LASIK Eye Surgery and Other Refractive Surgeries: An Updated Guide

LASIK surgery is one type of refractive surgery. Refractive surgery can eliminate the need for eyeglasses or contact lenses in people with these conditions:

• Nearsightedness
• Farsightedness
• Astigmatism (unevenly curved cornea)
• Presbyopia (age-related loss of sharp close-up focusing)

Done on both eyes, these procedures work by changing the eyes' focus to improve vision.

You might assume that refractive surgery is fairly new. But it goes back about 100 years! You're right, however, to think that today's state-of-the-art refractive surgery procedures are of more recent development. These newer techniques were first performed in the U.S. in 1978.

Types of Refractive Surgery

Three types of refractive surgery procedures are available. They include:

• Excimer laser procedures (including LASIK surgery)
• Artificial lens implantation
• Cornea reshaping procedures (including radial keratotomy, the first-used refractive surgery)

The Excimer Laser Used in LASIK Surgery

Developed in the 1980s, the excimer laser is computer-controlled.It gives eye surgeons the ability to remove precise amounts of tissue from the surface of the eye. This provides a high degree of safety and precision for laser-assisted procedures like LASIK.

LASIK Surgery Steps

LASIK is an abbreviation for "laser-assisted in situ keratomileusis." The steps of LASIK surgery include:

1. Eye numbing drops are given before surgery to prevent pain.
2. The eye surgeon creates a flap in the cornea. The surgeon may use either an instrument called a microkeratome or a femtosecond laser. The flap is folded back to reveal the cornea's midsection (stroma).
3. The excimer laser vaporizes part of the stroma.
4. The corneal flap is put back in place. It reattaches within a few minutes without sutures.
5. Eye drops or ointment is applied to aid healing.

Recovery from LASIK surgery is usually fast and painless.You may notice improved vision by the next day or sooner.

Procedures Related to LASIK Surgery

Doctors have developed other surgeries similar to the standard LASIK procedure. These include the following.

• Epi-LASIK uses a special instrument, the Epi-keratome, to create the corneal flap on the layer of cells covering the cornea (epithelium). Epi-LASIK is used in patients with corneas too thin to allow the standard LASIK surgery.
• Wavefront-guided LASIK creates a highly detailed "map" of how light moves through the eye. This shows even the subtlest distortions of focus. The goal is to reduce the chance of after-surgery problems such as glare, light "halos," and poor night vision.
• PRK (photorefractive keratectomy) corrects low to high nearsightedness, low to moderate farsightedness, and astigmatism. The eye surgeon removes the epithelium. Then the surgeon uses the excimer laser to reshape the cornea. Healing occurs with help from a "bandage contact lens" applied at the end of the procedure. Healing takes three to four days and may involve some discomfort. Full recovery may take several weeks. For these reasons, LASIK surgery has generally replaced PRK except for patients with corneas too thin for LASIK surgery.
• LASEK (later epithelial keratomileusis) is similar to PRK. The difference is that the surgeon replaces the epithelium after completing the surgery. LASEK may be recommended for people with thin corneas. As with PRK, healing may involve some discomfort.