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1. Refractive Error Surgery In India at Mumbai and Delhi at Low Cost
Refractive Eye Surgery in India
The shape of your eye determines how well your vision can focus. Light
rays enter the eye through the clear cornea, then through the pupil and
the lens. In a normal eye the light rays are focused onto the retina, a
light-sensitive tissue lining the back of the eye. Signals from the retina
are sent through the optic nerve to the brain, where they are
interpreted as the images we see.
Refractive errors exist because the curvature of the eye is mismatched
to the length of the eye and light rays cannot focus properly on the
retina. It is technically very complicated to change the length of the eye
(although it has been attempted) so refractive surgery procedures
either change the shape of the front surface or add a permanent lens to
improve the focus.
Myopia (Nearsightedness)
Myopia is the most common refractive error, affecting more than one
in four people in North America. Myopic patients are nearsighted; they
see close objects more clearly, but distant objects are blurry or even
indistinguishable. Myopia occurs when the eye is too long or the cornea
is too steep. As a result, light rays entering the eye fall in front of the

2. retina instead of directly on it. The condition can be inherited and
usually starts in childhood and stabilizes in the late teens or early
adulthood. Traditionally, corrective lenses such as eyeglasses or contact
lenses have been prescribed to refocus light entering the eye directly
onto the retina.
In myopia, the eye is too long or the cornea is too steep. Distant objects
appear blurry because images focus in front of the retina instead of on
it.
Hyperopia (Farsightedness)
Hyperopic patients are farsighted; they can focus on more distant
objects, but close-up objects appear blurry. Hyperopia occurs when the
eye is shorter than normal or the cornea is too flat. As a result, light
rays are not focused by the time they reach the retina.
In young people, the natural lens can sometimes correct the focus in
hyperopic eyes. With aging, the natural lens loses this ability and the
vision blurs. This is why many hyperopic patients do not become aware
of their condition until they enter their 20s or 30s.
In hyperopia, the eye is too short or the cornea is too flat. Close objects
appear blurry because images focus beyond the retina.

3. Astigmatism
Astigmatism occurs when the curve of the cornea, and sometimes the
lens, is uneven-steeper in one direction than the other-like a football or
the back of a spoon. Almost everyone has some degree of astigmatism,
but for some the uneven curve causes light rays to focus on many
points in the eye and distorts both close and far vision.
An astigmatic eye has an uneven cornea. Images focus in front of and
beyond the retina, causing both close and distant objects to appear
blurry.
Presbyopia
Presbyopia is the age-related loss of close-up focusing ability. When we
are young, our eye's lens is soft and flexible and can change shape
easily, allowing the eye to focus on objects both close and far away. As
people enter their 40s, the lens becomes less flexible and is unable to
focus on close-up objects. Initially the blurring is worse in dim light,
which is why many people first realize they have presbyopia when they
have difficulty reading a menu.

4. Later, the fine print in newspapers, magazines and phone books
appears blurry. Near vision is most often corrected with reading glasses
or bifocals, but refractive surgery can be used to create monovision in
people who want correction for close-up vision. See the section on
"Monovision" for more information.
With presbyopia, the eye's lens can no longer change shape to focus on
close objects. Images are not in focus by the time they reach the retina.
Reading glasses or bifocals bend the light rays to move the focal point
onto the retina.
Q. What are the various refractive surgeries ?
The refractive power of the eye can be changed by any of the three
approaches : -
Changing the curvature of the cornea: this is the most popular mode of
refractive surgery.
Removing the natural lens and replacing it with an artificial lens of
adequate power: it is similar to a routine phacoemulsification surgery,
except that it is done in a clear lens and not a lens with cataract. As it is

5. an invasive procedure and it also increases the chances of retinal
detachment in eyes with high myopia, it is not recommended
nowadays.
Putting an additional artificial lens within the eye on top of the existing
natural lens: this technique is still not very popular as it is also invasive
and may increase the chances of cataract formation.
Q. What are the ways of changing the curvature of cornea ?
The commonly used methods for refractive surgery are : -
PhotoRefractive Keratotomy (PRK) : It is being used less commonly
nowadays.
Laser-Assisted In-Situ Keratomileusis (LASIK) :This is the most popular
form of Laser treatment.
LASEK (or Epi-LASIK) :This newer form of treatment may be suitable in
some selected patients with very high power.
Q. What is Excimer laser ?
Excimer laser is a far Ultra Violet (UV) light energy of wavelength 193
microns. It is invisible to human eye. This laser breaks the chemical
bonds within the molecules (photoablation) with minimal thermal
damage to the surrounding tissues. Thus it is very precise and can

6. remodel the cornea with an accuracy of more than a thousandth of a
millimeter.
Q. How does Excimer laser correct the refractive error ?
The effect of excimer laser on the cornea is very similar to grinding of a
glass lens to change its refractive power. In eyes with refractive errors,
excimer laser because of its high level of precision, can change the
shape of the cornea to change its refractive power to the desired state
and thus correcting the refractive error.
In myopia, the central part of the cornea is made flatter, and thus
decreasing the refractive power of the cornea and of the eye, and thus
correcting the refractive error.
Similarly in hypermetropia, the laser removes a ring of tissue from the
peripheral part of the cornea and thus makes the central part steeper
and corrects the refractive error.
As we know, in astigmatism, the cornea is more curved in one
direction. Excimer laser can correct astigmatism also by selectively
ablating the cornea in the required direction.

7. Q. What is LASIK ?
LASIK involves putting the PRK treatment not on the surface of the
cornea, but under a protective corneal flap. A very thin (about 0.16
mm) and precise flap is raised by a special instrument known as
microkeratome. The result is a corneal flap attached at one edge, the
hinge. The surgeon folds the flap to expose the inner stromal layer of
the cornea. The excimer laser treatment is applied on this stromal bed
to remodel it. After this the flap is repositioned to its original position
and it does not require any suture. Since the corneal epithelium has
only been minimally disturbed, there is only mild discomfort after the
procedure.
Q. What is Customised LASIK ?
This is a special form of LASIK in which the treatment parameters are
customised for the particular patient, based not only on the refractive
error, but also on the corneal map of the eye and other findings
detected by special tests. This procedure tries to correct aberrations,
maintains normal shape of the cornea and gives better night vision.
Q. Who is a suitable candidate for LASIK laser surgery ?
The person must be 18 years or older with a stable power. A contact
lens user must discontinue the use of contact lenses at least 2 weeks
before the procedure. A detailed eye checkup is done to look for
suitability for the procedure. Before the Laser is done the eyes are
checked with special machines to determine the exact power, the
corneal mapping is done and corneal thickness is measured. In patients
with high minus power, a special retinal checkup is done for detecting

8. any possible weak areas in the retina, which may need to be treated
before the LASIK is performed. The LASIK laser is performed only after
ruling out any contraindication and confirming the suitability of the
procedure.
Q. What happens during the Laser surgery ?
The LASIK surgery is done as an outpatient procedure and does not
require any admission. It is painless and is done after putting the
anesthetic drops and does not require any injections. The laser
procedure takes approximately 15-20 minutes for both eyes. After the
procedure, the patient can go back home after 20-30 minutes.
Q. What are the complications of LASIK ?
LASIK is a very safe procedure with a majority of patients achieving
very good results. However, since it is a surgical procedure, it does carry
some chances of complications as well, which would be discussed with
you before the surgery. The overall rate of significant complications in
LASIK is only of the order of 1-2%.
Some of these complications may be : -
Undercorrection or Overcorrection
Glare and difficulty in night driving

9. Flap complications, perforation
Infection
Scarring of the cornea
Q. What are the precautions to be followed after LASIK, and when can
one resume work ?
After LASIK surgery one needs to avoid using cosmetics in and around
the eye for a week or two. One should also avoid wetting or rubbing the
eyes for some period. Use the medications regularly and report
immediately in case of any discomfort, redness, injury or any other
problem. There is no restriction in reading, watching TV, going for walks
etc. In majority of cases, routine office or simple household work may
be resumed in a day or two.
Q. How are the results of refractive surgery ?
Before undergoing any refractive surgery procedure, one must realize
that none of these procedures can guarantee you perfect vision
without glasses in all the cases. These surgeries are based on the
average calculations from a large population, but as different
individuals may respond differently to surgery, there might be some
variation in the outcome results obtained. The aim is to decrease your
dependence on glasses/contact lenses.

10. The reliability of the procedure is quite good in mild to moderate levels
of refractive errors, with most of people being able to carry out their
daily activities without glasses. But for high degrees of refractive errors,
the variation is more and some people may still need glasses, though of
much lesser power than before, to see clearly.
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