Laser Refractive Surgery –LASIK (iLASIK), and PRK

LASIK surgery is a procedure that utilizes a laser to reshape the cornea (the windshield to the eye) to correct nearsightedness, farsightedness, and astigmatism. It is important for patients to understand that no eye surgical procedure is risk-free. Over 30 years of experience however, have indicated a high level of both safety and efficacy associated with both LASIK and PRK.

Why Refractive Surgery?

The goal of refractive surgery is to eliminate or reduce one’s dependence on eye glasses and/or contact lenses. The field of refractive surgery is ever changing, with major advances being achieved each year. Technology exists to treat almost all degrees of nearsightedness, astigmatism, and farsightedness, and advances in technology have improved both accuracy and safety of these procedures over time. New and improved technology has also helped us to better screen patients to determine which patients are truly appropriate and safe candidates for these procedures.

Who is a good candidate for Laser Refractive Surgery?

In general, candidates for iLASIK or PRK need to be 18 years of age or older with a stable glasses or contact lens prescription, without major underlying eye disease, and in good general health. The most important step in determining whether you’re a good candidate for PRK or iLASIK is to undergo a thorough refractive surgery screening consultation – preferably with a board certified, fellowship trained refractive surgeon such as Marc A. Goldberg, M.D. or Daniel J. Corbett, M.D.

To schedule a refractive surgery screening consultation please call our refractive surgery coordinator at (918) 584-4433.

LASIK (iLASIK) Surgical Procedure

iLASIK (IntraLase Assisted Laser In-situ Keratomileusis) utilizes a combination of two refractive laser surgery techniques. First, a femto-second laser technology (IntraLase) utilizes ultra-high frequency laser generated tiny overlapping acoustic shock waves to create a thin flap of corneal surface corneal tissue. (The IntraLase has in most practices replaced an older bladed keratome technology for LASIK flap creation because of the IntraLase’s ability to create thinner and more predictable flaps than the older keratome technology). The laser created flap is reflected back to expose the underlying central cornea. Excimer “cool” Laser Technology is then utilized to gently, accurately, and painlessly sculpt the exposed corneal tissue. The sculpting pattern is computer generated to correct precise degrees of nearsightedness, farsightedness, and astigmatism. State of the art iris-tracking and wavefront technologies have markedly improved the safety and accuracy of the procedure over time. After the Excimer Laser reshaping of the cornea, the flap is repositioned and naturally adheres to the underlying treated corneal tissue without the need for stitches or patching. 

By virtue of the flap creation in LASIK, the outer surface (epithelium) of the cornea is preserved. Healing is therefore quite rapid. Patients who have LASIK most often achieve excellent visual acuity rapidly; in fact, the majority of patients obtain better driving vision within 24-48 hours of the procedure. 

Since visual recovery is so rapid, surgery on both eyes can usually be performed on the same day. Antibiotic and anti-inflammatory drops are taken post-operatively for a period of a few weeks. Some minimal activity restrictions are required initially after surgery; however most normal daily activities can be resumed the day after surgery. 

PRK Surgical Procedure

PRK, like LASIK is a brief outpatient procedure that utilizes the exquisitely precise and safe Excimer Laser to sculpt a vision correcting curvature change to the corneal surface. In contrast to LASIK however, instead of creating a flap, the cornea’s surface cell layer (epithelium) is gently removed from the corneal surface. The epithelial layer is most often regenerated within three to five days after surgery. During PRK, computer-controlled pulses of cool laser light are then applied painlessly to the surface of the cornea to delicately reshape the eye’s curvature.

As with LASIK, the laser process is completed in approximately 30 to 60 seconds. Post-operatively, the eye is covered with a clear “bandage” contact lens which is usually worn for three days, and then removed. Antibiotic and anti-inflammatory drops are taken post-operatively for a period of a few weeks. After the PRK procedure, the eye may feel irritation or a foreign body sensation for a few days, but this discomfort is generally managed effectively with topical and/or oral medication if needed. 

LASIK vs PRK: What’s the difference?

Lasik and PRK are both effective laser procedures for the correction of nearsightedness and astigmatism. Some doctors and patients prefer LASIK to PRK due to the following advantages:

• Faster visual recovery
• Less potential discomfort after surgery
• Less risk of infection
• Slightly less risk of corneal haze or scarring

In some instances however, PRK may be the preferred procedure. Advantages of PRK over LASIK include the following: 

• Elimination of the potential for flap-related complications
• Possible reduction of subtle postoperative induced higher order aberrations (see Wavefront-Guided/CustomVue below)

Although there are some differences between LASIK and PRK, patients can feel comfortable in their choice of either procedure. Both procedures have been proven to be safe and effective when performed appropriately, and visual results are essentially the same over time. Dr.’s Goldberg and Corbett can discuss the most suitable procedure for each patient, based upon their individual examination results, needs, and preferences. 

Wavefront-Guided CustomVue LASIK

Common vision disorders such as nearsightedness, farsightedness, and astigmatism (known as “lower order aberrations”) are not the only refractive errors that can affect vision. Some vision problems, such as the glare and halos encountered in some low-light or night vision conditions, may be due to “higher order aberrations” that are not fully addressed with contacts, glasses or conventional LASIK or PRK.

Refractive surgeons can diagnose and measure higher order aberrations by creating a “wavefront map” of the eyes. Wavefront scanners can be used to reveal subtle aberrations by passing a light through the optical system of the patients eye and measuring optical distortion as the reflected light exits the eye and is collected by the scanner. The surgeon can compare the wavefront generated maps to the maps associated with normal vision, and then correct the identified aberrations using the CustomVue LASIK procedure – with a laser pattern generated to a patient’s unique wavefront mapping characteristics. Custom LASIK can be used to correct vision disorders caused by both lower and higher order aberrations.