Monday, 5 October 2015

Non-Corneal Refractive Surgery in Mumbai

What is LASIK ?

Lasik (Laser-Assisted in Situ Keratomileusis) refers to refractive Laser surgery which gives patients suffering from refractive errors like myopia, hypermetropia and astigmatism freedom from glasses.

MICROKERATOME                                                                                     LASIK FLAP 

ECXIMER LASER ABLATION                                                                  FLAP REPOSITION

Are you a LASIK reject ?

People believe that LASIK is just a simple surgery and everyone with glasses can get it done. But that’s not true.

LASIK procedure alters the shape of the cornea by laser so that the light entering the eye now gets focused on the retina correctly to give the crisp vision.
Only after a detailed preoperative evaluation of the eye especially the cornea the doctor can tell you whether you are a good candidate to get LASIK done, depending on the thickness of the cornea the range of the refractive error that is to be corrected.

Safety is of paramount importance and that should never be compromised for the sake of cosmesis.
Individuals who are not suitable candidates for the LASIK procedure are termed as LASIK REJECTS.

If I am a LASIK reject what are my options for enjoying the freedom from glasses ?

There are other options for correcting the refractive errors and one can opt for anyone according to individual preferences and characteristics of the refractive error one has.

Contact lenses : 

These help overcoming the problems encountered with spectacles use. But, these can be worn for maximum 10 hrs a day and one has to follow the cleaning and hygiene routine strictly so as to prevent any kind of eye infections. Overuse of the contact lenses can give rise to an allergic reaction in the eye which can necessitate their discontinuation in some on a temporary or permanent basis.

Implantable Collamer Lens (ICL) :

ICL is a flexible, soft lens made up of Collamer which is a biocompatible substance made by combining Collagen (naturally available in the body) and Polymer.
This is a unique refractive surgery option for the young LASIK Rejects to get rid of their glasses or contact lenses.


What is the technique of implantation of the ICL ?

The implantation procedure is quick and painless.

It is done after instilling anaesthetic eyedrops. No injections required.

The ICL is implanted inside the eye with a simple 10-15 minutes procedure through a small incision. It works similar to a contact lens designed to fit behind the iris and above the natural lens.

What are the advantages of ICL ?
  • No Corneal tissue removed, hence does not alter the natural shape of Cornea
  • Painless and quick
  • Safer option for the LASIK rejects.
  • Corrects higher range of refractive errors including myopia, hypermetropia and astigmatism
  • Retains corneal asphericity
  • Retains the contrast sensitivity
  • Preserves accommodation thereby near vision
  • No glare issues in case of people with large pupils
  • Stable and no regression 
  • It is implanted inside the eye so no maintenance issues as those faced with routine soft contact lenses
  • No dry eye issues, which are common with LASIK and other corneal refractive procedures
What are the potential Risks after implantation of the ICL ?
  • Over-correction or under-correction of the refractive error : this can happen because of miscalculation of the refractive power of the ICL to be implanted. Mild errors can be corrected by prescribing additional glasses. Rarely replacement may be required
  • Cataract formation : almost 60 percent population will develop cataract above the age of 65 years. ICL may accelerate the process of cataract formation by few years but this is rare.
  • Increased Intraocular pressure : This used to be a major risk few years before. Now-a-days after the introduction of the designs with central or midperipheral flow channels this risk is almost nonexistent 
Refractive Lens Exchange :

This refers to removal of the natural crystalline lens and replacing it with an artificial Intra-ocular Lens (IOL) for refractive purposes.

Due to the advances in Cataract surgery it has evolved from just a procedure to remove cataractous lens to a procedure focused on the best possible postoperative refractive result.

As the postoperative visual outcomes have become more predictable the use of lens surgery in patients without cataracts as a refractive modality has gained popularity.

What are the advantages of RLE ?

This procedure presents several advantages over corneal refractive surgery.
  • Patients with high degrees of myopia, hyperopia and astigmatism who are not candidates for laser surgery can undergo this procedure.
  • Wider range of refractive errors including astigmatism can be corrected.
  • Moreover, presbyopia can currently only be corrected with monovision or reading spectacles. RLE supplemented with multi-focal or accommodating intra-ocular lenses (IOLs) in combination with corneal astigmatic procedures might address all refractive errors including presbyopia, and eliminate the future need for cataract surgery.
Who are the best candidates for RLE ?
  • The individuals in their 40s who start developing presbyopia that is difficulty in reading and doing other activities requiring good near vision. Presbyopia is an age related process and such individuals even after undergoing LASIK surgery will require near vision glasses hence not giving them 100% spectacle freedom. On the other hand RLE with multi-focal Intra-ocular Lens will make them completely spectacle free.
  • Also beneficial in patients of older age group who will require cataract surgery in relatively near future and hence ameliorates the need for two surgeries in them and gives a better predicted end Visual result.
How is the Refractive lens Exchange done ?

The procedure of refractive lens exchange is exactly same to the routine cataract surgery.
It is done on a day care basis.
Takes around 15-20 minutes.
It is performed under topical anesthesia without any need of injection.

What are the potential risk factors involved in RLE ?
  • Overcorrection or under correction of the Refractive Error: this is RARE because of the advanced IOL power calculating machines and softwares available
  • Increased floaters
  • Decreased contract sensitivity with multi-focal implants
  • infection
  • Dislocation of the IOL
  • Retinal detachment : Very rare. Patients with high myopia are at increased risk of retinal detachment and proper preoperative retinal evaluation will eliminate this complication

The success of any refractive surgery depends on the patient’s understanding and expectations from the procedure. Choosing the procedure which is best suitable for you after discussing and understanding the benefits and risks of the procedure will help you enjoy spectacle freedom.

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