If you wear or need glasses, you’ve probably heard about laser surgery for sharper vision – you probably even know someone who’s had it done. The most common types are LASIK and PRK, and these treatments can either bring back 20/20 vision, or at least reduce your need for glasses or contacts.
But vision surgery can have some negative, even dangerous, side effects, so here’s what you need to know before you make an appointment.
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Good Candidates for Vision Surgery
Laser surgery helps people who are nearsighted, farsighted, or have an oddly shaped cornea, called astigmatism, but it’s not for everyone. It might work for you if:
• Your prescription hasn’t changed for at least one year.
• Your job allows laser eye surgery.
• Your eyes and overall health are good.
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Illnesses that affect healing can make vision surgery a poor choice in some cases. If you have diabetes, HIV, lupus, or rheumatoid arthritis, talk with an ophthalmologist about your best options. Other conditions that require careful evaluation and could make you a poor candidate for surgery include:
• Dry eye
• Large pupils
• Thin corneas
Surgery is not appropriate for people with keratoconus, which is a cornea disorder.
Remember: Even After Surgery, You May Still Need Glasses
There’s no guarantee that you’ll be able to toss your glasses completely, even with successful surgery. Reading and driving at night may still require glasses. With a strong prescription, there’s a chance you’ll still need glasses most of the time after surgery. Standard laser vision surgeries do not treat presbyopia, the blurry close-up vision that starts after age 40. “Blended” or monovision procedures are a newer option for presbyopia.
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LASIK & PRK: The Most Common Vision Surgery Options
How LASIK Works
LASIK reshapes the cornea, the clear, rounded surface of the eye, so it does a better job of focusing the light that enters the eye. The eyeball is held in place by a suction ring and the cornea is lifted and flattened. The surgeon cuts a small, hinged flap in the cornea and folds it back. Then an excimer laser — an ultraviolet light beam — reshapes the cornea based on your pre-op eye exam. The corneal flap is folded back in place.
Wavefront-Guided LASIK
This newer form of LASIK is more precise than standard LASIK. It’s also more expensive. Before surgery, the doctor creates a detailed map of your eyes using an “aberrometer.” This records even the tiniest imperfections in the cornea. In theory, this method gives better results and better vision. And in some studies, wavefront patients reported less trouble with night vision than those who had conventional LASIK.
PRK, Epi-LASIK, and LASEK
Surgeons operate directly on the surface of the cornea in these laser eye surgeries, rather than working under a flap. These procedures correct the same vision problems as LASIK, but may be a better option for people with thin corneas or preexisting dry eyes. Recovery time is longer and less comfortable than for LASIK. Patients usually wear a contact lens “bandage” for three to five days after the procedure.
Implantable Lenses: An Additional Vision-Correction Option
If you can’t get laser surgery because of a strong prescription, artificial lenses — called phakic intraocular lenses (PIOLs) — may be an option. They’re FDA approved for treating nearsightedness. The lenses are made of silicone or plastic and are surgically placed in front of the eye’s natural lens. Possible risks include loss of vision, night vision problems, and additional surgery to adjust, remove, or replace lenses.
Risks of Laser Eye Surgery
No surgery is risk-free. Many of the common side effects, such as dry eye or other discomforts, clear up within days to a few months. But some can require further surgery or cause permanent damage. Some of the more common risks of LASIK and PRK include:
• Permanent dry eye
• Halos, glare, or double vision — making night driving difficult
• Over- or under-correction of vision, requiring glasses or contacts after surgery.
• Markedly reduced vision or, very rarely, loss of vision
