progressive corneal diseases
  • pre-existing corneal damage
  • shallow depth of the anterior chamber of the eye (anterior chamber)
  • macular degeneration

Whether eye surgery is an option for you always depends on the type and severity of the visual impairment. Therefore, speak to your treating ophthalmologist about a suitable treatment method.

What do you do with refractive surgery?

Refractive surgery includes various operations on the eye that are performed using a scalpel or laser. Beforehand, the patient is often given a local anesthetic using special eye drops. Important refractive surgery procedures in detail:

Refractive Lens Exchange (RLA)

In refractive lens exchange (RLA), the ophthalmologist opens the eye with an incision on the edge of the cornea, crushes the lens with a special ultrasound device and sucks the resulting pieces out of their capsule through the opening. He now inserts an artificial lens made of a flexible material into this capsule. Finally, he sews up the set cut.

The procedure is mainly performed in more severe cases of nearsightedness or farsightedness.

Phakic intraocular lens (IOL)

The use of phakic intraocular lenses (IOL) is similar to a refractive lens exchange. However, the doctor does not remove the natural lens, but only inserts a second lens in the eye, so to speak, an implanted contact lens.

Like the RLA, this type of eye surgery is performed primarily in the case of severe short-sightedness or far-sightedness.

Intracorneal ring segments (ICR or INTACS)

Intracorneal ring segments (usually made of Plexiglas) are used in patients who have slight short-sightedness and minimal astigmatism. To do this, the ophthalmologist mills tunnel-like holes in the cornea into which he inserts the crescent-shaped Plexiglas rings. This flattens the cornea.

corneal cross-linking

In this procedure, after mechanical removal of the corneal epithelium, the doctor drips riboflavin (vitamin B2) onto the cornea. Then the cornea is irradiated with UV-A light for about 10 to 30 minutes (the exact duration of the irradiation depends on the intensity of the radiation). The procedure is intended to stiffen the cornea and thereby stop chronic corneal diseases.

Corneal cross-linking can be used in the following cases:

  • Keratoconus (cone-shaped protrusion of the cornea)
  • Pellucid marginal degeneration (PMD; thinning and bulging of the lower, peripheral cornea)
  • thin cornea (e.g. after eye laser surgery)
  • astigmatism

corneal implantation

With a corneal implant , the shape of the cornea can be changed. Alternatively, an artificial pupil can be created with it. The doctor places the implant in a corneal pocket in the non-dominant eye.

An implantation is usually used for presbyopia. However, it is not possible for most patients to do completely without reading glasses.

Astigmatic keratotomy

The term refractive surgery also includes keratotomy , i.e. the splitting of the cornea. It is used to compensate for astigmatism. The doctor uses a special diamond knife to make tiny incisions in the cornea, depending on the degree and direction of the astigmatism. The procedure is often performed at the same time as cataract surgery.

laser process

There are also a number of laser processes that can be used to change the refractive power of the lens. Well-known techniques are, for example, LASIK (laser in situ keratomileusis), LASEK (laser epithelial keratomileusis) and PRK (photorefractive keratectomy).

You can find out how the various laser procedures work, who they are suitable for and what risks they entail in the article Laser Eyes .

What are the risks of refractive surgery?

Before the patient decides to undergo refractive surgery, the ophthalmologist must inform him about the possible complications of the planned procedure. The probability of such complications is small – the complication rate in refractive surgery is less than 0.5 percent.

Basically, the operation on the eye can result in the following symptoms:

In some cases, refractive surgery can lead to more serious problems such as:

  • scarring of the cornea
  • Corneal protrusion (keratectasia)
  • Disorder of tear film secretion
  • eye
  • clouding of the lens (cataract)
  • Accumulation of water in the retina ( macular edema )
  • retinal detachment
  • worsened twilight vision

In five to ten percent of the patients treated, the ametropia is not treated or only insufficiently treated after the procedure and a repeat procedure is necessary.

What do I have to consider after refractive surgery?

Whether refractive surgery leads to the desired success also depends on you as the patient. Here are the most important tips:

  • Do not rub your eyes for the first few days after surgery. This allows the wound in the cornea to heal better.
  • Your doctor will prescribe special eye drops that you should use regularly, exactly as he or she has told you.
  • If you notice severe pain or a sudden deterioration in your vision, you must see your eye doctor immediately!

Keep in mind that refractive surgery does not always lead to an optimal result immediately. Some patients require post-correction , which the doctor usually does with a laser.

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