There are three possible treatments for myopia: glasses, contact lenses, and eye surgery.
Glasses can correct all vision errors, including hyperopia (farsightedness), myopia, and astigmatism. Bifocal lenses are particularly useful for older people with poor vision at long range and very close range. Looking through the upper lens helps long-range vision, while looking through the lower helps close-range vision.
Contact lenses can also correct these problems. Lenses with high correction factors (i.e., those made to correct very poor vision) are liable to be thicker and heavier than lenses that correct for less severe cases of myopia, and some people find them uncomfortable. This is particularly true of lenses that correct for astigmatism. Soft lenses are taking the place of hard and gas-permeable versions, as they're more comfortable and easier to adjust to, though they may be harder to clean. Disposable contact lenses, which can be worn and then thrown away, are also a popular option. Wearing lenses makes people somewhat more prone to eye infection. This risk can be minimized by cleaning them according to instructions, throwing away disposables on time, and never sleeping with the lenses in.
Many Canadians have opted for eye surgery, mostly to correct myopia. There are a few basic types of operations, which are usually done in an eye clinic:
- laser-assisted in situ keratomileusis (LASIK)
- laser-assisted subepithelial keratomileusis (LASEK)
- epithelial laser in situ keratomileusis (Epi-LASIK)
- photorefractive keratectomy (PRK or PK)
With LASIK, the doctor makes a small cut into the top layer of the cornea and then folds back this layer like a flap. A laser is then used to mould the inner tissue of the cornea underneath into a better shape. The flap is then replaced.
PRK is done with a computer-guided laser. A computer-controlled laser removes the epithelium (the very top protective layer over the cornea in the front of the eye), then reshapes the cornea by ablating (destroying) tissue in the periphery or outer part. The result is a cornea that is shaped to refract (bend) light correctly.
LASEK is a variation of LASIK and PRK. With LASEK, the flap created in the cornea is thinner, and the laser moulds the outer layer of the cornea (the epithelium).
Epi-LASIK is modified version of LASEK that uses a mechanical device to remove the outer layer of the cornea.
These techniques are about equally effective in improving sight. Infection of the area that was operated on may occur a day or two after the operation, but antibiotics are usually given to prevent infection. Otherwise, if infection does occur, it's usually easily treated with antibiotics.
Newer refinements of these procedures are constantly under development. One example is "wavefront" or "custom" LASIK, in which a computer maps the visual problems needing correction, increasing the accuracy of the result. Another procedure involves the insertion of a tiny removable ring into the cornea, which leaves the central part untouched, reducing the risk of complications.
The operations themselves are quick (less than several minutes per eye) and painless, though the eye will sting for a few days afterwards. Surgery can only be performed on uninfected healthy eyes. It's not suitable for children and teenagers, whose vision is still changing.
Eye operations don't always produce the desired results. Study results vary, but most people who have laser surgery have improved vision. It is important to realize, however, that some people do not notice any improvement in their vision, and a few end up with poorer vision.
Laser surgery can reduce the quality of your best corrected vision (the absolute best you could see with the right lenses). It can also impair night vision. In addition, the eye can change again after the operation. Sometimes, it heals from surgery into much the same shape it had before, producing only temporary improvement. Because eye doctors like to err on the side of caution, they may under-correct vision, and you may need follow-up procedures. In myopia, they often deliberately under-correct slightly, knowing that your eyesight will probably drift towards farsightedness as you age.
Finally, although laser surgery has been around for over 15 years, we still don't know the long-term consequences. While there's no reason to believe they'll have problems, we can't be absolutely sure. It is important to discuss potential complications thoroughly with an eye doctor before opting for laser surgery.
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