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- LASIK surgery: Is it right for you?
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LASIK surgery: Is it right for you?
LASIK surgery and presbyopia
LASIK surgery may benefit certain people with presbyopia, but there are limitations. Most people in their 40s have some symptoms of presbyopia — a refractive error that develops as you age — such as difficulty reading small print or performing other close-up tasks. You can usually manage the condition pretty well by using reading glasses.
If you have presbyopia, LASIK surgery may give you clear distance vision, but worsen your ability to see objects close up. To avoid this, you might choose to have your vision corrected for monovision. With monovision, one eye is corrected for distant vision and the other for near vision. Not everyone is able to adjust to or tolerate monovision, so it's wise to undergo a trial with contact lenses before having a permanent surgical procedure.
Other types of refractive surgery
Your eye doctor may recommend another type of refractive surgery if you're not a good candidate for LASIK surgery. These alternatives include:
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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. PRK removes the thin surface layer of your cornea (epithelium). Your eye surgeon then uses a laser to flatten your cornea or make its curve steeper.
The exposed 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 variations in your vision. It may take three to six months before maximal visual improvement. Most people undergoing PRK have both eyes done the same day.
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.
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Laser epithelial keratomileusis (LASEK). LASEK is similar to LASIK surgery, but during a LASEK procedure, a much thinner layer — the surface layer (epithelium) — of your cornea is folded back to allow the laser to focus only on parts of your cornea that need reshaping. The epithelial flap is then replaced.
If you have very thin corneas, you might be a better candidate for LASEK because the procedure allows your doctor to remove 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 the same day.
- Implantable lenses. Phakic intraocular lenses are implantable lenses that are surgically inserted into the eye to improve vision. Your eye doctor places the implantable lens inside your eye in front of your natural lens. One of the advantages of this procedure is the capability to correct high degrees of nearsightedness not easily corrected by other surgical procedures. However, not all eye doctors agree that this procedure is a good approach to vision correction, so it's not widely performed and remains controversial.
- Intracorneal ring segments. Intracorneal ring segments are used to treat mild nearsightedness. A small incision is made in the cornea, and two crescent-shaped plastic rings are placed on the cornea's outer edge. The rings help flatten the cornea so that light rays focus properly on the retina. However, the refractive change is difficult to predict and it tends to vary over time. The rings aren't permanent devices, though, so they can be removed at a later date, if necessary.
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- Bower KS. Laser refractive surgery. http://www.uptodate.com/home/index.html. Accessed Nov. 4, 2008.
- When is LASIK not for me? U.S. Food and Drug Administration Center for Devices and Radiological Health. http://www.fda.gov/cdrh/lasik/when.htm. Accessed Nov. 4, 2008.
- Sakimoto T, et al. Laser eye surgery for refractive errors. The Lancet. 2006;367:1432.
- Bakri SJ, ed. Mayo Clinic Guide to Better Vision. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2007:179.
- Robertson DM (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 14, 2008.
