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What is good vision?

Oct 15, 2024 | | 0 Comments

“Vision So Good You Can See Into the Future”

The other day, a patient told me, “After my LASIK, my vision felt so good, I felt like I could see into the future.” It was a lighthearted comment, but it made me reflect: Is it really a good thing to be able to see into the future?

What Type of Vision Can You Expect After Refractive Surgery?

Vision is incredibly subjective. We measure it by comparing what a person can see to what is considered “normal” using vision charts. If you can read the same small letters from a distance of 20 feet (or 6 meters) as the average person, your vision is considered “normal.” But often, patients with “better-than-normal” vision can feel dissatisfied, while others with worse-than-normal vision might feel content.

This brings us to a key point: how we perceive our vision often ties back to our expectations. A person who starts with very poor vision often feels a greater improvement after surgery than someone whose eyesight wasn’t so badly affected to begin with.

Advances in Refractive Surgery

Today, refractive surgery technology is truly incredible, giving us the ability to improve vision dramatically. However, age becomes a key factor:

Under 40: If you are younger than 40, your natural lens can accommodate well, allowing you to see both distant and near objects clearly. In this group, we can often achieve vision as good as—or better than—what you have with glasses or contact lenses. For patients with high amounts of higher-order aberrations on the cornea, we may perform a wavefront-optimized laser ablation, which not only corrects lower-order issues like myopia, hyperopia, and astigmatism, but also addresses these higher-order aberrations. This can lead to even better vision than what glasses or contact lenses could provide.
After 40: Vision becomes a bit trickier after 40, as the natural lens starts to stiffen and loses its ability to focus on near objects, a condition called presbyopia. Although we have various ways to optimize vision at this stage of life, it will unlikely be as sharp at all distances as it was at age 20.

Is It Really Good to See Into the Future?

Returning to the question—would it truly be helpful to see into the future? To know what trials or suffering lie ahead? Or, on a more optimistic note, to know what blessings or good experiences await us?

Probably not. Knowing the future might make us so worried about what’s to come that we’re unable to enjoy the present. Or, we might become discontent with today, longing for a future that hasn’t yet arrived.

Instead, I believe the key is to embrace the present. This moment is all we truly have control over. Being grateful for today and making the most of it is far more fulfilling than trying to peer into a future we cannot see.

While we can improve vision dramatically these days, one thing remains certain: we can’t see into the future. And perhaps, that’s just as it should be.

Dr Wilna Rautenbach

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Is LASIK Safe?

Oct 9, 2024 | | 0 Comments

A Look at the History and Advancements of Refractive Surgery
The number one question on most people’s minds when considering LASIK or other forms of refractive surgery is: Is it safe? It’s a valid concern. Our eyes are delicate, and the thought of surgery can feel intimidating. But the promise of better vision, free from the hassle of glasses or contact lenses, is appealing, especially when you think about the freedom it can bring.
Imagine hiking up Table Mountain, taking in the panoramic views, or spending a day at the beach, all without needing to worry about keeping your glasses secure. The idea of clear vision, without limitations, can be life-changing.
In fact, refractive surgery is so trusted that over 5 million procedures are performed annually worldwide, with LASIK being one of the most popular.

Weighing the Risks:
LASIK, like any surgery, carries risks, but serious complications are extremely rare. The chance of going blind from LASIK is about 1 in 500,000—the same odds as being struck by lightning. In comparison, the risk of dying in a car accident in South Africa is much higher, with approximately 97 out of 500,000 people affected annually. Most LASIK complications, such as dry eyes or temporary night glare, are mild and treatable.

A Brief History of Refractive Surgery:
Proof of Safety and Innovation
To truly understand why LASIK is so safe and effective today, we need to take a quick look back at how refractive surgery has developed over the years. It’s been a long journey of technological innovation, backed by decades of research, all aimed at refining and improving the safety of these procedures.

1940s – Radial Keratotomy (RK):
Refractive surgery began with Radial Keratotomy, where surgeons made radial cuts in the cornea to correct nearsightedness. This technique, first introduced in the 1940s and populariSed in the 1970s, offered a way to reduce dependence on glasses, but it had limitations, including long-term instability in vision.

1980s – Photorefractive Keratectomy (PRK):
PRK marked the first true leap into laser-based vision correction in the 1980s. Using an excimer laser to reshape the cornea’s surface, PRK was an improvement over RK but required longer recovery times. It’s still used today for certain patients who may not be good candidates for LASIK, especially those with thin corneas.

1990s – LASIK (Laser-Assisted In Situ Keratomileusis):
LASIK brought about a revolution in the 1990s, combining the precision of lasers with a faster recovery process. By creating a thin flap in the cornea and reshaping the underlying tissue with a laser, LASIK provided more accurate results and shorter recovery times compared to PRK. Since then, LASIK has been refined and is one of the most trusted procedures for vision correction, with millions of successful surgeries worldwide.

Early 2000s – Phakic Intraocular Lenses (IOLs):
For patients with extreme refractive errors, the early 2000s saw the introduction of phakic IOLs. These are implantable lenses that sit inside the eye, offering a solution for people whose vision problems are too severe for laser correction alone. Phakic IOLs are a great option for those not eligible for LASIK.

2010s – LALEX/CLEAR (Corneal Lenticule Extraction for Advanced Refractive correction):
The 2010s brought another leap forward with LALEX (Laser Anterior Lens Extraction) and CLEAR (Corneal Lenticule Extraction for Advanced Refractive correction). These procedures remove a small lenticule (a piece of corneal tissue) through a tiny incision, correcting vision without the need to create a corneal flap as in LASIK. These minimally invasive techniques provide another safe and highly effective option for vision correction.

The evolution of refractive surgery—from the early days of Radial Keratotomy to today’s advanced procedures like LASIK and LALEX proves that these surgeries have been thoroughly studied and refined over decades. Each generation of technology has addressed the limitations and challenges of previous procedures, making modern refractive surgeries safer and more precise than ever before.
Innovations like femtosecond lasers, wavefront-optimised and wavefront-guided treatments, and advanced eye-tracking systems allow today’s surgeons to tailor treatments to each patient’s unique eye anatomy, minimising risks and improving outcomes.

Final Thoughts:
In summary, I always tell my patients that unfortunately, there is no risk-free procedure in medicine. But what’s crucial is understanding the risks, which will vary depending on your specific eye condition. For many, the low risk of refractive surgery is outweighed by the life-changing benefits it can provide. The most important thing is to consult with a trusted refractive surgeon who can guide you in deciding whether LASIKor another vision correction procedure—is the right choice for you. With the right guidance, refractive surgery can be a truly life-transforming decision

Dr Wilna Rautenbach

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