Common Types of Laser Eye Surgery

Innovations in laser technology have had a tremendous impact on medical care and it has had likely more impact on eye surgery than any other specialty in medicine. Literally, every structure of the eye or surrounding tissues has been treated with various lasers. The skin surface of the eyelids can be treated with laser techniques. Corneal refractive surgery is primarily treated with lasers today. Other diseases such as cataracts, glaucoma, and retinal disease are also routinely treated with lasers.

 LASIK Eye Surgery (Laser-Assisted in Situ Keratomileusis)

LASIK

PRK / LASEK / ASA (Advanced Surface Ablation)

SMILE

Blended Vision / Monovision

corrective eye surgery types

The LASIK eye surgery acronym stands for Laser-Assisted In-situ Keratomileusis. To better understand the procedure let us look at each step.

1. Laser

In the LASIK procedure, the first step is to use a femtosecond laser to create a flap of tissue almost like creating the cover of a book. The flap has a hinge to allow for the flap to be folded back in position after the latter steps in the procedure are completed.

2. Assisted

The LASIK procedure is part computerized lasers and part surgeon directed. At Discover Vision Centers we take pride in utilizing the best technology available. But as with most technology, the best outcome is when the surgeon has a complete understanding of the technology. The concept of “the Indian vs the arrow“ holds true in LASIK. Our surgeons are fellowship-trained in refractive surgery and their experience provides the best opportunity for the best outcome for each patient. The surgeon remains the most important factor to optimize safety and outcome with any surgical procedure including LASIK.

3. In situ

In situ literally means “in original position“. So, the cornea which is the clear part of the eye is changed in its original position. How this is done will be explained next.

4. Keratomileusis

The word keratomileusis can be broken down to mean “kerato“ or cornea and “smileusis“ which means to carve or shape. The accuracy of the LASIK procedure come from the use of the second laser in the procedure called an excimer laser. The excimer laser is considered a cool laser as very little heat is created when it interacts with tissue. This laser gently and with extreme precision sculps or reshapes the cornea to all for optimal focusing of an image we want to see.

Who Is LASIK Suitable for?

Candidates for LASIK are typically between the ages of 18 and 60 with a stable glasses or contact lens prescription for the prior year. Most patients with nearsightedness, farsightedness, and astigmatism can be considered for surgical correction. Screening with the doctor can clarify if one is a candidate.

LASEK Eye Surgery (Laser-Assisted Subepithelial Keratectomy)

best type of laser eye surgery

LASEK is an alternative to the LASIK and SMILE procedures and a better choice for patients who have thinner corneas. LASEK stands for laser-assisted subepithelial keratectomy. LASEK anatomically is the same as PRK and Advanced Surface Ablation. These procedures do not involve the creation of a flap as done in LASIK. The surface cells have to be removed first. Then an excimer laser is used to reshape the underlying tissue. Although the procedure itself is painless the regrowth and recovery of the skin surface can involve discomfort for 3-5 days. Vision in the first few weeks after surgery is not as good as LASIK or SMILE but by 4-6 weeks it should be comparable. A bandage contact lens is placed for the first week after surgery and the doctors will remove this at the one-week visit. About 5-10% of patients are best suited for surface laser procedures.

Who Is LASEK Suitable for?

The best candidates for LASEK or surface procedures are those patients with thin corneas, asymmetric topographies, or those involved in combat sports.

SMILE Eye Surgery

SMILE stands for Small Incision Lenticule Extraction. As the name implies it has a small incision and does not create a flap. It has the advantages of LASIK in that there is very quick visual recovery. Most patients have legal driving 4 hours after surgery. It has the advantage of PRK in that no flap is created. Only one laser is used during SMILE eye surgery.

SMILE was first developed in the year 2000 and became FDA-approved in 2016. Dr. Doane and the FDA refractive team have been involved with the approval of SMILE since 2009 and conducted the FDA trial studies from 2012 to 2016.

The SMILE procedure accounts for about 20% of all laser refractive corrective procedures worldwide. Today it is used for treating nearsightedness and astigmatism and studies are being done for farsightedness. SMILE accounts for about 90% of the procedures performed at Discover Vision Centers. For those involved in combat sports, SMILE or PRK are the preferred procedures.

Who Is SMILE Suitable for?

SMILE is a good choice for those aged 18 to 60 with stable glasses or contact lens prescription. Patients with nearsightedness and astigmatism are the best candidates.

PRK (Photorefractive Keratectomy)

types of eye laser surgery

Photorefractive keratectomy or PRK is performed with an excimer laser to reshape the front surface of the cornea to treat nearsightedness, farsightedness, and astigmatism. The same laser used to reshape the cornea in LASIK is used with PRK. By reshaping the surface of the cornea images come into clear focus. Some patients, about 5-10%, are better suited for PRK. This is usually because of thin or slightly irregular corneas. The outer skin surface, epithelium, is removed prior to the laser being used to reshape the corneal surface. After the laser is used a bandage contact lens is placed and this will stay in place for 1 week. Some discomfort can be expected for the first 4-5 days after surgery and best vision is usually achieved by 4-6 weeks after surgery. Discomfort is reduced by the contact lens. Additionally topical and oral pain pills can be helpful.

Who Is PRK Suitable for?

Patients aged 18 to 60 with stable glasses or contact lens prescription are the best candidates for PRK.  Also, those involved in combat sports are well-suited for PRK.

Laser Blended Vision

Starting about age 40 the human crystalline lens loses its ability to focus up close. This is progressive from age 40 to age 65. It happens to all patients. When patients have laser vision correction the surgeon can alter the power of one eye to be best at distance and the other at near. This is called monovision or laser blended vision. About 70% of patients over age 40 who wear contacts use monovision to be less dependent on glasses for the close-up tasks such as reading. About 70% of patients undergoing laser vision correction over age 40 are candidates for laser blended vision. If they do not tolerate it the eye can be corrected for distance like the alternate eye and the patient can then use reading glasses.

Who Is LBV Suitable for?

Laser Blended Vision is best suited for patients over age 40 that want to minimize or eliminate the need for reading glasses.

PRP (Pan Retinal Photocoagulation)

Pan-retinal photocoagulation is used for diseased eyes. For patients who have diabetes or have had retinal vein occlusions, their doctor may recommend retinal photocoagulation to preserve vision. Abnormal blood vessels can grow in these patients and by doing photocoagulation the abnormal vessels can regress and the best vision can be maintained. Pan-retinal photocoagulation should not be confused with laser vision correction procedures. The prior is for diseased eyes that could be blinded if the diseases are not treated.

SLT (Selective Laser Trabeculoplasty)

SLT or Selective Laser Trabeculoplasty is a form of laser surgery to reduce eye pressure in patients with an eye disease called glaucoma. In glaucoma, the pressure within the eye can be so high that it damages the nerve of vision called the optic nerve. SLT can be used in combination with medications to lower eye pressure. With SLT the laser light is applied to the fluid drainage tissue. Over time the laser treatment allows for increased outflow of fluid with the goal of lowering the overall eye pressure.

Don’t Sure Which One Is the Right for You?

Medical lasers have had an immense impact on vision correction surgery over the past 30 years with over 100 million patients and 200 million eyes treated. To find out what procedure is best for you, a vision correction screening is the best next step at Discover Vision Centers.

You can contact our team by requesting an appointment through the website or by calling 816-478-1230.


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