General information
Who can have the surgery?
Refractive surgery to correct myopia, hyperopia, astigmatism or presbyopia can be performed on any person over 21 years of age with a stable prescription (change of less than half a diopter during the last year), after undergoing a complete ophthalmologic examination with the necessary refractive tests that recommend the surgery.
Dr. Francesc Duch, head of the Refractive Surgery Department, explains in this video who is a good candidate for surgery and what the previous tests consist of:
What refractive defects can refractive surgery correct?
Refractive or vision correction surgery is a set of ophthalmologic surgical procedures aimed at correcting refractive defects such as myopia or high myopia, hyperopia, astigmatism and presbyopia or eyestrain to achieve good visual quality and avoid depending on the use of glasses or contact lenses.
Will the refractive surgery patient see much better than with glasses or contact lenses?
Refractive surgery cannot improve the patient’s visual capacity. For example, a person with a visual capacity of 60% with their best correction (glasses or contact lenses), can achieve 60% vision without correction after surgery, but cannot improve beyond their own visual capacity.
Is there a maximum graduation limit to be considered suitable for refractive surgery?
No, there are limits in the diopters to be corrected. In each case, the clinical examination will be correlated with a rigorous evaluation of the complementary tests to offer each patient the most appropriate in his or her case, even in the case of extreme graduations.
Is it possible to obtain a zero diopter result through refractive surgery?
Yes, the aim of refractive surgery is emmetropia or final prescription at zero. However, sometimes the presence of a residual graduation may be observed, which may be due to undercorrection (diopters remain to be corrected), overcorrection (the correction is excessive) or treatment regression, that is, the partial loss of the correction achieved with surgery over time.There is the possibility of a complementary treatment with excimer laser (bioptics) in case of residual graduation or eventually the use of reinforcement glasses for precision work.
Can both eyes be performed at the same time?
Typically, laser surgery (LASIK/LASEK/PRK) is performed in a single session for both eyes and usually lasts 15 to 20 minutes.
As for surgery with intraocular procedure (ICL), to minimize the risk of infection and improve the predictability of the result, the procedure is performed sequentially: first in the non-dominant eye, and between 2 and 7 days later, in the dominant eye.
Is it possible to undergo refractive surgery if other visual problems are present?
Yes, we have a multidisciplinary ophthalmologic evaluation service with different subspecialties within ophthalmology that allow us to evaluate the patient in a comprehensive manner in order to offer the most appropriate in each case and maintain adequate control when various pathologies coexist.
If the patient has already undergone refractive surgery, is it possible to undergo surgery again in the future?
Yes, it is possible in the case that the patient who has undergone refractive surgery, over the years, presents again a certain graduation that is not related to the surgery, but to natural changes of the eye. For this purpose, the patient is examined again and the suitability of a new surgical correction is assessed in each particular case.
Can pregnancy change the outcome of surgery?
In general, no changes are observed. During pregnancy there are a number of hormonal variations that in some cases may affect eyes and vision, mainly due to small changes in the cornea and tear film. After delivery, these variations usually disappear. Interventions are not recommended during pregnancy or in the six months after birth.
Is summer a good time to perform a vision correction surgery?
Summer is considered a good time to consider a vision correction or refractive surgery, since outdoor activities multiply and this type of surgery allows eliminating the limitations caused by refractive problems (e.g. going to the swimming pool, going to the beach or practicing a sport such as scuba diving without having to wear glasses or contact lenses).
On the other hand, summer break is a good time to undergo surgery, since despite the little postoperative period required, this period will allow us to undergo surgery without so many concerns. It can also be a good option for those who do not want or cannot take sick leave.
It is also a good time for those who, after the summer, plan to sit for competitive or public exams for jobs that require physical exercise and good eyesight, such as firefighters or members of law enforcement agencies.
How much does vision correction surgery cost?
The price of surgery depends on the technique proposed in each particular case and whether the patient is private or belongs to a mutual insurance company.
ICR offers the option of a bank financing system of up to 4 years. More information.
A first visit is recommended in order to provide a personalized budget.
Why have surgery with us?
- We have more than 20 years of experience in the field of refractive surgery, with a team dedicated exclusively to this specialty.
- The center has the latest technological advances, both in lasers (such as the excimer or femtosecond laser), as well as in diagnostic tests and surgical and therapeutic procedures.
- We are a center that offers comprehensive ophthalmology services and offers all its specialties.
- We have 90 ophthalmologists and more than 350 professionals at your service.
What value-added does ICR provide?
- We carry out tests on weekdays and, from now on, also on Saturdays.
- We perform a rigorous and complete preoperative study in order to advise, in each particular case, which is the ideal solution. We will insist on this aspect as well as on the importance of the human and trusting contact between the doctor and the person who is looking for a solution to their visual problem.
- We have a 24-hour emergency service with a team dedicated exclusively to attend ophthalmologic emergencies 365 days a year.
- Our Research Department guarantees, promotes and facilitates research of the highest quality and rigor in the field of ophthalmology. It is accredited by the European Vision Institute (EVI), one of the most prestigious research organizations in Europe.
- We have collaborated with Generalitat de Catalunya in the preparation and drafting of the technical criteria for the authorization of centers that perform refractive surgery, as well as in the informed consent commission of the Spanish Society of Ophthalmology.
Is the Internet a reliable source of information on refractive surgery?
This is true in many cases, especially in the case of sources endorsed by scientific and ophthalmological societies, in which the information has been contrasted. However, there is also a great deal of information with commercial and advertising purposes that predominate over adequate information. It is advisable to avoid sources that promise miraculous cures, offers and promotions similar to those of a supermarket or where doctors appear with miraculous and unique treatments. Many professional ophthalmologists, specialists in refractive surgery dedicate part of their time to research, teaching and participation in scientific meetings in order to determine which techniques are truly safe and effective and can benefit patients. Any questions you may have should be discussed with the refractive surgeon you trust.
There are many patients who have undergone surgery. Do doctors also have surgery on each other?
Currently, there are millions of people undergoing surgery around the world, and more people are being operated on every year using different techniques. Physicians and surgeons, nurses, opticians and optometrists, as well as any person related to ophthalmology or healthcare, are operated on in the same way as the majority of the population. The evaluation procedure is the same, regardless of the profession, and the final decision must always be made by the individual according to their own criteria. There are people who are suitable candidates and do not want to undergo surgery; others would like to undergo surgery, but their ocular characteristics do not allow it, and finally there are many who undergo surgery, but do not want to make it public.
Surgical Techniques
Which technique is better: laser refractive surgery or intraocular lens implantation?
Both techniques have excellent results. The refractive surgeon, after a complete study of the patient, will indicate the most appropriate in each particular case.
LASIK/LASEK/PRK, What is laser surgery like?
The laser reshapes the cornea (the outer, transparent part of the eye) to reduce the number of diopters. After the application of a few drops of anesthetic, a thin layer of the cornea is lifted by means of (depending on the characteristics of each patient) the microkeratome or the femtosecond laser, a very sophisticated instrument.
Thus, a disc or “flap” is obtained, which is separated from the center of the cornea in order to apply the excimer laser directly on the stroma. The laser removes the appropriate portion of tissue, depending on the desired correction. In myopia we obtain a flatter surface, in hyperopia a more curved surface and in astigmatism a more regular surface.
This phase of the procedure is computer-controlled and planned by the surgeon according to the specific characteristics of each case.
Once the laser is applied, the corneal flap is replaced and the procedure is finished by applying a few drops of antibiotic eye drops. The patient leaves with protective goggles and, occasionally, therapeutic contact lenses are adapted to facilitate recovery.
These are surgeries that allow the recovery of vision without the use of glasses or contact lenses.
Yolanda Aradilla, optometrist optician, who underwent PRK surgery: “You forget about glasses, liquids,… especially when traveling and doing sports. For me it was a matter of economy and comfort”.
Irene Gallego, clinic assistant, who underwent PRK surgery: “I couldn’t tolerate contact lenses for more than a few hours and I always depended on my glasses. I finally made up my mind, and when I came out of the surgery I thought ‘but it was just a moment!'”
Vicenta Pajuelo, operating room instrumentalist, who had LASIK surgery: “I had a very low prescription and I only wore my glasses occasionally, to go to the movies or to drive. But when I walked down the street I couldn’t see which bus was coming…”.
What is achieved with laser surgery?
The new laser systems are used to correct not only diopters, but also what we call optical aberrations. These are related to the quality of vision and must be taken into account so that the person undergoing surgery can see well during the day, but also at night, when driving a vehicle, when there is little light or to avoid reflections.
Treatments based on aberrometry or the eye’s wavefront are called optimized or personalized, because they depend on the specific characteristics of each type of eye. In these treatments we use sophisticated eye movement control systems for the recognition of the iris, which is the part that gives color to the eye. The laser identifies, in each case, the pattern of each eye, both as a safety measure and to facilitate the correct application of the laser.
In cases of thin corneas, low graduations, etc., no cut is made, but the outermost layer of the cornea is separated: the epithelium. There are different techniques (LASEK, PRK, PTK, EPILASIK). These operations require a slightly longer postoperative period and we call them surface techniques, to differentiate them from the previous or lamellar techniques.
Typically, the procedure is performed on both eyes during the same session and the whole process takes about 15 minutes. After a moment’s rest, a final exam is performed, treatment instructions are given, a follow-up appointment is scheduled (usually the following day), and then the patient goes home.
What technology does ICR have available for laser vision correction?
At ICR we have the most advanced laser technology: Excimer and femtosecond laser platform (Wavelight Refractive Suite, ALCON).
We have the Wavelight® EX500 Excimer Laser (treatment time of 1.4 seconds per diopter) and the Wavelight® FS200 femtosecond laser (standard flap creation in approximately 6.0 seconds).
In addition, we have WaveNet™, an integrated computer network, which enables seamless transfer of patient data through diagnostic devices. The combination of the best excimer and femtosecond technology with this leading software leads to optimal results.
The combination of the two lasers with this system allows, in the indicated cases, to perform the entire laser surgery, both the flap and the corneal correction.
Dr. Duch talks about the technology and tools available at ICR for the safe, comfortable and effective correction of refractive errors.
For which cases are phakic intraocular lenses (ICL) indicated?
Intraocular lenses are implanted in the eye to correct myopia and hyperopia, generally high. They provide excellent quality of vision and are especially indicated in cases of amblyopia or “lazy eye”. Recently, we have started to use the latest generation of lenses that can also correct astigmatism effectively and, in their newest version, even have the possibility of being multifocal, providing another alternative for the correction of presbyopia (eyestrain) in young presbyopic patients.
These lenses are made of special materials that are biocompatible with the structures of the eye. In addition, they can be used to treat cases in which the condition of the patient’s cornea does not recommend laser surgery.
It is a very precise surgery, performed on an outpatient basis and under topical anesthesia.
Dr. Duch, head of the Refractive Surgery Department, explains the use and indications of intraocular lenses implanted for the correction of refractive defects.
Sergi Padró, computer scientist, who had ICL surgery: “I had been wearing glasses since I was 7 or 8 years old and I didn’t have surgery until I was 40 years old.
Is the intraocular lens visible?
Once implanted, the lens is not visible to the patient or other people and does not require any type of manipulation, except for treatment with drops during the postoperative period. It is also not noticeable and does not cause any discomfort. Possible post-operative sensations, such as stinging, grit, irritation, etc., are usually due to minor alterations of the ocular surface that get better with the use of eye drops to hydrate the cornea.
Is displacement of the implanted lens possible?
Yes, on some occasions, due to variations in the internal anatomy of the eye, implanted lenses may require reorientation to achieve their maximum effect and correctly correct astigmatism.
The repositioning is performed in the surgical room, usually in the days following the operation, by means of a slight maneuver to place the lens in the optimal position. The need to perform this maneuver is very rare, but advisable if necessary, to achieve the maximum corrective effect provided by the lens.
Is it possible to operate on presbyopia or eyestrain at the same time as myopia, hyperopia or astigmatism?
Yes, most people combine different refractive alterations, such as myopia or hyperopia and astigmatism in distance vision and, when presbyopia or eyestrain is added, they may consider correcting all their refractive problems at the same time. In this case it can be corrected safely and effectively by different methods, mainly with multifocal intraocular lenses or laser (monovision, PRESBILASIK). It is very important to determine the prescription for distance vision, since patients with zero diopters for distance vision who only wear glasses for near vision are not usually operated on.
Dr. Duch tells us about the most commonly used procedures to correct presbyopia.
M.ª Carmen León, anesthesiologist, operated for cataract and eyestrain with multifocal lenses: “With the sedation you don’t even notice it, I had almost no discomfort and I haven’t used my glasses again”.
¿Es posible someterse a una operación de cataratas tras una cirugía refractiva con láser?
Yes, and it does not constitute any added complication. The surgeon must know the history of the previous refractive surgery operation in order to plan the cataract surgery and, above all, to be able to calculate and select the appropriate intraocular lens to be implanted after removing the cataract.
Dr. Duch, head of the Refractive Surgery Department, explains in more detail what it means to have undergone laser refractive surgery if you want to have cataract surgery.
Preoperative information
If the patient wears contact lenses, is it necessary to take a break from wearing them before performing the preoperative study?
Sí, los portadores de lentes de contacto deben interrumpir su uso durante el periodo previo a los exámenes preparatorios, aunque una vez indicada la intervención pueden volver a utilizarlas hasta 24 horas antes de la operación, y podrán emplearlas en el ojo no operado durante el intervalo que va de la operación de un ojo a otro.
Por lo tanto, en el caso de lentes duras o rígidas es aconsejable suspender su uso al menos durante 1 o 2 semanas, y en el caso de las lentes de contacto blandas, al menos durante 48 horas. En casos especiales puede ser necesario un tiempo incluso más prolongado, como en los usuarios de lentes para ortoqueratología.
¿Cuánto dura una cirugía refractiva?
La cirugía láser (LASIK/LASEK/PRK) dura alrededor de unos 20 minutos y la estancia en la clínica es de unas 2 horas aproximadamente.
En cuanto a la cirugía refractiva mediante implante de lente intraocular (ICL/CCT), tiene una duración de unos 30 minutos y la estancia en la clínica es también de unas 2 horas, aproximadamente.
¿La cirugía refractiva requiere hospitalización?
No, la intervención se realiza de forma ambulatoria y no requiere ingreso en clínica.
What should I know about the preoperative period?
The purpose of the preoperative study is to evaluate whether the patient can be treated or not. The comprehensive preoperative examination allows us to study not only the diopters and the amount of vision, but also its quality, as well as to plan the optimal treatment in each particular case. Currently, we can perform personalized treatments that include the correction of higher order aberrations or treatments based on topography.
During the days prior to the tests, contact lenses must be rested: 48 hours if they are soft, 1 or 2 weeks if they are rigid or semi-rigid and in special cases it may be necessary even longer, as in users of lenses for orthokeratology. It is not possible to come to the center driving on the day of the study, since one of the tests requires pupil dilation. The effect of the drops causes the vision to be blurred for at least the next 8 hours (in some sporadic cases the effect can last up to 48 hours).
The same day the tests are performed, the patient will already have the results, which the surgeon will discuss with the patient. From the preoperative study, it is the refractive surgeon who decides whether the patient can be operated or not. From the third day after the tests have been performed, the surgery can be scheduled.
Is the patient’s general health status assessed prior to undergoing refractive surgery?
Yes, the patient will have to answer a series of simple questions to facilitate the evaluation of his or her health status.
If possible, it is recommended to bring a report from the family doctor indicating the diseases, interventions and medication that the patient usually takes.
What other practical information should I know about refractive surgery?
In case the patient can be operated, the surgery is performed at Clínica Bonanova de Cirugía Ocular.
Laser surgery is usually performed under topical anesthesia (a few drops of anesthetic in each eye). There is usually no discomfort beyond gentle pressure, glare from the microscope lights or slight stinging when the drops are placed. In special cases, sedation may be performed. At the end of the procedure, the patient will be given glasses (similar to sunglasses) to protect them from the air and light and they will be able to return home.
Depending on the type of surgery, in most cases, the sick leave is between 24 and 48 hours. Once the procedure is finished, the patient will be given a certificate with the sick leave forecast. During the day or days of sick leave, it is recommended not to drive, not to read, not to be in front of the computer or television, not to go to the movies or perform any activity that represents an effort for the eyesight.
During the three hours following the surgery, it is recommended to rest at home with your eyes closed, as you may experience a sensation of heaviness, tearing or sand.
Can makeup be applied the day of surgery or afterwards?
Makeup should not be used on the day of surgery. The use of nail polish on hands and feet should also be avoided, as well as the application of perfumes, colognes, hairspray or similar.
During the 2 weeks following the procedure, it is advisable to avoid the use of make-up, especially brushes, which could accidentally injure the surface of the eye (it is recommended to use brand new cosmetics and brushes).
Do I have to fast before surgery?
Yes, the patient must fast for at least 6 hours (no liquids or solids).
Do I have to be accompanied to the surgery?
Yes, the patient must come to the surgery and return home accompanied.
Is there any discomfort during the procedure?
There is usually no discomfort beyond slight pressure, glare from the surgeon’s microscope lights or a slight stinging when the drops are placed.
Postoperative information
What is the postoperative period like?
In general, 5 check-ups will be performed during the first year after surgery:
- Postoperative visit the day after surgery of each eye (2 visits).
- At one week or one month (according to the surgeon’s decision).
- After 3 months.
- The last visit is performed one year after surgery.
The patient will feel safe and accompanied at all times during their recovery, even if this means making some additional visits as required by each case.
What are the most frequent discomforts after surgery?
Although in most cases surgery is usually very well tolerated, more susceptible individuals may experience dry eyes and lightening or halos in night vision. In either case, treatment is available and the effects usually improve with time and eventually disappear.
In the case of the PRK technique, the patient may experience some discomfort during the first 2-3 days after surgery, such as pain sensation more or less intense depending on the sensitivity of each person. For this reason, the medication indicated in the surgery report should be used.
In addition, it is very important to maintain the lubricating treatment with artificial tears during the month following the intervention, since it will help to alleviate postoperative discomfort (itching, stinging, grit and foreign body sensation, etc.) and to achieve good vision. For this reason it is important to continue using it, even if the patient no longer has any discomfort.
If necessary, the medical team will make the treatment modifications it deems appropriate.
Could there be complications?
Although refractive surgery techniques are probably the safest and most effective in medicine, there may be complications that, fortunately, are statistically very rare. The main complication is an infection that, despite being treatable, may have more or less important visual sequelae, depending on the level of severity. When the risk/benefit ratio is assessed in each case and a type of procedure is indicated, it is because the advantages are very high and the percentage of risk is minimal. All possible measures are always taken to avoid infection.
Can the eyes be rubbed during the postoperative period?
No, rubbing the eyes should be avoided. If necessary, the patient can apply artificial tears around the eyelids with gauze.
Is there any treatment to follow after refractive surgery?
After surgery, the medical team will explain the treatment to be followed (eye drops, pills, etc.), the route of administration and the duration of the treatment. This information will be reflected in the surgery report that the patient will receive, always previous to being sent home from the clinic.
In the same clinic, the operated patient will be provided with a toiletry bag where they will find everything they need to start the postoperative treatment. In addition, written information is included, so that it can be consulted at all times.
It is very important to follow the indicated treatment for the operation to be successful. Normally this will consist of antibiotic eye drops, an anti-inflammatory and artificial tears during the first month.
How to protect the treated eye during the postoperative period?
It is advisable to avoid situations in which the eyes may suffer any type of impact. To this end, it is recommended to:
- Rest and keep the eyes closed for the first 4-6 hours after laser surgery. If vision correction has been performed by intraocular lens implantation, the eye will normally be left covered with an occlusive bandage (patch) for the first 4-6 hours after surgery.
- Avoid rubbing the eyes. If necessary, the patient can apply artificial tears around the eyelids with gauze.
- Use sunglasses whenever the patient is outdoors (they are not necessary indoors) and at least during the first week. You can use the ones included in the kit or others, as long as they have been properly approved and have been acquired in an accredited optician’s shop.
- Use a plastic eye shield to sleep during the first 3 days, which will be given to you at the clinic.
After intervention, how long is it necessary to wait before returning to a normal life and work?
Usually two days are enough, counting the day of the procedure. When we operate both eyes separately, it is necessary to plan the operation according to the type of vision and avoid activities that require great precision, such as driving.
Sport and light activities can be taken up again after a week, although for higher risk activities such as swimming, it is necessary to wait at least one month.
How long does it take to see well after vision correction surgery? How do I adjust to my new vision?
After the procedure, there is an important change in vision, which must be adapted to.
On the day of the surgical procedure, the vision is blurred during the first hours and for this reason it is advisable to rest as indicated. The following day you should try not to strain your eyesight and start adapting to the “new” vision. Although the eyes are the visual organ of our body, what we really see with is a specific part of the brain. The whole process of visual recovery requires a period of adaptation. To facilitate this process we recommend that from the time of the surgery until the visit, the patient should take some rest.
Usually you can resume your normal activities (except sports) after the next day’s visit; if there are any limitations due to your particular condition, these will be indicated by your surgeon.
During the first weeks you may notice variations and oscillations in vision, halos or glare. It is therefore important to adapt your activity to these changes and avoid straining your eyes if your vision is less clear. Frequent application of artificial tears will help to improve this situation. Returning to your normal activities will also help you to achieve optimal vision.
It should be remembered that, for certain prescriptions, such as hyperopia or astigmatism, visual recovery occurs a little slower than for myopia.
Any variation from the above recommendations will be duly indicated by the medical team.
After surgery, is correction stable?
Vision correction remains stable over time. During the first three months the reaction of the eye is assessed (individual for each person). About 3 % of laser-operated patients and 5 % of patients operated with multifocal lenses may require additional laser treatment to improve the results even more. Over the years, some patients who have undergone surgery may have a new prescription, which is not related to the laser operation, but to natural changes in the eye. In such cases, the patient is re-examined to assess the suitability of a new surgical correction.
Is it possible to practice sports after refractive surgery?
Mild sports can be resumed progressively from 5 days after the operation, with adequate protection with sunglasses outdoors. For contact sports or sports with risk of suffering a blow (boxing, soccer, rugby, basketball, etc.), it is recommended to start with light training after one week and to return to the full practice after one month. In order to prevent the possibility of infections and conjunctivitis, it is better to avoid swimming in the sea or pool during the first month after the surgery.
Is it possible to request a leave of absence for refractive surgery?
Not all companies (public or private) contemplate sick leave for this type of surgery, so we recommend consulting your family doctor or company doctor in advance. From a strictly ophthalmological point of view, after the surgery, it is necessary to rest for a few hours, as well as to attend the control visits, generally scheduled at 6 hours and 24 hours after the surgery. After the visit, a few more hours of relative visual rest will usually be indicated (avoiding prolonged efforts with the computer, reading, driving, etc.) before resuming normal activities from the following day.
For the particular case of surface laser surgery (PRK), and due to its slower recovery, it is advisable to have a period of approximately 5 days, which can be shortened or lengthened in a variable way for each person.
Is it possible to drive after refractive surgery?
It is not possible to drive after surgery and from the following day it is advisable to avoid “forcing” your eyesight (computer, cell phone, Tablet, TV, reading, driving, etc.) until the visit with the doctor, who will assess the evolution and confirm whether you can start to resume your usual activities.
In the case of professional drivers, it is advisable to consult the regulations in force at the traffic authorities that regulate driving licenses or at the centers authorized for this purpose. There are special limitations and conditions for patients who have undergone surgery, which must be observed and may affect this group of drivers in particular. It is advisable to inquire about this before the intervention, in order to consider how the regulations may affect each particular case.
Is it possible to travel by plane after refractive surgery?
Yes, the patient who has undergone surgery can travel in vehicles and airplanes, using non-prescription sunglasses as protection, especially outdoors.
Do you have any questions?
Contact us or request an appointment with one of our Refractive Surgery specialists.