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“Feast” your eyes (short-sighted and not only) – Corriere.it

Glasses and contact lenses for life Goodbye. In pursuit of this dream of freedom, many people with nearsightedness, farsightedness and astigmatism have undergone surgery with the excimer laser in the past 20 years, since its introduction. It happens, especially in those who chose this solution at a very young age, that a visual defect recurs. Or that, with the passage of years, we have become in need of cataract surgery, which is the opacity of the natural lens in our eyes (crystalline) that occurs with age because the eye dries up, oxidizes and becomes dense, gradually losing transparency.

It is possible to undergo laser twice

In these cases, is it possible to repeat the laser operation? Certainly yes – answers Francesco Bandello, Professor of Ophthalmology and Director of the Ophthalmology Clinic of the University of Vita Salute in San Rafael, Milan. Cataract surgery in a patient who has already undergone refractive surgery does not carry specific risks and problems. And if there is a need to correct the defect that appeared after many years in those who underwent surgery when they were young, the laser can be repeated, but it all depends on what was done in the previous surgery. Desire for a lot for simplicity: Treatments that reduce nearsightedness aim to flatten the cornea and reduce its curvature, so that the light rays that pass through it end up focusing on the retina and not in front of it (as happens in myopia). If the number of myopia to be reduced is high, the cornea should be “flattened” a lot and this reduces its thickness. In this case, if reprocessing is required, it is necessary to check whether further intervention (and “leveling off”) is possible. In fact, the risk lies in reaching very deep corneal layers, resulting in scars associated with a loss of transparency and uncomfortable symptoms for the patient.

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When to perform surgery: After the age of twenty

Laser surgery can be performed after the age of 18. It is effective and safe for correcting myopia, hyperopia and astigmatism. For presbyopia, the technique is still experimental and the only effective treatment is lens replacement with a multifocal intraocular lens implant. But what is the right moment to work with a laser? First of all, it is recommended that you be over 20 years of age, and regardless of age, the vision defect should have been stable for at least two years – explains Leonardo Mastropascua, Director of the Ophthalmology Clinic and National Center for High Technology Doctor of Ophthalmology and Surgery at the University of Chieti Studies Pescara. And for those who are no longer young, it should be assessed that they do not have a cataract in the formation because in this case a visual correction is recommended in conjunction with cataract surgery. The advanced minimally invasive robotic laser correction technology (SMILE) can be used, especially for higher myopia, which allows treatment of even patients with thin keratoplasty and provides greater stability of the result. In general, to correct vision defects, the operation is performed for both eyes in the same session, but the decision is made by mutual agreement between the ophthalmologist and the patient (for cataracts never, it is best to let at least 24 hours pass between one and the other). The operation is performed under local anesthesia (with eye drops) sitting – Mastropasqua continues – on an outpatient basis and does not cause pain. It takes a few minutes, most of it is for prepping the eye: the actual laser takes only a few seconds. Sight recovers in a few days.

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Possible side effects

What if something goes wrong? The serious complications arising from refractive surgery or laser cataract surgery are almost non-existent and exceptional, Pandelo asserts. Rare issues with the process can be small remnants of visual defect or perception of auras around light sources in night vision: disturbances that often resolve spontaneously over time. In most cases, the vision defect is corrected at a ratio of 100 per 100. In the rare cases when this does not happen, it can be retouched with a small intervention later, but if this is not possible or if you prefer not to perform further interventions, it is always possible to resume use Contact lenses: Refractive surgery is a very precise, effective and safe treatment and the choice of the laser technology used (Lasik, PRK, Lasek or SMILE) is up to the ophthalmologist. But for cataracts, the laser is not the only option available: the operation can be performed with a conventional technique that uses a classic scalpel and lens emulsion, which shatters the lens through the emission of ultrasound (then proceeds with aspiration of the shrapnel and implantation of a small artificial lens). By using the femtosecond laser, which is currently only available in specialized centers – Bandelo concludes – the accuracy (compared to the surgeon’s hand) increases in opening the eye and reaching the central part of the lens. Traditional technologies, which are paid for by health services, are equally effective and safe.

What does the National Health Service go through

Refractive surgery (which an ophthalmologist uses to correct refractive defects caused by defects in focusing images on the retina such as nearsightedness, farsightedness, and astigmatism) is no longer compensated by the NHS by interfering with the cornea or lens. With some exceptions set by the LEA (Basic Levels of Assistance), which relates for example to those with severe injuries, scars on the cornea, suffering from some serious disease or having vision defects greater than 4 diopters. It equals plastic surgery (because it is not essential to health, since lenses and glasses can be used), and is therefore not included in the deductible health costs. Except in some cases and after obtaining an appropriate medical certificate from a general hospital: for example for those who suffer from intolerance to contact lenses who have also shown problems using glasses.

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February 7, 2021 (Change February 7, 2021 | 20:55)

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