The Eye And Laser Eye Surgery

A Functioning Eye (Emmetropia)

The eye is the organ of sight. It is used in almost everything we do, from playing sport to reading. A normal and well functioning eye can focus objects and images, both near and far, perceive depth and adapt to changes in light.

The perception of depth is due to having two separate eyes creating two separate images, while the ability to adapt to light change is attributed to the iris and the dilator muscles. However these two aspects of the eye are not involved in laser eye surgery and will not be discussed in reference. The focusing of objects and images is very much part of laser eye surgery. In order for a clear visual image to be formed the image must come to a point on the retina. Light rays do not normally travel toward each other, usually the light rays either travel outwards or almost parallel, for this reason the light rays must be refracted. The cornea is the primary place of refraction, the “bent” light rays then travel through the aqueous humor and the pupil to the lens. Here the light is one again refracted even closer together, the light then goes through the vitreous humor and is projected onto the retina. The focus of the lens should be aimed at the fovea centralis (a tiny pit in the middle of the macula). It is in this region that vision is most sharp. For this reason, instead of simply staring at one point the eye must constantly “scan” the area to focus the whole object or image. In order to accommodate the changing distances of the object or image the lens in the eye has to adjust, becoming thinner to focus distant objects and fatter to focus near by objects. This process, of changing the lens thickness is known as accommodation. In order for this to occur the ciliary muscles contract and relax. The contraction fattens the lens and the relaxation stretches the lens.

The eye functions on much the same principle as a camera. The iris, or coloured portion of the eye, acts as a shutter to regulate the amount of light admitted to the eye. The cornea (the clear window at the front of the eye) and the lens (located behind the pupil) serve to focus light rays from the object viewed onto the retina at the back of the eye. The retina then transmits the "picture" of the object viewed to the brain where the object is "seen".

Clear vision is the result of light rays passing through the cornea,...

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...ubstantially reduced.

3) Post-operative visual acuity is restored within a few days rather than weeks.

4) Less corneal scarring in the long term, less change due to healing (regression) and thus greater stability of the correction.

When comparing only the benefits of Lasik over PRK the first impression is that Lasik has the potential to be a superior procedure. There is however, a very significant list of potential complications or risks and these include:

1) Failure of automated instrument to leave a hinge on the corneal flap, with the first incision.

2) Loss of the corneal flap during the operation.

3) Loss of the corneal flap after the operation.

4) Slipping of the flap and healing off center.

5) First incision too deep (perforation of the eye) or too shallow, causing a hole in the flap.

6) Invasion of the surface tissue into the central tissue of the cornea.

7) Infection of the cornea.

8) Loss of visual acuity - from scarring or from decentration of the PRK.

9) Technical problems with complex and finicky automated diamond-cutting devices.

10) The procedure is much more dependent upon surgeon's operating skills, than the computerized precision of the PRK procedure.