Refractive surgery aims to help patients gain spectacle independence and improve vision by correcting different refractive errors such as near-sightedness (myopia), far-sightedness (hyperopia), astigmatism or long-sightedness (hyperopia). There are various surgical procedures for adjusting the eye’s focusing ability, and the suitability of each treatment option will differ from patient to patient, depending on factors like age and lifestyle needs. At Atlas Eye, we provide 3 main types of refractive treatment options for patients across all ages:
1. Cornea Laser Refractive Surgery
This refractive surgical method aims to change the shape of the cornea permanently, which in turn restores the focusing power of the eye by allowing the light rays to focus precisely on the retina for improved vision. The main advantage of this eye surgery is that patients can reduce their dependency on spectacles or contact lenses. With the advancement in medical science and technology, there are now 3 generations of cornea laser refractive surgery that could help more patients correct their vision:
ReLEx® SMILE combines the qualities of both LASIK and PRK, which include doing away with the stripping off the surface of the cornea (as in surface ablation) and creating a flap (as in LASIK). The procedure promises faster recovery and lesser dry eye with a smaller 4mm incision compared to a 22mm incision with LASIK.
This is the 2nd generation laser surgery and has remained the most popular procedure to correct near-sightedness (myopia), far-sightedness (hyperopia) and astigmatism. The visual correction is made by creating a thin flap and gently folded back to expose the corneal surface, for a second laser to reshape the cornea.
This is 1st generation corneal laser refractive surgery, which is also known as Advanced Surface Ablation with Photorefractive Keratectomy (PRK). The visual correction is made directly to the cornea surface after the top cellular surface has been removed.
2. Implantable Collamer Lens Implantation
This procedure involves surgically implanting a lens inside the eye to correct the vision error. It is beneficial for patients with moderate to high refractive errors, or eyes that are unsuitable for laser refractive surgery.
3. Refractive Lens Exchange
Similar to cataract surgery, this procedure is also commonly known as clear lens extraction. It is usually more suitable for middle aged or older patients and those having early cataract.
|Top Surface Layer Intact||√||√|
|Estimated Days Off Work||8||3||3|
|Duration on Medication||weeks||days||days|
|Incision size (mm)||NA||20||2-4|
|No Risk of Flap Dislodgement||√||√|
|No Ablation Technique||√|
IMPLANTABLE COLLAMER LENS (ICL)
Implantable Collamer Lens
Implantable Collamer Lens (ICL) is surgically implanted behind the iris and in front of the natural crystalline lens. It is beneficial for patients with moderate to high refractive errors, or eyes that are unsuitable for laser refractive surgery.
The ICL is made from Collamer, a collagen co-polymer which is compatible with the human eye. It also contains an ultraviolet filter that protects the eye against harmful ultraviolet (UVA and UVB) radiation.
The quality of vision following ICL implantation may provide higher quality visual outcomes as compared to laser refractive surgery, especially in patient with high refractive error. The procedure is considered more invasive and usually entails a higher cost.
Careful assessment of the dimensions of the eye is needed in order to determine if the eye can accommodate the added volume of the ICL and to avoid potential complication such as raised intraocular pressure and the early formation of cataracts. Although the ICL is intended to be in place permanently, it may be removed if necessary.
Key Advantages of ICL:
- At high levels of refractive errors, ICLs can provide superior quality of vision than laser vision correction.
- Does not require thinning of the cornea as in laser vision correction.
- Better preservation of the structural integrity of the cornea.
- Should the need arise, the ICL can be removed.
REFRACTIVE LENS EXCHANGE
Refractive Lens Exchange
Is similar to a cataract surgery, also commonly known as clear lens extraction. The natural crystalline lens is replaced with an artificial intraocular lens (IOL) of a desired power to correct the refractive error.
This procedure is generally more suitable for middle aged or older patients and those having early cataract. IOL comes in monofocal, toric, accommodating or multifocal options to cater for different vision needs.
Corneal ectasia, or the inability of the cornea to maintain its shape, may occur following LASIK and to a lesser degree PRK and SMILE. The changes in shape of the cornea result in the development of new refractive errors that in some cases may not be correctable with either glasses or contact lens. It is rare and the incidence has fallen with better techniques of patient selection. This condition may also occur in individuals who may not have had previous eye surgery. Patients with high myopia, relatively thin cornea and asymmetric corneal topography are at higher risk.
Atlas Eye Specialist Centre offers a procedure known as Collagen Cross-Linking (CXL) as a supplementary procedure option to your ReLEx® SMILE, LASIK and PRK package.
This procedure is performed at the same sitting as the laser procedure. The procedure simply involves the combination of Riboflavin (Vitamin B) eyedrops and ultraviolet (UV) light, to create ‘cross links’ between collagen fibres in the corneal architecture to improve the structural strength of the cornea.
This aims to prevent progressive and irregular changes in corneal shape seen in post-LASIK ectasia. There are also reports that collagen cross-linking helps to improve the refractive stability of the operated eye. To determine which type of surgery best suits you and to fully understand each procedure, please visit us for a comprehensive eye examination.