Many people with myopia have considered undergoing surgery to remove their glasses, but they can’t help but hesitate:
Frankly, as an ophthalmologist, I am also very curious about this question. However, there is no relevant research that provides a clear answer at present. Therefore, I conducted a small-scale survey among the doctors around me.
I used a WeChat questionnaire to invite 52 doctor colleagues and friends. Fortunately, they all responded positively and completed the questionnaire, achieving a 100% response rate. So, let’s reveal the survey results together!
Since it is widely believed that the results of myopia surgery are significant and the safety is guaranteed, why don’t doctors get myopia surgery themselves?
This is a question that most doctors, even every ophthalmologist, are frequently asked.
Out of the 52 doctors surveyed, 48 had myopia, and the remaining 4 had normal vision. Interestingly, only 14.6% actually considered and underwent myopia surgery.
Next, let’s explore:
Do doctors who undergo myopia surgery
really as few as we think?
Among the group of doctors with myopia, is the proportion of those who accept myopia surgery higher or lower compared to the general population?
According to the 2023 “China and Europe International Myopia Surgery Big Data White Paper 2.0,” in 2021, only 0.7 out of every thousand people in China underwent myopia surgery, a figure significantly lower than that of the United States (2.6), Europe (1.3), and South Korea (3.8). However, this report is based on the overall population’s acceptance rate, and if we focus on the age-appropriate population, the proportion would undoubtedly be higher.
Therefore, based on the current small sample size statistical data, the proportion of doctors who accept myopia surgery is actually higher than that of the general population.
Although the proportion is higher than that of the general population, why is it that many ophthalmologists still do not undergo surgery? Don’t rush to conclusions, there are quite a few reasons:
1 Not allowed by personal conditions Some doctors want to have the surgery, but their physical conditions do not permit it. For instance, if the central corneal thickness is too thin, like a thin cookie that cannot withstand the surgical “cut,” or if the posterior corneal curvature is too high and the shape is incorrect, the risk of surgery increases, and doctors naturally have to be cautious.
2 Do not think it is necessary to undergo surgery Some ophthalmologists do not think it is necessary for them to undergo myopia surgery.
Due to attribution bias, we tend to pay more attention to doctors who wear glasses and have not undergone surgery.
Why don’t many doctors get myopia surgery?
Some doctors feel wearing glasses is safer, as glasses can block some pathogens and splashes;
Some doctors believe that wearing glasses better fits their professional characteristics, retaining low myopia is conducive to fine microscopic operations;
There are also some doctors over the age of 40, who worry about facing presbyopia shortly after surgery.
For related issues, you can read this popular science article: “Do the effects of myopia still exist after myopia surgery?”
3 Concerns about potential complications from surgery Some doctors, due to long-term exposure to computers, worry that the dry eye problem after surgery will not be effectively resolved;
Others, due to high-intensity daily eye use, worry about myopia rebound after surgery.
So, what are the situations that are not suitable for myopia surgery?
Which situations are not suitable for myopia surgery?
1 Minors and those over the age limit Adolescents < 18 years old, as the eyeball has not yet fully developed, there is still a possibility of continuous changes in myopia, the risk of postoperative regression of vision is relatively high.
With the continuous growth of age, the eye’s accommodative function gradually degenerates, and presbyopia follows, making it likely that one will need to wear reading glasses again after surgery. Generally,
According to relevant guidelines, if one is over the age of 35 to 40 and still wishes to undergo myopia surgery, it is particularly important to communicate fully with the doctor. At this stage, one should discuss and carefully design the surgical plan with the doctor, as there may be an undercorrection in terms of degree correction, and generally, there will no longer be an overcorrection. Otherwise, one may have just taken off their myopia glasses for a few years and then have to put on reading glasses.[2]
2 Keratoconus or thin corneas When the highest point of the corneal posterior surface height map exceeds the normal value by 50μm, or when the central corneal thickness is ≤450μm, the risk of stress-induced changes in corneal shape after surgery will increase.[3]
the age range of 35 to 45 is considered the pre-presbyopia stage, 45 to 52 is the early stage of presbyopia, and over 52 is classified as absolute presbyopia[1].
3 Unstable myopia Increase in myopia > 50 degrees/year in the past 2 years, it is possible to become myopic again after surgery, and the correction effect is not lasting. It is recommended to first control myopia, and consider surgery after the degree of myopia has stabilized.
Most patients’ progression of myopia will slow down with age, and the degree of myopia usually stabilizes before the age of 20. However, more and more studies have shown that even adults, if they engage in high-intensity close-up activities for a long time, such as college students majoring in medicine, engineering, and law, may continue to increase their degree of myopia during college, with an average annual increase of more than 50 degrees.[4]
So compared to undergoing myopia surgery at the minimum age limit of 18 years old right after the college entrance examination, a better choice is to confirm that the degree of myopia has been stable for two years before considering surgery.
4 Severe dry eye condition When tear secretion is insufficient or the quality is poor, postoperative dry eye symptoms may be exacerbated, so it is necessary to first undergo targeted treatment, and consider surgery after the condition stabilizes.
Reports in the literature indicate that among myopic patients in China, 40% have dry eyes, so it is important to check for dry eye-related signs before surgery.[5]
5 Active ocular inflammatory/disease conditions not under control For example:
●
●
●
The above are not suitable for myopia surgery.
6 Pregnant and lactating women Due to fluctuations in hormone levels, corneal healing may be affected(postoperative corneal protrusion incidence may increase), and postoperative visual stability may also be disrupted.
7 Limitations due to profession or lifestyle For example, military personnel, pilots, aviation security officers, etc., currently do not accept personnel who have undergone ICL implant surgery. These professions only allow myopia correction through laser corneal refractive surgery, and the postoperative time must be at least 6 months, with both eyes’ uncorrected distant visual acuity reaching or exceeding 1.0, while the refractive degree remains stable.
Divers, boxers, and other high-pressure sport practitioners are not suitable for myopia surgery because the cornea is prone to deformation due to external forces after surgery.
8 High psychological expectations/sensitive to pain Although most people believe that the pain during and after refractive surgery is negligible, research shows that after refractive surgery, 11% of people report persistent pain.
Patients with depression are more likely to experience intolerance to pain, or unsatisfactory visual quality after surgery.[6]
So, what complications may occur after myopia surgery?
Suffering from keratitis, conjunctivitis, iritis, uncontrolled glaucoma, fundus lesions, and other ocular diseases;
Or having unstable blood sugar (hyperglycemia affects corneal healing and increases the risk of infection) diabetes;
And autoimmune diseases (such as lupus).
What complications may occur after surgery?
1 Dry eye syndrome Mechanism:
Symptoms:
About 40% of patients experience it within half a year after surgery, most relieved by artificial tears.
2 Nighttime visual disturbances Mechanism:
Symptoms:
About 13% of patients experience at least one of the above symptoms, especially for those who need to drive at night or engage in fine work, the impact is relatively greater. However, in most cases, patients can gradually adapt to these symptoms.
The surgical process may damage corneal nerves, such as when full femtosecond laser ablation of the stroma, thereby affecting the normal secretion and regulatory function of tears.
Mainly manifested as dry eyes, burning sensation, and foreign body sensation.
A large dark pupil (>6.5mm) or a small ablation zone, light scattering leads to high-order aberrations.
Mainly manifested as glare, halos, double vision, and decreased night vision.
3 Refractive abnormalities Undercorrection/Overcorrection:
Myopia regression:
4 Other Laser corneal refractive surgery has a risk of postoperative corneal structure damage, corneal infection, and inflammation, but its incidence is relatively low, usually between 2% and 5%.[7]
If ICL implant surgery is chosen, there is a risk of glaucoma and cataracts (5%) caused by abnormal vault.
Ophthalmologists not undergoing myopia surgery themselves does not mean the surgery is unsafe, but rather due to a combination of factors, such as eye conditions, professional requirements, personal habits, etc. At the same time, it is important to objectively view the risks and benefits of myopia surgery.
Patients with myopia who wish to remove their glasses should not be overly fearful of myopia surgery due to misunderstandings, nor should they blindly pursue surgery while ignoring their actual situation. Instead, they should have strict and comprehensive examinations before surgery, and only those who meet the conditions for surgery can consider it.
It may be due to errors in preoperative refraction, or abnormal corneal healing after surgery, patients may need a second surgery for correction.
For high myopia patients (myopia degree over 600 degrees), the risk of myopia regression within 5 years after surgery is about 2.23%.
References
