Refractive errors, including myopia (nearsightedness), hyperopia (farsightedness), presbyopia, and astigmatism, make objects appear blurry or out of focus. In most routine cases the error can be corrected with either spectacles or contact lenses.  

However, some patients’ refractive errors are of such a nature that neither spectacles nor contact lenses are tolerated or give good enough visual results.  In these cases, surgery has a clear indication. 

Refractive surgery is always elective and voluntary.  

Patients between the ages of 18 and 50 should qualify for corneal refractive surgery because there are only a few contraindications for this type of procedure. 

If you are considering refractive surgery you should consult a Refractive Surgeon. Only a Refractive Surgeon can decide whether refractive surgery is possible or not and determine the risks involved for you as an individual. 

Cataract formation is usually the considering factor in lens versus corneal refractive surgery. Therefore, for patients above the age of 50 who would like to undergo refractive surgery, one has to consider the lens and presbyopia status.

Below the age of 50, we quickly opt for corneal surgery because we know that the patient should enjoy at least ten years of excellent vision before the development of cataracts. 

After the age of 60, we seldom do primary corneal refractive surgery because we know that the patient already has some form of cataract and this is bound to get only worse. 

The lens surgery options available in presbyopic patients also gives us more options to manage refractive problems. To learn more about Presbyopia Refractive Surgery CLICK HERE.

We weigh up all possibilities and factors including the number of surgeries, presbyopia correction and presence of cataracts.

Please note, however, that there is no upper limit to corneal laser surgery. Anybody that would like to be spectacle free, no matter the patient's age or lens status, could qualify for surgery. Therefore, a Refractive Surgeon needs to have a look and decide.

At Dr TC Botha, We offer a range of safe and effective treatment options to assist in correcting refractive errors and helping you achieve clear vision. These options include: LASIK, TransPRK, ICL (Implantable Contact Lens), Lens Exchange, Piggyback Intraocular Lens (IOL), Multifocal IOLs, and Extended Depth of Field IOLs.

Our most commonly performed refractive procedures (in rooms) include LASIK and TransPRK.

1. LASIK is the most commonly done refractive procedure today.  The effect is seen almost immediately, recovery time is minimal, side effects are minimal, risk factors are very low, and it is largely a painless procedure with excellent and consistent results.  To learn more about LASIK Surgery CLICK HERE.

2. TransPRK is the most versatile procedure as the least amount of tissue is changed.  In addition, individualized custom ablation profiles contribute to this fact. Even some of the thinnest of corneas can tolerate a TransPRK very safely, and subsequently TransPRK is the procedure with the lowest risk profile. The only drawback is the prolonged recovery time.  To learn more about TransPRK Surgery CLICK HERE.

The modern refractive surgery procedure is extremely safe.  It is seen as one of the safest procedures of any kind that can be done, with a combined risk of less than 0.1% irrespective of which exact procedure is used.  

Although refractive surgery is extremely safe there are complications that can occur.  Some of the more common complications are discussed below.

• Dry eye symptoms.  Up to 5% of patients have persistent dry eye symptoms.  This usually resolves by 3-6 months and lubrication eye drops are usually more than enough in management.

• Flap complications.  When LASIK flaps are created, one has a flap of tissue that can tear, get a small buttonhole, move etc.  This is still the most common serious complication and can be largely overcome with good surgical technique.

• Haze.  This used to be common with the PRK procedure, but with new techniques of MMC application, this has largely become an issue of the past.

• Over- / Under-correction.  Modern ablation formulae are excellent irrespective of the laser used, but all eyes are not the same and this can still occur.  However, most often it is negligible, and a quick routine top-up procedure is an option if desired.

• Infection.  As with all surgery, as soon as there is tissue manipulation, organisms can enter the tissue.  The procedure is done under sterile conditions on the eye with sterile instruments and techniques making infection very rare.  A wide range of antibiotics are available in management of this complication.

• Epithelium defect.  This usually just takes time to heal with conservative management and observation.  Bandage contact lenses are usually placed for comfort when a defect is present.

• Ectasia.  Modern screening pre-procedure has made this feared complication to occur in less than 0.05% of cases.  In any at-risk cornea, the PRK / Trans-PRK procedure would be preferred, making surgery even safer.

• Diffuse Lamellar Keratitis.  This develops 1-2 days post-procedure and most resolve by 5-8 days after initiation of appropriate therapy.  It very seldom progresses to flap melting, but mostly in neglected cases.  It can present with foreign body sensation, light sensitivity, pain and blurry vision.

• Subconjunctival Hemorrhage.  Patients can have a red eye induced by suction rings.  There is no risk for visual loss and blood resolves spontaneously.