As parents with children with nearsightedness, our aim is to stop its progression to avoid vision-threatening complications in the future. Learn about corrective vision options for attaining perfect 20/20 vision once they reach adulthood.
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As a parent of a child with myopia, the struggle to keep it under control and the refractive errors from progressing can be frustrating.Â
Myopia, also known as nearsightedness, is a common refractive error affecting millions of people worldwide. With the number of cases expected to reach 2.5 billion by the end of this decade, it is important to understand the different options available.
In myopia, distant objects appear blurry due to the shape of the eye being too long or the cornea having too much curve. This leads to light rays that should be focused on the retina focusing in front of the retina instead.Â
Even though there are only two general corrective options for children: eyeglasses and contact lenses, there are more treatments available to help them see clearly when they reach adulthood and when their myopia stabilizes.
In this article, we will delve into the surgical options for correcting refractive errors in adulthood, including keratorefractive surgery and intraocular refractive surgery. We will also discuss the factors to keep in mind. By understanding the available options, you can help them set up the optimal course of action for your child in years to come.Â
What is Keratorefractive Surgery?
Keratorefractive surgery is a procedure in which the shape of the cornea is modified with the intent of changing the refractive error of the eye. It is a popular and effective way to correct myopia for adults. The reshaping of the cornea leads to the correction of light rays that enter the eye and improves vision.Â
There are several types of keratorefractive surgery available, including LASIK (Laser-Assisted in Situ Keratomileusis), LASEK (Laser-Assisted Sub-Epithelial Keratectomy), PRK (Photorefractive Keratectomy), and SMILE (Small Incision Lenticule Extraction).Â
PRK was the first type of keratorefractive surgery approved by the FDA in 1995. This procedure removes the outer layer of the cornea to reshape the underlying tissue through a technique called surface ablation. This procedure is less invasive than LASIK and LASEK, but the recovery process is generally longer.
LASIK, which was approved by the FDA in 1999, is the most well-known and widely used form of keratorefractive surgery. It involves creating a flap in the cornea with a laser and reshaping the underlying tissue, then replacing the flap to cover the treated area. Most patients experience significant improvement in vision within 24 hours after the procedure.
LASEK, similar to LASIK, reshapes the outer layer of the cornea without creating a flap. While the recovery process may take longer, the procedure is less invasive. SMILE, a newer form of keratorefractive surgery approved by the FDA in 2016 for low to moderate myopia, removes a small disc of tissue from the cornea to reshape it. This procedure is less invasive than LASIK and is suitable for patients with a thin cornea. Furthermore, the FDA expanded its approval for SMILE in 2018, allowing it to be used for up to -10.00 diopters of spherical refractive error and -3.00 diopters of cylinder error.
Common risks or complications of keratorefractive surgery include over or under-correction, dry eyes, glare, halos, light sensitivity, visual fluctuations, visual correction regression, corneal scarring, and ectasia.
It is important to note that these procedures may result in a thin layer of tissue in the back of the cornea (the residual stroma). This can increase the risk of ectasia, which is a progressive thinning and bulging of the cornea. A suggested safe residual stromal bed thickness for LASIK is 250 µm.Â
The best option will depend on individual needs and circumstances, as each type of surgery has its own advantages and disadvantages.
What’s the Worse Refractive Error that LASIK or PKA Can Correct?
What is Intraocular Refractive Surgery?
Sir Harold Ridley implanted the first intraocular lens in 1947 after observing small pieces of PMMA material from a crashed plane in WWII that penetrated the eye were not rejected by the body.
Intraocular refractive surgery is a viable option for correcting myopia in adulthood. This type of surgery involves altering the power of the eye's lens to correct vision issues. There are two main forms of intraocular refractive surgery: Phakic Intraocular Lens Implantation (PILI) and Refractive Lens Exchange (RLE).
Refractive Lens Exchange (RLE) is a procedure that removes the natural lens of the eye and replaces it with an artificial lens called an intraocular lens (IOL). This new lens is designed to correct refractive errors and improve vision, making it a suitable option for those with high levels of myopia and presbyopia. However, it is important to note that the FDA has not approved the use of a pseudophakic IOL for solely correcting refractive errors in cases where there are no visually significant cataracts present.
PILI involves implanting an IOL directly into the eye without removing the natural lens. This procedure works to correct refractive error, providing clear vision without the need for glasses or contact lenses.
Intraocular refractive surgery is highly effective in correcting myopia. But they come with their own risks and benefits. Possible risks or complications include discomfort, inflammations, infections, retinal detachment, corneal edema, iritis, cataract development, visual fluctuations, and elevated eye pressure leading to glaucoma. Some patients may also experience blurred or halos around lights.
Ultimately, the best choice will depend on one's individual needs and circumstances. It is recommended to discuss treatment options, as well as their advantages and disadvantages, with an eye doctor.
What’s the Worse Refractive Error that Phakic Intraocular Lenses Can Correct?
Key Takeaways
Myopia is a common refractive error that affects millions of people worldwide, and as a parent of a child with myopia, it is important to understand that preventing its progression now can help reduce the likelihood of vision-threatening complications in adulthood.Â
When your child becomes an adult and after their myopia stabilizes, keratorefractive and intraocular refractive surgery, as well as other emerging treatments, are options they can consider to correct their refractive errors.
And a great bonus is that, by then, they will be old enough to pay for it themselves!
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Please be advised that this article does not cover all treatment options and considerations for correcting myopia. It is important to consult with your eye doctor to determine the appropriate treatment plan for your individual needs.
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