When we talk about refractive surgery we talk about a series of processes so that the person stops using glasses. They can be processes either on the cornea, carving the cornea, or using intraocular lenses.
The most frequent refractive errors are nearsightedness, farsightedness, astigmatism and presbyopia or tired eyesight. All of them except presbyopia can be corrected with operations on the cornea. However, presbyopia we would have to correct it with intraocular lenses.
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What refractive defect is operated more?
Myopia is operated more because the patient suffers more from the lack of sight. On the other hand, there are more hyperopes, but as hyperopia, the person compensates without effort, because the farsighted person does not complain so much and does not tend to operate so much.
What is the treatment for presbyopia or eyestrain?
The first treatment would be to wear multifocal glasses, but the current treatment we are doing is to put an intraocular lens in the eye that can be to see from far and near or to see from far, medium distance and near. The latter would be for people who work with computers that also need that distance although today we increasingly need the intermediate distance because for the use of mobiles and tablets it is the vision we need.
Is any patient a candidate for an operation?
You have to do a study of the patient. In presbyopia surgery we are putting artificial intraocular lenses that more or less compensate the function of our lens. However, people who see well from a distance or up close should not have surgery until they have defects both far away and up close because otherwise they may notice that they lose sight of the vision they saw well. This means that if they see well from afar and we put a lens on it, something will lose its light because they are lenses that we put with several lights and some of this light is lost and then they have the feeling that they do not see so well. When they have a lack of far and near vision, they do notice that when they improve their visual quality.
In this surgery of presbyopia we remove the lens that is like a lentil and put a flat lens. That is why it should not be done before the 50 years because inside we have a jelly that is called vitreous that until the 50 years is quite rigid and from the 50 it is more liquid and there is no problem that it can break the retina.
What is done in laser refractive surgery?
What we do in the cornea is to carve it according to what we have. If you have myopia, it is a helmet-shaped carving. If you have hyperopia, it is a ring-shaped carving and if you have astigmatism it is a mixture of the two.
What requirements must patients meet for refractive surgery?
You have to study the patient's cornea. If the cornea is thick enough to be carved and if it is a normal cornea because sometimes we have deformed corneas, problems in the cornea that although they do not produce any alteration to us, could alter the operation.
In which cases is laser surgery used and in which cases not?
The laser is used up to 8 diopters of myopia, 6 of farsightedness and 4 of astigmatism. Everything above that we have to resort to intraocular lenses.
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Do all lasers work the same?
In principle, all lasers act in the same way as by carving the cornea. It is a laser called Excimer and what it does is carve the cornea to the patient through rays and we see it through a microscope.
We put the data in the computer and it calculates what carving it has to do, what micron distance it has to carve. This happens because the carving is not the same throughout the cornea, in the central part it is deeper and then it decreases to prevent the patient from seeing rings of lights, which is very important especially for night driving.
