Smart Lens and Eye Laser Surgery (Refractive Surgery)

Smart lens treatment and eye laser surgery are modern surgical methods that permanently correct vision defects such as myopia, hyperopia, astigmatism, and age-related near vision loss (presbyopia). Providing clear vision without the need for glasses or contact lenses, these treatments are specially planned according to the patient's age, corneal structure, and eye prescription. While laser surgery is generally applied to young and middle-aged individuals by reshaping the cornea, smart lenses are based on replacing the natural lens inside the eye with a new multifocal lens for patients over 40.

• Laser surgery is generally performed on individuals over the age of 18 whose eye prescription has stopped progressing.
• Smart lens treatment is a permanent solution for patients over 40 who are experiencing near vision problems or have cataracts.
• Laser operations take about 10-15 minutes, and the recovery period ranges from 1 to 3 days depending on the chosen method.
• Astigmatism treatment can be successfully performed both with advanced laser methods and with toric lenses used in smart lens operations.
• Both surgeries are performed under local anesthesia (drops) and do not require hospitalization.

What is Smart Lens Treatment?

The natural transparent lens inside our eye gradually begins to lose its ability to focus on far and near distances around the age of 40-45. Normally flexible, this lens changes shape to allow us to focus at different distances. However, with advancing age or genetic reasons, this flexibility is lost, focusing on near objects becomes difficult (presbyopia), or the lens loses its transparency, paving the way for cataract formation. Smart lens treatment is the process of cleaning this dysfunctional natural lens using the phacoemulsification (phaco) method and replacing it with multifocal artificial lenses called trifocal lenses.

Thanks to this treatment, patients achieve clear vision at far, intermediate (computer distance), and near distances. Following the operation, the eye prescription does not progress further, and the risk of developing cataracts in the future is completely eliminated. We can divide the lenses used in cataract surgeries into three groups. Monofocal lenses only provide clear distance vision, while bifocal lenses show far and near but fall short at intermediate distances. Trifocal lenses, on the other hand, provide uninterrupted vision at all three distances, eliminating the patient's dependence on glasses.

Toric Lenses for Astigmatism

Astigmatism is a refractive error caused by the deformity of the cornea or the eye lens, resulting in blurred vision for both far and near distances. Thanks to new technological developments, astigmatism treatment can also be performed simultaneously during cataract or smart lens surgery. If the patient has regular astigmatism depending on their corneal structure, toric intraocular lenses are preferred over standard lenses.

These lenses provide highly successful results by providing correction up to 6 diopters in patients with high astigmatism. Trifocal toric lenses, which correct astigmatism as well as far, intermediate, and near distances at the same time, are an ideal option for patients who want to see every distance without glasses. However, if the patient has diabetes, glaucoma, or macular degeneration, single-focus toric lenses that only correct astigmatism should be preferred instead of multifocal lenses.

What is Eye Laser Surgery (Refractive Surgery)?

Refractive surgery is the process of reshaping the cornea using excimer laser technology. Working with ultraviolet light at a wavelength of 193 nm, these advanced technology devices permanently correct refractive errors such as myopia, hyperopia, and astigmatism. The laser procedure changes the refractive power of the cornea, the outermost transparent layer of the eye, ensuring that light focuses exactly on the retina.

The procedure time is quite short, and patients can usually return to their normal lives the day after the operation. Advanced eye-tracking systems found in excimer laser devices increase the safety of the treatment by adapting to small eye movements during the procedure. If the patient involuntarily makes a large eye movement, the device stops automatically and resumes the procedure from where it left off when the correct position is achieved.

Who is a Candidate for Laser Eye Surgery?

Laser treatment is a highly safe and effective method for candidates who meet certain criteria. Whether the procedure is suitable for you is determined as a result of a detailed eye examination. We can list the criteria for who can undergo laser surgery as follows:

• Individuals over the age of 18 whose eye structure has completed its development.
• Those whose glasses or lens prescription has not changed in the last year and has stopped progressing.
• Those with myopia up to 14 diopters, astigmatism up to 6 diopters, and hyperopia up to 6 diopters.
• Patients whose corneal tissue thickness is sufficient for the laser method to be applied.
• Those who do not have keratoconus, advanced glaucoma, or active herpes virus infection in their eyes.
• Those without uncontrolled systemic diseases that may affect the eye, such as diabetes, rheumatism, or lupus.

What are the Types of Eye Lasers?

PRK and No Touch Laser

In the PRK method, the epithelial tissue, which is the self-renewing top layer of the cornea, is gently peeled off with a special instrument, and then the laser is applied. In the No Touch Laser (TransPRK) method, no device touches the eye; the epithelial layer is directly vaporized with laser beams, and the treatment is performed. The patient only looks at a fixed green light for 30 to 60 seconds during the procedure. In both methods, stinging, watering, and mild pain may be felt for the first 48 hours after the operation. The recovery period is slightly longer compared to other methods, but it is a very safe option for patients with thin corneas.

LASIK and Femto LASIK

In the LASIK method, a thin flap is created on the corneal surface with an automatic blade called a microkeratome, the laser procedure is applied to the tissue under this flap, and then the flap is closed again. In the Femto LASIK method, this flap creation process is performed entirely with a computer-controlled Intralase iFS femtosecond laser without using a blade.

The femtosecond laser approaches the tissue with micron-level precision, ensuring the creation of a flawless flap specific to the person's eye structure. In these methods, the patient's vision usually becomes clear the next day, and complaints of pain are almost non-existent. Femto LASIK offers a better correction opportunity for astigmatism and creates a safe surgical environment by preserving corneal strength.

Smart Lens or Laser? Which Should You Choose?

One of the most frequently asked questions by patients who want to get rid of their glasses is which treatment method is more suitable for them. This decision is made by the physician according to the patient's age, eye prescription, and corneal structure. Laser surgery is generally the first option for patients between the ages of 18-40 who have suitable corneal thickness and only have trouble seeing far distances or have astigmatism. The laser intervenes in the cornea on the outer surface of the eye and corrects the refractive error.

Smart lens treatment, on the other hand, is ideal for patients aged 40-45 and over who experience near vision problems (presbyopia) due to the loss of flexibility of the natural lens inside the eye or who have early-stage cataracts. If you are over 45 and have to use both distance and near glasses, trifocal lens replacement offers a much more permanent and satisfactory solution than laser. Because laser cannot permanently stop presbyopia; however, smart lenses not only clarify far, intermediate, and near vision but also completely prevent cataract formation in the future.

Pre-operative Evaluation and Diagnostic Process

The first step to a successful surgery is an accurate diagnosis and a detailed eye examination. When you apply to the hospital, your visual acuity is first evaluated, and your eye prescriptions are measured. After checking the eye pressure, the anterior and posterior segments of the eye are examined with a biomicroscope. The pupil is dilated with drops to check if there is any tear, diabetic damage, or macular degeneration in the retinal layer.

To decide on the suitability for laser or lens surgery, a topographic map of the eye (corneal map) is created, and corneal thickness is measured with a pachymetry device. Corneal thickness is the most critical parameter determining which method to choose, especially in laser surgeries. As a result of all these tests, your physician creates the safest and most effective treatment plan for you.

Recovery Process and Things to Consider

Since both surgical procedures are performed under local anesthesia (drops), they do not require hospitalization. To prevent the risk of infection and accelerate healing after the operation, it is essential to regularly use the antibiotic and cortisone eye drops prescribed by your physician for the specified period.

After laser surgeries, the eyes should not be touched, rubbed, or exposed to water (no showering) for the first 24 hours. Wearing sunglasses when going outside protects the eyes from UV rays and dust. In smart lens surgeries, both eyes are generally not operated on the same day; unless there is a patient preference or medical necessity, operations are planned a few days apart. Patients can largely return to their daily activities the day after the operation, but heavy sports and physical activities that will strain the eye should be avoided for a while.

Possible Complications and Risk Groups

Although modern eye surgeries have high success rates, every surgical intervention has certain risks. In the first months after laser, temporary complaints such as dry eyes, light scattering (seeing halos), or glare may be experienced. After smart lens operations, the brain's process of getting used to the new multifocal vision (neuroadaptation) can take a few weeks, and light reflections may be noticed during this period.

Those with macular degeneration, diabetic vascular damage in the retina, and uncontrolled glaucoma patients are not suitable candidates for smart lens treatment. Instead of multifocal lenses, single-focus (monofocal) lenses that will preserve their current condition can be recommended to these patients. In laser surgery, the procedure cannot be applied to people whose corneas are structurally very thin or who have keratoconus disease.

When to See a Doctor?

Eye health is a sensitive issue that should not be neglected. If you experience any of the following symptoms after surgery or in your daily life, you should consult an ophthalmologist without delay:

• Sudden, severe, and throbbing pain in the eye.
• Sudden decrease in vision, blurring, or dark areas forming in the visual field.
• Intense redness, swelling, and inflammatory discharge in the eye.
• Flashes of light or dense black spots floating in front of the eye (floaters).

In such emergencies, you can call 112 even outside working hours or apply to the emergency department of a fully equipped hospital. On the other hand, sometimes eye diseases can manifest themselves only with a headache. As we mentioned in our article Not Every Headache is Stress: Your Eyes Might Be Giving a Signal!, a hidden refractive error may lie beneath persistent headaches.

Diagnosis and Treatment Process at BHT CLINIC

As BHT CLINIC İstanbul Tema Hastanesi, we offer advanced technology diagnostic and treatment methods to protect your eye health and improve your quality of life. Our experienced medical staff meticulously prepares the most appropriate, personalized treatment plan for the patient in refractive surgery and smart lens applications.

Thanks to our multidisciplinary approach, our patients who apply with eye complaints but have different underlying problems are quickly directed to the relevant departments. For example, the feeling of pain and pressure around the eyes can sometimes be confused with sinus problems. In such cases, we reach the correct diagnosis by working in coordination with our Otorhinolaryngology (ENT) department. Our hospital is safely by your side for all your health needs with its 24/7 emergency service.

Frequently Asked Questions

How long does smart lens surgery take?

The operation takes an average of 10-15 minutes for each eye. Since the procedure is performed under local anesthesia (drops), no pain is felt, and patients can usually be discharged and return home on the same day.

Does the eye prescription increase again after laser?

Before laser surgery, the eye prescription is required to have remained stable for at least one year. When this rule is followed, the probability of the prescriptions increasing again is very low. However, with advancing age, near vision impairment (presbyopia) can develop as a natural process.

Can laser surgery be performed a second time?

If it is determined that a prescription remains in your eye during the detailed check-ups performed at least 6 months after the first operation and your corneal thickness is suitable, a second laser procedure can be performed. This situation becomes clear with the pachymetry and topography measurements your physician will make.

Is astigmatism completely cured with laser?

Yes, in patients with a suitable corneal structure, astigmatism defects up to 6 diopters can be permanently corrected with a high success rate using excimer laser technology.

Is laser surgery a painful procedure?

Since anesthetic drops are instilled into the eye during the laser procedure, no pain is felt. There may only be a slight feeling of pressure and touch. Depending on the laser method chosen after the procedure (especially in PRK), it is normal to experience stinging and watering for the first 1-2 days.

Do cataracts form after a smart lens is implanted?

No, since the natural lens inside the eye is completely removed and replaced with an artificial lens in smart lens treatment, the possibility of the patient developing cataracts again in the future is eliminated.

For a detailed evaluation of your eye health and to determine the most appropriate treatment method for you, you can consult our specialist physicians by booking an appointment.

This article is for informational purposes only; please consult your physician for diagnosis and treatment.