According to the latest data from the Sight Defense Commission (CDV) [7] , 78% of the Italian population over the age of 14 has visual defects . According to a research by the same commission, 53% wear glasses with corrective lenses, or 83% of those who claim to have vision defects.More than half of the adult population therefore has to do with contact lenses and glasses and 47% of them consider having to wear them “a nuisance”, as evidenced by the results of a survey submitted to the sample analyzed by CDV.
It is therefore not surprising that more and more people choose, with the advice of their ophthalmologist, to undergo the surgical correction of myopia, hyperopia or astigmatism, more properly called laser refractive surgery .
In this post we will talk about:
What is laser refractive surgery and how does it correct vision defect
When is it possible to correct vision with the laser?
What is the right age to correct vision with surgery?
Post-operative hospitalization and subsequent therapies
What are the improvements after the surgery?
Correcting eyesight with a laser: costs and coverage of the National Health System
Conclusions and final advice
What is laser refractive surgery and how does it correct vision defect
Refractive surgery has, in our country, a twenty-year history which has allowed a considerable improvement of the techniques used both in terms of effectiveness and speed and comfort for the patient.
This type of surgery, which in itself is not very invasive, allows you to vary the shape of the cornea, the natural lens placed in front of the iris that allows focusing. The precision and power of the laser is used to remove microscopic areas of the cornea, reshaping the curvature of our natural lens. In essence, a diopter “correction” is applied without the need for an external lens.
There are different techniques that are used to correct different visual defects, as well as different “severities” of myopia, astigmatism or hyperopia. [1]
When is it possible to correct vision with the laser?
Generally it is possible to correct any vision defect, including presbyopia, but there are cases in which correction is certainly more appropriate than in others.
First of all when there are problems of particular gravity , such as severe myopia (greater than 4 diopters) , or with a strong difference in visual defect between the eyes . In fact, in these cases it is not always possible to wear contact lenses and, at the same time, the glasses present themselves with a discrepancy between one lens and another which makes them unsightly.
At the same time, refractive surgery is recommended when doing activities that make wearing glasses problematic . This is the case of professional sportsmen, or people who work in particular sectors for which the use of contact lenses or glasses constitutes an impediment or encumbrance.
The contraindications of this surgery are few . However, there are some cases in which it is not recommended by doctors:
When the patient has a cornea that is too thin (corneal pachymetry)
When the patient suffers from dry eye or other corneal diseases
When the vision defect exceeds 12 diopters for myopia or 6 for astigmatism. In these cases, in addition to the increased risk, the effectiveness of the intervention is not guaranteed.
In any case, the sine qua non is given by the positive opinion of a doctor and ophthalmologist. The first must give his ok on the basis of the preoperative examinations that verify the state of health and the possibility for the body to suffer a shock such as that of a surgical operation (because this is anyway). The second verifies that the ocular characteristics and conditions exist to proceed with a modification of the cornea. [2]
What is the right age to correct vision with surgery?
First of all, regardless of age, you must have the favorable opinion of the ophthalmologist and your doctor who, after analyzing the health parameters and the state of the vision defect, recommends or advises against the intervention.
Generally, however, the experts agree in recommending the intervention after the age of 20 and in a situation in which the defect stabilizes and has not deteriorated for at least 2 years. For the same reason and to avoid incisive post-operative discomfort, the operation after the age of 40 is not recommended, when presbyopia could appear. After a certain age, dry eye syndrome may also worsen the post-operative course and final recovery. [3]
Post-operative hospitalization and subsequent therapies
A refractive surgery operation, however fast and almost painless, is still a delicate operation for which it is necessary to consider the right amount of post-operative hospitalization and follow a recommended therapy.
The operation itself lasts a few minutes and is carried out in the clinic (without hospitalization). After the intervention, the use of dark sun lenses is usually recommended for a few days, as well as avoiding smoky, windy environments (including the use of motorcycles and scooters) or water activities (sea, swimming pool). Among the aids normally recommended there is a moisturizing eye drops and an antibiotic that protects against any infections.
Generally both eyes are operated on at the same time so it must be considered that, for a few days, you may have some problems in normal activities, including work ones.
It will be necessary to consider a period of rest from work that varies according to the type of use that takes place: “for jobs that take place in dusty environments it is advisable to rest for 20-30 days. For activities that require good visual acuity and computer use, it is necessary to stay off work for a week ”. [4]
After surgery, vision recovery is immediate but it may take up to 3 months for complete healing and total recovery.
What are the improvements after the surgery?
Refractive surgery aims to completely correct the vision defect , allowing you to “see well”, without using contact lenses or eyeglasses.
However, those who have retinal problems or eye pressure problems do not solve them with surgery. In any case, it is necessary to continue to undergo periodic eye examinations to evaluate the condition of the eye and the postoperative improvement.
In some cases, a slight visual defect may reappear after years . In particular cases, in which a vision defect of such a magnitude as to justify a new intervention and in the presence of specific conditions, the laser operation can also be repeated on the eyes.
Correcting eyesight with a laser: costs and coverage of the National Health System
Until recently, the NHS did not cover refractive surgery because it was considered “aesthetic”. However, some cases have been introduced in the new LEAs in which it is possible to access these surgical therapies in a guaranteed regime, i.e. with partial or total exemption, depending on the case.
Annex 4B to the document published by the Official Gazette on March 18, 2017 [5] sets out the conditions for the provision of refractive surgery in LEAs which are:
Anisometry greater than 4 diopters combined with intolerance to the use of contact lenses;
Astigmatism equal to or greater than 4 diopters;
PTK (Phototherapeutic Keratectomy, a specific type of laser surgery) in patients with corneal opacities, corneal tumors, scars, irregular astigmatism, corneal dystrophies, or in patients who have had undesirable outcomes after refractive surgery;
Outcomes of trauma or anatomical malformations that prevent the use of glasses or contact lenses.
The document specifies that “The certification of intolerance to the use of contact lenses, where required, must be issued by a public structure other than the one that performs the intervention”.
The operation can also be carried out privately and in these cases the costs must be fully covered by the patient . To provide an idea, it is possible to cite a document of the Ministry of Health that reports these data: ” The cost of a refractive surgery treatment with Excimer Laser varies today (on the free market) from a minimum of 300 euros to a maximum of 2,500 euro by eye , with a trend that is around between 700 and 1,000 euro and an average closer to 1,000 euro ” [6]
Conclusions and final advice
In many cases, those forced to wear glasses or contact lenses to correct a vision defect dream of undergoing a refractive surgery that can eliminate the “annoyance” of resorting to external supports to see better.
However it must be remembered that:
It is a surgery, albeit not very invasive, but which still presents some risks. It is therefore absolutely necessary to correctly evaluate with your doctor and the ophthalmologist the opportunity to proceed with a correction of the vision defect;
Consideration should be given to a postoperative rest period during which vision may be partially impaired. It is therefore good to plan work activities, especially if you are self-employed, or the possibility of being absent from the office for a few days;
It is necessary to verify the possibility of accessing the operation under a subsidized regime or as a basic service recognized by the new LEAs. The evaluation of these aspects depends on clinical data that the ophthalmologist will be able to clarify.
