Deciding on the vision correction procedure that’s right for you is an important task. There are several excellent refractive alternatives for patients that are not good candidates for LASIK: those with thin corneas, extremely high refractive errors, astigmatism, presbyopic patients over 40, early cataracts, dry eyes, or cornea problems. Learn about the different options and ask your eye doctor about which choice is best for you.
Photorefractive Keratectomy (PRK)
Photorefractive Keratectomy is similar to LASIK as it is laser eye surgery for correcting a person’s vision and reducing dependency on glasses or contact lenses. The PRK procedure uses a laser light beam to reshape the surface of the eye but differs from LASIK as no flap is created during the surgery. The thin outer skin layer of the cornea (the epithelium) is gently removed and the laser is done on the underlying surface. Vision recovery is a bit slower than LASIK with slightly more discomfort as the new epithelium grows back over the surface over 3-5 days. PRK may be suitable for people with thin corneas, larger pupils, other corneal issues, or dry eyes.
Refractive Lens Exchange (RLE)
Refractive Lens Exchange is essentially identical to cataract surgery, but exclusively for refractive purposes. In RLE, the clear natural lens of the eye is removed and replaced with an artificial intraocular lens implant (IOL). The replacement IOL is customized to the patient’s needs to correct most, if not all, of the patient’s myopia, hyperopia, astigmatism, and even presbyopia (difficulty reading for patients over 40 years old). Multi-Focus IOLs such as the ReSTOR, Tecnis, or Crystalens IOLs are the implants of choice for patients wanting the greatest freedom from glasses for a full range of vision - so one can see distance and near objects simultaneously quite well in both eyes without glasses in most cases. For this group of patients, these implants can be the best investment they ever make. Insurance DOES NOT cover the cost of these lens implants. RLE may be the best option for people with high refractive error, thin corneas, presbyopia, and/or early cataracts. Because RLE removes the natural lens, there is no possibility of developing a cataract in the future.
Staar Visian Implantable Contact Lens (ICL)
Staar Visian ICL - Implantable Collamer Lens or “Implantable Contact Lens”, is a soft, flexible lens that is placed in the eye to correct very high amounts of myopia (up to -16.0 D) thereby greatly reducing dependency on glasses or contact lenses. While traditional contact lenses go on the outside surface of the eye, the Visian ICL is positioned inside the eye between the iris (the colored part of the eye) and the natural lens where it stays indefinitely. Unlike LASIK and PRK, the Staar Visian ICL does not involve the reshaping of the eye and can be removed if a person’s vision changes dramatically. Once inside the eye, the Visian ICL is cosmetically invisible. Of Visian ICL patients, 99% report satisfaction with their results and 97% would elect to have the surgery again. In evaluation of optical quality of the ICL compared to high myopia LASIK, the Staar Visian ICL was superior and induced significantly less high order aberrations. The main complication seen in the FDA study was inducement of a cataract in approximately 2% of patients receiving the ICL.
Near Vision Conductive Keratoplasty (CK)
NearVision CK - Conductive Keratoplasty is a non-invasive technique for people with presbyopia (difficulty reading at near after 40 years old) that induces a bifocal effect and slight myopia in the patient’s non-dominant eye to help improve vision at near. NearVision CK is a surface procedure which which does not involve corneal incisions but rather uses controlled radio waves to gently reshape the curvature of the cornea to improve near vision. A radiofrequency probe is used to apply 8 to 16 spots to the corneal surface away from the center of vision thus giving NearVision CK one of the highest safety profiles among all refractive eye procedures. In the FDA clinical trials, well over 90% of patients could function without glasses for both near and distance tasks with both eyes open with no sight threatening complications whatsoever.
Limbal Relaxing Incisions (LRI)