Just for context and as this article only mentions LASIK and not other options such as (Trans-)PRK and SMILE, the majority of negative side effects one experiences post LASIK are not linked to the ablation/"carving" of the cornea, as they call it, but rather is a result of the need to sever the subbasal nerve plexus in the anterior stroma, which tends to be regenerate in a less comprehensive manner and significantly slower around the margins of the flap compared to other methods.
Flaps aren't inherently dangerous either (flap detachments are very rare, even more so with modern systems that create essentially a cavity where the flap can rest in), but the difference in healing post OP is a lead cause of heightened dry eye after LASIK. Both PRK and SMILE, due to the way they work, are less likely to suffer from this, but every procedure has trade-offs naturally.
With PRK, the epithelium in the area is removed and has to regrow, a process that takes a few days (to get the initial part done, full regrowth takes far longer but isn't noticeable in general). This regrowth can be both rather painful and also rob you of the "instantly perfect sight"-effect many people desire from their laser eye surgery. As the epithelium does regrow naturally however, it is less likely (both in theory and in medical literature) to lead to dry eye and other side effects in the short and long term, making it the preferred choice by many ophthalmologists when choosing such surgery for themselves.
SMILE, on paper, might be able to offer the best of both worlds, but is severely more expensive than either and there is not a sufficient degree of long term research to make a definitive statement that the side effect amount and severity is comparable to PRK, simply because it is rather new. What research is out there is promising though.
Overall, each option is very well tolerated, leads to major QOL improvements and we need to keep in mind that even the more common side effects one may face with LASIK may not affect everyone and still are comparably small considering other medical fields and their elective procedures.
In this context, I'm very excited to see whether this method might have even fewer short and long term side effects than PRK, but like with SMILE, it may take decades to have a conclusive answer.
Edit: Another thing I missed and which was not covered in the article, is the potential that this new method could be applicable to people who, because of a variety of factors, are not eligible for any ablative eye surgery. I myself was at the upper limit for Trans-PRK in regard to the severity of my Myopia and the thickness (or lack there off) of my Epithelium. In that regard, I see far more potential than just reducing already low side-effect risks further.
There are also intrastromal corneal rings to correct myopia (but not astigmatism) -- in the US (Intacs) for -1 to -3 diopter, while in the EU they go up to -6. They're inserted though a small hole to surround the cornea, and they can be removed. So overall less effective than lasers, but also more safe (though much less common, so harder to find a high-traffic expert surgeon).
> SMILE... is severely more expensive
This is the first I've heard of this. In my area it seems comparable in price, within 1.5x the cost of LASIK. Considering how relatively cheap it is (a couple months' rent, or a fraction of the price of a car, to correct your vision for decades) I've never seen cost mentioned as reason to choose one over the other.
> As the epithelium does regrow naturally however, [PRK] is less likely (both in theory and in medical literature) to lead to dry eye
This is exactly opposite to how I understood and experienced healing after Trans-PRK. My eyes are still very dry 6 months post surgery. Being at the upper limit of Trans-PRK yourself, did you actually go through with the surgery? If yes, how was your healing process? I would be very interested in chatting about it, since I am not particularly happy with mine, and wondering what can be done (and whom to blame).
Sorry to hear that it did not go well for you. Yes, I did go through with it, was in April of 2024 (Trans-PRK via a Schwind AMARIS) and I did have a rather painful recovery, especially on day two and three after the surgery.
From there on, the pain and foreign object feeling quickly subsided alongside the remaining "haze" and by day five, I neither had any subjective pain, nor any major issues reading text (both typed and digital). Had multiple check-ins of course, both at the clinic which performed the surgery and with my decades long ophthalmologist, no issues were found there either. Subjectively, I do not experience a heightened severity in dry eye symptoms for what that is worth.
Also had a clinical rotation in Ophthalmology just this month (small world, though was why I felt the urge to comment) and the attendings did assess my epithelium as having regrown evenly too.
What could have gone wrong for you and how to go about this, I really can't say and I am sure you have already considered /pursued it, but I can only suggest getting a second opinion from another established ophthalmologist, including looking at the eye drop regiment prior to the surgery and during, as well as post recovery.
Thanks for the elaborate answer. Reading about Schwind AMARIS it seems to be using SmartSurf which claims faster healing than conventional TransPRK. I can't assess how much of this is marketing speech or if it's basically the same as TransPRK.
In any case, I agree that a second opinion would be most helpful.
I couldn't tell one way or another, but honestly didn't choose that particular system for any reason beyond that being what was on offer where I live. My very limited reading prior to surgery though would indicate that currently there is no source showcasing a difference in subjective recovery experience between TransPRK and this Smartsurface. What has been used as a source when covering the technology is mainly focused on the first three months [0], rather than longer term as you are describing and does in my opinion not actually showcase a difference between Smartsurface and TransPRK specifically [1]. Full disclosure, I only include the name of the system because it felt like an HN thing to do. It wasn't some value judgement that these machines are superior or that others are inferior.
[0] https://crstodayeurope.com/wp-content/uploads/sites/5/2019/0... referenced from https://pubmed.ncbi.nlm.nih.gov/26871764/
[1] If you look at the source they are referencing, it compares TransPRK to aaPRK after three months and they were using Schwind machines, though did not clarify whether this was using Smartsurface. Very cursory search engine use tells me that this is toggleable, so an option on these machines. Even if this study did use Smartsurface though, that doesn't answer whether outcomes are different in TransPRK with Smartsurface vs TransPRK without Smartsurface. Additionally, I do not know whether this option was used in my case.
I'm not candidate for LASIK or any other eye surgery due to the thinness of my cornea :( I would love to see this new approach. Maybe I'll be a candidate for it.
I have had multiple PRK treatments. I completely understand why it is not mainstream.
It is an unpleasant procedure and the recovery is quite painful. There is a reason why it is almost never done today.
The rates of people getting PRK compared to LASIK seem to be raising.
https://moskowitz-eye.com/blog/most-popular-laser-eye-surger...
Wait, you can get PRK more than once?
I had it done about fifteen years ago. My vision was perfect for a decade, but now I'm back in glasses.
PRK recovery was certainly uncomfortable, but I'd gladly do it again for another decade without glasses.
Very good writeup
My bet is on SMILE evolving but we'll see where it goes
Finally some news regarding this research. I first heard about it back in 2019 when there was an ACS panel featuring it:
https://www.youtube.com/live/Dw9D7C8CpM0?si=e-KJ8J2u_oVy4RvM
Originally there was a mention of developing a less invasive method of correcting a deviated septum, but I guess they went with the harder problem first.
In any case I'm up for both, because while my vision is not terrible, it's slowly, but consistently getting worse, so max-twice-a-lifetime interventions like laser eye surgery won't cut it for me.
Agreed, going from 20/10 vision to "I've given up trying to read small text 50m away" as I age over 40 doesn't affect my quality of life, but it doesn't help my self-esteem.
I'm between +3 and +4 now depending on how tired I am. I used to be able to read the print on the smallest SMT packages :(
And it does affect my quality of life: forget glasses? Good there goes your day until you've found a replacement. The best improvement so far has not been the glasses but a simple string to make sure I don't put them down but they stay around my neck. That has made a massive difference and it also helps when looking down (so the glasses won't fall off) and it has cut the rate at which I was losing them to zero from about one pair per month (which really was not sustainable).
My in-laws all love their reading glasses with a split-bridge joined by magnets, and a built-in loop around the back. I think it’s these: https://cliceyewear.com/
If you don’t mind the aesthetics (though I personally can’t get past them), they solve the same problem as your string in an integrated way. Plus they rest more like a necklace, since it doesn’t require as long of a loop.
That's interesting. I won't be trying them though, I hate frames, it is bad enough with frameless but frames really spoil it for me. One brand in particular that I've found makes glasses that are almost invisible to me when I'm wearing them and that's the one that I've stuck with for the last couple of years. If the tech described here comes to general availability I'll be super happy.
I usually fold the arms, and hook them over my t-shirt, but they do tend to fall off that way when I bend over. I might have to go with the string approach as well.
There is a very painful reason why I stopped doing that.
Yeah :( I can still read tiny print, but only for a few seconds, and with a lot of light. Getting old sucks.
I got one of these a year ago and it has been a very nice experience so far:
https://www.elektor.nl/cdn/shop/files/andonstar-ad409-101-hd...
It is also one of those things that you find more and more uses for over time.
Is it really? I tried one of the USB microscopes with a screen, and the lack of depth perception was a massive hindrance when soldering. I solved it with a pair of jeweller's loupes:
You might want to look into UNR844-Cl. Research was dropped by Novartis, but it's available as a research chemical.
https://modernod.com/articles/2020-sept/coming-soon-presbyop...
(This is assuming your farsightedness is due to age-related presbyopia, hardening of the lens, and not true farsightedness from a change in eyeball shape)
This seems ideal. The only question I had was whether it's permanent on living cells, "Potentially reversible" at the end makes me think it is.
There’s a current product that does simple mechanical remodeling: sleep with this chunky contact lens in and the next morning you see better. But it wears off in ten hours or less.
Night lenses! Yeah they're pretty crazy (I'm in the process of getting them and a friend of mine has them). 10 hours is low though - they're supposed to easily make your vision last all day, even two. My friend says he only really stops seeing well after 3 nights of not wearing them.
It depends on your prescription.
I tried them and they were awful for me. Didn't last the full day, caused terrible halos while driving (and that was BEFORE 90% of cars drove with LED high beams), were generally too uncomfortable.
Same results for me. Absolutely awful, vision consistently began failing by becoming noticeably blurry about 8 to 9 hours after taking night lenses out, and I couldn't drive at night because of headlight and streetlight halos even after "topping off" with those uncomfortable lenses during the day. As an enthusiastic night sky observer, trying to use those lenses was depressing.
I gave up after extended tries with three different lenses (I think it was six to nine months total), with my highly experienced doctor consulting with different manufacturers and researchers from around the country. Turns out my pupils naturally open up too wide, made worse by corneas that apparently are not thick enough to retain the reshaping all day. These issues, incidentally, make me ineligible for the popular cut-n-burn style of eye surgery.
On the bright side, it was indeed completely reversible and I've suffered no effects of any kind after about two days of non-use. That was a bit over a decade ago.
It's called Ortho-K
> Though the next steps are planned, uncertainties in the team's scientific funding have put them on hold
take my money!
Would anyone know could they use this to fix the glares and halos from lights at night in person's vision, I understand cannot be fixed with any technology now? Including risk of making worse by laser surgery.
I only have wore glasses, i dont care about trying contacts. Its the glare with or without thats pretty bad driving at night in US
Halos and glare at night are usually a sign that something in the eye is scattering light. Sometimes it’s just uncorrected prescription, but it can also come from things like dry eye, early cataracts, or the way the cornea focuses light. Glasses can’t always fix that because they only correct the main focusing errors, not the little imperfections that cause glare.
Contacts (especially the rigid or scleral kind) can sometimes smooth out those imperfections, but if you’re not interested in them, the next step is usually an eye exam to look for things like lens changes or surface dryness. Cataracts, even very early ones, are a common culprit for glare driving at night in the U.S.
Laser surgery can sometimes make halos worse, especially if someone already has them, so you’re right to be cautious. But it’s not the only option. Treating dry eye, using anti-reflective coatings on your glasses, or addressing cataracts (if present) can all help a lot.
In short: it’s not hopeless, but the “fix” depends on what’s causing the scatter in the first place. A detailed eye exam is the best way to pin that down.
Sounds like astigmatism, which I also have. I don't know if this procedure, unlike LASIK, can correct astigmatism. I know you said you weren't interested, but for me personally, wearing contacts (not glasses) completely fixes my astigmatism and makes it much easier to drive at night.
LASIK can absolutely correct astigmatism.
Source: Had LASIK in 1999. Severe myopia and astigmatism, corrected to 20/10 and 20/15 (right and left eye).
My night vision was definitely worse after the surgery, but improved over a year or two. I still get blurry when my eyes are dry and tired, but otherwise remain glasses-free at 50+.
That's when I had my eyes done but not for astigmatism. Have you noticed your eyes getting drier lately? Mine started a couple of years ago and it's somewhat of an issue now having to keep drops around.
To my knowledge LASIK can correct astigmatism. A quick Google search confirms this pretty clearly. Do you have a source that claims otherwise?
Oh, I wonder what about the contact lens makes it different. I should try then I suppose
Contacts for astigmatism have a tiny weight on one side which keeps them oriented (enough) that they can cancel out mild to moderate asphericity.
I'm surprised LASIK still can't correct for astigmatism though, I know that was the case when it first came out but in principle I can't see why it wouldn't work.
I think the word you're looking for is "astigmatism".
As in, you have this without any eye surgery? My dad had LASIK and that gave him 20/20 vision but also what he described as horrible halos around all lights at night, to a point where he really found it difficult to drive in the dark. He had it done about 15 years ago so I wonder if the state of the art has improved in that area.
When I looked into it last year, it´s still an under-acknowledged issue. The impression I formed was that it was a bit of a crapshoot - along with some bad practitioners, there didn´t seem to be much information on when and why it would or would not occur.
As we age, most of us will have to deal with farsightedness. What's the best treatment option nowadays, besides prescription glasses?
As both Presbyopia and Cataracts come for us all, it is generally not advisable to do laser eye surgery once the former has set in. Both are a result of changes to the lens (and the ciliary muscles to some extend), so long term, a lens exchange, whether partially covered by (public) insurance as part of cataract surgery or as an expensive elective procedure is the only effective surgical option we have currently available.
That brings me to one of my personal pet peeves which is selling pensioners that qualify for cataract surgery on an expensive, but in fact identical but privately paid for IOL.
Same with selling some Myopic+Presbyopic person on laser eye surgery of any kind. At best you get a few short years out of the expense before it catches up with you or you tolerate mono, at worst you spend thousands to suddenly need reading glasses you didn't require before.
Course, if you are financially solid and Presbyopia is starting, getting a high quality lens exchange can be a very neat luxury, with the added benefit of not needing Cataract surgery later in life. Do note though that artificial lenses, while incredibly advanced, still cannot accommodate as well as the real deal as of now.
> As both Presbyopia and Cataracts come for us all, it is generally not advisable to do laser eye surgery once the former has set in.
I had a conversation with my ophthalmologist about this. She said the same thing. Then I said, I don't understand, right now I have to wear glasses for far vision and glasses for near and mid vision. If I got the surgery, I would still be presbyopic, but I wouldn't need glasses for far vision, only for near vision? and she said yes. So I said, that sounds like in improvement. What's the catch? She said it's mostly a matter of expectation. People think that LASIK means they don't have to wear glasses again, period.
But I keep hearing this, so I'm wondering if there's something more to it that she didn't explain? Is there some other disadvantage?
As someone who had perfect vision until 40 but now must wear reading glasses, I am super intrigued to hear about lens exchange!
When I heard that LASIK is not a solution to farsightedness, I specifically asked my eye doctor if there are other solutions for this. The only one mentioned was monovision (getting two different prescriptions for different eyes).
> Do note though that artificial lenses, while incredibly advanced, still cannot accommodate as well as the real deal as of now.
Cannot accommodate what as well?
"Accommodate" means change focus, like your natural lens does when you focus on objects at different distances. Most artificial lenses implanted today have zero ability to change focus. There are newer "accommodative" lenses that have a limited ability to change focus, but from what my ophthalmologist told me, they're still primitive and not even close to what natural lenses do, which is why fixed focus lenses are still more common.
"Eye accommodation is the eye's ability to automatically adjust its focus to maintain a clear image as the distance to an object changes. This process involves changes in the shape of the lens, the constriction of the pupil, and the convergence of the eyes. It's a reflex action that allows us to see objects clearly both near and far" (Google)
Have you tried being severely myopic to begin with? :D My presbyopia has kicked in surprisingly quickly (at a guess, 1.5 diopters over 2-3 years) but that just means I can look past my glasses at close things, like the opposite of your stereotypical half-moon reading glasses. Hey, I should make some of those out of an old pair...
I think they'll have to come up with a less scary name for it though.
Yeah, but knowing the analagous name for lasik is 'slicing off your cornea then gluing it back on', this one is immediately more appealing.
Is it even glued on I thought it just put there and sticks through adhesive forces
it's placed into a flap that is cut into corneal tissue.
the flap size itself keeps the lens in place; the elasticity of the underlying tissue itself, until it heals into an encapsulation.
the surgery videos of that procedure make me squeamish unlike other surgery videos. Watching an eyeball get deflated/inflated with liquid pressure from the surgeon is just un-nerving to me; not as bad as watching a glaucoma surgery -- but up there.
The place I had it done cuts the flap in one room, then has you walk (suddenly legally blind) to another room for the actual correction. A very interesting experience that cannot be adequately captured on video.
That would be a huge red flag for me. How is that even sterile or safe? What happens if you fall and need hospital care on the walk from one room to the other? Are you now blind until the hospital care is complete?
I heard about this research six years ago and at the time it was called "molecular surgery".
i mean the competition is lasik, which sounds like beaming a laser into you eye, doesn't really sound safe either
The long name (Laser assisted in Situ Keratomileusis) can sound a bit scary too... :p
I always wondered why we don't reshape eyes somewhat like we do for teeth. I guess this is coming. I can't wait to have more news about this as my severe myopia can't be treated by (most?) laser methods.
Reshape as in grind down and fill? Or reshape as in all of them with braces?
LASIK is almost the same as grind down and fille, isn't it? In the sense that the lens is a new shape when it's over. We replace lenses too.
Braces are essentially forcing teeth into new positions mechanically. Once they're in those new positions, we glue on wires and wear retainers to keep them in place, often for the rest of our lives. This doesn't sound like a comfortable eye procedure.
There are brace equivalents for eyes: https://en.wikipedia.org/wiki/Intrastromal_corneal_ring_segm...
One thing I am curious about is if the platinum shaping lens would be the same for everyone or is it custom made?
So, electrochemical ortho-K but better?
That's great news. I was discouraged of laser correction when I read some research that the layer they cut off and put back on doesn't really fuse back with the rest of the eyeball. The adhesion force is if I remember correctly 8% of the original. I wouldn't want to risk accidentally rubbing off an important chunk of my corona. The other option is just to cut it off completely and shape what's underneath but that heals slower and is also not great because the top layer is not the same as what's below.
I'm reading that flap detachment is very rare. It very well might be. Maybe the eye is vastly over-engineered and 8% is sufficient for most modern humans. But I'm sceptical.
The eyewear industry might not like this.
This is amazing!
Let's hope it pans out for eyesight, and I'm sure there must be a whole lot of other things this could apply to.
