Taiwan boasts the largest proportion of myopic individuals in the world! If you want to get rid of glasses or contact lenses, is “myopic laser surgery” the best choice? How safe is it? Learn about the pros and cons of this surgery in one article.
The importance of seeing with the naked eye – illustrated by earthquakes and emergencies
On January 17, 1995, a huge earthquake hit the Hanshin region of Japan. During the disaster, people with poor eyesight were unable to quickly escape because they couldn’t find or wear their glasses or contact lenses. This made them realize the importance of having good vision in emergency situations.
Following the earthquake, there was a significant increase in the number of people inquiring about laser surgery for myopia, according to Japanese ophthalmologists. Many people were considering laser surgery for myopia. The 921 earthquake in Taiwan also happened early in the morning and gave many myopic people a shocking lesson.
While most people don’t need to experience such a horrific natural disaster, it should be the dream of most myopic patients to be able to live a relaxed life free from the confines of their glasses or contact lenses in their daily lives.
Is myopic laser surgery today safer and more effective than in the past?
“Yes, definitely!” Said Dr. Wei-Li Chen, attending physician at the Department of Ophthalmology at National Taiwan University Hospital, professor at College of Medicine, National Taiwan University, and currently the education convener of the Taiwan Society of Cataract and Refractive Surgeons. Myopic laser surgery has been popular around the world for more than 20 years and has accumulated countless clinical experiences. With advanced diagnostic instruments and optimized surgical methods, the safety of myopic laser surgery has greatly improved compared to the early days.
“Surgeries that are less than perfect cannot stand the test of time,” said Wei-Li Chen. For example, Radial Keratotomy (RK), which was popular 30 to 40 years ago, is no longer used today because of the flaws that have been discovered.
In contrast, myopic laser surgery, which refers to excimer laser and femtosecond laser related surgeries in general, has been widely accepted since its introduction to the market over 20 years ago. Optimized versions of the surgery, such as SMILE, LASIK, FS-LASIK, TransPRK, and CLEAR, have also been introduced. The number of people undergoing myopic laser surgery worldwide has not decreased; in fact, it has increased. This indicates that the safety and efficacy of the surgery are widely recognized.
Picture/Dr. Wei-Li Chen states that, prior to performing myopic laser surgery, the patient’s eye condition will be evaluated and the most appropriate method will be discussed before proceeding. Provided by Dr. Wei-Li Chen
Advanced medical treatments greatly reduce the sequelae of surgery
Thanks to advanced diagnostic equipment and new surgical procedures, the much-criticized sequelae of early myopic laser surgery, mainly dry eye, corneal flap problems, keratoconus, etc., have been greatly reduced, emphasizing the importance of preoperative assessment.
Wei-Li Chen advised that patients at high risk should be carefully excluded. For example, myopic people with significant dry eye syndrome are not suitable for surgery. However, if you are treating a mild case of dry eye, you can choose SMILE or TransPRK, which is less harmful to the corneal nerve.
In the early days of myopic laser surgery, a small number of patients developed postoperative keratoconus, which can cause high myopia and irregular astigmatism. In severe cases, corneal transplantation may be necessary. However, in recent years, there have been very few such cases worldwide.
While no surgery can be completely risk-free, advancements in preoperative diagnostic imaging equipment and treatment processes have significantly reduced the risk factors. These advancements take into account factors such as anterior and posterior corneal surface curvature, corneal viscoelasticity coefficients, and trend variations in corneal curvature.
Furthermore, conventional LASIK surgery can result in corneal flap displacement or wrinkles due to its high impact. For individuals with myopia and particular lifestyles, TransPRK, FS-LASIK or SMILE surgery may be a safer option. However, LASIK’s biggest advantage is its ability to facilitate secondary correction in cases where myopia regresses after surgery, making it irreplaceable.
Regarding sequelae such as glare and halos, they are linked to the patient’s pupil size and surgical parameter settings. Most sequelae typically improve over time.
There are distinct benefits to each of the three myopic laser surgery options.
Currently, the most widely accepted surgical procedures are SMILE, TransPRK, and LASIK, each with its own unique features. Wei-Li Chen summarizes them as follows:
Picture/The three most commonly used types of laser surgery for myopia. Provided by Dr. Wei-Li Chen
Are ophthalmologists themselves willing to undergo laser surgery for myopia?
Many people who are skeptical about laser surgery for myopia often ask this question. According to Wei-Li Chen, there are no clear statistics on the proportion of ophthalmologists who have undergone laser surgery for myopia. However, Wei-Li Chen has attended numerous international conferences and observed that many ophthalmology professors from top hospitals in Asia, such as those in South Korea and Thailand, have performed the surgery on their own children and even used it as a coming-of-age gift for their children, which shows the safety of the surgery.
Furthermore, ophthalmologists are among the most discerning individuals when it comes to visual acuity. However, excessive eye use during their studies often causes high myopia, which may render them ineligible for myopic laser surgery. Therefore, individuals with myopia across various industries can focus more on the great benefits brought by surgery.
Best age to undergo myopic laser surgery
Wei-Li Chen noted that myopic laser surgery is generally recommended for myopic patients under the age of 40 with less than 1,000 degrees of myopia. If you are over 40 years old and have presbyopia, even after surgery to correct myopia, you will still need to address the issue of presbyopia.
While laser surgeries are available for presbyopia and myopia, the most common method currently used is ‘monovision’ surgery. This involves fully correcting myopia in one eye (usually the dominant eye) while retaining 100-200 degrees in the other eye (less than 250 degrees is recommended). This operation solves the problem of presbyopia by allowing you to see both far and near with one glance. All other solutions to presbyopia must be discussed prior to surgery to determine whether surgery is appropriate.
Will the effects of the surgery be permanent? Or will the condition “come back”?
Wei-Li Chen explained that many individuals who undergo myopic laser surgery are highly myopic and may develop early-onset cataracts. If myopia does recur after surgery, it is important to determine whether it is caused by the cornea or cataracts. If it is due to corneal factors (undercorrection or regression), most patients can receive a secondary correction and achieve good vision. If cataracts are the cause of increased myopia, cataract surgery may be necessary.
Picture/Dr. Wei-Li Chen shares that no surgery is 100% safe. While myopic laser surgery has not yet achieved perfection, it is very close to doing so. Provided by Dr. Wei-Li Chen
Is Taiwan’s medical care up to par with other countries, despite its high standards?
Taiwan has highly advanced medical care, however, the Ministry of Health and Welfare enforces stricter controls on new medical materials, instruments, and drugs compared to international standards. While this is a source of national pride, it is a double-edged sword that hinders the introduction of new medical treatments.
Wei-Li Chen provided an example. Corneal cross-linking has been used for many years in foreign countries as a recognized treatment and prevention method for keratoconus caused by laser surgery for myopia. However, Taiwan’s Ministry of Health and Welfare’s strict regulations have hindered its introduction to the country. As a result, a practice that has been widely used in advanced countries around the world is not yet available in Taiwan!
What should we do in such circumstances? Taiwanese ophthalmologists may need to refer patients to other countries, such as Singapore, Japan, or Hong Kong, for treatment. However, in recent years, the COVID-19 pandemic has made it difficult to decide to go abroad for treatment. This is not just true for ophthalmology; other medical specialties face the same dilemma.
“When safeguarding the health of the nation, the Ministry of Health and Welfare should revise many laws and regulations. In addition to preventing wrongdoings, it should also consider promoting benefits to create more convenient health policies for the public.” Wei-Li Chen said, expressing his sincere thoughts.
Does the grass always appear greener on the other side? Do doctors in Western countries have better skills?
Laser surgery for myopia is a self-paid treatment. Some people opt for treatment in the United States and other Western countries due to their trust in foreign medical technology. They do not realize that white doctors may not be as skilled as Taiwanese doctors! Wei-Li Chen explained that Asians have smaller eye fissures, which makes it difficult to use an eye opener to open the eye fissure during surgery. Therefore, almost all eye surgeries are much more difficult to perform in Asians than in Caucasians who have larger eye fissures. From this point of view, it is very likely that the surgical skills of Taiwanese ophthalmologists are superior to those of their counterparts in Western countries.
The best of all possible worlds
Finally, Wei-Li Chen said that no surgery is 100% safe. Perfection is definitely everyone’s goal, but it may not be possible in the real world. Although myopic laser surgery has not yet achieved perfection, it is very close to doing so. Of all the methods for myopia treatment, myopic laser surgery is the one with the best results, the fewest risks and the highest number of satisfied patients. Although there is still room for improvement in the future, you can say that this surgery is “the best of all possible worlds,” a view shared by most ophthalmologists around the world.
Reference: https://health.gvm.com.tw/article/90170
