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. Here’s a quick survey of the available alternatives to laser eye surgery:

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

What it is: Lens replacement surgery, also known as refractive lens exchange or clear lens exchange 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 it is: Astigmatic keratectomy is an old procedure. It 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 it is: 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 it is: Radial keratotomy is 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 it is: CK is 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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