Opinion: there is still a risk associated with corrective eye surgery and future advances in safety may lie in our genetic makeup

It's been 30 years since the first laser vision correction procedure was carried out to remove the need to wear glasses or contact lenses. Since then, second and third generation technologies have entered the eye clinic and have become the standard for most eye care professionals in diagnosing and treating their patients.

In fact, cataract and vision correction procedures are now the most performed health improvement surgery in many countries. In the UK alone, it is estimated that over 75,000 vision correction procedures are performed per year, with well over 500,000 cataract surgeries per year. Tens of millions of patients have benefited worldwide from these types of eye surgeries in terms of clearer vision and reduced costs associated with a lifetime of wearing glasses and contact lenses.

Given the extreme advances in the hi-tech industry of refractive surgery, you might be wondering where the next big breakthrough could lie. There is still a risk associated with those going for corrective surgery, and Ulster University researchers believe that future advances in safety and disease prevention lie in our genetic makeup.

From RTÉ Radio 1's Today With Sean O'Rourke Show, eye surgeon Dr Billy Power on laser eye surgery

Each of us has a unique genetic makeup which makes us who we are. Based on genetic variations within an individual’s DNA, what if an eye doctor could predict well in advance the outcome of the surgery, based on whether the patient was destined to develop a certain eye disease? What if their patient’s DNA code holds the knowledge to suggest what activities, treatments and surgeries should be avoided or indeed advised to curtail the development of certain eye disease?

There lies the potential for doctors to give their patients more options by understanding which genetic mutations can be associated with certain diseases. Avellino offers a test that does just that and detects the mistakes in our DNA that cause TGFBi corneal dystrophy. This inherited eye condition causes accumulation of proteins in the eye, leading to vision impairment in affected individuals.

We carry around 3 billion "letters" in our DNA and just one wrong letter in the TGFBi gene means you will develop corneal dystrophy. This disease may not manifest until we reach 30 to 40 years of age and we don’t even know we have it. But simple things ranging from a scratch on the eye or surgery cause it to surface and when it does it is blinding with no cure. The only solution is a corneal transplant once you cannot see.

From RTÉ Radio 1's Arena, Sonya Kelly's essay about looking for advice from a doctor about possible eye surgery

The Avellino test is available worldwide and is really accessible as it involves simply taking a swab from inside the cheek. Within a few days, the result can tell if you have any of the DNA "mistakes" known to cause this eye disease. For relatives of patients that are already diagnosed with this disease, this genetic test could be the key to enrolling family members into a monitoring program for the disease or seek preventative treatment of their own, should they have similar DNA mistakes to their diagnosed family member.

A very important application for the test will be for those considering refractive surgery or undergoing certain eye operations. Research has shown that those with these particular DNA "mistakes" could face catastrophic consequences when undergoing corrective surgery, ultimately threatening their sight. These surgeries for vision correction to be spectacle or contact lens free can essentially bring on changes in the eye that will lead to earlier onset or worsening of this eye disease in those patients who carry certain DNA mistakes.

Moving above and beyond the routine physical and imaging tests, the genetic test could impact the decision for a patient on whether or not to have surgery for vision correction. In addition, knowing the details of each patient’s genetic code with regards to the health of the eye could also change the procedure an eye doctor offers or how he performs it.

Research has shown that those with these particular DNA "mistakes" could face catastrophic consequences when undergoing corrective surgery

After testing over 800,000 individuals worldwide, the importance of pre-screening DNA of all refractive surgery candidates before offering eye surgery has become clear. This will allow the best possible clinical decision: a personalised medicine approach to eye surgery which ensures the best possible outcome and saving the vision where possible. The take home message is, if you are considering having refractive eye surgery, check your DNA first.


The views expressed here are those of the author and do not represent or reflect the views of RTÉ