Glasses and contact lenses for life, goodbye. In pursuit of this dream of freedom, many nearsighted, farsighted and astigmatic have undergone surgery with the excimer laser in the last 20 years, since it was introduced. It happens, especially in those who opted for this solution at a very young age, that a visual defect recurs. Or that, with the passing of the years, we come to the need for cataract surgery, the opacification of the natural lens contained in our eyes (crystalline) that occurs with aging because the eye dehydrates, oxidizes and becomes it thickens gradually losing transparency.
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It is possible to undergo the laser twice
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In these cases, can the surgery be repeated with the laser? Certainly yes – answers Francesco Bandello, full professor of Ophthalmology and director of the Ophthalmology Clinic of the Vita-Salute University at San Raffaele in Milan -. Cataract surgery in a patient who has already undergone refractive surgery does not involve particular risks and problems. And if there is the need to correct the defect that manifests itself many years later in those who underwent surgery as a boy, the laser can be repeated, but it all depends on what was done in the previous surgery. Wanting a lot to simplify: the treatments that reduce myopia have the purpose of flattening the cornea, reducing its curvature, so that the light rays that pass through it end up in focus on the retina and not in front of it (as happens in the myopic eye) . If the number of diopters of myopia to be reduced is high, the cornea must be “flattened” a lot and this reduces its thickness. In this case, if there is a need for re-treatment, it is necessary to check whether or not it is possible to intervene (and “plane”) further. In fact, the risk is that of reaching too deep corneal layers, which produce scarring associated with loss of transparency and annoying symptoms for the patient.
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When to do the surgery: after the age of 20
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Laser surgery can be performed after the age of 18. It is effective and safe to correct nearsightedness, farsightedness and astigmatism. For presbyopia, the still experimental technique and the only effective cure is the replacement of the lens with the implantation of a multifocal intraocular lens. But what is the right moment to operate with the laser? First of all, it would be advisable to be over 20 years old and, regardless of age, the vision defect should have been stable for at least two years – explains Leonardo Mastropasqua, director of the Ophthalmology Clinic and of the National Center of High Technology in Ophthalmology at the University of Studies of Chieti-Pescara -. And in those who are no longer young it must be assessed that they do not present a cataract in formation because in this case it is advisable to perform the visual correction together with the cataract surgery. Especially for the highest myopia, an advanced minimally invasive robotic laser correction technique (SMILE) can be used today, which allows to treat even patients with thin cornea and offers greater stability of the result. Generally, to correct vision defects, both eyes are operated on during the same session, but a decision that is made by mutual agreement between the ophthalmologist and the patient (for cataracts never, better to let at least 24 hours pass between one and the other). The operation is performed under local anesthesia (with eye drops) sitting – continues Mastropasqua -, on an outpatient basis and does not cause pain. It lasts a few minutes, most of which are dedicated to preparing the eye: the actual laser takes only a few seconds. Vision recovers within a few days.
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Possible side effects
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What if something goes wrong? Serious complications deriving from refractive surgery or laser cataract surgery are almost non-existent and exceptional – underlines Bandello -. The rare problems related to the operation can be a small residue of the visual defect or the perception of halos around the light sources in night vision: disturbances that, very often, resolve spontaneously over time. In most cases, the vision defect is corrected 100 per 100. In the rare cases where this does not happen, it can be retouched with a subsequent small intervention, but if this is not feasible or if you prefer not to make further interventions, it is almost always possible to resume the use of contact lenses. Refractive surgery an extremely precise, effective and safe treatment and the choice of the laser technique to use (Lasik, PRK, Lasek or SMILE) is up to the ophthalmologist. But for cataracts the laser is not the only option available: the operation can be carried out both with a traditional technique that makes use of the classic scalpel and phacoemulsifier, which shatters the lens through the emission of ultrasounds (and then proceeds to aspirate the fragments and the implantation of a small artificial lens). With the femtosecond laser, which is currently only available in specialized centers – concludes Bandello -, the precision (compared to the surgeon’s hand) increases in making the eye openings and in accessing the central portion of the lens. Traditional techniques, reimbursed by the health service, are equally effective and safe.
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What does the National Health Service pass
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Refractive surgery (used by the ophthalmologist to correct, by intervening on the cornea or on the lens, refractive defects due to a defect in focusing images on the retina such as myopia, hyperopia and astigmatism) is no longer reimbursed by the National Health Service. With some exceptions established by the LEA (the Essential Levels of Assistance), which concern for example those who suffer serious trauma, have corneal scars, suffer from some serious pathologies or have vision defects greater than 4 diopters. equal to cosmetic surgery (because it is not essential for health, since lenses and glasses can be used), therefore it is not even included among the deductible health costs. Except in some cases and upon appropriate medical certification from a public hospital: for example for those who suffer from intolerance to contact lenses and have also demonstrated problems in the use of glasses.
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February 7, 2021 (change February 7, 2021 | 20:55)
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