There are patients that experienced and ethical surgeons advise against LASIK surgery. These are patients presenting with visual errors which lie outside the range of LASIK treatment where removing the necessary amount of corneal tissue would have a destabilising influence on the health of the cornea.
There are other refractive surgery methods which are able to treat these people with very high refractive errors.

1.) Intraocular Lens implant. (ICL, Artisan, Nuvita)
2.) Bioptics (the combination of an Intraocular laens implant and an insueing LASIK)
3.) CLE (Clear Lens Exchange)

ICL implants and Bioptics are a good option for younger patients with high refractive errors, as their intraocular lens is elastic and it´s accommodation enables them to focus clearly at a reading distance. The fact this natural lens remains in place, these patients have the chance to free themselves from spectacle or contact lens dependance.
Patients who are treated by means of a clear lens exchange are traditionally over 40 years of age who have lost, or are loosing this ability to focus at a near. Their intraocular lens has lost it's inherent flexibility, making it necessary for them to use spectacles for reading. CLE is also an option in those patients who are starting to show signs of a cataract developing in their natural lens, where a lens exchange in the short to medium term would be expected.

Surgical Correction of High Refractive Errors of the eye

Lens implant in the phakic eye:
In contrast to laser refractive surgery (i.e. LASIK) where treatment takes place on the surface of the cornea, the implantation of an artificial lens involves the surgical opening of the eye. In this procedure, a 5 mm long tunnel like incision is made at the upper border of the cornea and sclera of the eye in a manner which allows this hole to self heal at the end of the procedure, which in most cases removes the need for stitches. This operation takes place in a sterile environment under local anaesthesia and requires around 20 minutes.

The implantation of an intraocular lens in addition to your own healthy lens (Lens = phakos in Greek) can be carried out using 2 methods. The lens is always implanted in front of your own intraocular lens, and is called an anterior chamber lens (or implant) if it is implanted in front of the Iris, or a posterior chamber lens if implanted behind the Iris (between the Iris and your lens). All lenses are made from high quality biocompatible and flexible materials.

The Artisan and Nuvita lenses are anterior chamber lenses that can correct shortsightedness from -10 to -20 dioptres, and longsightedness from +3 to + 8 dioptres. It is vital the anterior chamber is deep enough to fit these lenses, and great care needs to be taken in inserting them as there is a risk of damaging the very sensitive back surface of the cornea.

The ICL (Implantable Contact Lens) is a posterior chamber lens that can correct shortsightedness between -12 and -18 Dioptres, and farsightedness over +4 Dioptres. It still very debatable if an ICL can induce the early formation of a cataract. Should this occur then both lenses can be replaced with a clear artificial lens.

CLE (Clear Lens Exchange)

This refractive surgery procedure involves the replacement of the patients own clear intaocular lens with a lens implant. This is the same as cataract surgery (exchange of an opaque intraocular lens), and is indicated as the treatment of choice should the already discussed forms of refractive surgery not be applicable.This is in cases of very high refractive errors such as shortsightedness over -20 and longsightedness over +8 Dioptres.

The CLE operation is primarily carried out under local anaesthesia and has a duration of around a half hour,. It consists of 2 steps and the entire operative procedure is carried out using highly specialised surgical instruments.

In the first step the patients intraocular lens is removed. A 2,8mm peripheral incision is made through which the anterior capsule of the patients intraocular lens is reached and then opened in a circular manner. The patients lens is then broken up through ultrasound vibrations (phaco-emulsification) and sucked out under vacuum through this same hole.

The lens implant is then introduced through this hole and "injected" into the now empty lens capsule. The implant is durable enough to last for a life time, and it's refractive power is calculated before the operation by means of precise ultrasound measurements.

Modern surgical lens exchange techniques require that the remaining lens capsule is left in place to provide support for the lens implant. This may in some cases develop fine opacities, which is commonly termed a "secondary cataract" and can then be removed by using the YAG-laser. When carried out by a competent surgeon, complications are fortunately very rare, and when present can in most cases be managed successfully.