MYOPIA SURGERY - TREATMENT METHODS, EXAMINATION AND SURGERY PROCEDURES, SURGERY COSTS AND COMMON QUESTIONS

When wearing glasses becomes a barrier to work and daily activities, myopia surgery is considered an effective and necessary solution to improve vision and quality of life for patients. To understand myopia surgery comprehensively and objectively, let's find out detailed information about myopia surgery methods, examination and surgery procedures, implementation costs and answers to common questions of patients with Japan International Eye Hospital.

TS. Dr. Vu Anh Tuan - Professional Director at Japan International Eye Hospital performs myopia surgery

WHAT IS MYOPIA SURGERY?

Myopia is a common refractive error, making it difficult for patients to see clearly at a distance, but see clearly at a close distance. To overcome this condition, patients can use glasses, soft contact lenses or Ortho-K hard contact lenses. However, these are only temporary measures and do not completely treat myopia, patients still have to depend on supporting glasses to have clear vision in daily life.

Currently, the only solution proven to eliminate refractive errors in the eye safely and effectively is myopia surgery. Treatment methods for myopia are performed by changing the curvature of the cornea with Laser technology or placing Phakic intraocular lenses to restore clear and free vision to patients.

SHOULD I HAVE MYOPIA SURGERY?

Myopia surgery is a cosmetic surgery that helps patients feel more comfortable in their daily lives and eliminates their dependence on glasses. However, if the patient feels comfortable wearing glasses, myopia surgery may not be necessary. In addition, if the patient does not meet the surgical conditions, myopia surgery should not be performed because this will cause unstable vision after surgery.

For patients who experience many inconveniences and difficulties in using glasses, or need good vision to meet the requirements of specific fields of study and work (pilots, flight attendants, military, police, etc.), myopia surgery is necessary to help patients improve their vision, improve their quality of life and meet the requirements of jobs that require high vision.

SUITABLE SUBJECTS FOR MYOPIA SURGERY

• 18 years old and above.
• Stable refraction (no increase of more than 0.75 degrees in 6 months).
• Cornea thickness response (over 500 micrometers) to laser surgery.
• Anterior chamber depth response (over 3mm) and anterior chamber angle response (over Grade III) to Phakic surgery.
• Normal corneal structure, no acute or chronic eye diseases (infection, keratoconus, corneal scars, ...).
• Intraocular pressure within acceptable conditions.
• Not pregnant or within 6 months after giving birth.

METHODS OF MYOPIA SURGERY

Phakic surgery

• Mechanism: Using an intraocular lens (ICL/IPCL) placed directly behind the iris and in front of the lens to eliminate refractive errors.
• Treatment threshold: ICL lenses can eliminate up to 18 degrees of nearsightedness, 10 degrees of farsightedness, and 6 degrees of astigmatism. IPCL lenses can eliminate up to 30 degrees of nearsightedness, 15 degrees of farsightedness, and 10 degrees of astigmatism.
• Advantages: Wide treatment spectrum, preserving corneal structure, thus optimizing eyes with thin corneas, minimizing dry eye. Phakic provides sharp vision thanks to lenses personalized to the patient's eye condition, especially ICL lenses with integrated UV protection to help protect the eyes.
• Surgery time: Patients need to wait for the lens to be manufactured abroad to arrive in Vietnam for about 3 - 7 weeks. In case the eye has special parameters, the waiting time for the lens may be longer. Surgery for both eyes usually lasts about 15 - 20 minutes.
• Disadvantages: High cost.

Illustration of Phakic surgery

ReLEx SMILE surgery

• Mechanism: Using Femtosecond Laser to separate the cornea into 3 layers, automatically separating the middle tissue layer and pulling it out through a very small incision, thereby eliminating nearsightedness - astigmatism on the eye.
• Treatment threshold: 10 degrees of nearsightedness, 3 degrees of astigmatism.
• Advantages: Minimally invasive to the cornea with a small incision of only 2mm, helping to limit complications after surgery (dry eyes, discomfort, glare, infection, corneal flap displacement). High, even and stable visual quality after surgery. Surgery time: Eliminate refractive errors in 23 seconds for each eye with any degree of myopia. The total surgery takes 10-15 minutes.
• Limitations: Cannot treat farsightedness.

Illustration of ReLEx SMILE surgery

Femtosecond Lasik surgery

• Mechanism: Using Femtosecond Laser to create a corneal flap and using Excimer Laser to project multiple points onto the inner corneal stroma to treat refractive errors.
• Treatment threshold: 12 degrees of myopia, 6 degrees of astigmatism, 6 degrees of hyperopia.
• Advantages: Precise laser incision follows the physiological curve of the eyeball, the incision heals quickly.
• Surgery time: Eliminate 1 degree of refraction in 1.3 seconds. The total surgery takes 10-15 minutes.
• Limitations: Corneal flaps can increase the risk of dry eyes. Patients 
• It is important to follow the principles of post-operative eye care to avoid the risk of corneal flap displacement in the first few days after surgery.

Illustration of Femtosecond Lasik surgery

SBK Lasik surgery

• Mechanism: Using the Moria SBK knife to create a corneal flap and multi-point Excimer Laser to change the corneal structure, thereby eliminating the refractive error on the eye.
• Treatment threshold: 12 degrees of nearsightedness, 6 degrees of astigmatism, 6 degrees of farsightedness.
• Advantages: This is a method of nearsightedness surgery that has been proven effective for many years, with reasonable cost.
• Surgery time: The total surgery takes place in 10-15 minutes.
• Disadvantages: The corneal flap can increase the risk of dry eyes. Patients need to follow the principles of post-operative eye care to avoid risks. May cause dry eyes and corneal flap displacement in the first few days after surgery.

SBK Lasik surgery illustration

EXAMINATION AND SURGERY PROCESS

In-depth eye examination process before myopia surgery

At Japan International Eye Hospital, the in-depth examination and consultation process before myopia surgery is performed according to Japanese standards with the goal of accurately assessing the patient's eye condition, giving optimal treatment indications and providing information about surgery to the patient in a clear, detailed and transparent manner. The patient will go through the following steps:

1. Eye function assessment

• Intraocular pressure test.
• Refraction test.
• Visual acuity test with 6 specialized tests.

2. Corneal structure examination

• Cornea mapping on Pentacam.
• Cornea thickness measurement on Pentacam.

(This step will also provide reference indexes of anterior chamber depth and corneal curvature for reference).

3. In-depth examination for eyes with severe myopia and/or thin cornea.

• Wide-angle color retinal photography on the Optos Daytona (applicable for eyes with severe myopia of 6 diopters or more).
• Measure anterior chamber depth and anterior chamber angle on the Cirrus 6000. This step will also provide reference indexes of corneal epithelial thickness.
• Measure CCT and WTW indexes to assess the size of the space for placing intraocular lenses.

4. Examination and consultation with an ophthalmologist

• Examine the eye with a slit lamp.
• Evaluate the indexes, advise on appropriate surgical methods and answer the patient's questions about surgery.
• Advise on the risk of corneal and retinal diseases (if any) and make recommendations and treatment indications if necessary.

5. Consultant answers questions

Notes before myopia surgery

• Stop using soft contact lenses at least 2 weeks in advance, hard contact lenses at least 1 month in advance.
• You should make an appointment with the hospital at least 1 day in advance to get priority in the order of examination and minimize waiting time.
• You should not go to the examination alone, you should go with relatives or travel by public transport because the patient may be prescribed cycloplegic eye drops, causing blurred near vision for 2-3 days.
• Consider going to the examination when you are pregnant or have just given birth within the first 6 months, because hormonal changes and irregularities in lifestyle can cause unstable vision, leading to examination results that are not accurate enough to advise surgery.
• Consider going to the examination when your eyes are infected because this can cause inaccurate measurements.
• Consider going to the doctor if your eyes are working too hard because they may have accommodation disorders, pseudo-myopia, leading to inaccurate vision measurement.

Myopia surgery procedure

• Choose a surgical method.
• Recheck eye function parameters, eye condition before surgery.
• Blood test.
• Sign a surgical commitment.
• Receive a room and clothes.
• Receive a gift combo of eye protection glasses and medicine used after surgery, instructions for using medicine and instructions for post-operative care.
• Internal examination.
• Pre-operative disinfection.
• Receive instructions for coordination during surgery.
• Perform surgery.
• Rest.
• Eye hygiene.
• Post-operative check-up.
• Discharge.

Notes on the day of surgery

• Stop using soft contact lenses 2 weeks in advance and hard contact lenses 1 month in advance.
• Do not use alcohol, tobacco, or stimulants before surgery.
• Do not wear makeup, do not use perfume, keep eyes and face clean on the day of surgery.
• Do not wear pullovers, tight or furry shirts.
• Avoid wearing jewelry, watches, or hairpins when entering the operating room.
• Do not drive on the day of surgery.
• Eat and drink normally on the day of surgery (except for diabetic patients who need to go to the hospital for a blood test before eating).
• If the patient is taking medication, they can use the medication normally on the day of surgery.

Note on eye care after myopia surgery

1. Avoid dust, water, and bacteria from entering and causing eye infections by:

• Wearing protective glasses continuously for 3 days.
• In the first 3 days, absolutely avoid getting water in the eyes by limiting shampooing or only bathing from the neck down, washing the face with a towel in the area outside the eye area.
• Avoid living with pets for the first 2 weeks after surgery.

2. Follow your doctor's instructions

• Regular check-ups as directed by your doctor 
• Use antibiotics/anti-inflammatory drugs and artificial tears as prescribed by your doctor.
• You can bathe (from the neck down) after 1 day, and bathe your whole body after 3 days.

3. Eat and drink and use medications you are taking as usual.

4. You can drive after 3 days.

5. You can apply foundation makeup after 1 week, and eye makeup after 2 weeks.

6. You can do light exercise after 1 week, and vigorous exercise after 2 weeks.

COMMON SIGNS AFTER MYOPIA SURGERY

• Difficulty seeing close up: For myopic eyes, due to the degree of myopia, the eyes do not need to adjust to see clearly at close range. After myopia surgery, the refractive error is completely eliminated, the eye returns to normal vision, so most patients have difficulty seeing up close and need time to adapt and restore the natural regulatory function of the eye. Accordingly, this condition will improve after 1 - 3 - 6 months depending on each person's constitution.
• Sensitivity to light: Patients may see some phenomena such as glare, blurriness, and glare around lights after myopia surgery. This is a harmless phenomenon, and patients will gradually get used to it after a period of using the eye.
• Infection: All surgeries that affect living organisms have the risk of infection. Although the rate of infection after myopia surgery is very low, this can still occur, affecting the eye recovery process, even causing eye complications (dry eyes, blepharitis, chalazion, ...). To prevent infection, patients need to comply with the use of antibiotics and anti-inflammatory drugs as prescribed by the doctor.
• Dry eyes after laser surgery: Patients will experience temporary dry eyes due to changes in the corneal structure after surgery. This condition can be improved by using artificial tears for the first 3 - 6 months as prescribed by the doctor.
• Blurry vision after ReLEx SMILE surgery: Patients may see everything slightly blurry as if there is a thin layer of fog in front of the eyes. The cause comes from the mechanism of partial peeling of the stroma, causing the cornea to have a gap filled with water. When this layer of water dissolves, the two layers of the cornea will completely adhere to each other, the blurred vision will disappear. Depending on each person's constitution, this phenomenon will improve after 1 - 3 - 6 months.
• Temporary increase in intraocular pressure after Phakic surgery: Although Phakic lenses are made from safe materials and are highly compatible with human biological characteristics, when inserted into the eye, the body will still consider the intraocular lens as a foreign object, so some patients may experience temporary increase in intraocular pressure (feeling pain around the eyes, headache, nausea). This phenomenon can be controlled and does not affect the eyes if the doctor treats it promptly by using medication or performing an intraocular pressure lowering procedure.

COST OF MYOPIA SURGERY

Patients can refer to the cost of myopia surgery at Japan International Eye Hospital as follows:

• Phakic surgery: 90,000,000 VND - 100,000,000 VND for 2 eyes (depending on the type of lens).
• ReLEx SMILE surgery: 45,000,000 VND for 2 eyes (Original price 70,000,000 VND).
• Femtosecond Lasik surgery: 38,000,000 VND for 2 eyes.
• SBK Lasik surgery: 24,000,000 VND for 2 eyes.
• Corneal reinforcement crosslinking procedure: 9,000,000 VND for 1 eye, 16,000,000 VND for 2 eyes.

In particular, all patients undergoing myopia surgery will receive an additional gift combo worth 4,500,000 VND including a pre-operative eye examination package, eye protection glasses and medicine for 1 month after surgery, 12 months of unlimited free follow-up visits.