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2019-03-25

Vision correction. What lenses to choose

Many people today are trying to find simplicity in many of their everyday activities. Some of the complains we here every day in our practice are problems with refractive errors and spectacles, or contact lens wear. For more than 95% of the people across the world, there are options and methods of how they can correct their vision. 

Excimer laser vision correction

Laser vision correction has been practiced in the world for over 40 years with more than fifty million people who had this treatment performed to their own eyes. There are many methods of laser vision correction nowadays, and the primary difference depends on the depth of the cornea at which the surgery is done (surface of the cornea – PRK, middle of the cornea – LASIK).

The most critical information for all patients is that this type of surgery is safe for the eye and vision and that there is no possibility of the damage to the eye, nor any loss of vision.

All types of current techniques are fully computer-controlled with the help of precise software programs integrated into laser platforms. The devices can reduce one diopter in less than 2 seconds, while the systems for tracking the patient’s eye during the surgery (“trackers”) enable precise delivery of laser beams precisely to the given spot regardless of the eye movement. Thanks to the newest software systems, all surgeries are nowadays more than 95% safe.

Phakic intraocular lenses

The technique of implantation is painless and straightforward, and it consists of the small corneal incision through which the lens is implanted into the eye and enclaved on the anterior iris surface (Verisyse and Veriflex) or placed behind the iris (Vision ICL). All these implants are biocompatible; the organism can not reject them, nor cause any damage to the eye.

Like with the laser vision correction, a surgical procedure with phakic intraocular lenses is also done in topical anesthesia and lasts no more than 10 minutes per eye. Corneal incisions are mostly self-healing, except for the Verisyse phakic intraocular lens where one small corneal suture is required.

There are two significant advantages to this type of refractive error correction. First, with phakic intraocular lens implantation eye does not lose its accommodation, so it is advised to all young patients who do not need reading glasses. Second, this procedure is reversible, meaning that if the patients want to exchange their lenses, or for some reason returns to the previous refractive error, these implants can be safely removed from the eye.

Like with the laser vision correction, phakic intraocular lens implantation cannot cause any damage to the eye. The patient can return to his/her normal activities within five days after the surgery. Topical therapy of antibiotics and artificial tears is used for two weeks up to one month.

Currently the most popular phakic intraocular lens in Vision ICL (Implantable Collamer Lens). In comparison to its predecessors which are also sometimes used today (Verisyse, Veriflex), Vision ICL can not only correct higher diopter ranges (from -3.00 D to -23.00 D, or from +0.50 D to +10.00 D), it can also successfully correct astigmatism up to ±10.00 D.

Furthermore, this lens is much easier to implant and position in the eye, and it does not need to be fixated or enclaved to the iris tissue. This makes less intraoperative trauma to the eye itself, shortens the procedure, as well as the postoperative recovery. Besides this, an optical part of the lens is much bigger compared to all other phakic intraocular lenses, which makes it ideal for all the patients with large pupils.

All patients between 20 and 45 years of age who have a stable refractive error and no ocular diseases are good candidates for the phakic intraocular lens implantation.

Multifocal intraocular lenses

Multifocal and trifocal intraocular lenses are currently the most popular implants for correction of presbyopia or reading refractive error.

In fact, this technology allows correction of both distance and near refractive errors (multifocal intraocular lenses), or distance, intermediate and near refractive error (trifocal intraocular lenses). The surgical procedure is done under topical anesthesia and lasts about 10 minutes per eye. During the surgery, clear natural lens, or the lens with cataract, is extracted from the eye and replaced by the multifocal of a trifocal intraocular implant.

The clear corneal incision is 2.2 mm wide, which makes it self-sealing. It is advisable to operate both eyes the same day to get better and faster neuroadaptation to the new lenses.

Postoperative recovery lasts for no more than 5-7 days, where the patient is advised not to expose the eyes to dust, wind, and smoke, not to lift any heavy weights, and to use proper topical therapy.

Implanted multifocal/trifocal intraocular lenses are permanent, and they cannot form a cataract.

Multifocal/trifocal intraocular lenses can be implanted to all patients who are 45 years of age or older, and who want to correct their refractive error for far, intermediate, or near. There is no upper limit when it comes to the age, as long as the macula is healthy.

The text was compiled by Founder and Chief Medical Officer of one of the most famous European ophthalmological clinics "Svjetlost Banja Luka" Dr. Bojan Kozomara. The clinic uses all types of the above lenses from German, American and Dutch manufacturers.

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