Surgery for astigmatism: recommendations, contraindications, results

A severe vision disorder that results in loss of the ability to see objects clearly is classified as astigmatism. The disease develops due to changes occurring in the cornea or lens. When such a diagnosis is made, patients may be prescribed to wear glasses or contacts, but such measures will not help cope with the disease. In order for the course of treatment to lead to the desired result, surgical intervention is necessary. Today’s article will discuss this disease in detail and also determine what methods can be used to cure it.

Indications and contraindications

As medical practice shows, it is possible to achieve a pronounced effect in the process of treating astigmatism only through eye surgery. For astigmatism, it is prescribed in the following situations:

When a person decides to get rid of a vision problem once and for all.
The patient flatly refuses to wear glasses.
There is intolerance to contact optics.
Professional activities require high-quality vision (for example, a driver or a train driver).
Astigmatism is diagnosed in combination with hyperopia.
If visual acuity is impaired from three diopters.
When making a diagnosis, irregular astigmatism is detected.

When making a diagnosis such as astigmatism, surgery can only be performed if the patient’s condition meets the following conditions:

If a person suffers from diabetes, the glucose level must first be stabilized.
In case of hypertension, the blood pressure level is first stabilized.
The patient does not have cancer, infectious diseases, or inflammatory eye diseases.
Over the course of twelve months, the refraction does not change.
Refractive indexes up to plus five dioptres.
The age of the person preparing for surgery exceeds eighteen years of age.

In what cases is eye surgery for astigmatism contraindicated? Among other things, the operation can be canceled if the patient has an unstable mental state that makes it impossible to establish contact with a person. Surgery is contraindicated if a person suffers from the following diseases:

diabetes mellitus of the first or second type;
progressive myopia;
diseases of the visual system of an inflammatory nature;
when diagnosing glaucoma or cataracts.

Pregnancy is also a contraindication to surgery. If a person is diagnosed with astigmatism, surgery can be performed only after a complete examination and determination of the patient’s health. Only if there are no contraindications can you count on a positive outcome. If a person has contraindications to surgery, then the specialist will select an alternative treatment method.

Types of surgery

The inability to correct vision with glasses and contact lenses for a long time is a fairly compelling reason for surgical correction. In addition, in addition to the patient’s natural desire, there are direct indications for surgery. These are cases where myopia is combined with farsightedness, a degree of 3 diopters, “irregular” nature of astigmatism.

Taking into account the modern possibilities of reconstructive surgery in ophthalmology, together with the treating ophthalmologist, you can easily choose the most optimal method for yourself.

Keratotomy

The operation is relevant for myopic or mixed astigmatism.
The essence is to correct the curvature of the refractive surface by applying radial incisions (from 4 to 12) to the cornea. As a result, under the influence of intraocular pressure, the cornea partially protrudes and becomes narrower. It is performed on an outpatient basis under local anesthesia; the total duration, as a rule, does not exceed 2 hours, including preliminary preparation.

The average cost of an operation is from 9 to 16 thousand rubles, depending on the clinic and region.

BACKGROUND: Due to frequent subsequent complications, opinions regarding this technique are controversial. In this regard, most clinics use tools with a diamond attachment or completely replace the scalpel with a laser.

Laser correction

It is performed either by PRK (photorefractive keratectomy) or Lasik (laser-assisted intrastromal keratomyelosis).

PRK is indicated for myopic astigmatism. Using a laser, the central part of the corneal epithelium is removed, and the curvature of the surface changes. After surgery, the cornea is covered with a protective lens for 5-7 days to restore the natural volume of the epithelium. The cost of the operation varies from 25 to 35 thousand rubles per eye.

Lasik is used to correct vision if myopic, hypermetropic or mixed astigmatism is diagnosed. The middle layer of the cornea is subjected to corrective action (partial evaporation of tissue), for which the upper corneal part is first cut off according to the flap principle. After removing the required amount of tissue, the flap is applied back without any mechanical fixation. The cost of the operation is from 28 to 50 thousand rubles.

Here is an educational video about how laser correction works:

Thermocoagulation

Such surgical treatment is prescribed for hypermetropic astigmatism. The refractive power of the cornea is increased due to radial point cauterization of the peripheral zone. It is carried out using a hot needle that controls the depth, exposure time and temperature threshold. Currently, it is used extremely rarely , only in cases of impossibility or ineffectiveness of other correction techniques. The cost greatly depends on the region and ranges from 3 to 13 thousand rubles.

ARTICLES ON THE TOPIC:
Is there a danger in laser correction of myopia? Pros and cons of modern operations
What are the types of eye surgeries for farsightedness and how much does hyperopia correction cost?
All types of eye surgeries for myopia: features and contraindications for correction

Keratoplasty

The operation is performed when other treatment methods are ineffective or when the cornea is pathologically thinned. It is often used purely for cosmetic purposes on a blind eye to replace one’s own clouded cornea. The required spherical shape is achieved by partial or complete transplantation of donor or artificial material. With partial transplantation, the thickness of the cornea or its anterior layer is replaced.

The operation is performed on an outpatient basis. Postoperative sutures are removed within 6-12 months. The average cost is 100 thousand rubles, excluding donor material.

Implantation of lenses on the crystalline lens

It is performed for thinned corneas, a high degree of astigmatism and categorical contraindications to laser correction.
The essence of the technique is the implantation of a phakic intraocular lens made of collagen or silicone into the anterior or posterior chamber.

The lens is fixed either independently or with the help of additional elements, depending on the design. The operation is completely seamless and is possible if the natural accommodation of the lens is not lost. The price in Moscow clinics is from 50 to 125 thousand rubles.

Lens prosthetics

The operation is indicated for significant weakness or complete loss of optical power by the lens. Implantation of a multifocal toric lens, thanks to its characteristic imitation of the entire functionality of its own lens, allows the patient to see perfectly at any distance. The lens is removed using phacoemulsification (fragmentation by ultrasound). After insertion, the lens is carefully centered, positioned as necessary relative to the meridian axis and fixed with arms.

After preliminary rinsing, a bandage is applied to the eye. No stitches are required. In private clinics, the cost of the operation ranges from 40 to 150 thousand rubles (including lenses) per eye. State clinics quote prices from 25 to 110 thousand rubles.

Benefits of the operation

When a person is diagnosed with astigmatism, the operation is performed in the age range from 18 to 45 years. Surgical intervention in this case lasts no more than fifteen minutes. In addition, the advantage is that the operation is performed under local anesthesia, and the local anesthetic solution is well tolerated by the body and completely eliminates pain.

This treatment also differs in that it does not cause any complications, and the recovery period lasts a fairly short period of time. Immediately after surgery, a person begins to see well. Final normalization of vision occurs within the first seven days. As practice shows, loss of vision or its deterioration after surgery has never been recorded. Surgery is performed on an outpatient basis.

Recovery in the postoperative period

If the operation was completed without any unforeseen complications, vision is completely restored, depending on the technique used, from several hours to 2-3 weeks. A significant role is played by the patient’s behavior in the postoperative period and strict adherence to the mandatory rules:

During the first 3 days after surgery, it is highly recommended not to wash your hair;
as a wash, wipe your face with a cotton swab moistened with purified water and carefully avoid the eye area;
When sleeping, maintain the position on your back for the first 1-2 days;
in the next 2-3 days, do not rub your eyes or touch them with your hands;
For the first 10-14 days, the use of decorative eye cosmetics is unacceptable;
during the first 3 months, while reading or working at the computer, take regular breaks every 30-45 minutes;
for 2-3 weeks, any work with heavy physical exertion and tilting the head down is strictly contraindicated;
professional sports after surgery are permanently contraindicated;
You should refrain from swimming for the first 1-1.5 months;
visiting a solarium, sauna or bathhouse is permitted no earlier than 3 weeks after surgery.

IMPORTANT! Throughout the postoperative period, the attending physician sets a schedule of mandatory visits. Ignoring such examinations can lead to unpredictable complications.

Astigmatic keratotomy

When diagnosing astigmatism, surgery can be performed using different methods. Astigmatic keratotomy is considered one of the first external treatment methods. After a breakthrough occurred in the field of high technology, the opinions of experts were greatly divided. Many people refuse this method, explaining this by the high likelihood of the patient developing complications after it.

Keratotomy is as follows:

the doctor makes special notes in front of the patient’s eye;
then, using a diamond knife, an incision is made into the cornea of the eye;
the depth and number of microsections in each individual case is determined by the doctor individually.

The duration of such an operation does not exceed five minutes. Such an intervention is prohibited for people suffering from cancer, inflammation of the intraorbital location, infection and dermatitis, as there is a possibility of secondary infection. It is also prohibited to perform keratotomy on persons under eighteen years of age.

If astigmatism is characterized by myopia, surgery (astigmatic keratotomy) will help change the curvature of the cornea and correct the situation.

What is astigmatism?

This is an optical defect, which is characterized by a non-spherical shape of the eye. The eyeball should be round, but if there is curvature of the cornea, then this means the presence of astigmatism. Another shape of the eye, somewhat exaggerated, can be compared to a baseball. From this it becomes clear that astigmatism cannot be cured. We are not able to form, “blind” a new round eye. But is everything really so pessimistic or are there ways to somehow improve the situation? The next question that needs to be addressed is how people with astigmatism see.

Check your vision condition and choose an effective treatment method

and also learn about the effectiveness of methods specifically for you

Photorefractive keratectomy

What is it for? To treat astigmatism, laser surgery is an excellent option. It is carried out without direct impact on the internal structure of the eyes. It was thanks to this method that accurate and positive results were achieved. This effect is achieved as a result of evaporation of the tissues of the surface layer of the cornea.

Another advantage of photorefractive keratectomy is that no microsections are made on the eye. Despite the huge number of advantages, this surgical intervention also has disadvantages. They consist in the fact that the operation is prohibited from being performed on both eyes at once.

The essence of photorefractive keratectomy is as follows:

special anesthetic drops are dropped into the patient’s eye;
then the eyes are kept from blinking using an eyelid dilator;
Using a laser, the surface layers of the cornea are removed, and then new ones are formed;
the eyes are washed with a special solution.

After the operation there is a recovery period, during which the patient is recommended to wear special protective lenses.

Thermokeratocoagulation

How is this operation performed? The essence of this method is that microburns are applied to the cornea using a hot needle. Currently, in the treatment of astigmatism, the operation is performed not with the use of a needle, but with the help of laser correction. This method of therapy is used extremely rarely, since there are currently more modern and effective methods.

This method is used to treat farsightedness. Before the operation, intraocular pressure, vision, eye length, optical power of the cornea are necessarily measured, and the degree of development of astigmatism is determined.

Laser correction of astigmatism

Astigmatism
is an anomaly in the structure of the eye in which the cornea, and sometimes the lens, have different radii and refraction in different planes.

A person with astigmatism sees objects blurred and distorted. However, today there are many ways to get rid of this pathology and significantly improve vision.

Our patients, whom we have already helped, joke that it is better to look at “impressionist paintings” in a museum, rather than see them every minute before your eyes.

Implantation of phakic lenses

If a person is diagnosed with complex astigmatism, the operation requires a special approach. In this case, the patient is prescribed phakic lens implantation. The essence of this method is that the doctor inserts a phakic lens into the posterior or anterior chamber of the eye. After insertion, it is carefully straightened and fixed. In this case, no stitches are applied.

This surgical intervention is performed within fifteen minutes and does not require hospitalization, since no stitches are required. Drip anesthesia is used for pain relief.

Keratoplasty

Quite often, keratoplasty surgery is performed for astigmatism. Its essence lies in the fact that the modified cornea is completely replaced with an artificial or donor one. In most cases, the new cornea takes root well, but there are also situations where rejection occurs. Patients are prescribed corneal keratoplasty if other methods are not recommended for one reason or another.

Treatment of astigmatism

Laser correction of astigmatism is the most effective way to restore vision, characterized by a high degree of safety and excellent results.

Astigmatism correction with glasses is a non-surgical method that improves your vision while you use it. This is the simplest and most popular method of optical vision correction for this disease. It cannot be considered ideal, since high-quality vision can be no more than 2.0 diopters with the correction of astigmatism. It is clear that glasses for astigmatism only correct it, but do not correct it.

Cylindrical glasses can correct up to 2 diopters of astigmatism; for larger degrees, patients require other methods of correction

Contact correction of astigmatism – the quality of vision in toric contact lenses is higher than in glasses. It is comparable to the results of laser vision correction, because the contact lens forms a single optical system with the cornea. Toric contact lenses are quite expensive and, with long-term use, exceed the cost of laser vision correction. All the advantages and disadvantages of contact lenses are well known.

Contact correction of astigmatism – the quality of vision in toric contact lenses is higher than in glasses. It is comparable to the results of laser vision correction.

Eye surgery for astigmatism is the most radical way to restore normal eye optics. Eye microsurgery for astigmatism is used in difficult cases when, for one reason or another, laser vision correction cannot be performed. These may be very high degrees of astigmatism or contraindications from the eyes or general diseases of the body. To correct astigmatism, surgery is used to replace the clear lens with a toric IOL or implant phakic lenses inside the eye.

Eye microsurgery in the treatment of astigmatism is used in complex cases when, for one reason or another, laser vision correction cannot be performed.

For a detailed introduction to each method, read our detailed articles. Together we will look at all the main advantages and disadvantages of each type of treatment for astigmatism, discuss indications and contraindications, so that you have an objective picture of vision restoration in this disease.

What will help me get rid of astigmatism?

This question can only be answered competently by an experienced doctor who is professionally involved in the correction of astigmatism, using different methods depending on each case.

For effective and safe treatment of astigmatism, you need to correctly approach 3 questions:

Choosing a professional eye clinic for astigmatism treatment
Choosing an experienced ophthalmologist and eye surgeon
Which method is right for you?

Now, you know everything about the modern possibilities of ophthalmology in this direction. We recommend reading reviews about doctors and clinics, comparing prices for surgeries and making the right decision!

Lens prosthetics

Surgical intervention, which consists of prosthetics, is performed under local anesthesia. After the patient does not feel pain, he undergoes lens replacement and intraocular lens implantation.

In order for all work to be carried out, access to the cornea is provided. This is achieved by cutting the lens capsule. Regardless of how astigmatism is treated, there must be a recovery period after surgery. At this time, the patient must strictly follow all the recommendations of his attending physician.

Recovery period

If surgery is performed, vision with astigmatism is restored almost immediately. But despite this, the patient must undergo a rehabilitation course for a full recovery. The recovery process directly depends on the method of surgical intervention.

If a person has undergone astigmatic keratectomy, then he is prescribed antibacterial therapy, as well as non-steroidal anti-inflammatory drugs. After thermokeratocoagulation, the patient is prescribed anti-inflammatory drops.

In each individual case, drugs for rehabilitation are selected purely individually, not only depending on the method of surgical intervention, but also on the individual characteristics of the body and the course of the pathology.

Among other things, there are general recommendations that should be followed regardless of the type of operation. They are as follows:

During the first three days, it is strictly forbidden to wet your eyes and sleep with your face in the pillow;
After surgery, it is not recommended to use cosmetics for the first two weeks;
during the first three months, visual load should be limited;
For the first month and a half, when going outside, you need to wear sunglasses and limit lifting heavy objects.

Types of astigmatism

According to the nature of its occurrence, astigmatism is divided into congenital and acquired.

Congenital astigmatism - up to 0.5 D occurs in most children and is classified as “functional”, that is, this type of astigmatism does not affect visual acuity and the development of binocularity. However, if astigmatism exceeds 1 D or more, then it significantly reduces vision and requires treatment in the form of spectacle correction.
Acquired astigmatism appears as a result of gross scar changes on the cornea after trauma, damage, or surgical interventions on the eyes.

Depending on the refractive error with which astigmatism is combined, the following types of visual impairment are distinguished:

simple hyperopic or simple myopic astigmatism - a combination of farsightedness or myopia in one meridian of the eyeball and normal refraction in the other;
complex hyperopic or complex myopic astigmatism - a combination of farsightedness or myopia of varying degrees in the main meridians of the eye;
mixed astigmatism is a combination of farsightedness in one meridian and myopia in another.