Refractive surgery is a procedure that corrects common vision problems resulting from refractive errors. These surgeries aim to reduce or eliminate the need for glasses or contacts by reshaping the cornea.
The most common types of refractive surgery include:
| Treatment | Procedure | Benefits |
| LASIK (laser in-situ keratomileusis) | Involves creating a flap in the cornea with a femtosecond laser or a microkeratome to correct refractive errors. | Quick recovery time, minimal discomfort, and rapid vision improvement. |
| PRK (Photorefractive Keratectomy) | The cornea's outer layer (epithelium) is removed, and an excimer laser reshapes the underlying corneal tissue. | Suitable for people with thin corneas, no risk of flap complications, and effective for higher prescriptions. |
| SMILE (Small Incision Lenticule Extraction) | A femtosecond laser creates a disc-shaped piece of corneal tissue (lenticule) within the cornea, which is then removed through a small incision, reshaping the cornea. | Less invasive, lower risk of dry eye, and suitable for active lifestyles. |
| Phakic Intraocular Lens Implants (ICL) | A lens is implanted inside the eye without removing the natural lens. | Effective for severe refractive errors, people with high myopia, or those who aren’t candidates for LASIK or PRK. |
| Refractive Lens Exchange (RLE) | Removes the natural lens and replaces it with an artificial intraocular lens (IOL). | Suitable for people with presbyopia or high hyperopia and can be combined with other procedures to correct astigmatism. |
| Intacs (Intracorneal Ring Segments) | Small plastic rings are inserted into the cornea to flatten it and correct mild myopia or keratoconus. | Minimally invasive and can be removed or adjusted if needed. |
| LASEK (laser subepithelial keratomileusis) | A combination of LASIK and PRK. Uses an alcohol solution to loosen the epithelium. Instead of removing the tissue, the surgeon creates a flap. | The flap made during LASEK is thinner than the one created by LASIK, making it better for thin corneas. |
| Epi-LASIK | Epi-LASIK creates a thin epithelial flap with a microkeratome blade. It doesn’t involve using an alcohol solution. | After surgery, the cornea is less damaged, there is a smaller risk of dry eyes, and the corneal structure is more stable. |
| Limbal Relaxing Incisions (LRI) | This procedure involves making small incisions in the peripheral cornea. It can be performed alone or in conjunction with other refractive surgeries, such as LASIK. | It relaxes the tension on the cornea and allows it to assume a more spherical shape. |
What Are Refractive Errors?
Refractive errors are common vision problems caused by an irregular eye shape. This prevents light from focusing directly onto the retina, resulting in blurry vision.
The main types of refractive errors are:
- Myopia (nearsightedness). Difficulty seeing distant objects
- Hyperopia (farsightedness). Difficulty seeing close objects
- Astigmatism. Blurred or distorted vision from an irregular cornea
- Presbyopia (age-related farsightedness). Gradual decline in close-up vision due to age
Potential Risks of Refractive Surgery
Generally, refractive surgeries are considered safe and effective. However, all surgeries come with risks. The rate of complications varies depending on the procedure, but fortunately, it’s considered low.
Some potential risks of refractive surgery include:
- Glare or halos that don’t improve
- Persistent blurry vision
- Infection
- Pain
- Elevated eye pressure
- Retinal detachment
Lens implant surgeries are more invasive than laser refractive surgeries and generally carry a higher risk of complications.
For example, the risk of retinal detachment is higher with an RLE procedure (about 1.5% to 8.1% in those with high myopia) versus laser refractive surgery (about 0.05% to 0.19% among LASIK patients).
Which Refractive Surgery is Right for You?
An eye doctor will thoroughly examine your eyes to determine which surgery is best for you. They’ll consider your medical history and overall health before recommending a specific type of refractive surgery.
Other factors your doctor will take into consideration include:
- Existing eye conditions. LASIK can increase the risk of dry eyes, so a doctor may not recommend it for people with chronic or severe dry eyes.
- Lifestyle. PRK or SMILE may be recommended for people involved with high-impact sports, the military, or law enforcement to avoid flap complications.
- Cornea thickness. PRK, RLE, or phakic IOL may be recommended for people with thin corneas to avoid the risk of abnormal corneal thinning (ectasia)
- Prescription. People with high prescriptions are not eligible for LASIK or other laser refractive surgeries. An RLE or phakic IOL may be a more suitable option.
- Age. An RLE with multifocal or accommodating IOLs can correct presbyopia in people over 40 and prevent age-related cataracts in people around 60.
Overall, refractive surgeries can help you reduce or eliminate your dependence on glasses and contact lenses. However, it’s important to consider the risks and benefits of each procedure before deciding to get one. Talk to an ophthalmologist to help you decide.
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