Is vision correction possible for astigmatism? After laser correction of astigmatism – pros and cons. Prosthetics and corneal transplantation – keratoplasty

Before we talk about the treatment of astigmatism in our ophthalmology clinic, we suggest you understand what astigmatism is.

What is astigmatism?

Mikhail Konovalov explains: "Eye It is designed like a camera - it also consists of several lenses. One of the main lenses is the cornea - this is the superficial part of the eye, the transparent tissue. The cornea refracts rays, which then fall on the retina. Ideally, the cornea should be spherical, like a dome, and symmetrical. The vertical and horizontal axes of the cornea should be the same. If the cornea has an irregular shape, then eye astigmatism occurs - a phenomenon when one axis refracts light more strongly and the other weaker, so the beam of light hitting the retina is blurry. This defect can be corrected using: special cylindrical lenses, contact lenses or surgery. With the help of surgery, we make the cornea the way it should be - spherical. This is most often accomplished through refractive surgery using an excimer laser.”

Astigmatism. The program “Live Healthy”, says Prof. Konovalov

Release of the program “Live Healthy” dated September 15, 2010. (about astigmatism from 32 minutes of video)

Degrees of eye astigmatism

There are three degrees of astigmatism:

• mild astigmatism (up to 3 D);
• moderate astigmatism (3 -6 D);
• high degree astigmatism (more than 6 D).

The nature of eye astigmatism

Eye astigmatism can be either congenital or acquired.

• Congenital astigmatism is common in children. A slight astigmatism is considered "functional", that is, it does not affect visual acuity in any way. However, if astigmatism of more than 1 D is observed, it is necessary to take measures in the form of spectacle correction.
• Acquired eye astigmatism is associated with gross scar changes on the cornea due to trauma, damage or surgery.

Types of astigmatism correction

Modern medicine offers 3 ways to correct astigmatism:

• wearing glasses,
• contact lenses
• and excimer laser correction.

Correcting astigmatism with glasses

For astigmatism, special glasses with complex cylindrical lenses are prescribed. This correction method may be associated with the appearance of unpleasant symptoms, especially in patients with a high degree of astigmatism: they often complain of dizziness, a feeling of pain in the eyes and visual discomfort.

Correcting astigmatism with contact lenses

Until recently, correcting astigmatism with lenses involved wearing uncomfortable hard contact lenses, but today special toric contact lenses are used to effectively correct astigmatism without discomfort.

Treatment of astigmatism with laser (astigmatism surgery)

Excimer laser correction of astigmatism (operation astigmatism) is the only way to get rid of this disease forever. Laser correction of the cornea using the LASIK method is performed under local drip anesthesia and takes no more than 10-15 minutes. And relatively recently, the latest laser correction method, FemtoLasik, has been used in the treatment of astigmatism.

Why is astigmatism dangerous?

If a patient with astigmatism does not go to the clinic in time, this disease can cause strabismus and a sharp drop in vision. Astigmatism can also cause headaches and pain in the eyes.

Mikhail Konovalov: "Astigmatism a very serious disease, especially in children. If a child has severe astigmatism, and it has not been corrected, then, as a rule, he then develops amblyopia. Amblyopia is a condition where even with further correction of astigmatism, we cannot achieve high vision. A person will never be able to see normally. Therefore, it is important to diagnose this disease and correct it, at least with banal glasses.”

Laser correction of astigmatism

Equipment for diagnosing and treating astigmatism

For laser correction of astigmatism at the main stage of the operation we use an excimer laser WaveLight® EX500. This is the latest generation model that provides excellent results for astigmatism correction. A flap from the upper layers of the cornea is formed using a French microkeratome Moria M2 Evolution(LASIK surgery) or using a femtosecond laser IntraLase iFS(FEMTO-LASIK operation), which has shown its high accuracy and efficiency when working with eyes of different anatomical structures, as well as in the case of thin corneas, when a corneal flap of minimal thickness is required.

Preoperative diagnostics are carried out using the device ALLEGRO Oculyzer, which examines the anterior segment of the eye and exports the resulting data via an internal network directly to the surgical excimer laser. This makes it possible to perform the “SuperLasik” operation according to individual data, taking into account the structural features of the cornea of ​​each patient. This operation allows you to obtain visual acuity of more than 100%, that is, “super vision”! The uniqueness of this technology is that it is performed without damaging the outer layers of the cornea, which makes its implementation during the postoperative period comfortable and absolutely painless.

In some cases, the operation of choice for correcting high degrees of astigmatism in combination with myopia or high hyperopia is implantation of a phakic toric IOL or a multifocal toric phakic IOL (“contact lens inside the eye”). The advantage of this operation is that it does not affect the cornea, so it can be recommended for patients with thin corneas when laser correction is not possible.

To correct astigmatism in elderly patients or patients with lens opacities, surgery to replace the opacified lens with an artificial toric intraocular lens may be recommended. (phacoemulsification cataracts with IOL implantation). In addition, in our Center it is possible to perform this operation with femtolaser support. This state-of-the-art technology allows, using the LensX femtosecond laser, to perform not only “knifeless” cataract surgery, but also to form incisions on the cornea to correct astigmatism, which, in combination with the implantation of a premium IOL, allows for the highest possible acuity and the best quality of vision after surgery.

Recovery after Lasik surgery

The rehabilitation period after excimer laser correction is minimal: the patient regains normal vision after 1-2 hours, but slight fluctuations in vision may persist for some time and do not interfere with normal life. The final restoration of vision will occur in 1-2 days.

Astigmatism manifests itself as a consequence of a violation of the cornea of ​​the eye, which occurs due to injury, hereditary predisposition, occupational factors, etc.

Side effects include diseases of the visual organs; visual impairment, lack of effect from surgery, retinal rejection and other consequences are also possible. Sometimes complications appear immediately after surgery and, often, depending on the severity, a repeat operation is performed.

However, there are cases where symptoms of complications appear after some time. This may occur due to a malfunction of the installed lens. Immediately after the operation, strict restrictions are imposed for a period from several days to 90 days, but, for example, visual and physical stress must be avoided for life.

What is astigmatism?

Astigmatism - consequences after laser correction Source: Astigmatism - consequences after laser correction

All information on the site is provided for informational purposes. Before using any recommendations, be sure to consult your doctor. Self-medication can be dangerous to your health. Astigmatism is one of the three most common vision defects.

This vision defect is more complex than myopia and farsightedness. The disease is caused by a disruption of the outer layer of the eyeball: the cornea and/or lens. The image seen by an astigmatic person is unclear and blurred in different axes of vision.

This eye defect can be corrected with glasses or contact lenses. The laser allows you to get rid of astigmatism once and for all. The disease results in poor visibility of all objects, regardless of whether they are nearby or far away. Typically occurs when the cornea is shaped like an elongated ellipsoid rather than a sphere.

The uneven shape causes light rays entering the eye to be focused in many places, not just on the retina. With astigmatism, the eye that looks at a point sees not a point image, but two linear ones, called focal ones.

Most often this happens because the cornea does not have a constant radius of curvature, i.e. it is not spherical. When the eyes are constructed correctly, light rays are focused at one point: the retina.

With astigmatism, due to irregularities in the curvature of the cornea, the beam of rays passing into the eye is focused at 2 points, causing image blurring effects. The irregular shape of the cornea (resembling a fragment of a rugby ball) is responsible for 98% of cases of eye defect (so-called corneal astigmatism).

In rare cases, this vision defect may also be a consequence of an irregularly shaped lens (called lenticular astigmatism). As a rule, it appears as a result of a congenital defect of the lens. Sometimes congenital astigmatism develops as a result of cataracts.

The disease is very common, affecting 1/3 of the population, usually from birth. In many cases, people with nearsightedness or farsightedness have slight astigmatism. A small degree of this refractive error is considered normal and does not require correction.

In mixed astigmatism, the symptoms of nearsightedness and farsightedness occur simultaneously. This combination causes the inability to see clearly.

Contraindications for correction

The use of laser techniques for vision correction is not a medical procedure. These are corrective manipulations that make it possible to eliminate the consequences of eye diseases, restoring vigilance, but not to treat the disease itself.

The use of such correction is recommended for severe myopia or farsightedness, sometimes complicated by astigmatism. A similar restorative technique is recommended for people who, due to professional factors or the individual structure of their visual organs, are not able to wear glasses or contacts.

A person with a large difference in diopters in different eyes can also undergo correction in order to avoid constant overwork of one of them. Before the procedure, the patient must undergo certain preparation. This may include:

• full examination to identify contraindications;
• checking visual acuity immediately before manipulation;
• application of anesthetic drops immediately afterwards.

During the day before the procedure, you should not use decorative cosmetics or drink alcohol. During the operation, a laser is used to target certain areas of the cornea, changing its shape. Many correction methods have currently been developed, for example, PRK, Lasik, Lasek, Epi-Lasik, Super-Lasik, Femtolasik.

Lasik machine

The first of them is a laser effect on the surface of the cornea in order to strengthen it and restore vision. The return of vigilance occurs gradually over the course of a month. Lasik techniques involve affecting the deep corneal layers, and vision returns to normal faster.

Not everyone is allowed to correct imperfections in their eyes. This cannot be done:

1. minors (sometimes young people under 25 years of age);
2. those over forty to forty-five years old;
3. pregnant and nursing mothers;
4. in the presence of keratoconus;
5. people with certain immune system or metabolic dysfunctions;
6. for serious eye diseases.

Correction is not carried out during periods of exacerbation of any chronic ailments. If contraindications are neglected, the risk of side effects can greatly increase. During the operation, a failure may occur, most often caused by technical reasons or insufficient professionalism of the doctor.

Risk factors for such problems include: Incorrect values ​​entered into the computer. Incorrectly selected tools. Lack or interruption of vacuum supply. The cut is too thin or split.

This or that complication can lead to clouding of the cornea, astigmatism, monocular double vision, and decreased vigilance. According to statistics, unpleasant consequences occur in 27 percent of cases.

Possibility of complications

During the first time after surgery in the dark, contrast sensitivity is significantly reduced; patients have difficulty distinguishing the boundaries of colors and the boundaries of objects. Therefore, driving at night and at dusk is strictly undesirable.

Patients also noticed the appearance of stars and circles before their eyes. Cases of excessive dry eyes are common. Inflammatory processes such as edema, conjunctivitis, epithelial ingrowth, inflammation, hemorrhage may also appear as postoperative complications.

The likelihood of their occurrence does not depend on the qualifications of the surgeon or on the apparatus with which the operation was performed. The reason for them is the individual characteristics of the patient’s body.

Such complications may require long-term and quite expensive treatment, which, however, is not guaranteed to give a 100% result (full recovery). There is also the possibility of “undercorrection”.

This is the so-called residual myopia, which is corrected by repeated laser correction two months after the first operation. This is another additional burden on an already weakened eye. There is a possibility of long-term consequences of laser vision correction.

Such consequences have not yet been practically studied, because It is difficult to calculate whether the complications that appeared 3 years after the operation were the result of the operation itself or whether these were characteristics of the body or even the patient’s lifestyle.

In the absence of serious medical indications, all ophthalmologists do not recommend resorting to laser vision correction or any other eye intervention. Although the percentage of successful operations is very high, it is still not 100% and, as you understand, there is a possibility of complications.

The eyes are your own, after all, and it’s better not to expose them to the laser. Glasses or lenses practically do not create problems and they can always be removed, unlike the results of an intervention, even by an experienced surgeon.

Diagnosis of the disease

To see if you have astigmatism, you will need to see an ophthalmologist. When such a vision problem was identified, the first tool for detecting it was the keratoscope - the invention of the Portuguese ophthalmologist A. Placido.

It is a disk with white and black consecutive circles. The study involves observing the shape of their reflection on the cornea. The degree and axis of astigmatism in the eyes is measured by an ophthalmometer (keratometer).

It uses an image of the Placido disk reflected on the surface of the cornea, which is recorded using a camera and then transferred to a computer and analyzed. The result of the study is a colorful map and section of the surface of the cornea, a map of the digital value of its curvature.

The last study is necessary before the procedure for laser correction of eye defects. In everyday practice, an autorefractometer equipped with a topograph is used. All these studies are painless and are carried out during an eye examination by an ophthalmologist using instruments.

What happens after surgery?

After laser vision correction, the patient does not experience any significant pain, but within 2-3 hours after the operation he may be very bothered by:

• Tearing
• Stinging in the eyes
• Feeling "sand"
• Photophobia

Bright light may aggravate these complaints, so you should bring sunglasses with you to the clinic. It is advisable to wash the frame well with soap in advance. After laser vision correction, the patient may experience pain in the eyes, a feeling of blockage, and watery eyes. After 3 hours these phenomena disappear.

During the first hour after surgery, your vision without glasses will improve, but there will still be fog and blurriness. In just a few hours, these complaints will subside, and just a feeling of discomfort will remain.

You should definitely have a follow-up examination at a slit lamp to ensure that the corneal flaps are properly seated. In extremely rare cases, if the patient accidentally roughly rubs the eyes, a slight displacement of them may occur, which requires the supervision of a doctor.

1-2 hours after the correction, you should undergo a control examination using a microscope and be allowed to go home until the next day of examination. After the doctor’s examination, you will be able to go home. We do not recommend that you drive yourself after the correction, as post-operative discomfort symptoms will not allow you to drive safely.

Take a taxi or ask your loved ones to take you. Public transport is not contraindicated, but one must be wary of eye infections and colds. It is better to leave the clinic by taxi or ask your loved ones to take you home. Driving is prohibited immediately after surgery.

In some clinics that take a particularly responsible approach to the prevention of complications, patients are given special occluders for the eyes - transparent protective screens with ventilation holes that eliminate the possibility of mechanical pressure on the eye, so as not to damage the cornea during sleep or accidental touch.

Many patients are afraid of the undesirable consequences of laser vision correction. Yes, they exist, but their percentage is so small that with proper selection of patients and exclusion of contraindications, it does not exceed 0.02-0.05%. Deterioration of vision after laser vision correction can be due to several reasons:

1. Firstly, this is the progression of myopia.

If the patient is young and his eye continues to grow in length, then the corrected myopia may partially return.
This issue is always discussed with the patient during the preoperative examination. If myopia returns, then it is possible to discuss with your doctor a repeat operation.

With careful preoperative diagnosis, undesirable consequences of laser vision correction occur in 0.02-0.05% of cases.

2. Secondly, the reason for dissatisfaction with the result may be incomplete correction.

Those. the patient has a residual 0.5 - 0.75 diopters of myopia, farsightedness or astigmatism. In this case, as a rule, additional correction is proposed to achieve the desired result, but not earlier than after 2-3 months. Experience shows that such cases of additional correction are infrequent: 1 eye per 100-200 operations, or even less often.

3. Thirdly, the cause of some changes in vision in the long-term period after vision correction may be mild cloud-like opacities.

These phenomena are extremely rare. A carefully collected anamnesis allows you to identify patients at risk and almost completely eliminate these problems.

Fluctuations in hormonal levels during pregnancy can adversely affect the healing of corneal tissue.
It is precisely because of the occurrence of corneal opacities that ophthalmologists recommend not planning childbirth or pregnancy after laser vision correction for at least six months.

This is due to the unfavorable effect of hormonal fluctuations on the healing processes of corneal tissue. Complications after laser vision correction can occur if the operation itself deviates from the planned plan. Most of these problems improve over time or with active treatment.

Postoperative restrictions

After laser vision correction, the operated organ becomes fragile and vulnerable. Any, even the smallest damage can lead to serious consequences, including blindness. It is very important for those undergoing the procedure to follow all the doctor’s recommendations. Prohibitions may include:

• touching the operated eye within 24 hours, rubbing it for at least three months after surgery;
• washing and washing your hair for 72 hours after laser vision correction;
• drinking alcohol while taking antibiotics;
• heavy physical work, professional sports for 90 days after eye surgery;
• swimming, sunbathing and applying decorative cosmetics for a similar time;
• driving at dusk and at night for approximately two months after the procedure due to a temporary decrease in contrast sensitivity.

During the postoperative period, clinic clients sometimes complain about the appearance of stars or circles in the eyes, as well as dry vision. Also after laser vision correction you may experience:

1. swelling,
2. retinal rejection,
3. conjunctivitis,
4. epithelial ingrowth,
5. hemorrhages,
6. sensation of a foreign object in the eyes.

Such side effects do not occur due to low qualifications of the doctor or malfunctioning devices. Such complications are caused by the body’s individual reaction to surgery. In some cases, they go away after a rehabilitation period, but sometimes additional treatment is required.

Another type of complication is called undercorrection, when instead of one result another is obtained. For example, vision decreases in the form of residual myopia. Or instead of myopia, a person develops farsightedness. This will require repeated correction after a period of one to three months.

Long-term consequences of surgery

Complications can appear long after laser vision correction. Such long-term troubles pose the greatest danger to health. Correction removes the consequences of eye diseases that lead to decreased vision.

But she is unable to eliminate the causes of these ailments. In this case, as the disease progresses, vision may deteriorate after laser correction after several years. True, it will be difficult to say whether this is due to hidden problems during the operation or the patient’s lifestyle. Each of the following problems may appear months after the procedure:

• disappearance of the positive effect of laser intervention;
• thinning of the tissues affected by the device;
• clouding of the corneal layer;
• development of eye diseases that did not exist before.

To prevent the operated patient’s vision from subsequently deteriorating, he must lead a healthy lifestyle, say goodbye to bad habits, avoid excessive physical or visual stress, and follow other doctor’s instructions.

If a person feels that his vision is deteriorating after correction, he should immediately consult an ophthalmologist. Of course, problems after eye surgery can be eliminated. But there is no absolute guarantee that after the new correction everything will get better. Although doctors can still predict the chances.

If there are no vital indications for eye surgery, it is better not to perform it. Then you won’t have to deal with complications after laser vision correction. But if correction is necessary, you should choose a trusted clinic and a doctor who has performed many successful operations.

Laser correction of astigmatism - consequences

Source: bolezniglaznet.ru

Laser vision correction has recently enjoyed well-deserved popularity. One of the most popular techniques is currently considered LASIK (Laser-Assisted in Situ Keratomileusis) - a type of vision correction using an excimer laser.

Device capabilities

This operation allows a person to regain vision and corrects almost all deviations from the norm. Restoring vision through laser vision correction has many positive aspects, but we should also not forget about the dangers of this operation, which can affect the human body in various ways.

You need to be interested in and know this before resorting to such a method. Of course, these are postoperative difficulties in restoring the body that can be overcome. But researchers also talk about cases of deterioration in the quality of vision after surgery.

With such complications, vision is no longer amenable to such correction. The statistics of Russian colleagues also largely coincide with foreign studies. Scientists studied 12,500 operations performed using the Lasik technique, noting that subsequently various complications and side effects were observed in 18.61 percent of cases.

This is already a serious reason to think about it. Moreover, these operations were performed by the best doctors using only the best and modern equipment. Scientists also note that in 12.8 percent of cases the operation had to be repeated. Here are the complications you may encounter after laser correction.

These are various difficulties of postoperative recovery of the body. First of all, this includes the usual inflammatory reactions: inflammation, swelling, conjunctivitis, epithelial ingrowth, “sand in the eye” syndrome, hemorrhages, retinal detachment, binocular vision disorders and much more.

These consequences do not depend on the skill of the operation performed, but are purely individual and related to the characteristics of the body of each client. The treatment period is also quite long, and requires special attention and the use of high-quality medications.

In some cases, repeated operations are even required. But in such situations, it is imperative to consult with your doctor. Also, postoperative complications are also understood as simply the client’s dissatisfaction with the result and quality of the operation.

Surgical complications. Unlike postoperative complications, everything here depends on the quality of the equipment and the professional level of your doctor. According to the data, the percentage of such complications is 27, and the proportion of surgical complications that subsequently affect the quality and result of laser vision correction is approximately 0.15 percent.

And it entails both a decrease in maximum visual acuity, monocular double vision, induced astigmatism and irregular astigmatism, and corneal opacification. Although the percentage of these complications is small, nevertheless, no one is immune from such consequences.

No doctor will give a 100% guarantee about the outcome of the operation. Therefore, before resorting to surgical intervention, think carefully and weigh the pros and cons.

Complications associated with ablation. This type occurs quite often and is associated with unsatisfactory results after laser correction. Most often this manifests itself in residual myopia. In such situations, doctors resort to repeat surgery after 1-2 months.

If the doctors did more than was initially expected, then they will also have to perform another operation, but after 2 or 3 months. But, as in previous cases, this does not mean that a repeat operation will fix everything. But, nevertheless, not everything is as scary as it might seem at first glance.

Long-term consequences of laser vision correction. Such consequences are the most dangerous for the human body. This is due to the fact that laser vision correction surgery does not cure myopia, farsightedness, or astigmatism, but only corrects the shape of the eye so that the image becomes clear without affecting the disease itself.

Therefore, over time, the result of this correction weakens and returns the person to his previous vision. There are more deplorable cases. It has been recorded that sometimes the patient, over time, acquires a list of additional diseases of the body.

Also, various physical stress and damage to the eye can lead to rupture of the membrane. The consequences of which are by no means happy. Also, do not forget about groups of people who are strictly prohibited from resorting to laser vision correction.

Of course, these are young people under 18 years old. Some are talking about a limit of up to 25 years. Also, after the age of 40, farsightedness develops. These visual defects are already associated with the aging of the body, and not with the disease as such. It is also worth mentioning the complications after laser correction that occur in the evening.

Farsightedness as a complication

People with such consequences have circles in their eyes when looking at the lights and headlights of cars. This puts car drivers at particular risk. Particular complications arise when correcting myopia. Professor John Marshall from St. Thomas's Hospital in London says that in some cases even a corneal transplant was required.

In any case, no matter what, the patient must be informed about all possible complications before resorting to laser vision correction. However, the risk of such a new method has not yet been fully studied, but the Lasik method is already very popular and more and more people are resorting to this particular treatment for the disease.

What are the most serious complications?

Complications with LASIK are up to 6%, with femtoLASIK and FLEX - up to 2%, with SMILE - 0.5-1% (depending on the generation of lasers, 0.5% is the sixth).

One of the worst complications of any correction other than PRK is keratoectasia (when the cornea bulges, as in keratoconus). As a result of surgery, this can happen due to a significant violation of the biomechanics of the eye - as a rule, either due to incomplete diagnosis, or due to a surprise that the doctor's diagnostic tools could not detect.

That is why it is important to do the diagnosis very carefully and using different methods. It must be admitted that clinics often skimp on the most expensive “reinsurance” equipment. On the other hand, if a patient already comes in with keratoectasia, then he will most likely have a direct indication for good old PRK.

In general, any thin cornea, and even one that is not completely smooth, can be smoothed well by PRK. In the early stages of keratotonus, PRK levels the surface and immediately on top we also do cross-linking (treatment with a product high in B12, then the release of oxygen due to laser heating and fixation of collagen in ultraviolet light - everything to make it rigid, but more on that later separately ).

This niche will ensure the life of PRK for at least another 10 years. Keratoconus is a complex complication in the medium term. Cross-linking is done immediately, that is, cartectasis is treated as usual. Intracorneal half-rings can be inserted.

Historically, some of the keratoectasia after SMILE are cases where the surgeon discovered a diseased cornea and decided not to do the invasive procedure LASIK or its derivative, but for some reason decided that ReLEx could “ride” due to its low invasiveness. A diseased cornea does not need to be corrected without strengthening. You can do cross-linking, rings, transplantation.

Our next most popular flap is the flap after LASIK, femtoLASIK or FLEX. More often, of course, they get LASIK - they have a total risk of various side effects of 6%, and at the same time they are still being done a lot in the country. Any patchwork correction methods are a contraindication for contact sports.

You can give birth, but getting punched in the face is undesirable. There were cases when the flap was torn off because a child simply inaccurately poked his finger in his mother’s face, because a woman caught her eye on a tomato stick - in general, all sorts of things.

The crux of the problem is that with these methods, a “lid” is cut, which is “folded back” to create a lens inside the cornea, and then this “lid” is closed back. It is connected to the eye by a thin bridge-“loop” and a thin layer of epithelium that has grown on top.

The flap does not grow in, and is held in place without opening, only with the help of the superficial epithelium on top. The LASIK flap itself can be removed even after 8-10 years (there have been cases) - and it will come out exactly where it was on the day of the operation.

In the case of femtoLASIK and FLEX, the flap holds more firmly, there is often scarring along the edges (a thin white stripe) - after 2-3 years you can already try to tear it off with your teeth, and it will not give in. In the case of SMILE, there is no flap at all, but there is a “tunnel” (2.5 mm incision) through which the lenticule is removed from the cornea - it is also covered with epithelium, but before it heals, you cannot wash, so as not to cause an infection.

Contrary to popular myth, Bowman's membrane, which is located on top of the cornea (which is destroyed during PRK and severely damaged during femtoLASIK methods) does not provide protection against impact-type mechanical damage. It provides “slow” type stability, in particular, it compensates for pressure from inside the eye.

Now it’s worth talking about the halo effect - this is a halo around light sources at night. Any laser correction can give it. It depends on the size of the correction zone in relation to the pupil. The usual correction zone is 7 millimeters. Some people's pupils open up to 8 millimeters in complete darkness.

Previously, correction zones of 4-5 millimeters were generally made. The second reason for a halo (more relevant to modern surgeries) is how flat your cornea is in the center. The center should be elevated (a healthy cornea has more diopters in the center than at the edges - for example, 38 D in the center, 42 D at the edges).

A good professional calculates the profile for laser cutting so that the cornea is flattened over a large area. Excimer lasers have different aspheric profiles for this purpose. ReLEx SMILE itself is aspherical in its very intervention architecture. Yes, the natural state of the cornea worsens with any correction, but with SMILE - a little less.

Then we have photophobia and tissue overgrowth. The problem is with the medications. In PRK in Russia, the “usual” metamycin for this operation is not used (it is not approved at the state level). Analogs are a little riskier. Now ophthalmologists are trying to lobby for the approval of this drug for operations.

The next case is incomplete extraction of the lenticule during SMILE surgery. There were extremely rare cases when there was a part left that could not be picked up with tweezers. In this case, cortisone is injected, which stains the small fragment and then you can go inside and remove it.

In London, one of the very expensive surgeons makes a second cut for such a case opposite the first - he does not use it, but keeps it in case of problems during the operation. Usually, if the laser did not cut something in the lenticule, this is the problem of the surgeon, who for some reason went in and tried to separate the place where there was no cut.

That's right - let it heal and do PRK with topography. Or, as an option, switch to FLEX instead of SMILE. Then tearing the edge of the incision is a very unlikely thing in experienced hands, when the surgeon uses an instrument to tear the entrance to the “tunnel” leading to the lenticule.

For this to happen in practice, you need to push him in the shoulder during the operation. However, there is usually no problem: the incision was 3 mm, it will become 3.5 mm - no big deal, really. In the vast majority of cases, the incision is torn radially, but there was one example at the very beginning of the history of corrections, when a tear of 1.5 mm occurred towards the center.

From a zone of 7.8 mm to a zone of 6.8 mm, the patient received a halo effect in deep darkness. The solution is simple - you need to hold the eye with tweezers with your other hand, since then this has been included in the mandatory SMILE protocol. One of the serious (but, fortunately, reversible) cases is keratitis.

This is an inflammation of the cornea, most often as a result of an infection. Its three stages - in the second, usually cortisone and treatment at the discretion of the doctor, and in the third, rinsing the pocket is mandatory (there is a risk of irreversible scarring). Therefore, after the operation, you are observed the next day and several more times.

Everything else, as a rule, goes away within a week or two after surgery, and is associated with the body’s reaction to mechanical damage to tissues, or the characteristics of medications. Yes, you may cry for a couple of hours, yes, it may sting, yes, in some people the painkiller then causes a wild desire to touch the eyes (which you should not do). And yes, for the first couple of days it is better for you not to appear at the beauty contest and take portraits for the dating site. Then everything will be fine.

Daily Life Forecast

The disease interferes with everyday life and activities that require good vision, both from afar and up close. The difficulties depend on the extent of the vision defect and how it can be effectively corrected.

Absence or ineffective correction can lead to diseases such as chronic inflammation of the conjunctiva, eyelid margins or constant headaches, increased fatigue when working on a computer.

Children sometimes develop a reluctance to learn, and adults experience blurred vision and increased fatigue when driving a car, which is why they cannot see the lights of other cars. Therefore, contact lenses and corrective glasses for this eye defect must be precisely selected.

Vision can be corrected with glasses with cylindrical glasses or soft toric lenses, but if the surface of the cornea is destroyed to a significant extent (for example, due to scars, diseases) or the astigmatism is large, then with an optical disc.

If the vision defect is corneal, eye astigmatism can be treated with laser correction. If the origin of the defect is related to the lens, for example, it arose as a result of cataracts, then the problem disappears after surgery to remove the underlying disease.

Using Alternative Methods

In the case of cataracts, surgery involves replacing the clouded natural lens with an artificial one. With slight astigmatism (up to 1 diopter), glasses are generally worn only for studying, driving a car, or working on a computer.

And almost every person experiences so-called physiological astigmatism: about 0.5 diopters, because the correct cornea is destroyed more vertically than horizontally.

Tips for patients

You need to find out who is a real professional in this field. To do this, you should chat with people on forums on the Internet. You should also consult with an ophthalmologist or ophthalmologist. Please note that surgery to restore vision will not be cheap.

Once you have an appointment with a specialist, do not be afraid to ask him all the questions that interest you. Examination before surgery makes it possible to identify those people for whom this operation is unlikely to significantly help. The specialist must conduct a thorough examination of the eyeball.

The doctor measures the size of the pupil in the dark, determines the thickness of the cornea, as well as its topography, and carefully examines the fundus of the eye (there may be a retinal detachment or rupture). Be sure to inform your ophthalmologist about all, even minor, diseases.

For competent doctors, the rate of surgical complications does not reach even one percent. All major clinics monitor and provide assistance after surgery, right up to correction after surgery (if necessary).

Astigmatism is a vision disorder associated with an irregularly shaped lens or cornea. Laser correction of astigmatism is the most common surgical method for eliminating pathology. With this disease, a person sees objects in a distorted form: curved, sometimes blurry.

With astigmatism, light rays do not converge at one point on the retina, so objects appear distorted. Straight lines may appear crooked, and some parts of the subject may appear blurry or not visible at all. There are four types of astigmatism:

• independent pathology;
• astigmatism with farsightedness - hypermetropic;
• - myopic;
• with myopia in one meridian and farsightedness in the other - mixed.

Depending on visual acuity, medicine distinguishes three degrees of the disease:

1. first - up to 3 diopters;
2. the second - from 3 to 6 diopters;
3. the third - more than 6 diopters.

Laser vision correction for astigmatism was first performed in 1985 in Berlin. The essence of the method is that a laser beam evaporates a thin layer of the cornea and changes its curvature.

Laser treatment for astigmatism helps focus light rays directly onto the retina, resulting in clear images of objects. The process of laser exposure to the cornea lasts 1 minute. The manipulation is carried out under local anesthesia. If everything went well, the patient can return home the same day.

The laser method for correcting astigmatism has the following advantages:

• the procedure is absolutely painless;
• the risks of damage are minimal;
• the ability to improve vision in a short time;
• stability of the results obtained after correction;
• no need to use glasses or contacts;
• psychological comfort;
• good vision will significantly improve the patient’s quality of life.

However, this method has a number of contraindications for use:

• inflammatory eye diseases;
• age under 18 years;
• progressive deterioration of vision;
• pregnancy, breastfeeding;
• spasms of the lens muscles;
• the need to strengthen the retina.

Such conditions are absolute contraindications. In addition to these, in some cases laser correction may be prohibited for cataracts, glaucoma, keratoconus, severe diseases of the vascular system, diabetes mellitus, retinal surgery, and age-related farsightedness.

Many patients are concerned about the question: can the eye be damaged during laser correction? The integrity of the internal structures of the eyes is not damaged, since the laser only affects the cornea and does not affect deep tissues.

Laser correction methods

Laser correction of astigmatism is carried out using several methods, depending on the type and degree of development of the pathology. Today, the following laser treatment methods are mainly practiced:

1. Lasek;
2. Lasik;
3. Super Lasek;
4. Super Lasik;
5. knifeless correction Femto Lasik.

The Lasek method involves laser exposure to the superficial layers of the cornea. The procedure takes about 40 seconds. Then a contact lens is placed on the operated eye. After 4 days, the lens is removed. The advantages of this method include:

• possibility of correction for thin cornea and thin retina;
• the effect is carried out only on the upper layer of the cornea, excluding interference in the deeper layers.

The Lasik method is carried out by influencing the deep layers of the cornea. When performing this procedure, a flap is formed for the cornea, which is moved to the site of laser exposure, and after manipulation is returned back. The flap fits tightly to the site of exposure; other measures for securing are not needed. The advantages of this technique are obvious:

• improvement in vision becomes noticeable already on the day of surgery;
• Both eyes can be operated on on the same day;
• eliminates the risk of corneal clouding.

Super Lasek and Super Lasik techniques represent a novelty in modern ophthalmology. The impact of these methods is preceded by analysis of the cornea with the Keratron system. This ensures the most accurate impact of the laser beam on the cornea of ​​the eye. The laser corrects only those areas that have pathologies. The advantages of these correction methods include:

1. high level of impact accuracy;
2. the ability to provide visual acuity of more than 100%;
3. good vision not only in the daytime, but also at night;
4. the possibility of correcting the flaws of surgical surgery performed on the eyes.

The Femto Lasik technique is a knifeless laser correction method. The essence of the procedure is to create a corneal flap using a laser device without a manual incision. This technique is the safest and can be performed even on patients with a high degree of vision pathology or those with a very thin cornea.

Cost and postoperative period

The price for laser vision correction depends on the degree of astigmatism, the presence of complications, the chosen technique, and the clinic. Previously, such procedures were very expensive. Today, the laser correction technique is quite common, and there is competition among clinics. Correction of one eye using the Lasik method for simple astigmatism and visual acuity up to - 1 diopter will cost from $120, up to - 4 diopters - from $270.

Corrective surgery

After the operation, visual contact with objects is not lost. The patient can immediately return to normal life. However, it is still necessary to adhere to some safety measures to prevent complications.

It is recommended to come to the operation with a person who will accompany the patient home after the procedure. Despite the fact that laser correction methods are safe, a person may become nervous, and anesthesia sometimes leads to slight dizziness and absent-mindedness. Support in such cases will definitely not be superfluous.

During the first week of the rehabilitation period it is prohibited:

• visit swimming pools, saunas, baths, public swimming places;
• do not allow detergents to get into your eyes;
• exercise;
• use cosmetics, creams, hairspray;
• sunbathe.

After laser correction, for a month it is forbidden to lift loads weighing more than 3 kg, frequently bend over, or overexert yourself. It is also not recommended to watch a lot of TV or sit at the computer for a long time. You should adhere to a healthy diet, consume more vitamins A and C. Products such as are enriched with them:

• carrot;
• tomatoes;
• apricots;
• black currant;
• blueberry;
• citrus;
• liver;
• pumpkin.

During this period, it is not recommended to eat fatty meats, fried foods, or drink alcohol. These measures are aimed at creating optimal conditions for improving vision after surgery. Usually improvements become noticeable the very next day after the procedure. However, complete recovery takes approximately 1-1.5 months.

This is a vision pathology in which visual perception is disrupted and the visible image is distorted. In the vast majority of cases, this visual anomaly is a congenital disease that is inherited from the parents. With astigmatism, light rays cannot converge at one point after refraction. Only correction of astigmatism can restore the functioning of the optical system of the eye.

Modern ophthalmology can offer three leading methods of vision correction for astigmatism, which are officially recognized throughout the world. Of course, spectacle correction of astigmatism has long been known. This is the simplest, cheapest, but outdated and ineffective way to improve the quality of vision. It is applicable to pediatric patients. For such correction, glasses are used, in which, depending on what type of disorder is diagnosed, cylindrical positive or negative lenses are used.

A very popular method of correcting astigmatism is the use. However, contact lenses can correct vision only for patients suffering from a small degree of astigmatism. An ophthalmologist selects special toric lenses for a person, with the help of which the defect is corrected.

However, today the most effective and popular method by which the quality of vision can be restored to patients suffering from astigmatism is laser correction. If previous methods only direct light rays to the desired point, then with the help of laser correction the disease is treated. The laser method of vision correction for astigmatism has certain limitations: it is used in persons who have reached the age of eighteen.

Video of laser surgery

Methods of laser correction of astigmatism

There are several laser techniques for correcting astigmatism. One of them is LASIK technology. This type of treatment combines excimer laser and microsurgical interventions. Its advantage is that when performing laser correction using the LASIK method, the structure of the layers is not disturbed. It is considered the most effective treatment for astigmatism. After surgery performed using this technology, the patient regains normal vision. Already on the day of laser correction of astigmatism using the LASIK method, a person can not only see normally, but even read, and also watch TV.

What you need to know about laser correction of astigmatism

Laser surgery techniques today have been worked out to the smallest detail. In fact, the risk of side effects from the intervention is minimized, as are contraindications to surgery. However, not all patients suffering from astigmatism are candidates for laser correction. It is not performed if there are such contraindications:

(the clear tissue layer on the front of the eye) is not as spherical as it should be.

It must be perfectly curved to focus light correctly on the retina.

A flattened cornea will cause images to become blurry or distorted.

Correction of astigmatism is possible in several ways - correction means and laser procedures.

Is it possible to do vision correction for astigmatism?

Laser correction of visual perception for this condition is the best way to get rid of optical correction devices. The procedure is permitted if there are certain indications and there are no contraindications.

Astigmatism refers to a group of eye conditions called refractive errors that cause blurry images.

Features of laser surgery for astigmatism

Astigmatism implies the absence of a focal point. It occurs due to the irregular shape of the cornea, less often the disease is caused by a change in the shape of the lens.

The peculiarity of laser vision correction is the formation of a spherical surface. Achieving a normal shape of the cornea is achieved by removing its superficial and deeper layers.

Vision correction for astigmatism and myopia is carried out by burning a precisely calculated amount of tissue to give the required shape.

Indications for laser vision correction for astigmatism

Laser correction is not performed for acute inflammatory processes and infectious diseases. It is also contraindicated during pregnancy, the postpartum period, during breastfeeding (since it will require taking antibiotics and other drugs that pass into breast milk) and for endocrine disorders.

Types of laser vision correction

Correction is possible using all currently existing methods:

• ReLex SMILE - this vision correction is indicated for astigmatism and myopia or a combination of both refractive errors with a small incision on the surface of the cornea.
• FLEX - 100% femtosecond technology. Similar to SMILE, an individual lens is cut into the cornea, but a flap cap is cut around its circumference to remove it.
• Femto LASIK - use of a femtosecond laser.
• LASIK laser keratomileusis is used to treat nearsightedness, farsightedness and astigmatism. Since its invention in the early 90s, LASIK has been the most popular surgical treatment for correcting refractive errors. Treats vision defects by reshaping the cornea to correct the way light is focused at the back of the eye.
• PRK involves creating a thin circular flap and loosening the top layer of corneal cells using a special solution. This surgery may be an option for patients who are looking for a cost-effective refractive laser surgery option.
• Opti LASEK is a more advanced OptiPRK technique. It consists of removing the epithelium in a single layer, returning to the surface at the end and installing a contact lens.

Preparing for surgery

1–2 weeks before the planned surgery, the patient undergoes an examination in the clinic. It is necessary to exclude the use of glasses and contact lenses, during which time the natural shape of the cornea will have time to restore.

Preparation includes:

• blood analysis;
• study of corneal thickness;

Laser correction for astigmatism

The use of laser correction for refractive error depends on the type of procedure prescribed.

Some choose PRK, despite a longer recovery period and discomfort after surgery. The outer top layer of cells is removed to expose the second layer to the laser. A protective bandage is put on the eye until the epithelium is restored.

The smile is made using a short impulse. The device is programmed to pass harmlessly through the top layers of the cornea, focusing on a specific sublayer to create a lenticule. The outer layer is not removed; only a small cut is made on the surface.

On average, the procedure takes 23 seconds for one organ of vision. The surgeon removes the lens formed by the laser inside the cornea. The corneal nerves that stimulate the tear glands are less affected and can therefore still help keep the eye moist.

With LASIK, the surgeon creates a piece of tissue by making a flap at the front of the eye to expose the inner layers of tissue to the laser. They use either a mechanical instrument called a microkeratome or a femtosecond laser. The excimer laser shapes the cornea by removing tissue that has been exposed to it. The procedure is completed by returning the flap to its original position.

After operation

Vision recovery occurs quickly. Upon arrival home, the patient will see better. Visual perception is completely normalized over the next 24 hours.

After operation:

• Do not rub the operated eye;
• rest more and not overexert yourself;
• wear sunglasses to prevent sun exposure and harmful UV rays;
• use eye drops for several days after surgery to prevent infection and relieve dryness;
• Avoid contact sports for 2 weeks.

Doctors recommend wearing the patch for 1 week while you sleep to avoid accidentally scratching your eye while it heals., lacrimation and the appearance of halos. There is a small risk of infection and return of astigmatism.

Price

Table. The cost of laser vision correction for astigmatism, depending on the type

Type of operation		Average price in rubles
Lasik	with simple astigmatism up to -1 diopter	7681
	up to -4 diopters	up to 18000
ReLex SMILE		70000
Femto LASIK		20000
PRK		11400