I’ve worn glasses and contacts for so long that I can’t imagine what it would be like to wake up in the morning and be able to see clearly.
But refractive eye surgeries, the most well-known being LASIK (laser in-situ keratomileusis), are procedures that would allow me to do just that.
Refractive errors occur when your cornea is not shaped quite right or your eyeball itself is too long or too short. These irregularities prevent light from focusing on the correct part of your eye and result in nearsightedness, farsightedness or an astigmatism, which is when objects appear blurred at any distance.
Learn how refractive eye surgeries can correct impaired vision, what to expect during the LASIK procedure and ways to ease recovery.
What are the types of refractive surgery?
“Refractive surgeries include many techniques depending on an individual patient’s situation,” says Dr. Tueng Shen, an ophthalmologist who sees patients at the UW Medicine Eye Institute at Harborview and the Eye Center at UW Medical Center – Montlake.
The most common and well-known type of refractive surgery is LASIK. In this procedure, a doctor creates a small flap in your outer cornea and then uses a laser to reshape your inner cornea. Afterward, the flap is placed back over your eye, and it reattaches in a matter of minutes.
Some other refractive surgeries include photorefractive keratectomy, refractive lens exchange, conductive keratoplasty and intracorneal rings.
While less common, these are useful surgeries if you do not meet the requirements for LASIK or have a unique eye shape or refractive error.
What should you consider before deciding on refractive surgery?
“In general, the first consideration in refractive surgery is that your refraction has to be stable for a few years. If it’s not, we won’t offer the surgery because the longevity of its benefits will be quite short,” Shen says.
You don’t want to have surgery only to find out your prescription changed, leaving you back at square one. To avoid this, it’s best to do LASIK surgery when you are 21-40 years old.
If you are younger than 21, your vision is likely still changing. If you’re older than 40, your vision may start to change again due to presbyopia (eye loss caused by your lenses stiffening), and you might need reading glasses as the result.
Another consideration is eye health.
Ahead of surgery, your doctor will conduct an exam to make sure you do not have any conditions, like thin corneas or unusual cornea curvature, that would put you at risk of vision loss if you had the surgery.
Your doctor should also check for less-extreme conditions like dry eyes, as refractive surgeries can exacerbate these symptoms. Other risks of refractive surgeries include seeing halos or glare, though this is uncommon.
It helps to clarify why you want surgery in the first place and discuss this reason with your doctor, be it participating in sports without wearing glasses or improving eye health if you do not keep up with contact cleaning hygiene.
“Different approaches are more appropriate based on an individuals’ habits and desired outcome,” Shen notes. “Deciding if refractive surgery is right for you is a particular discussion you should have with your doctor.”
If LASIK isn’t a good fit, you have other options. Photorefractive keratectomy is effective on more mild vision impairment; conductive keratoplasty is best suited for people 40 and older; refractive lens exchange works for people with severe farsightedness (in cases where LASIK is not recommended); and intracorneal rings aid those with thin corneas.
How can you prepare for refractive surgery?
Before deciding on surgery, you should consult with your doctor and talk about your prescription. This is a good time to bring up your eye care habits, why you are seeking surgery and any past medical conditions.
If you decide to move forward, you’ll schedule an exam in which your doctor will confirm your prescription, check your eye health and measure your eye.
“We will ask you to not wear contacts before the exam for one week for each year you’ve worn contacts,” Shen says.
This means if you’ve been wearing contacts for the past five years, you’ll need to wear glasses (and go without contacts) for five weeks leading up to the appointment. Contact lenses change the shape of your cornea, so this waiting period allows time for your corneas to revert to their natural shape so your doctor can take accurate measurements.
Roughly a day before the surgery, avoid any lotions or makeup, as they could increase your risk of infection. You’ll also want to plan for someone to drive you home after the surgery.
What can you expect during a refractive surgery?
Refractive surgeries are quick: You can plan to be in and out in about 30 minutes. Better yet, the actual time for the laser to reshape your cornea usually takes less than a minute.
You will start by checking in, and then your doctor will take you to a suite where the surgery will be performed. You’ll sit in a chair and your doctor will apply eye drops, which will take about 30 seconds to numb your eyes. Your doctor will use a device to help keep your eyes open, so you don’t need to worry about accidentally closing them during the procedure.
At this point, your doctor will use a laser to create the corneal flap and then to shape your cornea.
“It’s normal to feel anxious when someone is working on your eye,” Shen says.
The good news is that the process is straightforward and painless. Your vision will be a little blurry and you will hear some noise from the laser, but you won’t feel a thing, Shen notes.
If you’re feeling concerned about anything, you can bring it up with your doctor in the moment. Oftentimes, your doctor will work on both eyes at once, but you can also ask for a breather in between eyes if you need a moment.
Once your doctor has reshaped your corneas, they will put the flap back in place and provide you with a shield to protect your eyes.
What is recovery like after refractive surgery?
Recovery is a little different depending on which refractive surgery you have, but in general, you may experience some itching, sensitivity to light and redness in the first couple days after surgery — though Shen notes that LASIK surgery results in less overall irritation than other refractive surgeries.
No matter the type of refractive surgery, you will be sent home with some eye drops and, if needed, a prescription for pain medication. Shen recommends taking a week off of work after the procedure to help you heal. This is especially true if you work on a computer.
“You can see well enough to function after the procedure but using a computer or cell phone right away will be uncomfortable and might slow down recovery,” she notes.
Avoiding makeup and other products that might cause infection, plus passing on contact sports for the first couple weeks, will also help your eyes rest and recover. Soon, you’ll be back to your regular routine with better vision than ever.
While the decision to do refractive surgery is a big one, it’s also one that offers tremendous benefits.
“Refractive surgery can be quite liberating,” Shen says. “It allows people to do all the activities they like to do without restrictions of glasses or contact lenses.”