LASIK is one of the most well-known surgical procedures used to correct a range of vision problems, called refractive errors. These errors involve problems with the shape of the cornea, which changes how light enters the eye. Common conditions are nearsightedness, farsightedness, astigmatism, and farsightedness from aging (presbyopia).
If you have one of these conditions, you may be tired of constantly getting new glasses and contact lenses, and you want to cut your expense and hassle by solving your vision problems. LASIK is one of several refractive surgeries that can do this, and though you may not qualify for LASIK, you may benefit from another procedure.
Ask your optometrist or ophthalmologist about refractive surgeries in general or specific ones that may target your particular vision problems. There are also refractive surgeries that may benefit more advanced medical problems that would otherwise disqualify you from LASIK. In some cases, you may not qualify for any of these alternatives, or you may decide that the side effects are not worth the benefits.
What Are Refractive Surgeries?
LASIK is one of the most famous eye surgeries that corrects vision. Using a laser focused on the cornea, LASIK removes some tissue from that part of the eye in order to correct vision. Millions of people have undergone LASIK surgery since the procedure was approved by the Food and Drug Administration (FDA) in 1998.
While the name LASIK is almost synonymous with vision-correcting surgical procedures, there are alternatives to LASIK that should be considered. Not everyone is a good candidate for LASIK, and other options may produce better results with fewer side effects, especially for specific, serious conditions.
The LASIK procedure is just one of several refractive surgeries, procedures designed to correct problems with the parts of the eye that refract light. There are various types of refractive errors.
- Myopia: Also called nearsightedness, myopia means that the further away an object is, the harder it is to see clearly.
- Hyperopia: Commonly referred to as farsightedness, this condition is essentially the opposite of myopia — things far away are clearer than objects nearer the face.
- Astigmatism: This is an imperfection in the curvature of the cornea or lens of the eye that leads to light rays refracting improperly onto the retina.
- Presbyopia: These age-related vision changes lead to the gradual inability to see objects clearly up close, which most people start to notice around 40 years old.
Any refractive surgery achieves changes in the cornea’s shape — steeper or less steep, for example — to enhance vision and reduce problems. However, the methods by which this change is achieved can differ, so people with different types of vision problems may wish to pursue a procedure that is not LASIK.
LASIK Alternatives to Improve Your Vision
If you are interested in a surgical procedure to correct your vision, you may want to consider LASIK alternatives.
- Wavefront-guided LASIK: In traditional LASIK surgery, the laser is programmed to sculpt the cornea based on the patient’s vision correction prescription, aiming for 20/20 vision. In wavefront-guided LASIK, the laser is instead programmed with the individual’s wavefront data, which creates a three-dimensional model of the existing cornea, so the laser can more precisely sculpt it for vision correction. This three-dimensional map will look a little like a mountain range, allowing the technology to correct smaller abnormalities on the surface, achieving better correction than just a prescription number for glasses or contact lenses. This procedure also reduces side effects like trouble with night vision or light sensitivity. It has been shown to increase the number of patients who achieve perfect vision.
- LASEK (laser-assisted subepithelial keratomileusis): While LASIK focuses on corneal sculpting, LASEK focuses on the very top layer, or epithelium, of the cornea. An instrument is used to create a flap of corneal tissue; then, an alcohol solution is applied to loosen epithelial cells. After that, the cornea itself is sculpted. Healing should take about four days.
- EpiLASIK: Similar to LASEK, this procedure focuses on the epithelial tissue of the cornea. A special microkeratome, called the epi-keratome, separates a thin sheet of epithelial tissue from the cornea and it is lifted aside. After it is treated, it may be re-adhered or removed, depending on the needs of the reshaped cornea to create perfect vision.
- Conductive keratoplasty (CK): This noninvasive procedure specifically treats mild to moderate farsightedness in people over the age of 40, typically when presbyopia develops. This uses thermal refractions created to radio frequency (RF) energy instead of a laser, applying heat to the cornea to reshape it. Rather than removing layers of cells, the RF emissions make the peripheral areas of the cornea contract, tightening like a belt, which increases the curvature of the cornea itself.CK is also used to create monovision, or blended vision, enhancing the ability to focus on all depths. One eye’s near vision is improved while the other eye is set to far vision. For most people, farsightedness will return as the eyes continue to age.
- Phakic intraocular lenses (IOLs): Sometimes, a patient may have so many refractive errors that normal corneal-based refractive surgery is not enough. Instead, the phakic IOL is like an implantable contact lens placed inside the eye in front of the natural lens. The organic lens is not removed, just adjusted with a secondary lens, so the eye’s ability to focus is not impaired.
- Refractive lens exchange (clear lens extraction): This procedure is similar to phakic IOL, but instead of adding to the eye’s original lens, the biological lens is removed and then replaced with an artificial lens that improves vision. In some cases, additional lenses are added to allow the eye to focus at multiple distances. RLE is similar to cataract surgery, and many people who have very early-stage cataracts may choose this procedure rather than waiting for progressing vision loss as their cataracts get worse. It is also an option pursued by some individuals who struggle with farsightedness but do not qualify for LASIK.RLE is not approved by the FDA, so any use of this surgery is considered off-label.
- Photorefractive keratectomy (PRK): Like LASIK, PRK adjusts the shape of the cornea to improve vision. This procedure is used for myopia, hyperopia, and astigmatism, but it is not considered effective for presbyopia. For people who have refractory errors but also struggle with dry eyes or thin corneas, PRK is a better solution than LASIK. It is also a better option for people who have active lifestyles because there is no cutting a flap of the cornea, which reduces healing time and the risk of accidents after the procedure.
- Radial keratotomy (RK): A more invasive procedure than LASIK, RK involves using a very sharp knife to slice one or more slits into the cornea to change its shape. RK is an older surgery than LASIK and PRK, creating the founding principles of corneal reshaping as a way to correct vision. In many cases, people undergo RK before another laser eye surgery, although RK only corrects myopia. The procedure is more rarely performed because it is so invasive, requiring an overnight stay in the hospital. One eye would receive the treatment, get a month to heal, and the other eye would then undergo the procedure.
- Intacs: This procedure inserts small semi-circular rings beneath the surface of the cornea, helping smooth the shape. It may be good for small refractive errors, like myopia or astigmatism, and it can also improve keratoconus, or a cone-shaped cornea. Instead of using lasers, the procedure uses devices, which may be good for people whose corneas are thinner or may not hold up to removing layers of cells.
If You Do Not Qualify for LASIK…
LASIK is very popular, but it is not the only procedure available. It is important to remember that glasses and contact lenses are great options to correct your vision. The FDA notes that you may not be a good candidate for any refractive surgery, LASIK included, if:
- You are concerned about complications like dry eyes, pain, double vision, glares or halos, and night vision problems.
- It may jeopardize your career. Certain jobs prohibit these procedures, especially if you are in the military.
- You worry about cost because LASIK and other refractory procedures are usually elective surgeries, meaning your insurance will not cover them, though they may cover glasses and contact lenses.
- You participate in active, contact sports that can cause damage to the cornea during the long healing process.
- You are in your early 20s or younger, partly for legal reasons, but also because your eyes are still growing and changing.
- You updated your corrective prescription in the past year, meaning you have refractive instability.
- Your hormones are changing due to pregnancy, breastfeeding, or medications.
- You take prescription medications that have side effects that may involve vision changes.
- You have some disease that affects wound healing, like autoimmune conditions or immunodeficiency diseases, including lupus, HIV, or diabetes.
It is important for your eye doctor to give you a thorough exam before recommending any refractive surgery and to guide you through options. The above information can help you ask informed questions, but ultimately, the decision to pursue a specific course is a conversation between you and a medical professional.
LASIK surgery isn’t always the first treatment option that comes to mind. Other options your eye surgeon may consider include:
Eyeglasses are a traditional option that most eye surgeons use to correct vision issues. They’re not only inexpensive (relative to surgery, especially) but also fashionable and easy to wear and take off. Unfortunately, you will have to wear them every time you engage in an activity that requires excellent eyesight.
Besides, you can’t use them when swimming or working on strenuous physical activity. While some people easily embrace glasses, others still consider them socially limiting. Even if you prefer them as a fashion accessory, you won’t like wearing the same pair in every event.
Contacts are a great option for those who don’t want to use glasses but want to improve their vision. They’re comparably cheaper than LASIK eye surgeries and great if you want a different eye color.
The main challenge associated with contacts is the hassle that comes with wearing them. Your surgeon will advise you to handle contacts with a clean and sterile hand, which may not be the case in most public settings. This explains why most long-term users of contacts can experience eye infections.
This is another non-surgical method used to treat astigmatism and myopia, conditions that focus lights in front of the retina instead of on the retina leading to blurry vision. Most eye surgeons use corneal refractive therapy, a form of orthokeratology that was approved in 2002 by the FDA.
Corneal refractive therapy involves the use of a special gas permeable contact lens that reshapes the cornea as you sleep. Even though these lenses are worn only at night, your cornea will retain the altered shape and corrected focus during the day. This means that you don’t have to experience dryness and irritation caused by contact lenses and the hassle of wearing glasses.
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Refractive Eye Surgery: Helping Patients Make Informed Decisions About LASIK. (May 15, 2017). American Family Physician.
What Is Photorefractive Keratectomy (PRK)? (September 27, 2017). American Academy of Ophthalmology (AAO).
Radial Keratotomy (RK) – Vision Correction Before Laser Eye Surgery. (August 24, 2017). Vision Eye Institute.
How Painful Is Recovery From Intacs Surgery? (October 5, 2015). American Academy of Ophthalmology (AAO).
When Is LASIK Not for Me? (July 11, 2018). U.S. Food and Drug Administration (FDA).