LASIK and Refractive Surgery

LASIK and Refractive Surgery Procedures

Overview

Overview

Understanding the various LASIK and refractive surgery procedures available is a key step for anyone considering vision correction surgery. This overview provides a summary of different techniques used to correct common vision problems like nearsightedness (myopia), farsightedness (hyperopia), astigmatism, and presbyopia. These procedures aim to reshape the cornea or replace the eye's natural lens to help light focus properly on the retina, reducing or eliminating the need for glasses or contact lenses.

Expert ophthalmologists specializing in vision correction surgery offer a range of options, including laser vision correction procedures, lens implants, and other refractive surgery procedures. The best choice for you depends on your specific vision problem, eye health, age, lifestyle, and goals.

Laser Vision Correction Procedures

Lens Implants

Other Refractive Surgery Procedures

  • Astigmatic Incisions (also known as Corneal Relaxing Incisions or CRI, including Arcuate Incisions and Limbal Relaxing Incisions - LRI)

Laser Vision Correction Procedures

LASIK

LASIK, which stands for Laser-in-Situ Keratomileusis, is a popular laser vision correction surgery procedure for correcting Nearsightedness, Farsightedness, Astigmatism and Presbyopia (often achieved through monovision). LASIK eye surgery is the most common refractive surgical procedure worldwide and over 21,000,000 LASIK procedures have been performed in the United States since it was first approved..

LASIK surgery involves creating a thin corneal flap using either a femtosecond laser (All-Laser LASIK) or a surgical blade (mechanical microkeratome). The flap is then gently folded back, and an excimer laser is used to reshape the underlying corneal tissue. The flap is then repositioned, where it adheres without sutures. LASIK has been approved by the FDA for the correction of myopia, hyperopia, and astigmatism. Monovision LASIK for presbyopia is also a common application.

For more information, please visit our LASIK Surgery discussion page.  

All-Laser LASIK (Bladeless LASIK)

During All-Laser LASIK, also known as Bladeless LASIK, a femtosecond laser is used to create the corneal flap instead of a mechanical blade (microkeratome). This provides surgeons with a high degree of precision and control over the flap's thickness and diameter, potentially making the flap creation step safer and more predictable.

Several FDA-approved femtosecond lasers are used for bladeless flap creation, including those utilizing technology originally introduced by IntraLase™. Bladeless LASIK is considered a refinement of traditional LASIK, emphasizing precision in the initial step of the procedure.

For more information, please visit our "All Laser" (Bladeless) LASIK discussion page.

PRK

PRK, which stands for PhotoRefractive Keratectomy, is a laser vision correction procedure that can correct Nearsightedness, Farsightedness, Astigmatism, and is sometimes used for Presbyopia (via monovision, which is considered an "off-label" use of the laser). PRK was the first laser refractive procedure approved by the FDA in 1996.

The PRK procedure involves carefully removing the surface layer of the cornea (the epithelium) before applying an excimer laser directly to the underlying corneal tissue to reshape it. Because no flap is created, PRK is considered a surface ablation technique. While PRK generally produces visual outcomes comparable to LASIK, patients typically experience more initial discomfort and a slower visual recovery as the corneal epithelium needs to regrow over several days.

For more information, please visit our PRK Surgery discussion page.

Advanced Surface Ablation (ASA) 

Advanced Surface Ablation (ASA) is a refined form of PRK and is also a flapless laser vision correction procedure. ASA techniques aim to improve upon traditional PRK by using advanced methods for removing or managing the corneal epithelium before excimer laser treatment. These methods may include using an alcohol solution (LASEK) or a specialized instrument (Epi-LASIK) to separate the epithelial layer, sometimes preserving it. ASA’s FDA-approved status since 1995 ensures safety, with modern lasers like the WaveLight EX500 enhancing precision.


ASA reshapes the cornea to correct Nearsightedness, Farsightedness, and Astigmatism.   A bandage contact lens is typically placed on the eye after the laser treatment to protect the healing surface. ASA is FDA-approved and considered a safe option.

Best candidates for ASA can be patients with thin corneas, existing dry eyes, or those with high-risk lifestyles where a LASIK flap could be problematic.

Benefits of ASA include eliminating flap-related complications and potentially reducing dry eye risk compared to LASIK. While visual recovery is typically slower than LASIK (taking 1-2 weeks for functional vision) and typically reqruierd , ASA offers comparable long-term outcomes for many patients. It preserves more corneal tissue than LASIK, potentially reducing the risk of post-surgical corneal bulging (ectasia), making it a safer choice for certain corneal anatomies. 

For more information about Advanced Surface Ablation, please visit our ASA discussion page.

If you think you might be a candidate for ASA, we recommend finding an expert surgeon from our Trusted LASIK Surgeons® Directory who can properly evaluate and recommend the best vision correction treatment for you. 

Custom LASIK and PRK

"Custom" LASIK and PRK/ASA procedures utilize advanced diagnostic technology, such as Wavefront technology or Topography-Guided imaging, to create a highly personalized laser treatment plan for each eye. This approach goes beyond correcting only lower-order aberrations (like myopia, hyperopia, and regular astigmatism, which are addressed by glasses prescriptions) to also address higher-order aberrations.

Wavefront technology measures the unique optical imperfections of the entire visual system, creating a "fingerprint" of how light travels through the eye. Topography-Guided imaging creates a detailed map of the corneal surface shape, useful for irregular corneas or prior surgeries.

By using this detailed data, the excimer laser can be programmed to perform a truly customized reshaping of the cornea. This may lead to potentially sharper vision, improved quality of vision (especially at night), and a reduced likelihood of experiencing issues like glare, halos, or starbursts that can sometimes increase with conventional laser treatments.

Custom procedures are used for treating Nearsightedness (Myopia), Farsightedness (Hyperopia), Astigmatism (Blurry Vision), Presbyopia (Monovision).  Different variations exist:

  • Wavefront-Guided LASIK: FDA-approved for LASIK. Uses wavefront data to guide the laser ablation pattern.
  • Wavefront-Optimized LASIK: FDA-approved for LASIK. Prioritizes maintaining the natural corneal shape to reduce induced spherical aberration.
  • Topography-Guided LASIK: FDA-approved for LASIK. Uses detailed corneal surface mapping to guide the laser, particularly helpful for irregular corneas or prior surgery.

Understanding FDA Approval and "Off-Label" Use:

The FDA approves medical devices, like excimer lasers, for specific uses (indications). When a laser technology is FDA-approved for LASIK to correct certain refractive errors, it means clinical trials demonstrated safety and effectiveness for that specific procedure and indication.

Using a laser technology that is only FDA-approved for LASIK to perform PRK or ASA (which are surface ablation procedures) is considered an "off-label" use. This means the use is not explicitly included in the laser's FDA approval. However, "off-label" use in medicine is common and perfectly legal. Surgeons can use their medical judgment and scientific literature to determine if an off-label use is safe and effective for their patient.

  • Some laser systems utilizing Wavefront-Guided or Wavefront-Optimized technologies are also FDA-approved for PRK for certain indications.
  • Topography-Guided technology's FDA approval for refractive procedures has historically been primarily for LASIK, although its use with surface ablation (PRK/ASA) is also performed off-label by experienced surgeons based on clinical evidence.

The choice between these custom technologies and whether to perform them with LASIK or surface ablation (PRK/ASA) depends on a variety of factors, including your prescription complexity, eye health (like corneal thickness and shape), and specific visual needs. Consultation with an expert laser vision correction surgeon is always recommended, as they can properly evaluate your eyes and determine the most appropriate FDA-approved or clinically supported treatment for your individual case.

For more information, please visit our "Custom" LASIK and PRK discussion page.

SMILE Eye Surgery

SMILE Eye Surgery (Small Incision Lenticule Extraction) is an advanced refractive surgery procedure for addressing Nearsightedness (Myopia) and Astigmatism. It is considered a minimally invasive approach.

The SMILE procedure uses a precise femtosecond laser to create a small, lens-shaped piece of tissue (a lenticule) inside the intact cornea. The laser also creates a small incision on the corneal surface. The surgeon then removes the lenticule through this small incision, which alters the cornea's shape to correct the refractive error and improve vision. As a flapless procedure with only a small incision, SMILE offers a different recovery profile and set of potential benefits compared to LASIK.

To learn more, please visit our SMILE Eye Surgery discussion.

EpiLasik

EpiLasik is considered a variation of PRK. In EpiLasik, the corneal epithelium (the outer layer) is removed using a specialized mechanical microkeratome designed to separate this layer in a sheet, rather than scraping it away as in standard PRK. The underlying corneal surface is then treated with an excimer laser to correct the refractive error. The epithelial sheet may sometimes be repositioned, though it often doesn't survive and the epithelium regrows as in PRK.

LASEK

LASEK (Laser-Assisted Sub-Epithelial Keratectomy) is also a form of PRK. In LASEK, an alcohol solution is typically used to loosen the edges of the corneal epithelium. The epithelial layer is then gently moved aside (like a flap) before the excimer laser is applied to the underlying cornea. After the laser treatment, the epithelial layer is repositioned. However, often the loosened epithelium is simply removed, and the procedure proceeds like standard PRK, relying on natural epithelial regrowth. LASEK recovery is similar to PRK.

Lens Implants

Lens Implant procedures involve surgically placing an artificial intraocular lens (IOL) inside the eye to correct vision. These procedures are distinct from laser vision correction, which reshapes the cornea. Lens implants are often used to correct higher refractive errors, treat presbyopia, or in conjunction with cataract surgery.

RLE (Refractive Lens Exchange) or CLE (Clear Lens Exchange)

RLE (Refractive Lens Exchange), also known as CLE (Clear Lens Exchange), is a refractive surgery procedure where the eye's natural, clear lens is removed and replaced with an artificial intraocular lens implant (IOL). Your eye surgeon will calculate the power of the replacement lens implant through special measurements of the length and curvature of the eye, which are then entered into a special computer formula. This is the same technique used in cataract surgery, but RLE/CLE is performed when the natural lens is clear or only minimally cloudy, with the primary goal being to correct refractive errors. 

RLE/CLE is a treatment option for:

By replacing the natural lens with an IOL of a calculated power, RLE/CLE can significantly reduce or eliminate the need for glasses or contacts and also prevents the future development of cataracts in the treated eye.

For FDA-approved lens implants used for RLE/CLE, please below for Toric Implants, Light Adjustable Lens Implants, and cataract lens Implants sections.

For more details on CLE/RLE surgery, please see our cataract surgery discussion CLE/RLE is equivalent  to cataract surgery in most respects.

For more details on lens implants, please see our Lens Implants (IOL) discussion page.

Phakic Implants 

Phakic Implants are intraocular lens implants (IOLs) that are surgically placed inside the eye in front of the eye's natural lens. Unlike RLE/CLE, the natural lens is kept in place. Phakic implants are used to correct moderate to high degrees of Myopia (extreme nearsightedness)  and Astigmatism, often for levels that are too high (usually above -8.00 D to -10.00 D in an eye), which is often not correctable by laser eye surgery. Phakic Implants can also be used in cases with lower amounts of myopia if laser eye surgery is contraindicated because the cornea is too thin or abnormally shaped. to be treated with laser eye surgery (LASIK/PRK) or when laser vision correction surgery is contraindicated due to thin or abnormally shaped corneas.  

EVO-ICL

The EVO Visian Implantable Collamer Lens (EVO ICL) is a modern and increasingly popular type of phakic implant. Approved by the FDA in 2022, the EVO ICL is an artificial lens made from a biocompatible Collamer material that is implanted behind the iris and in front of the natural lens. It is a treatment option for moderate to high Nearsightedness and Astigmatism, particularly favored by individuals typically aged 21-45 who still have good natural focusing ability (accommodation). The EVO ICL procedure is reversible, and it avoids the removal of corneal tissue.

For more information on the EVO ICL, please visit our EVO ICL (Implantable Collamer Lens Surgery discussion page.

Toric Implants

Toric Implants are a type of intraocular lens (IOL) specifically designed to correct Astigmatism along with Nearsightedness or Farsightedness. Toric IOLs have different powers in different meridians of the lens to counteract the uneven curvature of an astigmatic cornea.

These specialized lens implants are available for use in both RLE/CLE procedures and Cataract Surgery. By implanting a Toric IOL, a surgeon can correct both the need for lens replacement (due to refractive error or cataract) and the patient's pre-existing astigmatism simultaneously, potentially reducing or eliminating the need for glasses to correct astigmatism after surgery.

Toric Implants have the astigmatism correction incorporated in the power of the implant and they are available for some eyes undergoing RLE/CLE as well as for cataract surgery.  FDA-approved Toric Lens Implants include:

For a list of FDA-approved Toric Lens Implants, please or consult with a highly qualified cataract and IOL expert surgeon.

Light Adjustable Lens (LALs) Implants

The Light Adjustable Lens (LAL), developed by RxSight, is a unique type of intraocular lens (IOL) used in Cataract Surgery and Clear Lens Exchange (CLE) / Refractive Lens Exchange (RLE). What sets the Light Adjustable Lens apart is its ability to have its power adjusted after it has been implanted in the eye.

Following surgery, once the eye has healed, the surgeon can use a special light delivery device in the office to apply a specific pattern of UV light to the LAL. This light causes photopolymerization within the lens, precisely changing its shape and thereby adjusting its power. Multiple light treatments can be performed to fine-tune the vision for distance, intermediate, and near needs, based on the patient's feedback and visual goals. This post-operative adjustability offers an unprecedented degree of precision in achieving the desired visual outcome. Light Adjustable Lenses are often recommended for patients seeking the most personalized and accurate post-operative vision correction possible.

To learn more, please visit our [Light Adjustable Lenses discussion page](LINK TO LAL DISCUSSION PAGE) and our [Intraocular Lens Implants (IOL) discussion](LINK TO IOL DISCUSSION PAGE).

Light Adjustable Lens (LAL): A unique type of intraocular lens (IOL) used in cataract surgery and CLE or clear lens exchange (also sometimes referred to as Refractive Lens Exchange or RLE). What sets the Light Adjustable Lens apart is its ability to have its power adjusted after it has been implanted in the eye. Using a special light device in the surgeon's office, the lens can be customized to fine-tune your vision for distance, intermediate, and near vision needs weeks after surgery. This adjustability offers a high degree of precision in achieving your desired visual outcome. Light Adjustable Lenses are often recommended for patients seeking the most personalized post-operative vision correction possible. To learn more please visit our Light Adjustable Lenses and Intraocular Lens Implants (IOL) discussions.

Cataract Lens Implants

Refractive Surgery Treatment for:

Cataract Surgery is performed under local anesthesia on an out-patient basis. The surgery is accomplished in 15 to 30 minutes, utilizing a very small incision, usually without sutures. The cataract is broken up (emulsified) with an ultrasonic vibrating needle and the liquefied cataract is aspirated through this same needle. The cataractous lens is then replaced with a lens implant designed to replace the natural lens. This new lens can usually reduce or eliminate the previous need for glasses in near sighted or farsighted patients so they may no longer require glasses for distance. Lens implants can also create a monovision situation similar to the monovision form LASIK or PRK. 

Cataract Lens Implants are the artificial intraocular lenses (IOLs) that are implanted during Cataract Surgery to replace the eye's natural lens, which has become cloudy (a cataract). Cataract surgery is a common outpatient procedure performed under local anesthesia. The clouded natural lens is removed, typically using ultrasonic phacoemulsification through a small incision, and replaced with a clear IOL.

While the primary purpose of cataract surgery is to restore clarity by removing the cloudy lens, the implanted IOL also provides refractive power. Standard monofocal IOLs typically restore clear vision at a single distance (usually far). However, the same types of advanced and premium IOLs used in RLE/CLE (such as Toric, Multifocal, Trifocal, EDOF, and Light Adjustable Lenses) can also be used in cataract surgery to correct pre-existing astigmatism or provide a range of vision, reducing the need for glasses after surgery.

IOLs used in cataract surgery are the same types of IOLs that can be used for RLE/CLE lens implant procedures.

Below are some of the IOLs used in cataract surgery which also also used in RLE/CLE lens implant procedures, please: 

Please also see the section above regarding Toric Lenses which can also be used for cataract surgery to correct astigmatism.  As noted above all IOLs that can be used for cataract surgery can also be used for RLE/CLE).  For more information, please visit our Cataract Surgery and Lens Implant (IOL) discussion pages.

Other Refractive Surgery Procedures

Astigmatic Incisions

Astigmatic Incisions, also known as Corneal Relaxing Incisions (CRIs) or Astigmatic Keratotomy (AK), are surgical techniques used to correct (not surprisingly) Astigmatism by making precise incisions in the cornea. These incisions alter the shape of the cornea, making it more spherical and thereby reducing the blurriness caused by astigmatism.

The two main types of Astigmatic Incisions are Arcuate Incisions and Limbal Relaxing Incisions (LRIs). Arcuate Incisions are typically placed closer to the center of the cornea, while LRIs are made near the limbus (the edge between the cornea and the white of the eye). These incisions can be created manually using a diamond blade or with greater precision using a femtosecond laser.

Astigmatic Incisions can be performed as a standalone procedure or, very commonly, in conjunction with Cataract Surgery or a Lens Implant (IOL) procedure (like RLE/CLE) to address astigmatism at the same time. They are a safe and reliable option for correcting mild to moderate astigmatism, particularly when other options like toric implants or laser astigmatism correction may not be suitable or affordable.

For more information, please visit our Astigmatic Incisions and Limbal Relaxing Incisions discussion page.

Why Choose Surgeons Featured in the Trusted LASIK Surgeons® and Trusted Cataract Surgeons® Directories?

Finding a highly qualified and experienced eye surgeon is the most critical step in your vision correction journey. Our Trusted LASIK Surgeons® Directory and Trusted Cataract Surgeons® Directory feature surgeons who have undergone a rigorous screening process based on objective measures of their extensive experience, professional accomplishments, and recognition by their peers.

Our directories were founded on the principle of connecting patients with truly expert eye surgeons who prioritize patient care and outcomes above all else. By choosing a surgeon from our directories, you are selecting a professional who has demonstrated a commitment to excellence in the field of vision correction and has undergone a rigorous screening process.

Surgeons listed in our directories are more likely to have proven expertise in performing a range of vision correction procedures, including various laser vision correction procedures, lens implant options, and other refractive surgery techniques mentioned on this page. Their broad experience helps them to:

  1. Accurately and comprehensively evaluate your eyes and vision problems.
  2. Discuss all suitable vision correction options for your specific needs, whether it's LASIK, PRK, SMILE, RLE/CLE, Phakic Implants, Cataract Surgery, Astigmatic Incisions, or the use of specific technologies and premium lenses like Custom treatments, Light Adjustable Lenses, or Laser-Assisted Cataract Surgery.
  3. Perform the recommended procedure with a high level of skill and precision.

We believe that choosing an expert surgeon with proven expertise is paramount. Our directories are designed to help you find surgeons who are not simply specialists in one area but are accomplished vision correction experts.

Looking for a True Expert Surgeon?

To find a vision correction expert surgeon who has qualified to be listed in our Trusted LASIK Surgeons® Directory or our Trusted Cataract Surgeons® Directory nearest to you, please ciick on the links below.  Most of the LASIk surgeons in our directory offer other procedures beyond LASIK and most of the cataract surgeons will offer IOLs, including EVO-ICLs).

Find a Trusted LASIK Surgeons®

Find a Trusted Cataract Surgeons®  (most cataract surgeons will typically also offer lens implant procedures like EVO-ICLs). 

Important Note: While surgeons listed in our directories are highly qualified in various vision correction procedures, not all surgeons listed perform every specific procedure discussed on this page, such as Laser Assisted Cataract Surgery, Astigmatic Incisions nor will every surgeon found here offer LALs or EVO-ICLs. If you are interested a particular procedure, use of a specific technology technology or option,  or certain premium lenes, please contact the surgeon's office directly to ensure they what you are looking for.

To learn more about the screening process and standards we use to screen and qualify surgeons please visit:

How Are LASIK and Cataract Surgeons Qualified at Trusted LASIK Surgeons®?

Trusted Vision Surgeons, including vetted Trusted LASIK Surgeons® and Trusted Cataract Surgeons®

Trusted Vision SurgeonsTM is an online business that provides LASIK and Cataract Surgeon directories and consumer resources concerning eyesight and vision correction as well as a Consumer Checklist for the True Cost of LASIK.

Please Contact Us or call for more information.

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