We have compiled a list of commonly asked questions by patients considering Refractive Surgery. If you have any further specific questions please contact our Refractive Surgery Co-Odinator via info@eyesurgery.com.au

What are some common refractive vision problems?
What is PRK (Photorefractive Keratectomy)?
What is LASIK (Laser In Situ Keratomileusis)?
Who is suitable?
What should I expect after the laser?
What are the side effects?
Are there any contraindications?
What are the benefits of laser surgery?

Other Refractive Procedures

What is Astigmatic Keratectomy?
What is Refractive Lensectomy?
What are Implantable Contact Lenses?

In a normal eye, light rays pass through the cornea and lens to focus on the retina in a precise way without blurring. Distortions of the shape of the eye will cause refractive errors which are correctable by glasses or contact lenses.
There are 3 main categories of refractive errors:

• Short-sightedness (myopia)
• Long-sightedness (hypermetropia)
• Astigmatism

Developments in ophthalmology have meant that all of these errors are usually able to be treated with refractive surgery.

Eye Surgery Associates offers the full range of refractive surgical options, including

• All Excimer Laser procedures (PRK, PARK, LASIK & LASEK)
• Implantable Contact Lenses
• Astigmatic Keratotomy
• Refractive Lensectomy

PRK is a refractive technique which recontours the shape of the cornea using the excimer laser. The surface layer of the cornea (epithelium) is removed before the refractive correction begins. The laser uses pulses of high-energy ultraviolet light and can remove tissue without heating or damaging surrounding areas. PRK is usually performed on one eye at a time.

During the procedure, an ophthalmologist uses the excimer laser to reshape the cornea which adjusts the way light travels through the surface. The actual amount of tissue removed is thinner than a human hair.

Not all patients are suitable candidates for PRK. Patients with lower units of refractive error (ie 1-4 dioptres of myopia) are considered to be ideal candidates for PRK. This method offers very little risk and excellent accuracy and predictability for this group of patients. Visual recovery is rapid and the second eye may be treated within a few weeks of the first. Patients with low units of astigmatism may also be treated effectively using this method (PARK).

LASIK allows the correction of higher levels of myopia, hypermetropia and astigmatism. Some ophthalmologists perform LASIK in preference to PRK for all degrees of myopia and hypermetropia. However, many believe that for low degrees of myopia (ie up to -4.00D), the benefits of LASIK over PRK do not justify the additional risks of the procedure. For high myopic corrections (ie over -6.00D), most ophthalmologists skilled in both procedures would currently advise LASIK.

Immediately after PRK drops and antibiotic cream are put in the eye which is then firmly patched. You are then able to return home. Varying levels of discomfort will be experienced for the first 24-36 hours. Post-operative medication, such as analgesics, will be provided to help ease any discomfort. It is rare for a patient undergoing LASIK to experience discomfort, however some minimal irritation may be experienced.

You will be routinely seen 2 days after PRK and on the first postoperative day following LASIK. Regardless of the procedure you must attend follow-up visits which are scheduled at 1, 3, 6 and 12 months. Failure to attend these follow-up visits could jeopardise a good result. These appointments can be made with your local optometrist if it is more convenient for you.

LASIK offers a faster visual recovery with patients enjoying a marked improvement in their unaided visual acuity the very next day. Visual recovery after PRK is not instant, with unaided visual acuity only beginning to improve after the epithelium has regrown (usually taking 48 to 72 hours).

LASIK also offers faster refractive stability with a stable result usually achieved by 3 months. After PRK, the vision without glasses should be fairly good at 6 weeks and continues to improve for 3 to 6 months at which time good vision should have stabilised.

Less corneal haze is involved with LASIK which can be a significant problem after PRK, particularly with higher refractive errors. Corneal haze can cause symptoms such as glare and haloes or starbursts around lights (particularly headlights while driving at night).

As with any surgery, complications are possible. The following possible side-effects and complications should be discussed with your surgeon:

• PRK overcorrection; undercorrection; regression; decentration; delayed healing; halo effect; and corneal haze.
  
• LASIK many of the complications of PRK can also occur with LASIK. However the marked regression seen in PRK for higher refractive corrections are less evident after LASIK. Delayed epithelial healing and the severe haze that can occur after PRK are not seen with LASIK. The additional complications of LASIK almost all relate to the creation of the corneal flap or its replacement. Complications of LASIK: flap complications; under and over correction (retreatment is possible in most but not all cases); minor decrease in best-corrected visual acuity (your vision will not be as crisp as it was prior to surgery with your glasses).

Refractive eye surgery is an elective procedure. Corrective surgery is a benefit of modern technology and medicine, offering an alternative that can enhance the quality of life. Patients may elect to have refractive surgery for a number of reasons, with some of the most common being:

• independence from glasses and/or contact lenses
• inconvenience of wearing (and losing) glasses
• intolerance to contact lenses
• freedom to play various sports such as windsurfing, swimming, scuba diving, horseriding, or to provide the visual requirements needed for certain occupations such as the police force.

The implantable contact lens (ICL) is a new development in refractive surgery. The ICL is a thin, soft, foldable implant which is inserted through a small corneal incision. It is placed in the posterior chamber of the eye in front of the natural lens, without limiting accommodation. ICL's are effective for treating very high levels of shortsightedness or longsightedness which are beyond the range of LASIK because the ICL can be made of a high power and does not rely on recontouring the shape of the eye. Vision recovers rapidly within a day or two of surgery and the procedure is both permanent and reversible. The best candidates are over 35 years of age, or have a very high refractive error.

The ICL is an investigational device at present so there is very little published data. Thus far they appear to be well tolerated but the long-term risk of cataract development is unknown. Dr Grant Snibson has been selected as one of the Australian clinical investigators of the ICL, allowing him to offer this procedure as an option to his patients.