Refractive Surgery Tips

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What do I need to know before choosing refractive eye surgery?

What You Need to Know Before Choosing Refractive Surgery

Before you seek refractive surgery, you should meet with your optometrist to go over your options. Be aware that if your corrective lens prescription has changed in the past year, you may be asked to wait till your eyes are more stable before pursuing surgery.

You will also need to consider on your own whether this surgery is affordable for you, and whether you are prepared to accept the results. Positive outcomes are normal, but not guaranteed, and even if you like the results, they may not be permanent, and you may have to wear corrective lenses later on.

You should also discuss the potential side effects with your optometrist, and consider whether you are willing to accept them. Many people, for example, experience difficulty in night driving after refractive surgery, so if your job or lifestyle requires a lot of driving at night, you may choose to stick with corrective lenses.

What questions should I ask my refractive surgeon?

Questions for Your Refractive Surgeon

Refractive surgery is a permanent process that could affect your sight for the rest of your life. It's a good idea to consult with more than one surgeon or clinic before making a final decision. Questions to ask your refractive surgeon include:

-- How many surgeries of this type have you performed?

-- What laser will be used for my surgery? Is it FDA-approved for this procedure?

-- Who will be responsible for my preoperative and postoperative care?

-- Will I need glasses after my treatment?

-- What percentage of your patients achieve vision of 20/40 or better after surgery?

-- What percentage of your patients have required followup enhancement surgery?

-- What do you charge for enhancement surgery?

-- What tests will you perform before the surgery? (The surgeon should test for corneal thickness and dry eye, at a minimum.)

-- What certifications do you hold that apply to this surgery?

What are RK and AK?

RK and AK: Two More Choices

RK and AK offer two more choices for refractive surgeries.

Radial Keratotomy (RK) is a procedure for people who suffer from mild or moderate myopia. This type of procedure has been in existence for 30 years. During RK, tiny holes or incisions are made around the cornea using a radial pattern. These incisions are what cause the change in the cornea's curvature. RK has basically been overtaken by the safety and the precision of the LASIK procedure.

Astigmatic Keratotomy (AK) is another refractive surgery. It is appropriate for those with astigmatism. When someone has astigmatism, their cornea is curved more in one direction compared to the other, which results in visual distortions. During AK one or more incisions is made into the cornea. These incisions help eliminate the curving in the cornea, which results in clearer vision. The procedure generally takes 5 minutes for one eye. Only one eye is done on the day of the surgery, you must return at a later date for the other eye.

What are the alternatives to refractive surgery?

Alternatives to Refractive Surgery

After investigating your options, you may choose not to have refractive surgery. Perhaps you have a medical condition that makes you a poor candidate for the surgery. Perhaps you have a military or aviation career and are not permitted to have it and keep your job. Or perhaps you have studied the side effects and possible risks and decided you're not prepared to take them.

Of course you still have the option of glasses or contact lenses for vision correction. Newer forms of disposable lenses last 30 days and in some cases do not need to be taken out at night.

You may, however, be interested in non-surgical alternatives to refractive surgery. One, Ortho-K, uses contact lenses worn briefly each day to reshape the cornea. This does not produce any permanent improvement, but is often used in young people whose eyes have not stabilized.

Beware of "vision therapists" and pseudo-scientific institutes who claim that vision can be improved through exercises. Your eyes should be treated by a licensed professional.

What does refractive surgery cost?

Costs of Refractive Surgery

Refractive surgery costs money, and even people with vision coverage on their health insurance plans often find they cannot get insurance coverage for the surgery, which is considered cosmetic.

Refractive surgery clinics quote their prices per eye. It's a good idea not to choose the clinic with the lowest price. In some cases, unethical clinics will offer a low price -- $500 per eye, let's say -- but then find reasons why an individual patient will need to pay more.

In general, refractive surgery costs $1,800 to $2,200 per eye, depending on the procedure, the laser used, and the part of the country. Custom procedures will cost more. Less expensive clinics may cut costs by providing less-than-complete preoperative care and testing, or by charging separately for required medications.


What is Refractive Surgery?

Many people use the word "LASIK" to refer to all sorts of refractive surgery. In fact, LASIK is only one of the options available.

Refractive surgery includes a wide variety of procedures for correcting a patient's visual acuity. Unlike glasses or contact lenses, which compensate for flaws in the eye's natural focusing ability, refractive surgery aims to change that ability and allow the eye to focus correctly. Over the past several years, this field has expanded to include treatments for a wider variety of conditions, and new procedures are being tested all the time.

Because this field is relatively new, it's a good idea to be well informed before you choose a refractive surgeon.

What can I expect after I have refractive eye surgery?

What to Expect After Refractive Eye Surgery

Refractive surgery is sometimes advertised as a quick miracle. In fact, the process of completing a vision correction with refractive surgery can take up to six months.

That being said, some types of surgery produce noticeable improvements with in a day or two. Others require recovery periods of a few days to a couple of weeks. Your refractive surgeon should inform you about what to expect.

Some patients will experience visual side effects after surgery such as ghosts, halos, and starbursts. These complications can get in the way of visual clarity for several weeks after the operation.

Your surgeon should also discuss realistically what level of visual improvement you can expect. If you are over 40, you may still need reading glasses. If you are very nearsighted or farsighted, you may experience some improvement but still not be able to achieve 20/20 vision.

Why Have Refractive Surgery?

Why Have Refractive Surgery

There are several reasons why someone chooses refractive surgery.

-If you have nearsightedness, refractive surgery may help.

-If you have farsightedness, refractive surgery may be a choice.

-If you have astigmatism, refractive surgery is an option.

-If you wish to have improved vision and not have to wear contact lenses or glasses anymore, refractive surgery may be for you.

If you are considering refractive surgery, please speak to your doctor about the right choice for you.

I have dry eyes. Can I still have refractive surgery?

Refractive Surgery and Dry Eye

Patients with dry eyes may not be good candidates for refractive surgery because the dryness may make it harder to heal afterwards, and may even get worse. Particularly, people with medical conditions that get in the way of tear production (Sjogren's syndrome and rheumatoid arthritis are two of the most common) are usually not considered good refractive surgery candidates.

Mild dry eye problems can be treated with medication and eye drops, so if you have dry eyes, consult your optometrist. You may still be a candidate for refractive eye surgery. However, if your eyes are now so dry that you cannot wear contact lenses, it may be worthwhile to wait a while. Refractive surgery treatments that are now in experimental and testing stages may be more suitable for you.

How Do I Prepare for Refractive Surgery?

Getting ready For Surgery: Refractive

As with any surgery, refractive surgery has guidelines to follow prior to the procedure.

If you wear make-up, make sure you do not wear any for three days prior to surgery.

Make sure you have a driver arranged to drive you home following the procedure.

If you wear hard or gas permeable contact lenses, you should avoid wearing them for three weeks prior to surgery.

If you wear soft contact lenses or disposable lenses, they should not be worn for two weeks prior to surgery.

You will need to have had a complete eye exam by the surgeon doing your procedure.

You should wash your face with a mild soap before the procedure.

Avoid medications or alcohol that cause drowsiness.

Fill any prescriptions given to you by your eye surgeon prior to the procedure.

Expect to meet with your surgeon the day of your surgery, shortly before the procedure.

Your eye surgeon may offer more suggestions for preparing yourself for refractive eye surgery. Please follow his instructions carefully.

What Risk Do I Take of Losing My Best Corrected Vision?

Loss of Best Corrected Vision: Are You At Risk?

Before your refractive eye surgery you should know the risks involved. One of these risks is the possible loss of "best corrected vision". This means that as a result of the surgery, you run the risk of not being able to see as well, even with glasses or contacts, as you did before the surgery.

Currently, eye surgeons only see about one percent of people who have had refractive eye surgery lose their best corrected vision. So, the risk of having this occur is very, very small. If you are worried about this, please speak to your eye surgeon.

What are my options for refractive eye surgery?

Options for Refractive Eye Surgery

There are now many options for correcting vision surgically. Here are a few of the best known:

-- LASIK, the most popular and widespread refractive surgery: The surgeon makes a small incision ("flap") in the cornea, then reshapes the tissue underneath with a laser.

-- LASEK: The same as LASIK, but the flap is confined to the surface (epithelemium) of the cornea.

-- Epi-LASIK: A tiny separator is used for creating the flap, instead of a blade.

-- PRK: The surgeon uses the laser to reshape the surface of the cornea.

What are the types of refractive surgery?

Types of Refractive Surgery

Considering refractive surgery? Here are some popular options:

PRK: Photorefractive Keratectomy, a more recent development in refractive surgery. This involves using a laser to remove outer layers of the cornea that ends in flatter shaped cornea. This procedure is appropriate for this with nearsightedness and astigmatism.

LASIK: Laser In Situ Keratomileusis, uses a laser to reshape the cornea but rather than removing the layers of the cornea, a flap is created with a special cutting instrument, the flap is then pulled back to expose tissue and a laser is used to reshape the tissue. LASIK may be acceptable for those with near or farsightedness and those with our without astigmatism.

LASEK: Laser epithelial keratomileusis, is a similar procedure to LASIK, however during the surgery a much thinner layer of your cornea is cut and folded back and then the flap is replaced. LASEK may be appropriate for those that aren't eligible for LASIK.

Please ask your doctor which refractive surgery may be right for you.

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