Eyes - laser eye surgery

Laser corneal sculpting is a medical procedure that involves the use of laser to reshape the surface of the eye. This is done to improve or correct myopia (short-sightedness), hypermetropia (long-sightedness) and astigmatism (uneven curvature of the eye’s surface). The first laser sculpting procedures were performed almost over 20 years ago.

The cornea is the transparent tissue that covers the front of the eye. It helps to control focusing. During laser eye surgery, a computer-controlled excimer laser is used to remove microscopic amounts of tissue from the front surface of the eye (the cornea). The aim is to restore normal eyesight, without the need for glasses or contact lenses.

In one of the available operations using the excimer laser, the thin outer layer of the cornea (called the corneal epithelium) is removed and the underlying layers are reshaped. This procedure is known as photorefractive keratectomy (PRK).

In another more commonly used procedure, a thin flap of corneal tissue is created with a fine instrument known as a microkeratome or another type of laser known as a femtosecond laser. This flap is then lifted out of the way. The excimer laser reshapes the underlying tissue and the flap is replaced to cover the newly recontoured surface. This procedure is known as laser-assisted in situ keratomileusis (LASIK).

Myopia (short-sightedness)
Estimates suggest that around 30 per cent of Australians have myopia (short-sightedness). A person with myopia has no trouble focusing on close objects, but objects in the distance are blurry and difficult to see.

Hypermetropia (long-sightedness)
Hypermetropia is more common than myopia but tends to cause vision problems more commonly in people over 40. A person with hypermetropia sees distant objects better than close objects. They depend on glasses for up-close tasks such as reading.

The most common variation of this is presbyopia. This is where people can see quite well in the distance but need to hold reading material further and further away from their eyes to be able to see clearly. This usually cannot be corrected with laser corneal sculpting.

Reasons why surgery may be considered
The reasons why a person may consider laser corneal sculpting include:

• They can’t wear contact lenses and would prefer not to wear glasses for cosmetic reasons.
• They want to engage in work or leisure activities that cannot be done while wearing glasses or contact lenses.
• They don't want the inconvenience of contact lens wear and the care required.

• You should be at least 20 years old before you consider laser eye surgery.
• The refractive error (prescription in glasses) should be stable.
• People with diabetes, uncontrolled rheumatic conditions, diseases of the immune system or a family history of keratoconus should be very careful in proceeding with laser eye surgery. An experienced refractive surgeon will be able to advise you appropriately.
• Laser eye surgery carries extra risks if performed on patients with abnormally shaped or very thin corneas. These are easily determined during preoperative testing in a refractive surgeon’s office.

• Myopia - the central apex or peak of the cornea must be flattened to reduce the degree of short-sightedness.
• Long-sightedness - the central apex of the cornea needs to be made steeper. This is done by applying the excimer laser to the edges of the cornea.
• Astigmatism - this occurs when the cornea is more curved in one direction than the other so the laser is applied in a more linear fashion to make the cornea more evenly curved.

• Minor discomfort
• To be able to see, though not perfectly clearly
• That you will need to be driven home, or catch a taxi.

• Treatment not successful - this may be due to over treatment or under treatment. You may need a second ‘enhancement’ procedure.
• Dry eyes - you may need to use lubricating eye drops.
• Delayed healing - the superficial layer of the cornea or the flap (if LASIK procedure was used) may not heal properly. Follow-up treatment may be required.
• Infection - treatment with antibiotics may be necessary.
• Superficial scarring - this will require a further procedure to fix.
• Excessive thinning of the cornea - this may lead to a return of sight problems and require the use of contact lenses or further surgery.
• Sensitive eyes - some people report increased sensitivity to glare, which can make driving dangerous.
• Blurred vision - ‘halos’ or rings of fuzzy light may result from the treatment.

• Use antibiotic and anti-inflammatory medication (in the form of drops) in the operated eye(s) for a period after surgery.
• Use plastic shields over the operated eye(s) for several nights after surgery to prevent damage caused by rubbing.
• Do not use pressure to rub the operated eye(s).

• Prescription glasses
• Contact lenses.

• Your local doctor
• Ophthalmologist
• Recognised laser vision correction centre
• Optometrist.

• Laser eye surgery is a medical procedure that involves the use of a laser to reshape the surface of the eye. This is done to improve or correct short-sightedness, long-sightedness and astigmatism.
• Some people who have laser vision correction will still need to wear glasses or contact lenses to achieve optimum vision.
• It is an expensive procedure not covered by health insurance.

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