What is the goal of refractive surgery?
The basic goal is to reduce people’s dependence on glasses and contact lenses.
Does it work?
Yes, for the vast majority of patients. However, some patients are much better candidates than others.
I’m nearsighted. Would it work for me?
Nearsighted people under the age of 40 need glasses to see well for distance. They can often see well up close with or without eyeglasses, but without eyeglasses have to hold things pretty close to their eyes. Refractive surgery usually eliminates or significantly reduces the need for contact lenses or glasses for near and distance, until about age 40, when reading glasses are often needed for everything up close.
I’m nearsighted, but over 40 years old. What about me?
If the vision in both eyes is corrected so you see well in both eyes at distance without eyeglasses, you will need reading glasses for everything up close. The computer screen may be OK at age 42 but by age 45 you will probably need computer glasses.
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My friend who’s over 40 does “monovision” with his contacts. What is that?
Monovision is where one eye is corrected to see well for distance while the other eye is corrected to see well up close (but that eye is blurred at distance). The patients who like this feel as if they have the best of both worlds. The brain uses the distance eye when they want to see far and automatically switches to the near eye when they look up close. The patients who don’t like monovision feel as if they have the worst of both worlds, where both eyes aren’t working together for distance and near.
Can I get monovision with refractive surgery?
Yes, but then it’s “permanent.” With contacts, if you don’t like it, the contacts can be changed. That’s not as easy after refractive surgery. In general, we would only perform monovision with refractive surgery when someone is very happy with it in contact lenses.
What about me, I’m farsighted?
Farsighted patients generally need glasses (or contacts) to see well far away and up close. Refractive surgery can be done for farsighted patients, but the results generally aren’t quite as good as for nearsighted patients.
I have astigmatism. Can I have refractive surgery?
Yes, most cases of “regular” astigmatism can be corrected with laser refractive surgery.
Is there a limit as to how much nearsightedness, farsightedness, or astigmatism one can have to be a candidate for refractive surgery?
Absolutely. High degrees of nearsightedness, farsightedness, and astigmatism aren’t well-corrected by laser refractive surgery. These patients may be candidates for other refractive surgery procedures such as an ICL or refractive lens exchange.
I’ve heard of a few different types of refractive surgery. What are they?
There are a wide variety of refractive surgery procedures that are done, but we primarily perform PRK and LASIK. PRK is when the surface layer of the cornea is removed and the laser used to reshape the cornea. LASIK is when a flap of cornea is created and lifted, the middle of the cornea is reshaped with the laser, and the flap replaced.
Are the vision results the same for PRK and LASIK?
Yes, after the first few weeks. LASIK has a faster visual recovery.
Why do PRK then?
PRK and LASIK each have advantages and disadvantages. The advantages of PRK involve the fact there isn’t a LASIK flap to worry about. Rarely, there can be problems with creation and healing of a LASIK flap. Also PRK doesn’t weaken the eye as much as LASIK. The main downsides of PRK are discomfort for 3-4 days and mediocre vision for 5-7 days, which gets much better over the first few weeks.
What about LASIK?
The advantages of LASIK are the fact that the discomfort only lasts about 6 hours and the vision is quite good the next day. Disadvantages include the rare problem with flap creating or flap healing. The flap can also be dislodged days or even years later if the eye is poked at the flap edge.
Are both eyes treated the same day?
It can be done either way, but most patients opt for treating both eyes the same day.
What is done for the discomfort after PRK?
The post-op eye drops and bandage soft contact lens help a lot. Frequent ice packs over the eyes and pain pills for the next few days also help.
When is the next appointment?
Everyone is seen 1 day after surgery.
What kind of vision can I expect a month after PRK or LASIK?
It really depends on the strength of your glasses before surgery. Many patients can see 20/20 without glasses or contacts a month after surgery, but not everyone. Some patients are better candidates than others.
How can I tell if I’m a good candidate?
You need to undergo a refractive surgery evaluation. This is a complete eye examination with numerous extra tests to measure your corneas. It takes about two hours and your eyes are usually dilated that visit. At the end of that visit, your surgeon should be able to tell how good a candidate you are for refractive surgery.
What makes someone a good candidate?
Age over 21, stable strength of glasses/contact lenses for at least a few years, no family history of corneal disorders such as keratoconus, with a normal corneal shape and thickness.
Anything special I need to do if I wear contact lenses?
You should not wear your soft contact lenses at all for a period of time (some say 3 days, others say 2 weeks) and your hard contact lenses for at least 3 weeks before your evaluation and before your surgery.