So, you have been told to wear glasses, but you do not want to. What are the options available to you now? This article will try to give you an overview of the latest options you have now. The discussion also includes basic suggestions on how to choose the options that are best suited for each individual patient.
What Is Refractive Error?
There may be a variety of problems which may cause a decrease in the ability of a person to see clearly. Of these numerous causes, glasses/contact lenses/refractive surgery/low vision aids, etc., can only correct disorders related to 'refractive errors'. Refractive errors are diseases which cause an aberrant focusing of light rays inside our eyes. Myopia (near-sightedness) is a condition in which light rays come to a focus in front of the retina, in hypermetropia (far-sightedness), light rays come to a focus behind the retina, astigmatism causes light rays from different meridians to come to a focus at different points and presbyopia is an age-related deterioration of the near focusing mechanisms of the eye.
The important point in refractive error treatment is that timely treatment, especially in younger children, will prevent complications such as amblyopia, which is incurable in older children and adults. Hence, there is a lot of stress on children and adults using glasses to cure refractive errors. But, due to various reasons, this proposition becomes resentable among patients.
What Are the Options Available for Patients with Refractive Errors Who Do Not Want to Wear Glasses?
1. Refractive Surgery
The latest, most promising modality in the field of treating refractive errors. Refractive surgery offers several advantages, the most important of which is that it is the only way to be truly glasses-free. In contact lenses, the lens would be resting on and covering the cornea of the eye, depriving this structure of oxygen. This fact makes contact lenses wear option only for occasional use and not for daily wear for extended periods. The lenses will cause problems like corneal edema if worn for longer periods and contact lens-induced keratitis when used without proper hygiene-related precautions.
The most commonly done procedure is LASIK, which stands for laser-assisted in-situ keratomileusis. In this procedure, the cornea is cut using a microkeratome (automated or manual) to raise a flap. The area of the cornea underneath the flap is then ablated using an excimer laser to mold the shape of the cornea so as to achieve a zero refractive error.
The most advanced procedure of today is ReLex Smile, which stands for refractive lenticule exchange small incision lenticule exchange. In this procedure, the laser creates a lenticule inside the corneal stroma. This lenticule is then removed out using a small incision. The lenticule removal corrects the refractive error.
The other notable procedure includes PRK, which stands for photorefractive keratectomy. This procedure is done using the same machine as LASIK. The only difference being that PRK does not need a flap and hence avoids flap-related complications of LASIK.
Pros and Cons of Each Surgery:
ReLex Smile is the latest and best procedure when it comes to results. The procedure allows for relatively thinner corneas unsuitable for LASIK to undergo refractive surgery. The drawbacks are that there are very few centers which perform Smile, and the cost of the procedure is twice or thrice the cost of most other refractive surgeries. This being a new procedure, in spite of having very good results, no one knows about the long-term complications.
LASIK has been around for almost one to two decades, depending on which part of the world you stay in. It has a good long-term safety record. It has good postoperative results and is available at far more centers compared to LASIK. The price is variable but always less than Smile. The cons are that it is surgeon-dependent and has a high rate of flap-related complications in inexperienced hands.
PRK has all the advantages of LASIK, along with the advantage that it is free of flaps-related complications. The cons of PRK are that it has a long recovery period postsurgery, with patients having very bad stinging and burning sensation postsurgery. This complication, although transient, can be quite discomforting.
2. Implantable Contact Lenses (ICL/IPCL)
The concept of ICL is similar to a contact lens, the only difference being that the lens is implanted inside the eye. The procedure is well known and gives very good visual quality to patients. The pros being, it is a reversible procedure, that is, once there is power change, the ICL can always be exchanged for an ICL of another power, unlike refractive corneal procedures which are irreversible. The cons being that the lens when inserted can incite a reaction due to its position in the eye, it also carries a risk of introduction of infection inside the eye. It is also quite expensive, although local lenses are hitting the markets and the costs of these are almost half those of imported models, results and patient satisfaction were similar.
3. Contact Lenses
Although very popular and available ubiquitously, they are only meant for occasional use. Contact lenses cover the cornea of the eye and deprive it of oxygen. This oxygen deprivation is detrimental to corneal health and may cause permanent corneal scarring and neovascularization, which are deadly complications.
The best form of usage for most people with refractive errors is soft contact lenses which are monthly disposable. Presbyopic contact lenses are also available. The main feature which is to be followed by all contact lens users is hygiene, the instructions for which are duly highlighted on the lens solution bottles.
The main advantages of contact lenses are that they can be used in individuals in the waiting time before refractive surgery. In case the power changes, the lenses can be readily discarded and a new pair with a different power can be bought. It does not have any long-term vision-threatening side effects when used in the proper way.
In the end, the choice of which modality to choose depends on a lot of factors, these being medical, financial and personal. But there are ample alternatives to choose from, although the best judge to determine which is best for you, will be your ophthalmologist.
Frequently Asked Questions