Is Vision Correction Surgery for You?

If you've thought about vision correction surgery -- also called refractive eye surgery -- and have even begun to do your research, you know by now that there's an alphabet soup of confusing options.

There's the well-known, and still vastly popular, LASIK (laser in situ keratomileusis), but also wavefront LASIK, Epi-LASIK, and PRK -- just to name a few techniques.

The boom in options and acronyms is triggered by improved technology and better surgeons' skills. As a result, the scope of vision problems that can be corrected with refractive eye surgery has expanded greatly in the past few decades, says George Waring, MD, a clinical professor of ophthalmology at Emory University in Atlanta and editor-in-chief of the Journal of Refractive Surgery, who has served as a consultant for an ophthalmic medical equipment company.

"We can correct nearsightedness, astigmatism [unevenly curved cornea], farsightedness -- and we can correct presbyopia [focusing difficulty that occurs with age]," he says.

Results have improved, says Waring. "We are now at the point where over 95% of patients with nearsightedness corrected with LASIK see 20/20 or better without their glasses," Waring says. Among the downsides: some people do need a second procedure or "enhancement" to get the best possible vision; some have complications that interfere with their life and work.

Overall, however, the results seem long lasting, with a recent study published in the Journal of Refractive Surgery showing that nearly 95% of eyes corrected for moderate to severe nearsightedness have 20/20 or better and the results held over a seven-year follow-up.

Side effects such as dryness of the eye can occur, Waring, says, "because you cut through a nerve." It generally goes away after three months, he says, and it can be managed with medications.

If you're a candidate for refractive eye surgery, the surgery should be tailored not only to your vision problems, but also such factors as age, occupation, and lifestyle, Waring and other experts say. There's no one-size-fits-all surgery, and be wary if your eye doctor suggests that's true.

LASIK

LASIK still makes up the bulk of vision correction surgery, says James Salz, MD, a Los Angeles ophthalmologist and veteran refractive surgeon who is also a clinical professor of ophthalmology at the University of Southern California Keck School of Medicine and an attending eye surgeon at Cedars-Sinai Medical Center, Los Angeles.

"Ninety percent of the surgeries done in the U.S. are still LASIK," he says. About 700,000 Americans a year have LASIK, according to the American Academy of Ophthalmology.

LASIK works by changing the shape of the cornea -- the clear covering of the front of the eye -- so that light rays focus on the retina and improve vision. The surgeon uses a blade device called a mechanical microkeratome, a laser device called a laser keratome, or a femtosecond laser, to cut a flap in the cornea.

A hinge is left at one of the end of the flap and it's folded back so that a computer-controlled laser can vaporize the midsection of the cornea before the flap is reattached.