Laser surgery can remove vision problems

Published On: Jan 31 2013 01:51:48 PM CST   Updated On: Feb 13 2013 10:41:13 AM CST

By Jeffrey Bramnick, Pure Matters

Laser procedures can help correct refractive errors, or problems caused by an imperfectly shaped eyeball or cornea. (The cornea is the front, transparent part of the eye that bends and focuses light.) Refractive errors cause light from an object to be imprecisely focused on the retina of the eye, causing a blurred image. Refractive errors usually occur in otherwise healthy eyes.

These are the four basic types of refractive errors:

Laser procedures

LASIK (laser in-situ keratomileusis) makes up 90 to 95 percent of all laser vision correction surgery and has the broadest range of uses. LASIK is a procedure that permanently changes the shape of the cornea, the clear covering of the front of the eye. A knife called a microkeratome is used to cut a hinged flap in the cornea. The flap is folded back revealing the stroma, the middle section of the cornea. Pulses from a computer-controlled excimer laser vaporize a portion of the stroma and the flap is replaced.

In PRK (photo refractive keratectomy), the surgeon uses a laser to remove the cornea's outer covering and reshape it. This type of refractive surgery gently reshapes the cornea by removing microscopic amounts of tissue from the outer surface. Recovery takes a bit longer than it does with LASIK.

LASEK (laser epithelial keratomileusis) is a surgery that combines LASIK and PRK techniques. It may be used for people who cannot have LASIK. The cornea's surface is loosened with an alcohol solution and moved aside before a laser reshapes the cornea. No flap is cut.

LTK (laser thermal keratoplasty) is a less-invasive laser procedure to correct farsightedness and astigmatism. LTK uses heat to reshape the cornea. The advantage of LTK is that it's a "no touch" procedure, meaning there's little chance of infection or loss of vision.

Is refractive surgery for you?

You should know that health insurers rarely pay for this type of surgery, which is considered cosmetic. Although prices vary a lot experts warn that cost shouldn't be your sole concern.

Laser surgery may not be right for you. "About 10 to 15 percent of adults are not good candidates," says Steven E. Wilson, M.D., director of corneal research at the Cole Eye Institute, part of the Cleveland Clinic. These are factors that indicate you are not a good candidate:

Besides the illnesses listed above, other diseases may negatively affect the outcome of LASIK surgery:

These are other risk factors that may affect the outcome of your surgery:

Finding a good surgeon

Only ophthalmologists are permitted to perform LASIK. Ask your eye doctor or optometrist for a referral to an ophthalmologist who performs LASIK. Ask for a referral from an ophthalmologist who does not do refractive surgery. You can also visit the American Academy of Ophthalmology's website (, which offers a list of its members who perform LASIK. Ninety-five percent of all ophthalmologists are AAO members. Ask your surgeon the following questions:

Make sure your surgeon is using a laser approved by the U.S. Food and Drug Administration. The FDA has approved five lasers for LASIK; they are manufactured by VISX, Summit, Bausch and Lomb, Nidek and ATC.

Many people don't have 20/20 vision after surgery, but most are 20/40 or better. Eight to 10 percent, Dr. Wilson says, need an added procedure. Some need eyeglasses or contact lenses to make up for over- or under-correction.

Complications include night glare, infiltration of the cornea, ripples, infection, regression of correction, under correction, loss of visual acuity, dry eyes, difficulty in fitting contact lenses for additional correction and the need for re-treatment. The complication rate is around 10 percent.

If you're a good candidate for a LASIK procedure, have realistic expectations and choose the right surgeon, chances are very good that you will do well.