Recent Advances in Laser Refractive Surgery

By Pankaj G. Shah, M.D.

Published on July 20, 2006

In the early days of laser refractive surgery, ophthalmologists performed a technique known as PRK to correct nearsightedness (myopia), farsightedness (hyperopia), and astigmatism. In this technique, the top-most part of the cornea (the epithelium) was removed and an excimer laser treatment was performed on the underlying stroma to correct a patient's vision. Although results were often good with this procedure, there were some difficulties. Some patients experienced moderate pain, and visual recovery was often delayed for 3-4 days. Also, in those patients needing higher degrees of correction, occasionally corneal haze developed, which sometimes reduced visual quality.

Because of these issues, investigators looked for another approach, which became known as LASIK. The LASIK procedure is performed by creating of a corneal hinge-type flap and then treating the underlying corneal stroma with the excimer laser to correct the vision. Advantages include excellent visual results and minimal discomfort. Disadvantages include dry eyes, possible flap-related complications, and visual aberrations induced by the flap. Though these complications can occur with a microkeratome or with the new all-laser technology (Intralase), it is very uncommon.

With the advent of custom, wavefront-guided surgery; it has become even more important to minimize distortions in the cornea to optimize the quality of vision. As a result, some leading ophthalmologists are no longer making corneal flaps to perform refractive surgery. This has become possible because of better lasers with smoother ablations, better management of postoperative discomfort, and better surgical techniques to avoid corneal haze. Cutting-edge ophthalmologists are now performing LASEK, whereby the corneal epithelium is temporarily pushed aside, the laser treatment is performed, and the epithelium is then replaced into its original position. Visual results to date have been very encouraging with high patient acceptance.

These are exciting times for patients contemplating refractive laser surgery. Recent advances in custom vision correction and the ability to perform LASIK without a flap have made this procedure safer than ever before.

Dr. Pankaj G. Shah is a board certified ophthalmologist and fellowship-trained refractive surgeon based in Mission, Texas.

For more information on the author, please visit www.shaheyecenter.com