Correcting Myopia with Refractive Surgery

Myopia is a common vision disorder

Myopia is the most common eye disorder, with its prevalence varying significantly worldwide. It affects 30% of the European population, while in Asia, rates reach 80 to 90%. The opposite of myopia is hyperopia, a refractive error where light rays focus behind the retina. Hyperopes therefore see well at a distance but less well up close.

Myopia typically appears during school age, when children begin to read and their vision is tested.

Wearing glasses and contact lenses for myopia

Myopia is initially corrected with glasses. This is practically the only viable option for children. For young children, glasses can sometimes lead to acceptance issues.

Severe myopia may not be correctable with glasses. High-powered lenses needed to correct severe myopia can cause distortions at the edges of the visual field and be heavy and unattractive. For these reasons, an ophthalmologist may recommend contact lenses for patients with severe myopia. Contact lens use requires strict hygiene to avoid infections and special precautions for those who play sports. Contact lenses are generally not suitable for pre-teens.

When to use refractive surgery for myopia?

Is laser surgery suitable for correcting myopia?

In the most challenging cases of myopia, refractive surgery can be considered. However, the results are not always stable over time and cannot completely replace glasses.

Laser techniques provide satisfactory results for mild to moderate myopia, but not for more severe refractive errors. The laser works by breaking molecular bonds through energy release, vaporizing thin layers of the cornea. This selectively thins the cornea, sparing surrounding tissue. The technique is very precise; correcting 3 diopters of myopia typically requires removing about 60 microns of corneal tissue.

The surgery aims to modify the curvature and thickness of the cornea, thereby changing its refractive power so images are properly focused on the retina.

Which laser is used for myopia?

Excimer lasers are used to correct myopia, with techniques chosen based on the degree of myopia and corneal thickness, such as:

• PRK: Photorefractive keratectomy (PRK) is a superficial corneal ablation technique acting primarily on the cornea's anterior surface. It reshapes the cornea to correct the visual defect. Recovery time is generally longer than with LASIK because the intervention is more superficial but covers a larger area. Post-operative pain or discomfort may occur.
• LASIK: This method acts on deeper layers. LASIK is known for its precision, control, and personalization, allowing for the treatment of a wider range of myopia. A femtosecond laser creates a flap allowing the excimer laser to act on the underlying corneal tissue. The postoperative period is less painful and recovery is faster.

Neither technique requires sutures. Laser surgery for myopia does not prevent degenerative damage from high myopia, as it cannot alter the eye's anatomy. It also cannot correct severe myopia. Finally, surgery is only an option once the myopia has stabilized, typically at the end of adolescence.

For myopia exceeding 8-9 diopters, a corrective intraocular lens (IOL) is implanted. The high prevalence of myopia, the risks of surgery, and the not always stable long-term results are driving the search for pharmacological treatments. Developing drugs to affect myopia progression is complex, as the mechanisms behind eye elongation are not yet fully understood.

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In conclusion

The simplest and most immediate treatment for myopia is glasses, which correct the refractive error. For severe myopia, contact lenses can be used to avoid the drawbacks of thick, unattractive glasses. Myopia can also be treated surgically, either with an excimer laser or by implanting an intraocular lens.

Treatment depends on the severity of the myopia and the individual's age. Surgery is considered only after the myopia has stabilized, typically at the end of adolescence. Intraocular lenses are generally preferred for severe myopia. Spending time outdoors, maintaining proper reading distance, and avoiding eye strain can help reduce the risk of developing myopia.

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