Refractive Eye Surgery

Even though it was once deemed risky, surgery aimed at correcting refractive errors of the eye has become an acceptable practice that produces remarkable benefits. Any refractive surgical procedure is completely elective and voluntary. Recent advancements in technology have made it an elective just as glasses or contacts would be, and the potential for complications is rare.

Everyone considering a refractive surgical procedure should carefully study the indications, methods, possible risks and limitations for any procedure, keeping in mind their own individual occupational and recreational visual needs. Two of the most crucial factors to be aware of are the experience of the refractive surgeon and the quality and maintenance of the sophisticated equipment.

Laser surgery is not for everyone. "It's not a foolproof procedure and people need to know that some can end up with worse eyesight than before they went in," says Ralph A. Rosenthal, M.D., director of the FDA's division of ophthalmic devices. Mary Ann Duke, M.D., a general ophthalmologist, adds, "People who are slow healers or who have ongoing medical conditions are not good candidates for laser surgery. That's why it's so important for patients to undergo a thorough examination with their doctor."

Poor candidates for this surgery also include those with uncontrolled vascular disease, autoimmune disease, or people with certain eye diseases involving the cornea or retina. Since the refraction of the eye may change during pregnancy, pregnant women should not opt for refractive surgery.

There are several different types of surgery for you to choose from, depending on your situation- Intracorneal Rings (ICR), Radial Keratotomy (RK), Astigmatic Keratotomy (AK), Photo-Refractive Keratectomy (PRK), Automated Lamellar Keratoplasty (ALK), and Laser in-situ Keratomileusis (LASIK). Each is an outpatient procedure.

Intracorneal Rings
In this procedure, small arcs of clear plastic are surgically placed in the periphery of the cornea in an effort to relatively flatten the central cornea in order to correct myopia. There is no laser-tissue interaction during this surgery, sparing the central cornea, and this procedure has the potential for reversibility with removal or adjustment, if the need arises.

Radial Keratotomy
This procedure reduces myopia by surgically changing the curvature of the cornea over the pupil. Through the use of a microscope and microscopic instruments, the surgeon is able to make several deep incisions (keratotomies) in the cornea in a radial or spoke-like pattern. The normal pressure present inside the eye causes the area around the incisions to bow or steepen, as the center or optical zone of the cornea flattens. It is this flattening that reduces the refractive power of the cornea and allows light rays to focus closer to, or directly on the retina.

Astigmatic Keratotomy
In this procedure used to reduce astigmatism, the surgeon makes incisions in a curved rather than a radial pattern. AK can be combined with RK to reduce myopia with astigmatism. It is a rare occasion when complications occur, but when they do they can be serious.

Photo-Refractive Keratectomy
This outpatient corneal surgery that can reduce or correct mild to moderate myopia, uses a laser to precisely reshape the cornea to eliminate dependency on glasses or contact lenses. The laser is computer controlled and programmed by the ophthalmologist to specifically address the patient's own unique corneal shape and refractive error. It produces a highly concentrated beam of light, which flattens the front surface of the cornea by removing micro-thin layers of tissue, allowing light to focus more accurately on the retina.

Automated Lamellar Keratoplasty
When correcting myopia, the surgeon creates a flap by slicing across the front of the cornea with an instrument called a microkeratome. He then removes a thin disc of tissue from the exposed surface of the cornea, flattening the optical zone and reducing the myopia.

When correcting hyperopia, the surgeon slices the cornea at a deeper level with the microkeratome. The internal pressure of the eye stretches the remaining thin corneal surface, causing it to bulge forward.

Laser in-situ Keratomileusis
This procedure is used to correct or reduce moderate to high levels of myopia. The surgeon uses a keratome and an eximer laser to remove a thin layer of tissue from the center of the cornea, thus flattening the central cornea and reducing the myopia.

Each procedure has side effects and risks attached to it, and should be discussed with the doctor of your choice. Be aware that there are always entrepreneurial organizations that will offer these procedures at "discount or budget" rates. This is definitely one area where spending the extra money could make your procedure a better, safer one. Keeping abreast of the currently approved and emerging technologies and with careful selection and planning with an experienced surgeon, the best overall refractive surgery outcome can be safely achieved.