The Rush Refractive Surgery Center offers different procedures depending on your individual needs. After your consultation, your doctor will sit down to discuss your results with you and go over your optimal treatment option. Whether you are looking to correct your nearsightedness (myopia), farsightedness (hyperopia) or astigmatism, we offer the latest technology.
LASIK (laser-assisted in situ keratomileusis) is the most commonly performed refractive procedure used to treat nearsightedness, farsightedness and astigmatism. A laser is used to reshape the cornea — the clear, round dome at the front of the eye — to improve the way the eye focuses light rays onto the retina at the back of the eye. With LASIK, an ophthalmologist creates a thin flap with the help of the LenSx femtosecond laser. The surgeon folds back the flap and precisely removes a very specific amount of corneal tissue under the flap using the state-of-the-art Wavelight eximer laser to treat and reshape your cornea. The flap is then laid back into its original position, where it heals in place. For people who are nearsighted, LASIK is used to flatten a cornea that is too steep. Farsighted people will have LASIK to achieve a steeper cornea. LASIK can also correct astigmatism by shaping an irregular cornea into a more normal shape.
It is important that anyone considering LASIK have realistic expectations. LASIK allows people to perform most of their everyday tasks without corrective lenses. However, people looking for perfect vision without glasses or contacts run the risk of being disappointed. More than 90 percent of people who have LASIK achieve somewhere between 20/20 and 20/30 vision without glasses or contact lenses. If sharp, detailed 20/20 vision is essential for your job or leisure activities, consider whether 20/30 vision would be good enough for you. You should be comfortable with the possibility that you may need a second surgery (called a retreatment or enhancement), or that you might need to wear glasses for certain activities, such as reading or driving at night. Also, you should be aware that LASIK cannot correct presbyopia, the age-related loss of close-up focusing power.
LASIK is performed while the patient reclines under the laser in an outpatient surgical suite. First, the eye is numbed with a few drops of topical anesthetic. An eyelid holder is placed between the eyelids to keep them open and prevent the patient from blinking. A suction ring placed on the eye lifts to flatten the cornea and help keep the eye from moving. The patient may feel pressure from the eyelid holder and suction ring, similar to a finger pressed firmly on the eyelid. From the time the suction ring is put on the eye until it is removed, vision appears dim or goes black. Once the cornea is flattened, a hinged flap of corneal tissue is created using a laser. This corneal flap is lifted and folded back. Then, the excimer laser, preprogrammed with the patient's unique eye measurements, is centered above the eye. The surgeon checks that the laser is positioned correctly. The patient looks at a special pinpoint light, called a fixation or target light, while the excimer laser sculpts the corneal tissue. The surgeon then places the flap back into position and smoothes the edges. The corneal flap sticks to the underlying corneal tissue within two to five minutes, and stitches are not needed. The patient should plan to have someone drive them home after the procedure, and then take a nap or just relax. To help protect the cornea as it heals, the surgeon may place a transparent shield over the eye(s) to protect against accidental bumps and to remind the patient not to rub the eye(s). The patient may need to wear the shield only when sleeping. The surgeon will provide eyedrops to help the eye heal and relieve dryness. Although more than 90 percent of the effect of surgery is achieved within the first 24 hours, it may take three to six months after LASIK surgery for the improvements in a person's vision to fully stabilize and any side effects to go away.
Photorefractive keratectomy (PRK) is a type of refractive surgery. This kind of surgery uses a laser to treat vision problems caused by refractive errors. You have a refractive error when your eye does not refract (bend) light properly. During this procedure, the doctor removes a thin layer of corneal cells using a manual technique, then treats and reshapes the cornea with the PWavelight eximer laser. A bandage contact lens is placed and the procedure is complete.
The goal of photorefractive keratectomy is to correct your refractive error to improve your vision. PRK may reduce your need for eyeglasses or contact lenses. In some cases, it may even enable you to do without them completely. If you have dry eyes or thin corneas and want to have refractive surgery, PRK may be a good choice for you. This is because some other types of refractive surgery, such as LASIK, are not recommended if you have these conditions. Also, if you lead an active lifestyle or have an active job, PRK may be a better option for you than LASIK or similar procedures. This is because PRK does not involve cutting a flap in your cornea like LASIK and similar surgeries do. If you are highly active, you could accidentally dislodge a corneal flap, causing problems. Some people who have certain lenses put in their eyes during cataract surgery may have PRK to fine-tune their vision.
These are the eligibility requirements for PRK:
- You must be at least 18 years of age (ideally, at least 21 years old, when vision is more likely to have stopped changing).
- Your eye prescription should not have changed in the last year.
- Your refractive error must be one that can be treated with PRK.
- Your corneas must be healthy, and your overall eye health must be generally good.
- You need to have realistic expectations about what PRK can and cannot do for you.
Some people are not candidates for PRK. They include pregnant or nursing women, and people with any of the following:
- An unstable (changing) refractive error
- Skin or other disease that can affect healing
- A history of a lot of scarring
- Cornea abrasions or disease
- Advanced glaucoma
- A cataract affecting vision
- Uncontrolled diabetes
- A history of certain eye infections
During your consultation, we will talk to you about other conditions that may keep you from having PRK. To determine whether you are a candidate for PRK, your ophthalmologist will perform a thorough evaluation, which involves checking the overall health of your eyes, and measuring your cornea, pupil size and refractive error.
Refractive Cataract Surgery
Refractive cataract surgery is a relatively new term, used to describe the merging of traditional cataract surgery with modern refractive surgery techniques. In the past, the goal of cataract surgery was more purely medical and restorative. The surgery was performed when it was medically necessary to remove a cloudy lens to restore a person's ability to see (usually with the aid of eyeglasses or contact lenses after surgery). Refractive cataract surgery has a more aggressive goal: to enable the person with cataracts to regain good vision and to eliminate or greatly reduce their need for corrective eyewear, including reading glasses, after surgery.
The introduction of new premium intraocular lenses (IOLs) has been key to the development of refractive cataract surgery. These premium IOLs can rovide good uncorrected visual acuity at all distances after cataract surgery, eliminating or reducing the need for eyeglasses after surgery. In some cases, a person who has a cataract in one eye may choose to have a premium IOL (also called a refractive IOL) implanted in both eyes. The procedure of replacing a natural lens that does not yet have a cataract with a refractive IOL is called refractive lens exchange, or RLE.
Advantages of combining cataract surgery in one eye and RLE in the other eye includ the following:
- A better overall refractive result for more comfortable binocular vision.
- Correction of significant nearsightedness, farsightedness or astigmatism in the eye with the clear natural lens (to avoid the need to wear a contact lens on this eye after cataract surgery on the other eye).
- Correction of presbyopia in the eye with the clear lens to reduce the need for reading glasses.
- Pre-empting the need for cataract surgery at a future date in the eye with the clear natural lens.
- The field of refractive and cataract surgery is changing rapidly. To get the latest information about your options — in both premium IOLs and refractive cataract surgery — request a thorough preoperative consultation with our experts at the Rush Refractive Surgery Center.