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Refractive Surgery

Are you a good candidate for refractive surgery?

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Why refractive surgery?

Are you tired of wearing glasses? Do you dread having to get up out of bed and remove your contacts every night when you just want to fall asleep? Do you wish you could wake up with clear vision? If you answered yes to any of these questions, refractive surgery might be a good option for you! There are a few options of refractive surgery, the most well-known being LASIK (laser-assisted in situ keratomileusis). Another less known option is PRK (photorefractive keratectomy). In these procedures, a laser is used to reshape the cornea to allow one to see without glasses or contacts. The cornea (front surface of our eyes) bends light that enters our eye to focus on the retina (back part of the eye). This is what allows for crisp and clear vision. However, each individual person’s cornea is shaped differently. This means that those with steeper or flatter corneal surfaces will bend light in front of or behind the retina. Light not falling directly on the retina will affect how well you can see, creating a blurry image. Refractive surgeries create precise microscopic changes in corneal tissue to adjust the shape of the cornea to help redirect light back onto the retina. This allows for 20/20 vision or better without glasses or contacts. Refractive surgeries can be completed within 30 minutes and are very low risk procedures with great outcomes. In addition to LASIK and PRK, there are several other options available that your eye doctor can discuss with you to get you seeing your best!


Candidates for refractive surgery

  • Realistic expectations
    • Refractive surgery is not a permanent fix and will not guarantee that you will not need glasses in your future. Understand that you could still need glasses or contacts after the procedure as well as reading glasses as you age.
  • Free of corneal diseases
  • Have a stable prescription
  • Adequate corneal thickness
  • Greater than 18 years old
  • Good general systemic health
  • Pupil size
  • Good lid hygiene
  • Controlled glaucoma
rk scarring

How is LASIK performed?

LASIK surgery is a relatively quick procedure, taking less than 30 minutes for both eyes combined. The surgeon will clean and numb your eyes with drops, putting a device on your eyes to keep them open and to prevent blinking. You will feel slight pressure and vision may briefly go dark. The surgeon will use a laser to cut a thin flap in your cornea and move it out of the way to expose the underlying layers of the cornea. They will reshape the exposed cornea with a laser and reposition the flap after they are done.


Keratoconus patient with Intacs

How is PRK performed?

PRK and LASIK have comparable procedure times, PRK can be complete in less than 30 minutes for both eyes as well. The main difference between the two procedures is that PRK does not require the formation of a corneal flap following surgery. Instead, the outer layer of your cornea is simply removed completely in order to shape the exposed area underneath with a laser. You may experience slight pressure and dimming of vision as the procedure progresses. Once reshaping of the cornea is complete, a bandage contact lens and drops will be placed. This will allow for the tissue to heal below the contact lens. The epithelium of the cornea takes around 3-5 days to grow back.


LASIK vs PRK: Pros and Cons

  • The advantages of PRK come from a lack of a flap following procedure. PRK is preferred for people who have a higher risk of direct trauma to their eyes such as professional boxers or fighters. It is also associated with less dry eye post-surgery. The most common reason PRK is done over LASIK is due to corneal thickness. PRK candidates requires less corneal thickness than LASIK candidates. However, vision typically gets worse before it gets better with PRK. Healing takes longer and full visual outcomes takes about a month. The use of eye drops following surgery can be more demanding and used for a longer duration.
  • LASIK has a quicker recovery time and so getting back to your everyday routine is easier. However, due to the presence of a flap following surgery, this places patients at risk for more complications such as flap wrinkles, epithelial ingrowth, and inflammatory processes. Vision is better right after LASIK in comparison to PRK. Most patients experience 20/20 vision the morning following surgery. Discomfort following the surgery is less than that of PRK. However, LASIK is associated with dry eye that can be long lasting.

How to prepare for the procedure

  • Avoid eye makeup or creams around your eyes prior to surgery
  • Ensure you enlist someone to drive you home after the procedure, you won't be able to drive.
  • If you’re a soft contact wearer, discontinue use of contacts for 2 weeks prior to the procedure.
  • If you’re a gas permeable contact lens wearer, discontinue use of contacts for 1 month prior to the procedure.

Recovery after the procedure

Following PRK, a bandage contact lens is placed in the eye to promote healing and serve as a protective barrier for the eye. LASIK does not require the use of this bandage contact lens. With either procedure, you will need to avoid any strenuous activity for the first week. Avoid any eye rubbing. Avoid sun exposure. Wear sunglasses for the recommended time frame mentioned by your eye doctor. Both procedures use eye medication drops to prevent infection and promote healing.


Side Effects

Both procedures are associated with a low incidence of side effects and complications. The most common complaints are:

  • Glare and halos around lights
  • Trouble with night vision
  • Light sensitivity
  • Mild irritation
  • Blindness
  • Corneal haze or scarring
  • Under or over correction
  • Dry eye

In very rare cases, there may be eye infections or a loss of vision.

Complications

  • Material under flaps
  • Infection
  • Blindness
  • Epithelial ingrowth
    • Epithelial ingrowth is an uncommon but progressive condition following LASIK. It involves corneal epithelium growing in areas where it doesn’t belong. Treatment depends on severity. Repositioning of flap and cleaning underneath is typically the treatment of choice when needed.
  • Flap folds
    • Flap folds or wrinkles occur after LASIK due to uneven flap alignment. Treatment involves lifting the flap and repositioning.
  • Diffuse lamellar keratitis (DLK)
    • DLK is a rare noninfectious but inflammatory condition that appears a few days following LASIK. Treatment for this involves increased use of steroids for about a week until improvement.

Frequently asked questions about refractive surgery

Am I a candidate for LASIK?

In order to definitively know if you are a candidate for refractive surgery, please visit your local eye doctor to undergo proper assessment and testing. In general, adequate corneal thickness, refractive error (your prescription), and good eye health are important considerations.

Will I be put under anesthesia?

No, you will be numbed locally but you will be awake for the duration of the procedure.

Will this fix my vision forever?

Although most patients are extremely satisfied with their vision following their procedure, there is a chance of some residual refractive error (prescription) which would require the use of glasses or contacts. If you are over the age of 40, glasses will be required for reading tasks regardless of if you had refractive surgery or not.

Will I have perfect 20/20 vision after?

Reasonable expectations are important when considering refractive surgery. These surgeries are aimed at restoring vision. However, vision may continue to fluctuate due to other factors such as pupil size, lighting conditions, and age. Don’t be discouraged! The vast majority of people do achieve 20/20 or better vision following surgery.

Are there side effects?

Following the procedure, you may experience burning, itching, or painful eyes. Vision may remain blurry for a few days. Light sensitivity during the day as well as glare and halos around lights during the night may occur. Although very rare, it is possible to get an eye infection or lose vision after. In general, refractive surgeries are very safe and common procedures. With technology advancements and use of a laser, this eliminates possible complications associated with use of a blade.

Is it expensive? What is the cost?

Cost depends entirely on the provider, insurance, and type of procedure. In general, PRK tends to be slightly less expensive as it is easier and faster to perform. Reach out to your eye doctor to go over your treatment options and potential costs.

Which procedure is best for me?

A consultation with your eye doctor is the best way to determine which procedure is best for you. Your doctor can go over pros and cons with you. They can also determine which procedures you are qualified for. Once your options are known, consider all pros and cons and determine which procedure best suits your lifestyle.

How many follow ups are involved?

Following LASIK, common follow up times include 1 day post op, 1 week, 1 month, and 1 year. PRK typically involves more frequent follow ups due to the use of a bandage contact lens following the procedure as well as a longer healing period.