Myopia surgery in Toulon: laser and implant (refractive surgery)

The expert’s view on myopia surgery

Myopia surgery is the most commonly performed refractive procedure in the world. In Toulon, I offer all modern techniques, but PRK remains my technique of choice for the majority of patients: simple, fast, effective and almost risk-free, it causes less dry eye than LASIK and gives excellent visual results. LASIK keeps its place for patients under professional time pressure, ReLEx SMILE for those who want a minimally invasive approach, and the ICL phakic implant for high myopia or thin corneas. The choice is made during the assessment, based on your cornea, your age and your lifestyle.

Dr Hugo Bourdon

Definition — Correcting distance vision with laser or implant

Myopia surgery is a refractive procedure aimed at lastingly correcting a refractive error of the eye. Two main families of techniques exist:

• Laser techniques — The laser reshapes the curvature of the cornea to make it flatter, which repositions the focal point onto the retina.
• Implant techniques — A concave lens is inserted into the eye (without removing the natural lens for the ICL, replacing the natural lens for the PreLex) to refocus the light beam onto the retina.

What is myopia?

La myopia is a refractive error characterised by blurred distance vision, while near vision remains sharp. It is caused either by excessive corneal curvature, or by an eye that is too long (axial myopia, the most common): light rays focus in front of the retina, which makes the image blurred.

Why and when to operate on myopia?

Myopia surgery is indicated when the myopia is stable for at least 2 years and you are at least 18 years old (ideally 21). It aims to reduce or eliminate dependence on glasses or contact lenses, and to improve everyday quality of life: sport, work, travel and leisure.

Advantages and disadvantages of the surgery

• Advantages: considerable improvement in quality of life, independence from glasses and lenses, often rapid recovery, improved and lasting vision
• Disadvantages: cost of the procedure not covered by French state health insurance, technique choice to be individualised according to the cornea and lifestyle, possible light phenomena in the first few weeks

Pre-operative assessment — Vision, topography, OCT

Several examinations are routinely carried out at the Centre Iris in Toulon before any surgical decision:

• Refraction — Subjective measurement, and after cycloplegia, of the refractive error
• Corneal topography — Assessment of the shape, thickness (pachymetry) and regularity of the cornea — screens for early keratoconus
• Pupillometry — Measurement of the pupil in photopic and mesopic conditions (important for assessing the risk of halos)
• Cycloplegia — Temporarily relaxes accommodation to confirm the true correction
• Tear film examination — Checks for pre-existing dry eye
• Ocular biometry — Axial length of the eye, required if an implant is to be inserted
• Optical coherence tomography (OCT) — Cross-sectional images of the retina to screen for a macular complication of myopia

Contraindications to myopia surgery

Certain conditions or anatomical features contraindicate surgery or point towards a specific technique:

• Cornea too thin or irregular, keratoconus confirmed
• Age under 18 (myopia still progressing)
• Unstable or rapidly progressing myopia
• Glaucoma uncontrolled, severe dry eye, certain retinal conditions
• Poorly controlled diabetes, lupus or another uncontrolled systemic disease
• Pregnancy or breastfeeding (better to wait for hormonal stability)

Surgical techniques — Laser and implants

The techniques fall into two categories: laser et intraocular implants.

Laser myopia surgery

The laser makes the cornea flatter to correct myopia:

• PRK — The technique with the longest track record. Reshapes the corneal surface directly with a single laser. No flap risk, ideal for thin corneas and contact sports.
• LASIK — The best known. Combines two lasers: femtosecond to create a corneal flap, excimer to reshape the inner layer. Recovery in 24-48 h.
• ReLEx SMILE — The most recent. A single femtosecond laser creates a lenticule inside the cornea, removed through a small incision. Minimally invasive approach, rapid recovery.

Intraocular implant myopia surgery

Implant techniques involve inserting a concave lens into the eye. They are preferred for high myopia ou les corneas that are too thin for laser treatment:

• Phakic implants (ICL / IPCL) — The implant is inserted between the iris and the natural lens, without touching the natural lens. Suitable for patients aged 20 to 45. Reversible: the implant can be removed.
• PreLex — The natural lens is removed and replaced with a multifocal or EDOF implant. Suitable for patients over 50, it simultaneously treats presbyopia and removes any risk of later cataract.

Comparison table of refractive surgery techniques for myopia

How to choose the most suitable technique?

The choice of technique is individualised during the pre-operative consultation and depends on several combined factors:

• Severity of the myopia — Low to moderate myopia (up to -8 D) is treated with laser (PRK, LASIK, SMILE); high myopia (beyond -8 to -10 D) benefits from the ICL phakic implant.
• Corneal thickness and regularity — A thin or slightly irregular cornea points towards PRK or ICL rather than LASIK.
• Age — Before 45: laser or ICL. After 50: PreLex is preferred, as it corrects myopia AND early presbyopia, while removing the risk of later cataract.
• Lifestyle — Contact sport, a job exposed to eye trauma, intense night-time activity, prolonged screen use: each profile points towards a specific technique.
• Pre-existing dry eye — Points towards PRK or SMILE rather than LASIK.
• Professional constraints — Recovery time available (LASIK et SMILE = rapid return to work ; PRK = 5-7 days off work).

Stay — Outpatient or day-case

• Laser surgery (PRK, LASIK, SMILE) — Performed on an outpatient basis at the laser institute: 1 to 2 hours on site, immediate discharge with a companion.
• Implant surgery (ICL, PreLex) — Performed as a day case at the clinic, in a dedicated operating theatre: home the same day.

Anaesthesia — Local, rarely general

• Laser procedures — Local anaesthesia with eye drops (oxybuprocaine). The patient stays awake and cooperative.
• Implant procedures — Local anaesthesia with drops ± light sedation by the anaesthetist. General anaesthesia exceptionally, in cases of major anxiety.

How the operation is performed

Laser — PRK, LASIK, ReLEx SMILE

Laser procedures take place in a dedicated sterile room, lying on your back. The procedure differs according to the technique:

• PRK — The surgeon removes the first corneal layer (epithelium) then applies the excimer laser directly to reshape the cornea. The epithelium heals on its own within a few days under a bandage contact lens.
• LASIK — The femtosecond laser creates a thin flap on the surface of the cornea. The surgeon lifts it, applies the excimer laser to the inner layer, then repositions the flap, which adheres without sutures.
• ReLEx SMILE — The femtosecond laser shapes a lenticule inside the cornea. The surgeon removes it through a 3 mm small incision. No corneal flap, no second laser.

Implants — ICL and PreLex

Implant procedures take place in the clinic’s operating theatre:

• ICL phakic implant — A small incision on the side of the eye; the foldable implant is inserted and positioned behind the iris, in front of the natural lens.
• PreLex — The same type of incision, but the natural lens is removed (phacoemulsification) before being replaced with a multifocal or EDOF implant that corrects myopia and presbyopia.

Vision and recovery after surgery

Myopia surgery makes it possible to achieve 20/20 vision without correction in the great majority of patients (> 95% for moderate myopia). The speed of recovery depends on the chosen technique:

• LASIK and ReLEx SMILE : 24 to 48 hours
• ICL phakic implant and PreLex : 2 to 5 days
• PRK : 5 to 7 days (the time for epithelial healing)

Risks and complications

Myopia surgery is one of the safest surgical procedures in ophthalmology. Complications remain possible but rare:

• Dry eye — Usually transient (a few weeks to a few months), especially after LASIK
• Infection or inflammation — Rare, treated with antibiotic or anti-inflammatory eye drops
• Residual refractive error — Under-correction or over-correction possible, sometimes warranting an enhancement
• Glare and halos — Night-time light phenomena, especially in the first few weeks, usually transient
• Refractive regression — Partial return of myopia in about 5% of patients in the long term
• Implant-specific complications — Very rare: displacement, induced cataract, increased intraocular pressure

Cost of myopia surgery in Toulon

Myopia surgery is a refractive surgery that is not reimbursed by state health insurance. However, most complementary health insurers offer a refractive surgery allowance partially covering the cost — it is advisable to check your policy. Here are the fees charged by Dr Bourdon at the Centre Iris in Toulon:

The fees include the procedure, post-operative follow-up and check-up consultations.

Frequently asked questions about myopia surgery

Sources

• American Academy of Ophthalmology — LASIK for Myopia and Astigmatism: Safety and Efficacy
• Mayo Clinic — Nearsightedness Surgery
• NIH — Current Trends in Surgical Management of Myopia
• French Society of Ophthalmology — Refractive surgery recommendations
• European Society of Cataract and Refractive Surgeons (ESCRS) — Guidelines for myopia surgery
• QualiDoc — Myopia surgery / Toulon