Information - Refractive Surgery

The aim of refractive surgery is to reduce a person’s dependence on glasses and contact lenses. This is achieved by treating nearsightedness, farsightedness and/or astigmatism (where both close and distant objects are blurry).

Most refractive surgery techniques rely on altering the shape of the cornea. Poorly focused images can be improved by prescription glasses, contact lenses or refractive surgery.

As the cornea is responsible for about two-thirds of the eye’s focusing power, vision can be improved by permanent reshaping of the cornea.

Your optometrist will advise you:

·        Whether your eyes may benefit from refractive surgery.

·        About the type of refractive surgery that would be most suitable for your eyes, general health and lifestyle.

Candidates for Refractive Surgery

The criteria for a good candidate usually include the following:

·        You’re at least 18 years of age, as younger people often have significant changes to their vision as they mature.

·        Your prescription for glasses or contact lenses has remained stable for at least 6 months.

·        You have a vision problem that can be treated by refractive surgery.

·        Your cornea is thick enough to safely allow tissue removal.

·        You don’t have a chronic illness that may tend to limit the effectiveness of surgery or slow the cornea’s ability to heal.

·        You’re free from eye conditions or any other type of eye problem that may put your vision at risk.

·        You’re not pregnant or breastfeeding.

·        Your expectations are realistic, and you understand that refractive surgery entails risk, and in some cases can only reduce your need for prescription glasses or contact lenses.

Other factors may exclude a person from undergoing refractive surgery, including:

·        Pre-exiting “dry eye” syndrome.

·        Corneal scarring and keratoconus.

·        Severe myopia or hyperopia.

·        Advanced age.

·        An autoimmune disorder.

·        A history of ocular herpes.

·        Taking a prescription drug that slows the healing process or increases the risk of infection.

Recovery from Refractive Surgery

Most patients notice visual improvements at once or within 1-7 days following surgery, but this may depend on which surgical procedure was used.

·        Healing time will vary depending on the procedure used, your age and your general health.

·        Depending on the procedure, you may be fitted with bandage contact lenses for a few days. These lenses help to reduce pain, discomfort, and irritation of the cornea due to blinking.

·        Try to rest your eyes for the first 24 hours.

·        Your optometrist may provide you with a special pair of sunglasses or eye covers to wear outdoors for the first 24 hours.

·        Your eyes may feel uncomfortable, gritty or irritated for the first day or two but pain-relieving medication can help this.

·        Antibiotics and eye drops may be prescribed for a few days to reduce the risk of infection and inflammation while the cornea heals.

·        Don’t get water in your eyes.

·        Do NOT rub your eyes under any circumstances. Eye rubbing can dislodge the healing corneal flap, and further surgery may be needed to reposition it.

·        You should wear eye shields at night for up to 1 week to stop yourself from accidentally rubbing your eyes during sleep.

·        Don’t wear eye make up for 7 days.

·        Medicated eye drops could be needed for a few weeks to reduce the risk of hazy eyesight, depending on the type of treatment.

·        Don’t drive until your vision has improved or until both eyes have been treated and vision is good.

·        Avoid smoky or dusty locations for at least 7 days.

·        Don’t swim for at least 2 weeks.

·        Your eyes may feel dry for a few weeks or months following surgery and they can be eased with prescription eye drops that help keep the eyes moist.

·        Crispness of vision in the operated eye may vary over the course of the day, but this should settle within 3 months of surgery.

·        Make sure you attend all follow-up visits to your optometrist.

·        Contact your optometrist immediately if you experience any unusual or unexpected symptoms.

Before Surgery

If your optometrist considers you a suitable candidate for refractive surgery, you will need to stop wearing contact lenses for a certain amount of time prior to surgery as this allows the cornea to return to its natural shape. Healing is generally rapid. However, you will need to arrange some time to allow vision to recover.

General Risks of Refractive Surgery

·        Light sensitivity – short term or long term.

·        Small red patches on the sclera lasting for a few weeks.

·        Your eyes may feel dry.

·        The procedure may worsen your eyesight, despite the use of prescription glasses or contact lenses.

·        Vision problems.

·        The cornea may react too much or not enough and you may elect to have further refractive surgery.

·        The cornea may become infected, and treatment with various antibiotics may be necessary.

·        The cornea may become permanently misshapen, swollen or scarred. This can lead to the need for a corneal transplant and severe, permanent and visual loss.

·        The cornea may lose some of its new shape during the healing process.

·        The natural lens may become cloudy and require removal.

·        Your vision may lose contrast sensitivity, which means everything looks slightly hazy or blurred even if your vision is 20/20.

·        The only long-term risk that has been identified is a progressive thinning of the cornea.

·        After corneal refractive surgery, the measured intraocular pressure may decrease slightly.

·        Rarely, retinal or optic nerve problems may occur after refractive surgery that may lead to permanent visual loss or blindness.