Dr. Carlos Cury Jr.Ophthalmic Surgeon

Chapter 04 — Optical independence

Refractive Surgery

Correcting refractive error is an elective decision. That's why the most important step in refractive surgery happens before it: honestly determining whether the patient is truly a good candidate.

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Excimer laser platform in an operating room

The approach

The evaluation covers refractive stability, corneal thickness and regularity, ocular surface health and a retinal exam — criteria that can rule out the procedure even when the patient wants it.

Once the indication is confirmed, the technique is chosen based on the eye's profile, not commercial preference.

  • PRK

    Indicated for thinner corneas or specific profiles related to physical activity or occupation.

  • Femto-LASIK

    Flap creation with a femtosecond laser, with rapid visual recovery.

  • Presbyopia

    Personalized strategies for near vision after the age of forty.

  • Phakic lenses

    An alternative for high refractive errors or corneas unsuitable for laser treatment.

Planning

When the crystalline lens is also part of the plan

Depending on age, refractive error, the condition of the crystalline lens and the individual examination, corneal laser surgery is not always the only possible strategy.

The eye changes throughout life. In some people, particularly from around the age of 55, the crystalline lens — the eye's natural lens — begins to lose transparency or focusing capacity, which can affect both visual quality and the outcome expected from laser surgery.

Chronological age alone determines no indication. The approach is defined case by case, after a complete examination and a conversation about each patient's visual needs.

Refractive lens exchange (refractive phaco)

The crystalline lens is replaced by an intraocular lens selected for the profile of the eye and the patient's routine. It may be considered when the lens is already part of the visual problem or when the cornea is unsuitable for laser. It is an intraocular procedure with its own criteria, benefits and risks, which must be discussed individually.

What the individual assessment considers

Refractive error, cornea, crystalline lens, presbyopia, retina, everyday visual needs and overall ocular health. No single element decides on its own — their combination defines whether there is an indication and which strategy makes the most sense.

PRK, FemtoLASIK and phakic ICL remain distinct strategies

For appropriately selected patients, corneal laser techniques and phakic lenses (ICL) remain valid, independent options. There is no single best technique for everyone: there is the appropriate technique for each eye.

The patient journey

How each case is managed

  1. 01

    Rigorous screening

    A battery of tests to confirm — or rule out — the surgical indication.

  2. 02

    Personalized planning

    Choice of technique and simulation of the expected outcome for each eye.

  3. 03

    Post-laser follow-up

    Visits in the first 24 hours, during the first week and over the following months.

Frequently asked questions

Can anyone have refractive surgery?

No. Refractive stability, corneal characteristics and ocular surface health determine eligibility.

Is the result permanent?

The correction is long-lasting, but the eye keeps aging — presbyopia, for example, occurs regardless of the surgery.

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