Myopia surgery in Paris
Myopia surgery is a common procedure, most often performed using a laser with LASIK and PRK techniques. In cases of high myopia, surgery can also be performed using phakic intraocular implants, or, depending on the patient’s age, by lens extraction surgery. For all these techniques, any associated astigmatism can be corrected during the same surgical session.
Learn more about other vision issues
Astigmatism
Presbyopia
Hyperopia
Laser surgery for myopia (LASIK, PRK)
The underlying principle of myopia is that the eye is slightly too long. Light rays entering the eye focus in front of the retina, resulting in blurred vision.
Laser surgery for myopia, using LASIK or PRK, involves excimer laser photoablation of a superficial layer of the cornea. For both techniques, the ablation profile (the area of the cornea treated) is the same: the laser sculpts the central corneal stroma to make it more concave, thereby decreasing the cornea’s refractive power. As a result, light rays focus directly on the retina rather than in front of it, restoring clear vision.
In both LASIK and PRK (classic or transepithelial), the cornea is treated in the same way, and the outcomes are equivalent. The difference lies in how the corneal surface is accessed:
- LASIK for myopia: A thin corneal flap, 90 to 110 microns thick, is created—like a lid that is lifted to access the underlying corneal layers for laser treatment. At the end of the procedure, the flap is repositioned, leaving the corneal surface intact. Vision becomes clear within a few hours, and the postoperative period is painless, with only mild discomfort such as burning and tearing for 2 to 4 hours.
- PRK for myopia: A thin layer of the cornea—the epithelium, about 50 microns thick—is manually removed. This allows access to the corneal layers to be treated with the laser. At the end of the procedure, a contact lens is placed on the eye to guide healing and reduce postoperative pain. Healing causes discomfort, which may be painful, lasting 2 to 3 days, and vision gradually returns as the cornea heals over the following week.
- Trans-epithelial PRK (Trans PRK): In this technique, derived from classic PRK, the epithelium is vaporized directly by the excimer laser in a first phase lasting a few seconds, before the myopia treatment. The advantage is that it is a no-contact technique, and healing is faster and less painful than with classic PRK.
The choice between these techniques is made during the preoperative assessment, based on clinical examination and additional tests.
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Myopia surgery with phakic intraocular lens implants
If myopia is too severe to be treated with laser refractive surgery, surgery with a phakic intraocular lens (IOL) can be performed. This involves inserting a lens into the sulcus, the anatomical space between the iris and the crystalline lens, in each eye.
The STAAR laboratory manufactures the fifth-generation ICL phakic lens implant. This lens is made of collamer and can remain in the eye permanently without needing to be replaced. The material is safe and well-tolerated. The first phakic lens implants were placed in the 1990s, and currently, 200,000 phakic lens implants are placed worldwide each year.
STAAR’s ICL phakic lens implants can correct myopia ranging from -0.5 to -18 diopters and, if necessary, associated astigmatism from 0.5 to 6 diopters. They feature a central hole (Central Flow technology) that allows aqueous humor to circulate, eliminating the need for an iridotomy.
Myopia surgery by lens extraction
Lens extraction surgery for myopia is preferred in patients over 60 years of age. Whether for clear lens extraction or cataract surgery, the principle is to remove the natural crystalline lens and replace it with an implant, or artificial lens.
The power of the implant is chosen based on the eye’s biometric data, allowing prediction of postoperative vision. Thus, the pre-existing refractive error can be corrected during surgery.
For myopic patients, several correction options are available:
- Monovision: The dominant eye is corrected for distance vision and the non-dominant eye for near vision. This allows the patient to see both far and near without glasses. This is a proven solution, often used in presbyopic myopes with contact lenses.
- Multifocality: For mild myopia, multifocal (trifocal diffractive) implants can be used, enabling each eye to see both far and near without glasses.
Frequently asked questions about myopia surgery
Does myopia surgery require general anesthesia?
No, not at all. Regardless of the chosen technique (laser, phakic implants, lens surgery), the procedure can be performed under local anesthesia, with lidocaine eye drops. For laser procedures, the patient must be conscious, but anxious patients may request mild sedation or brief general anesthesia. These details are discussed during the preoperative process.
Is it possible to operate on both eyes on the same day, regardless of the chosen technique?
Laser methods (LASIK, PRK, and SMILE) allow for both eyes to be treated during the same session. In contrast, implant placement (phakic or lens implants) requires two separate procedures, usually spaced at least one week apart.
Can a child with myopia undergo laser eye surgery?
No. This would be a serious medical error. Myopia results from a mismatch between the eye’s length and the refractive power of the cornea and lens. As the eye continues to grow during childhood, it is essential to wait until the eye has reached its final size before performing laser corneal photoablation.
How is myopia measured in diopters?
The degree of myopia is quantified in diopters. The higher the number, the greater the myopia. For a given patient, the number of diopters is the inverse of the distance (in meters) at which an object is clearly seen. For example, someone who sees clearly at 50 centimeters (0.5 meters) has a myopia of 1/0.5 = 2 diopters (2D). If clear vision is at 25 centimeters (0.25 meters), the myopia is 4 diopters: 1 divided by 0.25.
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This page was written by Dr. Camille Rambaud, an ophthalmologist based in Paris and a specialist in refractive surgery.
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