Refractive Surgery Options in Japan: Surgical Modalities and Clinical Safety Protocols
1.Introduction
With the widespread adoption of digital devices, the global prevalence of myopia has risen steadily in recent years. Because refractive errors directly impact daily productivity and quality of life, an increasing number of patients are considering corrective procedures for long-term vision recovery. When seeking advanced eye surgery in Japan, international patients benefit from sophisticated diagnostic systems, modern surgical technologies, and strict clinical protocols established by national ophthalmic associations. For individuals prioritizing clinical data and comprehensive pre-operative evaluations, medical institutions in Japan provide reliable solutions for vision correction, alongside broader innovations in areas such as regenerative medicine.
2.Hole ICL: Standardized Technology Originating from Japan
The technological foundation that improved the safety profile of phakic intraocular lens (ICL) surgery was originally developed in Japan.
The Hole ICL (commonly known as EVO ICL), featuring a central micro-hole, is now widely utilized across global ophthalmic practices. This technology was pioneered by Dr. Kimiya Shimizu and his research team at Kitasato University (1). According to a five-year comparative study led by Japanese ophthalmologists, introducing a 0.36 mm aperture—termed the "KS-AquaPORT"—at the center of the lens significantly improved intraocular aqueous humor circulation. The longitudinal trial demonstrated a 0% incidence rate of post-operative crystalline lens opacification (cataract development) over the five-year follow-up period (2). This structural modification eliminated the need for a preliminary iridotomy, reducing procedural invasiveness and lowering the risk of secondary complications such as elevated intraocular pressure and cataracts.
Long-term clinical findings generated in Japan demonstrate the robust safety parameters established for modern intraocular lens procedures.
3.Regulatory Guidelines and Quality Management in LASIK
Laser-Assisted In Situ Keratomileusis (LASIK) remains one of the most widely performed refractive procedures globally.
Leading medical facilities in Japan utilize advanced excimer laser systems equipped with high-speed, multi-dimensional eye-tracking technology to execute customized ablation protocols tailored to individual corneal topographies. Surgical indication screenings and infection control measures strictly follow the Refractive Surgery Guidelines established by the Japanese Ophthalmological Society (3). Thorough pre-operative screenings ensure that unsuitable candidates, such as those presenting with keratoconus, are screened out, preserving predictable long-term visual stability for eligible patients.
Adherence to standardized medical guidelines ensures high clinical safety and consistent post-operative outcomes.
4.Clinical Evidence for Minimally Invasive SMILE Procedures
Advanced femtosecond laser techniques designed to minimize corneal disruption have shown remarkable predictive accuracy and favorable safety profiles.
Small Incision Lenticule Extraction (SMILE) utilizes a femtosecond laser to construct and extract a thin tissue disc (lenticule) from within the corneal stroma. Compared with traditional LASIK, SMILE requires a substantially smaller peripheral incision—approximately 2 mm to 3 mm. This reduced incision length minimizes disruption to corneal nerve fibers, lowering the incidence of post-operative dry eye syndrome and helping preserve structural corneal strength. Consequently, SMILE is particularly well-suited for individuals with active lifestyles. Rapid surface healing often allows patients to resume standard daily activities and work routines within twenty-four hours post-procedure.
In a one-year prospective clinical trial evaluating ReLEx SMILE outcomes published in Scientific Reports, 94.3% of treated eyes achieved a spherical equivalent within ±0.50 D of the intended target at the one-year mark. Furthermore, the study recorded zero severe surgical complications resulting in a loss of corrected distance visual acuity, supporting the stability of post-operative visual recovery (4).
Ophthalmic institutions and university hospitals across Japan began adopting this femtosecond laser system around 2010, building extensive clinical experience across thousands of surgical cases. Additionally, facilities maintain controlled cleanroom environments with rigorous management of airflow, temperature, and humidity to optimize surgical equipment performance.
Objective outcome data, combined with refined clinical protocols, support stable post-operative visual clarity and provide a reliable framework for international patients seeking eye surgery in Japan.
5.Conclusion
The key to a successful refractive procedure lies in selecting the clinical technique best suited to an individual patient’s corneal profile and lifestyle requirements.
Refractive procedures offered in Japan are built upon evidence-based medicine, high-precision equipment, and structured risk-management protocols. For patients evaluating treatment options—from corneal laser procedures to advanced research fields like regenerative medicine—a comprehensive evaluation by specialized ophthalmologists in Japan offers a clear, objective path toward vision correction.
References
Shimizu K, et al. Early clinical outcomes of implantation of posterior chamber phakic intraocular lens with a central hole (Hole ICL) for moderate to high myopia. Br J Ophthalmol. 2012; 96(3):409-412.
Shimizu K, et al. Long-term comparison of posterior chamber phakic intraocular lens with and without a central hole (Hole ICL and Conventional ICL) implantation for moderate to high myopia and myopic astigmatism. Medicine. 2016; 95(14):e3260.
Japanese Ophthalmological Society. Refractive Surgery Guidelines (8th Edition). https://www.nichigan.or.jp/Portals/0/resources/member/guideline/refractivesurgery_8.pdf (accessed July 2026).
Nicula CA, et al. One year outcomes after small incision lenticule extraction ReLEx SMILE in a group of Romanian patients. Sci Rep. 2019; 9(1):4752.
About the Author
Daiki Sakai, MD, PhD
Japanese Board-certified Ophthalmologist
Founder, Ophthoagent Team
