Refractive surgical procedures include any and all procedures that reduce refractive error, i.e., reduction of myopia (nearsightedness), hyperopia (farsightedness), and astigmatism. All of these procedures are designed to minimize dependence on eyeglasses and contact lenses, and represent exciting and extraordinary advances in the field of ophthalmology. 

The best procedure for any given individual depends on many factors, including age, type of refractive error (nearsightedness, etc.), degree of refractive error, and concern for reversibility. Certain refractive procedures have been studied and utilized extensively (e.g., LASIK and PRK), while others have only recently been evaluated and approved by the FDA (e.g., phakic IOLs).  Because of the many considerations in choosing the best procedure for each person, Dr. Sullivan offers free, personal consultations to review which option fits for you and your eyes.

LASIK (laser in-situ keratomileusis)

LASIK (Laser assisted in-situ keratomileusis) is a refractive surgical procedure that results in rapid recovery of vision and has the capability to benefit patients with nearsightedness, farsightedness, and astigmatism by reducing dependence on eyeglasses and contact lenses. Millions of people worldwide have already undergone this exciting and marvelous procedure. The great majority of individuals who wear glasses or contacts may now benefit from LASIK. Candidates must be at least 18 years of age (21 for Advanced CustomVue™) and have a stable prescription.

LASIK is a procedure in which the eye surgeon creates a thin surface flap of the cornea using a microkeratome (blade) or by using a separate laser (Intralase™, which is blade-free) to expose underlying tissues (stromal bed). It is within the deeper layers of the cornea that the surgeon then applies the Excimer laser beam to create the refractive ablation. This reshapes the cornea using the extraordinary precision of the Excimer laser. 

One of the keys to a successful LASIK procedure is the measurement your ophthalmologist takes to determine your refractive error. Now an enhanced version of LASIK called Advanced CustomVue™ is available. This customized LASIK uses a special device (WaveScan) to precisely measure the eye’s unique irregularities and variations. Then during the LASIK procedure, these measurements will guide the computer-driven excimer laser to provide a truly customized treatment of each person’s vision. Once the laser ablation is completed, the surgeon gently replaces the corneal flap to restore surface integrity of the eye. It's as if the refraction is "ground in" to the middle layers of the cornea!

The results are often dramatic and very rapid, with most patients seeing well enough to drive a car without correction the very next day. However, the best post-operative visual acuity may not be obtained until 2 to 3 weeks, or in some cases, even a few months, after the procedure.

PRK (photorefractive keratectomy)

Photorefractive keratectomy (PRK) is a procedure in which the surface of the cornea is reshaped by an ophthalmologist using an Excimer laser. PRK does not involve creation of a corneal flap utilizing the microkeratome, and therefore, the protective superficial layers of the cornea must heal post-operatively. This generally means that patients who undergo PRK will require significantly more time than LASIK patients to achieve their best vision. 

Although the outcomes of PRK and LASIK are quite comparable at the 6 month post-operative visit, it has been argued that LASIK may be safer than PRK due to the greater risk of scarring (haze) and unpredictable healing of the cornea with PRK. The risk of infection is also slightly higher with PRK than with LASIK, although infections following either procedure are rare.

Clear lens replacement:

For individuals over 40 who are considering refractive surgery to decrease dependence on glasses and contact lenses, clear lens replacement (CLR) is an exciting option. In essence, this procedure entails removing the natural lens of the eye and replacing it with an intraocular lens implant. The procedure is essentially the same as a cataract operation with lens implant; however, in this case, the procedure is completed prior to cataract development for the refractive advantage. With the benefit of powerful ultrasonic instrumentation to measure the length of the eye to within 100ths of a millimeter, and sophisticated IOL formulas, ophthalmologists have become very accurate at determining the proper IOL power to decrease post-operative dependence on eyewear. 

CLR is a procedure that is more invasive than LASIK or PRK, with consequent greater potential risks. However, CLR may be an excellent alternative to these procedures for people already wearing bifocals or for those who do not qualify for other refractive procedures due to extremes of refractive error. Because CLR requires entering the eye to place the lens implant, the patient has a small risk of infection inside the eye (endophthalmitis) that is not present in the other, above mentioned, refractive procedures. Unlike these procedures, however, CLR avoids any treatment of the cornea and instead changes the refractive power of the eye in a potentially more natural position (i.e., natural lens of the eye). CLR, thus, avoids any significant risk of reduction of contrast acuity. 

Because CLR requires removal of the natural lens of the eye, the patient is subsequently unable to focus at near (accommodate). This is why CLR is best suited for patients over 40 who are already wearing bifocals. One potential solution to this problem of accommodative loss is implantation of a multifocal or accommodating IOL implant. These implants, brand names of ReZoom™, ReSTOR™, and Crystalens® allow focusing at both near and far, allowing most patients to read small size print and drive a car without glasses, following implantation of the lens in each eye. One potential drawback would be some difficulty with halos or glare, especially for the first several months after the procedure, but this effect diminishes with time. Studies show however that 92% of patients with multifocal lens implants, report “never” or only “occasionally” needing to wear glasses.

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