Limbal Relaxing Incision

6 sources cited
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What is a Limbal Relaxing Incision (LRI)?

Limbal Relaxing Incisions (LRIs) are partial incisions made on the limbus, the outer edge of the cornea, to correct refractive errors due to astigmatism.1 Astigmatism is a condition characterized by an irregularly curved cornea. 

Instead of the usual round shape, the cornea may have an oval shape. This affects how light is refracted and causes blurry or distorted vision.

Limbal Relaxing Incisions treat astigmatism by flattening the steep corneal curvature, making it more evenly round. This allows the lens to better focus light on the retina for good vision.

Most people seek LRI to eliminate the need for glasses or contacts. LRI can be performed during cataract surgery, after corneal transplantation, or when the ideal intraocular lenses (toric IOLs) are unavailable.2

Who is a Candidate for LRI?

A surgeon will perform initial eye exams to determine if LRI is the best option. The ideal candidate should be:

  • At least 50 years or older
  • In good health with no underlying issues
  • Free from eye infections
  • Diagnosed with mild to moderate corneal astigmatism
  • Set for cataract surgery and ready to correct their astigmatism
  • Wanting to eliminate the need for contact lenses or prescription glasses
  • Experiencing residual astigmatism following previous surgery
  • Developing realistic expectations.

How Much Does LRI Cost?

Compared to other refractive surgeries for astigmatism, such as LASIK and toric IOL, LRI is relatively cost-effective. 

However, the procedure is considered an elective, and therefore, insurance is unlikely to cover the costs. 

On average, expect to pay about $700 or more per eye. This cost may vary based on your location, available facilities, and the surgeon's experience. 

Talk to your eye doctor and insurance provider to determine the exact cost before committing to the surgery.

LRI Procedure: What to Expect

LRI is an outpatient procedure performed under local anesthesia. No stitching is required, and you'll be able to return home on the same day. Before the surgery, your doctor will carefully evaluate your medical history and eye health to determine your suitability for LRI. 

Then, using special computer technology, they will create a topographic map of your eye to guide the procedure. 

Preparing for the Procedure

Like any surgery, preparation is important. Plan to be at your surgery center at least 1 hour before the scheduled time for the surgery. Once you arrive at your doctor's office, you'll sit on a reclining chair, and the surgeon will prepare your eyes for the procedure. 

They will first clean the eyes and place a drape around them to reduce the risk of surgical site infection (SSI).3

Next, they will administer a numbing agent to help you relax and prevent discomfort during surgery. Finally, they will use an eye speculum to hold your eyelids and prevent blinking during the procedure. At this point, you'll be ready for surgery.

Procedure Steps 

Before making incisions, the surgeon will make temporary marks on the limbus (where the cornea and the sclera meet). The marks indicate where they will make the tiny incisions. The location is based on age and the level of correction required. 

Using a sharp blade or a femtosecond laser device, your surgeon will proceed to make the small, arc-shaped incisions to relax and flatten the corneal curvature. 

Today, surgeons prefer laser-guided surgery to blade surgery because it offers more accuracy and reduces the risk of complications such as overcorrection or undercorrection.4 

While making the corneal relaxing incisions, a laser-guided measurement system provides real-time evaluation of your vision changes, helping them achieve the desired vision correction. 

No stitches are required, and the entire procedure takes about 30 minutes. You may need a 30-minute post-surgery evaluation to ensure everything is okay.

Aftercare & Recovery 

Following the LRI procedure, your surgeon will provide you with some post-op care instructions to ensure successful recovery:

  • Avoid swimming in pool water or hot tubs for several days after surgery. You can resume your showering routine 24 hours after surgery.
  • Avoid eye makeup for at least 24 hours after surgery.
  • Avoid rubbing your eyes as it may cause further irritation and possible complications.
  • Take medication as prescribed. 

Most people can return to work and other activities the day after LRI. Vision will significantly improve within 24 hours after surgery, although temporary blurriness may occur for several days.

Following your doctor's advice will reduce recovery time and prevent severe side effects or complications.

What are the Side Effects & Risks of LRI? 

Some people may experience mild pain and post-operative discomfort. These can be managed with over-the-counter (OTC) pain medication such as acetaminophen (Tylenol) if necessary.5 

Other minor side effects include:

  • Swelling
  • Tearing
  • Light sensitivity (photophobia)
  • Red eyes
  • Temporary blurry vision

Risks of LRI

LRI is low-risk for serious complications. However, potential risks of LRI include:

  • Eye infection
  • Corneal perforation
  • Decreased corneal sensation
  • Overcorrection
  • Under-correction

If you're unsatisfied with your refractive outcomes, discuss corrective techniques that can improve outcomes with your surgeon.

Outlook & Success Rates

Limbal relaxing incisions are minimally invasive, safe, and effective for most people. According to research, LRI has a 96% success rate in treating cataract patients with visually significant astigmatism.6

The procedure is also less costly compared to similar ones like toric intraocular lenses. However, LRIs are surgeon-dependent and cause some variability and unpredictability.

Summary

Limbal Relaxing Incisions (LRIs) are partial incisions made on the peripheral cornea (outer edge of the cornea) to correct refractive errors in astigmatic people. The incision flattens the cornea to achieve the ideal shape for refracting light and improving vision.

The procedure is minimally invasive and safe, with few minor side effects and little downtime. Furthermore, corrective techniques are available in the case of unsatisfactory outcomes.

6 Cited Research Articles
  1.  Bronner A., “Steep Competition: LRIs vs. Toric IOLs,” Review of Optometry, 15 Mar. 2012
  2. Monaco G., and Scialdone A., “Long-term outcomes of limbal relaxing incisions during cataract surgery: aberrometric analysis,” Dove Medical Press,  31 Aug. 2015
  3. AST Standards of Practice for Surgical Drapes ,” Association of Surgical Technologists (AST)
  4. Gapinski K., “The State of the Art in Astigmatism Correction,” Outpatient Surgery Magazine, 03 Mar. 2015 
  5. Over-the-counter pain relievers,” National Library of Medicine, 01 April 2022
  6. Israel R., “Limbal Relaxing Incisions Made Simple,” OphthalmologyWeb, 27 Aug. 2008
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