Tired of Eyeglasses and Contacts — What About Refractive Eye Surgery?

If you are tired of wearing eyeglasses and contacts, refractive eye surgery may be the way to go. But don’t make a decision until you do your homework.

Not everyone is a candidate for these procedures and there are some risks to consider.

It is the hope of the ISPB that the following information will give you some background information and points to consider before “going for it.”

What Is Refractive Eye Surgery?

Refractive Eye Surgery is any surgical procedure which permanently alters the focusing power of the eye in order to change refractive errors—myopia (nearsighted-ness), hyperopia (farsightedness) and/or astigmatism (minor visual distortions to blurred vision).

Some Available Procedures

Since the 1970’s, procedures have emerged for the correcting of refractive errors. Here are some of the procedures:

	RK (Radial Keratotomy), made available in the 1970’s, is used to correct myopia. A surgeon uses a diamond scalpel blade to make tiny spoke-like incisions in the periphery of the cornea, causing it to bulge; and in turn, flattens the cornea.
	PRK (Photorefractive Keratectomy), made available in the 1990’s, is used for low to moderate nearsightedness and astigmatism. A surgeon uses an excimer laser, controlled by a computer to emit high-energy pulses to modify the shape of the cornea.
	LASIK (Laser in-situ Keratomileusis), made available in the mid-1990’s, is a variation of PRK and is used to treat nearsightedness, farsightedness and astigmatism. It is the most popular procedure available at present. A mechanical cutting tool is used to make a flat flap on the cornea (a laser may also be used to make the flap). The flap is flipped back and the corneal bed is treated with an excimer laser to reshape the surface of the cornea. The flap is repositioned to complete the procedure.

LASIK (known as flap-and-zap)

	LASEK (Laser Epithelial Keratomileusis), made available in the late 1990’s, falls in between PRK and LASIK and is used for people who may not be a good candidate for LASIK. This procedure utilizes a trephine and an alcohol solution to create an epithelial flap rather than the use of laser. The corneal bed then is treated with laser and the flap is carefully repositioned. A contact lens is placed over the cornea as a bandage for several days to aid the healing process.
	CK (Conductive Keratoplasty), made available in 2002, is used to correct low to moderate farsightedness for people over 40. It is a non-invasive procedure using a low-energy, high-frequency radio current applied directly to the periphery of the cornea with a tiny probe in a circular pattern, causing constriction which increases the curvature of the eye. CK is currently in Phase III clinical trials for nearsightedness.

New Procedure

The laser vision corrections in procedures above correct visual distortions caused by nearsightedness, farsightedness and astigmatism (called “lower order aberrations”) giving 85-90 percent overall quality to vision. Because of other imperfections that can also affect vision clarity — like glare, shadows, halos (called “higher order aberrations”) — the quality of vision may not be as ideal even with vision of 20/20.

Wavefront-Guided Laser Surgery is the newest procedure being used to improve 20/20 quality vision, for additional surgery from other procedures and for first-time eye corrective surgery. It uses a computerized wavefront-measuring instrument in which flat waves of light are passed through your eye, measuring the distortions in your vision. These distortions are compared to a perfectly flat light waves, generating a 3D map; which, in turn, tells the laser where to reshape your cornea to correct your vision.

A Few Points to Consider

1. Ask yourself: Why are you considering refractive eye surgery? Is it for the convenience of a reduced need for glasses and contact lenses? Keep in mind that even with 20/20 vision, other imperfections, like glare, halos, shadows may affect the quality of vision.
2. Talk to your ophthalmologist on your particular refractive error(s), what procedures are available for your consideration, and if you are an eligible candidate. Not all people are good candidates.
3. Select a board-certified ophthalmologist/surgeon who uses FDA-approved laser equipment and has great deal of knowledge and experience in conducting the procedure. Don’t be afraid to ask questions about the procedure, the preoperative, operative and postoperative expectations, possible side effects, various risks involved and if additional surgery is needed. A second opinion is always an option to consider.
4. Money should not be the final factor in your decision. Be wary of inexpensive procedures without thorough investigation.
5. Remember: This is an out-of-pocket expenses. Most insurance companies do not cover this type of elective surgery.

Whatever you decide — be it refractive eye surgery or staying with your eyeglasses or both — the ISPB wants you to be informed.

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The Visionary, published as a service of the Illinois Society for the Prevention of Blindness,
is available upon request. The information contained in this issue,
taken from sources considered to be accurate,
does not replace the need for professional eye care consultations and treatments.

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