The most common refractive surgical procedures are as follows:

• Radial keratotomy (RK):  RK was the first widely-accepted refractive surgery procedure, and was widely used from the mid-1980s to the mid-1990s.  With RK surgery, 4 to 16 incisions were made in the cornea with a diamond blade to change the curvature of the cornea.  RK required an exceptional amount of surgical deftness and experience, so outcomes varied widely by surgeon.  Night-time ‘halos’ and gradual overcorrection were reported by up to 10% of patients, but in general the surgery was a great success.  RK is no longer considered a state-of-the-art refractive surgical procedure. 

• Wavelight photorefractive keratectomy (PRK):  PRK was first introduced in the mid-1990’s with the widespread introduction of the excimer laser, a laser first tested in clinical trials by Midwest Eye Care doctors in the early 1990’s.  Rather than using blades to change the shape the cornea, surgeons utilized the excimer laser to remove very fine layers of tissue on the outside layers of the cornea.  Vision with PRK typically takes a few weeks to stabilize but may offer the most predictable outcomes of any refractive surgery.

• Laser-assisted in situ keratomileusis (LASIK):  LASIK was first introduced as an off-label use of the excimer laser and, by the time the procedure was officially approved by the FDA in the late 1990’s, millions of Americans were having the procedure each year.  LASIK uses the same laser as PRK, but also employs a piece of equipment called a microkeratome to create a small flap on the cornea.  The flap is folded back, and then the excimer laser is used to treat the corneal tissue underneath the flap.  Once the tissue is removed, the flap is put back into place, and the eye begins the healing process.  Vision with LASIK tends to stabilize in a few days, and patients report that there is virtually no pain associated with the recovery. 

• Laser assisted epithelial keratomileusis (LASEK):  LASEK was introduced in the past few years as a slight variant to LASIK.  Instead of using a microkeratome, the flap is created by applying an alcohol solution to create a thinner flap.  At this point the LASEK procedure does not appear to be an improvement over LASIK.

• IntraLase LASIK:  Intra-LASIK is a branded name for the LASIK procedure when the IntraLase laser is used to create the flap instead of a microkeratome.  Any type of excimer can be used with the IntraLase laser, and our practice uses the Allegretto Optimize Wavelight Laser.  With IntraLase, the surgeon creates the flap with the femtosecond laser. IntraLase technology gives the doctor the capability to precisely design the patient's intracorneal architecture in terms of diameter, depth, edge angle and morphology - creating the optimal stromal bed for the refractive procedure. IntraLase technology delivers many of the essential componets of the ideal Lasik flap and offers enhanced safety.

• Intacs corneal rings:  Corneal rings were introduced in the late 1990’s as an alternative to LASIK.  With the procedure, two clear arc-shaped pieces of plastic polymer are inserted into the cornea to change the shape of the cornea.  Corneal rings can be removed when necessary with no residual effects, but at this point corneal rings can only be used for the correction of myopia up to a –3.00 diopters.  

• Conductive keratoplasty (CK):  CK is a procedure that uses radio waves to reshape the cornea to correct the vision of patients with small degrees of hyperopia or presbyopia.  When effective, CK is a temporary solution for hyperopia and presbyopia.  The other refractive surgery procedures discussed here are considered by the FDA to have permanent effects.

• Crystalens intraocular implant:  Over the past few years, a few dozen refractive surgeons across the country have been recommended that severely myopic patients undergo a clear lens exchange instead of LASIK.  A clear lens exchange is identical to cataract surgery, except that the natural lens is replaced not because it is cloudy, but rather because an artificial lens with a different refractive power will improve the patient’s distance vision.  In the past there were two arguments against this procedure.  First, the risk of complication with intraocular surgery is a bit higher than LASIK.  However, the more important concern was that the natural lens being replaced often still had the capacity to accommodate between viewing near and far objects, and that capacity was lost when the artificial lens was implanted.

In 2004, a new artificial lens called Crystalens was introduced that allows for accommodation for viewing both near and far images.  This new advance, as well as the ReSTOR artificial lens introduced in 2005, are now excellent options for patients considering refractive surgery or refractive surgery.  More information on these options are included in the discussion on Cataracts.

• Implantable contact lenses (ICL, Artisan, VeriSyse):  These devices were introduced in 2004 but have been met with only marginal success.  With this surgery, a new artificial lens is implanted into the eye immediately in front of or behind the iris (the colored part of your eye).  Your natural lens, which may eventually develop a cataract, is left untouched. 

The specific surgical options available to you will depend on your refractive error, the underlying condition of your eyes, your visual needs, and your post-surgery visual expectations.

The animation below provides an overview of refractive surgery.