Currently, with significant technological advancement and continuing research Refractive Surgery has motivated multiple publications and congresses worldwide.
Due to these remarkable technological advances, people now have another option to treat refractive errors surgically.
Surgical treatments of myopia, hyperopia, and astigmatism have accomplished good results, allowing the patients to leave aside the use of glasses or contact lenses.
Can a Person With Glaucoma Have Lasik Surgery?
There are two techniques that are especially useful in cases of moderate or low refractive errors namely keratorefractive with excimer laser, especially LASIK and PRK.
On the other hand, in cases of individuals with higher refractive errors or individuals with below normal thickness of the cornea, for laser treatment the use of intraocular techniques is expanding. It is worth mentioning that one of these techniques is the phakic intraocular lens implantation, in which the patient’s natural crystalline is preserved, and this implant is used until around 50 years of age.
Only in patients who are 50 or older, it is indicated the use of pseudophakic intraocular lenses, which take the place of the crystalline (this is a part of the eye, located behind the pupil, which consists of a transparent body in the shape of a biconvex lens whose function is to make the light rays converge so that they form images on the retina). This has been used routinely in cataract surgery, and it offers the possibility in some cases to correct presbyopia which is an ophthalmological condition in which individual has trouble seeing object placed at a fair distance. It is commonly termed as farsightedness. It is caused by loss of elasticity of the lens of the eye. It is seen to develop in the middle to old age population typically in middle and old age.
Lasik Surgery In Patients With Glaucoma
Despite the fact that the optic disc and the visual field are assuming increasingly important roles in the diagnosis of glaucoma, estimating the base level and the desired level of intraocular pressure (IOP) are still important in the diagnosis of glaucoma.
In addition, as more patients are opting for refractive procedures to correct myopia, hyperopia, astigmatism and presbyopia, the population that will eventually develop glaucoma or ocular hypertension continues to increase. Taking this into account, it is important to understand the cause-effect relationship between intraocular pressure and refractive surgery. Another interesting issue is whether a patient with glaucoma has a higher risk of progression when undergoing a refractive procedure.
The Central Corneal Thickness And The Intraocular Pressure
The central corneal thickness (CCT) has been largely ignored in the thousands of patients diagnosed with glaucoma until the discoveries made with studies that show that thinner corneas are a risk factor that does not contribute to the progression of glaucoma. Although the role of CCT in IOP levels was recognized by tonometry by applanation, the true importance of this factor has recently come into play, mainly due to the popularity of refractive procedures that modify corneal pachymetry. As IOP still plays an important role in the diagnosis of glaucoma and its treatment, it is still important to estimate the patient’s actual IOP, regardless of the corneal thickness.
It has been shown that IOP can vary between +/- 4 and 5 mm within the normal range of pachymetry (it is a procedure that allows the measurement of the thickness of the cornea).
It would not be advisable for a patient with moderate to advanced glaucoma to undergo Lasik, not only because of the already known IOP measurement problems that cause an impediment in the appropriate control and treatment of the glaucomatous state, but because of the potential risk of increasing the loss of nerve fibers in glaucoma and increase visual field defects due to transient but at the same time high levels of IOP during surgery.
An exhaustive control evaluation of the glaucoma status must always be carried out before the LASIK procedure.
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