Alternatives to LASIK
Your personal goals and medical and vision history play an important role in determining which refractive surgical option is right for you. If you are not a good candidate for LASIK, you may be eligible for one of these alternatives.
PRK: The Most-Common Alternative to LASIK
If you have thin corneas or dry eyes, a type of advanced surface ablation, called PRK, may be an option. PRK (photorefractive keratectomy) works best for low-to-moderate nearsightedness. Compared to LASIK, there is a lower risk of certain complications, but recovery time is longer and less comfortable. Patients usually wear protective contact lenses for 3-5 days after surgery. Follow-up studies suggest:
- 70% of PRK patients achieve 20/20 vision
- 92% of PRK patients achieve 20/40 vision or better
Other, less common, types of advanced surface ablation include LASEK (laser epithelial keratomileusis) and EpiLASIK.
SMILE: Minimally Invasive, Flapless Surgery
ReLEx SMILE (small incision lenticule extraction) was FDA approved for the treatment of nearsightedness in 2016. Sometimes called "flapless LASIK," this minimally invasive procedure combines techniques from PRK and LASIK. During the procedure, a highly precise ZEISS VisuMax femtosecond laser reshapes the cornea by removing a small amount of eye tissue. From start to finish, the whole procedure takes just minutes. SMILE is one of the most gentle vision correction procedures available. Most patients feel no pain during and after the procedure, and they are able to return to their daily activities quickly. This surgery is available at Mass. Eye and Ear, Waltham.
LASEK combines certain techniques from LASIK and PRK. The surgeon retains a very thin layer of corneal surface cells (epithelium) that is placed on the cornea at the end of surgery. LASEK typically results in less discomfort than PRK.
EpiLASIK is very similar to LASEK, except that it uses a blunt blade to smoothly separate the epithelium from the cornea.
Corneal inlays are placed in the cornea and are designed to correct presbyopia—the blurry close-up vision that happens after age 40. The procedure can also be combined with LASIK.
Phakic intraocular lenses: If you are extremely nearsighted or have vision problems caused by cataracts, artificial lenses—called phakic intraocular lenses (PIOLs)—may be an option. The lenses are surgically placed in front of the eye's natural lens. Certain types of IOLs, such as multifocal or accommodative lenses, may improve both distance and reading vision. Possible risks include loss of vision; night vision problems; and additional surgery to adjust, remove, or replace lenses.
Premium (multifocal) cataract lenses: During cataract surgery, the natural lens of the eye is replaced. Unlike standard intraocular lenses, which provide sharp focusing power at one distance, premium intraocular lenses correct vision at multiple distances—significantly reducing or eliminating the need for glasses.
Refractive clear lens exchange (refractive lensectomy): If you are extremely farsighted or have early cataracts, you may be a viable candidate for refractive clear lens exchange, also known as pre-cataract surgery. During this procedure, the eye's natural lens is replaced with an artificial, intraocular lens. This corrects refractive error and helps achieve sharper focus.
During arcuate keratotomy, one or two peripheral incisions are made in the cornea to reduce astigmatism. Recovery is generally brief, although it may take one month or more for vision to stabilize.
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