• 06 DEC 17
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    Corrective Eye Surgery 101: What’s Available to Toronto Residents

    Corrective Eye Surgery 101: What’s Available to Toronto Residents

    Whether near-sighted or far-sighted, people have been using eyeglasses to correct vision problems for centuries. The only problem is that, well, to correct your vision with glasses, you need to wear the glasses. Eyeglasses can break easily, they can get lost, and on some people, they just don’t look so great.

    Plenty of Toronto residents who thought they were going to be stuck wearing glasses or contact lenses for the rest of their lives breathed a sigh of relief when they learned about corrective eye surgery, which was first introduced sometime in the 1980s. Over the course of just a few decades, corrective vision procedures have advanced by leaps and bounds.

    Learn more about the types of vision surgery available and whether corrective eye surgery is a good option for you.


    Who Is a Candidate for Corrective Eye Surgery?

    Corrective eye surgery isn’t right for everyone. Some people have eye conditions or other medical conditions that would complicate the surgery or the healing process. Here are a few people for whom corrective eye surgery wouldn’t be an option:

    • People under the age of 18. Children aren’t good candidates for vision correcting surgery, as their eyes might continue to change shape as they grow, potentially undoing or changing the results of the operation.
    • People with glaucoma. About a quarter million people in Canada have glaucoma, which causes increased pressure in the eyes and can lead to vision loss. Those who don’t have glaucoma under control are usually not good candidates for laser eye surgery, as the procedure can increase the pressure in the eye.
    • People with large pupils. If your pupils are larger than average, even in bright conditions, corrective eye surgery is most likely a no-go. The laser might cause damage that leads to halos, ghosts or other vision issues.
    • People with cataracts. Cataracts will interfere with the laser’s ability to reshape or improve the eye. You might need surgery to remove cataracts before you have surgery to correct your vision.
    • People with dry eye. Corrective eye surgery can make dry eyes worse.
    • People who are pregnant. Laser eye surgery isn’t recommended for women who are pregnant.


    Along with people for whom corrective eye surgery is a no-go, there are a few who should proceed with caution before deciding to have surgery. In some cases, having certain conditions, such as diabetes, might rule out one type of eye surgery, but not others.


    What Does Corrective Eye Surgery Correct?

    When a person has perfectly healthy vision, the eye produces images by focusing them on the retina at the back of the eye. Vision problems that are caused by refractive errors occur when the images are produced or focused in another part of the eye.

    Initially, laser or corrective eye surgery could only correct certain types of vision problems. But advances in technique mean that it is now possible to fix a full range of issues. Those issues include:

    • Near-sightedness (aka myopia). People with myopia can see items that are close by. Things that are farther away look blurry to a myopic person. The condition is caused by the shape of the eye. A near-sighted person usually either has a cornea that curves sharply or an eye that is longer than usual. The shape of the eye or cornea causes light to focus in front of the retina, which makes things in the distance look blurry.
    • Far-sightedness (aka hyperopia). People with hyperopia have pretty much the opposite problem as people with myopia. Their eyes are shorter than average, or their corneas are flatter than usual, which causes light to focus just behind the retina instead of on the retina. As a result, items in the distance are usually clear and easy to see, while close-by objects end up looking blurry. Some people with hyperopia also have difficulty seeing things in the distance.
    • Astigmatism. When a person has astigmatism, the shape of his or her cornea isn’t even or smooth. It might be curved where it should be flat or flat where it should curve. Objects near and far end up looking blurry.
    • Presbyopia. Presbyopia is a condition that typically occurs with age. The crystalline lens on the eye becomes less flexible and less elastic as people get older, making it difficult for them to focus on objects that are close. To counteract the effects of presbyopia, many people wear reading glasses. Recent updates to laser eye surgery have meant that the procedure can now correct presbyopia as well as other common vision problems.


    How Corrective Eye Surgery Has Changed Over Time

    Admittedly, the history of corrective eye surgery is short. One of the first types of vision correcting surgeries available came about in the 1980s. It was known as radial keratotomy, and it involved making incisions in the eye to flatten the surface. The primary issue the surgery fixed was myopia or near-sightedness.

    The big issue with radial keratotomy was that, for some people, at least, it caused more problems than it solved. Some patients ended up experiencing side effects such as glare, fluctuating vision, and regression. Patients who had higher prescriptions and underwent surgery often ended up with difficulty seeing at night.

    The likelihood of unpleasant side effects and the evolution and development of more advanced and more efficient laser vision surgeries pretty much-caused radial keratotomy to go the way of the dinosaur.


    Modern-Day Corrective Eye Surgery Options

    Fortunately for people with myopia, hyperopia, astigmatism or presbyopia today, corrective eye surgery has come a long way. The differences between the procedures available today and those available in the 1980s and 1990s are like the differences between night and day.

    Today’s corrective eye procedures have fewer side effects, less pain after surgery, and a faster healing time. Residents in Toronto have a range of procedures to choose from, based on their particular vision problem.

    Photorefractive Keratectomy

    Also known simply as “PRK,” photorefractive keratectomy changes the curve of the cornea by removing tissue directly from the surface of the eye. At the start of the surgery, a surgeon uses either a blunt instrument or a blade to remove the epithelium or the outer layer of the cornea.

    Next, a laser destroys small pieces of tissue beneath the cornea’s surface. The entire procedure helps to reshape the cornea to improve vision. Healing and recovery after the surgery take about a week.

    PRK has some advantages when compared to other modern-day corrective vision procedures. For one thing, there is less of a risk for dry eye and specific other complications after the surgery, since the nerves on the surface of the eye heal quickly afterward.

    Usually, PRK is the recommended procedure for people who haveafterwardsthan average corneas. Since the surgery is entirely on the surface of the eye, the risk of surgical flap problems is eliminated as well.

    PRK is appropriate for patients with near-sightedness, far-sightedness or astigmatism.


    LASIK, or Laser-Assisted in situ Keratomileusis, is probably the surgery that comes to mind when people think of corrective vision procedures. In fact, you could argue that “LASIK” is like “Xerox” or “Kleenex” when it comes to corrective eye surgeries. People use the term, even when they are talking about something else entirely.

    That said, during a LASIK laser eye surgery procedure, the surgeon first cuts a flap in the cornea, using either a laser or a sharp blade. The surgeon next directs a laser at the tissue beneath the cornea to reshape it. Once the reshaping is complete, the surgeon replaces the flap.

    The significant advantage of LASIK over PRK is that the recovery is much shorter — just a day or two, compared to a week.

    A few different types of LASIK procedures exist, which offer some distinct advantages of improvements over the traditional procedure. They include:

    • LASEK. LASEK stands for Laser Epithelial Keratomileusis. During the procedure, the surgeon cuts away the outer layer of the cornea with a blade (as during LASIK). Next, he or she uses alcohol to lift the layer away, then directs a laser at the tissue beneath it before replacing the outer layer Typically, LASEK is reserved for minor vision problems. Recovery takes about two weeks.
    • Epi-LASIK. Epi-LASIK is similar to LASEK. The big difference is that a blunt object, rather than a blade, lifts away the epithelium.
    • Wavefront LASIK. Perhaps the most advanced form of LASIK, wavefront LASIK uses a special machine to analyze the eye, measuring how light travels through it. The lasers are then able to pick up on and adjust for specific, subtle errors in vision while the cornea is reshaped. One of the benefits of wavefront LASIK compared to other forms is that it has a lower risk of night glare following the procedure.
    • Bladeless LASIK. As you might guess, bladeless LASIK replaces the sharp blade that typically cuts away the flap with a laser.

    Conductive Keratoplasty

    Conductive keratoplasty is a relatively new form of corrective eye surgery. During the procedure, a small probe and low-heat radio waves place spots around the eye’s clear front surface. The result is an increase in the curve or angle of the cornea. Typically, the surgery is performed on people with hyperopia, but it can also help those with presbyopia or those who have had LASIK but still have trouble seeing close objects.

    Implantable Lenses

    Not all types of corrective eye surgery involve lasers. Some involve surgically implanting lenses into the eye to help correct vision issues, including near-sightedness, far-sightedness, presbyopia, and astigmatism.

    Some types of intraocular lens procedures completely replace the internal lens in the eye. One option, Visian ICL, doesn’t require that the lens of the eye be removed. Instead, it is placed in front of the lens, sort of like a permanent contact lens.

    Refractive Lens Exchange is another type of implantable lens. The procedure is often compared to cataract surgery, but with one significant difference. While cataract surgery involves removing a cloudy, damaged lens, Refractive Lens Exchange involves taking out a clear lens. The replacement lens is usually a different shape from the one removed, which helps to correct hyperopia.


    Choosing the Best Corrective Eye Surgery for You

    Which type of corrective vision surgery is most appropriate for you depends on a variety of factors. The kind of vision problem you have is one concern,  but so is your age.

    Often, LASIK and similar procedures are recommended for people who are relatively young (20s and 30s) and who haven’t started to notice age-related vision changes.

    Older people, usually people over age 40, might have to take a multi-pronged approach when it comes to correcting vision issues. That can mean having LASIK or a similar surgery early on to fix mild near-sightedness or far-sightedness. If a person is beginning to develop presbyopia, he or she can undergo a conductive keratoplasty or other procedure to eliminate the need for reading glasses.


    What Else You Need to Know Before Scheduling Corrective Eye Surgery

    Before you schedule corrective eye surgery, it helps to know the potential side effects and risks and what you can expect from the procedure in the long run. While LASIK, PRK, and corrective lenses will help to fix particular vision problems, it’s important to understand that they might not provide results that last for the rest of your life.

    Additionally, even when performed by highly trained and expert surgeons in the Toronto area, there are still a few risks associated with the surgeries. For example, some of the more common side effects of LASIK surgery are dry eyes and poor night vision. People sometimes develop “halos” or experience glare, which can make it difficult for them to drive at night.

    Also, it’s fairly common for people to have hazy vision while they recover, particularly after PRK. People who have PRK might also have regression, meaning their eyes develop the same refractive error again. If that occurs, a patient might need a second surgery.

    In the long run, though, most people are happy that they sought out corrective eye surgery. Carefully weighing your options and working with an eye doctor with plenty of experience in refractive laser and other corrective vision surgeries can help you get the best results possible, no matter which option you end up choosing.

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