Refractive Eye Surgeries: 5 Interesting Facts To Know

Refractive surgeries are a very popular group of eye procedures performed to reduce dependence on glasses or contact lenses. These help patients correct refractive errors in their vision, such as:

• Nearsightedness (myopia)

• Farsightedness (hyperopia)

• Astigmatism
  

While these are common surgeries, many patients know little about the range of refractive eye surgeries available, their similarities and differences, and which one may suit them best.

Learning a few basic facts about refractive surgery can help patients make more informed choices about their eye care.

LASIK surgery is the most popular refractive eye surgery, with around 700,000 procedures performed every year in the United States.

During LASIK, the doctor uses a laser to reshape the cornea by removing thin, microscopic layers and smoothing irregularities.

After surgery, patients will experience crisper, clearer vision, with the advantage of a short recovery time — most patients enjoy clearer vision shortly after the operation.

LASIK is the most marketed refractive surgery, but it is not the only one available. Patients should be aware that there are a variety of refractive eye surgeries.

Other surgeries are just as safe and effective as LASIK and may be a better choice based on a patient's preferences and medical history.

Many refractive surgeries use lasers to correct vision errors. In addition to LASIK, there are other laser-based surgeries available to patients:

Like LASIK, PRK surgery (photorefractive keratectomy) improves vision by using a laser to operate on the cornea of the eye. However, these surgeries have a key difference.

During LASIK, the eye doctor creates a flap in the cornea to reshape the deeper corneal layers. The surgeon then replaces and aligns the flap to its original position.

In PRK, the doctor removes a superficial layer of tissue called the epithelium, and the more superficial layers of the cornea are reshaped by the laser. This tissue regenerates on its own — meaning the eye doctor does not put it back in place.

PRK is just as effective as LASIK but has a longer recovery time. Following a PRK procedure, it may take 7-10 days for a full recovery. Patients will be uncomfortable for a few days following the procedure.

Although they have nearly identical names, LASIK (laser in-situ keratomileusis) and LASEK (laser epithelial keratomileusis) are not the same. In fact, LASEK has more in common with PRK surgery.

Like PRK, the eye doctor operates on the epithelium. However, during LASEK, the surgeon replaces the epithelium at the end of the procedure. This can lead to a more comfortable recovery in some patients.

SMILE (small incision lenticule extraction) is a relatively new laser-based surgery that corrects nearsightedness and astigmatism.

During the procedure, the doctor uses a laser to alter the shape of the cornea. This shape change improves the way light rays focus on a patient’s retina — allowing for clearer vision without the aid of glasses or contacts.

The SMILE procedure shares similarities to LASIK. It may be a better choice for patients with an active lifestyle because it does not involve cutting a flap in the eye like LASIK.

Not all refractive eye surgeries use lasers like LASIK. Procedures like refractive lens exchange (RLE) and implantable contact lens (ICL) are two popular lens-based refractive surgeries.

Refractive lens exchange is a lens-based eye surgery that corrects refractive errors. It has a nearly identical procedure to cataract surgery.

During RLE, the eye doctor removes the patient’s natural lenses and replaces them with an artificial intraocular lens (IOL) that improves poor vision. Patients can choose from a variety of artificial lens replacements — some of which can correct for multiple vision ranges and astigmatism.

RLE, and other lens-based surgeries, are considered more appropriate procedures for patients over 40. This is because the artificial lens implants used in the surgeries don't age, offering patients relief from presbyopia and other age-related eye conditions.

This lens-based procedure corrects the refractive error by implanting a contact lens.

Regular contact lenses are placed on the eye's surface but, in this surgery, the eye doctor implants them between the iris and the eye’s natural lens.

Implantable contact lenses offer patients a flexible eye care option as they can be removed or replaced if they have a vision change.

While approved refractive surgeries are safe and effective, not all patients will respond the same way to each surgery. Certain refractive eye surgeries will be better suited for certain patients based on their preferences and medical history.

For example, refractive lens exchange is considered a better option than LASIK for patients over 40 years old because it can correct age-related eye deterioration.

A surgery like PRK may be more appropriate for patients with thin corneas, who enjoy active lifestyles and are at a greater risk of eye injury.

Some factors for patients to take into account when picking a refractive surgery are:

• Age

• Visual needs

• Any associated ocular diseases

Choosing a refractive surgery should be approached with care. As a best practice, we recommend a comprehensive eye exam and consultation with an ophthalmologist specialized in refractive eye surgery. This can guide patients in finding the best procedure for achieving their desired goals.