Vision Correction Surgeries: What Options are Available?

Vision Correction Surgery

A refractive eye surgery is any that is meant to improve vision by changing the refractive state of the eye (its ability to bend light). This type of surgery can decrease or totally eliminate the need for glasses or contact lenses.

While there are several types of refractive surgery available, the most well known are those which use lasers to reshape the cornea, treating vision disorders such as nearsightedness (myopia), farsightedness (hyperopia) and astigmatism. The most common of these is LASIK eye surgery, but other options may be recommended based on the patient’s vision, personal health history and other factors. Some people may not be eligible for one type of surgery, but are great candidates for another.

There are several different methods involved in refractive surgery including flap surgeries, surface procedures, corneal incision procedures and thermal procedures.

Flap Surgery
In a flap procedure, the first step is fairly obvious: a flap is cut into the surface of the eye. For instance, excimer laser ablation is done under a partial thickness lamellar corneal flap - a microkeratome cuts a very thin flap into the corneal tissue, the work is done to correct the vision as much as possible and the flap is replaced.

  • LASIK is often done as a flap procedure as is Automated Lamellar Keratoplasty (ALK). In traditional LASIK, this flap is created using a microkeratome blade. And alternative is bladeless LASIK (sometimes called “all laser LASIK”) which uses a laser to create the flap instead. Wavefront guided LASIK uses a computer-controlled excimer laser and measurements which are obtained by the Wavefront sensor. Wavefront technology allows a light beam to be tracked and mapped as it travels to the retina and then bounces back out for more accurate, individualized vision correction.

Surface Procedures
Surface procedures do not cut a flap into the cornea but still use the excimer laser to perform the work that changes the vision of the patient.

  • Of these, one of the most common is the photorefractive keratectomy (PRK) which works to reshape the cornea by removing small bits of tissue from the corneal stroma. It differs from LASIK in only the top layer of the epithelium is removed so there is no flap needed. However, with PRK the recovery time can be longer and the final results are usually about the same.

  • LASEK surgery is differs from LASIK surgery in a number of ways. In addition to being a surface procedure, it uses an alcohol solution to lift a very thin layer in the cornea. It has drawbacks however because is it reportedly as uncomfortable as PRK, described above.

  • Epi-LASEK is similar to LASEK surgery but uses the epi-keratome to remove only the top layer of the epithelium and does not use the alcohol solution, eliminating the possible negative effects of it. In addition, there is less discomfort than with LASEK or PRK.

Corneal Incision

  • Radial Keratomy (RK) is one of the corneal incision procedures that cuts spoke shaped incisions to alter the shape of the cornea. It was once used to treat myopia and astigmatism but has been largely replaced by other surgical procedures.

  • Arcuate Keratomy (AK) is a surgery that is similar to RK however the incision is made at the periphery of the cornea. AK is used to treat astigmatism and may be used to treat residual astigmatism after other procedures are completed. For instance, AK may be done during or after a cataract surgery.

  • A limbal relaxing incision is done to treat minor astigmatism and involves a small incision made near the outer edge of the iris (the colored part of the eye).

  • Intacs corneal implants can be used for some patients to correct low degrees of myopia. These special implants are inserted into the outer edge of the cornea, and the resulting outward pressure causes the cornea to flatten slightly, improving vision. Since no tissue is removed during this procedure, the surgery can be reversed if you are unhappy with the results, making Intacs a great option for those who fear the potential permanent side effects of other surgeries.

Thermal Procedures

  • Laser thermal keratoplasty (LTK) is a surgery that is done with a Holmium Laser. This infrared laser uses heat to shrink corneal tissue and change the shape of the eye. LTK can be used to treat those with mild farsightedness, presbyopia, and patients whose vision was overcorrected by another refractive procedure.

Talk to your doctor
The only one who can help you decide if any vision correction surgery is right for you, and which ones you are a candidate for, is your eye care professional. Make sure that you discuss risks, costs and other factors before making your final decision.

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