Refractive surgery is any surgery that helps the refractive state of the eye and decreases the need for glasses or contact lenses. This is either done via surgery on the cornea or via the lens/cataract.
Corneal Refractive Surgery
This is the best option for younger patients, who presumably have no cataracts. Because of their age, they should enjoy a stable eye and great vision for a number of years afterwards. The two major corneal refractive surgeries are LASIK and photorefractive keratectomy (PRK). Dr. Raja prefers PRK for his patients, as there is a lower chance of abnormal corneal thinning, postoperative dry eye and no risk of future flap dehiscence or tissue growing under the flap (epithelial ingrowth). The vision does take longer to recover than LASIK, but ultimately the vision outcome is the same for both.
In LASIK, a blade or laser is used to make a flap in the cornea, exposing the meat, or stroma, of the cornea underneath. Excimer laser is used to change the shape of the corneal stroma to help focus images onto the retina. The flap is then replaced. In PRK, the skin on the surface of the cornea, the epithelium, is gently massaged off and the stroma underneath is lasered. The epithelium grows back over the stroma, leaving no permanent flap. Also, because PRK leaves a thicker corneal bed, there tends to be less dry eye.
PRK can be great for patients who want to be more glasses-free. It can also help with patients who cannot tolerate contact lenses or who get frequent contact lens-related infections. Lastly, considering the lifelong cost of wearing glasses and contact lenses, PRK provides a one-time cost-effective solution. It can even be covered with an HSA account!
Refractive Lens Exchange (RLE)
When patients have cataracts that are not quite visually significant yet, they are not great corneal refractive surgery candidates. This is because the cataracts can change the prescription over time. It is best to remove the cataracts and replace them with intraocular lens (IOL) implants. These IOLs can be customized, just as they would be in cataract surgery. In fact, the surgery is no different than cataract surgery, other than being considered a cosmetic procedure. Many patients undergoing RLE opt to have multifocal IOLs placed to help make them glasses-free at both distance and near.