By Dr Angelo Appiotti

Don’t say NO to refractive surgery

By 13 December 2019 No Comments
Don’t say NO to refractive surgery
Refractive surgery is an effective and safe way of correcting one’s vision problems: it has been around for over 40 years and eye surgeons all over the world perform it with high success rates. 

In the light of the above, one may think that refractive surgery is widely known and well received by the public and that there is no doubt as to it being a safe procedure.
Unfortunately this is Italy, and there are as many myths surrounding this surgical procedure as there are in the Iliad. Lucky for us, many of such “myths” are so utterly absurd that anyone could dismiss them; some, however, have permeated society and general culture and have become “facts”.
As a result, some people think that, for example, astigmatism cannot be treated with refractive surgery, and that people under 25 cannot undergo surgery because their eyes are still growing.
It is a shame that many do not undergo surgery because of hearsay, which is why I decided to write an article explaining everything there is to know about refractive surgery and eligibility criteria.

Please keep in mind that it is true that for some patients refractive surgery is not an option. Such patients usually suffer from serious medical conditions that damage the eye in such a way that surgery would not be helpful or might result in increased risk of complications arising; however, it is quite rare. Such conditions are severe collagen diseases and retinal alterations, diabetic retinopathy with active diabetes, severe autoimmune diseases, diseases of the immune system like AIDS and other conditions affecting the cornea.
With the exception of the cases stated above, in order to find out whether you are a good candidate for refractive surgery you must undergo specific tests by order of an eye doctor specialising in refractive surgery, which means not a general eye doctor, nor one specialising in glaucoma or strabismus, who may be very good in their field yet unfamiliar with refractive surgery.

Moreover, it is worth mentioning that there is more than one surgery technique, depending on the vision problem of the patient. In addition, depending on the type and seriousness of the refractive error, different measures may be adopted during the procedure itself. As a matter of fact, surgery may change depending on the eye: each patient is given a customised treatment in order to achieve perfect visual acuity.
PRK, Femto-LASIK and ReLex Smile are the laser techniques used in refractive surgery, in combination with surgery techniques such as intraocular lens implant and refractive lens exchange.
In order to know if you are a good candidate for surgery, the following tests are done:
Aberrometry:
This test detects optical aberrations, i.e. when light is distorted by imperfections in the cornea and crystalline lens. Most times such aberrations can be treated surgically.
Corneal topography (anterior and posterior) (topography and pentacam or orbscan to study the corneal posterior surface)
This test offers a detailed description of various curvature and shape characteristics of the cornea, like the presence of astigmatism, while also providing useful information on the surgical procedure to follow. More specifically, it allows the surgeon to assess on which area of the cornea to operate so as to get the best possible result.
Cycloplegic refraction:
By contracting the ciliary muscles, our eyes alter the refractive power of the eye lens. During this test, eye drops are used to temporarily paralyse the ciliary body, so as to determine the true refractive error of the eye. Doing that is essential to treat the vision problem effectively, without over- or under-correcting it.
Pachymetry:
A pachymeter is a device used to measure the thickness of the cornea, which is fundamental to choose the best refractive surgery technique to follow.
Each technique requires a specific corneal thickness, which is why this test is necessary.
Fundus examination:
This diagnostic procedure is carried out to assess the retina and see if there are any retinal diseases. More generally, it helps assess whether or not the patient may benefit from refractive surgery.
Pupillometry:
This test is performed to measure the scotopic pupil size (with dim light, therefore at night usually) so as to plan a customised laser treatment covering an area larger than the pupil so as to limit or eliminate the risk of halos and night aberrations with artificial lights.

In conclusion, unless you suffer from one of the diseases mentioned above, the only way to know for sure if you are a good candidate for refractive surgery is going to an eye doctor specialising in refractive surgery and undergoing the appropriate examinations. Any information you find on the Internet may be misleading, which is why it is of paramount importance for you to refer to a professional to dispel any doubts.