Refractive Surgery in the 2nd Decade of the 21st Century

Today, the concept of Refractive Surgery is not restricted to the narrow field of Laser repair of the common refractive anomalies, such as myopia, hyperopia and astigmatism, in young adults who wish to relieve themselves from their glasses and contact lenses.


Of course, even in this category, considerable progress has been made with super-modern devices such as the Excimer Laser, which can repair, quantitively as well as qualitatively the above anomalies. For example, the patient can undergo corneal customized ablation correcting refraction and other kind bad aberrations of the optical system, with the objective of perfect vision.


In some cases of middle-aged patients, with the use of specialized programs, we can reshape the cornea, so as to give it a multifocal profile for the treatment of presbyopia.


Another significant advancement in the subcategory of Refractive Laser Surgery, named LASIK, is the F-LASIK or Femto-LASIK method. In this method a new device which produces another form of Laser (Femtosecond) prepares the flap, before the application of Excimer Laser, with no use of the classic keratome. The keratome is a special form of mechanical scalper, which has been used since the discovery of LASIK.


The rapid evolution of Femtosecond Laser seems to classify it to the top of refractive surgery, as the exclusive surgical tool, without the use of Excimer Laser, in the field of ametropias (myopia, hyperopia, astigmatism) as well as the surgical repair of presbyopia and cataract.


Consequently, refractive surgery extends to many sections of ophthalmology, and addresses a wider age spectrum. Due to the rapid evolution of the technology of surgical machinery, tools, implants and chemical agents, we can plan and create in reality, from the beginning, an entirely new refractive system, which can totally satisfy every patient’s binocular vision.


For example, getting back in the field of Laser, in a 50 year-old patient with myopia, we can surgically repair the disease, taking also into account the presbyopia, in the surgical plan, leaving in his non-dominant eye a low degree myopia, which does not severely disturb distant binocular vision, and simultaneously satisfies his short vision, without using glasses (Monovision Technique).


In the elderly, on the occasion of opacity of the crystalline ocular lens (cataract), we can achieve similar results, as those described above, either with the application of Intraocular Lenses, specifically selected for each eye, or, in some cases, with the implantation of specific diffractive lenses with multifocal function.


In the surgical treatment of cataract, we now have the opportunity to repair astigmatism at the same time, without the additional application of Excimer Laser, by implanting a special Toric Intraocular Lens. The modern technology of intraocular lenses gives us the opportunity to repair myopia or hyperopia at the same time as astigmatism or presbyopia repair.


In a young adult with severe ametropia (myopia, hyperopia, astigmatism) or with specific anatomical corneal shape, fundus damage or other problems which do not allow for the use of Excimer or/and Femtosecond Laser in combination with one of the currently used methods (Femto-LASIK, LASIK, PRK, LASEK, EPILASIK), we now have the opportunity to apply Special Intraocular Lenses in the anterior chamber of the eye. These lenses are supported in the angle or the iris, as well as the posterior chamber, between the iris and the crystalline lens. The methods/implants described above do not intervene with the normal ocular lenses, and we completely preserve the normal accommodation (Near Vision). Furthermore, we can combine the two methods, for the achievement of the best refractive result , after the preparation of the corneal flap with the non-traumatic Femtosecond Laser, before the application of the Intraocular Lens.


The combination described above, as well as the general technique of combining intraocular lenses with Excimer or/and Femtosecond Laser in the cornea (Bioptic Technique) may bring the best outcomes in patients with complex refractive anomalies, such as severe anisometropia, that is the very big discrepancy of refractive strength between the patient’s eyes, unilateral cataract (Juvenile, Traumatic, Inflammatory, etc.) as well as in many other problems due to human eye diversity.


Obviously, the above cases constitute only a small traction of all the refractive ophthalmological problems which need to be solved, in the field of refractive surgery. The main target of each surgery is the improvement of human vision, as a primary human sense, and quality of life.


Certainly, the success of every surgery depends among others, on the longevity of its outcomes. Therefore, during the pre-operative control, as well as the surgical planning, the surgical team is responsible to be aware of the nature of the patient’s problem in its medical basis, which constitutes the reason of his arrival, as well as the his expectations, too, in relation with his age, his mentality and his everyday needs and activities.