Pennsylvania Optometrics • 215.387-3600

Refractive Surgery

The decision to have refractive surgery is an important one that ultimately, only you can make. It is important that you have realistic expectations and that your decision be based on facts, not hopes or misconceptions. The goal of any refractive surgical procedure is to reduce your dependence on corrective lenses; it cannot absolutely promise 20/20 or even 20/40 vision.

Our office is not biased towards encouraging you to have these procedures. We recognize refractive surgery as a viable alternative to glasses or contacts, but not as the best alternative for everyone. As such, our refractive surgery evaluations and surgeon recommendations are based solely upon your best interests, as is our postsurgical follow up care should you elect to have us provide it.

Refractive surgery is more than LASIK. It is a group of procedures designed to permanently correct nearsightedness, farsightedness, astigmatism, and now presbyopia.

Having a successful experience with your refractive surgery begins with realistic expectations of what it can do. The majority of refractive surgery patients are able to perform most activities without glasses, but some may still need help for especially demanding visual situation, such as driving at night or reading stock market quotations. Also, refractive surgery reduced your need for glasses but does not affect any factors which naturally cause your eyes to change like genetics, work demands and age. It is generally not permanent, not repeatable and not reversible. Also, depending on which surgical procedure is performed, you may need reading glasses as you grow older. We can give you more information on what results you can expect at a refractive surgery evaluation.

Refractive surgery can benefit most people whose lifestyle would be enhanced by good vision without glasses & contact lenses. In general, though, we have found that the people who gain the most value from refractive surgery fall into three categories:

ACTIVE LIFESTYLE
People for whom glasses or contacts interfere with challenging activities such as swimming, boating, skiing, horseback riding, tennis, golf, rock climbing, just to name a few. An active lifestyle isn't just confined to sports; it can also include family activities or vacations.

DEMANDING OCCUPATIONS
People for whom glasses or contacts make performing their job more difficult or more dangerous. This may include firefighters, police officers, lifeguards, dancers, professional athletes and more.

CONTACT LENS INTOLERANCE
People who have dry eyes, allergies that cause irritation, giant papillary conjunctivitis or other conditions that make it difficult to use contact lenses.

Refractive surgery has a very high success rate, but it is not right for everyone and cannot correct every vision problem. To make an informed decision about refractive surgery, start by scheduling a refractive surgery evaluation.

Refractive Surgery Options

Laser Refractive Surgery (LASIK)
LASIK involves using a very precise computerguided excimer laser (just beneath the corneal surface) to change corneal shape. A thin flap of corneal tissue is lifted so that the laser may deliver a programmed number of pulses of ultraviolet light onto the newly exposed part of the cornea. The flap is then put back in place without the need for stitches. The cornea is now reshaped so light rays are focused more directly on the retina, and images are in batter focus. LASIK can be used to treat nearsightedness, farsightedness and astigmatism.

Autonomous LADARvision Excimer Laser
Autonomous LADARvision Excimer Laser combines the newest "flying spot" laser technology for correction of nearsightedness, farsightedness and astigmatism with the most advanced eyetracking system to eliminate concern about eye movement during the procedure. The LADARVision radar tracking system measures eye movement 4,000 times per second. The LADAR system can also accommodate larger pupil sizes so that more patients are able to have LASIK than before.

Custom Cornea Wavefront Guided LASIK
The latest advance in LASIK surgery can achieve an even higher quality visual outcome by customizing LASIK treatments to fit each patient's unique visual system. Wavefront CustomCornea both measure and treats distortions in the eye that cause glare, halos, and blurred vision. Unless these added distortions are addressed, the visual quality may not be ideal, even if 20/20 vision is achieved. With Wavefront CustomCornea, the end result is a higher quality of vision, especially in dim lighting.

Surface Laser Ablation
For those patients who do not have adequate corneal thickness or have corneal surface problems, and alternative to LASIK is available. Similar to the LASIK procedure, surface ablations use an excimer laser to reshape the corneal surface. The difference is that surface ablations are done without creating a corneal flap. Different types of surface ablations include PRK and LASIK. In PRK, the laser is applied to the exposed surface of the cornea. In LASEK and EpiLASIK, a very thin flap is created from the tissue surrounding the outer surface of the cornea and then replaced once the laser treatment has been delivered. New medications have made these techniques safer and more accurate over a greater range of refractive power.

Refractive Lens Exchange
Refractive lens exchange can be used to treat certain high refractive errors, including very high nearsightedness or high farsightedness. The natural lens of the eye is replaced with a new lens of the proper power to correct the refractive error. There are now different lens options depending on the outcome one wishes to achieve.

Crystalens Focusing Lens Implant
Crystalens is a revolutionary breakthrough the first and only FDA approved intraocular lens that allows patients to focus at all distances, much like their own eye used to. This lens works with the muscles of the eye to restore vision at near, far and everywhere in between. It is designed to move back and forth as the muscles in the eye contract and relax during focusing. This movement is what gives patients the ability to see at all distances seamlessly. Most patients are able to see without depending on glasses for near or far soon after surgery.

Intraocular Contact Lens Implant (ICL)
This thin lens is implanted behind the iris and in front of the natural lens in the eye. No tissue is removed, and the patient's own natural lens is left in place. The ICL is both removable and replaceable. The implantable Intraocular Contact Lens can be used to treat moderate to very high nearsightedness. The ICL is particularly useful in younger patients due to the fact that it allows them to retain their natural focusing ability when looking at near objects.

Conductive Keratoplasty (CK)
CK is a new "non laser" procedure for the treatment of mild farsightedness. It can reduce or eliminate the need for reading glasses or bifocals. By using radiofrequency energy, CK can help to regain the reading vision we lose after age 40. CK can change how the eye focuses images by reshaping the surface of the eye. This energy is gently applied to the pupil area. The points form a tightening ring that steepens the cornea and allows the patient to see more clearly closeup.

Astigmatic Keratotomy (AK)
Astigmatism is a condition that causes visual distortion or blurriness as a result of the cornea being too oval. AK uses tiny incisions to cause the cornea to assume a normal, round shape. It can be performed for refractive purposes in patients with significant astigmatism, or it can be combined with cataract surgery or refractive lens exchange to improve the postoperative result.

Radial Keratotomy (RK)
RK is most effective at correcting low to moderate degrees of nearsightedness. RK uses tiny incisions in a radial pattern on the outer portion of the cornea. These incisions cause the center of the cornea to flatten to allow light entering the eye to focus more accurately on the retina, creating a sharper image.