What are the types of laser eye surgery?
There are a wide range of lasers that are used in ophthalmology to treat various eye diseases or to correct the vision. Here are the main ways how lasers are used in eye care:
- Refractive Surgery: This is what most people think of when they hear the term "laser surgery". There are many types of refractive surgeries, but they are all intended to provide the patient with correction of their vision to eliminate the need for eyeglasses or contact lenses.
- Cataract Surgery: Much of the modern cataract procedure involves the use of lasers resulting in efficient, precise results and minimal recovery. Posterior Capsular Opacification (PCO) is where the membrane that holds the lens implant that is placed after cataract surgery becomes cloudy. This results in hazy vision following cataract surgery, but is easily corrected at the cataract surgeon's office with laser. A YAG laser capsulotomy is a quick and painless process done in an office setting that clears the PCO resulting in clearer vision immediately following the procedure.
- Glaucoma Treatment: There are two lasers used in glaucoma. One is for treatment and one is for prevention
- Selective Laser Trabeculoplasty (SLT) and lesser used Argon Laser Trabeculoplasty (ALT) are an effective way of treating glaucoma. These procedures are gaining in popularity as first-line treatments for glaucoma in lieu of or in addition to eye drops to lower the eye pressure. An ophthalmologist specializing in glaucoma will perform this in-office laser procedure, which targets the drainage system of the eye to increase the outflow of aqueous that fills the eye. By improving the outflow of aqueous it results in lower eye pressure. It is about as effective as taking one glaucoma eye drop, but with the advantage of being a one time procedure that can last months to years and is repeatable as needed.
- Laser Peripheral Iridotomy (LPI) utilizes laser to decrease a patient's risk of Angle Closure Glaucoma. This in-office laser procedure performed by an ophthalmologist specializing in glaucoma essentially creates a small hole in the iris. This is done for people with a certain anatomy called "narrow angles", which is referring to where the edge of the iris meets the edge of the cornea. If the iris and cornea meet at an acute angle, there is a chance that they could eventually stick together and cause the drainage system of the eye to close off leading to a quick increase in eye pressure. An angle closure event can increase the pressure so high that it may result in permanent glaucomatous vision loss within hours to days. If it is determined that you have anatomical narrow angles at your routine eye exam, it may be suggested to have an LPI done. Having this done does not mean that you have glaucoma, but is to prevent you from getting glaucoma secondary to an angle closure attack.
- Retinal Detachment: Think of the retina as the wallpaper that lines the inside of the eye. Just like how wallpaper tends to start to peel from the corners of a room, a retinal detachment typically begins in the corner of the eye. If caught early enough, a barricade of laser can be applied to prevent the retina from detaching any further. Think of pressing thumbtacks along the leading edge of where the wallpaper is peeling off to prevent it from coming off towards the center of the wall.
- Retinal Vascular Disease: Laser can be used in cases where there is unwanted new blood vessel growth known as neovascularization. This neovascularization can be a result of many things such as: diabetes, macular degeneration, sickle cell, and retinal vein occlusion to name a few. Laser can be applied to the retina in an effort to prevent this neovascularization from leaking or to preserve the areas of the retina that are most important for vision.
What is refractive surgery?
The "refraction" is the portion of the eye exam when your optometrist or ophathlmologist flips between various lenses within a phoropter, and asks "what is better: one or two?". This procedure is to determine which lens power best refracts, or bends, the light onto the retina resulting in your new eyeglass prescription.
Refractive surgery is when an ophthalmologist will alter the structures of the eye so that the light entering the eye will be refracted, or bent, into focus on the retina. This is most commonly done by manipulating the curvature of the cornea, which is the front surface of the eye. There are many different types of refractive surgery, but they are all intended to provide clear vision and eliminate the need for eyeglasses or contact lenses.
Refractive surgery is when an ophthalmologist will alter the structures of the eye so that the light entering the eye will be refracted, or bent, into focus on the retina. This is most commonly done by manipulating the curvature of the cornea, which is the front surface of the eye. There are many different types of refractive surgery, but they are all intended to provide clear vision and eliminate the need for eyeglasses or contact lenses.
How do I know which corrective eye surgery is right for me?
Your optometrist or ophthalmologist will be the best resource to go over the pros and cons of each type of refractive procedure. Figuring out which option is best for you will depend on several factors including: your eyeglass prescription, your eye anatomy, your flexibility during the recovery period, and your budget.
Am I a candidate for LASIK surgery?
The only way to get a definitive answer to if you are a candidate for LASIK surgery is to get examined by an optometrist or ophthalmologist that does LASIK consultations. Given the advances with the procedure, the parameters that determine a patient's candidacy for LASIK surgery are pretty wide, making it an excellent option for most of the population. Keep in mind, LASIK is only one of several refractive surgery options. If you are not a perfect candidate for LASIK, there is likely an alternative option to provide clear vision without the need for eyeglasses or contact lenses.
Here are the main factors that determine if you are a candidate for LASIK:
Here are the main factors that determine if you are a candidate for LASIK:
- Eyeglass Prescription
- Myopia (Nearsighted): Up to -11.00 with or without astigmatism up to -5.00
- Hyperopia (Farsighted): Up to +4.00 with or without astigmatism up to +2.00
- Corneal Thickness (Pachymetry)
- The average corneal thickness is between 520-560 microns thick. A calculation will be made by your optometrist or ophthalmologist to determine how much treatment is required based on your prescription. The more treatment required, the thinner it will leave the cornea. If the cornea is left too thin it can end up bulging forward resulting in distorted vision.
- Curvature of the Cornea (Keratometry)
- A machine called a topographer is the best way to map out the curvature of the cornea. The whole purpose of LASIK surgery is to alter the curvature of the cornea, so if the cornea is either too steep or too flat to begin with then that may not leave enough change to be made. The corneal topography will also reveal if there are any underlying corneal dystrophies, which are conditions resulting in distorted corneas that can be made worse by LASIK surgery.
What is LASIK?
Laser-Assisted in situ Keratomileusis (LASIK) is the most common type of refractive surgery and is intended to correct a patient's vision to eliminate the need for eyeglasses or contact lenses with the lease amount of downtime for the recovery. The objective of LASIK is to reshape the cornea in order to refract, or bend, light focused onto the retina. The corneal nerves are extremely sensitive, as you know if you have ever gotten poked in or scratched your eye. LASIK is performed by creating a "flap" which is done by separating the top layer of cells and peeling them back before applying the laser treatment. Once the treatment is complete, the flap is laid back down leaving the nerve endings virtually untouched. The result is a painless procedure with minimal inflammation and clear vision right away.
As a general rule of thumb, if patients get LASIK on a Thursday, they will sleep as much as possible the rest of the day and avoid rubbing their eyes. They will wear protective goggles while sleeping to protect the cornea and keep the surface of the eye moist. Patients will return for a one day follow-up and then be back to normal activity with some restrictions after that.
If there are any minor complications following LASIK, they are most likely to occur within the first week and are addressed in-office. These can include wrinkles in the flap, excessive inflammation, or infection. Following a successful 1 week follow-up, the patient will be seen at 1 month, 3 months, and 6 months. If any enhancements to refine the prescription are required, they are generally not done sooner than the 6 month follow-up, which allows the cornea to fully heal and treatment to take full effect and stabilize.
The results of LASIK are considered permanent, but any regressions will be monitored at yearly checkups thereafter. If regressions are significant enough, then the patient may see if they are a candidate for an enhancement surgery or end up wearing eyeglasses or contact lenses to correct their vision.
As a general rule of thumb, if patients get LASIK on a Thursday, they will sleep as much as possible the rest of the day and avoid rubbing their eyes. They will wear protective goggles while sleeping to protect the cornea and keep the surface of the eye moist. Patients will return for a one day follow-up and then be back to normal activity with some restrictions after that.
If there are any minor complications following LASIK, they are most likely to occur within the first week and are addressed in-office. These can include wrinkles in the flap, excessive inflammation, or infection. Following a successful 1 week follow-up, the patient will be seen at 1 month, 3 months, and 6 months. If any enhancements to refine the prescription are required, they are generally not done sooner than the 6 month follow-up, which allows the cornea to fully heal and treatment to take full effect and stabilize.
The results of LASIK are considered permanent, but any regressions will be monitored at yearly checkups thereafter. If regressions are significant enough, then the patient may see if they are a candidate for an enhancement surgery or end up wearing eyeglasses or contact lenses to correct their vision.
What is PRK?
Photorefractive Keratectomy (PRK) is basically LASIK without the "flap". The corrective laser is applied directly onto the cornea. You may experience more discomfort following PRK compared to LASIK, which is why a bandage contact lens is applied immediately after the surgery. The contact lens provides comfort and allows for the cornea to heal beneath. The vision over the course of the first 5 days is likely to be hazy as the cornea heals, but once the bandage contact lens is removed around day 5 post-op, the vision will show improvement and tends to sharpen over the next few weeks. The advantage of PRK is that there is no flap that could potentially harbor a bacteria or get dislodged during post-op. These complications are very rare after LASIK, so most people that get PRK may have corneas that are too thin for LASIK or take part in high impact activities like martial arts or are in the military.
What is ICL?
Implantable Collamer Lens (ICL) is also sometimes called the Implantable Contact Lens, which is somewhat of a misnomer, but gives the patient a general picture of what the procedure entails. A thin implant, that looks like a miniature contact lens, is placed in the space between the back of the iris and the front of the crystalline lens. If you were told that your prescription is too high for LASIK, consider getting a consultation for ICL, because the parameters are much more inclusive. There is a higher cost for the ICL procedures, but if you prescription is too high for LASIK, that means your vision is a severe handicap and warrants a permanent solution besides glasses and contacts, which in your case also cost more because of special lens materials to support your higher prescription.
Does insurance cover LASIK?
LASIK and other refractive surgeries are out-of-pocket expenses. Check with your vision plan (VSP, EyeMed, UnitedHealthcare Vision, etc.) to see if they offer discounts. There may be something along the lines of 15% off if you go to a provider in their network. Most laser vision centers offer in-house financing options to spread out the cost over years into manageable monthly payments.
