In last month’s column, I discussed some of the factors to take into account when considering refractive eye surgery. Now I will explain some of the surgical options available. Photo-Refractive Keratectomy (PRK) was the first procedure using the Excimer laser. With PRK, the outer layer of the cornea, called the epithelium is gently removed. The laser is then used to reshape the cornea, which is the clear covering of the eye. The epithelium regenerates over the treated area within days. PRK achieves excellent results especially for patients who may have thin corneal thickness measurements. The main drawback to PRK is that there is some eye pain or irritation for the first few days after surgery. Laser In-Situ Keratomileusis (LASIK) also uses the Excimer laser and it the most common type of refractive eye surgery. With LASIK, patients experience faster vision recovery and minimal eye discomfort from the procedure. A tiny oscillating blade known as a microkeratome is used to create a thin flap of corneal tissue. The flap is folded back and the laser is applied to the exposed inner corneal tissue. The flap is then repositioned, where it bonds tightly without the need for stitches. Instead of using a blade to create the flap, a laser can be used to make the flap as well. Commercially known as Intralase, the laser (different from the laser that reshapes the cornea) can create a thinner, more uniform flap with potentially less complications than the microkeratome. This can lead to better visual recovery. Both PRK and LASIK are very quick and accurate surgeries. However, they may, in limited instances, produce visual aberrations in the form of glare or haloes under dim lighting conditions and dry eye syndrome. Roughly five per cent of patients who undergo PRK or LASIK will need to undergo additional surgical correction or enhancement. In the last few years there has been the release of wavefront-guided or custom PRK/ LASIK. Custom laser eye surgery is an advancement of the standard laser treatment and provides a more personalized treatment that is unique to each patient. Advantages of the custom treatment include improving the quality of vision after surgery and decreasing the incidence of glare of haloes. The custom laser eye surgery is now being marketed quite heavily due to its inherent benefits. The next type of refractive eye surgery is clear lens extraction (CLE). This procedure does not involve a laser and is the same as cataract surgery. With CLE, the normal clear lens of the patient is removed from the eye and is replaced with an artificial lens. The artificial lens provides proper focusing power to improve vision. CLE is more invasive than the above surgeries and is generally reserved for patients with extremely high spectacle prescriptions. The final type of refractive eye surgery is implantable contact lens (ICL) surgery. As the name suggests, a small contact lens is gently positioned inside the eyeball. Once again this surgery is mostly done on patients with high prescriptions. Since there is the risk of developing post-operative glaucoma or cataracts, proper screening must be done prior to surgery. Like with all surgical procedures, refractive eye surgery has the risk of complications. Fortunately, the likelihood of vision loss is minimal. Your optometrist or ophthalmologist will be able to offer an informed opinion regarding your candidacy for any of the refractive surgery options available.
A regular eye exam is a key part of good vision health. Use our find an optometrist directory to find an eye doctor near you and to schedule an appointment.