23 October 2016
LASIK surgery may not be the best option for a stewardess who wears contact lenses in the dehydrated plane cabin. Photo: HKEJ
LASIK surgery may not be the best option for a stewardess who wears contact lenses in the dehydrated plane cabin. Photo: HKEJ

Which laser refractive surgery suits you?

Laser-assisted in-situ keratomileusis (LASIK) has been the mainstream surgical corrective procedure for vision for the last 10 years, as both the surgical duration and rehabilitation time are short.

LASIK also sets a high successful rate record given the advances on existing techniques.

However, LASIK surgery is not suitable for all patients.

Take the following examples.

Case one: Mr. Chan, aged 24, has been wearing eyeglasses since secondary school. Despite having high myopia of more than 1,000 degrees, he has been a very active person enjoying contact sports such as basketball, football and taekwondo.

Chan has decided to become a police officer and would like to receive a laser refractive surgery for correcting his severe shortsightedness so he doesn’t need to wear eyeglasses in the future.

Careful consideration should be taken. First, though the results for LASIK in patients with high refractive error are generally satisfactory, the possibility of myopic regression cannot be ruled out —myopia might return in the future.

Depending on the thickness of the cornea, Chan could consider having another surgery, or wearing eyeglasses or contact lenses for correcting the increased myopia.

The more important factor worth noting is that the corneal flap created during the surgery will inevitably become a permanent weakness on the cornea even after the complete healing between the flap and the surrounding corneal tissue.

LASIK patients are prone to accidental flap displacement when they have injuries or there is impact on the eyes.

Since Chan loves contact sports, this further increases the risk of accidental flap displacement. In addition, he will soon be a law enforcement officer, where there is greater chance for him to be involved in physical scuffles at work.

Given Chan’s medical conditions and future needs, Advanced Surface Ablation (ASA) is a safer alternative to LASIK. ASA, in fact, came earlier than LASIK and has been practiced for correcting patients’ nearsightedness for 20 years. Both ASA and LASIK outcomes are similar in the long run.

ASA surgery is suitable for patients with thin corneas, large pupils, dry eyes or high-degree refractive error. Active people who frequently engage in contact or aggressive sports, professional sportspeople as well as military and law enforcement officers should also consider ASA instead.

Meanwhile, on top of LASIK and ASA surgeries, the implantation of intraocular lens is also possible for correcting myopia.

Case two: Ms. Cheung, aged 30, is a flight attendant and has been wearing contact lenses for 12 years. Since she wears contact lenses for long durations in the dehydrated cabin of the plane, she has suffered from severe dry-eye symptoms.

Cheung had hoped to get rid of her contact lens by undergoing LASIK surgery. However, she was told during consultation that the dry-eye symptom has been one of the most common complications for LASIK patients.

LASIK surgery will make corneas even drier. If patients have been suffering from dry-eye symptoms prior to LASIK, they have to reduce the duration and frequency of wearing contact lenses, so that their corneas can have ample rest.

Artificial tears have to be applied to moisturize the surface of corneas to relieve the dry-eye symptoms. The LASIK surgery can only be conducted when the corneas of the patients have reached a satisfactory standard.

As mentioned earlier, ASA surgery can be considered instead of opting for LASIK. The latter involves the cutting of the corneal flap where optical nerves on the cornea tissues will be cut off and that will intensify the problem of dry eyes.

Regardless of the refractive surgery treatment, patients should have full and comprehensive consultation sessions with the ophthalmologist.

The correction choice depends on the patient’s job nature and occupation, personal daily activities and living habits.

Most of the patients who have received corrective refractive surgery can enjoy a long-term satisfactory result.

This article appeared in the Hong Kong Economic Journal on Aug. 17.

Translation by Darlie Yiu

[Chinese version中文版]

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Dr Jhanji is the Assistant Professor and Director of Refractive Surgery Service in the Chinese University of Hong Kong Eye Centre; Dr. Chong is the Assistant Professor and Associate Director of the CUHK Laser Refractive Surgery Center at Hong Kong Eye Hos

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