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Refractive surgery

Definition

Refractive surgery can quickly and with great security correct most vision problems – especially myopia, hyperopia, astigmatism, as well as presbyopia.

Refractive surgery

Definition

Refractive surgery can quickly and with great security correct most vision problems – especially myopia, hyperopia, astigmatism, as well as presbyopia.

Treatment

Treatment

1- Surgical Correction: myopia, astigmatism and hyperopia

The different refractive surgery techniques allow the focalization of light on the retina by modifying the intraocular convergence of light, as well as the curvature and/ or shape of the cornea. In cases of myopia, the latter is flattened to reduce its focusing power. On the other hand, in cases of hyperopia, the cornea is instead curved to increase its focusing power. Finally, in cases of astigmatism, the different available techniques aim to improve corneal sphericity.

 

For instance, in many cases, excimer laser treatments can nowadays be specifically adapted to the particular morphology of each cornea – whether to its curvature, thickness, or its micro-irregularities (also called aberrations).
It is important to raise the issue of professional aptitudes post-surgery. Indeed, having recovered a normal or near normal visual acuity after surgery may trigger some concerns, especially when it comes to security-related jobs. Regulations for each profession are continually modified. It is therefore imperative that you check with your administration in order to verify if refractive surgery is accepted (army, police, marine, fire brigade, rail transport, air transport, maritime transport, inland waterways, etc.).


The therapeutic goal of refractive surgery can in no way be aesthetic; its sole purpose is to treat all forms of visual impairment.

 

SUPERFICIAL REFRACTIVE PHOTOKERATECTOMY USING EXCIMER LASER (PRK):


Guided by a computer, excimer laser consists in a powerful beam of ultraviolet light capable of flattening the cornea to treat myopia, of curving it out to treat hyperopia, or of improving its sphericity to treat astigmatism.


The procedure is performed under local anesthesia and its duration generally does not exceed twenty minutes. After peeling the corneal coating, the application of the laser beam takes a few minutes. The perfect balancing of the treatment is performed automatically, with the aid of an infrared camera. Postoperative pain is frequently observed for the first twenty-four to forty-eight hours. A local treatment with eye drops is prescribed for a few weeks to a few months after the surgery, depending on the visual result.


The recovery of a clear vision is obtained after a period of several weeks. In rare cases, a touchup is needed to address the following issues: shifting (which may lead to daytime glare and/or feelings of diplopia when it is sufficiently sizeable), undercorrection, overcorrection, or excessive scarring resulting in corneal opacity (haze) which can limit the degree of visual recovery and lead to a recurrence of the preoperative refractive problem. Unlike the formerly practiced radial keratotomy, photorefractive keratectomy using excimer lasers does not weaken the eyeball and thus, the practice of sport – even when violent – is not contraindicated.

 

LASIK :

 

Lasik is a mixed technique combining surgery and excimer laser, which is intended to cure stronger myopia or hyperopia, possibly accompanied by astigmatism.


The procedure is performed under local anesthesia in an outpatient facility, and rarely exceeds thirty minutes. Using a femtosecond laser, the surgeon creates a flap inside the cornea, which allows the excimer laser to treat not simply the surface, but the corneal thickness itself. Femtosecond lasers have now replaced the mechanical microkeratomes still used it a few years ago, increasing both safety and precision. The corneal flap is then replaced at the end of the surgery, and immediately adheres to the deep layer of the cornea. No sutures are necessary. In very rare cases, the cutting of the corneal flap is irregular, incomplete, or instead goes all the way through, which makes it impossible to continue the intervention. The flap is therefore simply repositioned with or without suture, and without any excimer laser treatment, after which the eye returns to its previous visual state. A new test can once more be carried out after a few months. A local postoperative treatment is generally prescribed for a few weeks after the surgery. The visual recovery is faster than with other procedures, rarely exceeding 24 to 48 hours. Finally, though there is less postoperative pain, the foreign body sensation in the operated eye may last a few days.


Again, a touch-up is sometimes necessary after a few months to treat a decentered ablation or an over/undercorrection. For the latter, the surgeon simply needs to lift the flap initially made and apply the excimer laser, before repositioning the flap. In very rare cases, cells from the corneal coating can migrate into the interface along with debris, which can potentially impact visual outcome. A touch-up is once again needed and consists in lifting the initial corneal flap, cleaning the interface and reapplying the flap.

 

 

 

 

EPILASIK and LASEK :

 

This technique combines surgery and excimer laser, and is meant to cure stronger forms of hyperopia or myopia, potentially accompanied by astigmatism. The flap made is thinner than with that which is needed for LASIK surgery. This technique, intended for thin corneas, is in fact very close to PRK in terms of the procedure itself and of the delay of visual recovery. 

 

SMILE :

 

SMILE (SMall Incision Lenticule Extaction) is an alternative to LASIK to cure myopia of 4 to 10 diopters, especially recommended for patients with thin corneas or for those practicing combat sports such as boxing.

The surgical procedure is performed with a femtosecond Visumax laser developed by Zeiss. The surgeon applies the laser beam twice, with each application being separated by a thickness proportional to the desired refractive effect. The corneal stroma is thus cut and manually extracted through an incision of 3.5 to 4mm. This technique requires a certain surgical skill.

 

 

 

INTRACORNEAL RING SEGMENTS:

 

Recently introduced, intracorneal ring segments or half-segments enable the correction of mild myopia. In the very near future, they will also correct mild astigmatism and mild hyperopia. Two arcs of transparent Plexiglas are surgically inserted into the cornea, changing its curvature to correct refractive error. The intervention itself and the post-operative period are not painful. Like any technique, this type of surgery carries a minimal risk of infection, and may also lead in exceptional cases to intolerance to the materials in place.


The major advantage of this technique is its reversibility. A young myopic having previously undergone such a surgery may, after becoming presbyopic at the age of 45, regain his initial myopia and therefore recover a near vision without the need for correction.

 

INTRAOCULAR LENSES:

 

High-degree myopia and hyperopia can be treated with the use of intraocular implants. The procedure consists in placing an additional lens either inside the eye in front of the human lens or after the latter’s extraction, in order to correct the refractive error. The power of the implant is chosen based on the desired correction, and the accuracy of the result is excellent. Both the size and power of the implant are determined on a customized basis, depending on the preoperative measurements.

The advantage of this technique is also its reversibility, along with the possibility of resorting, if required, to another type of surgery several years down the road.

 

 

1- Surgical Correction: myopia, astigmatism and hyperopia

The different refractive surgery techniques allow the focalization of light on the retina by modifying the intraocular convergence of light, as well as the curvature and/ or shape of the cornea. In cases of myopia, the latter is flattened to reduce its focusing power. On the other hand, in cases of hyperopia, the cornea is instead curved to increase its focusing power. Finally, in cases of astigmatism, the different available techniques aim to improve corneal sphericity.

 

For instance, in many cases, excimer laser treatments can nowadays be specifically adapted to the particular morphology of each cornea – whether to its curvature, thickness, or its micro-irregularities (also called aberrations).
It is important to raise the issue of professional aptitudes post-surgery. Indeed, having recovered a normal or near normal visual acuity after surgery may trigger some concerns, especially when it comes to security-related jobs. Regulations for each profession are continually modified. It is therefore imperative that you check with your administration in order to verify if refractive surgery is accepted (army, police, marine, fire brigade, rail transport, air transport, maritime transport, inland waterways, etc.).


The therapeutic goal of refractive surgery can in no way be aesthetic; its sole purpose is to treat all forms of visual impairment.

 

SUPERFICIAL REFRACTIVE PHOTOKERATECTOMY USING EXCIMER LASER (PRK):


Guided by a computer, excimer laser consists in a powerful beam of ultraviolet light capable of flattening the cornea to treat myopia, of curving it out to treat hyperopia, or of improving its sphericity to treat astigmatism.


The procedure is performed under local anesthesia and its duration generally does not exceed twenty minutes. After peeling the corneal coating, the application of the laser beam takes a few minutes. The perfect balancing of the treatment is performed automatically, with the aid of an infrared camera. Postoperative pain is frequently observed for the first twenty-four to forty-eight hours. A local treatment with eye drops is prescribed for a few weeks to a few months after the surgery, depending on the visual result.


The recovery of a clear vision is obtained after a period of several weeks. In rare cases, a touchup is needed to address the following issues: shifting (which may lead to daytime glare and/or feelings of diplopia when it is sufficiently sizeable), undercorrection, overcorrection, or excessive scarring resulting in corneal opacity (haze) which can limit the degree of visual recovery and lead to a recurrence of the preoperative refractive problem. Unlike the formerly practiced radial keratotomy, photorefractive keratectomy using excimer lasers does not weaken the eyeball and thus, the practice of sport – even when violent – is not contraindicated.

 

LASIK :

 

Lasik is a mixed technique combining surgery and excimer laser, which is intended to cure stronger myopia or hyperopia, possibly accompanied by astigmatism.


The procedure is performed under local anesthesia in an outpatient facility, and rarely exceeds thirty minutes. Using a femtosecond laser, the surgeon creates a flap inside the cornea, which allows the excimer laser to treat not simply the surface, but the corneal thickness itself. Femtosecond lasers have now replaced the mechanical microkeratomes still used it a few years ago, increasing both safety and precision. The corneal flap is then replaced at the end of the surgery, and immediately adheres to the deep layer of the cornea. No sutures are necessary. In very rare cases, the cutting of the corneal flap is irregular, incomplete, or instead goes all the way through, which makes it impossible to continue the intervention. The flap is therefore simply repositioned with or without suture, and without any excimer laser treatment, after which the eye returns to its previous visual state. A new test can once more be carried out after a few months. A local postoperative treatment is generally prescribed for a few weeks after the surgery. The visual recovery is faster than with other procedures, rarely exceeding 24 to 48 hours. Finally, though there is less postoperative pain, the foreign body sensation in the operated eye may last a few days.


Again, a touch-up is sometimes necessary after a few months to treat a decentered ablation or an over/undercorrection. For the latter, the surgeon simply needs to lift the flap initially made and apply the excimer laser, before repositioning the flap. In very rare cases, cells from the corneal coating can migrate into the interface along with debris, which can potentially impact visual outcome. A touch-up is once again needed and consists in lifting the initial corneal flap, cleaning the interface and reapplying the flap.

 

 

 

 

EPILASIK and LASEK :

 

This technique combines surgery and excimer laser, and is meant to cure stronger forms of hyperopia or myopia, potentially accompanied by astigmatism. The flap made is thinner than with that which is needed for LASIK surgery. This technique, intended for thin corneas, is in fact very close to PRK in terms of the procedure itself and of the delay of visual recovery. 

 

SMILE :

 

SMILE (SMall Incision Lenticule Extaction) is an alternative to LASIK to cure myopia of 4 to 10 diopters, especially recommended for patients with thin corneas or for those practicing combat sports such as boxing.

The surgical procedure is performed with a femtosecond Visumax laser developed by Zeiss. The surgeon applies the laser beam twice, with each application being separated by a thickness proportional to the desired refractive effect. The corneal stroma is thus cut and manually extracted through an incision of 3.5 to 4mm. This technique requires a certain surgical skill.

 

 

 

INTRACORNEAL RING SEGMENTS:

 

Recently introduced, intracorneal ring segments or half-segments enable the correction of mild myopia. In the very near future, they will also correct mild astigmatism and mild hyperopia. Two arcs of transparent Plexiglas are surgically inserted into the cornea, changing its curvature to correct refractive error. The intervention itself and the post-operative period are not painful. Like any technique, this type of surgery carries a minimal risk of infection, and may also lead in exceptional cases to intolerance to the materials in place.


The major advantage of this technique is its reversibility. A young myopic having previously undergone such a surgery may, after becoming presbyopic at the age of 45, regain his initial myopia and therefore recover a near vision without the need for correction.

 

INTRAOCULAR LENSES:

 

High-degree myopia and hyperopia can be treated with the use of intraocular implants. The procedure consists in placing an additional lens either inside the eye in front of the human lens or after the latter’s extraction, in order to correct the refractive error. The power of the implant is chosen based on the desired correction, and the accuracy of the result is excellent. Both the size and power of the implant are determined on a customized basis, depending on the preoperative measurements.

The advantage of this technique is also its reversibility, along with the possibility of resorting, if required, to another type of surgery several years down the road.

 

 

2- Surgical correction of presbyopia

Les premières techniques opératoires concernant la presbytie se développent depuis peu.
Elles reposent sur la réalisation d'un presbylasik au laser excimer d'une bascule chirurgicale (l'oeil directeur est corrigé de loin, l'autre de près), sur le remplacement du cristallin par une lentille intra-oculaire multifocale, et sur la réalisation de sillons intra-cornéens concentriques au laser Intracor.

 

LE PRESBYLASIK est la technique la plus répandue à ce jour. Autrefois exclusivement réservée aux hypermétropes ses indications se sont considérablement étendues avec l'avènement de lasers excimer de nouvelle génération. Elle peut être désormais proposée dès l'âge de 45 ans à tous les patients, hypermétropes, mais aussi myopes et astigmates, ainsi que les emmétropes, c'est-à-dire tous ceux qui ont une bonne vision de loin non corrigée.

 

Le principe est de créer une excellente vision de loin et intermédiaire sur l'oeil directeur et de privilégier les visions intermédiaire et de près sur l'autre oeil. Le traitement induit une discrète myopisation sur l'oeil dominé, la plupart du temps parfaitement supporté par le patient. La tolérance à cette situation visuelle et sensorielle nouvelle est systématiquement vérifiée avant la réalisation de l'intervention.

 

Les vision de loin et intermédiaire (ordinateur) sont excellentes, la vision de près très satisfaisante même s'il peut être parfois encore nécessaire de recourir au port de verres correcteurs pour la lecture de tout petits caractères sous un faible éclairage.

Dans de rares cas, si le résultat s'avère insuffisant, une retouche gratuite est toujours envisageable quelques mois après l'intervention initiale.


LES IMPLANTS MULTIFOCAUX simultaneously correct presbyopia and other potential vision defects potential (myopia, hyperopia, astigmatism). They cater to older patients (at least 55 years of age).

Having become both very effective and very safe, they can transiently induce an increased sensitivity to light, as well as the perception of halos around light sources at night.

There exists today a variety of multifocal implants. Some favor the intermediate vision, the other near vision. The choice of implant depends on the particular needs and lifestyle of each patient.

The surgical technique is exactly the same as the one used for cataract surgery, except that instead of removing and replacing an opaque crystalline lens, the procedure is applied to a clear crystalline lens. This type of surgery is not supported – even partially – by the Social Security. The patient must therefore bear the financial burden himself, and can receive a more or less substantial refund by his private healthcare insurance.

 

The INTRACOR technique can reshape the cornea using a femtosecond laser (Technolas) to counteract presbyopia. This is one of the first therapeutic applications of the femtosecond laser. This operation is a circular intrastromal keratectomy. 5 to 6 circles are created around the optic zone (2-3 mm) and determine a bulging effect without an ablation of the corneal tissue. The surgery is purely intracorneal. This avoids two additional steps: the peeling of a flap necessary for a LASIK intervention, as well as the rupture of the Bowman membrane induced by the usage of an excimer laser on the surface.

 

Description
This modern process was developed by the Technolas ™ Perfect Vision laboratory. This technique has now been used by Luis Ruiz (Baraquer Institute) for 4 years, whose published results show stability over time. Clinical trials – which began in Germany, South Africa and Turkey – have now been completed, which is why this procedure is now being conducted in every country.


In October 2009, La Clinique de la Vision began this process on a Technolas 520 laser with a doubled frequency (80), CE approval.
The treatment is fast, only requiring 10 seconds, and is painless. The postoperative care is simple.
Currently, this technique only applies to some patients having troubles almost only with their near vision (emmetropic presbyopia), as well as very small hyperopia and very limited astigmatism.
The central corneal curvature induced corrects on average 2.5 D of presbyopia. All patients wishing to get rid of their near glasses can be operated regardless of their age. Complementary glasses with a very slight correction may be necessary over time for prolonged reading or if the lighting conditions are not good.
The visual recovery begins the next day, and near vision quickly improves significantly. Distance vision may be slightly reduced for a few weeks or months.


This reduces the risks and postoperative complications associated with more invasive techniques. The postoperative comfort is also greatly improved. The method is universal and involves creating concentric circles only within the corneal stroma. This correction principle corrects near vision while maintaining a fairly good distance vision in the vast majority of cases. The first results are very promising and induce less dry eye than other laser surgeries.

 

Technical
Two steps are necessary: the laser and then the centering. The crucial point is the centering of the rings since the optical zone of treatment is very limited. Any shift can induce side effects such halos, a reducing of the refractive effect and sometimes a drop in the corrected visual acuity. The tracking and pointing are done under a microscope.


The course of the laser is simple: a cone stabilizes the globe, after which the laser treatment is delivered. A protective shell and glasses are given afterwards. Eye drops should be instilled for a few days after the procedure. Like all surgeries, laser technology is final and irreversible.

 

Post-surgery
After the operation, just as all refractive laser surgeries, it will be possible to undergo a cataract surgery if necessary. The choice of the implant will then be carefully evaluated. The surgeon will need to calculate the IOL power needed to achieve good distance vision, given that the multifocal cornea will persist after the cataract surgery – which enables the patient to retain a good near vision.


In the near future, INTRACOR ™ will be offered to patients having already been operated with laser, as well as to patients who have undergone cataract operations and who possess a good distance vision. Starting next year, it is expected that this measure will be extended to patients suffering from myopia and astigmatism. 

 

2- Surgical correction of presbyopia

Les premières techniques opératoires concernant la presbytie se développent depuis peu.
Elles reposent sur la réalisation d'un presbylasik au laser excimer d'une bascule chirurgicale (l'oeil directeur est corrigé de loin, l'autre de près), sur le remplacement du cristallin par une lentille intra-oculaire multifocale, et sur la réalisation de sillons intra-cornéens concentriques au laser Intracor.

 

LE PRESBYLASIK est la technique la plus répandue à ce jour. Autrefois exclusivement réservée aux hypermétropes ses indications se sont considérablement étendues avec l'avènement de lasers excimer de nouvelle génération. Elle peut être désormais proposée dès l'âge de 45 ans à tous les patients, hypermétropes, mais aussi myopes et astigmates, ainsi que les emmétropes, c'est-à-dire tous ceux qui ont une bonne vision de loin non corrigée.

 

Le principe est de créer une excellente vision de loin et intermédiaire sur l'oeil directeur et de privilégier les visions intermédiaire et de près sur l'autre oeil. Le traitement induit une discrète myopisation sur l'oeil dominé, la plupart du temps parfaitement supporté par le patient. La tolérance à cette situation visuelle et sensorielle nouvelle est systématiquement vérifiée avant la réalisation de l'intervention.

 

Les vision de loin et intermédiaire (ordinateur) sont excellentes, la vision de près très satisfaisante même s'il peut être parfois encore nécessaire de recourir au port de verres correcteurs pour la lecture de tout petits caractères sous un faible éclairage.

Dans de rares cas, si le résultat s'avère insuffisant, une retouche gratuite est toujours envisageable quelques mois après l'intervention initiale.


LES IMPLANTS MULTIFOCAUX simultaneously correct presbyopia and other potential vision defects potential (myopia, hyperopia, astigmatism). They cater to older patients (at least 55 years of age).

Having become both very effective and very safe, they can transiently induce an increased sensitivity to light, as well as the perception of halos around light sources at night.

There exists today a variety of multifocal implants. Some favor the intermediate vision, the other near vision. The choice of implant depends on the particular needs and lifestyle of each patient.

The surgical technique is exactly the same as the one used for cataract surgery, except that instead of removing and replacing an opaque crystalline lens, the procedure is applied to a clear crystalline lens. This type of surgery is not supported – even partially – by the Social Security. The patient must therefore bear the financial burden himself, and can receive a more or less substantial refund by his private healthcare insurance.

 

The INTRACOR technique can reshape the cornea using a femtosecond laser (Technolas) to counteract presbyopia. This is one of the first therapeutic applications of the femtosecond laser. This operation is a circular intrastromal keratectomy. 5 to 6 circles are created around the optic zone (2-3 mm) and determine a bulging effect without an ablation of the corneal tissue. The surgery is purely intracorneal. This avoids two additional steps: the peeling of a flap necessary for a LASIK intervention, as well as the rupture of the Bowman membrane induced by the usage of an excimer laser on the surface.

 

Description
This modern process was developed by the Technolas ™ Perfect Vision laboratory. This technique has now been used by Luis Ruiz (Baraquer Institute) for 4 years, whose published results show stability over time. Clinical trials – which began in Germany, South Africa and Turkey – have now been completed, which is why this procedure is now being conducted in every country.


In October 2009, La Clinique de la Vision began this process on a Technolas 520 laser with a doubled frequency (80), CE approval.
The treatment is fast, only requiring 10 seconds, and is painless. The postoperative care is simple.
Currently, this technique only applies to some patients having troubles almost only with their near vision (emmetropic presbyopia), as well as very small hyperopia and very limited astigmatism.
The central corneal curvature induced corrects on average 2.5 D of presbyopia. All patients wishing to get rid of their near glasses can be operated regardless of their age. Complementary glasses with a very slight correction may be necessary over time for prolonged reading or if the lighting conditions are not good.
The visual recovery begins the next day, and near vision quickly improves significantly. Distance vision may be slightly reduced for a few weeks or months.


This reduces the risks and postoperative complications associated with more invasive techniques. The postoperative comfort is also greatly improved. The method is universal and involves creating concentric circles only within the corneal stroma. This correction principle corrects near vision while maintaining a fairly good distance vision in the vast majority of cases. The first results are very promising and induce less dry eye than other laser surgeries.

 

Technical
Two steps are necessary: the laser and then the centering. The crucial point is the centering of the rings since the optical zone of treatment is very limited. Any shift can induce side effects such halos, a reducing of the refractive effect and sometimes a drop in the corrected visual acuity. The tracking and pointing are done under a microscope.


The course of the laser is simple: a cone stabilizes the globe, after which the laser treatment is delivered. A protective shell and glasses are given afterwards. Eye drops should be instilled for a few days after the procedure. Like all surgeries, laser technology is final and irreversible.

 

Post-surgery
After the operation, just as all refractive laser surgeries, it will be possible to undergo a cataract surgery if necessary. The choice of the implant will then be carefully evaluated. The surgeon will need to calculate the IOL power needed to achieve good distance vision, given that the multifocal cornea will persist after the cataract surgery – which enables the patient to retain a good near vision.


In the near future, INTRACOR ™ will be offered to patients having already been operated with laser, as well as to patients who have undergone cataract operations and who possess a good distance vision. Starting next year, it is expected that this measure will be extended to patients suffering from myopia and astigmatism. 

 

WEARING GLASSES AND/OR CONTACT LENSES IS NOT ANYMORE A FATALITY


myope paris ophtalmologie

YOU ARE SUFFERING
FROM MYOPIA

hypermetrope paris ophtalmologie

YOU ARE SUFFERING
FROM HYPEROPIA

presbyte paris ophtalmologie

YOU ARE SUFFERING
FROM PRESBYOPIA

astigmate paris ophtalmologie

YOU ARE SUFFERING
FROM ASTIGMATISM

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SCHEDULE YOUR APPOINTMENT WITH DR. WEISER


PRACTICE

61 rue de Rennes
75006 Paris

Phone : +33 (0)1 45 48 31 13

Consultations and preoperative explorations.

CLINIQUE DE LA VISION

131 rue de l’Université
75007 PARIS

Phone : +33 (0)1 58 05 20 00

Refractive Surgery. Surgery on Thursdays

CLINIQUE JOUVENET

18 rue Jouvenet
75016 PARIS

Phone : +33 (0)1 42 15 41 19

Cataract, glaucoma, cornea...
Surgery on Monday afternoons, Tuesday afternoons and Wednesday mornings.

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WARNING

This site only presents information on anterior segment surgeries, such as refractive, cataract, and glaucoma surgery. It does not include advertising. It refers only to recognized methods, proven by a vast majority of specialists. Its contents may not be exhaustive as recommended by the French administration. The responsibility of the website solely belongs to his author, Marc Weiser, M.D. Our privacy policy.

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