A Brief Overview of Modern Refractive Surgery
If you're considering LASIK surgery, you'll find that Davidson Eye Associates offers the latest LASIK technology, personalized attention from the surgeon performing the procedure, and an affordable, competitive cost.
Our LASIK surgeon, Thomas Hawkins, MD, FAAO, is directly involved with each step of the LASIK treatment, from the initial exam, to the procedure and the last post-op visit. Having a surgeon so intimately involved is not always the case at other practices that offer LASIK.
It all begins with a thorough eye exam to determine if you are a good candidate for the LASIK procedure. This is crucial to avoiding potential problems. The exam may also reveal that you are better suited for a different vision correction procedure, such as PRK.
It's true that you can get advanced vision care right here in Davidson County. We offer the latest technology such as Custom LASIK and Wavefront-Guided LASIK so the procedure is tailored specifically to each individual patient's optic system.
To schedule your appointment and see if you are a candidate for LASIK, call 336-243-2436.
The rapidly changing field of refractive (corrective) surgery for nearsightedness, farsightedness, and astigmatism has revolutionized eye care, enabling us correct vision in ways that were unthinkable just 20-30 years ago. The purpose of this educational center on refractive surgery is to give you a basic understanding of what is available and the pro's and con's of each procedure. This is not intended to be a comprehensive review of refractive surgery and all the inherent risks, nor is it intended in any way to offer advice as to which procedure is best or whether or not to have surgery. There can be no better substitute for one on one discussion with your ophthalmologist regarding your particular circumstances. Remember, refractive surgery is only one out of three options for correction of your vision (the other two being glasses and contact lenses). Also there may be other factors about your eyes that would make a surgical procedure for you less than ideal such as severe allergies, chronic infections, corneal disease such as keratoconus, uncontrolled diabetes, dry eye problems and other factors that may be determined by your ophthalmologist. REFRACTIVE SURGERY SHOULD NOT BE DONE IF YOUR NEARSIGHTEDNESS OR ASTIGMATISM IS STILL CHANGING OR IF YOU ARE UNDER THE AGE OF 18.
Refractive surgery has been most successful with nearsighted and astigmatic disorders. Surgical correction for farsightedness is still evolving but rapidly improving. Nearsightedness is when the focal point of light focuses IN FRONT of the retina, whereas in farsightedness, the focal point is BEHIND the retina (you must therefore "focus" your eye in order to see clearly). Both deal with ONLY ONE abnormal focal point. Astigmatism, however, mostly deals with an abnormal corneal shape causing TWO abnormal focal points. Certain types of astigmatism (astigmatism with many irregular focal points) cannot be corrected surgically at this time. IT IS IMPORTANT TO REMEMBER THAT THE GOAL OF REFRACTIVE SURGERY IS NOT PERFECT VISION, but rather the creation of independence from the use of glasses or contacts. Even in the most "successful" surgeries, there often is some residual error left resulting in a need to use corrective lenses on a part time basis. For those persons over 40 years of age and who wear bifocals, some form of glasses wear for reading will usually continue. Technology is rapidly evolving, and surely there will be more added to the alphabet soup. Below is a discussion of current technology and some new procedures being developed. For more information, click on Links for other related sites, or e-mail Dr. Slyman at or Dr. Hawkins at
|LASIK Brochure (This brochure, published by VISX, contains vital information. All surgical candidates must read this brochure prior to surgery.)||LASIK Pre/Post Operative Instructions (These can be printed out for your convenience.)||LASIK Consent Form (All surgical candidates must print out this form and bring to the office for review and signature prior to surgery.)|
During the past several years, LASIK has rapidly become the most popular method of refractive surgery. Basically, the procedure involves surgically removing the top layer of the cornea (flap), reshaping the bed of the cornea to a flatter or steeper contour (depending upon correction for near or farsightedness) using a laser beam, and replacing the flap. Much higher amounts of nearsightedness and astigmatism can be corrected than most other methods of refractive surgery, and there is good potential for the correction of farsightedness as well. In uncomplicated situations with skillful technique, corneal haze and pain experienced with PRK (see below) are generally not an issue with relatively rapid visual rehabilitation as seen with RK. Also, LASIK doesn't cause as much structural weakening issues with the cornea as were encountered with the older RK procedure.
CREATION OF THE FLAP LASERING THE BED FLAP REPLACED
Creation of the flap
Lasering the bed
RISKS: Generally include possibilities of under or overcorrection, reduced or loss of vision due to mechanical problems with the corneal cap, corneal warpage, corneal perforation, infection, night glare, halos, and reduced contrast sensitivity. (For complete details of risks, please click here.)
- Correction of high amounts of nearsightedness possible with a high level of success.
- Low risk procedure.
- Relatively rapid visual rehabilitation in uncomplicated cases.
- Both eyes can be done in a relatively short period of time as possible with RK.
- Relatively less pain than PRK and possibly less on average than RK.
- Visual fluctuation with atmospheric changes not a factor as with RK.
- Increased risk of ocular perforation with ocular injury probably not a factor as theoretically possible with RK.
- Instrumentation still evolving.
- Small risk for overall visual loss.
- Loss of some contrast sensitivity with blurred vision at dusk or at night, especially in older adults.
- Candidacy for LASIK may be limited by refractive error, corneal shape corneal thickness.
Questions? Please feel free to call or contact our doctors by e-mail.
For further information, please click here for other web sites on refractive surgery and other topics.
|PRK Consent Form|
PRK is purely a laser procedure that uses a powerful excimer beam of ultraviolet light to flatten the central part of the cornea. The laser beam actually removes small amounts of tissue from the front of the cornea to accomplish this. The beam does not penetrate any deeper into the eye than the top layer of the cornea. PRK can generally correct from large amounts of nearsightedness and astigmatism. The more correction needed, the more corneal tissue will be necessary to remove. Like any refractive procedure, PRK should not be done until your nearsightedness and astigmatism stabilizes.
|In this procedure, the top skin of the cornea called the epithelium is removed. The laser is then used to "chisel" away the right amount of tissue much the same way with LASIK resulting in a new corneal curve with the desired effect. Healing of the corneal surface then takes place, generally over a longer period of time relative to LASIK.|
RISKS: Include mild to moderate discomfort (up to 3 - 4 days after surgery), blurred vision due to corneal haze (usually temporary, rarely leads to permanent corneal scarring with loss of vision), difficulty with night vision, increased sensitivity to bright light (all of which are usually temporary, but may occasionally be prolonged over 1 - 6 months and uncommonly longer). Like any refractive procedure, undercorrections and overcorrections may occur. Permanent visual loss is a possibility.
- Unlike RK or LASIK, does not require corneal incisions. Also, it is not considered a weakening procedure such as with RK.
- Not associated with flap complications that can be seen occasionally with LASIK
- May be better alternative to LASIK for persons with thin corneas, and for those with "small eyes (tight orbits and narrow interpalpebral fissures).
- May be better alternative to LASIK for persons with certains types of corneal problems such as corneal scars, surface irregularities and erosions, and the like.
- Generally will correct more nearsightedness and astigmatism than RK
- Expensive technology relative to RK.
- Pain generally more a factor for 3-4 days than with LASIK, which is generally pain free.
- Longer healing time for the cornea with blurred vision, reduced night vision, and sensitivity to light that commonly lasts for several weeks and not uncommonly longer.
Questions? Please feel free to call or contact our doctors by e-mail.
For more information, please click here for other webs sites on refractive surgery and other information.
Developed and practiced in Italy, this combines aspects of the LASIK and PRK procedures. This technique has recently received some attention. The initial flap made here is much thinner than seen with LASIK and involves only the upper most layer of the cornea called the epithelium. The laser part is carried out in much the same way, and the flap is then repositioned. While technically more challenging to do, it seems to eliminate some of the potential flap complications of LASIK. It also reduces some of the main drawbacks of PRK, such as postoperative pain, regression, haze, and slow recovery. We’ll keep you posted for any new developments here.
RK is a procedure that was very popular throughout the 80’s and until the mid-90’s for the correction of nearsightedness. This is rarely done anymore in the United States because of advances in LASIK and PRK laser technology. In this procedure, deep incisions were made around the center of the cornea causing the corneal curve to flatten. This in turn causes the focal point to move backwards to be focused on the retina. The number and length of the incisions determines HOW MUCH correction is achieved. Generally, older persons require less surgery to achieve the same level of correction required of a younger patient because older corneas are "softer" and flatten more easily than younger "stiffer" corneas.
|Four incisions into the cornea||
The incisions allow the cornea to flatten thereby neutralizing near-Sightedness.
AK is a procedure to correct astigmatism by placing curved incisions midway between the pupil and the sclera (white part of the eye). It was often done in conjunction with RK and is now used by some cataract surgeons to eliminate or reduce postoperative astigmatism.
RK may be used to correct errors from 1.0 diopters to 5.0 diopters of error depending upon age. Because incisions into the cornea weaken the structure of the cornea, RK generally should not be done in persons whose activities involve a high level of risk for eye injuries. Some activities and professions where this may apply include contact sports, law inforcement, fire fighters, and such. Also, during activities involving atmospheric pressure changes (high altitude skiing, piloting, deep sea diving), the vision can transiently blur. Generally, RK should not be done on persons less that 20 - 21 years of age
RISKS: Include night glare, sunburst effect to lights, fluctuation of vision although these are usually temporary. Undercorrections that may require additional surgery are not uncommon. More serious but uncommon complications include disabiling corneal warpage, serious infection that could result in loss of vision, and permenant overcorrection that would require full time correction and/or bifocals. If your visual result is less than ideal requiring corrective lenses, contact lenses may not be possible after RK even if you were a contact lens wearer prior to your surgery. Be sure to talk with your ophthalmologist about other risks that may pertain to your situation.
- High level of success with proper candidate.
- Both eyes done generally within a short period of time (average several days to 1 week).
- Least expensive of other refractive procedures.
- Rapid visual rehabilitation.
- Usually only minor discomfort for first 24 hours following surgery.
- Amount of correction possible for nearsightedness is limited.
- Structurally weakens the cornea, theoretically increasing the risk of perforation with a blunt injury.
- Risks inherent as discussed above.
- May not be procedure of choice given job activities, types of hobbies, etc., as discussed above.
- Other refractive procedures being developed that may be a better choice given your circumstances.
Implanting a permenant lens in the eye for the correction of nearsightedness or farsightedness. Instead of a contact lens floating upon the cornea, specially designed lenses made of various materials are placed INSIDE the eye and can either lie in the space between the cornea and pupil, on top of the iris/pupil itself, or behind the pupil. This technology holds a lot of promise as surgical techniques and materials improve.