It is important for patients to understand that no eye surgical procedure is risk-free. Ophthalmology literature to-date, however, has indicated a high level of safety and efficacy associated with excimer laser refractive surgery.
Why Refractive Surgery?
The goal of refractive surgery is to eliminate or reduce one's dependence on eye glasses and/or contact lenses. The field of refractive surgery is ever changing, with major advances being achieved each year. Technology now exists to treat almost all degrees of nearsightedness, astigmatism and even farsightedness. New technology has also helped us to better screen patients to determine which patients are truly appropriate and safe candidates for thse procedures.
Although some new procedures are only available under investigational protocols, the FDA has recently made available to the public some of the latest cutting edge technology, such as wavefront-guided "custom" excimer laser surgery (see below). Dr. Marc Goldberg of The Eye Institute is a highly trained laser refractive surgeon offering refractive surgery consultations by appointment.
LASIK Surgical Procedure
LASIK (Laser In-situ Keratomileusis) utilizes a combination of two refractive surgery techniques. An automated instrument called a microkeratome is first used to create a thin flap of corneal tissue. This outer protective flap is reflected back to expose the underlying central cornea. The laser is then utilized to gently and painlessly sculpt the exposed corneal tissue. The sculpting is computerized to correct precise degrees of myopia and/or astigmatism. The flap in then repositioned and naturally adheres to the underlying treated corneal tissue without the need for stitches or patching.
By utilizing the flap technology the outer surface (epithelium) of the cornea is preserved. Healing is therefore quite rapid. Patients who have LASIK often achieve excellent visual acuity rapidly and most patients obtain driving vision or better with 24hours of the procedure.
Since visual recovery is so rapid, surgery on both eyes can usually be performed on the same day. After the surgery, patients are usually instructed to use eye drops four times a day for a week. Some minimal activity restrictions are required initially after surgery; however, most normal daily activities can be resumed the day after surgery. Because LASIK is so precise, the results can be fine-tuned at three months after the original surgery, if necessary.
PRK Surgical Procedure
PRK is an outpatient procedure that usually takes about 10 minutes to perform. It utilizes exquisitely precise and safe Excimer Laser to exert this vision correcting effect. During PRK, computer-controlled pulses of cool laser light are applied painlessly to the surface of your cornea to delicately reshape your eye's curvature. Your cornea's new curvature is shaped to ensure the correction of your contact lens or glasses prescription. This allows you to reduce or eliminate your dependence on glasses or contacts.
To effectively reshape your cornea, Dr. Goldberg will gently remove the protective surface layer (epithelium) from the eye. This epithelial layer is most often regenerated within three to five days.
The laser process is completed in approximately 30 to 60 seconds. Post-operatively, the eye is covered with a clear "bandage" contact lens which is usually worn for three days, then removed by Dr. Goldberg. Antibiotic and anti-inflammatory drops are taken post-operatively for a period of several weeks. After the PRK procedure, your eye may feel irritation or a foreign-body sensation for a few days, but this discomfort is usually effectively managed with medication if needed.
LASIK vs PRK: What's the Difference?
LASIK and PRK are both effective laser procedures for the correction of nearsightedness and astigmatism. Some doctors and patients prefer LASIK because for the following advantages:
- Faster visual recovery
- Less risk of discomfort after surgery
- Less risk of infection
- Less risk of corneal haze or scarring
- Less need for anti-inflammatory eye drops
- Fewer post-operative visits
Advantages of PRK include the elimination of the potential for flap-related complications and the possibility of reduction in postoperative-induced higher order aberrations (see Wavefront-Guided, below) with PRK relative to LASIK.
Since the surface of the cornea (epithelium) is preserved, LASIK patients see well the day following their procedure. PRK patients require about three days for the epithelium to heal and allow clearer vision. Although these differences in healing patterns exist, patients can feel comfortable in their choice of either procedure, as both procedures have been proven to be safe and effective when performed appropriately. Dr. Goldberg will help determine the most suitable procedure for you, based upon your examinations and consultations.
Wavefront-Guided "Custom" LASIK
Common vision disorders such as nearsightedness, farsightedness and astigmatism (known as "lower order aberrations") are not the only problems that can affect vision. Some vision problems, such as the glare and halos caused by low-light or night vision conditions, may be due to "higher order aberrations" that cannot be corrected with contacts, glasses or conventional LASIK.
Dr Goldberg diagnoses and measures higher order aberrations by creating "wavefront map" of the eyes. Wavefront mapping reveals visual disturbances by passing a narrow ray of light through the optical system and measuring the optical distortion as the light exits the eye. Dr. Goldberg compares these wavefront maps to the maps associated with normal vision, and then corrects the associated visual disorder using a "custom" LASIK procedure customized to your eyes and your eyes alone. Custom LASIK can be used to correct vision disorders caused by both lower and higher order aberrations.
