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 (TOL) implant. The power of the artificial lens implant can be adjusted so that the eye can see well without glasses.

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 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.

HOW REFRACTIVE LENSECTOMY WORKS

Unlike laser corrective surgeries which alter the shape of the cornea, a refractive lensectomy changes the focusing power of the lens within the eye. For this procedure, the eye's natural lens is removed and replaced by a manufactured lens implant which has been selected to provide clear focusing ability. 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.

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 under 45 still have significant flexibility in their natural lens, which allows them to vary their focus naturally. 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:
The refractive lensectomy procedure is performed on an outpatient basis. Patients are not put to sleep, but they can be sedated with oral or intravenous medications, if necessary. Only one eye will be treated at a time. After the eye is completely numbed with topical or local anesthesia, the eye's natural lens will be gently vacuumed out through a tiny incision, about one eighth of an inch wide.

Next, the new, intra-ocular lens will be folded and inserted through the same micro-incision. It will then be unfolded and placed into the "capsular bag" that originally surrounded the natural lens. This incision is "self-sealing" and usually requires no stitches. It remains tightly closed by the natural outward pressure within the eye. This type of incision heals quickly and provides a more comfortable recuperation.

If your eye has pre-existing astigmatism, your surgeon may elect to make micro-incisions in the cornea to reduce your astigmatism. These are called limbal relaxing incisions. 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.

AFTER SURGERY EXPECTATIONS
Visual recovery from a refractive lensectomy in most cases is fast. A few hours after the surgery, patients are usually able to see well enough to engage in regular activities with increased visual freedom.

Typically side effects are minimal. Most patients experience some temporary blurring for a few days from tear film variations or some fluid in the cornea. Patients can also expect increased light sensitivity for a few weeks, so sunglasses need to be worn more often than usual during this time.

The lens capsule closes around the new lens implant in the weeks following surgery, sometimes changing the focusing range to a small degree because of a shift in position. 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. However, the risks are minimal. The low incidence of complications listed here reflects the surgeon's experience:

Increased Possibility of Retinal Detachment (less than 1%)
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 risk of retinal problems because of surgery is extremely small. A retinal examination required before the surgery helps to determine the risk factors for each patient. Even if a detachment occurs, it can generally be effectively repaired.

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 extremely rare. It is a 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.

 
 
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Copyright © 2009 Robert C. Arffa, M.D., 1370 Washington Pike, Bridgeville, PA 15017