LASIK and other refractive surgeries: Say good-bye to eyeglasses

Considering surgery to correct your vision? Explore three procedures that can restore your eyesight.

If you wear glasses or contact lenses, you might be interested in surgery to correct your vision. Keep in mind, though, that as much as you might like to toss out your glasses or put an end to the daily ritual of inserting and removing your contact lenses, surgery to correct vision problems isn't for everyone.

Familiarize yourself with the procedures eye doctors use to correct vision problems and the risks and benefits of each. Then discuss your options with your doctor to help you decide whether refractive eye surgery is for you.

What is refractive eye surgery?

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Eye anatomy Eye anatomy

Refractive eye surgery is a surgical procedure to change the way your eye refracts light. As light rays enter your eye, your cornea and lens bend (refract) the rays to focus them on the back of your eye — your retina. If you have a refractive error, your eye is shaped in such a way that light rays aren't sharply focused on your retina.

During refractive surgery, your cornea is reshaped. Your cornea can be flattened or steepened based on your specific vision problems. Refractive surgery is usually considered an elective surgery — which means it isn't vital to your health and well-being. For this reason, Medicare and most insurance companies won't cover the cost of the surgery.

Who can have refractive eye surgery?

Refractive eye surgery is for people with certain refractive errors in their vision, such as:

* Nearsightedness (myopia). Nearsightedness is the most common refractive error. It generally occurs when your eye is slightly larger than the average-size eye. It can also be caused by a cornea that is too curved. Nearsightedness causes light rays to focus in front of your retina, rather than right on it, causing blurry distant vision.

* Farsightedness (hyperopia). Farsightedness affects near vision. It generally occurs when your eye is slightly smaller than the average-size eye. It can also be caused by a cornea that's too flat. Farsightedness causes light rays to focus beyond the retina, rather than right on it, causing blurry vision.

* Astigmatism. Astigmatism makes it difficult to see objects at any distance. It's caused by a cornea that's uneven — curving and flattening in different spots on your eye.

Refractive surgery can't correct or prevent presbyopia — a type of refractive error that is common as you age. Most people in their 40s have some signs of presbyopia, including difficulty reading or doing up close work. If you're approaching your 40s or if you already have presbyopia, keep in mind that refractive surgery may give you clear distance vision, but it might make it even more difficult for you to see objects close up.

To avoid this, you might choose to have your vision corrected to give you monovision. With monovision, one eye is corrected to see objects far away and your other eye is corrected to see close objects. Some people can adjust to this whereas others can't. You can also choose to wear glasses solely for reading or other close up work. Ask your eye doctor about your options if you have presbyopia.

Your eye doctor will likely recommend that you try other ways of correcting your vision before you turn to surgery. Glasses or contact lenses are usually your first option. Some people might have only mild refractive errors that don't require vision correction.

MORE ON THIS TOPIC

* Nearsightedness overview

* Farsightedness overview

* Astigmatism overview

* Presbyopia overview

* Contact lenses: What to know before you buy

What might disqualify you from having refractive surgery?

Not everyone with a refractive error is a candidate for refractive surgery. Whether surgery is right for you is also based on:

* Your general health. Certain diseases or conditions might make it difficult for your eyes to heal after surgery. Diseases that affect your immune system, such as autoimmune and immunodeficiency diseases, affect your ability to heal. One example is rheumatoid arthritis.

* Your eye health. Eye diseases and conditions that make your eyes dry can make it difficult for your eyes to heal after surgery. Examples include Sjogren's syndrome and rheumatoid arthritis. Abnormally shaped corneas may make surgery more difficult to perform.

* The stability of your vision. The degree of refractive error in your eye must be stable. If your vision is fluctuating or progressively worsening, you may not be eligible for refractive surgery. Women who are pregnant or breast feeding, for example, usually have fluctuating degrees of refractive error.

* Other factors. Your eye doctor will take into account additional factors. For example, deep-set eyes may make the surgery more difficult and risky.

To determine whether you're a candidate for refractive surgery, your eye doctor will conduct an in-depth eye exam to determine the degree of your refractive error, the shape of your corneas and the general health of your eyes. Talk with your eye doctor about certain aspects of your eyes that might influence whether you're eligible for refractive surgery.

MORE ON THIS TOPIC

* Dry eyes overview

* Eye exams: What to expect

What types of refractive eye surgery are available?

Several surgical procedures are available if you have a refractive error in your vision. What type of surgery you choose will depend on the type and degree of refractive error that you have. Get to know the common types of refractive surgery and discuss your options with your eye doctor.

Laser-assisted in-situ keratomileusis (LASIK)

LASIK is the most common refractive eye surgery. You might choose LASIK if you're nearsighted or farsighted, with or without astigmatism. LASIK is performed using a laser programmed to remove a defined amount of tissue from your cornea. With each pulse of the laser beam, a tiny amount of corneal tissue is removed. The laser allows your eye surgeon to flatten the curve of your cornea or make it steeper.

During the LASIK procedure, your eye surgeon uses a special blade or special cutting laser to cut a hinged flap about the size of a contact lens away from the front of your eye. Folding back the flap allows your doctor to access the tissue in your cornea that needs reshaping. Using a laser, your eye surgeon then targets specific parts of your cornea. The flap is then folded back into place and usually heals on its own without stitches.

Your eye doctor determines which specific areas of your cornea need to be flattened or curved during your eye exam. This allows your eye doctor to chart your eye and remove tissue from your cornea very precisely.

You will receive an anesthetic to numb your eye during the LASIK procedure, which helps ensure you'll experience little pain. You may be given medication or eyedrops after the procedure to soothe any pain you might have for several hours after your surgery. Your eye doctor might also ask you to wear a shield over your eye at night until your eye heals. You might have the option of having LASIK on both eyes on the same day.

Typically you're able to see the day of your surgery, but your vision won't necessarily be better right away. Expect your vision to improve over the next two to three months. Most people who have refractive surgery will have vision that is close to 20/20. Your chances for improved vision are based, in part, on how well your eyes saw before surgery.

Laser epithelial keratomileusis (LASEK)

LASEK is similar to LASIK and might be an option if you aren't eligible for LASIK. During a LASEK procedure, a much thinner layer of your cornea is folded back to allow the laser to focus on parts of your cornea that need reshaping. The flap is then replaced.

If you have very thin corneas, you might choose LASEK because the procedure allows your doctor to cut out less of your cornea. People who play sports or have jobs that carry a high risk of eye injuries might also prefer LASEK because a thinner flap means less damage to your vision should the flap be torn before it can heal. As with LASIK, the LASEK procedure can be done on both eyes on the same day. Expect your vision to take time to recover — it may take several months.

Photorefractive keratectomy (PRK)

PRK is sometimes used if you have a low-to-moderate degree of nearsightedness or farsightedness, or if you have nearsightedness with astigmatism. With PRK a thin layer on the surface of your cornea is removed. Unlike with a LASIK or LASEK procedure, this layer isn't replaced during PRK. Your eye surgeon uses a laser to flatten your cornea or make its curve steeper.

The raw surface of your cornea repairs itself, assisted by a contact lens you wear as a bandage over your eye for three or four days after surgery. You might have eye pain for a few days until your cornea heals. It generally takes up to a week for your eye to regenerate the surface tissue that was removed. During this time you'll notice changes in your vision. It may take three to six months before your vision improves completely. Most people undergoing PRK have one eye done at a time. After your first eye has healed, you might consider having surgery on your other eye.

PRK has become less common in recent years because more eye surgeons prefer the LASIK procedure. Healing after LASIK is more predictable and usually involves less discomfort and scarring.

Other types of surgery

Other types of refractive surgery exist, although LASIK, LASEK and PRK are the most popular. Talk to your doctor about what types of refractive surgery are available to you. If you have severe refractive errors, your eye doctor may propose more than one type of surgery to help you regain your vision.

What are the risks and benefits of refractive eye surgery?

Refractive surgery can offer you improved vision without the hassle of glasses or contact lenses. In general, you have a very high chance of achieving 20/40 vision or better after refractive surgery. About 85 percent of people who've undergone refractive surgery no longer need to depend on their glasses or contact lenses most of the time.

Your results will depend on your specific refractive error and other factors. People with a low grade of nearsightedness tend to have the most success with refractive surgery. People with a high degree of farsightedness along with astigmatism have the least predictable results.

As with any surgery, refractive surgery carries risks, including:

* Undercorrections. If the laser removes too little tissue from your eye, you won't get the vision results you were hoping for. Undercorrections are more common for people who are nearsighted. It may require another refractive surgery within a year to remove more tissue.

* Overcorrections. It's also possible that the laser will remove too much tissue from your eye. Overcorrections may be more difficult to fix than undercorrections.

* Astigmatism. Astigmatism can be caused by uneven tissue removal. This sometimes occurs if your eye moves too much during surgery. It may require additional surgery.

* Glare, halos and double vision. After surgery you may have difficulty seeing at night. You might notice glare, halos around bright lights or double vision. Sometimes these signs and symptoms can be treated with an eyedrop that contains a type of cortisone, but sometimes a second surgery is required.

* Dry eyes. As your eyes regenerate the nerves cut during surgery, your eyes might feel dry for the first six months or so. Your eye doctor might recommend that you use eyedrops during this time. More severe cases of dry eye may require special plugs for your tear ducts to prevent your tears from draining away from the surface of your eyes. Keeping the tears on the surface of your eyes for a longer time will help keep them moist and more comfortable.

* Flap problems. Flaps folded back during surgery and then replaced after surgery can cause complications, including infection, tearing and swelling. The flap removed during PRK may grow back abnormally.

Talk to your doctor about your concerns. He or she can explain the risks that are most likely to affect you.

Considering refractive eye surgery

As you make your decision whether to have refractive eye surgery, consider the benefits and the risks. Also consider the cost of surgery. Most importantly, discuss your decision and your concerns with your eye doctor. He or she can help you decide if refractive surgery is right for you.