In the modern landscape of ophthalmology, laser vision correction stands as a beacon of hope for millions troubled by refractive errors, such as near-sightedness, far-sightedness, and astigmatism.
In a pair of healthy eyes, the clear front part (the cornea) and the lens work together to bend light precisely onto the back of the eye (the retina), ensuring sharp vision. However, conditions like near-sightedness (myopia), far-sightedness (hyperopia), and astigmatism can cause blurriness by messing up how light bends.
Laser vision correction can improve mobility, freedom, and safety by reducing reliance on traditional vision correction methods like glasses and contact lenses. It can be especially beneficial if glasses or contact lenses interfere with your enjoyment of regular activities.
What is laser vision correction surgery?
LASIK, or laser refractive surgery, is a vision correction surgery that reshapes the cornea using a laser. The first modern-era LASIK procedure with corneal flap creation was performed in 1990 using a mechanical microkeratome and the precision of an excimer laser to reshape the cornea. Over the years, LASIK technology has evolved to use femtosecond lasers and wavefront-guided ablation for more precise and predictable results. LASIK can correct a range of vision problems, including near-sightedness, far-sightedness, and astigmatism, and has helped millions of people achieve clear vision without glasses or contact lenses.
What are the different types of laser vision correction?
SMILE Pro is the newest and latest femtosecond laser technology available in laser vision correction. It's a flapless upgraded SMILE version utilising the most recent generation machine (ZEISS VISUMAX® 800) with an innovative femtosecond laser platform, technology, and laser beam scanner system. The total laser's active time is shortened to less than 10 seconds from 25 in ReLEx SMILE, reducing the risk of complications. The femtosecond laser beam passes through and magically and precisely carves out a lenticule without disturbing the outer corneal layers by dynamically varying the laser pulse duration, frequency, and energy. SMILE Pro represents a genuine generational leap over the previous generation of SMILE devices with intelligent robotic assistance and integrated digital workflow, providing faster, safer, and more precise results with better vision, quicker recovery, and greater comfort. SMILE Pro expands the scope of treatable conditions, including thin corneas, active lifestyles or occupations, and more severe vision correction needs:
- ReLEx SMILE, short for Small Incision Lenticule Extraction, was the most advanced and minimally invasive FDA-approved laser vision correction procedure before the advent of SMILE Pro. With no flap, it creates a customised, thin contact lens-shaped disc (lenticule) just beneath the eye surface with a femtosecond laser, then removes it through a tiny 2-4 mm incision to reshape the cornea and correct vision like SMILE Pro.
LASIK
LASIK, short for laser-assisted in situ keratomileusis (the surgical reshaping of the cornea with the laser), is the best-known and most-performed laser refractive surgery to correct vision problems. Ophthalmologists create a small flap of corneal tissue using a mechanical microkeratome blade (microkeratome LASIK) or a femtosecond laser (femtoLASIK) or bladeless LASIK, which are more precise and predictable flaps than microkeratomes, and then flip open the flap, akin to opening a book cover. The excimer laser then reshapes the underlying corneal tissue to correct vision. The corneal flap is then folded back and stays in place without stitches. FemtoLASIK is a painless, safe, and more accurate surgical procedure compared to microkeratome LASIK.
PRK
PRK, the original laser vision correction surgery, gently removes the cornea's outer surface layers. Then, a computer-controlled excimer laser precisely removes and sculpts microscopic amounts of corneal tissue without creating a flap. PRK is a good option for people with thin corneas working in high-risk occupations, such as boxers, pilots, military personnel, or police officers.
What are the pros and cons of these procedures?
SMILE
Pros:
- Minimally invasive, with quicker treatment and recovery.
- Lower risk of flap-related complications.
- Reduced chance of dry eyes, with milder symptoms and a shorter duration.
- Potential preservation of corneal biomechanical stability.
Cons:
- There is limited suitability for farsightedness correction at present.
LASIK
Pros:
- Speedy recovery, especially compared to PRK.
- High precision and enduring outcomes.
Cons:
- Possibility of flap-related issues, though modern techniques like FemtoLASIK have mitigated this risk.
- Potential for dry eyes and nighttime vision disturbances.
PRK
Pros:
- Ideal for individuals with thin corneas and those in high-risk professions.
- No flap-related complications.
Cons:
- Discomfort or eye irritation lasting 5-7 days post-procedure.
- Prolonged healing duration compared to LASIK and SMILE due to regrowth of the removed outer layers over the cornea.
Surgeons will assess suitability based on individual needs and conditions.
Criteria for suitable candidates for laser vision correction typically include:
- Age of at least 18 years.
- Consistently stable vision or stable prescriptions for eyeglasses and contact lenses over the past year.
- Absence of any current or past corneal diseases.
- No significant medical or ocular conditions like prior corneal ulcers, progressive corneal thinning (keratoconus), severe dry eye, diabetic retinopathy, macular degeneration, or uncontrolled glaucoma.
- autoimmune disorders (e.g., lupus, rheumatoid arthritis), compromised immune systems (e.g., HIV), or unmanaged diabetes, all of which can impact healing processes.
- Not pregnant or breastfeeding.
- Not using specific medications, including isotretinoin, amiodarone, or steroids.
- Realistic expectations regarding the outcomes of the procedure.
For those contemplating laser vision correction, the cornerstone of informed decision-making lies in consulting with a seasoned eye surgeon of utmost expertise. Through meticulous evaluation, these specialists discern the intricacies of each case, crafting personalised recommendations grounded in both medical acumen and individual nuances. Trust in their guidance ensures not just vision enhancement but a journey towards optimal ocular health and clarity, tailored precisely to your needs and medical background.
Author: Thitima Wungcharoen, MD, Ophthalmologist specialising in Cornea and Refractive surgery, Eye Care Center, MedPark Hospital Tel. +66 2023 3333.
Series Editor: Katalya Bruton, Healthcare Content Editor and Director, Dataconsult Ltd. Dataconsult’s Thailand Regional Forum at Sasin provides seminars and extensive documentation to update business on future trends in Thailand and the Mekong Region. Contact: info@dataconsult.co.th Tel: 662-233-5606/7
