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Surgery for myopia

Everything about the operation of myopia

 

Nearsightedness surgery is surgery of the eyes, made most often with a laser, under local anesthesia and on an outpatient basis (not hospital). It allows short-sighted patients no longer wear glasses or lenses. Each year, millions of short-sighted people benefit from their myopia correction by LASIK or PKR and become independent at a lens correction by far (glasses, lenses), which gives them a better quality of life.

This page is dedicated to the principles that allow to operate the myopic eyes of safe and effective. Links lead to pages containing more detailed items (ex:) Learn more about the myopia).

 

Surgery of myopia in a few lines:

Nearsightedness surgery caters to the short-sighted people who no longer want to wear glasses or lenses.

Techniques using the laser and re-surfacing of the cornea are commonly used)LASIK, PKR). The SMILE is to bulk remove a duckweed pre with a laser femtosecond

Both eyes are operated the same day, under local anesthesia, outpatient.

The vision improves quickly, we can rework the next day After a LASIK, and from the 3rd or 4th day After PKR.

Thecomplications are exceptionalWhen l 'indication is well put and well-executed technique.

THEastigmatism And myopia occur at the same time.

Presbyopia is not a contraindication to surgery for nearsightedness.

 

Principles to correct nearsightedness

The myopic eye is assigned a excess of Optical power. From light rays from a distant point source are refracted by the cornea and the lens and converge in front of the retina, then diverge, then forming a circular spot on the retina, instead of a point.

The affected eye of myopia has an excess of optical power)vergence). This excess of power or vergence is quantified by the digit "en." diopters "the prescription glasses or lenses (the symbol of the unity of diopter is D). For example, a lens-3.50 D corrects an eye which the excess of optical power is equal to 3.50 D. Do not confuse diopter and tenths: the presence of myopia (in power) reduced theVisual acuity the eye (in tenths).

If is reduced to the desired value (vergence) optical power of the myopic eye, from rays from a distant source converge in terms of the retina and the image becomes sharp. Schematically, for a myopia of-2.50 (glasses or lenses) it is necessary to subtract 2.50 D to the vergence eye to make Emmetropic patients.

Nearsightedness surgery is to reduce the optical power of the myopic eye, and make the patient Emmetropic (NET vision from afar without correction). For this, either:

  •  reduce the optical power of the cornea

  • replace the lens with a less powerful implant.

Indeed, even if the main cause of myopia is an excessive length of the eye (too much axial length), it is not possible in practice to shorten the eye (IE reduce the axial length, allowing the retina to be in the plan where the light is focused by the cornea and the lens).

 

Site of action of surgery

(Vergence) optical power of the eye is equal to the sum of the respective powers of the cornea and the crystalline lens.

The principles of the myopia surgery differ depending on whether it is exercised on the cornea (remodeling laser to reduce his power), or the lens (replaced by a suitable power implant).

The site of action of refractive surgery depends on many parameters, including the age of the patient, the presence of a debutante cataract, etc. Once the site has been chosen, the surgeon determines the most suitable technique.

Surgical correction techniques

Schematically, the myopia operation is based on the following principles:

Reduction of the optical power of the cornea

In PKRthe correction is issued by laser excimer on the surface of the cornea, after resignation of the epithelial layer. The excimer laser sculpts the front of the cornea in order to reduce the curvature, and so the vergence.

principles of the bischofsweihe myopia on the cornea laser

Correction of myopia by photoablation laser on the cornea. The myopic eye has excessive length towards the power of the cornea and the lens focus. The image formed on the retina is blurred because de-focused: image of a distant source is a light disc, instead of a ' point '. " The myopia corneal refractive surgery uses laser to reshape the surface of the cornea. In the case of myopia, you should remove the power of the cornea focus: this is done by reducing the camber of the cornea with a laser (LASIK or PKR) sculpture. The degree of reduction of the corneal curvature depends on the importance of correct myopia, and the size of the optical area chosen to deliver the laser correction. The cornea is thinner at the Center after treatment.

In LASIKthe sculpture to the excimer laser is delivered in the thickness of the cornea, after cutting and a superficial corneal flap uprising. This flap is cut with a femtosecond laser.

In Smile, the femtosecond laser is used to cut "in situ" a duckweed, which is then dissected and extracted manually through a small incision.

Depending on the site of the laser issue, so there are techniques of:

– LASIK (the laser is delivered in the thickness of the cornea after cutting a flap that is reclined during the delivery of the Excimer laser)

– Smile: The femtosecond laser cuts the path of the duckweed in the thickness of the cornea. The duckweed should be dissected and then extracted manually.

– PKR (the laser is delivered to the surface of the cornea, after removing a superficial leaf: the corneal epithelium, which then regrows in a few days).

Outside the delivery site and the method of withdrawal, the volume removed for correction of the same myopia is identical for the three techniques (at least in theory, because in smile the volume of fabric is more important, because artificially increased to increase The thickness of the edges of the duckweed and facilitate manual extraction.

 

These techniques are carried out under local anesthesia by drops. Both eyes are operated consecutively on the same day.

Whether in LASIK or PKR, the excimer laser delivers a «» profile of ablation "that depends on the number of diopters correct: to reduce the curvature of the cornea, this profile contains a number of shots in the center of the cornea. Most nearsightedness is strong, and the deeper Central removal of the treatment is high. We can associate the correction of astigmatism with myopia: astigmatism correction is integrated into the overall treatment. Once the laser is issued, the cornea becomes "less arched", and its optical power (vergence) is reduced.

Techniques ReLEx (for "Refractive duckweed Extraction") are a variant of LASIK, the principle of which is to cut a superficial corneal flap with femtosecond laser (ReLex-Flex techic), together with the cutting (always with laser femtosecond) of a duckweed refractive Corneal (the equivalent of what would be "vaporized" by the Excimer laser). This technique is poorly realized, because if one cuts out a flap, it is better to expose the stromal tissue underlying the excimer laser and to perform a LASIK (the femtosecond laser performs a less precise work than the excimer laser for sculpture Refractive of the cornea).

The RELEX technique in its variant Smile Allows the removal of the duckweed without cutting of a flap, at the cost of a manual dissection Intracornéenne, the duckweed to be extracted by an incision of a few millimetres. The smile technique is therefore more "surgeon dependent" than that of LASIK, and its current results are comparable to those of LASIK, although longer to obtain (it takes a few weeks to a few months to obtain a visual recovery Complete with the smile technique). The ReLex techniques do not allow to benefit from certain technological advantages provided by LASIK and PKR such as selective refocusing on the visual axis, prevention of Cyclorotation,... Retouching after smile can not be done in smile. A PKR is then necessary.

Read: Smile or LASIK?

Various pages are devoted to the fundamental aspects of the correction of myopia laser, to the characteristics of laser ablation profiles, which that of simple myopia, to the simulations of correction of myopia.

 

Rlocation of the lens with an artificial lens implant

These techniques are based on the removal of the lens, and its replacement with an implant. The lens is removed by surgery under local anesthesia (drops): This operation is equivalent to that of cataract. Both eyes are not operated on the same day (a week apart).

surgery for nearsightedness principles of the replacement of the lens by an implant

To correct high myopia, we can reduce the focal power of the couple "crystalline corneal" by replacing the lens with an implant, whose optical power is calculated to correct the myopia of the operated eye. This calculation is called 'biometrics': it logically depends on the length of the eye (called axial length) and power (curvature) corneal, who is not changed by this surgery.

The power of the implant that replaces the lens is calculated before the operated eye is more nearsighted after implant placement. The calculation of the power of artificial lens implant is called "biometric calculation" or "ocular biometry".. This technique is particularly indicated in patients over 40 years, and who have a cataract associated with a high (for example more than 12 D of myopia) myopia (see sclinical simulation and case). It is similar in its technical realization a cataract surgery.

Adding an implant of negative power into the anterior chamber or the posterior Chamber.

Indications are more rare and relate to the correction of high myopia, when it is deemed preferable not to remove the lens. The tolerance of these implants seems limited in time, to 10 years on average. In the past, there is often a reduction in the density of endothelial cells with implants of anterior Chamber, cells that are located on the back (inside) of the cornea, making the risk of corneal edema. The posterior Chamber implants, placed behind the iris, are located close to the lens and can be the cause of cataracts which require a re-intervention including the removal of the implant and the replacement of the lens by an implant emmétropisant. They give dramatic functional results in strong short-sighted, and it is best to offer patients at least 35 years of age.

 

Conclusion

The choice of the site and the technique will be made is a function of many parameters (age, degree of myopia, the thickness of the cornea, presence of a cataract, etc.).

Younger patients without cataract and cornea is sufficiently thick and regular benefit from refractive surgery laser. Older patients, more strong myopic and presenting a beginning of cataracts are logically more likely to benefit from a cataract surgery, with correction of myopia with the wise calculation of a suitable implant power)Biometry). This site contains lots of information on techniques and indications for the correction of myopia (see for example): choice of technique: LASIK, PKR?), the videos devoted to these techniques.

40 responses to "myopia surgery"

  1. Dr. Damien Gatinel says:

    25 you are certainly not presbyopic (can be short-sighted and have astigmatism?). The indication of a laser surgery is due to several parameters. Strong dry eyes can worsen after Lasik. The PKR might be more appropriate in your case. Everything depends on the degree of myopia, the topography and the State of your corneas. Possibly get a second opinion by asking more specific questions to your surgeon.

  2. Manon Lamarche says:

    Hello

    I went to Lasikmd for a laser surgery. I could not benefit from lasik because I had too much pressure in the eye. probably due to the fact that I'm wearing lenses since my teenage years. Could an implant be possible in my case? I have a fairly high myopia around-12.

    Thank you

  3. Dr. Damien Gatinel says:

    The presence of a hypertonia (increased intra ocular pressure) unfortunately is a contraindication to the implant surgery to correct nearsightedness. The port of lenses is not responsible for an increase in the intra ocular pressure. But myopia is a risk factor for chronic glaucoma. It is important to regularly check your eye pressure and possibly perform an assessment of glaucoma.

  4. Adam harly says:

    Hi, I have a question to ask you doctor here I am 24 years old and I'm nearsighted (-1.5 for both eyes) I wonder if the Laser operation will work for my case.. .and is what there will be no side effects.. .thank you

  5. Dr. Damien Gatinel says:

    You are certainly debilitating myopia in distance vision (myopia of-1.50 D limited visual acuity to 2 or 3 tenths for the concerned eye), but which in PKR or LASIK correction is accurate. It is necessary to perform a check to verify the absence of contraindications to refractive surgery. If the corneas are not thick or regular enough to practice a LASIK, a PKR (surface laser) will be proposed principle. On this site you will find many pages devoted to the description of these techniques and their side effects.

  6. Roger Jahchan says:

    Hello, doctor,
    I have to have cataract surgery of the right eye. I am myopic (4 diopters). I am told that I will no longer have to wear glasses of myopia after the intervention. Is that true? Is this the best solution?
    With my early Thanks,
    Roger J

  7. Eric Pezzulla says:

    This type operation of myopia is - it possible to 58 years?

  8. Dr. Damien Gatinel says:

    There is really no age limit for myopia laser surgery, must be made in full and in the absence of cataract eye assessment, and by aiming for a strategy of correction adapted to your wishes, it is possible to consider this type of surgery.

  9. Dr. Damien Gatinel says:

    It is indeed possible that you can benefit from the placement of an implant whose power will be calculated for the emmetropia (NET vision from a distance without glasses). But in this case, you will need to have recour to glasses to see up close. At the short-sighted people, who are used to read close without glasses, it is sometimes difficult to give up this facility. A strategy to leave a slightly myopic to keep a bit of vision closely (monovision) eye may be interesting in some case. Furthermore the use of multifocal implants is also to consider. It is to the patient to decide according to their personal preferences and its relation to the glasses.

  10. Veronica Musacchio says:

    Hello Dr.
    I have had myopia with Lasik a little less than 20 years ago (I had-9 and-9.5) and from my 30 years (I currently have 42) myopia has returned. I have-2.75 and-3. Today I went to see the specialist and he strongly advised me the method of the implantation of slow ICL (posterior chamber) since the thickness of the cornea does not allow to remake the laser. I would therefore like to know if with this method the risks of developing a cataract before age 65 are important.
    Thank you for your reply!
    Sincerely,
    Verónica

  11. Dr. Damien Gatinel says:

    It would looks best to carry an additional laser photoablation, unless your corneas are truly too thin for a recovery. A PKR is another possibility, certainly less invasive than implants, for low myopia that you present. Finally, a correction to the posterior side of the flap is also possible (if the flap is relatively thick). I recommend instead the implant in your situation, because its implementation requires an opening (incision) existant, and the insertion of a lens with actually a risk of early cataracts.

  12. Alice FADY says:

    Dr. Ganeshan,
    I went to a centre practicing laser operation for the correction of myopia, and it was indicated to me that in my case no operation could be practiced. The doctor I saw did not give me a clear explanation and I would have liked to know your opinion.
    The reason why I was told that I could not be operated is on the refractive axial map/sagittal (anterior face). The figures shown in the centre on either side of the dotted circle are 41.7 and 43.3. The doctor told me that the gap was greater than 1, there could be no surgery. Is that true? If so, can you give me a clearer explanation?
    Thank you for your response.
    Alice FADY

  13. Dr. Damien Gatinel says:

    It is difficult to give you detailed explanations of why you are excluded from refractive surgery; We must examine and inspect the topographic maps in their entirety, and possibly confront them with the desired correction...

  14. Dr. Ganeshan,
    For a young subject (19 years old) with a myopia of 3, 5d for the left eye and-22D for the right eye, without cataract, and whose cornea is not thick enough, is there an operation that could be practiced to correct this myopia?

  15. Dr. Damien Gatinel says:

    Only surgery involving the insertion of an implant could reduce the myopia on the left side, but it is still a May too early to suggest this: the wearing of lenses (ex rigid) is preferable; The insertion of a phake implant is more indicated in the Thirties.

  16. ROFFET says:

    Hello
    I'm 37 years old. I was operated in 2002 by PKR for a myopia of-3 with astigmatism-2.5/-3). At the exit of the operation, I still had astigmatism (-1) but since my eyesight has deteriorated.
    I have today-1.25 diopters with each eye + astigmatism (-1.5) and a cornea of 385 and 414 microns at the very end. In all honesty, do you consider me re operable in the course of an intervention?
    Kind regards

  17. Dr. Damien Gatinel says:

    A reprocessing is possible depending on the appearance of the corneal topography, at least on one eye (the Guiding eye). Re-processing is done again in PKR (surface laser).

  18. COULON Pierre says:

    Hello doctor,
    Operated by your Care (PKR) in 2007 at the age of 19 years for professional reasons, I noticed a decrease in eyesight, forcing me about 3 years after the operation to wear corrective lenses. The wearing of lenses is impossible (eyes too dry), is a new operation possible? I am more deeply affected by the effect of "halos" at night, making me very difficult driving in agglomeration. Would a re-operation amplify the phenomenon??
    Kind regards

  19. Dr. Damien Gatinel says:

    It is a priori possible to consider a retouching after PKR, again in PKR. Operated at 19 years old, it is possible that your myopia was not completely stabilized at that time. A recurrence of a small myopia could quite explain your symptoms. A review is necessary to confirm the possibility of a late retouching.

  20. HDCaulfield says:

    Hello Damien,

    I am myopic & astigmatism (-9 left eye, – 14 right eye) and has been wearing lenses for more than 15 years (I have 30 today) and so far the ophthalmologists have told me that operation implants was possible to my correction but not advisable if I support the Lenses.

    Do you share that point of view? If I was not allowed to support the lenses, what is the likelihood that I can wear implants via operation?

    Thank you for your return

  21. Dr. Damien Gatinel says:

    It is actually rather appropriate to continue wearing contact lenses for now. The tolerance of Piol implants (for the correction of strong myopia) is not unlimited over time. It is better to use these when the tolerance of the lenses becomes insufficient.

  22. Bass says:

    BSR I am 37 years old and I have a strong myopia of-13 and-16 I wear contact lenses. For 17 years I comance to be tired of putting them and removing them every day of the coup I plan to make me make implants.
    In the waiting cordially

  23. Dr. Damien Gatinel says:

    This is indeed a good indication, vis-à-vis your age (> 35 years) and your degree of myopia (beyond the possibilities of correction in LASIK).

  24. V. Durand says:

    Hello

    I am 28 years old and I am myopic with lightweight Astigmat:
    OD: – 13
    OG: – 13. 50
    In view of my myopia I am offered an ICL implant. When do you think? Is it possible to make me a LASIK?
    I've been wearing lenses since 14ans now. And my eyes are starting to be dry... I can't stand the rigid lenses.
    Thank you in advance for your return.

  25. Dr. Damien Gatinel says:

    For this degree of myopia, it is rather advisable to carry out a chirurige by the installation of ICL implants. The indications of LASIK are usually limited to 10 or 11 D depending on the thickness of the cornea.

  26. Bruno CANALIS says:

    Hello doctor,

    Already congratulations on your site which explains very clearly the different types of operations to correct myopia.

    I am 63 years old and I wear oxygen permeable lenses of type Menicon Ex Z since the age of 25 years with the following corrections:
    OD: – 8
    OG: – 6
    For now 3 years I hardly support my lenses essentially the left eye.
    So I'm thinking of having an operation.

    What scares me is that I should not wear my lenses for a long time before the operation.
    Is this true and does this period depend on the type of operation?
    Thank you in advance for your answer.

    Greetings

  27. Dr. Damien Gatinel says:

    It is indeed recommended not to wear rigid lenses a few weeks before the completion of the pre-operative balance sheet (so as not to distort in part the examination of corneal topography). However, it is possible to replace the rigid lenses with soft lenses during this period. These precautions are useful for both contact surgery (LASIK, PKR, etc.) and surgery by replacing the Crystalline lens (indicated in case cataracts).

  28. Ziat says:

    Hello Doctor

    I'm going to be 44 years old and I've been wearing lenses for 39 years I have a strong myopia but now I want to get oprerer, is this still possible at my age, I have a right eye correction-18 addition. Left Eye 17.50

    Thank you

  29. Dr. Damien Gatinel says:

    LASIK does not help to correct such an important myopia. It is necessary to use an implant chirurige, either by inserting an implant without removing the Crystalline lens (implant Phake) or by replacing the Crystalline lens with an implant (this method will be preferred if you present Signs of "Pre-cataract", which may appear more précocémment in the strong myopic. A pre-operative assessment is of course indispensable.

  30. U. David says:

    Hello doctor,
    I'm currently 27 years old. I have-10.5 diopters with each eye + astigmatism (-1.5). The thickness of the cornea in the center is 510 microns. Can I benefit from the Lasik operation? If not, do you think an ICL implant is a good solution to no longer wear glasses?
    Thank you in advance for your return.

  31. Dr. Damien Gatinel says:

    A LASIK could be achieved but with certain constraints like the necessary reduction of the optical area treated, and this porurait compromise the vision in low light. This to put in connection with your "dynamic pupillary" (diameter of the pupil in low light conditions). An ICL implant is able to correct you in full, but piol implants are sometimes the source of some long-term complications (ocular tension, cataracts, etc.). It is recommended in some case to wait until the thirties to ask them.

  32. Sonia says:

    Hello doc I'm myopic from birth, astigmatism for 10 years, I wear soft lenses for my myopia, I have-24 and-23 and glasses over for astigmatie;;; I'm 44 years old
    I suffer more and more from this handicap because you suspect well I do not see well despite the 2 corrections I heard about ICL is what this operation is expensive
    Is she risky thank you
    Kind regards

  33. Dr. Damien Gatinel says:

    Your degree of myopia exceeds the possibilities for correction by ICL implant. The best is to consider early surgery of the catrace. Eyes with strong myopia are often afflicted with cataracts early in life and replacing the Crystalline lens By a suitable power implant will be able to reduce very strongly your myopia and possibly correct at the same time all or part of your myopia.

  34. Dorothée says:

    Hello
    I have 37 years and a steady myopia for some years-3.25 and-3.50.
    I support the lenses but I sometimes feel some discomfort especially to the right eye.
    I don't want to wear my glasses on a daily basis. I am considering the operation but, in your opinion, is it still worth knowing that the presbyopia will arrive in a few years... and that I again have to wear glasses?
    Kind regards

  35. Dr. Damien Gatinel says:

    It is possible to case Of operation, to realize a slight under correction of the non-dominant eye to anticipate the appearance of the presbyopia. Moreover, this one does not necessarily simplify the life of the myopic, because if you wear lenses, it will require glasses "in addition" for reading (or else to carry out a kind of "under correction" of the non-dominant eye...).

  36. CASTRO says:

    Hello, doctor.
    I'm 37 years old and I've been wearing lenses for over 14 years.
    I have a high myopia of-17 and Astigmat.
    I would like to know which method is recommended to me because after a ophthalmologist consulted more than 7 years ago it would not be possible to apply a lazer in my case .
    Please inform me to be able to decide.
    Kind regards

  37. Dr. Damien Gatinel says:

    A myopia of 17 diopters is not correctable in LASIK. On the other hand, the insertion of piol implants is a possibility of correction at 37 years.

  38. Khadija says:

    Good evening
    I am 27 years old, I have a strong myopia-9.5 associated with a strabismus diverging only in the right eye, the left eye is neutral. I consulted with two ophthalmologists for a laser correction one recommended to me and the other not on the pretext that we do more laser correction when the myopia exceeds-6. I was stuck in front of these two conflicting opinions I don't know what to do anymore. Can you give me your opinion, doctor?
    Kind regards

  39. Dr. Damien Gatinel says:

    It is possible to operate a strong myopia (ex-9.50 D) in corneal surgery type LASIK, provided that the cornea has sufficient thickness and regularity. A detailed pre-operative assessment is therefore necessary before deciding.

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