What are the best treatment options for high myopia with high astigmatism?

Doctor's Answers 4

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Dr Daphne Han

Ophthalmologist

Depending on your corneal measurements, you may still be eligible for corneal refractive surgery such as Lasik extra or smile, provided your power is stable for at least the past 1 year. In Singapore, in general, age of eligibility for cornea refractive op is above 21 year old. From 18-21 year old, on a case by case basis, it can still be done.

If your corneal measurements are inadequate for lasers, implantable contact lens (ICL) can be considered. In general, ICL causes less side effects like dry eyes and glare/halos that are more commonly associated with lasers. It however has its own set of pros and cons. I generally offer ICL for suitable patients above 21 year old.

At 17, such high degrees can indeed be quite cumbersome. I hope you are coping with glasses or contacts for now.

I hope you find a good solution for your refractive errors that will allow you to pursue the life that you want. Best wishes!

Dr Han

The first priority is to wait till you are at least 18 years of age before considering any form of refractive surgery. Children (including teenagers) should generally avoid any refractive surgery as their eyes are probably yet to have matured and may still experience significant changes in refractive errors.

It would be imperative that your refractive error is no longer increasing to ensure that your post m-operative results remain stable.

In terms of your current level of myopia and astigmatism, I would only recommend implantable collamer lens (ICL) as a viable option, provided there is sufficient space within the eye to accommodate the ICL.

Lasers (e.g. PRK, LASIK and ReLEx SMILE) at these high levels may not provide sufficient long term stability and there may be a higher chance of certain complications such as dysphotopsia (haloes & glares) and corneal ectasia.

Dr David Chan

Photo of Dr Claudine Pang
Dr Claudine Pang

Ophthalmologist

I agree that you are definitely eligible for LASIK refractive surgery if your corneas are thick enough or implantable contact lens (ICL) if your corneas are thin. Both refractive procedures should be done after the age of 21 years old or when your degree is deemed stable and no longer changing.

At the same time, I wanted to share that I have seen many young patients with degree as high as yours who have other retinal problems such as asymptomatic retinal holes/tears/schisis, glaucoma, cataract and myopia degeneration without knowing. My advice would be to have an annual eye check with a good retinal doctor to pick up any retinal problems that can be treated, early rather than late. The risk of a sudden retinal detachment is higher in those with high myopia.

Seek ways to maintain the health of your eyes and retina, while you are young! This also prevents your myopia from progressing further. Some quick tips:

1. Have good reading habits including posture and lighting!

2. Don't rub your eyes as that exacerbates astigmatism!

3. Take frequent breaks (5mins break every 45 minutes)!

4. Avoid excessive screen-time, or use a blue light filter to cut down eye fatique!

Hope that helps!

Dr Claudine Pang

Hi Kenneth

As the other doctors have pointed out, refractive surgeries such as LASIK and Implantable Collamer Lens (ICL) surgery are generally done for people who are above 21 years of age, and on a case by case basis for those between 18-21 years of age depending on stability of spectacle power.

Having said that, the 2 main treatment options for high myopia and high astigmatism would generally be LASIK and ICL surgery. What would be most suitable (or 'best') would depend on the particular patient's characteristics eg spectacle power, corneal thickness, size of eye (anterior chamber depth), etc.

In general, where the cornea is thick enough and the spectacle power low enough to allow an 'acceptable' treatment zone with LASIK, that would be my preferred choice. A treatment zone that is large enough, minimizes visual problems like halos and glare, and LASIK in general can be considered a 'simpler' and 'less invasive' procedure than ICL surgery.

However, there are patients where lasering an 'acceptably' sized treatment zone would result in a cornea that is dangerously thin (ie patients with very high spectacle power or thin corneas). In such cases, it would be preferable to have ICL surgery that preserves corneal integrity and still provides very good visual quality after surgery.

It is quite likely that someone with your spectacle degree would do better with ICL surgery than LASIK, but you can only find out for sure after undergoing tests such as a cyclorefraction (spectacle power check with pupil dilation), corneal topography and anterior chamber depth measurement.

Since you are still too young for surgery, try to observe good habits which may help to stabilize your shortsightedness. Most importantly, try to spend time outdoors while there is still sunlight 1-2 hours everyday, and hopefully this is as high as your spectacle power ever gets!

Similar Questions

Will the outcomes of LASIK be worse if I have high myopia?

For high myopia close to 1000 degrees, the option of which refrative surgery technique to choose depends on a few factors: 1) How thick is the cornea Thick corneas with regular features may be worth a shot with LASIK (or LASIK EXTRA or SMILE for more stability of power in the long run). However, as the cornea will be made thinner with all of these laser-based procedures, you may not have adequate tissue thickness left for future enhancement should there be regression of myopia, which can still happen even if LASIK EXTRA or SMILE was chosen.

Photo of Dr Daphne Han

Answered By

Dr Daphne Han

Ophthalmologist

What are possible solutions regarding treatment/enhancement of poor ReLEx® SMILE® surgery results?

Thank you for the extensive information. Let us address the issues one at a time. With regards to enhancement surgery following ReLEx® SMILE®, it is usually enhanced by way of PRK as the prescription to correct by then is usually low. PRK, in this case, is able to offer distinct advantages for lower prescription for example, the benefits of a flapless treatment are preserved. LASIK may also be a possible method, however, it involves the creation of a flap which does have its own disadvantages.

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