Download Alternatives to refractive lensectomy

Refractive Lensectomy
Most vision correction procedures attempt to change the focusing power of the
cornea by reshaping it. Refractive lensectomy, on the other hand, corrects
nearsightedness or farsightedness by replacing the eye's natural lens with an
artificial intra-ocular lens (IOL) implant. The power of the artificial lens implant
can be adjusted so that the eye can see well without glasses. The lens implant
remains within the eye, without needing any further care after surgery. It provides
a wide range of focusing freedom, but since it is a fixed focus lens, glasses are
necessary for all near vision activities such as reading.
Refractive lensectomy is a surgical procedure that uses the same successful
techniques used in modern cataract surgery. These surgical techniques have
evolved and improved dramatically over the last 20 years. Cataract surgery (link)
is now the most common surgical procedure performed in medicine today.
The main difference between standard cataract surgery and refractive
lensectomy is that cataract surgery is primarily performed to remove a patient's
cloudy natural lens (cataract) that is interfering with their vision, while refractive
lensectomy is performed to reduce a person's dependence on glasses or contact
lenses. Refractive lensectomy can be combined with other procedures that treat
astigmatism such as relaxing incisions or LASIK..
Refractive Lensectomy is for those who:

want to reduce or eliminate their dependence on
glasses or contacts

are not be a good candidate for laser vision
correction

are 18+ years of age

have no health issues affecting their eyes
Who Benefits Most?

• People with extreme degrees of nearsightedness or farsightedness,
beyond what is easily corrected with laser
corrective options

• People with signs of early cataract development

• People over 50 years of age who are dependent on
corrective lenses for distance and reading vision
Cataracts are a part of the normal aging process and if a person lives long
enough chances are they will develop cataracts. People who have refractive
lensectomy now, will not need cataract surgery in the future.
A refractive lensectomy is not generally recommended for people under 45 years
of age, unless the diagnosis and careful testing reveals it to be the best option.
People less than 45 still have significant flexibility in their natural lens which
allows them to vary their focus naturally (read without glasses). This ability is lost
in a lensectomy procedure. This ability is lost during the natural aging process,
so those over 50 to 55 may not lose a significant amount of natural focusing
flexibility through the procedure.
What to expect on surgery day
A refractive lensectomy procedure is similar to modern cataract surgery. The
procedure is performed on an outpatient basis. Only one eye is treated at a time.
Patients are not put to sleep, but they can be sedated with intravenous
medications, if necessary. After the eye is completely numbed with topical or
local anesthesia "frozen" for this painless surgery.
To begin, the surgeon makes a small incision of 1/8 of an inch (2.8 mm) at the
edge of the cornea. The surgeon inserts a delicate instrument to create a
smooth, round opening in the outer capsule of the natural lens. Using an
ultrasonic suction probe, the surgeon proceeds to gently break up and suction
out the gel from the lens capsule. Then, the surgeon inserts a high quality lens
implant of appropriate power and positions it securely within the natural lens
capsule. In most cases a foldable lens implants is used, so that it can be inserted
through a smaller incision. For extremely high corrections, foldable lenses are
not manufactured, so the incision is enlarged for the placement of a more rigid
lens implant. The surgery is usually completed without stitches, since the incision
is designed to be self-sealing. The whole procedure takes around 15 minutes.
After Surgery
You will go home soon after the surgery and relax for the rest of the day.
Everyone heals somewhat differently but many patients report improvement in
their vision almost immediately after the procedure. Most patients return to their
normal activities within a day or two.
Side effects are minimal. Most patients experience some temporary blurring for a
few days. Patients can also expect increased light sensitivity for a few weeks, so
sunglasses need to be worn more often than usual during this time.
As the eye heals after the surgery your vision may change – it takes about a
month to stabilize. If the stable visual result is not ideal, a second surgical
procedure to adjust or replace the lens is possible. An additional laser surgery to
improve the focus is also possible.
Possible Complications
As with any surgery, there are some possible complications to a refractive
lensectomy.
Retinal Detachment
Farsighted people have a very low risk of detachment, however, most
nearsighted people have eyes that are longer than normal, resulting in retinas
which are more vulnerable to detachments. The more nearsighted you re, the
greater the risk of detachment after surgery. For very nearsighted people (more
than -10) the risk of retinal detachment is about 4%. In more than 75% of cases a
retinal detachment can be repaired and good vision maintained.
Inner Eye Surgery Complications (less than 1%)
The following complications are very uncommon, but they can occur:
hemorrhage or infection within the eye, swelling around the eye, reflections or
sight distortions from the lens implant, an increase of floaters, loss of corneal
clarity, dislocation of the lens implant, wound leak, glaucoma and uveitis
(inflammation). Most of these complications can be effectively treated if they
occur.
Corneal Surface Surgery Complications (less than 1%)
The corneal surface problems of induced astigmatism and slightly increased
dryness are not generally serious and may be effectively treated.
Alternatives to refractive lensectomy
Refractive lensectomy is not the only surgical procedure designed to correct
nearsightedness. LASIK and PRK are the most common procedures, but phakic
lens implants are also possible in some cases. Which type of surgery is best for
you depends on many factors. You should discuss the advantages and
disadvantages of each procedure with your doctor.
Specific Advantages of Refractive Lensectomy

• Correction for most ranges of nearsightedness and farsightedness

• Predictable outcome

• Fast visual stabilization

• Minimal side effects

• Can be combined with laser or incision corrective options to
correct astigmatism

• Eliminates the need for cataract surgery in the future

• Long history of successful outcomes
Realistic expectations
The decision to have refractive lensectomy is an important one that only you can
make. The goal of refractive lensectomy is to reduce or eliminate your
dependence on glasses or contact lenses. However, we cannot guarantee you
will have the results you desire.
Serious complications with refractive lensectomy are rare. It is a relatively safe,
effective and permanent procedure, but like any surgical procedure, it does have
some risks. Going to an eye specialist experienced with the procedure can
significantly minimize the risks involved with refractive lensectomy.
After a thorough eye exam, you and your doctor will determine if refractive
lensectomy is an option for you. If you are a good candidate, you will be given
additional information about the procedure that will allow you to make an
informed decision about whether to proceed. Be sure you have all your questions
answered to your satisfaction.