From the Guidelines
Refractive eye surgery is a highly effective and safe option for correcting vision problems, with the goal of improving the patient's visual needs and quality of life, as emphasized in the refractive surgery preferred practice pattern 1. The most common procedures include LASIK (Laser-Assisted In Situ Keratomileusis), PRK (Photorefractive Keratectomy), and SMILE (Small Incision Lenticule Extraction), each with its own benefits and potential risks 1.
Key Considerations
- Determine the patient's visual needs and identify any refractive errors 1
- Discuss the nature of the refractive error, appropriate nonsurgical and surgical alternatives, and the risks and benefits of each approach with the patient 1
- Inform patients about common adverse effects, such as dry eye and eventual presbyopia, especially those considering corneal refractive surgery 1
- Maintain a record of preoperative keratometry and refraction, as well as postoperative refraction, to ensure proper follow-up care and management of any side effects or complications 1
Surgical Options
- LASIK: creates a thin corneal flap before using an excimer laser to reshape underlying tissue
- PRK: removes the outer corneal layer completely before laser reshaping, suitable for patients with thinner corneas
- SMILE: a newer, minimally invasive option that creates a small lens-shaped piece of tissue removed through a tiny incision
Post-Operative Care
- Antibiotic drops for 1 week
- Steroid drops on a tapering schedule over 1-4 weeks
- Lubricating drops for several months
- Avoid rubbing eyes, swimming, and wearing eye makeup for at least one week after surgery It is essential to prioritize the patient's safety and well-being by following the recommended practice patterns and guidelines, as outlined in the refractive surgery preferred practice pattern 1.
From the Research
Definition of Refractive Eye Surgery
Refractive eye surgery refers to a group of surgical procedures designed to improve vision by correcting refractive errors such as myopia, hyperopia, and astigmatism. These procedures aim to reduce or eliminate the dependence on contact lenses and eyeglasses 2.
Types of Refractive Eye Surgery
Some common types of refractive eye surgery include:
- Radial keratotomy (RK)
- Photorefractive keratectomy (PRK)
- Laser-assisted in situ keratomileusis (LASIK)
- Laser thermal keratoplasty (LTK)
- Intrastromal corneal rings (ICR)
- Keratorefractive lenticule extraction
- Phakic intraocular lenses (pIOL) implantation 2, 3
Evolution of Refractive Surgery
Refractive surgeries have evolved significantly over the years, from traditional incisional corneal procedures to the use of advanced technologies such as femtosecond lasers and new-generation phakic intraocular lenses (pIOL) 3.
Safety and Efficacy
Current refractive surgery procedures are associated with high efficacy and predictability, enhanced safety, and a significant reduction in sight-threatening complications 3. LASIK, in particular, has been shown to be a safe and predictable method for enhancing refractive results in eyes that have had previous corneal surgeries 4.
Comparison of LASIK and PRK
Studies have compared the effectiveness and safety of LASIK and PRK for the correction of myopia, with results indicating that LASIK gives a faster visual recovery and is a less painful technique, while both procedures appear to give similar outcomes one year after surgery 5.
Available Surgical Options
Available surgical options for refractive eye disorders treatment include corneal surgery (e.g., LASIK, FemtoLASIK, PRK) and intraocular surgery (e.g., phakic lenses, refractive lens exchange) 6.