Personalized refractive (laser) surgery

What is personalised laser refractive surgery?

This refers to a suite of advanced surgical techniques designed to correct refractive errors (myopia, long-sightedness, astigmatism, and presbyopia) using a bespoke approach tailored to the unique anatomy and optical imperfections of each eye.

There are two primary methods of personalisation:

• Topography-guided: Based on detailed mapping of the corneal surface (addressing shape and surface irregularities).

• Wavefront-guided: Based on a comprehensive analysis of the optical aberrations of the entire eye (cornea, lens, vitreous, and retina) as measured by an aberrometer.

These methods aim to optimise visual quality, particularly in low-light conditions, by reducing higher-order aberrations (such as coma, trefoil, and secondary astigmatism).

A thorough pre-operative assessment is essential, including topography, aberrometry and pachymetry.

What are the risks and benefits?

Benefits

• Excellent visual acuity without the need for glasses or contact lenses.
• Enhanced night vision compared to standard laser treatments.
• Reduction of specific individual optical aberrations.
• Bespoke treatment plans for each eye.
• Rapid recovery (particularly with LASIK).

Risks

• Temporary or persistent dry eye.
• Halos or night-time glare (though less frequent with personalised treatments).
• Potential over- or under-correction (uncommon and usually treatable).
• Flap complications (LASIK): Such as displacement or micro-striae.
• Corneal ectasia: Rare, occurring primarily due to poor indication, insufficient residual corneal thickness, or excessive eye rubbing.
• Delayed healing or haze (specific to PRK).

Patient satisfaction rates are exceptionally high, with stable outcomes provided the clinical indications are met.

Indications and Contraindications

Indications (Who is it for?)

• Patients eligible for standard PRK or LASIK surgery.
• Those with irregular corneal profiles (subject to clinical assessment).
• Patients experiencing symptomatic higher-order aberrations (e.g., poor night vision or reduced image clarity).

Contraindications

The contraindications are identical to those for standard refractive surgery:

• Insufficient corneal thickness.
• Active ocular disease (e.g., uveitis, herpetic keratitis, or chronic conjunctivitis).
• Uncontrolled glaucoma.
• Pregnancy or breastfeeding.
• Endothelial decompensation.
• Severe dry eye syndrome.
• Poorly controlled diabetes.
• Psychiatric disorders or unrealistic expectations.

Special Situations

Keratoconus

Keratoconus surgery using customised laser treatment (PRK/Trans-PRK) combined with Corneal Collagen Cross-linking (CXL) can improve vision with glasses and reduce reliance on complex contact lenses (such as scleral lenses).

Please note: Laser treatment alone is strictly contraindicated for keratoconus, as it may exacerbate ectasia and lead to the requirement for a corneal transplant (DALK or PKP).

Corneal Transplants

Following a transplant, therapeutic refractive surgery can be utilised to correct residual corneal irregularities and reduce the patient's dependence on corrective lenses.