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When my doctor told me I wasn’t a good candidate for LASIK I was crushed, but the other surgery he recommended turned out to be just what I needed.”

 

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Other Surgeries


LASIK is the most commonly performed surgery to correct vision. However, if you are not eligible for LASIK due to eye health, professional and lifestyle considerations, there are excellent alternatives to consider.

Learn more about these surgeries below:

Photorefractive keratectomy (PRK)

    PRK corrects nearsightedness, farsightedness and astigmatism. It was the first FDA-approved use of laser for the correction of refractive errors. It is an excellent choice for those patients whose corneas are too thin for LASIK or who are not candidates for LASIK because of their serious involvement in contact sports or combat situations (which might predispose patients to corneal flap displacement).

    PRK involves removing the epithelium, the surface layer of the cornea. Then, a computer-controlled laser reshapes the cornea of the affected eye. Anesthetic drops in the eye help ensure that the patient experiences minimal discomfort. The procedure is typically quicker than LASIK, although the recovery is slightly longer. Patients typically wear bandage contact lenses for pain reduction for a few days while the epithelial tissue regenerates. Postoperative antibiotic and anti-inflammatory drops are used for several days to several months.

    While the long-term visual results achieved are predictable and stable with PRK, patients may experience discomfort for 24 to 72 hours while their epithelium regenerates. Advanced techniques, bandage contact lenses and medications have significantly reduced the postoperative discomfort. Initially, the visual recovery associated with PRK is not as fast as with LASIK, although data demonstrate that visual outcome is the same as with LASIK by approximately three to six months. Typically, both eyes are not treated at the same time, although they may be.

    As with any surgery, there are risks involved. The complications associated with PRK are similar to those with LASIK. Patients should discuss the risks and benefits in detail with their surgeons.

Conductive keratoplasty (CK)

    Conductive keratoplasty is a temporary treatment for farsightedness and/or presbyopia. It is also used as an enhancement procedure to treat overcorrections after LASIK or PRK for nearsightedness and to treat astigmatism, as well.

    CK uses heat generated by radio frequency energy to change the shape of the cornea. After anesthetic drops have been applied, a special probe is used to apply the radio frequency energy to a number of treatment areas around the edges of the cornea. Over time, the cornea tends to return to its original shape and the treatment regresses, which is why the procedure is viewed as a temporary solution.

    As with any surgery, there are risks involved, although this is one of the safest refractive procedures. Patients should discuss the procedure in detail with their surgeons.

LASEK and Epi-LASEK

    LASEK, laser epithelial keratomileusis, is a less commonly used variation of the PRK procedure. LASEK involves preserving the extremely thin epithelial layer on the cornea by loosening it with alcohol and lifting it from the eye’s surface prior to reshaping the cornea by laser. The epithelium is then replaced on the cornea’s surface and a bandage contact lens is used to help with healing.

    While some small studies have shown that the clinical results after LASEK are slightly better compared to PRK, others have shown delayed re-epithelialization and increased discomfort without any clear advantage.

    Epi-LASEK is a variation of LASEK that uses a plastic blade, called an epithelial separator, to lift the epithelial layer from the cornea. The epithelial flap is then usually replaced after reshaping the cornea but is sometimes discarded. Healing afterward is similar to LASEK. As with LASEK, however, this procedure is not performed routinely, for it does not have any consistent clear-cut advantage over modern PRK.

Intacs

    Intacs are very small, transparent, crescent-shaped pieces of a plastic polymer inserted into the cornea to reduce or eliminate nearsightedness and astigmatism in patients where contact lenses or eyeglasses no longer work to provide functional vision.

    Intacs are generally used to treat a rare complication of LASIK called ectasia or a condition called keratoconus.

Phakic IOLs

    Phakic intraocular lenses (IOLs) are an excellent alternative to laser vision correction for patients with high amounts of nearsightedness and for those who cannot have LASIK or PRK due to thin or irregularly shaped corneas.

    Phakic IOLs are lenses surgically implanted into the eye. The implants are similar to contact lenses, but they are permanent. They may be implanted in the front of the iris, clipped to the iris, or placed behind the iris but in front of the crystalline lens. There is no sensation of a phakic IOL in the eye and it requires no maintenance (unlike contact lenses). However, after implantation of phakic IOLs, patients will require regular yearly checkups.

    Studies of highly nearsighted eyes show a rapid return to stable, excellent quality vision after the implantation of phakic IOLs. The potential side effects of phakic IOL surgery are similar to risks associated with cataract surgery or presbyopia lens replacement surgery.

Limbal relaxing incisions

    Sometimes called corneal relaxing incisions, this surgical procedure is usually performed during cataract surgery, presbyopia lens replacement surgery (also called refractive lens exchange) or during insertion of phakic IOLs.

    Limbal relaxing incisions correct mild astigmatism by flattening the curvature of the cornea (the clear outer part of the eye). Limbal relaxing incisions are placed at the limbus, which is the boundary separating the cornea from sclera (the white of the eye).

    Sometimes the arc-shaped incisions are placed in the peripheral cornea slightly closer to the center to better preserve the cornea’s surface. This is known as astigmatic keratotomy (or AK).

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Glossary

Not sure what a particular term means? Click on words in bold to pull up the glossary tab.

FAQ

If I'm not eligible for LASIK, are there other options available to me?

    Some patients are not good candidates for LASIK surgery because of eye health, overall health or various lifestyle factors. However, if you are not eligible for LASIK, you may still be a good candidate for an alternative surgical procedure [hyperlink: other surgeries] such as PRK, LASEK, Epi-LASIK or a non-laser vision correction procedure. Talk with your ophthalmologist about your surgical options.

Is PRK laser surgery a better option for people with thin corneas or a propensity for dry eye?

    Some patients are not good candidates for LASIK surgery because they have pre-existing health conditions, their corneas are too thin or they experience chronic dry eye. When this is the case, there are other surgical options, including PRK, LASEK and Epi-LASIK and non-laser vision correction procedures that may be more appropriate. These procedures do not involve the creation of a corneal flap, a part of the LASIK procedure that may not be appropriate for someone with thin corneas or chronic dry eye.

Can I have LASIK if I play extreme contact sports?

    Many members of the military, pilots and professional football and basketball players have had successful LASIK procedures. However, regular participation in contact sports such as boxing or wrestling may disqualify you for LASIK. If you are disqualified for LASIK because of these types of activities, other surgeries such as PRK may be a more appropriate option.

Glossary Entries

Anesthetic
Medicine that causes a loss of sensation including loss of pain. Local anesthetic causes numbness and pain relief in a localized area, such as the eye, without affecting the senses in the rest of the body.

Astigmatism
Common vision problem and type of refractive error. Caused by either irregularity in the curvature of the cornea or the lens of the eye. People with astigmatism generally have difficulty seeing fine details at all distances. Treated with corrective lenses, laser vision correction or toric IOLs.

Cornea
Clear, curved surface at the front of the eye through which light enters the eye. Along with the sclera (the white part of the eye), provides external protection for the eye. Often called the window of the eye. During many types of vision correction surgery, such as LASIK, the cornea is reshaped to reduce or eliminate the main types of refractive error - nearsightedness, farsightedness and astigmatism.

Corneal flap
Thin slice of tissue on the surface of the cornea made at the beginning of LASIK surgery. Made with either a microkeratome or a femtosecond laser. The flap is folded back before the LASIK procedure can shape the inner layers of the cornea.

Ectasia
Progressive thinning and bulging of the cornea (the clear outer covering of the eye).

Epithelium or epithelial layer
Cellular tissue that covers the outside of body surfaces, including the outside of the cornea (the clear outer covering of the eye).

Farsighted, farsightedness (or hyperopia)
Common vision problem and type of refractive error. Caused by too little curvature of the cornea or too little distance between the front of the eye and the retina at the back. Both structural defects cause light entering the eye to focus incorrectly on the retina, resulting in blurred close-up vision. Treated with corrective lenses, laser vision correction or multifocal or accommodative IOLs.

Intraocular lens (IOL)
Artificial lens made of plastic, silicone or acrylic. Designed to be implanted in the eye in place of or in front of the natural lens to improve focus and correct vision problems, such as cataracts and presbyopia.

Keratoconus
Degenerative eye disorder in which structural changes within the cornea cause it to thin and change to a more conical shape than its normal gradual curve. Can cause substantial distortion of vision, including multiple images, streaking and sensitivity to light. Typically diagnosed during adolescence and is most severe by the patient's 20s and 30s. If afflicting both eyes, deterioration in vision can affect the patient's ability to drive a car or read normal print.

Keratomileusis
Reshaping of the cornea which was done with a lathe and blade before the development of LASIK techniques.

Laser vision correction
A class of surgeries where a laser is used to reshape the cornea to correct refractive errors. LASIK, PRK, LASEK and Epi-LASIK are all types of laser vision correction.

LASIK (laser in-situ keratomileusis) surgery
Type of laser surgery in which the cornea is reshaped to improve vision. Either a microkeratome or a femtosecond laser is used to surgically create a thin, hinged flap of corneal tissue. The flap is folded back, and an excimer laser is directed to the corneal surface exposed beneath the flap to reshape the cornea for corrected vision. Then the flap is brought back into place.

Nearsighted, nearsightedness (or myopia)
Common vision problem and type of refractive error. Caused by either too much curvature of the cornea or too much distance between the front of the eye and the retina at the back. Both structural defects cause light entering the eye to focus incorrectly on the retina, resulting in blurred distance vision. Treated with corrective lenses, laser vision correction or multifocal or accommodative IOLs.

Overcorrection
When the change to refractive error after refractive surgery exceeds the attempted correction.

Presbyopia
Also called age-related focus dysfunction. Common vision problem that develops naturally over time. Characterized by loss of the eye's ability to focus at close distances or on fine details. Treated with reading glasses, contact lenses, presbyopia laser vision correction (also called LASIK monovision) or presbyopia lens replacement surgery.

Refractive error
Irregularities in the cornea, lens or shape of the eye that prevent correct focus at any distance.

Sclera
White part of the eye. Provides external protection for the eye, along with the cornea (the clear outer covering of the eye).

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