Refractive Surgeries

Macular degeneration is the leading cause of blindness affecting more Americans than cataracts and glaucoma combined.

Few people are aware that macular degeneration is an incurable eye disease and that it is the leading cause of blindness for those aged 55 and older in the United States, affecting more than 10 million Americans.
Macular degeneration is caused by the deterioration of the central portion of the retina, the inside back layer of the eye that records the images we see and sends them via the optic nerve from the eye to the brain. The retina`s central portion, known as the macula, is responsible for focusing central vision in the eye, and it controls our ability to read, drive a car, recognize faces or colors, and see objects in fine detail.

The former Director of the National Eye
Institute, National Institutes of Health,
has stated that macular degeneration will
soon take on aspects of an epidemic.

 width=According to a recent poll, Americans dread blindness more than any other disability. Recent studies indicate that by the year 2025, the population of people over the age of 65 in the United States will be six times higher than in 1990. The reason - "baby boomers" are aging and overall life expectancy is increasing. Since many people diagnosed with macular degeneration are over age 55, the number of cases of macular degeneration in the U.S. will increase significantly as baby boomers age. In January 1997, Dr. Carl Kupfer, then the Director of the National Eye Institute, National Institutes of Health, stated publicly that macular degeneration will soon take on aspects of an epidemic.

For demographics in the United States, please see;

The AMDF Web site will help our readers to better understand macular degeneration. To understand macular degeneration, you should have a basic knowledge of the anatomy of a normal human eye.

Optical Diagnostics has created a software program which simulates macular degeneration, both "wet" and "dry" types, from early to late stages.

1. Vision Problems in the U.S.--Prevalence of Adult Vision Impairment and Age-Related Eye Diseases in America A joint project of the National Eye Institute and Prevent Blindness America

This technique was invented by a Russian scientist Prof. Fyodorov way back in 1970. It involves the use of diamond knife to make radial cuts on the surface of the cornea 95% deep in order to alter its shape. The number of cuts on the cornea varies according to the refractive error. More the error, more the number of cuts required to flatten the central part of the cornea to neutralise it.

However this technique is not very safe & predictable and has the following disadvantages.

  • Glare / intolerance to bright light
  • Infection
  • Permanent weakening of the eyeball
  • Rupture of the globe with minor injuries
  • Under/over correction
  • Inability for good night driving




In the mid-1980s, a few scientific working groups worldwide investigated the potential of excimer laser and its interaction with the tissue of the eye. Researchers found that IBM's excimer laser which was initially used for etching computer chips, also had medical applications. Today, the technologically advanced excimer laser has added a tremendous amount of precision, control and safety in etching the cornea and treating nearsightedness, farsightedness and astigmatism.

The excimer laser is an ultraviolet laser, and utilizes gases (argon and fluorine) to create a non-thermal, cool beam of laser light. This light breaks molecular bonds in a process commonly referred to as photo ablation. To put it simply, directing the laser beam on the cornea is like placing the curvature from your glasses or contact lenses onto the front surface of the eye, thus allowing one to see without the need for corrective lenses.

The most important aspect of the excimer laser is that it is remarkably precise. It is able to remove 0.25 microns of tissue in a single pulse; that is, 1/200th of a human hair, 1/40th of a human cell, 1/28th of a red blood cell, or 39 millionths of an inch in 12 billionths of a second.


It is a more conventional method of refractive error correction, which involves application of Excimer laser energy on the surface of the cornea. This is an outpatient procedure, which takes around 15-20 minutes for one eye. This is the procedure in which the first layer of the cornea (Epithelium) is scraped with the help of a spatula followed by the application of laser energy on the bed of the cornea to reshape it. The eye is patched thereafter for 3 days. The healing process differs from person to person according to one’s healing response.It takes 3-4 weeks for the cornea to become normal.

The disadvantages of this procedure are:

  • It requires patching of the eye and daily dressing for 3-4 days
  • There is severe post-operative pain, watering and foreign body sensation in the eye for 3-5 days.
  • High chances of infection due to open epithelial wound.
  • There is possibility of fluctuation of vision which lasts for few months.
  • There is possibility of permanent corneal opacity and recurrence of glasses number.
  • The visual outcome is largely dependent on the healing response of the patient.
  • There is need for use of steroid drops for upto 6 months resulting in steroid induced side-effects on the eye in some individuals
  • Frequent follow-up visits are necessary for 4-6 months.



In contrast, the LASIK procedure is more advanced since the laser energy is given under a hinged corneal flap and this flap is placed back after the laser procedure. This flap is self-healing and does not require any suturing. In this procedure the Bowman's layer of the cornea is left intact which makes the technique safer and more predictable. The corneal flap is raised with the help of a special instrument called the Microkeratome. The entire procedure takes 20 minutes with actual laser time varying between 15-145 secs. The procedure is done under topical anaesthesia (use of drops) and it is painless.


Implantable Contact lens has been the latest breakthrough in Eye Surgery & Eye cares practice.

This revolutionary device is beneficial to persons having myopia between (-) 18 to (-) 30 Diopter & Hyperopia between (+) 6 to (+) 15 D. It can change the lives of millions of people transforming them from visual cripples to visually normal people.

Q 1 What is Implantable Contact Lens?
A 1 ICL is made of highly biocompatible flexible polymer – "Collamer" The polymer material is soft, Elastic and hydrophillic. It has a high refractive index and a thin profile.

Q 2 How does ICL correct high myopia?
A 2 ICL can correct myopia more than – 18 D. The ICL is inserted in the eye through a 3mm incision. It is placed and positioned behind the iris. No sutures are necessary, as the opening is self-healing. However 2 weeks prior to the ICL surgery, two small openings are made in the iris called "iridotomy" With N-d Yag & Argon laser.

Q 3 Is the patient required to stay in the hospital?
A 3 This surgery is carried out as an out – patient surgical procedure and is performed by using topical anesthetic drops. It does not require general anesthesia. The patient does not have to stay in the hospital.

Dr. David (M.D.) eye specialist at Eye Centers of Florida calls this procedure a "walk-away procedure, because once you get the implant in successfully, the patients vision is restored immediately".

Q 4 What is criteria for selection of patient?
A 4 The patient selection is:

  1. Age must be 20yrs & above
  2. Indication – myopia – 18D to – 30D
  3. Indication – hyperopia +6D to + 15D
  4. For high myopia, a combined LASIK & ICL procedure may be indicated.


Q 5 What is the post – operative care to be taken?
A 5 The patient has to put steroid antibiotic drops for 1-2 weeks after the ICL surgery.

Q 6 What has been the experience of the ICL surgery abroad?
A 6 The ICL has been developed by Staar Surgical AG of Switzerland & has been used for 2years in Europe and Latin America. Food & Drug Administration have also approved clinical trials in USA. Several hundreds of ICL surgeries have been done Internationally.

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