All materials on the site were prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

The light beam is refracted several times in the eyeball before hitting the sensory cells and further along the nerve pathway into the brain. The main site of this process is the lens. How we perceive an object depends mainly on its properties and abilities. Correcting pathological changes in the lens is quite difficult; the most effective way is to replace it - a complex, high-tech operation.

But there is an alternative method - exposure to the cornea. This is one of the layers of the spherical eyeball. It is here that the primary refraction of light occurs before it hits the lens. Non-surgical vision correction for farsightedness, nearsightedness or astigmatism involves exposing the cornea to a laser and changing its curvature.

Indications for laser vision correction

The operation is performed for three main eye diseases:

• Myopia. This disease is also called myopia. It occurs as a result of a change in the shape (stretching) of the eyeball. Focus is formed not on the retina, but in front of it. As a result, the image appears blurry to the person. Correction of myopia is possible by wearing glasses, contact lenses, laser and surgical methods. Eliminating the cause of the disease - the altered shape of the eyeball - is currently impossible.
• Farsightedness. The disease occurs due to a decrease in the size of the eyeball, decreased accommodation of the lens (often occurs in old age), and insufficient refractive power of the cornea. As a result, the focus of nearby objects is formed behind the retina, and they appear blurry. Farsightedness is often accompanied by headaches. Correction is carried out by wearing glasses, lenses, and laser operations.
• Astigmatism. This term refers to a person's ability to see clearly. It arises from an abnormality in the shape of the eye, lens or cornea. The focus of the image is not formed on the retina. The disease is often accompanied by migraines, eye pain, and rapid fatigue when reading. It can be corrected by wearing special glasses with different longitudinal and transverse curvature of the lenses. But the most effective is laser surgery.

All these diseases are united under the general name “ametropia”. This includes ailments associated with problems with focusing the eye.

Indications for vision correction surgery for the three diseases described are:

1. The patient's desire to get rid of glasses and contact lenses.
2. Age from 18 to 45 years.
3. Refractive indexes for myopia are from -1 to -15 diopters, for farsightedness – up to +3 diopters, for astigmatism – up to +5 diopters.
4. Intolerance to glasses or contact lenses.
5. Professional needs of patients, the requirement of special visual acuity and speed of reaction to the image.
6. Stable vision. If the deterioration gradually progresses (more than 1 per year), then you first need to stop this process, and then talk about laser correction.

Contraindications

The operation is not performed in the following cases:

Preparation for laser correction

The patient must stop wearing glasses or contact lenses at least a week before the correction. It is better to take a vacation during this time. This is necessary for the cornea to take its natural shape. Then the correction will be more adequate and accurate. The doctor may increase the period of refusal from artificial lenses at his discretion.

Each clinic has a list of necessary tests that must be taken before surgery. Usually this is the absence or presence of certain infections, blood tests, and urine tests. Test results have a limited validity period - from 10 days to a month.

For two days you need to stop drinking alcohol and using eye makeup. Before visiting the clinic, it is better to wash your hair and face. It is important to get a good night's sleep, calm down and not be nervous before laser vision correction. If the patient feels too scared or anxious, the doctor may recommend mild sedatives.

Types of operation

There are two main methods of correction - PRK (photorefractive keratectomy) and (laser keratomyelosis). The first operation allows you to correct myopia up to 6 diopters, astigmatism up to 2.5-3 diopters. Both types of laser correction are carried out sequentially: first on one eye, then on the other. But this happens within the framework of one operation.

For laser correction of farsightedness and myopia complicated by astigmatism, Lasik is more often used. This is because PRK requires a long (up to 10 days) healing time. Each type of operation has its pros and cons, but still Lasik is a more promising direction, so this method is most often preferred.

Photorefractive keratectomy

The operation is performed under local anesthesia. The doctor treats the eyelid and eyelashes with an antiseptic. Sometimes an additional antibiotic is instilled to prevent infection. The eye is fixed using an eyelid speculum and washed with saline solution.

At the first stage, the doctor removes the epithelium. He can do this surgically, mechanically and laser. After this, the process of evaporation of the cornea begins. It is carried out only with a laser.

The method is limited by the required residual thickness of the cornea. To perform its functions, it must be at least 200-300 microns (0.2-0.3 mm). To determine the optimal shape of the cornea and, accordingly, the degree of its evaporation, complex calculations are carried out using special computer programs. The shape of the eyeball, the ability of the lens to accommodate, and visual acuity are taken into account.

In some cases, it is possible to refuse excision of the epithelium. Then the operations are faster and with less risk of complications. In Russia, a domestically produced Profile-500 installation is used for this purpose.

Laser intrastromal keratomyelosis

Preparations are similar to those for PRK. The cornea is marked with safe ink. A metal ring is placed over the eye, which additionally secures it in one position.

The operation takes place under local anesthesia in three stages. On the first the surgeon creates a flap from the cornea. He detaches the superficial layer, leaving it attached to the underlying tissue, using a microkeratome instrument—specially modeled for eye microsurgery.

laser vision correction: progress of the operation

The doctor removes excess fluid with a sterile swab. At the second stage he folds back the flap and laser vaporizes the cornea. The entire process takes less than one minute. During this time, the flap is also covered with a sterile swab. At the third stage the separated piece is placed in its place, according to the previously applied marks. After rinsing the eye with sterile water, the doctor smoothes the flap. No sutures are required; the cut-off piece is fixed on its own due to negative pressure inside the cornea.

The possibility of performing an operation is determined largely by the anatomical structure of the patient's eye. To implement this, it is necessary that the cornea of ​​the eye is of sufficient size. The flap must have a thickness of at least 150 microns. The deep layers of the cornea remaining after evaporation are at least 250 microns.

Video: how laser vision correction is done

Postoperative period, patient instructions

On the first day after laser correction, the following reactions are normal:

• Pain in the operated eye. With Lasik, it is usually insignificant and feels like a foreign object getting under the eyelid.
• Discomfort when looking at light.
• Tearing.

The patient is prescribed a course of antibiotics and corticosteroids to prevent the development of infectious or non-infectious inflammation. Beta blockers may be prescribed to prevent increased intraocular pressure.

In the first few days after surgery, the patient is recommended to:

• Be in a darkened room. Light can cause pain and stinging in the eyes. It unnecessarily irritates the cornea, which prevents its healing.
• Avoid touching the eye, especially in the first day. Important! The patient may feel as if a speck has gotten under his eyelid; there is no need to try to remove it! If the discomfort is very severe, you should consult a doctor as soon as possible. If there is no cause for concern, he may prescribe desensitizing medications.
• Refusal to shower and wash. It is very important that your eyes are not exposed to any chemical agents that may be contained in soap or shampoo. Even water sometimes has a negative effect on the operated eye.
• Avoid alcohol until the course of medication is completed. Antibiotics are incompatible with alcohol. It also makes many other drugs work worse.

During the first few weeks it is advisable to:

1. Stop smoking and visiting polluted places. Smoke has a bad effect on the cornea, causes it to become dry, and impairs its nutrition and blood supply. Because of this, it may heal more slowly.
2. Do not engage in sports that may impact the eyes - swimming, wrestling, etc. Injuries to the cornea during the recovery period are extremely undesirable and can lead to irreparable consequences.
3. Avoid eye strain. It is important not to spend a lot of time at the computer, reading a book or watching TV. You should also avoid driving in the evening.
4. Avoid bright light, wear sunglasses.
5. Do not use cosmetics for eyelids and eyelashes.
6. Do not wear contact lenses for 1-2 weeks.

Risks and consequences of the operation

There are early and late postoperative complications. The first ones usually appear within a few days. These include:

• Non-healing corneal erosion. Its treatment is quite complex and requires consultation with specialized specialists. Common methods of therapy are the use of collagen coatings of the cornea, contact vision correction (use of soft lenses).
• Reduced thickness of the epithelial layer, its progressive destruction. It is accompanied by swelling and the development of erosions.
• Keratitis (inflammation of the eye). It can be infectious or non-infectious in nature. Keratitis manifests itself in redness of the eye, pain, and irritation.
• Opacities in the evaporation zones of the cornea. They can also occur later in the rehabilitation period. Their cause is excessive evaporation of corneal tissue. The complication, as a rule, responds well to treatment with the use of resorption therapy. In some cases, it is necessary to resort to repeated surgery.

The overall rate of long-term complications with Lasik is 1-5%, with PRK – 2-5%. In the later stages, the following negative consequences of laser correction may become apparent:

Vision restoration

For the final determination of the success or failure of the operation, as well as for the stabilization of its results, a rather long period usually must pass. The recovery period can last up to 3 months. Only after its expiration can a conclusion be made about the effectiveness of the treatment, as well as subsequent corrective measures.

Results vary depending on the type of surgery, underlying disease, and degree of vision impairment. The best results are possible with correction at the initial stages of the disorder.

For myopia

The most predictable operation is Lasik. It allows in 80% of cases to achieve correction with an accuracy of 0.5 diopters. In half the cases, in patients with slight myopia, vision is completely restored (acuity value – 1.0). In 90% of cases it improves to 0.5 or higher.

With severe myopia (more than 10 diopters), repeat surgery may be required in 10% of cases. In this case it is called additional correction. During this procedure, the already cut flap is raised and additional evaporation of part of the cornea is carried out. Such operations are carried out 3 and/or 6 months after the first procedure.

It is quite difficult to provide exact data regarding PRK vision correction. The average visual acuity is 0.8. The accuracy of the operation is not very high. The diagnosis of undercorrection or overcorrection is made in 22% of cases. Visual impairment occurs in 9.7% of patients. In 12% of cases the result does not stabilize. The big advantage of using PRK compared to Lasik is the low risk of keratoconus after surgery.

For farsightedness

In this case, vision restoration, even with the Lasik method, does not follow such an optimistic scenario. Only in 80% of cases it is possible to achieve a visual acuity score of 0.5 or higher. Only in a third of patients the functions of the eye are fully restored. The accuracy of the operation in the treatment of farsightedness also suffers: only 60% of patients have a deviation from the planned refraction value of less than 0.5 diopters.

PRK is used to treat farsightedness only if the Lasik method is contraindicated. The results of such correction are quite unstable, which means that quite serious regression is possible over the years. With a weak degree of farsightedness, it is satisfactory only in 60-80% of cases, and with severe impairments - only in 40% of cases.

For astigmatism

With this disease, both methods manifest themselves almost identically. Research from 2013 was published on the Ophthalmology Portal. According to the results of observations, “no statistically significant difference was found in effectiveness [efficacy index = 0.76 (±0.32) for PRK versus 0.74 (±0.19) for LASIK (P = 0.82)], safety [safety index = 1 .10 (±0.26) for PRK vs. 1.01 (±0.17) for LASIK (P = 0.121)] or predictability [achieved: astigmatism<1 Д в 39% операций, выполненных методом ФРК и 54% - методом ЛАСИК и <2 D в 88% ФРК и 89% ЛАСИК (P = 0,218)”.

However, it is worth noting that the success rate of operations is not too high - 74-76%. And also the improvement in vision when using the Lasik method is slightly higher than with PRK.

The cost of laser vision correction, surgery under compulsory medical insurance policy

The question of the possibility of free vision correction is quite controversial. Insurance companies tend to classify such operations as cosmetic, which, according to the law, are paid for by patients themselves.

There is information about the possibility of receiving such assistance for military personnel and their relatives in military hospitals. So, on the website of the Military Medical Academy named after. CM. Kirov city of St. Petersburg indicated: “The Academy provides inpatient and outpatient treatment to military personnel and their families, as well as citizens who have compulsory medical insurance or voluntary health insurance policies from companies that have entered into an agreement with the Military Medical Academy. Without a policy, the VMA provides services to the population on a paid basis.” The list of medical procedures provided includes “ laser correction of visual acuity“. Probably, in general practice, such operations are carried out free of charge if there is an agreement with a specific hospital in the region of military service/residence and the technical capabilities of the medical institution.

The vast majority of laser vision correction operations are carried out on a paid basis. However, working citizens can return a tax deduction of 13% by writing an application. Also, many companies provide discounts to their regular customers and some social groups - pensioners, disabled people, students.

The cost depends on the type of operation, clinic and region. On average, PRK in Moscow costs 15,000 rubles. Lasik, depending on the modification of the method, ranges from 20,000 to 35,000 rubles. Prices are for vision correction in one eye.

Clinics in Moscow and St. Petersburg

The most popular and well-known medical centers in the two largest cities of Russia are:

To do or not to do vision correction is a question that the patient must decide for himself first. This operation is not considered necessary or vital. However, the majority of patients who have undergone laser correction report a huge improvement in their quality of life and their well-being.

Video: LASIK laser vision correction – patient review

Video: laser vision correction - progress of the operation

You are most likely asking the question: “How many of them exist and what are they, how do they differ?” And most importantly: where to find honest information?

First, remember how many laser correction methods you have encountered and read about. Probably more than a dozen. At the same time, there is no clear understanding of what is truly a method and what is just a marketing ploy. Let's figure it out.

First, let's remember once again what it is - this is photochemical ablation (evaporation, removal) of the layers of the cornea under the influence of an excimer laser beam, which results in a change in the curvature of the outer surface of the cornea and, as a result, the return of ideal vision.

Taking into account the types of lasers available in the world and the features of their operation, we can distinguish 3 techniques that differ significantly from each other in the way the laser acts on the cornea:

• Photorefractive keratectomy (PRK);
• LASIK;
• ReLEx SMILE.

The PRK technique and the LASIK technique are not competing (if you do not take into account the ambitions of individual manufacturers and clinics), but complement each other. It is advisable to use superficial methods such as PRK to perform operations to correct myopia and complex myopic astigmatism; the correction of other refractive errors is more effective when using valve technologies (LASIK).

Photorefractive keratectomy (PRK)(the most ancient method of laser correction).

The impact is made directly on the outer surface of the cornea. Its varieties:

• LASEK;
• Epi-Lasik,
• Trans-FRK.

An excimer laser is also used to change the shape of the cornea. During the operation, only 5-10% of the corneal thickness is removed for mild and moderate myopia and up to 30% for severe myopia.

The main advantage of this operation is that the integrity and strength of the cornea is preserved. The excimer laser allows you to remove individual corneal cells without damaging neighboring ones. This allows you to change the shape of the cornea with maximum precision, while minimally damaging it. In addition, this method allows you to correct not only myopia, but also farsightedness and astigmatism.

Advantages of the method:

• superficial nature of most complications;
• persistent refractive effect;
• “knifeless” surgical technique.

Disadvantages of the method:

• long recovery;
• not always predictable refractive effect;
• removal of the natural protective layer of the cornea - the epithelium, the restoration of which takes time;
• severe discomfort for 3–4 days after surgery.

LASIK Laser intrastromal keratomileusis

LASIK Laser-Assistedin Situ Keratomileusis– the impact is made on the inner layers of the cornea, which are previously exposed by a tangential cut of a surgical instrument or a femtolaser (FemtoLasik) and bending the resulting valve.

LASIK (or LESIK) is a hybrid technology that is a combination of laser exposure and microsurgical techniques. If PRK is performed only with the help of a laser, then LASIK surgery is performed using an additional device - a microkeratome, which allows you to make a thin section of the surface layers of the cornea (while the protective layer is preserved). Laser exposure is carried out deep in the corneal stroma.

Until recently, the main complications during LASIK were associated with the flap. Now these problems are becoming a thing of the past, as modern reliable and accurate (automatic) microkeratome models have appeared, where the human role is reduced to a minimum.

This laser vision correction technology has several advantages over PRK. LASIK quickly and effectively improves visual acuity, avoids wearing a bandage (or special lenses), pain in the postoperative period, and the occurrence of complications characteristic of PRK, such as the development of haze and delayed reepithelialization (restoration of the epithelial layer). In addition, LASIK allows you to correct high degrees of ametropia (myopia, farsightedness, astigmatism).

LASIK technology underwent multi-stage clinical trials before it began to be used in ophthalmology centers and clinics. Long-term observations of patients have shown that the excimer laser does not cause any disorders, since the impact occurs only on one of the refractive media - the cornea, and the depth of impact is strictly limited.

Today, medical centers and clinics in 45 countries work with it. Over the past 10 years, more than 5 million vision corrections using the LASIK technique have been performed worldwide.

Sometimes you can find references to the methods “Intra-LASIK” and “Super-LASIK”, etc., which are practically no different from each other, and are used in different contexts only for advertising purposes.

As for the calculated parameters, it is worth noting that most refractive surgeons prefer excimer laser correction using the individualized program, which is the latest software update for the laser machine. It allows you to calculate laser correction parameters as accurately as possible and simulate a corneal surface that maximally compensates for all existing distortions. Custom-Q LASIK is also recommended for those patients whose lifestyle or profession require a special quality of vision.

Advantages of the method:

• rapid restoration of vision;
• preservation of the epithelium;
• absence of pain and risk of haze formation;
• more accurate predictability of the outcome of the operation;
• allows for correction of high degrees of ametropia (myopia, farsightedness and astigmatism);
• Both eyes are operated on the same day.

Disadvantages of the method:

• impossibility of use with a sufficiently thin cornea;
• limitation for keratoconus.

FemtoLasik is a type of LASIK - a relatively new laser refractive surgery that allows vision correction without the use of scalpels and mechanical microblades, by performing the procedure exclusively with lasers.

ReLEx® SMILE

Not so long ago, a laser correction method appeared, the operation in which takes place without the formation of a corneal flap (flap), as in LASIK technology, and without displacement of the corneal epithelium, as in PRK/LASEK operations. The operation is performed using only a femtosecond laser. The laser beam forms a lenticule (lens) of predetermined parameters in the thickness of the corneal tissue, which is then removed through a small incision of 2-4 mm on the surface of the cornea.

But so far, according to a number of leading refractive surgeons, this method is inferior to the well-proven individualized (Custom-Q) LASIK.

Let's summarize the above. If my friends or acquaintances asked me which method of laser vision correction I would recommend to them, then in 99% of cases it would be LASIK using the individualized method (Custom-Q).

Victor Kopylev

Refractive Surgeon

Today, there are more than 20 methods for correcting myopia, farsightedness and astigmatism. However, ophthalmologists around the world recognize the excimer laser vision correction method as the most effective.

Such operations are carried out using the most modern and advanced technologies LASIK (LASIK) and EPI-LASIK, which preserve the layer-by-layer structure of the cornea, do not leave seams and allow you to painlessly obtain excellent vision the very next day after the operation. The correction can be carried out in one day on both eyes. If indicated, correction can be carried out using traditional PRK technology.

PRK

1) Anesthetic drops are instilled into the patient’s eyes (anesthesia is not used). After the anesthesia has taken effect, the eyelids are opened with an eyelid expander. The patient is asked to look at a lighted dot on the device to center the position of the eye. If necessary, the eye is fixed with a vacuum ring. Markings are applied to the cornea.

2) The epithelium is removed from the area that will be affected by laser radiation using a laser or surgical instrument.

3) Using an excimer laser, a new surface of the cornea is formed; the progress of laser correction is controlled by an ophthalmologist. After completion, the cornea is washed with a special solution, then anti-inflammatory drops and antibiotics are instilled. A bandage is placed on the eye to protect it from external influences.

When carrying out vision correction using the PRK technique, the laser changes the outer layers of the cornea. As a result, the surface layer - the epithelium and the Bowman's membrane on which it is located - is damaged, leaving an open wound surface, which is then gradually covered with epithelium. The recovery process lasts 3-4 days, accompanied by unpleasant sensations; contact lenses are used to relieve pain.

Lasik

1) The first stage completely coincides with the PRK technique

2) Using a microkeratome (special instrument), the upper layer of the cornea is separated, it is lifted and folded back. Then the laser action of the excimer laser begins, forming a new shape of the cornea.

After completion of the laser treatment, the cornea is washed with a special solution. The surface layer falls into place and serves as a kind of “natural bandage”. Due to the characteristics of this avascular layer of tissue, it is well fixed after just a few minutes, so no sutures are required. The patient is given anti-inflammatory drops and antibiotics.

Unpleasant sensations during the recovery period are minimal. As a rule, after a few hours a person already gains the ability to see much better than before vision correction. Vision is finally restored within 3-5 days, depending on the individual characteristics of the eye.

EPI-LASIK

EPI-LASIK is the most modern method of vision correction, retaining all the advantages of the Lasik method - rapid restoration of vision with minimal pain. EPI-LASIK is a superficial corneal sculpting procedure along with PRK and Lasik.

EPI-LASIK is considered the most suitable technique for patients with low levels of myopia, thin corneas, and in all cases where the formation of an epithelial flap may pose certain problems.

Laser exposure during surgery is performed on the surface of the cornea after removal of the epithelium (this is its similarity with PRK and LASIK). The ophthalmic surgeon does not use a microkeratome with a blade, but uses a special epikeratome to delaminate and separate the epithelial flap. By maintaining the viability of the epithelial flap, the healing process is more efficient, making patients feel much better than after PRK and LASIK procedures. Also, the Epi-LASIK method does not use an alcohol solution, this is its difference from the LASIK operation, and more than 80% of epithelial cells remain viable. After the epithelial flap is returned to its place, these cells are distributed throughout the cornea, creating a very smooth surface and a favorable environment for further restoration of epithelial cells.

• Today, medical centers and clinics in 45 countries use laser techniques;
• over the past 10 years, about 5 million vision corrections have been performed worldwide using the Lasik method;
• in the USA and Japan, the procedure for restoring vision using laser vision correction has long gone beyond specialized clinics; small laser correction centers can be seen in the territories of large shopping and entertainment complexes, next to dental and cosmetology offices and beauty salons;
• The US government, as part of the national program for improving the armed forces, has been paying for laser vision correction for military personnel of all ranks and branches of the military for several years.

Contraindications

Age less than 18 and more than 45 years. This is justified by physiological reasons: before the age of 18, the eyeball, and the entire human body, is not yet fully formed, and vision may change;

Pregnancy and lactation period;

Diabetes mellitus, rheumatism, thyroid diseases and a number of other diseases;

Some types of eye diseases (corneal dystrophy or degeneration, glaucoma, iridocyclitis, etc.)

The final decision on the possibility of laser vision correction is made by the doctor after diagnosis.

Diagnostics

Any type of laser vision correction begins with a comprehensive vision diagnosis, during which visual acuity is checked, the type and degree of visual impairment are determined, intraocular pressure, curvature, thickness and topography of the cornea are measured. All these and other indicators make it possible to diagnose corneal diseases, which may be contraindications for LKZ.

Before the diagnosis, you must not wear contact lenses: soft – 7 days, hard – 14 days.

Some misconceptions

1. It will hurt.

Laser vision correction is an effective and painless method of vision correction. Modern technologies have overcome the “pain barrier” and make it possible to carry out the laser correction procedure under local drip anesthesia, which is more easily tolerated by patients of all ages. In addition, it does not put stress on the heart, blood vessels and other organs.

2. Vision will take a long time to recover.

The patient’s vision begins to improve within 1.5-2 hours after correction, and within a week all processes of visual functions are normalized.

3. Vision will become even worse.

As world practice data show, the likelihood of side effects after laser correction is reduced to tenths of a percent, thanks to a thorough diagnostic examination before correction and the perfection of modern laser systems.

4. Over time, the result of laser correction will deteriorate.

Laser correction has been used in widespread practice since 1985. Long-term observations of patients have shown that laser correction does not cause any disturbances in the internal structures of the eye, since the depth of impact is strictly limited. During the entire period of laser correction, there were no cases of vision deterioration or loss due to laser exposure.

5. After laser vision correction, you will not be able to live a full life.

Laser vision correction is the only way to restore vision for those who experience maximum stress: test pilots, rescuers, climbers, stuntmen, athletes; after surgery there are no restrictions on physical and visual stress.

7. The result will not be the one promised.

It is possible to predict what vision will be like after laser correction immediately after diagnosis. Laser correction is the only method that allows you to achieve the predicted result, which is one of its main advantages compared to other methods.

The radical keratotomy method, which appeared in the 30s of the twentieth century, was the first method of surgical vision correction. The essence of this technique is that, using a special diamond knife, shallow cuts were made on the surface of the cornea, and the depth was on average one third of the thickness of the cornea.

The notches were directed from the pupil to the periphery and grew together over time. As a result, the shape of the corneal layer changed, which led to a change in its refractive power; At the same time, vision improved. There were a lot of disadvantages to this technique.

The surgical knife did not have micron precision, and therefore it was very difficult to calculate the depth of the notches and their required number, so the result of the intervention was poorly predictable. Also, the postoperative period for radical keratotomy was very long.

The patient was forced to stay in the hospital for a long time, limit any physical activity, and avoid overexertion. Also, in each patient, the incisions healed differently, which was influenced by the speed of the regeneration processes. Various complications often occurred after surgery.

This technique was often used in the eighties of the last century. A supporter of such interventions in Russia was Svyatoslav Fedorov. However, due to a large number of shortcomings, specialists needed to search for new, more advanced methods.

In the global community of ophthalmologists, the beginning of the use of the excimer laser is considered to be 1976, when doctors showed special interest in the development of the IBM company. Specialists from this corporation used lasers to engrave information on the surface of computer microchips. This technique attracted doctors due to the colossal precision achieved during engraving. Scientists conducted several experiments that showed the possibility of using high-precision lasers in medicine. This technique allows precise control of the depth and diameter of exposure in refractive surgery practice. Since that time, the triumph of the excimer laser began, and this technology has now become one of the most reliable in restoring visual function.

PRK - photorefractive keratectomy (PRK - Photo Refractive keratectomy)

The first operation using the PRK technique was performed back in 1985. This was the first time the excimer laser was used in ophthalmic surgery. In photorefractive keratectomy, non-contact changes were made to the upper layers of the cornea using an excimer laser, while the internal structures of the eyeball remained intact.
When using the PRK technique to correct ametropia, microdamages occur in the outer layers of the cornea, which change its shape during healing. At the same time, regeneration processes take quite a long time, so long-term use of special eye drops is required. Using this technique, it is impossible to correct vision on both sides.

The PRK technique is applicable to correct visual acuity in the following cases:

• Myopia within -1...-6 diopters;
• Farsightedness within +1…+3 diopters;
• Astagmatism from -0.5 to -3 diopters.

LASIK - laser keratomileusis (LASIK - Assisted in Situ Karetomileusis)

Laser keratomileusis has been used since 1989. The advantage of this technique is that during the operation the surface layers of the cornea, including the epithelium, are not damaged; laser transformation is carried out only in the middle parts of the cornea. During correction, special microkeratomes are used, which allow the thin epithelial layer to be released and the middle layer of the cornea to be exposed. After this, laser evaporation is carried out to change the shape of the cornea.

Among the advantages of LASIK, the following characteristics are worth mentioning:

• Carrying out surgery on an outpatient basis;
• Possibility of simultaneous correction of both eyes;
• Preservation of the anatomical structure of the layers of the cornea;
• Stability and predictability of results;
• Painless.

LASIK is used in patients with:

• Myopia (up to -15 diopters);
• Farsightedness (up to +6 diopters);
• Astigmatism (up to +6 diopters).

LASEK - laser epithelial keratomileusis (LASEK - Laser Epithelial Keratomileusis)

LASEK has become widespread since 1999. M. Kamelin is considered the founder of this technique. This type of laser intervention is most often used for thinned corneas, when standard LASIK cannot be performed. The LASEK procedure is, in essence, a modification of PRK. The essence of the technique is that during the intervention the epithelial layer is preserved, and the postoperative field is covered after the operation with a tissue flap. This technique is more painful than LASIK, and the recovery period after surgery is also longer.

The LASEK method is used for patients in the following cases:

• Myopia up to -8 diopters;
• Hypermetropia up to +4 diopters;
• Astigmatism up to 4 diopters.

Epi-LASIK (Ephithelial LASIK)

Epi-LASIK is a modification that began to be used at the beginning of the 21st century (since 2003). It is usually prescribed to patients who have contraindications to traditional LASIK surgery.

The advantages of Epi-LASIK surgery include:

• Preservation of the corneal structure;
• Short rehabilitation period;
• Absence of a wound surface when forming a flap from the epithelial layer of the cornea;
• Possibility of refractive correction even with a thinned cornea;
• Complete restoration of epithelial layer cells;
• Low likelihood of developing subepithelial opacities;
• Minor discomfort that the patient experiences after surgery.

The Epi-LASIK technique is suitable for patients with:

• Myopia up to -10 diopters;
• Hypermetropia up to +6 diopters;
• Astigmatism within 4 diopters.

Epi-LASIK is performed after preliminary removal of the epithelial layer from the surface of the cornea. This operation is similar to PRK and LASEK. In this case, the surgeon does not use a microkeratome, a knife blade, or alcohol treatment during the operation. During the intervention, the ophthalmic surgeon, using a special epikeratome, exfoliates the corneal substance and carefully separates the epithelial flap. Due to the fact that the cells in the epithelial flap remain viable, the healing process proceeds quite quickly and efficiently. The epithelial flap itself resembles the corneal flap used in LASIK surgery, but it is less thick, so patients experience less discomfort than after LASEK and PRK.

During the Epi-LASIK operation, no alcohol solution is used, and therefore the majority of epithelial cells (up to 80%) remain viable. After placing the epithelial layer in its original place, the cells spread over the entire surface of the cornea and create a smooth surface, which creates favorable conditions for the subsequent restoration of the epithelial cover of the cornea. After this, a special contact lens is placed over the cornea, which can be removed 3-5 days after the intervention (depending on the healing rate).

Super LASIK (Super Lasik-Custom Vue)

Super-LASIK is the most modern method of vision correction for ametropia. A special feature of this type of operation is the precise reshaping of the cornea, which takes into account preoperative data obtained through aberration analysis. This analysis is carried out using unique equipment called a Wave Scan wavefront analyzer. In the process of computer processing of the obtained data, distortions of the cornea, as well as the entire optical system of the eye, are taken into account. Thanks to the presence of a special program, computer data can be entered into the laser installation before the operation begins.

Super-LASIK is currently considered the most accurate technique used to correct refractive errors. It helps to eliminate not only myopia, farsightedness and astigmatism, but also to correct distortions in the visual system (aberrations) of a higher order. As a result of performing Super-LASIK, the patient's vision becomes of exceptionally high quality.

Femto-LASIK (Femto-Lasik or All Laser Lasik)

Femto-LASIK is a modification of the generally accepted LASIK technique. The first time such an operation was performed was in 2003. The only and most important difference between Femto-LASIK and LASIK is the method of forming the corneal flap. In this case, a special femtosecond laser is used to split the cornea, rather than a conventional microkeratome or epikeratome, as in other types of operations. That is, during the intervention, the layers of the cornea were not dissected mechanically. This significantly increased the safety of the technique and also reduced the likelihood of side effects, such as corneal astigmatism. This technique also has another name - full laser LASIK.

Among the advantages of Femto-LASIK surgery it is worth noting:

• Almost complete absence of corneal damage;
• Possibility of vision correction even with a thin cornea;
• Broad indications for the use of the technique.

The Femto-LASIK operation provides very rapid healing after the intervention, since the border of the corneal dissection occurs without mechanical influence on the cells and is perfectly smooth. The results of the operation remain very high.

Indications for Femto-LASIK intervention include:

• Astigmatism up to 3 diopters;
• Myopia up to -15 diopters;
• Farsightedness up to +6 diopters;
• Myopic astigmatism up to -6 diopters;
• Hypermetropic astigmatism up to +4 diopters.

1. Photorefractive keratectomy or, if you prefer, PRK– one of the oldest, but still used methods of vision correction. The procedure is highly traumatic and carries a risk of developing corneal clouding. It does not require high qualifications from the doctor; for this reason, it has been used to this day since the 60s of the 20th century.

   It’s better not to carry out such a procedure, of course.

2. ReLex- femtosecond laser, which allows you to form a lenticule of the cornea inside and it is removed through the incision. The procedure can only correct low-level myopia.

   

   Quite effective and harmless procedure

3. LASEK– this vision correction is intended only for those people who have a thin cornea, it is highly traumatic, the method was developed in Italy. During the procedure, a person may feel pain.

   

   Mechanism of the procedure

4. LASIK– allows you to correct myopia of 12 diopters, allows you to perform surgery on both eyes. The procedure is highly effective, minimally traumatic and has a short recovery period.

   

   This is how LASIK vision correction works

5. Super LASIK– this correction method differs from others in its high effectiveness, is carried out quickly and allows the patient to see the world in all its colors within 1-2 hours after the operation. At the moment it is considered the most progressive, which undoubtedly affects the cost of the procedure.

   

   This is how Super LASIK vision correction is performed

Indications and contraindications

The following diseases are considered to be the main indications for correction:

• myopia;
• farsightedness;
• astigmatism.

Even if these diseases are combined with each other or only 1 eye is affected, the operation is performed because it will help restore vision and cope with the existing defect.

Laser correction is also carried out in cases of retinal detachment, but in this case the procedure has a slightly different focus; it allows you to stop retinal detachment using a laser.

The procedure has much more contraindications; they can be divided into relative (that is, temporary) and absolute, that is, permanent.

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Relative contraindications include:

1. Childhood. Patients under 18 years of age do not undergo surgery. Since until this time the child’s body is actively growing and forming, the same can be said about his eyeball.
2. Pregnancy and lactation period. At this time, the woman’s hormonal background is unstable, as a result of which the healing process may take a different path and complications may arise. In addition, women are prescribed antibiotics, which can harm the fetus.
3. Diseases of an inflammatory or infectious nature of the organs of vision. It is enough to get rid of the disease for this contraindication to be eliminated.
4. Dystrophic changes in the retina. First, they eliminate one problem, and then move on to vision correction using a laser. The retina needs to be “soldered”, the progress of the disease must be stopped, and then another surgical intervention must be started.
5. Problems with the immune system. Various diseases that reduce the functioning of the immune system are also considered a relative contraindication. If the functions of the immune system are reduced, the recovery process will take a long time, and unwanted complications may arise.

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The video shows indications for vision correction surgery:

Absolute contraindications:

• diabetes mellitus and other systemic diseases that reduce the activity of the immune system;
• skin diseases: psoriasis, eczema, etc.;
• various psychological diseases (due to the patient’s inadequacy);
• some eye diseases (optic nerve atrophy, cataracts, glaucoma, etc.);
• age over 45 years (due to the fact that age-related changes have begun in the body);
• Keratoconus is another eye disease caused by thinning and changes in the shape of the eyeball.

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Preparation

It comes down to carrying out standard procedures, these include:

1. Visit to an ophthalmologist. The doctor will measure your vision parameters, clarify the necessary information and recommend the appropriate method of surgery. A visit to an ophthalmologist can be called a planned one, since he will not perform any specific procedures.
2. Visiting a therapist. The doctor will measure your blood pressure, write out directions for tests, help identify hidden contraindications to surgery, and do a cardiogram. The doctor will act according to the standard scheme; he needs to know how well the body will tolerate such an intervention and what the likelihood of complications, consequences or various force majeure situations is. The therapist will write out directions for tests, which will also have to be taken.

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What tests are taken before laser correction:

• blood for HIV, syphilis, hepatitis B and C;
• general clinical blood test for biochemistry;
• general urine analysis;
• blood test for clotting.

If necessary, the therapist can add other tests and examinations to the list. For example, patients undergoing surgery are often recommended to undergo fluorography. If there are problems with the cardiogram, then ultrasound of the heart.

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Postoperative period

Continues for 3–4 weeks from the date of surgery. At this time it is recommended to refuse:

1. From visiting saunas, baths, hot baths.
2. From using various cosmetics.
3. From drinking alcoholic beverages.
4. From physical activity.
5. From sports activities and all kinds of games.

It is recommended to wear dark glasses even in cloudy weather, and only take them off in a room with dim lighting. Do not rub your eyes with your hands; there is a high risk of displacing the formed corneal flap and reducing the doctors’ efforts to zero.

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Possible complications in the postoperative period:

• the appearance of edema;
• development of inflammatory lesions in the organs of vision;
• hemorrhages;
• displacement of the flap formed
• various injuries;
• decrease in contrast (considered a temporary phenomenon and goes away on its own).

The most dangerous complication is considered to be a retinal burn. This leads to its detachment, requiring long-term treatment and several surgical interventions of a different nature. If the burns are local, then doctors will only be able to partially preserve the patient’s vision. Against the background of such a complication, complete blindness can develop.

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Price

1. FRK 25-30 thousand rubles.
2. Lasik up to 53 thousand rubles (the price depends on the complexity of the surgical intervention).
3. Super Lasik from 50 thousand rubles.

Much depends on the clinic where the operation is planned to be performed. The cost can be clarified with an ophthalmologist or an employee of the institution, additionally.

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Laser vision correction is an operation that is characterized by low trauma, it lasts several minutes and after it is performed the patient can get rid of the existing problem and restore visual acuity. In some cases, such a procedure is the only possible option, but do not forget that any operation is associated with risks, even if it is carried out using modern technologies.