Refractive eye surgery involves changing the refractive state of the eye to decrease one’s dependency on glasses or contact lenses. The first corneal refractive surgical procedure developed was radial keratotomy (RK). Corneal instability and progressive shifting of the refraction (glasses prescription) made this surgery obsolete. 

LASIK (Laser-Assisted In-Situ Keratomileusis) and PRK (PhotoRefractive Keratectomy) use the excimer laser to reshape the cornea to help focus the light rays onto the retina like glasses or contact lenses do.  These laser vision correction (LVC) procedures can correct nearsightedness, farsightedness, and astigmatism.

Patients who may not be good candidates for LVC:

• Thin corneas
• High glasses prescriptions
• Keratoconus
• Autoimmune diseases like rheumatoid arthritis
• Perfectionists
• People who need excellent nighttime vision, like truck drivers or airline pilots
• Currently on certain medications like Accutane/isotretinoin (or other acne medications)
• Large pupils
• History of past corneal infections
• Unstable glasses prescription
• Severe dry eyes

Presbyopia (decreased ability to see up close) starts in the mid-40s. If both eyes are lasered to correct their distance, then they will need reading glasses. Monovision is an option where one eye is set for distance and the other eye is set for or left with some nearsightedness.

Nowadays, both eyes are usually lasered in the same sitting. The first step in LASIK is to use a femtosecond laser or a micro-keratome blade to make the corneal flap. In PRK, the top layer of cells (epithelium) is carefully scraped off. The excimer laser energy is then applied to the exposed cornea to reshape it. This laser may take up to ~50 seconds per eye. If PRK was performed, then a bandage contact lens is placed to help the epithelium to grow back and for pain control. With LASIK the vision may be fairly sharp immediately after the procedure. PRK has a slower recovery because the epithelium has to grow back onto the cornea. The final results of the PRK may not be seen for several weeks. PRK may be chosen because of thin corneas and for people who are in a profession where eye injuries can occur. LASIK has become the more popular procedure because of its quicker recovery and less discomfort.

Complications may include corneal infections, intra-flap inflammation (diffuse lamellar keratitis (DLK)) in LASIK, halos at night, and difficulty driving at night. Ectasia (progressive thinning and warpage of the cornea) may be difficult to treat and the patient may need to wear hard contact lenses to improve their vision.

The ICL (Implantable Contact Lens) is a refractive intraocular lens that is placed into the area behind the iris and the natural lens. This can treat high amounts of nearsightedness and astigmatism without having to sacrifice any corneal tissue.

The SMILE (SMall Incision Lenticule Extraction) procedure utilizes the femtosecond laser to create a disc of corneal tissue that is removed. This procedure, which can correct nearsightedness and astigmatism, has not been used in the United States as much as in Europe and other countries.

Here is another great resource on Laser Vision Correction.

To find out more about Dr. Curtin Kelley, go to his practice website or follow his practice on Facebook.

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.