Alternatives to Laser Eye Surgery

Alternatives to Laser Eye Surgery

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Laser eye surgery was first introduced in 1989, and is now considered a primary solution to sight problems. However, not everyone is suitable for laser eye surgery. Certain factors such as age, pre-existing medical and eye conditions, as well as the nature of the sight problem make it necessary for some patients to undergo alternative procedures. In this article we cover the following alternatives to laser eye surgery:

Phakic IOL/Visian ICL Implants
Clear Lens Extraction/Refractive Lens Exchange (CLE/RLE)
Intra-Corneal Rings (INTACS)
Astigmatic Keratectomy
Laser Thermal Keratoplasty (LTK)
Radial Keratotomy
Conductive Keratoplasty (CK)

Phakic IOL/Visian ICL Implants

What is Phakic IOL?

Firstly, IOL stands for ‘intraocular lens’ — a lens implant which is inserted into the eye. A phakic IOL is a little different to other IOLs, in that it’s implanted in addition to the natural (crystalline) lens. Whereas other IOLs are used to replace the natural lens, for example in cataract treatment.

What can an ICL procedure achieve?

An ICL procedure is able to treat a high range of prescriptions — beyond what’s treatable by laser eye surgery — including short-sightedness (myopia) up to -20D, far-sightedness (hyperopia) and astigmatism.

ICL surgery is also reversible, if needed. Should a patient’s prescription change dramatically, or they choose to follow another form of vision correction, a phakic lens is easily removed.

How does Phakic IOL work?

The ICL implant is a soft foldable lens, placed inside the eye through a small opening created at the base of the cornea. This corrective lens sits behind the iris (the coloured part of the eye) and in front of the natural crystalline lens. Once in place, the phakic implant allows light to focus properly on the retina — therefore removing the need for you to wear glasses or contact lenses.

If you choose to have phakic IOL surgery, you can expect the procedure to be painless, thanks to the numbing medications applied to the eye beforehand.

Who can benefit from ICL surgery?

ICL surgery may be suitable for patients who have been advised against having other corrective laser eye treatments (e.g. LASIK and LASEK/TransPRK treatments) because they have dry eye, a high myopic prescription, or thin or bulging corneas.

Because a phakic procedure doesn’t doesn’t involve remodelling the cornea, it doesn’t induce dry eye.

Generally speaking, those undergoing phakic IOL surgery should be of good health and between 21 and 60 years of age. They may be near-sighted with mild to severe myopia (-0.5D to -20D), farsighted with mild to severe hyperopia (+0.5D to +10.0D) or have astigmatism between 0.5 and 6.0 D.

There’s one key limitation though: phakic patients should not have had a change in prescription of more than 0.5D in a year.

Are there any risks with Phakic IOL?

As with all surgical treatments, there are some risks to be aware of. With phakic IOL, there is a possibility that the patient may develop an increase in eye pressure or sustain damage to the crystalline lens as a result of the procedure.

Vision over- or under-correction is also a risk of any refractive treatment.

Make sure you speak to your optician, or another trusted source, before you undergo any eye surgery.

Learn more about the specific ICL options:

One phakic IOL you may have come across is the Visian ICL, also known as the Implantable Collamer® Lens or ICL.

The Visian ICL is a removable lens implant that, like many other IOLs, can be used to correct common visual problems such as near-sightedness (myopia), far-sightedness, and astigmatism.

Clear Lens Extraction/Refractive Lens Exchange (CLE/RLE)

What it is: CLE is a fairly new procedure that replaces the lens of the eye with a synthetic one. The natural lens is replaced by either being completely removed or having the synthetic one placed in front of it.

What it can fix: Severe longsightedness, shortsightedness, astigmatism and cataracts.

Procedure: The surgeon puts anaesthetic eyedrops in the patient’s eye and holds it open with a speculum. If the lens is to be removed, the surgeon then uses a probe that emits ultrasound pulse to break up the patient’s lens. The broken fragments of the lens are then sucked out and the synthetic lens is put in place.

Advantages:  Can correct high prescriptions which would normally not be fixed by laser eye surgery.

Risks: There’s a possibility that the patient will develop glaucoma or eye oedema, or sustain eye damage and even loss of vision.

Suitability: The patient must be of generally good health in order to undergo this procedure.

​Intra-Corneal Rings (INTACS)

What it is ​: INTACS involves the insertion of colourless semi-circular clips into the cornea. The clips are made from a special type of plastic and are designed to reshape and strengthen the cornea.

What it can fix: Myopia (shortsightedness) and keratoconus, a condition where the cornea is too thin which makes the eye bulge and  causes astigmatism and myopia.

Procedure: The surgeon puts anaesthetic eyedrops in the patient’s eye to make it numb. The eyelids are held open and the surgeon makes incisions around the cornea to insert INTACS under it. The INTACS then stick to the cornea and reshape it. The surgeon then stitches the INTACS to secure them. The patient is given eyedrops to prevent infection. The surgeon removes the stitches after a couple of weeks. Vision correction can happen straight away, but can sometimes take up to months.

Advantages over laser surgery: No pain and no tissue removal involved, the INTACS can be changed if the patient’s vision does and it lowers the risk of nighttime glare and starbursts.

Suitability: Patients must be over 21 years old, not pregnant or breastfeeding and must be free from autoimmune disorders.

Astigmatic Keratectomy

What is Astigmatic keratectomy?

It’s a relatively old procedure that involves the use of a knife instead of laser to reshape the cornea in order to correct astigmatism.

What it can fix: Astigmatism.

Procedure: The surgeon measures the patient’s eye and treats it with anaesthetic. The surgeon then marks the cornea and makes two incisions to help it become more spherical. The patient is given medication after the procedure to prevent any infection. Normal vision returns after just a few days, although sometimes it might take a patient a few months to fully recover.

Risks: Complications such as nighttime starbursts and glare and aversion to light might develop. Some patients may also have to undergo enhancement surgery at a later date.

Laser Thermal Keratoplasty (LTK)

What is LTK?

LTK is a procedure intended to increase the steepness of the cornea through the use of a laser. This involves no tissue removal.

What it can fix: Astigmatism and longsightedness.

Procedure: The surgeon uses a laser beam to cut progressively larger circles on the surface of the cornea, starting near the centre of the eye. This scoring process causes the cornea to be steeper, thus increasing the refractive power of the eye and allowing the patient to see things up close.

Advantages: Quick and simple procedure with very little pain, low infection risk and short recovery period of around two days.

Risks: The results are temporary and the patient will have to have the procedure within two years.

Suitability: The patient must be at least 40, has a stable prescription and a suitably shaped cornea.

Radial Keratotomy

What is Radial Keratotomy?

It’s similar to LASIK, but uses blades instead of a laser to reshape the cornea.

What it can fix: Astigmatism and shortsightedness.

Procedure: After applying anaesthetic on the patient’s eye, the surgeon will cut concentric circles in the cornea with a very sharp blade to flatten it, thus reducing the refractive power of the eye and allowing the patient to see objects from a distance.

Advantages: Cheaper than LASIK (from £300 to £500 per eye) and suitable for people who are terrified of laser eye surgery.

Risks: There’s a possibility of over-correction or under-correction as well as nighttime glare and starbursts. The patient may also still need to wear glasses even after the procedure and infections can occur in some cases.

Suitability: Patients must be over 18 and have only mild shortsightedness.

Conductive Keratoplasty (CK)

What is Conductive Keratoplasty (CK)?

Its a simple, laser-less procedure that uses radio waves to shrink parts of the cornea to help increase its refractive power.

What it can fix: Longsightedness and presbyopia.

Procedure: The surgeon puts anaesthetic eyedrops in the patient’s eye and holds the eyelids back with a speculum. The surgeon will then mark small circles on the cornea using a special type of ink and move a pencil-shaped tool around the cornea. This will shrink the cornea and allow the eye to see objects up close.

Advantages: Vision is improved straight away, it is painless and the recovery is relatively quick (two days).

Risks: In some cases, the patient’s vision takes up to month to return to normal. There’s also the possibility of over-correction, nighttime glare and starbursts, fluctuations in vision and dryness.

Suitability: Ideally patients are 40 or older, fit and well with no history of eye problems, have no pacemaker, are not pregnant and are not diabetic.

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