Chapter One

Refractive Surgery:
What Is It?

The world of ophthalmology is one of the fastest evolving fields of medicine. Never before have so many new techniques and scientific breakthroughs been brought before the public in such a short period of time. LASIK and the introduction of implantable lenses now offer millions of people the opportunity to see without the use of glasses or contacts.

The media are filled with amazing stories about laser eye surgery and how it painlessly corrects vision. What is LASIK, this marvelous new laser eye procedure? Is this ultramodern eye surgery really safe? How do I know if I'm a good candidate? Who should perform the surgery? This book is designed to help you answer all of these questions.

Refractive Surgery

Refraction: This word as it relates to vision has to do with the ability of our eye to refract (bend) rays of light. In order to see clearly, light that enters the eye must be bent in such a way that it is focused on the retina (the back surface of the eye). If the light is not bent properly and is focused instead in front of or behind the retina, then we will not see clearly, and what we have is a refractive error. Refractive surgery is any surgical technique or procedure that may safely be used to help the eye bend the light rays properly and restore clear vision.

Refractive Surgical Procedures

The most common refractive surgical procedures performed today are

• Laser in-situ keratomileusis (LASIK)
• Photorefractive keratectomy (PRK)
• Intacs corneal ring segments
• Astigmatic keratotomy (AK)
• Cataract surgery
• Clear lens extraction (CLE)
• Older refractive surgery procedures include
• Automated lamellar keratoplasty (ALK)
• Radial keratotomy (RK)

New refractive procedures currently under investigation by the FDA include

• Bioptics
• Conductive keratoplasty (CK)
• Laser thermal keratoplasty (LTK)
• Phakic intraocular lens implants (PIOL)
• Surgery for presbyopia
• Anterior ciliary sclerotomy (ACS)
• Scleral expansion bands (SEB)

The names of these procedures may be hard to pronounce, but the results in correcting poor vision due to refractive errors have been excellent. The high rates of success reported with these procedures--and LASIK in particular--have lead to their widespread acceptance within the ophthalmologic community. Which procedure is right for you depends on multiple variables, all of which will be presented in this book.

The increasing number of refractive procedures developing throughout the world is testimony to the magnitude of the problem. The development of a laser procedure to correct nearsightedness, farsightedness, and astigmatism that is both predictable and safe was prolonged, in part, by the vastness of the problem. In some parts of the world, the incidence of nearsightedness is close to fifty percent. In the United States alone, as many as seventy million people are believed to be afflicted with myopia. Additional estimates by the National Institutes of Health report that as many as one adult in four suffers from myopia.

While there are many types of refractive surgery, this book focuses primarily on LASIK, which is performed with the excimer laser. This procedure has proved to be highly effective and safe for most ranges of nearsightedness and farsightedness and is readily accepted by ophthalmologists today.