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Refractive surgery

Refractive surgery

Refractive surgery is a set of surgical techniques that correct vision disorders (myopia, hyperopia, astigmatism and presbyopia) in order to reduce or eliminate the need for glasses or contact lenses.

Principle

Surgery works mainly by means of a laser, reshaping the cornea. In certain cases where laser is not indicated, a lens is implanted inside the eye, with or without associated lens surgery. Each technique has its advantages and its limits: the choice depends on many criteria (age, correction, anatomy of the eye, lifestyle and activities).

Main indications

  • Aged over 18
  • Myopia and hyperopia, with or without astigmatism, stable for at least 2 years
  • Presbyopia
  • No ocular contraindication (cornea too thin, irregular, diseased, etc.)

The pre-operative assessment

A complete pre-operative assessment is essential to determine eligibility for surgery and the most suitable technique for each patient. At the end of this consultation, a clear and objective explanation is given to the patient. The choice of technique depends on the correction, the shape and thickness of the cornea, the presence of dry eye, any associated presbyopia, lifestyle, habits and the patient’s age.

“Zero glasses” cannot be guaranteed, particularly in cases of high correction, significant astigmatism or presbyopia.

The different surgical techniques

Principle

Creation of a thin corneal flap using a femtosecond laser, followed by correction of the refractive error with an excimer laser.

Indications

Myopia, astigmatism, hyperopia, presbyopia.

Advantages

  • Wide range of corrections
  • Rapid visual recovery (24 to 48 hours)
  • Painless
  • Precise, comfortable and very widely used technique

Disadvantages

  • Presence of a flap: rare flap-related risks (displacement, folds, etc.)
  • Dry eye sometimes more pronounced at first
  • Less suitable for certain occupations or sports with a high risk of eye impact

Principle

The femtosecond laser cuts a lenticule of corneal tissue, which is removed through a micro-incision. There is no corneal flap.

Indications

Myopia, low astigmatism.

Advantages

  • Minimally invasive technique
  • Less dry eye
  • No corneal flap

Disadvantages

  • More limited indications (myopia, low astigmatism)
  • More complex enhancements (PRK or femto-LASIK)

Principle

The laser acts directly on the surface of the cornea after removal of the epithelium.

Indications

Myopia, astigmatism.

Advantages

  • Suited to thin or irregular corneas

Principle

Personalised correction of presbyopia, with or without other refractive errors. It is based on monovision (one eye sees better at distance, the other at near) combined with a “blended” corneal profile (smoother transition zones). The surgical technique is the same as for femto-LASIK.

Advantages

  • Reduced dependence on glasses at all distances
  • Reversible and adaptable technique

Disadvantages

  • Requires an adaptation period

Principle

Implantation of an intraocular lens inside the eye, in front of the crystalline lens, without removing the natural lens.

Advantages

  • Corrects high refractive errors
  • Indicated when laser is not (corneas too thin or diseased)
  • Excellent optical quality
  • Preserves the cornea

Laser surgery takes place at the Swiss Visio Beau-Rivage refractive surgery centre. Phakic implants (ICL) are fitted in an operating theatre. Post-operative consultations generally take place at the Swiss Visio Beau-Rivage refractive surgery centre.