PRK: Photo-Refractive Keratectomy
Photo-Refractive Keratectomy (PRK) was the original form of excimer laser vision correction to correct nearsightedness, astigmatism, and farsightedness. It involves a non-thermal ultraviolet wave length excimer laser to reshape the surface of the cornea for correction of these refractive errors. This surgery typically takes less than five minutes per eye and has a healing period requiring a bandage contact lens for three to five days following surgery, a protracted course of topical steroids for one to two months, and a slow improvement of visual function over several days to several weeks. Dr. Duffey reserves this procedure primarily for patients with thin corneas or other conditions that might preclude LASIK surgery for a patient.
LASEK: Laser Assisted SubEpithelial Keratomileusis
Laser-Assisted SubEpithelial Keratectomy (LASEK) is a variant of PRK where the epithelium is removed with alcohol and saved to be replaced after the laser application. A contact lens is still applied for three to five days. In some patients, this may provide more rapid healing than with PRK, although still slower than LASIK.
RLE: Refractive Lens Exchange
In some patients who have large refractive errors outside the range treatable with LASIK, and who have no or only mild cataract formation, removal of the natural lens of the eye and replacement with an intraocular lens (IOL) may be helpful in reducing their dependence on glasses or contact lenses. This procedure is very similar to cataract surgery that is done for a cloudy lens. The accuracy in obtaining the desired improvement is quite high. In some patients, presbyopia-correcting lenses (multifocal and accommodative IOLs) may be helpful in improving both distance and near vision. Some patients may opt for distance vision in both eyes or monovision (one eye set for near vision, and the dominant eye set for distance vision).
Phakic Intraocular Lenses (P-IOL)
Phakic intraocular lenses are artificial lens implants that are placed inside the eye while the patient’s natural lens remains intact. Patients who would benefit from a phakic intraocular lens implant are those who have too much nearsightedness to be a great candidate for LASIK. The surgical technique is similar to that used in cataract surgery, the major difference being that the natural lens is not removed and remains functional. Using topical or local anesthetic, Dr. Duffey creates a small incision in the eye and inserts the lens using specialized instruments. The exact technique and placement of the implant will differ depending on the type of lens implant chosen. Some phakic IOL are referred to as implantable contact or collagen lenses (an ICL) and LASIK may be used after a P-IOL to correct any remaing small refractive error.
You’re a good candidate for ICL if:
- Your have extreme nearsightedness
- Your have thin corneas and are not a LASIK candidate
- You have history of severe dry eyes or have an autoimmune disease
- You have excessively large pupils
Visian ICL (Implantable Collagen Lens)
Prior to the surgery Dr. Duffey will make two microscopic openings in the iris, and your eye will be numbed with anesthetic drops. Dr. Duffey will insert the ICL behind the iris and in front of the crystalline lens. This insertion procedure is performed one eye at a time. There is very little discomfort and normally no pain associated with the procedure. Some drops will be prescribed and a follow-up visit is scheduled the day after surgery. Patients will be advised to arrange for someone to drive them to and from surgery.