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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.