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High myopia, very nearsighted, vision correction options - A State of Sight #24

In this episode of A State of Sight, Isaac Porter, MD explains the vision correction options available for patients that are very nearsighted. Glasses and contact lenses are usually the first choice, but surgery can be considered for those who would like to reduce their dependence on glasses or contacts. The four primary choices that are covered are LASIK, PRK, cataract surgery, and lens implants.




Welcome to a State of Sight, I’m Isaac Porter, MD from Porter Ophthalmology and this is your update in ophthalmology and eye care from Raleigh, NC. I would like to explain the options that patients have to surgically correct their vision if they are very nearsighted and want to decrease or eliminate their need for glasses or contact lenses.


When patients have a prescription around -6.00 or higher we consider them to be highly nearsighted or highly myopic. If they want to improve their vision, there are a few modern options available.


One option is LASIK. My wife used to be very nearsighted around -8.00 and she had LASIK. Now her vision is great, she is very happy and she does not have to use contacts or glasses to see clearly. This can be a good option for many people. LASIK changes the shape of the cornea in the front of the eye using a laser to correct vision.


There is a certain thickness that we need to leave behind in the cornea for a safety margin in order to provide strength and stability of the eye moving forward. If a patient’s cornea is too thin or if the treatment is too large, then they may not qualify for LASIK. They may need to go with another laser vision correction option, which is PRK.


It may be safe to perform PRK in some patients that are very nearsighted when they cannot have LASIK. However, when we treat large prescriptions with PRK, we become more concerned about the development of haze, scarring, or cloudiness of the cornea after surgery which can interfere with vision.


To help lower the risk of corneal haze or scarring occurring after PRK we can use an additional medication during the laser eye surgery called mitomycin-C. Also, patients may need to use more steroid drops after the procedure to help prevent the development of haze. Since this problem can keep patients from seeing the best that they can, we try to avoid any scarring if possible.


Another option when PRK may not be a good choice would be cataract surgery or refractive lens exchange. With this procedure, we remove the lens from inside a patient’s eye and replace it with a clear artificial lens implant. The lens implant (IOL) can include the power that is needed in glasses or contacts into the eye. Therefore, we can correct vision with this operation. After surgery the glasses prescription needed to see clearly will most likely be small, allowing patients to see better without glasses or contacts.


Most of the time cataracts occur in patients that are older, and those who are younger usually don’t have cataracts. If there is no cataract, we can perform refractive lens exchange which is a procedure similar to cataract surgery where we remove the clear natural lens of the eye and replace it with an artificial lens.


Because there is no cataract, refractive lens exchange (RLE) is not considered medically necessary and is not covered by insurance. Also, there is additional risk with RLE compared to laser eye surgery including the risk of retinal detachment. Therefore, we have a thorough discussion before patients consider this procedure weighing the benefits of improved vision and freedom versus the potential risks of surgery.


An additional option would be placing a lens implant inside the eye without removing the patient's natural lens. This additional lens implant can contain the power needed in glasses or contacts and correct vision. This operation is called ICL placement.


Recently, SMILE laser vision correction has been approved to correct nearsightedness and can be very effective for those who are highly nearsighted. With SMILE, a laser is used to create a thin contact-lens shaped 3D layer just under the surface of the cornea. This lens is then removed from a small opening to correct the visual problem.


There are other options out there, these are just a few of the more popular ones. If you are very nearsighted or you have any questions about the ways to improve your vision without glasses or contacts, please give us a call at 919-876-4064 to schedule your free refractive surgery evaluation. Also, you could click here to request an appointment at a convenient time. Thanks for your interest and we hope to see you again soon on A State of Sight.