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Jan 30

2015

Bioptics, The Back-to-Back Procedures For Corneal And Refractive Corrections

The method brings an excellent combination of RLE (Refractive Lens Exchange) and PRK or LASIK to get rid of the dependency on visual aids. Surgeons prepare the flaps before performing the RLE procedure. It brings an immediate visual rehabilitation and recovery. The implants can be single or multifocal depending on the need. It is also possible to do monovision bioptics using the method. When multifocal lenses are implanted, they eliminate the dependency on external visual aids completely for near or farsightedness.  Bioptics procedure can restore far and near vision when combined with corneal implant. It is useful in astigmatism correction as well. The treatment is quite effective for patients above 40 years of age who are losing or already lost) the ability to focus on near objects. It is a great method for patients showing signs of cataract development in the natural lens and when a short-term to medium-term lens exchange is planned.

What is bioptics?

Bioptics is an advanced method of vision correction that greatly compensates the inherent error of prediction in an intraocular lens formula. It is a combination of laser eye surgery and cataract operation. Deciding the exact power of an intraocular lens is extremely crucial because it is not like a normal pair of glasses where a trial-and-error method is used to derive at the clearest image. Swapping lenses isn’t possible, in this case. Hence, doctors use predictive formula on the basis of various measurements of the eyes. It is based on various measurements of normal eyes, and the results are normally distributed to make a bell curve.  Though a majority of patients fall within the accurate range, a small percentage may fall outside the accuracy of prediction.  Laser treatment allows refining the outcome greatly if it follows outside the refractive outcome predicted before the surgery.

The benefits of bioptics

Bioptics can be incredibly useful while patients ask for 100 percent accuracy. Sometimes patients do not want to use specs after the surgical procedure, the surgeons make an initial prediction and then fine tunes it for perfection. It is quite effective in patients with an exceptionally long or short sightedness.

There are cases when patients having 24D nearsightedness did not require any keratorefractive procedure after IOL, but there are also cases when even nearsightedness of level 14D has a residual astigmatism of 4D after the implant and the surgeons need to perform refractive procedure to correct it. Today, doctors feel that bioptics should be an inevitable aspect of IOL implant. If there is no 100% correction achieved after IOL, they perform the refractive procedure.

There is no difference in the way precutting of flap is done while performing the procedure. Today, LASIK is performed on corneas that have undergone keratoplasty procedure earlier. It is also performed in trauma situations where flap creation may trigger major refractive changes. Still, the value of the dual procedure hasn’t decreased, and a majority of refractive surgeons use bioptics in diverse situations.  Surgeons feel it a way of optimizing results by combining various technologies for higher synergies. Since enhancements are becoming common, the combination becomes an effective way of achieving better vision correction.

Why does it become so popular?

Experts feel that as the popularity increases for different types of lens implants (Phakic, multifocal and accommodative); there is an equal increase in the corneal plane corrections. It is said that bioptics is an incredibly effective method and a viable option for correcting a corneal astigmatism or high spherical error, after an intraocular implant. Many surgeons are learning the skill of bioptics or appointing specialists who can do it proficiently because of increased demand for the new method. It becomes the part and partial of the refractive enhancement methods.  Those ophthalmologists, who have been frontrunners in handling cases of intraocular lens implants, know its increasing importance in the field of ophthalmology.

Since a Phakic intraocular lens is in spherical format only, people with astigmatism feel an impact in their acuity level after the surgery. Hence, it is necessary that the surgeon corrects it at the time of surgery only.  After implanting a pseudophakic multifocal lens, there is always a need of astigmatic refractive error correction and spherical correction.  Surgeons know that they can’t achieve 100% perfect vision in case of IOL; they inform the patients about the possibility of keratorefrective procedures.

Refractive improvement can be achieved in the eye in two distinct planes. First the corneal one and the other is lenticular one. It isn’t possible sometimes to achieve clear vision on only one plane. For example, an intraocular implant may need a secondary refractive surgery like PRK or LASIK to refine the correction further. Sometimes, these surgeries may be required to correct the astigmatism after the lens implant.

Risks and disadvantages

The procedure doesn't have particular risk or disadvantage. However, the normal risks can be there just like any other eye surgery. Sometimes, bleeding during lens implantation can be experienced. Rarely, there is an abnormal corneal bulge after LASIK surgery. Some patients complain dry eye after the procedure. These are very common and curable risks. Doctors take utmost care and precaution while performing both procedures. If the doctors suspect anything abnormal, then the procedure is avoided or postponed depending on the situation.

Conclusion

Modern vision correction techniques greatly depend on technology. Hence, there is a little possibility of error. Doctors take utmost precautions by performing pre-operative procedures so that there is no complexity afterward. Still, due to the inherent anatomy of a human eye, a refractive error can be seen after performing IOL procedure. For this reason, bioptics comes out to be a great solution for excellent results. When there is a post-operative astigmatism of .75 Diopters or more, bioptics can be very useful. It corrects the blurred vision caused by irregularity of the corneal curvature and brings great clarity. The first step creates a corneal flap and implants a lens. The second procedure (performed after two to three months), the flap is lifted, and fine corrections are made with a laser beam to correct the residual refractive error.