With LASIK now in its second decade, it is often the procedure of choice for permanently improving vision. More than a million life-changing refractive surgeries are successfully performed each year in the United States. While LASIK is an excellent solution for many people, each person’s eyes and visual needs are unique, and for some individuals, alternative procedures may produce better results. Some examples include people with thin corneas or severe nearsightedness.
Emory Vision physicians are proficient in a wide variety of procedures. For example, Dr. Randleman and Dr. Stulting have been principal investigators of the long-term safety and efficacy of the Artisan phakic intraocular lens. All Emory Surgeons are board-certified cornea fellows. Because of their broad expertise, Emory Vision is able to offer the widest available range of refractive surgery options, providing the best available outcomes for patients.
LASIK: Laser in-Situ Keratomileusis
After your eye has been completely numbed using “eye drop” anesthesia, an eyelid holder will be placed between your eyelids to prevent you from blinking.
Next, a surgical instrument makes a protective flap in the cornea. During this process you may feel a little pressure, but no discomfort. You will be asked to look directly at a target light while the laser reshapes the cornea, usually in less than a minute.
To treat nearsightedness, the cornea must be made flatter. This is accomplished by removing tissue from the center of the cornea.
To treat astigmatism, the cornea must be made more spherical. This is accomplished by removing more tissue from one part of the cornea than the other.
To treat farsightedness, the central cornea must be made steeper. This is accomplished by removing tissue from around the central area.
Then, the protective flap is folded back in place where it bonds securely without the need for stitches. After LASIK, there is typically slight discomfort that goes away within twenty-four hours.
Photo Refractive Keratectomy (PRK)
If a person’s cornea is too thin, the degree of myopia too high, or the shape of the cornea abnormal, laser treatment of the surface of the cornea (PRK) or phakic intraocular lens implantation may be the best option.
Photorefractive Keratectomy (PRK) was the first procedure performed using the Excimer laser. It corrects vision by reshaping the surface of the cornea. First, the epithelium, a thin layer of cells that covers the cornea, is completely removed. After the laser reshapes the surface, new epithelium grows back over the treated area, usually in three to seven days. Functional vision typically returns within the first week. Many surgeons feel that PRK achieves outstanding results, but patients who have PRK have more discomfort and the healing process is longer meaning good vision takes longer to achive than it does in those who have LASIK.
Laser Epithelial Keratomileusis (LASEK)
LASEK is a relatively new procedure that combines elements of PRK and LASIK, and offers some advantages to certain patients. Instead of removing the epithelium as with PRK, a flap of surface epithelium is loosened and moved aside. The surface under the epithelium is treated with the laser and the epithelial flap is returned to its original position, just as it is with LASIK. A protective, soft contact lens is then placed over the cornea to make the eye more comfortable while it heals.
Phakic Intraocular Lens (IOL)
A phakic intraocular lens (IOL) is a plastic lens that is inserted in front of the natural lens during a surgical procedure. This type of lens is called a phakic IOL because the eye still has its natural lens in place. The IOL is made of the same type of material that has been used to make intraocular lenses for cataract surgery. The phakic IOL is used to correct nearsightedness in patients who are not good candidates for LASIK or surface ablation. People with thin corneas or high myopia (-10 to -20 diopters) may benefit from this procedure.
Refractive Lens Exchange (IOL)
In some cases, removal of the natural lens and implantation of an artificial intraocular lens (IOL) is indicated. This procedure, which is the same as the one used to remove cataracts, may be an option for certain patients who have both presbyopia and refractive errors but do not make good candidates for any other refractive surgery procedure. Some IOLs are designed to restore the eye’s ability to focus on both distant and near objects.
Blended Vision
For those of you experiencing presbyopia, which creates the need for reading glasses or bifocals around the age of 45, blended vision is an option. Blended vision is produced using refractive surgery to have one eye remain slightly nearsighted while correcting the other for best distance vision.
