laser eye surgery pupil size

Refractive Surgery Options – Making an Informed Decision, The Key to Success

The consideration of refractive surgery is a major decision in ones life that requires substantial research by the patient and a comprehensive consultation with an eye doctor.  All options should be considered and a thorough refractive consultation should include the pros and cons of all of the options under consideration.  The role of your eye doctor will be to help you focus on which option or options best fulfill your visual needs.  Here are the most common options.

Glasses

This is the most common, safest and simplest option and gives patients excellent, consistent vision. Sometimes the best solution is to do nothing at all.  Any patient that has concerns about having refractive surgery should choose an options that is not permanent.  Let’s face it though, sometimes glasses are a pain in the nose and are just plain inconvenient.  That said though, all contact lens wearers should have a pair of glasses that they can fall back on when they can’t or should not be wearing their contact lenses.

Traditional Contact Lenses

Traditional contact lenses provide a number of options with variable replacement schedules from soft contact lenses that are discarded daily, every two weeks or monthly. There are also contact lenses that can be safely worn overnight from 6 nights to as many as 30 consecutive nights. Studies have shown that contact lens wear even considering a lifetime of wear, is safer than refractive surgery. Both soft and gas permeable lenses can correct high amounts of nearsightedness, astigmatism and farsightedness. Contact lenses can also correct presbyopia, allowing patients over 40 to see at both near and far without bifocal glasses or reading glasses.

The most common reason why patients report they can not wear contact lenses is because their eyes are too dry.  There are currently many new treatments available to patients with dry eyes and a huge amount of research being done in this area. If you are a “contact lens dropout” consider having your eye doctor evaluate you for dry eye syndrome.

Orthokeratology

Also known as Ortho-K, Vision Shaping Treatment, Corneal Refractive Therapy and the Gentle Vision Shaping System.  Orthokeratology uses specially made contact lenses that are worn while the patient sleeps to gently reshape the cornea allowing the light to be refocused in the same way as LASIK.  Adults as well as children are candidates for Ortho-K.  Numerous studies have shown that an additional benefit of Orthokeratology in children is that it appears to markedly reduce the progression of nearsightedness (myopia).  There is currently an FDA sponsored study underway to verify these earlier claims.  Thus far in year two of the five year study it appears that Orthokeratology does indeed reduce the progression of myopia in children.

Refractive surgery

Refractive surgery is a very popular option for reducing a patient’s dependency on glasses, however, not everyone is a candidate for refractive surgery.  Often contact lenses or glasses are simply not an option for a patient.  Some occupations do not lend themselves well to contact lenses or glasses, for instance a very nearsighted professional diver or a person that works in a dusty environment may find that wearing contact lenses is unsafe.

The most popular refractive procedure is LASIK or Laser ASsisted In situ Keratomileusis, however, PRK or Photo Refractive Keratectomy is still very popular as well. Non laser refractive surgeries such as a Refractive Lensectomy and Implantable Contact Lenses are also available, however they are not nearly as popular as LASIK or PRK. There are a number of reasons why a person may not be a candidate for lasik or PRK

Why Not Have LASIK

The most common contraindications to refractive surgery are

• large pupil size
• thin corneas
• occupation
• refractive error
• surgical expectations
• corneal dystrophies
• age

In addition, some patients simply are not comfortable with having surgery on their eyes or are hesitant to undertake something such as LASIK or PRK that is permanent.

The best source of accurate, unbiased information is your optometrist.  Your optometrist has the benefit of being an expert in all of the options available to you.  Should surgery be your best option your optometrist has the benefit of seeing the refractive results for all of the refractive surgeons in the area and can best help you decide which one is best for you.  In addition, if your optometrist has been approved by the FDA to fit the overnight Orthokeratology lenses it gives you an additional option to solve your refractive dilemma.  Virtually all optometrist can fit patients with extended wear contact lenses which can be a safe, non permanent refractive option.

Research all of your options, consult your eye doctor and you will be making a complete, informed decision.

About the Author

Dr. Richard A. Driscoll is a therapeutic optometrist and optometric glaucoma specialist at Total Eye Care.  With offices serving Colleyville, Texas and Keller / Southlake, Texas the eye doctors at Total Eye Care, in addition to providing comprehensive eye care for family members of all ages, provide specialty contact lens care for patients with advanced ocular conditions such as keratoconus and post refractive surgery.  Dr. Driscoll provides refractive consultations to patients allowing his patients to consider all of the refractive options available to them such as orthokeratology, LASIK, PRK, contact lenses and refractive lensectomies.