Laser refractive surgery, RLE (refractive lens exchange) and phakic lens implantation – different types of procedures and different treatment methods depending on the visual defect
Modern ophthalmic surgery has a number of options for vision correction, and the type of procedure, the specific method of surgery or specific lens implants are always selected keeping in mind the specifics of the defect, the anatomical conditions of the eye, the patient’s general health and his expectations for visual acuity after treatment.
One possible division of laser vision correction methods is between superficial and deep methods. Everything he would like to know about this topic can be found here: https://swisslaser.pl/blog/powierzchniowe-i-glebokie-metody-laserowej-korekcji-wad-wzroku/
However, not every patient qualifies for laser correction, in which case they are offered refractive lens replacement or phakic lens implantation.
We take a look at the types of treatments and surgical methods that Swiss Laser offers to patients with particular vision defects and eye dysfunctions.
Short-sightedness
Everything you want to know about the defect.
In people with a stabilized defect, when treating myopia with an ophthalmic laser, the central part of the cornea is flattened to reduce refractive power. Vision-correcting lasers are used in the following treatments:
LASEK/PRK: the procedure involves either deflecting (LASEK) or removing (PRK) the upper cellular layer of the cornea (epithelium) and then appropriately reshaping the underlying corneal tissue with an excimer laser. The goal of the procedure is to properly model the central surface of the cornea with a laser beam so that it focuses the image precisely on the retinal surface.
LASIK: a two-step technique; the cornea is incised with a scalpel (microkeratome), and then the corneal surface is modeled so that it can properly focus the image onto the retina.
Femto-LASIK: using a precise femtosecond laser, the surgeon makes a cut in the cornea, creating a thin flap 0.1 mm thick – a flap. He uses an excimer laser to reshape the previously exposed cornea for a few seconds, then the flap is closed back up; it attaches and forms a protective corneal barrier.
Trans-PRK smart surFace: the least invasive laser treatment for myopia. Dioptric correction is done in the first stage of the procedure, while the surgeon uses a high-precision excimer laser. PRK used to be the standard method of laser eye treatment, and LASIK replaced it because it involved less pain. However, the LASIK technique failed in patients whose corneas were too thin or irregular. Trans-PRK’s state-of-the-art capabilities helped optimize the procedure at the most important point.
Patients who do not qualify for laser vision correction – the maximum myopia to be treated with laser is usually up to -10 diopters, although this limit may shift on a case-by-case basis – can undergo refractive lens exchange (RLE) or CLE (clear lens extraction) or phakic lens grafting.
Hyperopia (farsightedness).
Everything you want to know about the defect.
When treating farsightedness with an ophthalmic laser, a greater curvature is created, which increases the refractive power of the eye and thus improves comfort and visual acuity.
Vision-correcting lasers are used in the following treatments:
LASIK: a two-step technique; the cornea is incised with a scalpel (microkeratome), and then the corneal surface is modeled so that it can properly focus the image onto the retina.
FemtoLASIK: using a precise femtosecond laser, the surgeon makes a cut in the cornea, creating a thin flap 0.1 mm thick – a flap. He uses an excimer laser to reshape the previously exposed cornea for a few seconds, then the flap is closed back up; it attaches and forms a protective corneal barrier.
In the case of high hyperopia, which cannot be corrected by laser, refractive lens exchange (RLE) is used. The treatment method depends on the number of diopters and is determined individually during the initial examination and consultation with the doctor.
Astigmatism
Everything you want to know about the defect can be found here.
Laser correction of astigmatism is performed using the following methods:
Femto-LASIK (All-Laser-LASIK): With a precise femtosecond laser, the surgeon makes a cut into the cornea, creating a thin flap 0.1 mm thick – a flap. He uses an excimer laser to reshape the previously exposed cornea for a few seconds, then the flap is closed back up; it attaches and forms a protective corneal barrier.
LASIK (laser assisted in situ keratomileusis): a two-step technique; the cornea is incised with a scalpel (microkeratome), and then the corneal surface is modeled so that it can properly focus the image onto the retina. LASEK/PRK: the procedure involves either deflecting (LASEK) or removing (PRK) the upper cellular layer of the cornea (epithelium) and then properly modeling the underlying corneal tissue with an excimer laser. The goal of the procedure is to properly model the central surface of the cornea with the laser beam so that it focuses the image precisely on the retinal surface.
LASEK/PRK: the procedure involves either deflecting (LASEK) or removing (PRK) the upper cellular layer of the cornea (epithelium) and then appropriately reshaping the underlying corneal tissue with an excimer laser. The goal of the procedure is to properly model the central surface of the cornea with a laser beam so that it focuses the image precisely on the retinal surface.
Presbyopia (presbyopia)
Everything you want to know about the set of physiological changes that occur with age in the human eye can be found here.
Depending on whether presbyopia is the only dysfunction of the eye or is accompanied by vision defects, the patient can choose from the following methods of laser correction:
- without any other vision defect – /Femto-LASIK/Monovision PresbyMAX/ lens replacement, phakic lens
- Hyperopia/myopia +3 to -5 Femto-LASIK/Monovision PresbyMAX/LASIK inpresbyopia,
- all vision defects – lens replacement with monofocal or multifocal implants and EDOF
LASIK (laser assisted in situ keratomileusis): a two-step technique; the cornea is incised with a scalpel (microkeratome), and then the surface inside the cornea is modeled so that it can properly focus the image onto the retina.
Femto-LASIK (All-Laser-LASIK): With a precise femtosecond laser, the surgeon makes a cut into the cornea, creating a thin flap 0.1 mm thick – a flap. He uses an excimer laser to reshape the previously exposed cornea for a few seconds, then the flap is closed back up; it attaches and forms a protective corneal barrier. This method allows for multifocal correction and monovision.
Refractive lens exchange (RLE) is also used to treat presbyopia. We use the following types of lenses:
- Multifocal lenses of the latest generation (trifocal lenses, EDOF, for near and far vision and intermediate area)
- Monofocal lenses (also known as “enhancement lenses,” often used in cataract surgery)
- Toric lenses (for astigmatism correction)
- Toric trifocal lenses (correct presbyopia and astigmatism)
It is also possible to dock a phakic lens.
Cataracts
Everything you want to know about cataracts can be found here.
At SwissLaser, we remove cataracts using the following methods:
Cataract phacoemulsification: a method of removing cataracts using an ultrasonic tip and implanting an artificial intraocular lens. The procedure is performed under surface anesthesia applied as a gel or drops into the conjunctival sac. In place of the removed lens, a new one is inserted – a flexible, retractable, acrylic lens that unfolds on its own in the natural lens bag and settles in the right place in the eyeball. The incision is minimal (1.5 to 3 mm). We have many types of lenses that can, by the way, correct vision defects such as myopia, hyperopia, presbyopia or astigmatism.
High-precision femtosecond laser surgery: a method that involves making micro-incisions (called ports) in the cornea and removing the cloudy lens through them and then inserting a new lens. The treatment takes 10-15 minutes.
Read all about state-of-the-art lens implants used in cataract surgery here here.
