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Other Refractive Eye Surgery Options
What are some other laser surgery options?
Surgery Options Center
Laser Surgery Options
Non-Laser Surgery Options
Automated Lamellar Keratoplasty
Intrastromal Corneal Ring Segments
Although LASIK has virtually supplanted other refractive surgery procedures that involve the use of a laser, there are still cases in which another procedure may be appropriate. As we have pointed out before, the more you know about refractive vision correction procedures, the more comfortable you will be in making a decision with respect to your own surgery.
PRK and LASEK
Photorefractive Keratectomy (PRK) and Laser-Assisted Sub-Epithelial Keratectomy (LASEK) are laser eye surgery procedures intended to correct a person's vision and reduce their dependency on glasses or contact lenses. The procedures permanently change the shape of the anterior central cornea using an excimer laser to ablate (burn off) a small amount of tissue from the corneal stroma at the front of the eye, just under the corneal epithelium. The outer layer of the cornea is removed prior to the ablation. A computer system tracks the patient's eye position 60 to 4,000 times per second, depending on the brand of laser used, redirecting laser pulses for precise placement. Most modern lasers will automatically center on the patient's visual axis and will pause if the eye moves out of range and then resume ablating at that point after the patient's eye is re-centered.
The outer layer of the cornea, or epithelium, is a soft, rapidly regrowing layer in contact with the air that can completely replace itself from limbal stem cells within a few days with no loss of clarity. The deeper layers of the cornea, as opposed to the outer epithelium, are laid down early in life and have very limited regenerative capacity. The deeper layers, if reshaped by a laser or cut by a microkeratome, will remain that way permanently with only limited healing or remodelling. In LASEK the corneal epithelium is preserved with a chemical solution, peeled off, and replaced after the laser ablation is complete. With PRK the epithelium removed is discarded and allowed to regenerate. Both procedures are distinct from LASIK (Laser- In Situ Keratomileusis), a form of laser eye surgery where the epithelium is not removed.
Visit our PRK page for more information
IntraLASIK®
A new development known as the Intralase™ FS Laser keratome has been very successful in accurately and precisely cutting very thin LASIK flaps of uniform thickness. Thin flaps are useful for treating patients who require a high degree of refractive correction because a thinner flap allows for more ablation of tissue. Initial results so far show that IntraLASIK® produces comparable results in terms of post-operative visual acuity as that experienced after conventional LASIK, which uses a mechanical keratome.
Although the incidence of flap complications is slightly reduced by cutting a flap with an Intralase laser, problems such as flap stride causing double vision or traumatic flap dislocations may occur because the flap is still being cut.
This is in contrast to LASEK or epi-LASIK which, by eliminating the flap itself, also totally eliminates all flap related complications. This has been shown in many studies to be responsible for the majority of complications.
Laser Thermal Keratoplasty (LTK)
LTK involves a Holmium laser instead of an excimer laser. The Holmium laser is a hot laser that uses infrared light and heat to shrink the peripheral area of the cornea and steepen the shape of the cornea to treat hyperopia. Conductive Keratoplasty (CK) is a similar procedure that uses radiofrequency energy instead of a Holmium laser. Studies show that there is a tendency of the shrunken tissue to heal itself and return to its previous condition. Such regression can usually be retreated within a few months, but it is a major drawback of this procedure that does not occur with LASIK or LASEK.
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What are some non-laser surgery options?
Automated Lamellar Keratoplasty (ALK)
ALK is a procedure in which the flap and underlying tissue are cut and sculpted by a microkeratome. Newer developments such as LASIK and LASEK have replaced the need for this procedure, but a variation of ALK is still used in certain cases for corneal transplant surgeries.
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Implantable Contact Lens (ICL)
For the ICL procedure, a prescription lens is surgically inserted between the iris and the natural lens of the eye. The patient must undergo a peripheral iridotomy a few days before the ICL. This is a procedure in which a special kind of laser known as a YAG laser is used to place microscopic holes on each side of the eye. The YAG laser is not used for visual corrective purposes, but the microscopic holes are necessary to facilitate fluid drainage in the eye after the artificial lens is implanted. The advantage of this procedure is that the implanted lens can be removed at any time, should some other type of treatment be desired. This is still under FDA investigation.
Intracorneal Lens Implants
This procedure is similar to the ICL procedure described above, but differs in that a tiny plastic lens is implanted within the corneal tissue to correct myopia. There are two types of lenses under FDA investigation for the treatment of myopia. A third type of intracorneal lens is under FDA investigation for the treatment of presbyopia.
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Clear Lens Extraction (CLE)
This procedure is virtually the same as for the removal of cataracts and involves the implantation of a plastic prescription lens to replace the natural lens. The only difference is that the natural lens being replaced by CLE is clear, while a cataract lens is cloudy.
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Intrastromal Corneal Ring Segments (ICRS)
This relatively new procedure involves the surgical implantation of two plastic ring segments, shaped like tiny arcs, in the peripheral area of the cornea. This flattens the cornea to the degree required, and is used to treat mild to moderate myopia. Reported results have been promising, but the company behind this development is currently bankrupt.
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