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Refractive eye surgery or contact lenses?

Posted on 04 July 2014

There is no doubt that technology has advanced beyond imaginings over the last 100 years. Surgery is now possible to correct a myriad of conditions and diseases. This includes surgery for correcting vision impairment and refractive errors. Alongside these surgical advances, progress in contact lens technology has kept pace. In fact, contact lens technology has advanced so far that 30-day continuous wear contact lenses are now approved and available for increased flexibility, comfort and ease. The question is, which is the best decision for you? Refractive surgery or thinking about moving to an extended wear contact lens?

What is refractive eye surgery?
The most common refractive eye surgery is LASIK or PRK laser surgery that can correct common vision impairments including myopia, hyperopia and astigmatism, thereby reducing dependency on glasses or contact lenses. Put simply, small amounts of corneal tissue are removed to reshape the cornea. Most contemporary procedures use a computer-guided laser. Another alternative are ICLs (Intraocular contact lenses) or a refractive lensectomy.  Both of these procedures involve intra-ocular surgery. 

What are the benefits of refractive eye surgery?
The procedure is quick, relatively painless, with a high success rate. 

What are the limitations of refractive eye surgery?
Refractive eye surgery is not recommended for everyone. In particular, for anyone who has not had a stable spectacle prescription for the 12 months or is under 18 years of age, refractive eye surgery is not an option. Further restrictions on laser surgery include pregnancy and some auto-immune diseases or corneal dystrophies such as keratoconus.

The real limitation of refractive eye surgery however is the cost. On average, laser refractive surgery costs approximately $5000 and this is not covered under Medicare. Intraocular contact lenses can cost $9000 however some private health funds may subsidise the cost. 

The need for ongoing eye care is still required after surgery. Most people report the exacerbation of dry eye and the need for lubricating eye drops, however this usually eventually improves. Regular eye check ups are still scheduled to monitor for eye disease or a change in vision.

The final limitation is the simple fact of undergoing surgery. All surgery comes with inherent risks - althought the risk is small, things can go wrong. This can make surgery an emotionally or psychologically traumatic event for some people.  The alternative is extended wear contact lenses.

What are extended wear contact lenses?
Extended wear contact lenses are about lifestyle. Pitched to the market of people who are tired of the daily insertion of lenses and who require flexibility and comfort, these next generation lenses are approved for 30 day continuous wear. This removes the hassle and time spent removing, cleaning and inserting lenses twice daily. People whose lifestyle demands a measure of flexibility choose extended wear contacts. The same kind of people may be considering refractive surgery for the exact same reasons. 

How do extended wear contact lenses work?
The possibility of extended wear lenses emerged after the invention of the silicone hydrogel lens. Since this technology allowed for more oxygen to reach the ocular surface, the length of time the contact lens could safely stay in the eye was extended. 

What are the benefits of extended wear contact lenses?
Unlike surgery, contact lens prescriptions can be adjusted as necessary into the future. It would be an expensive adventure to undertake surgery only to find the refractive error changed after the surgery. Extended wear contact lenses are most importantly affordable. Averaging $250 to $300 for one years supply, extended wear contact lenses are a steal compared with the upfront cost of refractive eye surgery. 

What are the risks of extended wear contact lenses?
Sleeping in contact lenses means that there is an increased risk of eye infection such as a corneal ulcer or microbial keratitis. Some studies have shown this risk to be approximately 1 in 500 per wearing year. Eye

Which is best: refractive eye surgery or extended wear contact lenses?
Both options are suitable for people living active, and perhaps unpredictable lives, who no longer want the interference of eyeglasses or a daily contact regime. Taking advice from an eye care professional is necessary to find out if either surgery or extended wear contact lenses are options. 

Even so, the decision is largely personal and weighing up the benefits and limitations of each is critical to making an informed decision. 

If opting for refractive eye surgery it must be remembered that the procedure is irreversible, so it is important to be certain that the refractive error will not later progress. Extended wear contact lenses offer the same flexibility and freedom but with the ability to adjust the prescription to changing vision over time. They are also much more affordable. The technology of contact lenses has easily kept pace with surgical procedures and most people first try extended wear contact lenses before committing to refractive surgery.