In case you want better vision without your glasses and contact lenses, the options available today are several: and all are equally safe and effective. The choice of laser eye surgery for specs removal therefore depends on your refractive error, visual needs and the structure of your eye. That is, the choice of surgery for removal of glasses has to be customized to the individual patient.
The choices available today are almost mind-boggling, this article aims to help you understand the laser eye surgery landscape better, so you can make an informed choice, and ask your eye surgeon the right questions, when discussing what is best for your eyes.
Conventional LASIK is the most commonly performed vision correction procedure in the world and has stood the test of time in both safety and effectiveness. In LASIK, your surgeon raises a thin, circular corneal flap, and then uses a special laser to remove some of the corneal substance called stroma, in order to modify its shape. This flap can be raised using a special tool called microkeratome (conventional LASIK and SBK), or a special laser (Contoura Vision and Femtosecond LASIK). This precisely controlled change in the shape of the cornea means the rays of light are now focused sharply on the retina, obviating the need for glasses. The corneal flap is then placed back into its original position, and so the comfort and speed of recovery are significantly better than surface ablations discussed in the section above.
Sub Bowman’s Keratomileusis, SBK
In SBK, the corneal flap raised is thinner than in conventional LASIK, and uses a specialized microkeratome. This surgery therefore offers patients greater safety and efficacy than conventional LASIK, and can be offered to patients with thinner corneas also.
The premium versions of LASIK are:
Femtosecond LASIK or blade free LASIK
In this, an ultra-speed laser, the femtosecond laser, to raise the corneal flap, making the surgery absolutely blade free, and the procedure thus is also called All-Laser LASIK. This offers the patient better flap stability, better precision and of course, a much faster recovery of vision. Femtosecond LASIK is fast becoming the standard of care in the more aware urban demographic.
Before Contoura Vision, ReLEx SMILE was thought to provide an additional advantage for patients choosing laser vision correction, especially in patients with dry eyes. In SMILE, instead of creating a corneal flap to access the tissue underneath, a small incision is made on the corneal surface. The surgeon then draws out a carefully sculpted corneal lenticule from the stroma, to modify the corneal curvature, earning the nickname, keyhole LASIK. Because it is minimally invasive, it definitely causes much less dry eye than conventional LASIK, however, the need for tear supplements following SMILE is almost the same as following Contoura Vision. The vision quality achieved is much superior to conventional LASIK, with fewer side effects, but may take a few days to stabilize.
Contoura Vision LASIK
Contoura Vision is the latest entrant into the LASIK surgeons’ armamentarium, and has fast caught the imagination of the surgeon and patients alike. Contoura Vision technology uses a highly sophisticated algorithm to capture as many as 22000 data points on the surface of the cornea, and uses the femtosecond (blade less) platform to modify them individually, to provide the kind of vision clarity and precision not seen until now. In fact more than half the patients undergoing Contoura Vision correction achieve super vision, that is, vision better than 6/6 or 20/20. In fact, patients have found a fashion analogy for the Contoura Vision LASIK: Contoura Vision is like an haute couture, custom designed suit, while the other versions are like suits you pick off the shelf. It is customized to your eyes, and corrects the individual flaws in the cornea which can cause side effects like glare and haloes, thus, provides the best fit of all.
Surface Ablation Procedures
PRK/ LASEK/ touch less LASIK: This group of laser vision correction procedures constitute the first group of surgeries ever performed to achieve freedom from glasses. They are also called surface procedures, because instead of creating a corneal flap as in LASEK, a very thin surface flap consisting of only the corneal epithelium is made. The surgery then proceeds as for LASIK, with the laser modifying the corneal curvature. Sometimes this epithelial flap is replaced, or removed completely. A soft contact lens is left in place, and the cornea takes up to a week to regenerate and heal completely. The patient may experience some blur and discomfort during this time. Most surgeons reserve this procedure only for patients who are unsuitable for LASIK.
Even if you are not fit for any of these laser refractive procedures, you can still achieve better vision without your glasses. The other two refractive procedures which are not laser assisted procedures, yet are effective in removal of glasses are Implantable Collamer Lenses, ICL and Clear Lens Extraction, CLE.
Implantable Collamer Lenses
Implantable Collamer Lenses, also known as phakic IOLs, offer permanent vision correction even in patients with refractive errors as high as -23Diopters, with thin cornea. They can be considered a hybrid between Contact Lenses and Intraocular Lenses (IOLs) used in cataract surgery. Like contact lenses they offer freedom from glasses, except they are surgically implanted inside the eye like an IOL, either between the iris and the natural lens of the eye, or on top of the iris. However, unlike an IOL they do not need removal of the natural lens of the eye.
Clear Lens Extraction
The Clear Lens Extraction technique also offers better vision without glasses to patients, and is the only surgery which can also correct near vision for most patients. In this, the normal lens of the eye is removed (quite like cataract surgery, except patient doesn’t have cataract) using the technique of phacoemulsification, and an intraocular lens is implanted. One can choose a monofocal lens for correction of only distance, or a multifocal lens which provides better vision for all distances.
Decision making: Spoilt for choice
Refractive surgery or surgery from freedom from glasses is safer, and more precise than ever before. In addition, you are spoilt for choice, when it comes to choosing the procedure best suited for your eye structure and vision needs.
When choosing a surgery, you must make sure you understand the risks and benefits of each of these surgical procedures, and discuss your vision needs with you eye doctor. He or she will then suggest the procedure best suited to your eyes, after conducting a comprehensive eye examination.
When choosing a surgeon or eye hospital, it is essential to make sure that the facility offers the entire range of refractive procedures, so that you doctor is not tempted into offering you a sub-optimal choice because he/ she doesn’t have access to the best technology. At present, there are two hospitals in New Delhi that offer the entire bouquet of refractive procedures. These include Dr. R P Centre for Ophthalmic Sciences at AIIMS, and the Eye 7 hospitals.
sophisticated Contoura Vision technology.