Alternatives to LASIK
Dr. Jose Barraquer
The LASIK technique was made possible by the Colombia based ophthalmologist Jose Barraquer who, around 1950 in his clinic in Bogota, Colombia, developed the first microkeratome and developed the technique used to cut thin flaps in the cornea and alter its shape, in a procedure he called keratomileusis. Our corneal specialist, Dr Salomon Esquenazi was trained under Professor Barraquer in the late 80’s.
An instrument called a microkeratome is used in LASIK eye surgery to create a thin, circular flap in the cornea. Currently a newer device called a femto-second laser is employed to perform the flap cut in a more reliable and safe manner. This new technique is called “all laser LASIK”. The surgeon folds the flap back out of the way, and then removes some corneal tissue underneath using an excimer laser. The excimer laser uses a cool ultraviolet light beam to precisely remove (“ablate”) very tiny bits of tissue from the cornea to reshape it. This allows the image to be formed at the retina place providing clearer vision than before. The flap is then laid back in place, covering the area where the corneal tissue was removed.
Nearsighted, farsighted and astigmatic people can benefit from the LASIK procedure. With nearsighted people, the goal is to flatten the too-steep cornea; with farsighted people, a steeper cornea is desired. While this is not widely recognized by consumers, excimer lasers also can correct astigmatism by smoothing an irregular cornea into a more normal shape.
Photorefactive Keractectomy (PRK)
Photorefractive Keratectomy (PRK) uses a laser to sculpt the surface of the cornea by firing the laser directly into the corneal surface. This contrasts with LASIK, which removes deeper tissue within the cornea, under a corneal flap. In PRK, instead of creating a corneal flap, the surgeon scrapes the superficial corneal layer called epithelium over the treatment area. The second step of PRK is identical to LASIK: an excimer laser is used to remove stromal tissue and reshape the underlying corneal. In PRK, when more than 60 microns of tissue are removed an anti-scarring agent such as Mitomycin-C is used to allow the cornea to be crystal clear postoperatively.
PRK is useful for treating low to moderate levels of myopia, hyperopia and/or astigmatism. It is often the laser vision correction procedure of choice for people with thinner corneas, borderline tear secretion and for individuals who may have certain anterior corneal dystrophies, superficial corneal scars, or recurrent corneal erosions.
After the laser ablation, a soft contact lens is placed over the eye as a bandage while the corneal epithelium grows back in place, which usually takes about 4 to 5 days. During this period, the patient usually experiences mild to marked discomfort and the vision has variable degrees of blurriness. Because of the need for epithelial healing in PRK, it can take several weeks before vision is clear and stable after the procedure.
Even though PRK has more post-operative discomfort and longer healing and visual recovery time than LASIK, it is the procedure of choice in certain cases such as thin corneas, borderline tear secretion and borderline topography images. In all these cases, PRK offers significant advantages over LASIK. In general, the final visual outcome is similar in both techniques.
Alternatives to LASIK
In cases in which LASIK is contra-indicated there are many alternatives to address the patients refractive needs and reduce his/her dependency on glasses and contact lenses. Among the alternatives are:
>> Eyeglasses /Spectacles
>> Contact Lenses
>> Advanced Surface prodecure (ASA) and Photorefractive keratectomy (PRK)
>> Radial Keratotomy (RK)
>> Corneal Relaxing Incisions
>> Intracorneal Ring Segments (INTACS)
>> Phakic Lens implantations
>> Clear lensectomy (CLEAR) with multifocal intraocular lens
Phakic Intraocular Lenses
PHAKIC lenses are an excellent solution for the correction of refractive errors in patients in which the cornea status does not allow to perform LASIK surgery. Eye surgeons from around the world have implanted over 100,000 since 1986. This represents 2% of the refractive surgery done worldwide during this time. Phakic lens implants are appropriate for those patients who are not corneal-based refractive surgery candidates because they have very high myopia or corneas that are too thin to do corneal refractive surgery or have severe dry eye syndrome.
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