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The Right to Sight: Means to a Better Vision

KPJ Care For Life Magazine Vol 3 Issue 4

Identifying the Problems
Refractive errors are very common eye disorders which occur when the eyes are unable to correctly focus the images seen, resulting in blurred vision. Some of the most common conditions include myopia
or nearsightedness, and hyperopia or farsightedness. Refractive errors are often present from birth. However, due to the flexible lens in children’s eyes, they are usually less noticeable.
As children grow up, the lenses become denser and lose much of their flexibility, which results in the gradual increase of refractive power. While this usually stabilises when they become adults, in some cases, it continues to develop and becomes so severe, it may cause visual impairment. While scientists agreed that genetics play a significant part, poor eye care and excessive near-work activities which include reading, and using the computer or laptop in dim light may also contribute towards myopia. Another form of refractive problems is astigmatism – distorted vision caused by the irregular shape of the cornea. Similar to other refractive errors, astigmatism is usually congenital, although it may also
develop in adults, especially after an eye operation or injury.

On the other hand, presbyopia usually comes with age, as the lens of the eye loses its ability to focus, making it difficult to see things up close. Usually occuring around the age of 45, it gets noticed usually because of having to hold reading materials further away in order to focus on them. Presbyopia is a natural part of the ageing process, which means it will affect everyone later in their life.

Correcting the Error
In most cases, refractive errors can be treated. The most widely used and cost effective treatment is the use of optical aids. In fact, corrective lenses in the form of glasses and contact lenses have become part of so many people’s lives that they are no longer seen as medical devices. Nowadays, over the counter glasses are available in many stores. Although in many cases these glasses will be able to provide a
certain degree of better vision, it is strongly advised that people consult eye specialists – optometrists or ophthalmologists – so they can be prescribed with proper optical aids. Tailored to the specific needs of the patient, these glasses have corrective lenses that will provide the clearest, most comfortable and most efficient vision for the users.

Refractive Surgeries
With the invention of new technologies, especially the utilisation of laser in surgery, scientists and eye experts are developing new methods to repair the vision. Some of the more popular treatments include
the following:

LASIK, or laser-assisted in situ keratomileusis is the most commonly performed procedure, when it comes to refractive surgeries. It uses laser to reshape the cornea, which will enable light entering the eye to be properly focused onto the retina for clearer vision. A candidate for LASIK will have to go through a thorough eye check to ensure suitability for the procedure. The shape of the cornea, pupil size, the severity of the refractive errors, and even the moistness of the eyes are evaluated, and if needed, a
precautionary treatment will be conducted to prevent any problems from happening. During this painless procedure, a flap is created on a flat cornea. The flap is then folded back and a highly specialised excimer laser is used to reshape the cornea by precisely removing a determined amount of corneal tissue to change its focusing power. The flap is then laid back in place, covering the area where the corneal tissue was removed. Performed on each eye separately, the full procedure for both eyes usually takes ten to twenty minutes.

Advanced Surface Ablation
Unlike LASIK, the Advanced Surface Ablation is a minimally invasive procedure which serves as an alternative, perfect for those who are unable to undergo LASIK due to having a thin cornea. Refractive error is treated by removing the epithelium on the surface of the cornea. Previously a blade was used to scrape the epithelium off. Nowadays, a diluted alcohol solution is used to gently loosen and remove cells on the outer layer of the cornea, before the excimer laser is used to carefully ablate or remove the surface layers of the cornea, shaping it into the intended shape.

Phakic IOL
Using surgically implanted lenses called Phakic Intraocular Lens can also be a viable option. An artificial lens made of either medical-grade plastic or a combination of soft contact lens material and collagen is placed permanently inside a patient’s eye to correct the refractive errors without removing the natural lens in a surgery. Unlike wearing contacts, Phakic IOLs create no sensation in the eyes, and require no maintenance as they are implanted in them.

I Can See Clearly Now
Refractive surgeries offer numerous benefits and can dramatically improve your quality of life, as most people achieve 20/20 vision or better after the procedures. With the improvement in the visual department, people can now perform activities that they may not have been able to do prior to surgery. Although surgery has its advantages, there is actually no best method for correcting refractive errors. It actually comes down to the condition of your eyes and your lifestyle. While refractive surgeries are in general very safe, there are still some risks and complications. Be sure to discuss your eye condition with your ophthalmologist before deciding which correction method might be the most effective for you.

Many people learn to live with the fact that they have a problem with their vision and depend on optical aids in order to get on with their lives. As vital as these are to enhance one’s quality of
life, it cannot be denied that artificial optical aids can be quite inconvenient at times. At KPJ, you can significantly reduce dependency on them as explained by Dr Choong Yean Yaw, a Consultant Corneal and Refractive Surgeon in the Centre for Sight Laser Eye Care Centre.

As Technologies Develop
As amazed as Dr Choong is by the advancement of technology nowadays which has led to the invention of various electronic devices, he is also concerned about the effect that they have on eyesight especially that of youngsters. This is because reading and utilising all the apps on laptops, iPhones and iPads for a long duration can lead to eye problems, particularly shortsightedness
(myopia). However, while technology may be the cause of the problem, it also provides the solution. Technological advances have opened up new ways for ophthalmologists and ophthalmic surgeons to help patients improve their vision, particularly utilising laser in eye surgery. There are actually many types of refractive treatment, depending on different factors including the patient’s age and needs, and the condition of the eye. “It is up to the patients to choose what kind of procedure they want. However, as doctors, it is our duty to inform them of all the possible treatments, and propose the best options after properly analysing each case,” Dr Choong added. LASIKally the same? One of the most widely-used procedures is Laser- Assisted in Situ Keratomileusis or LASIK, prompting most people to use the terminology to use this label for all laser refractive surgeries. However, although all the procedures are done to change the refractive power of the eyes, each of them is done differently. LASIK involves the cutting of a flap of corneal tissue and using laser to remodel the cornea by changing its shape and curvature. This pain-free procedure takes only 20 minutes to perform. A very quick procedure, the recovery rate is also a lot faster compared to other surgeries as no stitches are needed. “Most of the time, patients will be able to see well enough after a few hours,” Dr Choong claimed. In fact, they can recover almost 90 to 95% of their vision after a day, though it will take a few weeks to fully recover. “Patients can go back to work after a few days, and return to their normal activities after just a few weeks.”

Factors to Consider
However, LASIK is not for everyone. While it is a very safe procedure, it is not risk free. “This is why we have to examine the candidate properly to rule out those who are at risk,” the doctor added. So, who are the ones with high risk and are not suited for LASIK? “First of all, we examine the eye and assess the cornea. If it’s too thin, or has an abnormal shape, then we will not perform the procedure,” Dr Choong elaborated. Pregnant mothers are also not encouraged to do the procedure, as during pregnancy, the cornea may become weakened and this may cause fluctuation in refractive power. The same thing applies to children, as they usually have an unstable refractive power. “We need to make sure that the power is more or less stable for at least one year before we can perform the surgery, and in most cases the most appropriate age would be between 20 to 50 years old,” he said. For elderly patients, some other factors should be considered, as refractive errors are not the only common problems that affect people of this age. “If they have already developed cataracts, we would encourage them to undergo cataract surgery and while doing so, replace the opaque lens with a multifocal implant that would enable patients to see better. It’s like killing two birds with one stone,” Dr Choong added. Dr Choong also highlighted new technologies that will be available in KPJ soon, especially with the opening of the Eye Care Centre in KPJ Tawakkal Specialist Hospital. “The centre will host many new technologies in eye treatment and surgery, including the Refractive Laser Lenticular Extraction (Relex), a surgery almost similar to LASIK, but less invasive as the key hole surgery only requires an incision as small as 2 mm.” All these new technologies will help doctors in KPJ Hospitals to provide patients with the best treatment available when it comes to all things optical.