Checkup on Health - Keep eyes open when considering vision correction surgery

woman in eye glasses
Between 66 and 90 percent of people obtain 20/20 vision following refractive eye surgery.

By Mark J. Mannis, M.D. 

Most people who are dependent on glasses or contact lenses dream of being free of them and waking up each day with good eyesight. New refractive surgeries have made this dream a reality for many. Almost everyone has heard stories about perfect eyesight being restored.

Do you wonder whether this surgery is for you? As for any surgical procedure, it is wise not to rush into a decision. Choose an eye surgeon carefully, one who has had experience in refractive surgery. And make sure he or she takes the time with you to consider your personal potential risks and benefits from any procedure.

Wide variety of methods

New eye surgeries consist of an alphabet soup of confusing names. LASIK (laser in-situ keratomileusis), PRK (photorefractive keratoectomy) and ICRs (intra-corneal rings) all accomplish the approximately same thing by different means. They change the shape of the cornea (the clear area covering the front of the eye), which refracts light onto the retina in the back of the eye, allowing proper focus. Correcting vision is accomplished either by reshaping the cornea with a laser or by placement of a tiny, transparent ring into the cornea.

Which procedure to use depends on a variety of factors, including the type and degree of vision correction needed. Procedures also vary somewhat in the amount of discomfort and inconvenience following them.  There are new and exciting technologies that make this procedure even more precise and safe — including “bladeless” laser surgery, where not only the vision correction but also the corneal flap generation are done via the laser. This technology is now being made available at UC Davis.

Who can be helped

Who can be helped by refractive surgery? People who are nearsighted, farsighted or have astigmatism can benefit. However, refractive surgeries cannot combat the changes that come with aging, which require many people starting in their 40s to use reading glasses or switch to bifocals. These changes will not be corrected, and will still progress after refractive surgery. On the other hand, selected patients with the near-vision difficulties that accompany age can be helped with laser surgery.

People with certain conditions, such as severe diabetes and some autoimmune diseases, are also not good candidates. Consideration also includes individual eye characteristics, such as extreme dryness, a very thin cornea, extra-large pupil size and certain correction problems. Such factors may disqualify a patient, and can only be assessed with a careful eye exam by an ophthalmologist. 

Majority obtain 20/20 vision

Do the refractive surgeries really restore perfect eyesight? Yes, often. Between 66 and 90 percent of people obtain 20/20 vision following surgery, depending on the procedure employed and the initial refractive error. For most others, vision following surgery is 20/40, which, while not perfect, is good enough in most states for driving without visual correction. However, if you are someone who is accustomed to 20/20 with glasses or contact lenses, 20/40 may seem like a setback. And a very small percentage of people end up with worse eyesight following surgery, due to surgical complications, infection or other problems.

What does the actual surgery involve? The procedure itself is painless, typically taking less than 15 minutes. The patient is awake throughout, though may be mildly sedated if desired. After the procedure, the patient can go home at once, but usually should take it easy for a day. Most people have only mild discomfort and tearing for a short period of time.

Dr. MannisAbout the author

Dr. Mark Mannis is an ophthalmologist specializing in corneal and refractive surgery. He is the director of the Vision Correction Service for UC Davis Medical Group in Sacramento.

Typical visual side effects include some abnormalities, such as glare and halos around lights at night initially. Some people report differences in contrast, similar to the color changes of an old black and white photograph. In the vast majority of cases, such problems are transient.

Evaluate options carefully

If you are considering refractive surgery, don’t base your decision about where to have it done solely on an advertised “good deal.” Beware of doctors who make unrealistic claims, such as promising perfect success and no discomfort or risk. Avoid doctors who examine you only briefly before moving you into the procedure. Make an appointment for a thorough eye exam and discussion of the options, then go home to think about it before making a decision.

And if one doctor advises you that you are not a good candidate for refractive surgery, don’t shop around for another surgeon who is willing to do it. Instead, consider waiting a few years for newer technology, then get another consultation.