When it comes to refractive surgery, the two best options are LASIK (laser-assisted in situ keratomileusis) or PRK (photorefractive keratectomy). LASIK will result in a faster healing time, but may present more secondary complications. In addition, not all individuals are good candidates and may even suffer from serious issues post surgically if LASIK is performed. PRK is an alternative that has a longer healing period, but does not pose the same risks as LASIK. It requires more patience and therapy post surgically, but is a better procedure for individuals with thinner corneas, dryer eyes and other important factors.

PRK is performed by initially placing a ring on the surgical corneal area and filling it with alcohol to weaken the bonds of the corneal epithelium. Next, this outer corneal layer is moved aside using a surgical brush exposing the inner layers of the tissue. At this point an excimer laser is employed to ablate and reshape the inner layers of the cornea. This is the same laser used in LASIK. Upon completion of this step, a bandage contact lens is placed over the surgical area. This lens permits the re-epithelialization of the cornea. In addition, it protects the cornea and improves patient comfort. The patient should be seen frequently as long as the contact lens is on the eye to monitor healing of the abrasion, and possible infection of the wound.

The contact lens will be removed between 4-7 days once the epithelium is fully healed. In an effort to prevent infection, the individual must use a topical antibiotic such as Zymar for at least a week, and a topical steroid like FML for at least 6 weeks post operatively. The steroid will reduce the swelling, improve patient comfort and prevent scarring during this healing period. Depending on several factors, these drops may be modified if any corneal haze is present, there is over/under correction, an increase in intraocular pressure or an allergy to the drops. Further, immediately following the surgery there may be substantial discomfort; a pain reducing drop is used for 1-2 days like Xibrom is employed. It must be discontinued shortly following the procedure since it does retard the healing process.

Since the healing is slower and will be less comfortable initially, some patients may be reluctant to have this procedure. In addition, sunglasses must be worn for a full year following the surgery since UV light often will make the cornea hazy even after the healing appears to be complete. This is another distinction between PRK and LASIK.

The bottom line is that before one decides to have refractive surgery, they must be properly advised as to the benefits of all the options. Then, and only then can a truly informed decision be made. The choice should really be made by the surgeon as to which procedure would be safest and best for any patient. It should not be up to the individual based on what they would prefer. The final result is what is most important not simply how one gets there.

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From the early days of cataract surgery, ophthalmic surgeons have searched for the perfect implant. Initially, the natural lens was simply removed, and the patient was required to wear very thick eye glasses in order to see. Since this created substantial discomfort and distortion, special contact lenses were designed called Aphakic contacts to replace the eye glasses. This innovation dramatically improved patient comfort, and enhanced visual acuity.

As the surgery evolved, the development of intraocular implants vastly improved the visual situation as they eliminated the need for both the thick eye glasses, and expensive contact lenses. The first implants were placed in front of the iris, and were called anterior implants since they were located in front of the iris. Unfortunately, since they vibrated over time they caused damage to the cornea resulting in a secondary problem. In attempt to reduce this corneal insult, implants were inserted behind the iris and thus called posterior implants. This eliminated the vibration and did not adversely affect the cornea.

Further enhancements enabled the implants to be foldable, and could be inserted through a small tube which required a smaller incision, and ultimately did not even need sutures to close the surgically induced wound. Today the incision is made in the cornea and seals itself; so there are no stitches and healing occurs very quickly.

In spite of all these improvements, patients still wanted more. They wanted to completely eliminate glasses altogether following the surgery. They wanted to see clearly in the distance and at near. Thus the multifocal implants were developed. There are several types, and some are superior to others. The Restore and Resume implants are designed as alternating concentric circles of power. That is to say that the implant has actual circles on them with distance and near powers in an alternating fashion. This results in multiple images being projected on to the retina permitting the patient to see both far and near. The downside is that it also causes reflection off these borders resulting in substantial glare, especially in poor light. To date, there is little that can be done to improve this glare situation. On occasion, a pupillary constrictor, or Alphagan, a glaucoma medication, is prescribed to help reduce the glare at night. It does help, but only as long as the individual uses the drops. This glare can be visually devastating in sensitive patients. Proper patient screening is vital before implanting these lenses.

A recent innovation, the Crystalens implant does not have the concentric rings. It works on a principle similar to the natural lens of the eye, thus reducing glare. However, other issues are associated with this device. Regardless of which implant is used, a thorough understanding by both surgeon, as well as patient is vital to the success of any procedure.

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