Eye surgery in a few minutes
It is the icing on the cake, says the head physician of the iClinic eye clinic about the implantation of an anterior chamber lens, which works in the eye like mini glasses.
Did you know that you can get rid of glasses or contact lenses even without laser eye surgery? The head physician of the iClinic eye clinic, ophthalmologist MUDr. Ivo Ďurkovič, MPH, told us about a method in which your cornea is not disturbed in any way.
There are currently many different offers of refractive laser surgery, which began more than forty years ago. Their principle is the adjustment – reduction or enlargement – of the anteroposterior diameter of the eye. By removing corneal tissue, we obtain an optimal shape of the eye so that you have no dioptres. In addition, we can correct astigmatism if the cornea is not optimally curved.
Short-sighted people have a long eye, which needs to be shortened, by vaporising part of the cornea either with an excimer laser in combination with a femtosecond laser or, as the newest option, by removing a so-called lenticule from the corneal stroma. But we also have something else here, which I would call the icing on the cake. A method in which a custom-made lens is inserted through a two-millimetre opening in the cornea into the anterior chamber of the eye, which lies between the cornea and the lens. It is made of so-called collamer, it can be rolled up and it is literally just injected into the anterior chamber of the eye.
The implantation of an anterior chamber refractive lens has an extremely large number of advantages. Besides, not every eye is anatomically suitable for refractive laser surgery. Whether it is due to the anatomical structure of the cornea, degenerative changes in the cornea, or whether it is a matter of the lens or the retina... Each of us has a different corneal thickness. To remove one dioptre, about 16 microns of it must be removed with an excimer laser. However, there are certain limits to how much can be taken from the cornea. If you have high dioptres, say minus 10, it is not possible to perform laser surgery if you do not have sufficient corneal thickness and other important anatomical parameters of the cornea. But we can offer you what I have called the icing on the cake. With it, if the anatomical conditions of the eye allow, we can remove even 15 or 18 dioptres.
Certainly we will, the anterior chamber refractive lens has other advantages too. After older methods of laser surgery, such as Lasek or Te PRK, you are guaranteed dry eye syndrome for several months. With the newest methods it is already minimal, but it is there. You have to use artificial tears, you are sensitive to air conditioning and to temperature changes. With this method, dry eye syndrome does not occur even temporarily, because the surface and structure of the cornea are not disturbed; it remains intact and the tissue is undamaged. And that is a huge advantage. We simply insert a lens with a lifelong lifespan into your eye.
If your visual acuity were to change, you have two options. You can have the anterior chamber refractive lens exchanged for a current one – it can be removed and replaced in a few minutes – or you can have the cornea minimally corrected with a laser. That is no longer such a huge intervention; not as much corneal tissue is removed. But I must point out that I have already implanted about five to six thousand of these lenses and I have had only two corrections, when I had to correct patients with an excimer and a femtosecond laser. The probability that a correction will be needed in a few years is significantly lower than with refractive laser surgery.
If a cataract appears, we remove the lens. And since your eye has not been altered by any laser and the cornea is intact, we can precisely measure the anteroposterior diameter of the eye and give you, instead of the clouded one, a new lens with exactly the dioptre you need. In eyes after laser surgery, the anteroposterior diameter of the eye is different and the dioptre of the artificial lens cannot be measured quite precisely; it must be recalculated using certain formulas so that we can correct the vision to zero. So this lens is also an investment in the future.
For an experienced surgeon, lens implantation is quicker than refractive laser surgery. The procedure itself on one eye takes me about two minutes. Of course, dilating the eyes with drops, the anaesthetic drops and other preparation of the patient take about two hours.
That is also quicker than after laser surgery, as is the onset of sharp vision. With the oldest type of laser refractive surgery, the subsequent pain lasts one to four days; with second-generation laser surgery your eyes will certainly water for eight to ten hours, you have a feeling of sand in your eyes and blurred vision as if under water without swimming goggles. The insertion of an anterior chamber refractive lens, since, I repeat, it does not disturb the structure of the cornea, is painless even after the anaesthetic drops wear off. Of course, you must keep your eyes covered until the next day because of possible infection. The next morning you remove the cover and you see one hundred per cent.
They are very suitable for short-sighted patients who develop age-related long-sightedness over time. With anterior chamber lenses, we can correct both plus and minus dioptres.
There are, but fewer than with refractive laser surgery. The depth of the anterior chamber, degenerative diseases of the cornea and certain post-traumatic conditions of the cornea, cataract – those are the basic ones. Otherwise, it is suitable from the age of 18 with no upper limit. If, as a young person of twenty to thirty, I were deciding to have my eyes operated on, I would have this lens implanted.
The world has gone the way of laser methods, but I am now leaning more towards methods of implanting anterior chamber lenses. Because in the roughly six years I have been doing them, I really see stability in them, better quality of the patient's vision and no optical side phenomena. And most importantly, this method is reversible, unlike laser refractive procedures. I can even return the eye to its original state, and if someone wants to wear glasses again, I will remove the lens.
There is: the price of the procedure. The lens is patented and individually custom-made, so its price is about twice as high as laser surgery. Personally, I would rather sacrifice that money than have the anatomical structure of my cornea disturbed.
The interview was published in the weekly Plus 7 Dní, No. 34. You can also find it at this link.
Did you know that you can get rid of glasses or contact lenses even without laser eye surgery? The head physician of the iClinic eye clinic, ophthalmologist MUDr. Ivo Ďurkovič, MPH, told us about a method in which your cornea is not disturbed in any way.
What options for correcting refractive errors do you offer, apart from wearing glasses or lenses?
There are currently many different offers of refractive laser surgery, which began more than forty years ago. Their principle is the adjustment – reduction or enlargement – of the anteroposterior diameter of the eye. By removing corneal tissue, we obtain an optimal shape of the eye so that you have no dioptres. In addition, we can correct astigmatism if the cornea is not optimally curved.
Can the eye be made smaller?
Short-sighted people have a long eye, which needs to be shortened, by vaporising part of the cornea either with an excimer laser in combination with a femtosecond laser or, as the newest option, by removing a so-called lenticule from the corneal stroma. But we also have something else here, which I would call the icing on the cake. A method in which a custom-made lens is inserted through a two-millimetre opening in the cornea into the anterior chamber of the eye, which lies between the cornea and the lens. It is made of so-called collamer, it can be rolled up and it is literally just injected into the anterior chamber of the eye.
Is it more advantageous than laser surgery?
The implantation of an anterior chamber refractive lens has an extremely large number of advantages. Besides, not every eye is anatomically suitable for refractive laser surgery. Whether it is due to the anatomical structure of the cornea, degenerative changes in the cornea, or whether it is a matter of the lens or the retina... Each of us has a different corneal thickness. To remove one dioptre, about 16 microns of it must be removed with an excimer laser. However, there are certain limits to how much can be taken from the cornea. If you have high dioptres, say minus 10, it is not possible to perform laser surgery if you do not have sufficient corneal thickness and other important anatomical parameters of the cornea. But we can offer you what I have called the icing on the cake. With it, if the anatomical conditions of the eye allow, we can remove even 15 or 18 dioptres.
If I have lower dioptres, won't you offer me that icing on the cake?
Certainly we will, the anterior chamber refractive lens has other advantages too. After older methods of laser surgery, such as Lasek or Te PRK, you are guaranteed dry eye syndrome for several months. With the newest methods it is already minimal, but it is there. You have to use artificial tears, you are sensitive to air conditioning and to temperature changes. With this method, dry eye syndrome does not occur even temporarily, because the surface and structure of the cornea are not disturbed; it remains intact and the tissue is undamaged. And that is a huge advantage. We simply insert a lens with a lifelong lifespan into your eye.
What if my dioptres change over time?
If your visual acuity were to change, you have two options. You can have the anterior chamber refractive lens exchanged for a current one – it can be removed and replaced in a few minutes – or you can have the cornea minimally corrected with a laser. That is no longer such a huge intervention; not as much corneal tissue is removed. But I must point out that I have already implanted about five to six thousand of these lenses and I have had only two corrections, when I had to correct patients with an excimer and a femtosecond laser. The probability that a correction will be needed in a few years is significantly lower than with refractive laser surgery.
Does this lens also help in any way with cataract?
If a cataract appears, we remove the lens. And since your eye has not been altered by any laser and the cornea is intact, we can precisely measure the anteroposterior diameter of the eye and give you, instead of the clouded one, a new lens with exactly the dioptre you need. In eyes after laser surgery, the anteroposterior diameter of the eye is different and the dioptre of the artificial lens cannot be measured quite precisely; it must be recalculated using certain formulas so that we can correct the vision to zero. So this lens is also an investment in the future.
Is the operation itself, inserting the lens, demanding?
For an experienced surgeon, lens implantation is quicker than refractive laser surgery. The procedure itself on one eye takes me about two minutes. Of course, dilating the eyes with drops, the anaesthetic drops and other preparation of the patient take about two hours.
And healing after the procedure?
That is also quicker than after laser surgery, as is the onset of sharp vision. With the oldest type of laser refractive surgery, the subsequent pain lasts one to four days; with second-generation laser surgery your eyes will certainly water for eight to ten hours, you have a feeling of sand in your eyes and blurred vision as if under water without swimming goggles. The insertion of an anterior chamber refractive lens, since, I repeat, it does not disturb the structure of the cornea, is painless even after the anaesthetic drops wear off. Of course, you must keep your eyes covered until the next day because of possible infection. The next morning you remove the cover and you see one hundred per cent.
Can reading problems also be corrected with these lenses?
They are very suitable for short-sighted patients who develop age-related long-sightedness over time. With anterior chamber lenses, we can correct both plus and minus dioptres.
Are there any contraindications for them?
There are, but fewer than with refractive laser surgery. The depth of the anterior chamber, degenerative diseases of the cornea and certain post-traumatic conditions of the cornea, cataract – those are the basic ones. Otherwise, it is suitable from the age of 18 with no upper limit. If, as a young person of twenty to thirty, I were deciding to have my eyes operated on, I would have this lens implanted.
But laser procedures are still in the majority.
The world has gone the way of laser methods, but I am now leaning more towards methods of implanting anterior chamber lenses. Because in the roughly six years I have been doing them, I really see stability in them, better quality of the patient's vision and no optical side phenomena. And most importantly, this method is reversible, unlike laser refractive procedures. I can even return the eye to its original state, and if someone wants to wear glasses again, I will remove the lens.
Is there really not a single disadvantage?
There is: the price of the procedure. The lens is patented and individually custom-made, so its price is about twice as high as laser surgery. Personally, I would rather sacrifice that money than have the anatomical structure of my cornea disturbed.
The interview was published in the weekly Plus 7 Dní, No. 34. You can also find it at this link.
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