LASIK is the most commonly performed surgery to correct vision. However, if you are not eligible for LASIK due to eye health, professional and lifestyle considerations, there are excellent alternatives to consider.
Learn more about these surgeries below:
- Photorefractive keratectomy (PRK)
- Conductive keratoplasty (CK)
- LASEK and Epi-LASEK
- Phakic IOLs
- Limbal relaxing incisions
Photorefractive keratectomy (PRK)
PRK corrects nearsightedness, farsightedness and astigmatism. It was the first FDA-approved use of laser for the correction of refractive errors. It is an excellent choice for those patients whose corneas are too thin for LASIK or who are not candidates for LASIK because of their serious involvement in contact sports or combat situations (which might predispose patients to corneal flap displacement).
PRK involves removing the epithelium, the surface layer of the cornea. Then, a computer-controlled laser reshapes the cornea of the affected eye. Anesthetic drops in the eye help ensure that the patient experiences minimal discomfort. The procedure is typically quicker than LASIK, although the recovery is slightly longer. Patients typically wear bandage contact lenses for pain reduction for a few days while the epithelial tissue regenerates. Postoperative antibiotic and anti-inflammatory drops are used for several days to several months.
While the long-term visual results achieved are predictable and stable with PRK, patients may experience discomfort for 24 to 72 hours while their epithelium regenerates. Advanced techniques, bandage contact lenses and medications have significantly reduced the postoperative discomfort. Initially, the visual recovery associated with PRK is not as fast as with LASIK, although data demonstrate that visual outcome is the same as with LASIK by approximately three to six months. Typically, both eyes are not treated at the same time, although they may be.
As with any surgery, there are risks involved. The complications associated with PRK are similar to those with LASIK. Patients should discuss the risks and benefits in detail with their surgeons.
Conductive keratoplasty (CK)
Conductive keratoplasty is a temporary treatment for farsightedness and/or presbyopia. It is also used as an enhancement procedure to treat overcorrections after LASIK or PRK for nearsightedness and to treat astigmatism, as well.
CK uses heat generated by radio frequency energy to change the shape of the cornea. After anesthetic drops have been applied, a special probe is used to apply the radio frequency energy to a number of treatment areas around the edges of the cornea. Over time, the cornea tends to return to its original shape and the treatment regresses, which is why the procedure is viewed as a temporary solution.
As with any surgery, there are risks involved, although this is one of the safest refractive procedures. Patients should discuss the procedure in detail with their surgeons.
LASEK and Epi-LASEK
LASEK, laser epithelial keratomileusis, is a less commonly used variation of the PRK procedure. LASEK involves preserving the extremely thin epithelial layer on the cornea by loosening it with alcohol and lifting it from the eye’s surface prior to reshaping the cornea by laser. The epithelium is then replaced on the cornea’s surface and a bandage contact lens is used to help with healing.
While some small studies have shown that the clinical results after LASEK are slightly better compared to PRK, others have shown delayed re-epithelialization and increased discomfort without any clear advantage.
Epi-LASEK is a variation of LASEK that uses a plastic blade, called an epithelial separator, to lift the epithelial layer from the cornea. The epithelial flap is then usually replaced after reshaping the cornea but is sometimes discarded. Healing afterward is similar to LASEK. As with LASEK, however, this procedure is not performed routinely, for it does not have any consistent clear-cut advantage over modern PRK.
Intacs are very small, transparent, crescent-shaped pieces of a plastic polymer inserted into the cornea to reduce or eliminate nearsightedness and astigmatism in patients where contact lenses or eyeglasses no longer work to provide functional vision.
Intacs are generally used to treat a rare complication of LASIK called ectasia or a condition called keratoconus.
Phakic intraocular lenses (IOLs) are an excellent alternative to laser vision correction for patients with high amounts of nearsightedness and for those who cannot have LASIK or PRK due to thin or irregularly shaped corneas.
Phakic IOLs are lenses surgically implanted into the eye. The implants are similar to contact lenses, but they are permanent. They may be implanted in the front of the iris, clipped to the iris, or placed behind the iris but in front of the crystalline lens. There is no sensation of a phakic IOL in the eye and it requires no maintenance (unlike contact lenses). However, after implantation of phakic IOLs, patients will require regular yearly checkups.
Studies of highly nearsighted eyes show a rapid return to stable, excellent quality vision after the implantation of phakic IOLs. The potential side effects of phakic IOL surgery are similar to risks associated with cataract surgery or presbyopia lens replacement surgery.
Limbal relaxing incisions
Sometimes called corneal relaxing incisions, this surgical procedure is usually performed during cataract surgery, presbyopia lens replacement surgery (also called refractive lens exchange) or during insertion of phakic IOLs.
Limbal relaxing incisions correct mild astigmatism by flattening the curvature of the cornea (the clear outer part of the eye). Limbal relaxing incisions are placed at the limbus, which is the boundary separating the cornea from sclera (the white of the eye).
Sometimes the arc-shaped incisions are placed in the peripheral cornea slightly closer to the center to better preserve the cornea’s surface. This is known as astigmatic keratotomy (or AK).