Corrective Eye Surgery for Refractive Errors
Surgery for correcting or improving refractive errors
Clear vision depends on how well the cornea and lens permit light rays to fall onto
the retina. Light rays must be refracted (bent) to focus on the retina. The retina
is the light-sensitive nerve layer that lines the back of the eye. This creates impulses
from the light rays that are sent through the optic nerve to the brain.
If the cornea or eye shape is abnormal, vision can become blurry because light does
not fall properly on the retina. Called a refractive error, an abnormal cornea shape
can often be corrected by refractive eye surgery. This, in turn, corrects the vision
problem. Refractive errors can include myopia (nearsightedness), hyperopia (farsightedness),
astigmatism (an irregularly shaped cornea which causes blurring), and presbyopia.
Presbyopia is an aging condition that causes the lens to harden, impairing near and
The goal of most refractive eye surgeries is to reduce or eliminate a person's dependency
on eyeglasses or contact lenses. Refractive eye surgery is not for everyone. One type
of surgery may be more suitable for one person than another. Always see your healthcare
provider for a diagnosis and to discuss which type of surgery, if any, may be right
There are several types of corrective surgical procedures for refractive errors, including:
Laser in-situ keratomileusis (LASIK) surgery/wavefront-guided LASIK
Photorefractive keratectomy (PRK)
Radial keratotomy (RK)
Astigmatic keratotomy (AK)
Automated lamellar keratoplasty (ALK)
Laser thermal keratoplasty (LTK)
Conductive keratoplasty (CK)
Intracorneal ring (Intacs)
What is LASIK surgery?
LASIK, or laser in-situ keratomileusis, surgery is used to correct nearsightedness,
farsightedness, and astigmatism. When a person is nearsighted (myopic), his or her
eye is too long or the cornea is too steep, resulting in too much focusing power.
The light rays entering the eye come in focus before hitting the retina. This results
in blurry vision when looking in the distance. The procedure, which should be done
by an experienced LASIK surgeon, involves reshaping the cornea using an excimer laser.
LASIK has replaced many of the other refractive eye surgery techniques.
A promising new technology, called wavefront-guided LASIK, provides an advanced method
for measuring optical distortions in the eye. The Eye Surgery Education Council states
that healthcare providers can now use this technology as a roadmap to evaluate the
eye by measuring how light is distorted as it passes into the eye and then is reflected
back. This creates an optical map of the eye, highlighting individual imperfections.
In addition, the wavefront technology allows the LASIK surgeon to tailor the laser
beam settings for a more precise procedure. This provides sharper, better quality
vision, as well as a reduction in nighttime vision difficulties.
How is LASIK surgery done?
Although each procedure varies slightly LASIK surgery involves using a computer-controlled
excimer laser (a cold, ultraviolet laser) and a microkeratome (a surgical instrument)
or femtosecond laser. With these instruments, the surgeon cuts a flap in the center
of the cornea to remove a thin layer of tissue. By removing the tissue, the cornea
flattens, reducing the myopia. The flap, which is replaced without using stitches,
attaches to the cornea within minutes.
Recovery after LASIK surgery
In most cases, recovery from LASIK surgery is fast and involves minimal discomfort.
Mild pain relievers may be recommended by your surgeon to relieve discomfort during
the first day after surgery. People often take eye drops for a week after the procedure.
Possible side effects of LASIK surgery
Generally, LASIK has a high success rate. However, side effects do happen. The following
are the most common side effects and complications:
Dry eyes (during the healing process)
Eye discomfort (mostly during the first 24 hours following surgery)
Irregular astigmatism, which can decrease the corrected vision (astigmatism means
blurring caused by an irregularly shaped cornea)
Corneal haze or glare, or sensitivity to light
Overcorrected or undercorrected vision
Inability to wear contact lenses in the future
Loss of the corneal flap, requiring a corneal graft (transplant)
Inflammation or infection
Blurry vision or vision loss
Benefits of LASIK surgery
For most people, LASIK surgery usually involves little pain and fast recovery. Other
benefits may include:
LASIK can correct a wide range of myopia
LASIK can be repeated to correct the vision further.
The eyes stabilize between 3 and 6 months after LASIK surgery.
The eye is not weakened, because only one flap is cut into the cornea.
LASIK usually causes little or no scarring of the cornea.
Postoperative care is usually limited to using eye drops for a week after surgery.
What is photorefractive keratectomy (PRK) surgery?
Photorefractive keratectomy, or PRK, uses the same excimer laser used in LASIK surgery
and is done to reshape the cornea in an attempt to correct mild to moderate myopia
How is PRK surgery done?
Although each procedure varies slightly, in general, PRK surgery involves an excimer
laser beam reshaping the cornea by removing microscopic amounts of tissue from the
outer surface. The procedure, which generally takes a few minutes, uses a computer
which maps the eye's surface and calculates the needed corneal change.
Possible side effects of PRK surgery
PRK surgery has a high success rate. However, side effects do happen. Because the
corneal surface is cut, it takes several weeks to heal. There is some eye discomfort
after the surgery that may last for several weeks. The following are the most common
side effects and complications:
Who is a potential candidate for LASIK or PRK eye surgery?
According to the FDA, potential candidates for corrective laser eye surgery must meet
certain criteria. It is advised that potential candidates talk with their healthcare
provider before undergoing any type of corrective eye surgery. The criteria include:
Patients must meet certain age criteria, generally 18 years or older, to qualify for
surgery. This age requirement is necessary to make sure that the eyes have finished
The candidate must have mild to moderate nearsightedness (myopia).
The candidate must be free of eye disease, problems with the retina, or scarring of
The candidate must have the financial ability to pay for the surgery, since insurance
may not cover the procedure.
The candidate must be aware of all the side effects, risks, and benefits of the surgery.
Candidates should also be aware of the alternative treatment choices available.
What is radial keratotomy (RK) surgery?
Radial keratotomy surgery, or RK, is a procedure also used to correct myopia (nearsightedness).
The procedure involves making microscopic, radial incisions (keratotomies) in the
cornea to alter the curvature of the cornea, thus, correcting light refraction. Hundreds
of thousands of people who qualified for this type of surgery have undergone the procedure
since its introduction to the U.S. in 1978. While the procedure has been popular in
the past, it has been almost completely replaced by the LASIK procedure.
How is RK surgery done?
Although each procedure varies slightly RK surgery involves an eye surgeon cutting
(with a calibrated diamond scalpel) radial or spoke-like incisions into the cornea
outside of the center of the cornea (also called the optical zone, which is the area
where a person sees through). Due to pressure inside the eye, the incisions cause
the center, or optical zone, of the cornea to flatten, reducing refraction.
Possible side effects of RK surgery
One main side effect of RK surgery is the amount of time it takes for the cornea to
heal. In some cases, healing may take weeks. The following are the most common other
side effects and complications:
A weakened cornea that can rupture
Increased risk of infection
Difficulty in fitting contact lenses, if needed
Glare around lights
Fluctuating vision during the first few months
Cataracts (a change in the structure of the crystalline lens that causes blurred vision)
Loss of vision
Benefits of RK surgery
In most cases, RK has proven to be safe and effective for mild degrees of myopia.
What is astigmatic keratotomy (AK) surgery?
Astigmatic keratotomy (AK) is a surgical procedure, similar to radial keratotomy (RK).
This is used to correct astigmatism (an irregularly shaped cornea which causes blurring).
Instead of using a radial pattern of incisions, the surgeon makes the incisions in
a curved pattern when performing AK surgery.
What is automated lamellar keratoplasty (ALK) surgery?
Automated lamellar keratoplasty, or ALK, is a surgical procedure that is used for
hyperopia (farsightedness) and severe cases of myopia (nearsightedness). A person
with hyperopia has shorter-than-normal eyes or has a corneal that is too flat. This
causes objects up close to look blurry.
How is ALK surgery done?
Although each procedure varies slightly, ALK surgery for myopia involves the surgeon
cutting a flap across the front of the cornea with a microkeratome (surgical instrument).
The flap is folded to the side and a thin slice of tissue is removed from the surface
of the cornea. The removal of tissue flattens the central cornea, or optical zone,
reducing refraction. The flap is then put back in place, where it attaches without
During ALK surgery for hyperopia, the surgeon makes a deeper incision into the cornea
with the microkeratome (a surgical instrument) to create a flap. The internal pressure
in the eye causes the corneal surface to stretch and bulge. The bulging cornea improves
the optical power. This corrects the hyperopia. The flap is then put back in place,
where it attaches without stitches.
Possible side effects of ALK surgery
The following are the most common side effects and complications:
Astigmatism (blurring caused by an irregularly shaped cornea)
Overcorrection or undercorrection
Inability to wear contact lenses after the procedure
Loss of the corneal flap. This requires a corneal graft.
What is laser thermal keratoplasty (LTK)?
Laser thermal keratoplasty, or LTK, applies heat from a laser to the periphery of
the cornea to shrink the collagen fibers, and reshapes the cornea. When the tissue
is treated thermally, it contracts the tissue and causes the central cornea to steepen.
You must be age 40 or older to qualify for this procedure.
What is conductive keratoplasty (CK)?
Conductive keratoplasty, or CK, uses heat from low-level, radio frequency waves, rather
than laser or scalpel, to shrink the collagen and change the shape of the cornea.
A probe that is smaller than a strand of hair is used to apply the radio waves around
the outer cornea. This creates a constrictive band that increases the curve of the
cornea and improves vision. CK is used to correct mild to moderate farsightedness
in people over age 40
What is an intracorneal ring (Intacs)?
Intracorneal rings, or Intacs, is a microthin intracorneal ring that is implanted
into the cornea. Intacs produces a reshaping of the curvature of the cornea, thus
improving vision. Intacs are only available in the US for low degrees of myopia.
How to prepare for refractive eye surgery
Most refractive eye surgeries are performed on an outpatient basis, with most procedures
lasting less than one hour. In preparation for surgery, you may be asked to:
Arrange for someone to drop you off and pick you up again after surgery.
Not wear your contact lenses for a period of time before surgery to prevent corneal
Not wear eye makeup for a couple of days before surgery.
What to expect during surgery
Although each procedure varies slightly, in general, refractive eye surgery involves
minimal discomfort. The eye is usually numbed with eye drops before surgery. While
in surgery, you may also:
Specific events that happen during surgery vary depending on the type of surgery performed.
Recovering from surgery
Recovery times vary depending on the surgery, but can last anywhere from days to months.
The following are some common symptoms following surgery:
Sensitivity to light