New Delhi-based MBA student Sonal had a problem. With myopic eyesight of power -4.5, she could not do without her spectacles. But they made her feel uncomfortable, and contact lenses did not agree with her eyes at all. She did not know what to do, till her friends told her about Intralase, or iLasik. A state-of-the-art, blade-free procedure that improves on the now-commonplace Lasik, Intralase is now available in India.
“Initially, I was cautious and afraid. But when my friends reassured me, I took the plunge,” Sonal says. After a painless, 15-minute procedure, she had no regrets. “I no longer need spectacles. My eyes feel perfect,” she exclaims. The story has a happy ending. Sonal graduated successfully, and is now looking for a job.
Like Sonal, thousands of Indians with a variety of eye problems, minor and major, now have the option of relatively painless, quick outpatient procedures based on cutting-edge technology.
How the eye works
It is pretty much like a camera—the cornea and lens in the front of the eye help focus the image onto the retina, which could be regarded as the equivalent of camera film. Problems that ophthalmologists describe as “refractive errors”—such as near-sightedness and far-sightedness—occur when the lens and cornea do not focus light properly, so that the image is either focused in front of the retina, or is not in focus by the time it reaches the retina.
What is Lasik?
Spectacles and contact lenses help adjust light rays so they actually focus on the retina. But, for many, these are uncomfortable external objects. For them, Lasik was the first-generation option. Simply put, it was a computerized laser procedure in which the cornea was reshaped so that the light focused at the right place without spectacles.
More than 16 million people across the world have opted for the procedure and, according to the first review of its scientific literature by the American Society of Cataract and Refractive Surgery, 95.4% patients are satisfied with the results.
But, not everyone is a suitable candidate for Lasik. It is not recommended, for example, for those with thin corneas.
New versions of Lasik
A range of technologies—such as guided iLasik, Intralase, epiLasik, Intacs and phakic intraocular lenses—is available for various eye-related problems. Using these technologies to get rid of spectacles is not merely a matter of vanity. It can even enhance one’s career options. For example, 20/20 vision is needed for pilots, and dependence on spectacles can lead to disqualification. But commercial airlines have agreed to take on pilots who have opted for such procedures, says Mahipal Sachdev, director, Centre for Sight, Delhi.
A case study
Twenty-six-year-old Amit, a Delhi-based business executive, found that he could not see properly with his right eye, and went to an ophthalmologist about a year ago. The diagnosis was frightening. “Your right eye is dead.” “I panicked,” Amit recalls. He was diagnosed with keratoconus, a condition that occurs in 1 in 2,000 people, where the cornea—the part of the eye that we see—becomes thin and misshapen. In Amit’s case, it had become conical. The result: One sees the world as if looking through an ice cube.
After intensive investigations, the doctors held out hope: Amit could be treated, but had to go through two procedures. The first step—called corneal collagen cross-linking with riboflavin (C3R)—involved cross-linking the collagen fibres that anchor the cornea to help strengthen it. In this procedure, riboflavin (vitamin B2) eye drops are applied to the eye, and it is activated by ultra-violet light. An outpatient procedure that took about one-and-a-half hours, it required no local anaesthesia.
Amit’s second procedure, rare in India, was conducted at Centre for Sight, and observed by a Japanese team. It involved inserting Intacs—micro-thin rings—on the cornea to gently reshape it. As a pioneer patient, Amit remembers being worried: “The eye going into the machine felt like a journey into the sun, only without the heat.”
It was over in less than 10 minutes, and he walked out of the operating theatre feeling no pain whatsoever. Since then, there has been a “marked improvement” in Amit’s eyesight. “Earlier, because of the severity of my condition, I had to tilt my head to see with my left eye,” he says. The only disadvantage, he says, is that he can see the edges of the rings at night. One does not need to have keratoconus to opt for Intacs, however. As Dr Sachdev points out, anyone with myopia or hypermetropia (far-sightedness) can opt for it if he or she is unsuited to Lasik, or does not want a permanent procedure. Intacs only places rings in the cornea but does not cut any tissue, and is reversible.
Implantable contact lenses (ICL) are yet another solution for both near-sightedness and far-sightedness. Made of plastic of silicone, these lenses—also called phakic lenses—have been approved by the US Food and Drug Administration. They can be implanted into the eye permanently so the patient does not need to use spectacles or the usual “take out at night” contact lenses.
The phakic lens is inserted through a small incision and placed just in front of, or just behind, the iris. The patient’s natural lens also remains. For those suffering from cylindrical errors, or astigmatism, more advanced versions of these lenses, called ICL Toric, are also available.
And now, there is iLasik
This is an upgraded and more sophisticated form of Lasik that aims to improve vision “both qualitatively and quantitatively”, according to one eye surgeon, and gets its inspiration, literally, from beyond the earth.
“Wavefront technology”, usually used by the National Aeronautics and Space Administration to map the uneven surfaces of the moon, is deployed in iLasik to map the imperfections of the eye. These imperfections, or “aberrations”, as they are referred to in medical jargon, are then removed using a laser. The procedure is customized for each patient so that, for example, the patient can not only see objects clearly, but also in vivid colour range and sharpness.
The multifocal foldable intraocular lens
Cataract patients, too, have a choice these days. Earlier, after surgery, patients would need spectacles to focus on objects at different distances. The introduction of the multifocal foldable intraocular lens is a significant advance in this field. These are small silicon or acrylic lenses which can be folded and slipped in through a small incision, and replace the person’s natural lens after the cataract procedure. They allow patients, such as 72-year-old retiree Jyoti Sikand, the advantage of viewing an entire range clearly. Sikand is very happy with the outcome. “I am glad I went for the multifocal option,” he says. “I now read the morning paper, drive without spectacles. At times, even friends can’t recognize me!”
But not everyone is happy with multifocal foldable intraocular lenses. Some complain that the contrast can be poor, and ophthalmologists point out that patients may see halos or experience glares.
However, this is a new technology and, with time, the creases will be ironed out and there will be newer, better versions. For the moment, it adds to the options in our sight.
Information on common eye ailments has been provided by Anita Sethi, consultant ophthalmologist, Artemis Health Institute, Gurgaon
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