A doctor of optometry provides referrals to secondary specialists, such as ophthalmologists, for treatment of systemic disease or eye surgery when necessary. Doctors of optometry also co-manage the treatment of ocular diseases and pre- and post-surgical patient care with ophthalmologists.
There are several surgical options available when considering refractive eye surgery to reduce your dependence on glasses or contact lenses. A doctor of optometry can offer an informed opinion regarding your candidacy for any of the refractive surgery options available. Following refractive surgery, your doctor of optometry can help manage the use of the antibiotic, steroid and artificial teardrops required to aid the healing process.
Photo-Refractive Keratectomy (PRK)
With Photo-Refractive Keratectomy (PRK), the outer layer of the cornea, called the epithelium, is gently removed. A laser is used to reshape the cornea, which is the clear covering of the eye. The epithelium regenerates over the treated area within approximately 3-5 days. PRK achieves excellent results, especially for patients who may have a thinner than average cornea. Following healing, the corneal integrity is well maintained and the visual acuity is usually very good. The main drawbacks to PRK are that there is some eye pain or irritation for the first few days after surgery while the epithelium heals, and the prescription may take up to three months to stabilize.
Laser In-Situ Keratomileusis (LASIK)
Laser In-Situ Keratomileusis (LASIK) is a common type of refractive eye surgery. With LASIK, patients experience faster vision recovery and minimal eye discomfort from the procedure. A tiny oscillating blade known as a microkeratome is used to create a thin flap of corneal tissue. The flap is folded back and the laser is applied to the exposed inner corneal tissue. The flap is then repositioned, where it bonds tightly without the need for stitches. Rarely, there have been instances where the flap has come dislodged, such as while playing sports.
Instead of using a blade to create the flap, a femtosecond laser can be used to make a uniform thickness slice instead. Commercially known as Intralase SBK, this procedure can create a thinner, more uniform flap with potentially fewer complications than the microkeratome. The laser is then applied to the exposed inner corneal tissue. The flap is then repositioned, where it bonds tightly without the need for stitches. This type of flap can lead to better visual recovery and is more stable.
PRK, LASIK and SBK are very quick and accurate surgeries. However, they may, in limited instances, produce visual aberrations in the form of glare or haloes under dim lighting conditions and dry eye syndrome.
Customized wavefront guided laser PRK/LASIK/SBK is an advancement of the standard laser treatment and provides a more personalized treatment that is unique to each patient. Advantages of the wavefront treatment include improving the quality of vision after surgery and decreasing the incidence of glare of haloes around lights. Wavefront guided laser eye surgery is now being used quite heavily because of its inherent benefits.
Clear Lens Extraction (CLE)
Clear lens extraction (CLE) does not involve a laser and is actually the same procedure as cataract surgery. With CLE, instead of waiting for a cataract to form, the normally clear lens of the eye is removed and replaced with an artificial lens. The artificial lens provides proper focusing power to improve distance vision. CLE is more invasive than the above surgeries and is generally reserved for patients with extremely high prescriptions. Afterwards, reading glasses may be required to see up close.
Implantable Contact Lens Surgery (ICL)
In implantable contact lens (ICL) surgery, a small contact lens is gently positioned inside the eye. This surgery is mostly done on patients with high prescriptions. Since there is the risk of developing post-operative glaucoma or cataracts, proper screening must be done prior to surgery.