Sehklinik

Refractive errors

Correcting a refractive error — glasses, contact lenses or a procedure?

'I can no longer see the board.' 'The menu is suddenly too small.' 'The tail lights blur in the evening.' Behind it there is almost always a refractive error — not an illness but a question of optics: the eye does not focus the light exactly where the retina lies. It can be corrected in several ways. Which one suits you is decided not by what you want but by the findings.

How the eye focuses

Sharp vision is optics, and three variables are involved in that optics. The Cornea — the clear curve right at the front — bends the incoming light most strongly and supplies the greater part of the eye's refractive power. The lens behind it does the rest, and it is the only adjustable component: by way of the ciliary muscle it changes its shape and so switches from distance to near. That ability is called accommodation. The third variable is the axial length, that is, the distance from the cornea to the retina.

For an image to be sharp, these three have to fit together. The eye does not need 'good' values, it needs values that match one another. A corneal profile that is in itself perfectly normally curved produces a blurred image in an eye that is slightly too long, and a short eye with strong refractive power sees just as sharply as a long one with weak. The tolerance is small: a difference of well under a millimetre in the length of the eye already shifts the focal point far enough for you to notice.

If they do not fit together, the focal point lies in front of the retina, behind it — or it is not a point at all. That is exactly what the word Refractive errors; the medical term for it is ametropia or refraction error means. And here is the most important sentence on this page: A refractive error is an optical finding, not a disease of the eye. A short-sighted eye is not ill, it is built differently. So nobody who manages well without correction has to be treated.

Two qualifications belong with that nevertheless. First, pronounced short-sightedness is associated with a higher risk of retinal findings — which is why the care of highly short-sighted eyes includes the regular monitoring of Retina and vitreous and not just the determination of the spectacle values. Secondly, no correction changes the shape of the eye: glasses, contact lenses and a procedure on the cornea all compensate for the optics; the eye itself stays as long as it is. Anyone who was markedly short-sighted remains so from the retina's point of view, even after a laser correction. People affected rarely hear this point, and it matters.

What changes nothing about a refractive error: eye exercises, vision training, deliberately leaving the glasses off, bilberry preparations or food supplements. There is no training that makes an eye that is too long shorter. We do not say that in order to sell you something — on the contrary, we have none of it on offer.

How you notice a refractive error — and how you do not

A refractive error does not hurt. It announces itself by detours, and many people read those detours differently for years:

  • Screwing up the eyes, to see more sharply at a distance or close up — the classic, often unconscious trick
  • Headaches and burning eyes after longer spells of screen or reading work, typically towards the afternoon
  • Reading distance grows: the phone moves further away centimetre by centimetre
  • Poor vision at dusk, glare from oncoming headlights, halos around street lamps
  • In children: sitting very close to the screen, copying from the child at the next desk, an unusual tilt of the head, waning enthusiasm for reading
  • Rapid fatigue during activities that require concentrated vision

These signs develop slowly, over months to years. That is exactly what distinguishes a refractive error from anything urgent. What does not fit a refractive error: a deterioration within hours or days, a loss in part of the field of view, distorted or wavy lines, sudden double vision, flashes of light with many new spots, pain or a red eye. Complaints like these are a finding and not a question of the strength of your glasses — they can point, among other things, to a Retinal detachment and need to be examined the same day.

And a common confusion to close with: vision that fluctuates, better at some times of day and worse at others, is rarely a refraction problem. Behind it there is often an unstable tear film — see dry eyes. New glasses do not solve that; treating the ocular surface does.

The four refractive errors

Four forms cover practically everything that comes up in the consultation. They do not exclude one another — short-sightedness with astigmatism is one of the most common combinations there is, and beyond a certain age presbyopia is added to any of the others.

Myopia (short-sightedness)

The eye is too long in relation to its refractive power; the focal point lies in front of the retina. Everything at a distance becomes blurred while near vision stays good — hence the name. It usually begins at school age, increases during growth and, as a rule, stabilises in young adulthood. How strong it becomes depends on family predisposition and, on current knowledge, also on how much time a child spends outdoors in daylight. Where it is demonstrably increasing in a child, the course can be influenced — low-dose atropine, specialist spectacle lenses and ortho-K lenses are part of myopia management, which is described on the page on short-sightedness in the section 'Myopia management in children'.

What goes beyond the glasses prescription with short-sightedness: from higher values the eye becomes not only longer but also thinner-walled. With that, the frequency of retinal holes, retinal detachments and changes at the macula rises. So monitoring a highly short-sighted eye always includes a look at the peripheral retina with the pupil dilated. Everything on short-sightedness — how it progresses, how it is corrected, and what matters in children.

Hyperopia (long-sightedness)

Here the eye is too short in relation to its refractive power; the focal point would lie behind the retina. The tricky part: a young eye can compensate for this error itself through accommodation, and often completely. The eye test then comes out unremarkable while the eye is doing muscular work the whole time. It makes itself felt not as blur but as effort: headaches, loss of concentration, burning eyes in the evening.

Over the years this capacity to compensate declines — reading then blurs first and later distance as well. In children, moreover, an unrecognised, stronger long-sightedness is one of the most common reasons for a squint and for a lazy eye in the affected eye, which is why it should be looked for early rather than waited out. What goes beyond the glasses prescription with long-sightedness: the short eye has a narrower anterior chamber angle, which raises the risk of an attack of angle-closure glaucoma — more on that on the page on long-sightedness. Everything on long-sightedness — why it is often missed.

Astigmatism (curvature of the cornea)

An ideally shaped cornea is curved equally strongly in every direction. If it is more strongly curved in one axis than in the other, no single focal point arises but a zone drawn out in length: a point is imaged as a short line, letters look distorted, light sources draw out rays. The cause usually lies in the cornea, less often in the lens. Almost every eye has a slight curvature, and it is of no consequence. Only above a certain degree does it disturb — but then at all distances, not only far away or only close up.

A regular astigmatism is corrected with cylindrical spectacle lenses, with toric contact lenses or, at a lens operation, with a toric artificial lens. The distinction between regular and irregular matters: if the curvature increases over months, if the axis changes, or if corneal topography shows an asymmetrical pattern, the question of a Keratoconus arises. That is no longer an ordinary refractive error but a disease of the cornea — and in that situation refractive laser methods are expressly not indicated. Astigmatism in detail — regular, irregular, and what that means for the correction.

From around the age of forty-five the lens loses elasticity and can no longer change shape enough for near vision. The reading distance grows, small print becomes unreadable in poor light first, and the arms become — as most people put it — 'too short'. This affects everyone without exception, including those who have seen sharply all their lives. Presbyopia is therefore not a disorder but a process of ageing, like hair turning grey.

It is often confused with long-sightedness, because both make reading harder — but the mechanism is a different one: long-sightedness is a question of the length of the eye and is often present from birth, presbyopia a question of the elasticity of the lens and comes with the years. It is corrected with reading glasses, varifocals or occupational glasses, with multifocal contact lenses, with monovision — or, if the lens is going to be the issue anyway, as part of a lens operation. Presbyopia: which correction suits which distance — and when the lens becomes the issue.

Correction options at a glance

There are four ways to compensate for a refractive error: in front of the eye, on the eye, at the cornea or at the lens. All four work — and all four have limits that belong on the table before the decision and not after it.

Glasses

Glasses are the only route of correction that changes nothing about the eye and can be reversed or adjusted at any time. They correct short- and long-sightedness, astigmatism and presbyopia, in any combination, with no risk of infection and no procedure. If the values change, you change the lenses.

Their disadvantages are practical ones: they mist up, they get in the way during sport, they narrow the field of view at the edges, and with strong corrections the lenses become thick and change the perceived size of the image. If the two eyes differ markedly in strength, that difference in size can disturb binocular vision — one of the few situations in which contact lenses have a clear medical advantage. For most people glasses nevertheless remain the most sensible solution, and they remain so even when something else is advertised elsewhere.

Contact lenses

Contact lenses sit directly on the tear film and therefore correct without distortion at the edges and without a difference in image size. They do not mist up, they do not get in the way during sport, and with strong refractive errors and with large differences between the eyes they are often the better optics. Rigid lenses can also compensate for an irregular cornea, which glasses cannot.

The price for it is discipline. Contact lenses are the only visual aid without a procedure that carries a risk of its own: infections can arise by way of the cornea, and the dangerous ones among them — from bacteria or amoebae, for instance — leave scars. Sleeping in lenses, showering, swimming, or tap water in the case are the typical triggers. Hence the same rule for everyone who wears lenses: a red or painful eye means the lens comes out and you call the same day — more on that under corneal inflammation. Anyone prone to dry eyes, or spending many hours at a screen, also often fails to reach a comfortable wearing time; here it is worth treating the ocular surface first.

Refractive laser methods

In the laser methods the cornea is reshaped so that its refractive power matches the length of the eye. The techniques in common use differ in how the tissue is reached — with a corneal flap, at the surface, or through a small incision. Which technique suits which findings is decided by the preliminary examination; the names of the methods are the last step in that, not the first.

Refractive laser surgery we do not carry out ourselves at Sehklinik. We say that openly, because it makes the advice more honest: our recommendation at this point has no commercial interest behind it. What happens here is the complete preliminary examination, the assessment of your suitability, and the ophthalmic care around a decision of that kind.

And the limits that rarely appear in the brochure:

  • Presbyopia remains. A procedure on the cornea changes nothing about the elasticity of the lens. Anyone who has laser treatment at forty still needs reading glasses at forty-five.
  • The retina's risk profile remains. A long, markedly short-sighted eye stays long. Monitoring of the retina does not become unnecessary because of it — on the contrary, they remain just as important as before.
  • Dry eyes can increase temporarily, because the corneal nerves in the treated area are affected. Anyone who already has an unstable ocular surface beforehand has to take that particularly seriously.
  • Night-vision phenomena such as glare or halos are possible, particularly with large pupils and high corrections.
  • Not every eye is suitable. A cornea that is too thin or irregular, a suspicion of keratoconus, fluctuating values, certain eye diseases and the time of pregnancy and breastfeeding argue against it.

Lens-based methods

Where the cornea is not an option or the refractive error is very high, the correction can take place inside the eye itself. Two routes are in common use: with the phakic intraocular lens an artificial lens is implanted in addition to your own; your own lens stays in place and with it part of your ability to see close up. With refractive lens exchange your own lens is removed and replaced with an artificial one — technically the same procedure as cataract surgery.

Both are operations inside the eye, with the risks of an operation inside the eye, and both belong in a thorough discussion rather than a decision made in passing. Exchanging a clear lens also removes the ability to accommodate for good — which is the reason this route is judged cautiously in younger people and plays a quite different part in the second half of life. In short-sighted eyes, exchanging a clear lens additionally raises the risk of a retinal detachment — more markedly than in an operation that is due anyway because of a clouded lens.

What is an option for whom

The overview below is for orientation, not a recommendation for your eye — that needs measurements. Above all it shows that the situation in life and the findings decide together, and not what you want on its own.

Situation in life or findingsSensible optionsWhat argues against it
A child or adolescent with increasing short-sightednessGlasses; contact lenses depending on maturity and hygiene; where progression is documented, myopia management (low-dose atropine, specialist spectacle lenses, ortho-K) after measuring the courseRefractive procedures: the values are not yet stable, and any correction would be out of date within a short time
Adults between 20 and 40 whose values have been stable for yearsGlasses, contact lenses — and, depending on the findings, a refractive method after a suitability assessmentA procedure with fluctuating values, a thin or irregular cornea, or markedly dry eyes
High short-sightedness, cornea too thin for a laserGlasses, contact lenses; after assessment, a phakic intraocular lens as a possibilityLaser methods: too little load-bearing corneal tissue would be left
Irregular cornea or suspected keratoconusRigid contact lenses; cornea-specific assessment and monitoringRefractive laser methods — expressly not here, irrespective of what you want
From about 45: the arms become 'too short'Reading glasses, varifocals or occupational glasses, multifocal contact lenses, monovisionThe expectation that a procedure on the cornea makes reading glasses permanently unnecessary
From about 55, with the eye's own lens beginning to cloudAssessment for cataract; lens surgery with a suitable artificial lens as soon as there is an indicationA procedure on the cornea that leaves the clouded lens in the eye — the problem would still be sitting there afterwards
Markedly dry eyes, many hours of screen workGlasses; treat the ocular surface first, then reassessLong contact lens wearing times; a procedure before the tear film is stable
Pregnancy and breastfeedingGlasses, contact lenses where appropriateRefractive procedures: the values can change during this time, so the assessment waits

You will not find a sentence in this table that promotes a method. There is a simple reason for that: we do not carry out refractive laser surgery ourselves — and a correction that does not fit the findings is not cheap at any price. What we offer you is the examination from which a reasoned recommendation follows.

Preliminary examination: what decides suitability

Whether a correction is an option, and which one, follows not from the strength of your glasses but from the findings as a whole. These are the points we check before any method is even discussed:

  • Stable refraction. The measured values should, over a longer period — usually at least a year — have stayed essentially the same. If the short-sightedness is still moving, a procedure corrects a state that will soon no longer exist.
  • Corneal topography and corneal thickness. The topography maps the curvature of the entire corneal surface and shows irregularities that no eye test makes visible — above all a keratoconus in its early stages. The thickness decides how much tissue may be reshaped at all.
  • Pupil size in the dark. A pupil that is wide in the dark looks out past the treated zone at its edges. That is one of the reasons for glare and halos when driving at night — and it can be measured beforehand instead of regretted afterwards.
  • Tear film and ocular surface. An unstable surface distorts the measurements to begin with, limits how long contact lenses can be worn and worsens the course after a procedure. So it is treated first and measured again afterwards, not the other way round.
  • Retinal findings with the pupil dilated. Particularly with short-sightedness: holes and thin patches in the peripheral retina need to be found before anything else is planned. More on that under Retina and vitreous.
  • Intraocular pressure, optic nerve and lens. The baseline pressure matters, because the measurement after a treatment on the cornea comes out lower than the true value — a later glaucoma assessment needs that baseline value. And a lens that is already clouding changes the whole calculation.

The procedure, the individual methods and the question of how often which examination makes sense are described under Eye examinations ; what the Eye test measures exactly is set out there in detail. Plan enough time for an appointment with dilated pupils and do not come by car: the drops go on working for several hours, your near vision is blurred and you are sensitive to light. Sunglasses help.

When the lens is going to be the issue anyway

From the second half of life the question shifts. If your own lens clouds over — a cataract — it is replaced with an artificial lens during the operation in any case, and its power can be chosen so that it corrects an existing refractive error at the same time. An astigmatism can be taken into account with a toric lens. So anyone thinking about a spectacle correction at sixty who at the same time has a lens beginning to cloud should not plan two procedures but one — how that works in detail is set out under Treating cataract.

Said honestly alongside: an artificial lens cannot accommodate. Multifocal lenses spread the light across several distances, which works for many people and for some does not — halos and a softer contrast are the possible downsides, and an implanted lens can only be reversed with another operation. That is a conversation, not a sales argument, and it belongs before the procedure.

Costs & health insurance

What does the insurer pay for — and what not?

The most important sentence first: for adults, visual aids and refractive procedures are self-pay as a matter of principle. Basic health insurance (OKP) pays for the medical assessment, not for the glasses — and not for the procedure that is meant to replace them.

ServiceCoverageWhat this means for you

Glasses: lenses and frame

Self-pay

As a rule adults pay for glasses entirely themselves. A few supplementary insurance policies contribute an annual or multi-year amount — that is a matter of contract and is not affected by basic health insurance. For children and young people, and in certain medical situations, separate rules apply; ask us or your insurer before you buy.

Contact lenses and fitting them

Self-pay, with narrow exceptions

The fitting and the material you usually pay for yourself. With particular medical findings — an irregular cornea, for instance, or the state after procedures on the cornea — a contribution to the cost can be examined. That needs a medical justification and a request to your insurer before the fitting, not after it.

Determining the correction values with no suspicion of disease

Self-pay

Simply determining values for glasses or contact lenses is not a mandatory benefit for adults. If a finding of disease emerges in the process, the judgement changes: the rest of the assessment is then medically indicated and runs through basic health insurance.

Ophthalmic examination for symptoms or on suspicion

Basic insurance (OKP)

Anyone who comes with a symptom — rapidly worsening vision, double vision, flashes of light, pain — or who has a known eye diagnosis monitored has a medical indication. The deductible and co-payment apply as at any doctor's appointment.

Suitability assessment for a planned refractive procedure

Self-pay

The examination that establishes whether you are suitable for a procedure to replace your glasses does not treat any illness and is therefore billed privately. We tell you its extent beforehand. If the assessment shows a finding that needs treatment, that part is of course billed as what it is.

Refractive laser surgery or a lens implant to replace glasses

Self-pay

Procedures whose purpose is to make a visual aid unnecessary are not a mandatory benefit of basic health insurance. Some supplementary insurance policies contribute a share, often tied to conditions — obtain the agreement in writing before an appointment is fixed. We do not carry out these procedures ourselves; we advise and we examine.

Lens surgery for cataract with a medical indication

Basic health insurance, special lenses at extra cost

Where there is a medical indication, the procedure is a mandatory benefit. Specialist lenses that also correct an astigmatism or presbyopia go beyond that; the difference and the additional examinations that go with them you pay yourself. What that means in your case we set out for you before the procedure.

Deductible and co-payment. Of the costs that run through basic health insurance, you first pay your chosen deductible in full yourself, then the co-payment of ten per cent up to the statutory annual maximum. An examination 'at the insurer's expense' is therefore rarely free for you — that is not a peculiarity of our clinic but how Swiss basic health insurance works.

The honest arithmetic. A common sales argument is that a procedure pays for itself against decades of spending on glasses and lenses. That sum can be worked out, and it belongs to you — but it answers the wrong question first. First comes whether your eye is suitable; the cost question comes after that. A method that does not fit your findings is no saving at any price, and a method that does fit is made no worse by its price.

Ask beforehand, not once the invoice arrives. Tell us when you book why you are coming — then we tell you which category your appointment falls into. In writing you can reach us through the contact form, for an appointment all it takes is online booking; we advise you at all three locations in Zurich, Wetzikon and Meilen.

Medically reviewed by PD Dr. med. Andrea von Rückmann · Last reviewed

Frequently asked questions

Measure first, then decide.

Bring your previous spectacle prescriptions with you. We measure your values, assess the cornea, tear film, lens and retina — and tell you which correction suits you. Including when the most honest answer is 'your glasses'.

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