Refractive surgery is a term that encompasses all surgical methods used to permanently correct refractive errors of the eye, such as myopia, hyperopia, astigmatism, and presbyopia (difficulty seeing up close after the age of 45) through laser or other surgical techniques.
Refractive surgery can be performed on individuals who are 18 years or older and require glasses or contact lenses to see clearly.
What Are the Most Common Refractive Surgery Methods Today?
The eye is an organ that converts light into images. While performing this function, it refracts light—meaning it bends the millions of light rays reflected from a large external object and focuses them onto a small 2-3 millimeter area at the back of the eye to allow us to see. If the light is refracted too much, myopia occurs; if refracted too little, hyperopia develops; if refracted differently across 360 degrees, astigmatism emerges; and after the age of 45, presbyopia occurs due to the loss of autofocus ability as the lens behind the iris loses moisture.
The choice of refractive surgery method depends on factors such as the patient's age, general health condition, social and professional life, the degree of refractive error, and the suitability of the eye for treatment. The ophthalmologist determines the appropriate method and informs the patient before proceeding.
The most commonly performed refractive surgery today is Excimer Laser. Excimer Laser has been performed worldwide, including in our country, for about 30 years. It is a well-established and standardized refractive surgical method and remains widely used. The success rate of this procedure is around 96%. A successful Excimer Laser surgery does not cause any future eye diseases, nor does it prevent medical or surgical treatments for conditions such as cataracts or retinal diseases.
Other refractive surgery methods include phakic intraocular lens implantation, clear lens extraction, and artificial intraocular lens implantation.
Phakic intraocular lens implantation is typically performed on young patients with very high refractive errors or those whose corneal tissue is not suitable for Excimer Laser surgery. The eligibility for this procedure is determined by the ophthalmologist after evaluation.
Clear lens extraction and artificial intraocular lens implantation are identical to cataract surgeries. While this procedure is an alternative for younger patients when Excimer Laser or phakic intraocular lens surgery is not feasible, it is generally preferred for individuals over 50 years old.
After removing the natural lens, a single-focus (monofocal) or multi-focus (multifocal) intraocular lens, commonly referred to as a "smart lens," is implanted. Many patients express concerns about how to use these lenses. However, since both phakic intraocular lenses and intraocular lenses used in lens replacement surgery are implanted within the eye, patients do not need to worry about using them manually.
How Is Excimer Laser Performed? What Is the Preoperative Preparation and Surgical Process?
Excimer Laser is an outpatient procedure. The patient arrives at the hospital at a scheduled time and receives premedication (preoperative preparation medications). They are then taken to the laser operating room. The surgery itself lasts about 15-20 minutes, after which a plano (non-prescription) protective contact lens is placed on the eye. After a 30-minute rest period, the patient is examined by their doctor and provided with a prescription before being discharged. The first follow-up examination is performed the next day.
What Are the Different Excimer Laser Methods?
Although there are many named Excimer Laser techniques, they can generally be classified into two main categories:
1. Surface Laser
The first category is surface laser, which includes PRK and its variants. In this method, the corneal epithelium is removed over an 8-millimeter central area before applying the laser. After surface laser treatment, the corneal epithelium regenerates within 48 hours. During this time, patients may experience burning and stinging sensations in their eyes. While vision is sufficient for basic tasks, it may not be adequate for work or driving. Most patients can return to work 3-4 days after the procedure, and vision continues to improve daily.
2. LASIK Method
The second category is the LASIK method, also known as the flap-based or deep laser technique. This method provides a much more comfortable postoperative experience. Most patients achieve near glasses-level vision clarity the day after surgery. LASIK patients can typically return to work within two days, provided they take necessary precautions.
The decision regarding which Excimer Laser method to use is made by the ophthalmologist after a detailed eye examination.
Prof. Dr. Emrah Kan
