Refractive Surgery Suitability Screening: A Complete Guide

Key Learning Points

• Refractive surgery suitability screening ensures patients are good candidates for vision correction surgeries like LASIK or PRK.
• Proper screening involves assessing eye health, prescription stability, and other factors like corneal thickness.
• Understanding your eye condition, lifestyle, and expectations is crucial to determine the best treatment.
• Cycloplegic refraction and a thorough dilated fundus exam are essential for accurate assessment.
• Some medical conditions or lifestyle factors may disqualify a patient from surgery.

What is Refractive Surgery Suitability Screening?

Refractive surgery, including LASIK (Laser-Assisted In Situ Keratomileusis) and PRK (Photorefractive Keratectomy), is a widely used option for correcting vision problems such as myopia (nearsightedness), hyperopia (farsightedness), and astigmatism. But before undergoing these surgeries, it's important to ensure that a patient is a suitable candidate through a refractive surgery screening.

This process assesses your eyes to determine if refractive surgery is safe, effective, and suitable for your specific condition. It involves a comprehensive eye exam, understanding your medical history, and evaluating specific eye structures.

We understand that the idea of surgery can be overwhelming, especially when it involves your vision. The purpose of the refractive surgery screening is to ensure your eyes are healthy and ready for surgery. Your eye health and safety come first. By undergoing these evaluations, we ensure that refractive surgery will help you achieve the best possible results with minimal risk. Each step of the screening process is designed to protect your vision and optimize outcomes.

Think of your eyes as the foundation of a house. Just as you wouldn’t renovate your home without checking that the foundation is strong, we wouldn’t proceed with refractive surgery without ensuring your eyes are structurally sound. The screening process is like that structural inspection – it ensures that your eyes can safely undergo surgery and that the results will last.

Symptoms Addressed by Refractive Surgery

Refractive surgery corrects vision problems related to how light is bent (refracted) in your eye. Common symptoms include:

• Blurry vision (due to nearsightedness, farsightedness, or astigmatism)
• Difficulty seeing at night
• Eye strain or discomfort from prolonged focusing
• Double vision in some cases of astigmatism

By reshaping the cornea, refractive surgery can reduce or eliminate the need for glasses or contact lenses.

What Does the Screening Involve?

1. Comprehensive Eye Examination: The first step involves an in-depth evaluation of your overall eye health. This includes checking for dry eye, cataracts, glaucoma, or any retinal diseases. It is crucial to identify any underlying conditions that may affect the outcome of surgery.

2. Cycloplegic Refraction and Dilated Fundus Exam: Cycloplegic refraction temporarily paralyzes the eye's focusing muscles, allowing the doctor to accurately measure refractive error without the interference of the eye's natural focusing ability. A dilated fundus exam assesses the retina and optic nerve, ensuring no hidden problems exist that could complicate surgery.

3. Corneal Thickness Measurement: The cornea’s thickness is measured using pachymetry. This step ensures the cornea can withstand reshaping without complications. Thin corneas may be at risk for post-surgical weakening, such as ectasia.

4. Topography and Tomography: These tests create a detailed map of the cornea’s surface, helping to identify any irregularities like keratoconus (a condition where the cornea thins and bulges) that may disqualify a patient from surgery.

5. Wavefront Analysis: Wavefront technology measures how light travels through the eye, identifying higher-order aberrations that affect visual quality, such as glare or halos, especially at night.

6. Tear Film and Dry Eye Assessment: Dry eyes can significantly affect healing and vision outcomes after surgery. Special tests, like tear breakup time (TBUT), are performed to assess tear production and quality.

Treatment Options

Based on the screening results, your ophthalmologist will determine whether you are a good candidate for refractive surgery. If you are eligible, the following are some of the options:

• LASIK: The most common type of refractive surgery, LASIK reshapes the cornea to correct refractive errors. It’s a quick procedure with a short recovery time, but not suitable for everyone, particularly patients with thin corneas.
• PRK: A good alternative for those with thinner corneas, PRK involves removing the outer layer of the cornea (epithelium) before reshaping it. It has a longer recovery time but achieves similar results to LASIK.
• SMILE: Small incision lenticule extraction is a minimally invasive procedure for myopia and astigmatism correction, with less impact on corneal nerves and faster recovery.
• Lens-based Procedures: For those who are not candidates for laser procedures, implantable collamer lenses (ICL) or refractive lens exchange (RLE) may be options.

Preventing Complications

While screening helps identify potential risks, patients can also take measures to optimize their results and healing post-surgery:

1. Stable Prescription: Ensure your prescription has remained stable for at least one year before surgery to avoid regression post-surgery.
2. Manage Dry Eye: Address any dry eye issues before surgery, as this condition can complicate healing.
3. Follow Doctor’s Orders: After surgery, follow your surgeon’s advice regarding rest, medications, and follow-up visits.
4. Lifestyle Adjustments: Avoid activities like swimming and contact sports for a few weeks after surgery to prevent infection or injury.

Post-Screening Care

After refractive surgery, your eyes will need time to heal. Here are some important steps to follow:

• Use prescribed medications: These may include antibiotic and anti-inflammatory drops to prevent infection and reduce swelling.
• Avoid touching or rubbing your eyes: This could dislodge the corneal flap in LASIK or disrupt healing in PRK.
• Wear protective eyewear: Especially during activities that might expose your eyes to dust or injury.
• Attend follow-up appointments: Regular check-ups ensure your eyes are healing well and there are no complications.

Frequently Asked Questions

1. How long does refractive surgery take? The procedure typically lasts about 10-15 minutes per eye, but plan for about 2 hours at the clinic to allow for pre-op preparations and post-op observation.

2. Will I need glasses after refractive surgery? Many patients achieve 20/20 vision after surgery, but some may still need glasses for reading or certain activities, especially if presbyopia is present.

3. What is the recovery time after surgery? LASIK patients usually experience improved vision within 24 hours, while PRK patients may take several days to a week for clear vision to develop.

4. Am I too old for refractive surgery? Age itself is not a limitation, but older patients may be better suited for lens-based procedures like ICL or RLE due to the development of presbyopia or cataracts.

5. Is refractive surgery painful? The surgery itself is typically painless due to anesthetic eye drops. After surgery, some discomfort or irritation is common, but it usually resolves within a few days.

6. Can refractive surgery correct astigmatism? Yes, both LASIK and PRK can correct astigmatism by reshaping the cornea to improve how light enters the eye.

7. What if I blink during surgery? A device is used to keep your eyes open, and advanced lasers have tracking systems that follow even small eye movements.

8. How do I know if I am a good candidate? A thorough screening process will assess your eye health, prescription stability, and lifestyle to determine if you are a good candidate.

9. Can I go blind from refractive surgery? The risk of serious complications is extremely low. With modern technology and experienced surgeons, blindness is highly unlikely.

10. What happens if my vision changes after surgery? If vision changes over time, enhancement procedures can be done to adjust the correction.

Take-home Message

Refractive surgery suitability screening is an essential first step to ensure that laser vision correction is safe and effective for you. This comprehensive process helps avoid complications and ensures the best possible outcome for your vision. By identifying potential risks and customizing treatment to your needs, your ophthalmologist can ensure long-lasting vision improvement. Follow-up care and lifestyle adjustments play a critical role in maintaining clear vision post-surgery.