Would you like to reduce your dependence on eyeglasses and contacts? Refractive surgery reshapes the cornea or adds a lens inside the eye so that light focuses properly on the retina, reducing or possibly eliminating the need for glasses or contact lenses. With new and improved vision, patients are inspired to pursue life with confidence and enthusiasm. Today's options include LASIK, Custom Wavefront LASIK, PRK, LASEK/Epi-LASIK, SMILE, and the implantable collamer lens (ICL). Each corrects nearsightedness, farsightedness, or astigmatism in a different way, and the right one depends on your prescription, the thickness of your cornea, and the health of your eyes.

LASIK (Laser-Assisted In Situ Keratomileusis)

LASIK remains the most common laser vision correction procedure. Anesthetic drops numb the eye and a small holder keeps the eyelids open. A thin flap is created in the cornea, either with a microkeratome blade or with a computer-controlled femtosecond laser, and gently folded back. Pulses of a cool excimer laser reshape the cornea, and the flap is laid back in place, where it adheres naturally without stitches. The surface heals within hours, which is why LASIK is so comfortable. Most patients see well the next day and return to work and driving within a day or two.

Custom (Wavefront) and Bladeless LASIK

Custom LASIK, also called Wavefront LASIK, uses a three-dimensional map of how your eye processes images to guide the laser more precisely, improving not only how much you can see but how well you see it. Conventional LASIK treats nearsightedness, farsightedness, and astigmatism. Custom LASIK can also reduce higher-order aberrations, the irregularities behind glare, halos, and poor night vision. Bladeless LASIK (also called iLASIK, IntraLASIK, or All-Laser LASIK) creates the corneal flap with a laser instead of a blade.

PRK (Photorefractive Keratectomy)

PRK was the original laser vision correction procedure and is still an excellent choice for many patients. No flap is created. Instead, the epithelium (the outermost layer of the cornea) is removed and the same excimer laser reshapes the surface of the cornea. A bandage contact lens protects the eye for three to five days while the epithelium regrows. Vision takes longer to sharpen than after LASIK, but the results are equivalent, and PRK is often preferred for thinner corneas or for patients whose work or sports carry a risk of a blow to the eye.

LASEK and Epi-LASIK

LASEK and Epi-LASIK are variations of PRK. The epithelium is loosened and moved aside rather than removed, the excimer laser reshapes the cornea, and the epithelium is put back in place. A bandage contact lens is worn for three to five days while the surface heals.

SMILE (Small Incision Lenticule Extraction)

SMILE is the newest laser procedure. A femtosecond laser shapes a thin disc of tissue, called a lenticule, inside the cornea, and the surgeon removes it through an opening only a few millimeters wide. There is no flap and no excimer laser. Because the surface of the cornea is left largely intact, SMILE tends to cause less dry eye than LASIK and avoids flap-related concerns, with a recovery nearly as fast. SMILE corrects nearsightedness with or without astigmatism; it is not currently used for farsightedness.

ICL (Implantable Collamer Lens)

The ICL takes a different approach. Instead of removing corneal tissue, the surgeon places a soft, flexible lens inside the eye, behind the iris and in front of your natural lens, through a small opening. The lens is made of Collamer, a material that is compatible with the eye, and it cannot be seen or felt. The ICL corrects moderate to high nearsightedness and astigmatism, including prescriptions too strong for laser treatment, and it is a good option for patients with thin corneas or dry eyes. It is also removable, so the procedure can be reversed if your needs change. Because the lens sits inside the eye, your surgeon will confirm there is room for it and will follow your eye pressure and the health of the lens over time.

Comparing Procedures

Procedure	How it works	Best suited for	Recovery
LASIK and Custom LASIK	Corneal flap plus excimer laser reshaping	Nearsightedness, farsightedness, astigmatism; normal corneal thickness	Clear vision in about a day
PRK, LASEK, Epi-LASIK	Surface reshaping with no flap	Thinner corneas, contact sports, some dry eye cases	Several days to a few weeks; results match LASIK
SMILE	Laser-shaped lenticule removed through a small opening, no flap	Nearsightedness with or without astigmatism; patients prone to dry eye	About a day or two
ICL	Lens implanted inside the eye, cornea untouched	Moderate to high nearsightedness and astigmatism, thin corneas, dry eyes; reversible	About a day or two

LASIK, PRK, LASEK/Epi-LASIK and SMILE produce similar visual outcomes for the prescriptions they treat; the main differences are recovery time and which eyes they suit. Patients who are not candidates for LASIK because of thin corneas, large pupils, corneal scars, or a high prescription can often be treated with PRK, SMILE, or the ICL.

Are You a Candidate?

Good candidates are at least 18 years old (21 for the ICL), have had a stable prescription for a year or more, and have healthy eyes free of active disease. To find out which procedure fits your eyes, call any of our offices to schedule a complimentary consultation.

Refractive Surgery