Ophthalmology is one of the fastest-growing branches of medicine, with laser vision correction being its most dynamic field.
It is a remarkable invention and a true achievement of modern science. I have been specializing in vision correction for 15 years,
witnessing and participating in an incredible technological revolution. Today, the scope of knowledge, predictability, and precision in this field is unprecedented.
From these years of practice and the experience of 40,000 procedures, I have learned one vital lesson: precision and diligence are the most valuable assets in this work.
With so many correction methods available, choosing the right one can be difficult for a patient – especially since there is no objectively or universally “best” method for everyone.
Each technique has unique attributes designed to benefit a specific group of patients.
To make it easier to understand how different vision correction methods are applied, we can use the concept of “Effective Reshaping Power” (ERP).
Effective Reshaping Power is the potential of a specific correction method (SMILE, Femtolasik, PRK, EBK) to
correct a particular vision defect – essentially, it indicates which method is most effective for a given condition.
It is important to note that when considering which method to use, we evaluate not only its effectiveness (the ERP factor) but also the amount of available corneal tissue.
Therefore, in some cases, the choice of method falls not on the one with the highest ERP, but on the one best suited to the specific patient’s situation.
Who is ReLex SMILE for?
Why choose ReLex SMILE?
Shortsightedness (Myopia), High Shortsightedness (High Myopia), Myopic Astigmatism, Presbyopia in Myopia
Who is FemtoLasik for?
Why choose FemtoLasik?
Shortsightness (Myopia), Astigmatism, Myopic Astigmatism, Hyperopic Astigmatism, Presbyopia
Who is Presbyond for?
Why choose Presbyond?
Shortsightness (Myopia), Farsightedness (Hyperopia), Astigmatism, Myopic Astigmatism, Presbyopia
Who is EBK for?
Why choose EBK?
Mild Shortsightedness (Mild Myopia) and Myopic Astigmatism, Mild Farsightedness (Mild Hyperopia) and Hyperopic Astigmatism, Mild Astigmatism
Who is Trans-PRK for?
Why choose Trans-PRK?
Mild Nearsightedness (Mild Myopia) and Myopic Astigmatism, Mild Farsightedness (Mild Hyperopia) and Hyoperopic Astigmatism, Mild Astigmatism
Who is Topo-guided PRK for?
Why choose Topo-guided?
Mild Nearsightedness (Mild Myopia) and Myopic Astigmatism, Mild Farsigthedness (Mild Hyoperopia) and Hyperopic Astigmatism, Mild Astigmatism
Phakic Lens Implantation (pIOL)
Phakic lens implantation is performed to correct vision in patients for whom laser vision correction is either contraindicated or would not offer the expected results. The procedure involves implanting an artificial lens made of a specialized composite material called Collamer. Collamer is a combination of naturally occurring collagen, which provides high biocompatibility while maintaining durability and transparency. Phakic lenses are implanted adjacent to the patient’s natural lens. Preserving the eye’s own lens is a key advantage, as the patient’s accommodation remains unchanged after the procedure.
The Procedure
The implantation is performed under local anesthesia after pupil dilation and takes approximately 30 minutes. The first step involves creating a corneal micro-incision (microport) 2–3 mm in length. A sterile gel (viscoelastic) is then injected into the eye chamber, allowing for the implantation of a folded lens without touching the eye’s internal structures—including the patient’s own lens and cornea. Once implanted, the lens begins to unfold spontaneously due to body temperature and the presence of the viscoelastic. After the lens is fully unfolded, the surgeon positions the phakic lens correctly in the posterior chamber. The corneal micro-incision seals itself and does not require sutures.
Reversibility
Phakic lens implantation is a reversible procedure. In the event that a patient develops cataracts later in life, the clouded natural lens is removed along with the phakic lens. A standard intraocular lens (IOL) is then implanted to compensate for the power of both previous lenses, ensuring the patient’s visual outcome remains consistent.
High Shortsightedness (High Myopia), High Farsightedness (High Hyperopia), High Astigmatism
Are you struggling with vision problems and want to effectively eliminate them? Contact us to determine the treatment method best suited to your case.
The corneal surface (the outer part) is its most valuable layer. SMILE technology leaves this vital outer section intact, as the procedure removes tissue only from the deeper layers of the cornea. As a result, corneal stability and strength after the procedure are higher than with any other method.
For example, correcting 4 diopters of shortsightedness using the SMILE method leaves the cornea significantly more resilient compared to other correction techniques such as Femto-LASIK or PRK.
SMILE technology works by creating a thin disc of tissue (lenticule) within the deeper layers of the cornea. Once this disc is removed through a tiny micro-incision, the cornea flattens and its refractive power is reduced. This effectively eliminates shortsightedness or myopic astigmatism—the two primary vision impairments for which SMILE technology is utilized. Consequently, the procedure does not require a corneal flap.
Hyperopia, hyperopic astigmatism, and astigmatism are the most resistant refractive errors to correct. To eliminate farsightedness, a change is required that results in increased corneal steepening. Steepening the corneal dome is significantly more challenging to achieve with laser correction than flattening it. This creates the need for a procedure with a higher EMO (Effective Modifying Power), which is more effective at reshaping the tissue. Femto-LASIK is such a procedure. It is a two-stage treatment. The first stage, which involves creating a corneal flap, simultaneously reduces the rigidity (softens) of the cornea. Once prepared this way, the cornea becomes much more pliable and susceptible to reshaping during the second stage. In the second stage, an excimer laser is applied to the corneal stroma exposed under the flap. In the treatment of presbyopia, we take advantage of the practicality and easy access provided by the presence of the corneal flap. As we age, the demand for visual power for near-distance work increases. To meet this growing need, we can compensate for the increasing near-vision impairment through a minimally invasive and simple method: a flap lift.
Presbyond gives the cornea a specific shape. After treatment with this method, the cornea has varying curvatures in different areas. This allows for increased corneal power in the specific zones used for reading, providing the patient with the additional boost needed for near-distance work.
However, not every patient is a candidate for the Presbyond procedure. Its effectiveness and feasibility depend on the initial corneal parameters, primarily the pre-operative corneal curvature, which is measured and evaluated at critical points.
EBK and PRK are surface vision correction methods in which the first, preparatory stage is the removal of the corneal epithelium. In PRK, the epithelium is removed manually using a special solution that loosens the connection between the epithelium and the corneal stroma. In EBK, also a manual method, a specialized device called an epikeratome is used to remove the epithelium.
The corneal epithelium regenerates—or regrows—within several dozen hours, forming a perfectly smooth and even surface. The epithelium has a massive impact on visual quality, and even microscopic irregularities on its surface can drastically impair vision.
The epithelium is a fascinating structure with the ability to mask any imperfections of the underlying stroma. This characteristic is very often utilized in the treatment of corneal irregularities and keratoconus.
The epithelium covers the corneal stroma and is its outermost layer. In surface methods (EBK, Trans-PRK, Topo-guided-PRK), the first step is the removal of the corneal epithelium. Due to the specific way the laser operates, removing the epithelium with a laser leaves the cornea highly uniform in terms of surface texture and hydration levels. The correction stage follows immediately after the epithelial removal phase, making the overall result significantly more predictable compared to manual removal.
The human eye is not perfect; minor irregularities often occur on the corneal surface. These are frequently compensated for by the overlying epithelium. Thus, the epithelium acts as a tissue that masks imperfections in the corneal stroma. When removing the epithelium manually, these surface imperfections are exposed rather than eliminated. However, by using an excimer laser for epithelial removal, we eliminate corneal irregularities along with the epithelium, achieving an optically ideal surface.
Topo-guided PRK treatment is fully integrated with corneal topography. Topography is a diagnostic test that analyzes light reflected from the cornea, sent in the form of several dozen concentric rings. Any areas of the cornea that reflect light in a distorted manner are analyzed to identify specific surface irregularities. Based on this analysis, a customized laser program is established to not only correct the refractive error but also to regularize the corneal surface in areas where it is irregular.
Phakic lenses offer the widest range of vision correction of all available methods. It is important to emphasize that they serve as both an alternative to laser vision correction and a viable treatment option for patients where laser treatment would not deliver satisfactory results. With this correction method, there is no tendency for regression (recurrence of the refractive error).
