Talking to Prof. Rafael I. Barraquer on ophthalmology and eye surgery. A clear and concise run-through of the questions that most concern patients.

What is refractive surgery? Must it always be carried out with a laser? What are the latest innovations?

Refractive surgery is the surgical correction of refractive errors (optical), myopia, hypermetropia and astigmatism. It is performed on the cornea, normally with a laser, or through the insertion of a lens implant into the eye, depending on the circumstances. Different types of lasers are used ranging from those that sculpt the tissue like the Excimer laser to those that make micro- incisions like the Femtosecond laser. There are constant advances and innovations opening up new frontiers, perhaps one of the most current of these frontiers is presbyopia treatment.

Is there any type of surgery to correct tired eyes?

As we have already mentioned, presbyopia or tired eyes is related to refractive surgery, but there is one crucial difference: it is a dynamic error; it is the loss of the ability to change the focal point (from far to near, to read, etc.). This is what makes it difficult to correct, since conventional refractive surgery only has a static effect. We see it reflected in a large number of techniques, which do not all have the same level of effectiveness or the same indications. Roughly speaking, the only type of surgery that completely makes up for it—yet still does not restore the function the patient had as a twenty year-old—is the replacement of the crystalline lens (with or without cataract) with a multifocal intraocular lens.

Are cornea transplant operations frequent? Are there many cornea-related diseases?

The cornea is the main lens in the eye and its window to the world outside. Many diseases and external aggressions may lead to a loss of transparency or optical quality. Given that its repair capacity is limited, in many situations its function can only be regained via a transplant. The most frequent causes include degenerative diseases such as keratoconus, endothelial failure and scars or "leukomas" left by infections or trauma.

Does strabismus only occur during childhood? Does it always require surgery?

There are many types of strabismus, ranging from congenital ones to those appearing during childhood or adulthood. It depends on the case itself, but they may or may not require surgery. One of the most frequent types of strabismus during childhood is due to a refractive problem and it can often be corrected by using glasses, following your ophthalmology specialist’s guidelines, of course.