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There are numerous surgical procedures available for correcting or adjusting your eye’s focusing ability by reshaping the cornea, the clear round dome at the front of your eye. The most widely performed types of refractive surgeries are LASIK (laser-assisted in situ keratomileusis) and photorefractive keratectomy (PRK). Both options utilize a precise laser technology to reshape the cornea.

Since the 1970’s, eye surgery for patients with focusing problems has significantly improved. Surgeons have been performing laser vision correction procedures for over two decades, and it is the most common elective vision procedure in the United States.

Whether you have nearsightedness, farsightedness, presbyopia or astigmatism, it is likely that you would qualify for refractive surgery. However, there are some conditions that may exclude patients.

During a complimentary consultation, your physician will determine if you are a good candidate and which procedure is right for you.


For years, LASIK was performed identically in both eyes for patients with similar prescriptions. This conventional LASIK method worked well but failed to account for subtle differences between the eyes. This, in combination with irregularities that can arise when cutting the corneal flap with a microkeratome blade, led to occasional side effects, such as vision problems in low light and other visually challenging situations.

Current LASIK Technology

Today, the use of IntraLase® and CustomVue™ for LASIK procedures has significantly improved visual results and has reduced the potential for night vision problems. The providers at Cascade Eye & Skin Centers are combining Wavescan Technology, IntraLase® and CustomVue™ to perform bladeless, custom LASIK (called iLASIK™), helping patients to reduce their dependence on glasses and contacts.

Rather than relying on a blade (called a microkeratome) to cut the corneal flap during LASIK, the Intralase Method™ (also called Femtosecond LASIK) employs a high-precision laser to create the flap. By applying concentrated light energy to an exact depth within the cornea, our eye surgeons create a layer of gas bubbles that makes a very smooth and uniform flap. The surgeon then carefully folds back the flap to reshape the cornea with a second laser. The IntraLase Method™ avoids the irregularities that sometimes occur when cutting the corneal flap with a blade. A smoother, more regular flap means a quicker, stronger healing eye and clearer vision.

When you have the iLASIK™ procedure, you’ll get a completely integrated, completely personalized procedure based on advanced vision correction technology at every step.

The term “custom LASIK” refers to the technology used in the second reshaping step of the LASIK procedure. At Cascade Eye & Skin Centers, this step is performed with the VISX CustomVue™ laser. CustomVue™ uses VISX WaveScan™ imaging technology, allowing our LASIK surgeons to create detailed three-dimensional maps of each patient’s individual eyes. Many of the optical distortions that are not corrected by a patient’s glasses prescription can now be defined and corrected with this WaveScan™ technique. The end result is an incredibly clear vision and a very low incidence of complications.

CustomVue™ imaging is used primarily in LASIK procedures, but the surgeons at Cascade Eye & Skin Centers also use this technology to improve the results of PRK – an alternative form of refractive surgery, occasionally used when a patient is not an ideal candidate for LASIK.

Photorefractive Keratectomy

Before undergoing PRK, or any refractive surgery, a patient receives a complete eye exam. If the surgeon determines PRK to be the best option, they would create a three-dimensional map of the eye using the WAVESCAN guided CustomVue™ technique. By creating this detailed “fingerprint” of the eye, the surgeon is able to tailor the PRK procedure to each patient’s eye anatomy and visual requirements.

PRK Procedure

Like LASIK, PRK involves using a precision excimer laser to reshape the cornea. Where the procedures differ is in their approach of exposing the inner layers of the cornea. The first surgical step in a LASIK procedure is to create a partial-thickness hinged flap of the cornea, with PRK there is no flap. Instead, the surgeon gently removes the outer corneal layer (epithelium). This layer will grow back quickly. At the time of PRK surgery, a soft bandage contact lens is placed to protect the eye for a few days while the epithelium heals.

PRK Recovery

Because PRK eye surgery is performed using anesthetic eye drops, the procedure is relatively comfortable. Visual recovery time for PRK takes longer (weeks) than for LASIK (overnight or within a few days). Some patients report mild pain or discomfort after PRK. LASIK is generally preferred by patients because of the speed of visual recovery.

Refractive Lens Exchange (Clear Lens Extraction)

Refractive Lens Exchange, otherwise known as Clear lens extraction, is another refractive surgery option for a few select patients. It involves the removal of the natural lens in the patient’s eye, and replacing it with a correctly focused lens to overcome nearsightedness, farsightedness, or astigmatism. Essentially, it is cataract surgery done before the patient has a clinically significant cataract. Once complete, the patient will not need cataract surgery in the future. This surgical option is available to some patients who are not LASIK or PRK candidates.

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