Eye Health & Surgical Options -- May 19, 2008 -- Dr. Thomas Wohl - NewsChannel5.com | Nashville News, Weather & Sports

Refractive eye surgery

Refractive eye surgery is any surgical procedure used to correct vision problems such as nearsightedness, farsightedness and astigmatisms. All vision correction surgeries work by reshaping the cornea, or clear front part of the eye, so that light traveling through it is properly focused onto the retina located in the back of the eye. While LASIK surgery is the most common, there are a number of different surgical procedures used to reshape the cornea.

Successful refractive surgery may give you freedom from glasses or corrective lenses, but before choosing refractive surgery, talk with your eye doctor and get all the facts. Know the pros and cons of each type of refractive surgery. Discuss your medical history with your eye doctor. Refractive surgery may not be for you if you:

• Do not have stable vision.
• Have a vision problem that is too severe.
• Have a condition that slows healing or increases your risk of infection.
• Have an eye disease, such as advanced glaucoma or cataracts.
• Are taking certain medications.
• Are pregnant or nursing, or are planning to become pregnant in the near future.

Types of refractive surgery:

• LASIK (pronounced "LAY-sik") stands for laser in-situ keratomileusis. It's a technique for reshaping corneal tissue to help you see better without glasses or corrective lenses. This procedure uses an excimer laser, which produces a concentrated beam of cool, ultraviolet light. Each pulse of the laser can remove a tiny portion of corneal tissue. LASIK can be used to correct hyperopia, myopia and astigmatism.
• LASEK (pronounced "Lay-SEEK") stands for laser epithelial keratomileusis. The epithelium (top layer of cornea) is softened with an alcohol solution to create a flap in the cornea. An excimer laser is then used to reshape the underlying corneal tissue. The excimer laser produces a concentrated beam of cool, ultraviolet light. LASEK can treat myopia, hyperopia and astigmatism.
• CK (conductive keratoplasty) uses a tiny probe to send radiofrequency energy into the cornea. This shrinks the outer portion of the cornea, making the central cornea steeper.
• PRK (photorefractive keratectomy) uses an excimer laser, which produces a concentrated beam of cool, ultraviolet light. Each pulse of the laser can remove a tiny portion of corneal tissue. PRK can be used to treat low to moderate myopia, hyperopia, and astigmatism.
• LTK (laser thermal keratoplasty) uses a holmium laser to gently heat certain areas of the cornea. It shrinks the outer portion of the cornea, making the central cornea steeper.

Surgery to correct cataracts

A cataract is a clouding of the lens in the eye that affects vision. Most cataracts are related to aging and are common in older people. By age 80, more than half of all Americans either have a cataract or have had cataract surgery.

The symptoms of early cataract may be improved with new eyeglasses, brighter lighting, anti-glare sunglasses, or magnifying lenses. If these measures do not help, surgery is the only effective treatment. Surgery involves removing the cloudy lens and replacing it with an artificial lens.

A cataract needs to be removed only when vision loss interferes with your everyday activities, such as driving, reading, or watching TV. You and your eye care professional can make this decision together. Once you understand the benefits and risks of surgery, you can make an informed decision about whether cataract surgery is right for you. In most cases, delaying cataract surgery will not cause long-term damage to your eye or make the surgery more difficult. You do not have to rush into surgery.

Sometimes a cataract should be removed even if it does not cause problems with your vision. For example, a cataract should be removed if it prevents examination or treatment of another eye problem, such as age-related macular degeneration or diabetic retinopathy. If your eye care professional finds a cataract, you may not need cataract surgery for several years. In fact, you might never need cataract surgery. By having your vision tested regularly, you and your eye care professional can discuss if and when you might need treatment.

If you have cataracts in both eyes that require surgery, the surgery will be performed on each eye at separate times, usually four to eight weeks apart. Many people who need cataract surgery also have other eye conditions, such as age-related macular degeneration or glaucoma. If you have other eye conditions in addition to cataract, talk with your doctor. Learn about the risks, benefits, alternatives, and expected results of cataract surgery.

What are the different types of cataract surgery?

There are two types of cataract surgery. Your doctor can explain the differences and help determine which is better for you:

• 1. Phacoemulsification, or phaco. A small incision is made on the side of the cornea, the clear, dome-shaped surface that covers the front of the eye. Your doctor inserts a tiny probe into the eye. This device emits ultrasound waves that soften and break up the lens so that it can be removed by suction.
• 2. Extracapsular surgery. Your doctor makes a longer incision on the side of the cornea and removes the cloudy core of the lens in one piece. The rest of the lens is removed by suction. After the natural lens has been removed, it often is replaced by an artificial lens, called an intraocular lens (IOL). An IOL is a clear, plastic lens that requires no care and becomes a permanent part of your eye. Light is focused clearly by the IOL onto the retina, improving your vision. You will not feel or see the new lens.

Is cataract surgery effective?

Cataract removal is one of the most common operations performed in the United States. It also is one of the safest and most effective types of surgery. In about 90 percent of cases, people who have cataract surgery have better vision afterward.

When will my vision be normal again?

You can return quickly to many everyday activities, but your vision may be blurry. The healing eye needs time to adjust so that it can focus properly with the other eye, especially if the other eye has a cataract. Ask your doctor when you can resume driving.

If you received an IOL, you may notice that colors are very bright. The IOL is clear, unlike your natural lens that may have had a yellowish/brownish tint. Within a few months after receiving an IOL, you will become used to improved color vision. Also, when your eye heals, you may need new glasses or contact lenses.