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Refractive Eye Surgery: What is Available to Patients Who Dislike Glasses and Contact Lens

Technology advances have occurred in all areas of medicine, but refractive surgery is one of the most affected specialties. Refractive surgery is the term used for surgery to overcome most of the need for glasses or contacts (i.e. LASIK, PRK and clear lens extraction). This surgery is for the patient who sees well with glasses, they just don’t like them. If the patient has a blur with glasses, then some type of eye disease may be occurring (like cataract or macular degeneration) limiting vision. If glasses help vision; meaning the patient is farsighted, nearsighted or has astigmatism; then they may be a good candidate for refractive surgery. By far, the most common refractive surgery done is LASIK, this stands for Laser Assisted In-Situ Keratomileusis. Traditional LASIK involved making a flap in the cornea (front surface of eye) using a blade, lifting up that flap and using a laser to change the shape of the cornea to provide better focus. This has been done since 1992 in the USA with great long term results. The next technology change occurred about 2004, refining the laser that reshapes the cornea. If a patient receives a CustomVue wavescan treatment, the reshape of the cornea is not done based on glasses prescription; but based on a computer scan that can detect unique vision imperfections and smooth down irregularities during the treatment giving less glare and better vision. About this same time, the modern lasers developed eye tracking ability. The laser is able to move with any eye movement, 60 times every second, to make sure the treatment is centered; it is even able to rotate if the eye is rotated.

The newest advance in LASIK surgery occurred in expanded use in the USA in 2007, the flap of LASIK can now be made with a laser instead of a blade (iLASIK). Cascade Eye and Skin, P.C. was the first practice in the south sound to offer this no-blade LASIK. Laser-made corneal flaps are very accurate in depth and location; avoiding almost all the complications a blade might cause. Some reports show laser-made flaps are 6 times safer versus a blade. No-blade Two-laser wavescan-guided LASIK with tracking ability is the state-of-the-art. Each advance has improved quality, but the patient must be leery to make sure they use these proven advances. Unfortunately, some northwest eye surgeons employ the used-auto salesman trick of bait and switch. They offer a low price to get the patient in the door; and then talk up the price to get the modern technology with its higher cost.

Many patients have misconceptions about LASIK. It is able to accurately overcome a large range of myopia (nearsightedness) and astigmatism. LASIK is also FDA approved to treat Hyperopia (farsightedness), but is not as accurate and has less of a range of treatments available. It can be done starting at 21 years old onward. If the patient has lost their ability to see near due to age (Presbyopia, starts about 45 years old), the surgery can still be done. If, with LASIK, both eyes are made to see in the distance, and the patient is 50 years old, they will need to use reading glasses over-the-counter to see near. LASIK does not bring back the ability to change focus from distance to near that we all lose as we age. There is a compromise available, monovision. Monovision means we intentionally make one eye focus in the distance while the other eye focuses near. Thus, when driving one eye can see the distant signs, and with computer work the other eye is able to see the near. It is a compromise to avoid constantly needing reading glasses.

Refractive surgery is not for everyone, only certain patients can qualify. If the ophthalmologist/eye surgeon appropriately selects the patient who has reasonable expectations and understanding, it can be one of the best elective surgeries done for a patient. The high technology LASIK discussed has been approved by NASA astronauts, showing that although not risk-free, it is low enough risk to allow these vision-dependant expensively- trained patients to be done without too much worry. As an ophthalmologist myself, I accepted the small risk and have had LASIK on both my eyes with excellent results. It was the best medically elective procedure and way to spend money I have done for myself, by far.

Keith Dahlhauser MD FACS
Ophthalmologist / Eye MD/ Eye Surgeon
Cascade Eye and Skin P.C., 253-446-3760
University Place, Gig Harbor, Puyallup, Auburn.

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