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Refractive Surgery

February 28, 2022

What is it, and who is a good candidate?

Refractive surgery is elective surgery for the purposes of correcting a patient’s vision so they can eliminate or reduce the need for glasses and contact lenses.

Radial Keratotomy (RK)

  • This was performed in the 1970s and 1980s as a method of vision correcting surgery
  • Radial cuts were made in the cornea in order to have it flatten its shape as it healed
  • This flattening caused vision in near sighted people to improve
  • The long term results of RK can be unpredictable, and many patients I have seen with previous RK are now very hyperopic.
  • Can result in significant glare/halo, and can make additional vision correction difficult
  • We will still see some patients that have had this, but it is not very common


PRK (Photorefractive Keratectomy)


  • FDA approved in 1995 for the purpose of vision correction
  • The first laser refractive surgery
  • The top layer of the cornea (epithelium) is removed using alcohol and then underlying cornea tissue is reshaped to correct for the needed vision correction
  • Over the next several days the epithelium regenerates, and vision improves as the cornea heals
  • A soft contact lens is placed on the eye for the first few days to aid in pain relief and healing
  • Can be an uncomfortable process (especially the first couple of days), long term results are very good
  • Can be done on people with thinner corneas because no flap needs to be made like LASIK


LASIK (Laser Assisted In Situ Keratomileusis)

  • Most common refractive surgery procedure that we will see
  • FDA approved in 2000 for vision correction
  • Similar to PRK, but uses an epithelium flap instead of removing the epithelium entirely
  • Patient will have better initial results compared to PRK
  • Much less uncomfortable that PRK
  • Certain complications can arise from the flap that may need to be corrected with additional surgery or medication


ICL (Implantable Contact Lens)

  • A different type of refractive surgery that uses an implantable lens situated between the iris and the lens
  • Can be done on very high prescriptions where other methods are not an option
  • It is a reversible procedure unlike other refractive surgery options
  • Can cause complications like cataracts over time due to the contact between the ICL and the crystalline lens
  • Not very commonly performed


RLE (Refractive Lens Exchange)

  • Permanent implanted lens to replace the natural crystalline lens
  • Depending on the IOL used, can correct for any type refractive error
  • Can help near vision in presbyopia if a multifocal lens is used
  • Can be performed after previous refractive surgery (LASIK, PRK)
  • The same surgical procedure as cataract surgery
  • Can be about twice the cost of LASIK
  • Has the same risks as cataract surgery

Who is a good refractive surgery candidate?

  • Stable refractive error (I will usually tell people 2-3 years of stability), I always recommend no refractive surgery procedure before age 25 because RX is still very likely to change at younger ages
  • No other corneal disease (keratoconus, Fuchs, etc.)
  • For PRK and LASIK the cornea must be thick enough (Higher RX requires thicker corneal because more tissue will need to be removed to perform correction)
  • PRK and LASIK do not help presbyopia, so patient will still eventually need reading glasses/contact lens
  • People with previous LASIK or PRK can still eventually get RLE