Everything you need to know about glasses, lens transplants and your weakened eyes by Salomé Delport
Just look at all the fantastic “parts” you can get for your eyes. And not one day. Now. You can still upgrade your eyes today.
Eye surgeon Etienne van Aswegen from the Cape Eye Hospital explains what is possible.
(Keep your glasses on first. It still remains one of the most incredible value-for-money medical developments – and possibly still the best option for you.)
First a little background
Even if you think you look perfect, you are, like most of us, probably either far-sighted or near-sighted. You feel like you have 20/20 vision because your smart eye makes a plan that you see optimally.
For sight, the two most important parts of your eye are:
- Your eye lenses, which sit right behind your blue / brown / green / gray iris. Incoming light falls through the pupil on the lens, which reflects it to the retina.
- Your retina is a layer of light-sensitive cells that sits in the back of your eyeball. As soon as light falls on them, they send it as messages to the brain, which interprets it as images – and so you see.
When do you see sharp?
It’s about where the light falls on your retina, Etienne explains. There are three groups of us:
- Light from distant objects falls exactly on the retina, while light from near objects falls just behind the retina – perfect for creating sharp images. You have ideal vision, and the doctor calls you an emmetrop.
- In a very large number of us, light from distant objects falls in front of the retina, while light from near objects falls on the retina itself. So you can see up close and easily thread a thread through a needle’s eye, but the farther things are from you, the more blind you are. Your doctor calls you a myopia. We say we are nearsighted.
- In a third group of us, the reflected light of distant objects behind the retina focuses, and the focus on near objects falls even further behind the retina. This group needs plus lenses, and is called hyperopic. If you can see the Southern Cross but can not read a single word on your phone without glasses, you fall into this group.
But most of us see pretty well, even if we are not emetropics. The reason? The muscles around your eye lenses “help” your eye. They pull your eye lenses rounder or plantter so that the incoming light falls on your retina. So they make sure you see clearly, even if you are a myopic or hyperopic. This ability of your eye to improve the focal point is called “accommodation”.
Why a pair of shop glasses at forty?
Through accommodation, your eye provides 20/20 vision for years, or sight that comes very close to it – until somewhere after forty.
As you get older, your eyelashes become denser, just as jelly gets stiffer the longer it lasts. Your eye muscles can no longer pull the lenses flatter or rounder, no matter how hard they try. Your accommodation is declining, and you need to add reading glasses, which helps by focusing the light on the retina. And now you’re called a presbioop. Presbyopia cannot be corrected with surgery – but there are other plans.
All your options
First, says Etienne, nothing can ever give you back what you lost. “We can improve your vision as it is now and make you less dependent on glasses. But do not believe the ads that say you will never wear glasses again. It is so that some people see perfectly after an operation, while others’ vision is still slightly out, or weakens further with the years. If you are over 45, you may still need +1.50 – + 2.00 glasses when you want to see very fine – which is at least much better than being completely dependent on glasses. I just want people to have realistic expectations. ”
1 Glasses
Reliable and cheap – from R100 at your pharmacy to R3 000 for cheaper tested glasses up to R20 000 and even more for luxury multifocal glasses with a fashion frame, and lenses that do not mist up, stay clean on their own and filter out blue light . Most people need new glasses every 3-5 years.
It works for everyone – myopia, presbyopia and hyperopia.
2 Contact lenses
Reliable and relatively cheap – from R1 000 for a three-month supply of reusable lenses to R5 000 for a year’s one-day lenses.
But contact lenses do not work for everyone. Many people cannot adapt to it, or do not get lenses that fit on their eyes. As you get older, chances are good that your eyes are starting to refuse contact lenses. You may not swim with contact lenses, due to the very real danger of irreversible eye infections that can permanently damage your vision. It is also suitable for myopia, presbyopia and hyperopia.
3 Laser (Lasik in PRK)
Laser works for hyperopia and myopia – not for presbyopia who have to wear strong plus-lens glasses at forty. Doctors hold these two laser treatments for people who wear glasses from -6 to +3.
With both, the shape of the cornea (the bright outer layer of your eye) is slightly altered, with the goal of focusing incoming light more precisely on the retina.
With LASIK, small incisions are made in the cornea. The doctor lasers inside the cornea, to change the shape so that incoming light falls on the retina. The deeper layers of the cornea do not exactly make new cells, and so your vision remains stable for many years, such as immediately after surgery.
With PRK laser the doctor on the outside of the cornea and remove some of it, until the shape allows light to fall accurately on the retina. There is no deep work inside the cornea, which makes PRK somewhat safer. PRK is also the most painful. With LASIK, you recover the fastest and the chances of long-term success are the best.
You can expect to pay around R25 000 – R30 000 for both eyes. *
The new possibilities
4 The iris fixation lens, or ‘artisan’ lens
A pair of glasses is a wonderful piece of technology. It’s just annoying because you put on, take off, clean and sometimes lose your glasses all day. But what if you could attach the lens directly and permanently to your eye?
This is now possible, and the surgeon only takes half an hour. These lenses come with claws that hook into your iris (the colored part of your eye). These lenses are placed behind the glassy cornea, so nothing will move or fall off. These are some of the most convenient, safest options, with very little intervention or chance of damage to your other eye structures.
But it is expensive – R30 000 per eye – and it is not for everyone. Your natural cornea should be thick enough, which is a matter of luck, because you are born with thin or thick corneas. It is suitable for hyperopics carrying up to +10 lenses, as well as for myopia of up to -23.
The lens can last a lifetime but your vision may change as you age, or you may develop cataracts. It may be necessary to replace it or exchange it for one of the other options.
5 The intraocular contact lens (ICL)
It is very similar to an iris fixation lens, except that this lens is placed between your eye lenses and the iris, where it also cannot move around. You have the same benefits and risks, and if your vision changes due to aging you may also need to replace or exchange it. It works well for hyperopia up to +10 and myopia up to -30.
And the price? Also R60 000 for both eyes. *
6 Lens replacement, or cataract surgery
A cataract means that your eye’s own lenses begin to dim, with the result that light no longer penetrates as well. Cataracts are the cause of poor eyesight in one in three people over sixty, and if your problem lies here, none of the previous five options are going to work. A lens replacement is your best option – usually the case for most sixty-plus presbiops.
Where the other options add extra lenses or remove layers, the so-called cataract surgery involves removing your actual eye lenses and replacing them with synthetic lenses. Your eye lenses lie in a pouch, making it fairly easy to replace them, and the synthetic lenses can keep you going forever.
Disadvantage?
There are few risks but some people complain that they see a light circle around objects, especially at night. Sometimes your sight will still be a little bit out (no more than 0.5). You can
fix it with glasses. Instead, you can tune your sight with an extra LASIK fine tune.
Just look at the interesting options for cataract lens replacement
- You can choose two single-strength lenses that optimize your vision at a specific distance. You can choose whether you want to see up close, with glasses for far – or rather want to be able to see far, with glasses for near sight.
- You can choose two multifocal lenses that, just like multifocal glasses, allow you to see near and far. It usually works well but just as you have to get used to multifocal glasses, it is also a matter of adjusting.
- You can combine one multifocal lens on your dominant eye with a single-power lens on your other eye. This is called monovision. Your two eyes learn to work together very quickly, and you should be able to see very well at any distance. It usually works well for people who can do the same with their contact lenses. (Hint: if you do not know if it will work for you, try contact lenses for a week that give you monovision and see how well you do, before committing yourself permanently.) Talk to your eye specialist, which is the best option for your eyes will work out.
- The price? R25 000 for two single-power lenses, and an extra R10 000 per multifocal lens. *
* Prices approximate. Get a quote from your doctor and your medical fund. Some of these options are classified as cosmetic, for which your medical aid does not pay.
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