Laser Vision Correction has grown significantly over time, due to increased safety and precision as well as increased consumer awareness and expanded approval of new technology and treatment modalities.
LASIK (laser in situ keratomileusis) continues to be the most widely used surgery for most ranges of refractive corrections. It is safe and visual recovery is rapid. It can be enhanced and combined with other procedures like Phakic IOLs, Intraocular lens implantation etc. With the addition of the wavefront technology, femtosecond (FS) laser, photoablation is able to create precise subsurface incisional planes. Scanning excimer lasers now allow for bigger and smoother ablation zones.
A world literature review of LASIK completed in 2008 showed an overall satisfaction rate of 95.4%, the most common reasons for dissatisfaction being residual refractive error, dry eyes, older age, and night vision symptoms.
Most LASIK complications can be corrected so that no long-term problems persist. However, some uncommon complications can have permanent visual consequences.
A realistic picture has to be given to the Patient by the Surgeon. The basic procedure and normal clinical course following the surgery like side effects (dry eye, glare and halo sensation) should be explained prior surgery. Possibilities of retreatment or additional treatments (10-20% cases), post operative need of glasses (in presbyopes) must be told to the patient.
LASIK is recommended at the age of 18-21 years. Up to -10 D or myopia (short sightedness) and +4D of hyperopia (long sightedness) and astigmatism up to 5 D can be corrected. A stable refraction is the first and foremost criteria.
LASIK is not recommended in patients with collagen vascular disease, autoimmune, or immunodeficiency diseases; women who are pregnant or nursing; patients with signs of keratoconus; and patients taking isotretinoin or amiodarone.
Other conditions with potential adverse outcomes include ophthalmic herpes simplex or herpes zoster, or other systemic diseases like diabetes mellitus, HIV. Patients who are active in martial arts, contact sports, should be informed that with LASIK there is a chance of flap injury. (Source; text book of cornea Jay. H. Krachmer)
Though, much as been said about LASIK, the first and foremost modality today and in the future will be spectacles only.
Both the patient and the doctor will be able to decide on laser vision correction only after the refractive error has been corrected by spectacles. As laser correction is recommended after the age of 18, spectacle use is inevitable till that age.
The advantage of spectacles is that they can be prescribed by an optometrist also where as laser correction requires a super specialist. The cost of spectacles is way cheaper. Spectacles can be changed as and when the power changes whereas laser correction is irreversible.
The use of spectacles may not be optimal in certain patients who have high refractive errors as the peripheral vision is constricted but they are the only means one can correct refractive errors in children. Spectacles today are a fashion statement and designer frames with celebrities promoting it make it the first choice in younger generations even in those who have no refractive error.
Dr. Radhika Rao, MBBS. DOMS, Fellow General Ophthalmology
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