Refractive Surgery
Refractive surgery is eye surgery performed to improve vision by correcting refractive errors — such as nearsightedness, farsightedness and/or astigmatism. The goal of refractive surgery is to help people see clearly without prescription eyeglasses or contact lenses.
Refractive surgery is sometimes also used to correct presbyopia, which is the normal age-related loss of near vision that happens in middle age, requiring people to wear bifocals or reading glasses.
Unlike other types of eye surgery, refractive surgery is performed on perfectly healthy eyes, and therefore is considered elective surgery, like cosmetic surgery. For this reason, the cost of refractive surgery often is not covered by medical or vision insurance policies.
However, in some cases, cataract surgery can be considered to be a type of refractive surgery. (Cataract surgery cost usually is covered by most medical insurance policies. Contact your plan administrator for details.)
A cataract is when the lens inside the eye (located directly behind the pupil) becomes cloudy, causing vision loss. There are different types of cataracts, but most occur as an age-related change in the eye, affecting people over age 50.
In cataract surgery, the cloudy lens is removed and replaced with a clear intraocular lens (IOL). When the goal of cataract eye surgery is to reduce or eliminate the need for glasses after cataract removal, it is sometimes called refractive cataract surgery.
Typically, a person requires reading glasses after a cataract operation. But the need for reading glasses can be significantly reduced by choosing a Crystalens accommodating IOL or one of several brands of multifocal IOLs. These premium refractive IOLs designed for clear vision at all distances usually increase cataract surgery cost, however.
The most popular type of purely refractive surgery performed today is a laser eye surgery called LASIK (an abbreviation for "laser in situ keratomileusis").
LASIK surgery is a two-step procedure. First, the surgeon creates a very thin, retractable flap in the cornea (the clear front surface of the eye). This flap can be created with a precision cutting tool containing a surgical blade (called a microkeratome) or with a femtosecond laser. Use of a laser to create the flap usually increases the lasik eye surgery cost.
The surgeon then folds the corneal flap back and reshapes the underlying corneal tissue with an excimer laser. After the excimer laser treatment, the flap is returned to its original position, where it heals without requiring stitches to hold it in place.
If you currently wear bifocals and want to reduce your need for reading glasses after LASIK, you might want to consider monovision LASIK. This is when one eye is fully corrected for good distance vision and the other eye is made mildly nearsighted for good near vision. Though monovision LASIK might sound strange, most people who choose it are pleased with the freedom from glasses it usually provides.
LASIK complications are infrequent and usually can be successfully managed. The most common complication is LASIK dry eyes, which might last only a few weeks or can be long-lasting.
LASIK dry eye can cause a burning sensation, a gritty feeling on the surface of the eye, and fluctuating or blurred vision. Most cases can be successfully treated with artificial tears. Sometimes, anti-inflammatory eye drops also are recommended.
In cases of persistent LASIK dry eye, small silicone plugs might be inserted in the tear drainage ducts of your eyelids (a quick and painless in-office procedure) to keep your tears on your eyes longer to relieve dry eye symptoms.
To find out if you are a good candidate for refractive surgery, the first step is to visit your eye doctor for a comprehensive eye exam. If you appear to be a good candidate, your eye doctor will refer you to a refractive surgeon for additional testing and consultation to help you decide if refractive eye surgery is right for you.