Refractive Surgery

What is refractive surgery?

Vision disorders from mild vision changes to significant vision impairment impact millions of people worldwide. These conditions are called refractive errors as they occur when the eye does not correctly refract or bend light as it enters the eye.

Refractive surgery is a general term used to describe any surgical procedure that corrects or improves these vision problems to reduce or eliminate the need for prescription eyeglasses and/or contact lenses.

The most common refractive errors that are addressed by refractive surgery are:

· Myopia (short-sightedness) – Difficulty in seeing distant objects clearly
· Hyperopia (long-sightedness) – Difficulty in seeing close objects clearly
· Astigmatism – Distorted vision resulting from an irregularly curved cornea
· Presbyopia – Age-related difficulty in reading or seeing close objects clearly

There are many different surgical procedures performed by an ophthalmologist for correcting or adjusting the eye’s focusing ability; most are accomplished using a laser.

Why should I consider getting refractive surgery?

Refractive surgery might be a good option if you want to decrease your dependence on wearing eyeglasses or spectacles and contact lenses. Refractive surgery is often pursued by individuals such as athletes or workers where glasses are inconvenient during daily activities or for people who are unable to tolerate contact lenses.

Most candidates for refractive surgery need to be free of eye disease and have a refraction error that can be improved or corrected by surgery. Even with refractive surgery, there is a possibility that you will still need glasses or contact lenses after the procedure.

Did you know?

Vision problems come with a cost. Myopia is associated with substantial out-of-pocket expenditures. In 2013, the total cost of myopia for the Singapore population was SGD$959.0 million, or USD $755.2 million.¹

What are the risks of refractive surgery?

As with all surgical procedures, there are inherent risks for patients. Generally, these risks include:

· Dry eyes from a temporary decrease in tear production. The eye specialist may recommend eye drops during this time or a procedure to have special plugs put into the tear ducts to prevent tears from draining for the eye surface.

· After surgery and especially at night, some people have increased glare, halos around bright lights, or double vision. These side effects usually diminish after time.

· Some surgeries deliver less than perfect vision. If the laser removes too little, too much or uneven tissue the clearest vision results will not be realized. Some people may need another LASIK procedure at a later date to achieve optimal results.

· Several laser surgeries involve folding back or removing the flap from the front of the eye. Occasionally this flap surgery can cause complications, including infection and excess tears. Additionally, during the healing process, the outermost corneal tissue may grow abnormally underneath the flap.

· In very rare cases, a patient may experience loss of vision as a result of surgical complications.

How should I prepare for my appointment?

Adults and adults accompanying children should bring previous eye test results and medical history information. If glasses have been prescribed, please bring the glasses. If the patient has undergone any eye procedures or surgeries, you should be prepared to discuss the diagnosis and treatment with the specialist.

The appointment may include having the eyes dilated as part of the exam. In those cases, having a friend or family member available to drive you home is helpful. Additionally, when you make the appointment ask if there are any special instructions to follow and bring a list of any questions you want to ask.

What can I expect during refractive surgery?

Prior to the surgery, your ophthalmologist will determine if you are a good candidate for the procedure. The ophthalmologist will have evaluated the cornea and determined the precise amount of tissue that needs to be reshaped for the best result. Ophthalmologists often use a special technology to evaluate the eye and to create a detailed map of the eye with precise measurements.

Contact lens wearers will be required to stop wearing the lenses for a few weeks prior to surgery to prevent the cornea from changing shape. Your eye care specialist will give you instructions prior to surgery. This surgery is usually performed in a day surgery setting and you will need a driver to take you to and from the facility. Women will be asked to avoid wearing eye makeup on the day of surgery and possibly for a short time after surgery.

Some patients may be given a medication to help them relax, and the eyes are numbed with eye drops so an instrument can hold the eyelids open. A specialized suction ring is placed on the eye and the ophthalmologist will use a laser or small blade to create a flap so the cornea can be accessed. The ophthalmologist will use a laser that has been programmed for your surgery to reshape the cornea. The flap will be put back in place, and stitches may not be necessary. Most refractive surgery is completed in less than 60 minutes.

What happens after my refractive surgery?

Immediately after surgery, the eye might itch, burn, or be watery. Additionally, the vision may be blurred. Most patients will experience little pain, and vision recovers quickly. You might be given pain medication or eye drops to keep you comfortable for several hours after the procedure. Your eye doctor might also ask you to wear a shield over your eye at night until the eye has healed.

A follow-up appointment one to two days after surgery will be necessary to see how the eye is healing and to make certain that aren’t any complications.

Additional appointments will be discussed and scheduled. The specialist will discuss when you can resume activities including sports, swimming, and using eye cosmetics.

Improvements to vision will take time as the eye recovers and the vision stabilizes. For most patients, this will usually take two to three months following surgery.

[1] Zheng Ying-Feng, Pan Chen-Wei, Chay Junxing, Wong Tien Y. The Economic Cost of Myopia in Adults Aged Over 40 Years in Singapore. Finkelstein Eric, Saw Seang-Mei. Investigative Ophthalmology & Visual Science. 2013:11 (Vol.54), 7532-7537. doi:10.1167/iovs.13-12795