Current status of refractive surgery 

A. Surgery on the cornea:

Scratches: good for pure myopia up to -3 to -4 on the age of 20y (age of 40j : to - 5) / price: 370€  little pain / good view after 1 day , the refraction is almost certainly between -1 and +1  / the other eye is treated after 1 week / not good for astigmatism
Normal excimerlaser: good from -1 to -8 (also for astigmatism (= cylindric glasses) / price: 1000€  / some pain / good view after a fiew days - weeks/ result between - 1 and +1 in 85 % of the cases / retreatment is possible but very painfull/ the other eye is treated after 1 week - 1 month
Excimer laser under corneaflap ("LASIK-procedure "): good between +3 and  -12(even if there is astigmatism  (= cylindrical glasses)  - this replaced the normal excimerlaser because of the many benefits!: no pain / good vision after 1 day / result between-1 and +1 in 85 % of the cases /  additional treatment is easy and painless, because the flap can be detached very easily / the other eye is treated after 2 - 7 days / only the price is higher: 1.125€ 
 

B. Surgery in the eye

clear lensextraction  (= cataractextraction without  a cloudy lens): good for very hight refraction abnormalities (- or +) with patiënts over 40y  (because reading glasses are necessary after this surgery  - on the age of 40 everyone needs readings glasses and it is more acceptable !) / they pay the operation back for a part / the next day the vision is good  / the other eye is treated after 1 week / when the strength isn't good, the lens can't be changed easily, but can be chosen for a corneal refractive technique ( such as scratches for residual myopia), for addition correction. Optionally an addition lens can be applied
Intra-oculair contactlenses  (= implantation of an extra lens above the own lens):
good for large refraction-abnormalities (- or +) with patients under 40y (there is no reading glasses necessary after the surgery!) / they pay a part of the operation back /very fast good vision / the other eye treated after 1 week / when the strength isn't good we can replace the lens easily. Two types are distinguished: " harde " iris-claw lens, that is fixed on the iris or  a "soft" intra-oculair contactlens, that is palced on the own lens (price: 1.125€ cfr lasertreatment). Because we have many experience with the iris claw lens, most people choose for this. The soft lenses give cataract fast (in the first test results).
 

Decision:

     - less than 20y: contactlenses
     - between 20 and 40 year: 
          - more than +3: hard lens implant
          - between  +1 and +3: lasik
          - between -1 and -3: scratches are possible but not ideal - when the price is important
          - between -1 and -10: lasik - more predictable than scratches- the eye is less vulnerable  
           * both eyes are lasered at the same time, unless the patient wants it otherwise!
          - above -10: implant of a hard contactlens
          * astigmatism can only partly be solved with scratches and implant contactlenses
     - more than 40 y:

Clear-lens-extraction for all high refraction disorders ( - and +) is possible. Astigmatism is a little bit difficult especially against the rule - astigmatism. Afterwards reading glasses are necessary. Also for far distance glasses are necessary (because the goal is usually a mild myopia). This correction is always lighter than before and the patient can function without glasses!

NOTE: surgery to eliminate reading glasses is possible but is still experimental !!