What is the best treatment for myopia?
Again, the answer for the best treatment for myopia is that it depends. For younger patients with a clear crystalline lens, good accommodation, no presbyopia, they’ve got a lovely range of focus, we want to leave their lens alone. We have got two options to look at: either corneal laser eye surgery or intraocular contact lens implantation. Both are great options.
My go-to treatment for myopia tends to be corneal laser eye surgery for a whole host of reasons. It’s very accurate, gentle, incredibly safe, we’re outside the eye, a great track record and it’s just a great option. In fact, we have got a choice now. We have LASIK laser eye surgery and SMILE keyhole laser eye surgery. I have access to that because I have Zeiss VisuMax which is unique amongst femtosecond laser platforms and being able to deliver that treatment. The femtosecond laser is the laser we use to create a flap in LASIK. The advantage of this Zeiss VisuMax is that it’s so accurate, it can create the lens required to treat the short-sightedness within the cornea so that I can then remove it through a keyhole incision without making a flap. This has advantages regarding leaving the eye a little bit stronger, a little bit of quicker recovery from dry eye symptoms and allows us to treat slightly thinner corneas as well. It also means that the Zeiss VisuMax creates incredibly accurate and safe flaps for LASIK, which is still an excellent option.
For younger patients, SMILE and LASIK are my go-to options for treatment for myopia. For my older group of patients who are getting signs and symptoms of presbyopia where we’re losing that ability to shift focus from distance to near back out again, I want to do something more for them where I’m giving them more of a range of focus. If the lens inside the eye is in good condition, is not showing signs of cataract, and is just rigid and lost that flexibility, then I want to leave that lens alone and where possible and use Presbyond blended vision LASIK laser eye surgery to share the light out across distance and near, across the two eyes. We use blended vision so that both eyes provide a good overlap of intermediate distance and provide a good range of focus, so they worked together really well.
If the eyes are showing signs of cataract, then we want to be discussing with the patient about whether or not to bring their cataract surgery forward. These patients need particular care and attention in the assessment, and the reason is that of the small risks that are involved with lens replacement surgery.
The three things I lose sleep over are an infection inside the eye, though we’ve worked very hard to bring that risk down to about 1 in 10,000 for lens replacement surgery. That’s incredibly rare. Most of the patients who developed an infection, we can turn it around for them, and they’ll recover well.
Another thing I worry about is swelling at the back of the eye. About one in a hundred patients can experience this, so it is quite common. Thankfully, a bit of time, extra eye drops, and we can settle it down, and the patient does very well. It’s an annoyance, and we’d like people to see brilliantly straight away and don’t have any bumps in the road, but at least it’s manageable. I’ve never had a patient where we can’t eventually get that fluid dried up for them and the vision performing.
The final issue is a condition called retinal detachment, which can occur in people who have never had any eye surgery. It is much more common for individuals who are short-sighted. Eyes that are short-sighted are larger than average, and it appears that the enlargement slightly weakens the retina, especially around the edge and the periphery. That seems to predispose these eyes to be more likely to develop this condition called retinal detachment, which is treatable. It may be that performing lens exchange or cataract surgery can trigger a retinal detachment in patients who are at risk.
The careful assessment required is, if a short-sighted patients have a clear lens of their own and particularly if they show signs of slight weakness in the retina. Then I’ll leave their lens alone, and I’m not going to consider them for lens replacement. We’re very fortunate that I can perform Presbyond blended vision LASIK for them and leave the inside their eye alone.
Conversely, if they have a cataract, they need cataract surgery. There’s no point in doing cornea Presbyond LASIK or working on the cornea at the front of the eye because they’re going to need cataract surgery. We just have to look after them and do a nice cataract surgery, safely and accurately get the very best outcome we can for them. There are tests we can undertake at the Custom Vision Clinic to manage that risk pre-operatively as well to identify patients who need extra care and follow-up following the surgery.
To answer the question, what’s the best treatment for shortsightedness, you need access to all those technologies because they all have a role, depending on the age of the patient and the condition of the inside of the eye, particularly the condition of their crystalline lens.
