OTHER LASER VISION CORRECTION

PRK
PRK (photorefractive keratectomy) is a procedure in which a laser is used to reshape corneal tissue. PRK can be used to treat low to moderate myopia, hyperopia, and astigmatism.

Your surgeon uses a computer guided excimer laser to reshape the cornea.

After laser treatment, you will wear a contact lens as a bandage for a few days. This protects the cornea as it heals.

What to Expect
Before treatment, you may be given medication to help you relax. Eyedrops numb your eyes. A device is used to keep your eyes open. A small surgical tool or the laser is first used to remove the central portion of the epithelium. Laser treatment lasts for 10 to 90 seconds. For a few days after the procedure, your vision may seem worse. It should begin to improve in about 5 days, and become stable in about 6 months.

What You Should Consider
Pros

• No risk of flap complications
• Better for patients with thin corneas, previous glaucoma surgery, mild corneal scars, or other cornea problems

Cons

• Mild to moderate pain after surgery
• Longer vision recovery than LASIK
  May need to use eyedrops for 3 months or longer

Risk of:

• Corneal scarring or haze
• Temporary or permanent dry eye
• Night vision problems, such as halos, glare, or starbursts
• Undercorrection or overcorrection
• Loss of best corrected vision

LASEK
LASEK (pronounced “Lay-SEEK”) stands for laser epithelial keratomileusis. With LASEK, the epithelium is softened with an alcohol solution to create a flap in the cornea. An excimer laser is used to reshape the underlying corneal tissue. LASEK can treat myopia, hyperopia, and astigmatism.

The epithelium is softened. It is then rolled back to expose the inner cornea tissue.

Your surgeon uses a computer-guided excimer laser to reshape the cornea.

The epithelium is folded back over the cornea. You will wear a contact lens as a bandage for a few days. This protects the cornea as it heals.

What to Expect
Before treatment, you may be given medication to help you relax. Eyedrops numb your eyes. A device is used to keep your eyes open. An instrument with alcohol solution in it is briefly placed on the cornea. The surgeon then rolls back the softened epithelium. Laser treatment lasts for 10 to 90 seconds. The epithelium is then put back into place. For a few days after the procedure, your vision may seem worse. It should begin to improve in about 5 days, and become stable in about 6 months.

What You Should Consider
Pros

• Better for patients with thin corneas, previous glaucoma surgery, mild corneal scars, or other cornea problems
• Possibly less postoperative discomfort, haze, regression, or corneal scarring than with PRK
• Possibly faster vision recovery than with PRK

Cons

• Mild to moderate pain after surgery
• Longer vision recovery than LASIK
• May need to use eyedrops for 3 months or longer

Risk of:

• Corneal scarring or haze
• Temporary or permanent dry eye
• Night vision problems, such as halos, glare, or starbursts
• Undercorrection or overcorrection
• Loss of best corrected vision

IMPLANT PROCEDURES

Special devices maybe implanted in the eyes to change their focusing ability. Implants are made from types of plastic similar to those used for contact lenses and cataract treatment.

Phakic IOLS
Phakic intraocular lenses (PIOLs) are artificial lenses that are placed inside the eye. Some types are designed to go in front of the iris, some behind. This procedure may be combined with excimer laser surgery to reshape the cornea. PIOLs may be used to treat severe myopia or hyperopia.

A small hole is made in the iris to prevent fluid buildup in the eye. An incision is then made at the edge of the cornea.	The lens is inserted either in front of or behind the iris.
PIOLS are made of a safe plastic material

What to Expect
Before treatment, you’ll be given local anesthesia. You may also be given medication to help you relax. A peripheral iridotomy (drainage hole) is made in the iris. An incision is then made n the cornea. The lens is inserted through the incision. After treatment, your eye may be bandaged. Your vision should start to improve the next day. IT should become stable in 1 to 3 weeks.

What You Should Consider
Pros

• Implant can be removed or replaced if the desired result is not achieved
• Can correct some extreme refractive problems
• No loss of accommodation, since natural lens remains in place
• No thinning of the cornea
• Reduced risk of halos, glare, or starbursts

Cons

• Long-term effects are still unknown
• May increase risk of developing cataracts
• If infection or inflammation occurs, serious vision problems may result

Risk of:

• Vision loss
• Undercorrection or overcorrection
• Loss of best corrected vision

Intrasomal Corneal Ring Segments (Intacs)
Two flexible half-rings are inserted in the cornea. This changes the shape of the cornea. The ring segments are nearly invisible and cannot be felt. This procedure may be used to treat mild to moderate myopia.

The ring segments are placed in two tunnels, between the layers of the corneal tissue.

What You Should Consider
Pros

• No tissue is removed from the cornea
• Implants can be removed or replaced if the desired result is not achieved
• No scarring of central cornea
• May be used along with excimer laser procedures to refine correction

Cons
Risk of:

• Glare, halos, and other night vision problems
• Postoperative infection, requiring removal of the implant
• Anterior chamber perforation
• Blurred or double vision
• Undercorrection or overcorrection
• Loss of best corrected vision

Clear Lens Extraction
This procedure is similar to cataract surgery. A very small incision is made in the cornea. A very small incision is made in the cornea. The existing natural lens is then removed and replaced with a plastic lens. This procedure may be used to treat very severe hyperopia or myopia.

The natural lens is removed and replaced through a small incision in the cornea.

What You Should Consider
Pros

• Can correct some extremely high refractive problems
• Fast recovery

Cons

• Loss of accommodation due to removal of natural lens
• If infection or inflammation occurs, serious vision problems may result

Risk of:

• Retinal detachment for those with high myopia
• Vision loss
• Undercorrection or overcorrection
• Loss of best corrected vision

THERMAL PROCEDURES

These procedures use lasers or high-energy radio frequency waves to create heat. The heat shrinks parts of the cornea, reshaping it and changing the way it focuses light. These procedures are used only to treat mild hyperopia or to create monovision.

LTK
LTK (laser thermal keratoplasty) uses a holmium laser to gently heat certain areas of the cornea. This shrinks the outer portion of the cornea, making the central cornea steeper.

A holmium laser sends energy to the cornea in to or more rings. This reshapes the corneal tissue. Marks on the cornea are not visible after the procedure.

What to Expect
Before treatment, you may be given medication to help you relax. Eyedrops numb your eyes. A device is used to keep your eyes open. Laser treatment lasts a few seconds for each eye. Your vision should start to improve right away. It may take 3 to 6 months to become stable.

What You Should Consider
Pros

• Very safe procedure with few complications
• “No touch” procedure (no cutting or removal of corneal tissue)
• No scarring in the central cornea
• Low risk of dry eyes
• Immediate vision improvement

Cons

• Vision improvement may wear off over time.
• May take several months for vision to become stable

Risk of:

• Undercorrection or overcorrection
• Loss of corrected vision

CK
CK (conductive keratoplasty) uses a tiny probe to send radiofrequency energy into the cornea. This shrinks the outer portion of the cornea, making the central cornea steeper.

The tip of a radiofrequency probe is inserted into the cornea. The probe’s heat reshapes the corneal tissue. Marks on the cornea are not visible after the procedure.

What to Expect
Before treatment, you may be given medication to help you relax. Eyedrops numb your eyes. A device is used to keep your eyes open. The tip of a probe is then inserted into the cornea. The treatment lasts a few minutes for each eye. Your vision should start to improve right away. It may take 3 to 6 months to become stable.

What You Should Consider
Pros

• Very safe procedure with few complications
• No scarring in the central cornea
• Low risk of dry eyes
• Immediate vision improvement

Cons

• May take several months for vision to become stable

Risk of:

• Undercorrection or overcorrection
• Loss of best corrected vision

IS REFRACTIVE SURGERY RIGHT FOR YOU?

Successful refractive surgery may help you better enjoy your life at home, at work, and at play. But before choosing refractive surgery, talk with your eye doctor and get all the facts. Find out what refractive surgery can and can’t do. Knowing the risks will help you make an informed decision.

The Choice is Yours
Refractive surgery has risks and limitations:

• Even after surgery, you may need to wear glasses or contacts for some activities. For example, if you’re over 40 you may need reading glasses, even if you don’t use them now.
• After surgery you’ll have a recovery period of weeks or months. During this time, activities such as driving and certain sports may be restricted.
• If your first refractive surgery doesn’t produce the desired result, you may need to have a second procedure (enhancement).
• Any surgery involves risk. Be sure that you understand the possible risks and complications of each type of surgery before making a decision.

What You Should Consider
Discuss your medical story with your eye doctor. Refractive surgery may not be fore you if you:

• Do not have stable vision.
• Have a vision problem that is too severe.
• Have a condition that slows healing or increases your risk of infection.
• Have an eye disease, such as advanced glaucoma or cataracts.
• Are taking certain medications.
• Are pregnant or nursing, or are planning to become pregnant in the near future.

To reduce your risk of complications, schedule a follow-up with your eye doctor.

Vision for the Future
Your vision is precious. If you choose refractive surgery, you’ll need to see your eye care team for follow-8up visits. This will help you recover more quickly. And it reduces the risk of complications. You’ll also need to take good care of your eyes to preserve the gains you’ve made. Regular eye exams will help you to keep your vision clear and our eyes healthy. So can protecting your eyes from sunlight and taking care of your general health. Maintaining good vision can help you make the most of what life has to offer. Your eye care team can help.