Contemplating refractive surgery - What are the options for your eyes?

Before you seriously contemplate undergoing a refractive procedure, you should first consider your motivation for having any surgical procedure.  For example, some people don't mind wearing glasses or contact lenses but they aren't happy with the vision they have.  In many of these cases there is some other sort of visual limitation besides refractive error (e.g., corneal warpage from contact lens wear, keratoconus of the cornea, or some other disease state) and/or expectations for a refractive surgical procedure are too high.

Most refractive surgeons explain to their patients who consider refractive surgery that the "goal of refractive surgery is to reduce dependence on glasses and contact lenses".  Notice the operative term reduce in the sentence as opposed to the term eliminate.  Of course, every refractive surgeon would like nothing more than to eliminate dependence on glasses for every single patient.  But that isn't reality.  The best refractive surgical candidate must realize that refractive surgical procedures are inherently imperfect and carry risk.  In fact, world-renowned and pioneering refractive surgeon, Steve Slade, M.D., states, "the reputation of a surgical procedure is only as good as its worst outcome".  Although paraphrased, this statement is indicative of the fact that even excellent procedures may have a marred reputation because of a small but very significant number of adverse outcomes.  As you review the details regarding each type of refractive procedure, you must also consider the potential risks and complications as well as the potential benefits.

If you're a good candidate for a refractive surgical procedure, then you will first have a legitimate and compelling reason to have a refractive surgical procedure.  For example, perhaps you're becoming contact lens intolerant or you despise wearing glasses.  Maybe you like to snorkel or scuba dive… or you are regularly involved in any activity in which corrective eyewear is impractical.  Whatever the case, there should be a good reason to desire the surgery.  Next, you will have a solid understanding of the procedure as well as its potential risks, complications, and benefits.  Finally, you will have realistic expectations for the procedure.  If your doctor explains to you that you might have halos around lights at night following LASIK and you actually develop halos in the post-op period, then you shouldn't be surprised or displeased.  This is why you've agreed to a proper consent!

If you've decided that you have a compelling reason to have a refractive surgical procedure to reduce your dependence on corrective eyewear, then you should read ahead to determine which procedure might be best for you. 

First, make sure you have your glasses or contact lens prescription handy.  For ease of reference, I'm placing the table from chapter five in this chapter as well.  Using the table below, determine if you are a myope (nearsighted) or a hyperope (farsighted) and the degree of your refractive error (mild, moderate, or severe).  This will help to determine which procedures for which you might be a candidate.

Next, you must open your mind to the fact that there are a number of other excellent refractive surgical procedures besides traditional LASIK!  Although LASIK is still the dominating refractive surgical procedure today, you must consider the possibility that another procedure may be better suited for your particular eyes.  In fact, it is true that refractive surgeons have abandoned perfectly good procedures because they can't convince enough patients to choose the procedure!  Why?  Because many patients have decided that they want LASIK or nothing.  If this is you, then you should skip ahead to chapters seven, eight, and nine, which all deal with LASIK and related procedures including types of excimer lasers.  However, if you have an open mind and would like to consider your options, then peruse the procedures available for your degree of refractive error (in the tables below) and I'll inform you of the details in the appropriate chapter.  I've laid out a "refractive surgery decision algorithm", the fundamentals of which were developed by refractive surgeon, Deepinder K. Dhaliwal, M.D., associate professor, department of ophthalmology, at the University of Pittsburgh School of Medicine[i].  I believe this basic algorithm may be the most valuable asset of this entire website.  However, you must have, or already know, your glasses or contact lens prescription in order for these tables and /or the algorithm to have any value.  Again, I'm trying to simplify the approach for you, while at the same time making you aware of your options.  If you will follow these tables and/or the algorithm below, you will simplify the decision process for yourself immensely!

Individuals 18 to 39 Years of Age

Individuals Forty Years of Age and Older