March 2023

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Dr. Anat Galor on Refractive Eye Surgery

Excerpts from our conversation with Dr. Anat Galor, an eye surgeon and pain researcher at the University of Miami and the Miami Veterans Administration.

Read the story Shaping Clearer Vision: Is Eye Surgery Right for You? in NIH News in Health.

NIHNiH: At what ages can people have refractive eye surgery?

Galor: Refractive errors tend to get diagnosed around sixth, seventh, or eighth grade. Then they tend to get worse until you’re about 21 or 22. Women’s eyes stabilize a little earlier than men’s eyes.

If your refractive error is changing frequently, you’re not a good candidate for surgery. We don’t want to operate on a moving target. But in general, refraction stabilizes from somewhere in your 20s to when you start developing a cataractA clouding in the lens, the clear part of the eye that helps to focus light. in your 50s or 60s.

Another point to recognize is that as you get older, your lens starts to stiffen. Refraction may change again, but the most notable problem is that you can’t see up close like you used to. That’s called presbyopia.

So there’s a sweet spot, between the ages of around 20 and 55 to 60, where our refraction is relatively stable and surgery can be considered. But presbyopia starts to occur around age 40 and limits what surgery can achieve.

NIHNiH: What does an eye doctor take into account when deciding whether refractive surgery is safe for someone?

Galor: It depends on how healthy you are, how healthy your eye is, what your refraction is, and what the shape of your cornea is.

We’re looking for healthy eyes. So an eye can’t have abnormalities like scars or swelling. And we need the cornea to be thick enough that they can take the changes that we’re going to make, without the cornea becoming unstable. The shape of the cornea also matters. If you have something called ectasia, where your cornea is already a funny shape, you are not a good candidate for surgery.

And we’re looking for people who can heal well. So things like systemic diseases that can affect your eye, like diabetes that isn’t controlled, can make refractive surgery unsafe.

NIHNiH: How are researchers looking to make refractive eye surgery safer?

Galor: We believe it’s a great surgery, but we need to do better at identifying those people who aren’t great candidates. Most people are very happy that they had refractive surgery, but a minority are super unhappy for a variety of reasons. They may be unhappy about their visual quality after surgery or because they develop persistent eye pain. So we want to identify who those people are before they have surgery.

So that’s what my colleague Dr. Sue Aicher and I are working on, identifying factors, both clinical ones and proteins that we can measure in tears, that will tell us: Don’t operate on this patient.

We also think we can improve the ways we treat people who feel dryness or pain in their eyes after surgery. Those people fit into two different categories. Some people’s eyes are actually dry, and they can be treated as dry eye. Others, their eyes feel dry, but when you look at them, they don’t look dry.

When you perform refractive eye surgery, you are damaging nerves. But most of the time the nerves recover. But sometimes they recover in a way where they’re more sensitive than they were before. And they start firing. And so this may cause some people’s eyes to feel dry even if they’re not. And we think we can improve the ways we treat those people by targeting their nerves and making them less sensitive.