Alternatives to Contact Lenses
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There are a few alternatives to contact lenses. One option that has become more popular in recent years is refractive surgery.
What is refractive surgery?
Refractive surgery is a broad term used to describe surgeries to reduce nearsightedness, farsightedness, and astigmatism. The term “refractive surgery” actually refers to several procedures, including LASIK, PRK, LASEK, CK, Intacs, AK, RK, and several emerging techniques. Refractive surgery is not a single event, but a process including a careful preoperative examination and thorough postoperative care. In fact, the result of your refractive surgery is based as much on the preoperative evaluation and the postoperative care as on the surgery itself.
What is Laser Vision Correction?
The term “Laser Vision Correction” is used to describe those refractive surgeries which use a laser, including LASIK, PRK, and LASEK. LASIK is the most widely performed of the refractive surgeries, and for most but not all patients, is the procedure of choice. Laser vision correction is a precise, minimally invasive procedure used to reduce nearsightedness, farsightedness, or astigmatism by reshaping the cornea. The laser used is an “excimer laser” which has been thoroughly tested and clinically proven. Over a million patients have had a laser vision correction worldwide.
What is an “excimer laser?”
A laser is an instrument that emits a controlled beam of powerful light. The excimer laser produces a beam of cool light which removes microscopic amounts of tissue with each intense pulse. The tissue is removed with very little heat so that the underlying tissue is not disturbed.
What is the difference between LASIK, PRK, and LASEK?
In each of these procedures, the excimer laser is used to remove or ‘ablate’ small amounts of tissue from the cornea. This reshaping of the cornea will help to reduce nearsightedness, farsightedness, or astigmatism. The difference in the procedures is how the surgeon gets to the surface he wishes to treat. In PRK, the surgeon first removes the corneal epithelium using a brushing technique, and then uses the laser to remove the correct amount of tissue. In LASIK, the surgeon first makes a thin flap of corneal surface tissue using an instrument called a microkeratome and lifts the flap without removing it completely. Then the surgeon uses the laser to ablate the correct amount of tissue, and then replaces the flap. In LASEK, the surgeon loosens the epithelium and gently pushes it back, without making a flap and without removing it, then uses the laser to remove the correct amount of tissue, and then gently replaces the epithelium.
What are CK or Intacs?
Both CK and Intacs are types of refractive surgeries that do not use a laser. CK refers to ‘Conductive Keratoplasty.’ It is a procedure that uses radio frequency to shrink collagen tissue of the cornea. The cornea then steepens as it heals. This is used to correct small amounts of farsightedness and may have use in correcting irregularly shaped corneas.
‘Intacs’ are small plastic ring segments that are placed in between the layers of the cornea to flatten the shape of the cornea. This is used to correct small amounts of nearsightedness and may have use in correcting irregularly shaped corneas.
How do I know which refractive surgery to have?
Only a thorough examination and evaluation of your eyes and your visual system can help you determine whether it is reasonable to consider refractive surgery, and then, which procedure to choose. Many things go into this decision, including measuring the shape and thickness of your corneas, the size of your pupils, the degree of your visual correction, the health of your eyes, and even your age. A qualified optometrist or ophthalmologist should be your first step toward determining if your eyes are healthy and if you should proceed with the decision to have refractive surgery.
Who is involved in this process?
Optometrists are eye care professionals (OD) that have completed four years of undergraduate studies and four years of professional optometry school. They spend a minimum of four years studying only the eye. Some optometrists complete an additional year of training called a residency or fellowship. They are trained to provide eye care including vision correction, to diagnose, manage, and treat diseases of the eye and surrounding structures, and to detect systemic disease. In all fifty states optometrists are licensed to prescribe medications for the eye. In refractive surgery, they provide preoperative and postoperative care. Their background in clinical optics make their skills strong in measuring the refractive problems of the eye.
Ophthalmologists are eye care professionals who are physicians (MD or DO) and have completed four years of undergraduate studies, four years of medical or osteopathy school, one year of internship, and three years of ophthalmology residency. They spend a minimum of three years studying only the eye. Some ophthalmologists complete an additional year of training called a fellowship in their specialty area. They have strong medical training to diagnose and treat diseases of the eye and of the whole system. They provide total eye care including surgery to the eye. Some, but not all, ophthalmologists are refractive surgeons.
Many ophthalmologists work closely with optometrists to provide total care to their refractive surgery patients.
Are expensive places better?
As in other aspects of life, typically the more you pay, the better quality care and service you will receive. Contrary to what some advertisements might suggest, LASIK is not a standard product with consistency from place to place. It is a professional service with variable quality. Highly skilled surgeons and optometrists will charge fees commensurate with their expertise.
Centers that advertise deep discounts on refractive surgery sometimes limit contact between eye care providers and patients. Their quoted price often does not include medications, postoperative care, or enhancements. Sometimes these centers do not let you choose the surgeon or the doctor who does your preoperative or postoperative care. Patients should ask these questions of their provider before they commit to surgery and take the total package of services into account when determining value. Remember this is surgery and there are risks to this irreversible procedure.
What risks do I need to be aware of if I decide to have refractive surgery?
Refractive surgery is surgery and all surgical procedures have risk. The most serious risk is for developing infection or severe inflammation. Serious infection or inflammation, if not treated, can lead to vision damage or scarring. Most surgeons protect their patients from possible infection and inflammation with antibiotic and anti-inflammation eye drops during and after the procedure. Another risk is dryness to the eye. While dryness will not cause permanent vision damage, it is a nuisance. It can be managed in most cases with aggressive eye lubrication.
Your vision may fluctuate for a certain amount of time after the surgery. In fact, the greater your preoperative refractive error, the longer the fluctuation. Some patients do experience glare or halos, and light sensitivity during this time.
Some patients experience a slight overcorrection or undercorrection initially. This usually stabilizes during the healing period, but if it does not, the surgeon may discuss a second treatment, called an ‘enhancement.’ A second surgery is not mandatory, instead a patient may choose to correct the smaller amount of refractive error with glasses or contact lenses.
Why do I have to remove my contact lenses prior to the preoperative evaluation?
Contact lenses can leave an impression on the cornea, just like a watchband leaves an impression on the skin of the wrist. If you do not remove your contact lenses prior to evaluation and to surgery, the measurements taken can be inaccurate, thus giving you an unfavorable outcome to your surgery. Your surgeon and optometrist will have specific requirements for removing the contact lenses prior to your initial evaluation and to your surgery. If you wear hard or gas permeable lenses, you will have to be out of those lenses for a longer time than if you wear soft contact lenses. Your doctor will be able to tell you whether your corneas have returned to their normal shape by examining the eyes and taking special maps of the corneas.
If I am happy with my contact lenses, do I need to consider refractive surgery now?
No, of course not. Patients who are happy in their contact lenses or glasses, and who have healthy corneas in their contact lenses may wish to wait to have refractive surgery. Contact lenses are an obvious alternative to refractive surgery. They can allow the patients to have good vision without glasses, and without surgery. Contact lenses are a modifiable and reversible mode of vision correction. Refractive surgery is not reversible in most cases, and to modify a result usually requires more surgery. With some of the new contact lens technology available, you can now wear lenses in a disposable mode, for one day or two weeks, or even up to 30 days continuously. There are toric contact lenses to correct astigmatism, bifocal contact lenses to correct distance and near vision simultaneously, and colored contact lenses to change the color of your eyes. A newly approved procedure using overnight gas permeable contact lenses (CRT: Corneal Refractive Therapy) can dramatically reduce your need for daytime glasses or contact lenses. Ask your optometrist or ophthalmologist about new contact lens technology that might be right for you.
What is the first step if I’m interested in refractive surgery?
A complete vision and eye health examination by a trusted ophthalmologist or optometrist is the first step for anyone considering refractive surgery or contact lenses. He or she can help you determine what your refractive error is, whether any eye disease is present, and whether there are any compelling reasons not to consider refractive surgery. The decision to have surgery is, of course, up to you, the patient. The doctor will help guide that decision and be happy to discuss any risks, benefits, and the alternatives.
The above information was produced for Contact Lens Docs.Com. Advisors were David R. Hardten, MD and Marlane J. Brown, OD.