Have Thin Cornea & want Refractive Surgery?

Being told that your corneas are “too thin for LASIK” can be worrying, especially if you were excited about getting rid of glasses. Thin cornea, however, does not always mean surgery is impossible. Even with their thin corneas, with the correct tests and newer technology such as surface laser treatments and ICL, a large number of patients can safely cut or completely remove their reliance on spectacles and contact lenses.

The front part of your eye that is clear and dome-shaped, which aids in focusing the light, is known as the cornea. It is thin in microns and different in individuals as height or weight.

When the cornea is excessively thin, a laser surgery will result in thinner cornea after ablation, thus making the cornea too weak, and this can lead to more complications, such as corneal ectasia (progressive bulging). This is why the knowledge of your corneal thickness is one of the most critical safety precautions that you need to have in place before configuring any laser vision correction. Thin Cornea is not a disease in itself, but it changes the kind of refractive surgery that can be safest for you.

Why Standard LASIK May Not Be the Best Choice

The surgeon in the conventional LASIK will cut a thin flap on the cornea and then proceed to use a laser to correct your vision by reshaping the tissue beneath the flap. This implies that a portion of the tissue is employed in the flap and the other part is extracted to repair the power.

In case the cornea is already thin or your number is very high, standard LASIK can cause too little tissue to remain, and this can weaken the cornea with time. To this end, most advanced surgeons will not use flap-based LASIK with thin corneas and instead prescribe alternatives that either consume less or no corneal tissue.

Safer Refractive Options for Thin Cornea

There are three main categories of procedures commonly considered for patients with thin corneas: surface laser treatments, ICL, and selected special techniques.

1. Surface Ablation (PRK, TransPRK, and SmartSurf)

Surface ablation means the flapless procedures to save cornea tissues. The following are the types:

• PRK (Photorefractive Keratectomy): This is an obsolete method of flapless procedure. In PRK, no flap is created. Instead, the thin outer skin of the cornea (epithelium) is gently removed by brush or alcohol, and then the laser is applied directly on the corneal surface. The epithelium then grows back naturally over a few days, like a healing skin layer.
• TransPRK / SmartSurf (No-touch surface laser): TransPRK and SmartSurf are the latest and advanced, flapless “no-touch” versions of surface ablation where the laser removes the epithelium and reshapes the cornea in a single step. No blades or surgical instruments are touching the eye; everything is done by the laser.

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2. ICL (Implantable Collamer Lens) – No Corneal Tissue Removal

ICL surgery follows a totally new path. A thin and flexible lens is inserted in the eye behind the iris and in front of the natural lens, instead of reshaping the cornea. Imagine that it is a permanent contact lens that is permanently put into the eye, but inside it, instead of being applied to the surface.

Advantages of ICL for thin cornea include:

• Corneal thickness and strength are preserved.
• High degrees of myopia and astigmatism can be corrected safely in many cases.
• The lens can be removed or changed later if needed, making the procedure reversible.
• Quality of vision is much better post surgery.

Save Sight Centre offers ICL surgery for patients with thin corneas where laser options are limited or less safe.

3. Special Surface and Combined Approaches

Certain cases of thin cornea have been selected, and surgeries such as Epi-LASIK or well-thought-out topography-guided surface surgery can be considered. They are designed to fit certain patterns of the cornea, and they are based on the high-quality imaging and skilled judgment of the surgeon.​ In eyes that have early corneal weakness or irregularity, the doctor can also talk of corneal cross-linking of collagen in order to make the cornea stronger, usually with some limited laser correction. It’s best to discuss this with the LASIK specialist regarding this.

How Save Sight Centre Evaluates Thin Cornea Patients

For anyone with a suspected thin cornea, the evaluation is more detailed and careful. Common tests include:

• Corneal thickness measurement (pachymetry).
• Corneal topography or tomography to assess shape and rule out conditions like Keratoconus.
• Tear-film and dry eye assessment.
• Complete eye examination, including retina and eye pressure.

Based on these findings, the doctor at Save Sight Centre will help you understand whether:

• A surface laser (PRK/TransPRK/SmartSurf) is safe and suitable.
• ICL is a better choice due to the thin cornea and higher power.
• A combined or staged approach is needed, or if continuing with glasses/contacts is the safest plan for now.

Recovery: What You Can Expect

Recovery depends on which procedure is chosen for your thin cornea:

PRK / TransPRK / SmartSurf

• Mild discomfort in the first few days, with watering, light sensitivity, and foreign body sensation.
• Functional vision usually returns in 3-4 weeks and then keeps sharpening over the next few weeks.

ICL surgery

• Vision often improves noticeably within the first 24-48 hours.
• Mild glare or halos may be noticed initially and usually reduce with time and follow-up care.