Laser Vision Correction

Common Refractive Surgery Procedures (Old & New)

Radial Keratotomy (RK)
RK was a popular treatment for near-sighted correction in the 80's and early 90's. Radial incisions were placed in the peripheral cornea, which resulted in flattening the central cornea. RK was more successful for low levels of near-sightedness and has since fallen into disfavor among patients and surgeons alike with the advent of more precise laser refractive surgery technology.

Excimer Laser Treatment

Excimer lasers have been available since 1995 to reshape the cornea to correct near-sightedness, far-sightedness, and astigmatism. Excimer lasers do not correct presbyopia, which is the loss of accommodation, or ability to dynamically focus up close after the age of 40. There are two basic types of excimer lasers, "broad-beam" and "scanning." Scanning lasers were developed more recently, and use a small "flying spot" beam of laser energy to provide a smoother, more precise reshaping of the cornea. Many of the broad-beam lasers now have upgraded software to make them more scanning-like. Additionally, excimer lasers are now capable of custom, wavefront-guided treatment. This treatment improves surgical outcomes by modifying the laser correction to correct an individual's higher order optical aberrations in addition to the basic prescription for each eye. Two popular "scanning" lasers can perform this custom wavefront-guded treatment. With the Alcon LadarVision laser it is called "LadarWave" and with the Bausch & Lomb Technolas 217 laser it is called "Zyoptix."

PRK (Photorefractive Keratectomy)
PRK reshapes the front surface of the cornea without first creating a flap. In this case, the protective superficial layer of the cornea is not preserved and it will require several days to repair. For most patients, this means significantly more pain and a longer recovery time until clear vision is achieved. However, since no flap is created, there is no potential for a flap complication in PRK.

LASIK (Laser Assisted In-Situ Keratomileusis)
LASIK is a surgical procedure that utilizes the excimer laser to re-shape the cornea, but it also uses a micro-keratome or an additional laser to create a flap on the front of the cornea. The flap is lifted and the excimer laser energy is applied to the cornea behind the flap. This laser energy is delivered in a precise manner to reshape the cornea to correct the refractive error in each eye. Once the excimer laser has finished reshaping the middle layer of the cornea, the flap is placed back in its original position. LASIK generally results in less pain and faster vision recovery than PRK.

The corneal flap can be created using one of two methods. Microkeratomes use a diamond blade to cut the front surface of the cornea to create the corneal flap. A newer method of creating the flap utilizes a silent computer-guided laser at femtosecond speed, firing 15,000-30,000 pulses per second. This laser is the IntraLase FS laser. It makes 1 micron size spots and connects them to create a plane (the flap). This energy passes directly through the cornea and is absorbed at the exact depth the surgeon sets. The Intralase creates a uniform flap thickness that is controlled by the surgeon. It is possible to make a very thin flap allowing for treatment of higher corrections than most traditional microkeratomes. The Intralase also reduces some of the risks of flap complications and aborted flaps.

For more general information and a list of FDA approved lasers, visit www.fda.gov/

Intacs (Intracorneal Rings)
Intacs are micro-thin intracorneal rings which are inserted into the cornea to correct low levels of near-sightedness. Intacts can be removed at a later date and are therefore somewhat reversible. Intacs have been studied for about 10 years and they are FDA approved. Some patients have reported "glare" (light reflections) with them.

Implantable Contact Lenses (Phakic IOLs)
Intra-ocular lenses (IOLs) are placed inside the eye to correct vision. This has been done for many years following cataract surgery. The word "phakic" means that cataract surgery has not been performed, thus a "phakic IOL" is an intra-ocular lens placed inside the eye in without removing a cataract or the eye's natural crystalline lens. IOL's can correct very high levels of near-sightedness (much higher than LASIK or PRK) and are generally only used in cases of very high refractive error. The only phakic IOL that is FDA approved at this time is the Verisyse IOL.

If you think you may be interested in refractive surgery, please make an appointment at our office and we can discuss your the refractive surgery options and the risks associated with each of them.

Dr. Hamilton and Dr. Bollenbacher have both worked in refractive surgery centers offering pre and post care at the actual surgery center and would be happy to answer all of your questions. Additionally, Dr. Hamilton has had LASIK herself. You can schedule an appointment for a consultation and get honest answers without any sales tactics or pressure. If, after all of your questions are answered, you decide to proceed with refractive surgery, we will refer you to a surgeon that excels in the procedure you have chosen.