$Refractive Surgery (Vision Correction Surgery)$

Refractive Surgery (Vision Correction Surgery)

If your vision is less than perfect, you may wear glasses or contact lenses to help you see more clearly. But for many people, vision correction (refractive) surgery is an option, too.

If you’ve considered eyesight laser surgery, refractive eye surgery might be able to improve your eyesight and decrease your dependence on glasses or contacts.

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What is Refractive Surgery?

$Refractive Surgery Front Desk$ Refractive surgery adjusts where light focuses in the back of your eye, so it more precisely hits your retina. This surgery sharpens your vision so you can depend less on glasses or contact lenses.

There are many types of refractive surgery. Some involve reshaping the cornea — the clear dome in the front of the eye. Other methods involve implanting a lens (much like a contact lens) in the eye.

Refractive surgery can help improve your vision permanently. But you may still need to wear corrective lenses at certain times. You might need them when driving at night or reading small print (if over the age of 40).

What conditions do you treat? 

Refractive surgery can help correct:

Astigmatism — A condition in which the surface of the cornea has different curvatures (like a football). It causes blurry vision or ghosting.
Hyperopia (farsightedness) — A condition in which the length of the eye is too short for the optical power. Light focuses behind the retina instead of on it. This makes it hard to see things at a distance and up close.
Myopia (nearsightedness) — A condition in which the length of the eye is too long for the optical power. It causes faraway objects to look blurry. It happens when light focuses in front of the retina instead of on it.
Presbyopia — A normal part of the aging process, it happens when the lens hardens and becomes less flexible. It causes nearby objects to appear blurry. Presbyopia is common after age 45 and results in the need for reading glasses.

Who Is Refractive Surgery For?

Mercy Pavilion Equipment Refractive surgery is suitable for people who:

Do not have any eye diseases.
Have a correctable refractive error.
Want to reduce their dependence on glasses or contact lenses.
Understand that they might still need glasses or contacts for optimal vision.
Will accept the risks and potential side effects of the surgery.

Is refractive eye surgery right for me?

Only your eye doctor can tell you if refractive surgery is right for you.

To start, you'll need a baseline eye exam. Be sure to tell your eye doctor about any past and present health issues and any medicines you take.

After this exam, your doctor can suggest the best type of refractive surgery — if any — for your sight issue. They can also explain the pros and cons of each technique.

How do I know if I'm a candidate for refractive surgery?

Vision correction surgery can help many people, but it's not for everyone.

You might be a good candidate for refractive surgery if you want to decrease your dependence on glasses or contacts.

Other factors that might make you a suitable candidate include if you:

Are at least 18 years old.
Are healthy.
Aren't pregnant or nursing.
Don't have a cataract that affects your vision.
Don't have major eye problems (corneal ulcers, diabetic retinopathy, macular degeneration, or glaucoma).
Don't have uncontrolled diabetes.
Have had stable vision for the past year.
Know that any surgery carries risks and can have side effects.
Know what to expect in terms of results. You may still need to wear a thin pair of glasses, such as when you read or drive at night.

Contact the UPMC Vision Institute

To learn more or schedule an appointment, call us at 412-642-5421 or fill out the form below.

What Services and Treatments Do You Offer? 

UPMC Vision Institute offers vision laser treatment for people who want to end their dependence on glasses or contacts to see clearly.

What are the types of laser refractive surgeries?

Your eye doctor can discuss what type of eye surgery is best to correct your vision. They may suggest a form of laser or non-laser surgery.

Laser Eye Surgeries

The types of laser eye surgeries include:

LASIK is not only the most common laser eye surgery, but it is also the world’s most popular elective procedure, with more than 28 million surgeries performed worldwide.

The primary aim of LASIK is to correct refractive errors to improve vision. This surgery can potentially reduce or even eliminate the need for eyeglasses or contact lenses.

LASIK eye surgery changes the way light rays focus on the retina. Doctors use a laser to create a flap in the front of the cornea. They then lift the flap and sculpt the underlying cornea to change its curvature.

It is used to treat conditions such as myopia (nearsightedness), hyperopia (farsightedness), and astigmatism.

When it first gained U.S. Food and Drug Administration (FDA) approval, PRK quickly became the preferred surgical treatment for refractive errors in the eye. It offered more predictable and stable outcomes compared to the prior treatment, incisional keratotomy. However, PRK’s popularity declined as LASIK gained traction.

Although LASIK is the most commonly performed visual refractive surgery, there are still specific situations where PRK may be the better option.

In PRK, doctors use eye drops to numb the eyes and then remove the surface layer of the cornea. This layer grows back after a few days. They use a laser to reshape the front of the cornea to correct mild to moderate nearsightedness, farsightedness, or astigmatism.

Doctors sometimes advise PRK instead of LASIK if you have thin corneas.

SMILE is a newer but highly regarded laser refractive surgery to correct myopia and myopic astigmatism. Also known as refractive lenticule extraction (RLE), the procedure has gained popularity among refractive surgeons for its high patient satisfaction and reduced post-op dry eye.

In a SMILE procedure, the surgeon uses a femtosecond laser to precisely form a tiny disc of tissue — called a lenticule — inside the cornea. Then they make a small incision and remove the lenticule through this opening, reshaping the cornea to improve vision affected by nearsightedness or astigmatism.

Unlike LASIK eye surgery, SMILE doesn’t require a corneal flap. This makes it a bladeless, minimally invasive option that may reduce certain risks.

Non-laser Eye Surgery

Ways to correct vision without using lasers include:

The surgeon will insert a very thin, flexible Collamer lens (like a contact lens) under the iris. The Collamer lens helps focus the light on the retina correctly to treat moderate to high degrees of nearsightedness and astigmatism. Surgeons prefer to use this technique in people with dry eyes and thin corneas.

What is the recovery like after refractive laser surgery?

LASIK has the fastest recovery, with most people able to drive and return to work the next day. Most people see vision improvements immediately or within 24 hours, but complete healing can take months.
PRK has the longest recovery. Vision can take weeks to months to stabilize, and discomfort or blurry vision cab last for a few days to a week, requiring more rest and caution.
SMILE offers a very similar fast recovery to LASIK. Patients typically return to normal activities within a day or two and have clear vision in days to weeks.

Is refractive surgery the same as LASIK?

Refractive surgery refers to a range of surgical procedures designed to correct vision issues. LASIK is a form of refractive surgery. While all LASIK procedures are refractive surgeries, not all refractive surgeries are LASIK.

LASIK uses a laser to address vision issues stemming from refractive errors that occur when the eye does not refract (bend) light correctly. During LASIK, an ophthalmologist uses a laser to reshape the cornea, enhancing the way light is focused on the retina.

What’s the difference between refractive surgery and cataract surgery?

Cataract surgery — Cataract surgery aims to improve vision by removing the person’s cloudy lens and replacing it with an artificial one. The surgeon breaks down the old lens into tiny pieces using an ultrasound technique called phacoemulsification, allowing it to be suctioned out. The cloudy lens is replaced with an artificial lens, which may have magnification to correct vision.
Refractive surgery — Refractive surgery aims to improve vision by correcting refractive errors. Refractive errors occur when the eye is unable to refract (bend) light properly. Refractive surgery corrects vision by changing the shape of the cornea so that light rays are focused on the retina.

Is refractive surgery safe?

Yes, refractive surgery — especially LASIK — is considered very safe. LASIK is one of the most thoroughly studied elective procedures, with more than 20 million surgeries performed in the U.S. and a patient satisfaction rate above 96%.

Sight-threatening complications are extremely rare, occurring in less than 1% of cases. Decades of research, including thousands of FDA trial participants and more than 7,000 peer-reviewed studies, have helped refine patient selection and improve techniques to minimize side effects.

What to Expect Before, During, and After Refractive Surgery

Refractive surgery is an outpatient procedure, so you won't spend the night in the hospital.

Here are some of the things you can expect when you have vision correction surgery.

If you use contact lenses, stop wearing them two to three weeks before your baseline exam and a few days before surgery. Contact lenses can cause a reversible change in the shape of your cornea. That's why it's vital to keep them out.

The day before surgery, you should stop:

Using perfumes.
Wearing eye makeup.

Your doctor will numb your eye, but you'll be awake during the treatment.

Doctors perform LASIK and PRK in the office, while they do ICL surgery in the operating room.

Post-op, as the eyes heal, you may:

Be sensitive to light.
Feel like there's something in your eye, or have burning or itching. It's crucial not to rub your eyes.
Have fluctuating or blurry vision.
See halos or starbursts.

After your laser eye surgery, you'll need to:

Have someone drive you home.
See the eye doctor within 24 to 48 hours post-op. They will give you eye drops to help prevent infection and inflammation.
Wear clear eye shields to protect your eyes for the first day.

It's best to take a few days off work to help your eyes heal.

For at least six months after surgery, you'll have routine visits with your eye doctor. They will check your eyes and test your vision.

Risks and complications of refractive surgery

Like any surgery, refractive eye surgeries have post-operative risks and complications.

According to the National Institutes of Health, 99.5% of eyes surgically corrected with LASIK achieve 20/40 vision or better. While many people experience temporary side effects after the surgery, there is a small number of patients whose side effects are persistent after LASIK.

Side effects of LASIK may include:

Blurry, foggy, or hazy vision.
Decreased low-light vision.
Double vision.
Eye pain or discomfort.
Glare, halos, or starbursts around lights.
Light sensitivity.
Scratchiness, dryness, and other dry eye symptoms.
Small, red, bloody patches on the eye whites.

Side effects after PRK may include:

Corneal ectasia — Rare thinning and bulging of the cornea, less common than with LASIK.
Corneal haze — Opacity that can impair vision; more common with high myopia corrections.
Dry eye — Temporary or persistent dryness due to nerve disruption and inflammation.
Decentration — Misalignment of laser ablation causing glare, halos, and reduced sharpness.
High-order aberrations (HOAs) — Irregularities like coma or spherical aberration that affect visual quality.
Pain or delayed recovery — Short-term discomfort and slower visual recovery compared to LASIK.
Regression — Gradual loss of the intended correction.
Under- or overcorrection — Due to healing variability or biomechanical changes.

Side effects of SMILE may include:

Altered corneal biomechanics — Slight changes in corneal strength and pressure readings (less than LASIK).
Bowman’s membrane microdistortions — Minor structural changes seen on imaging. There is no long-term impact on vision.
Corneal ectasia —Weakening and bulging of the cornea. This is extremely rare with proper screening.
Diffuse lamellar keratitis (DLK) — A rare, noninfectious inflammation in the corneal interface. It is usually mild and treatable with steroids.
Dry eye symptoms — Less common than with LASIK but may occur temporarily due to reduced tear production.
Epithelial ingrowth — Rare migration of surface cells into the corneal interface, usually after incision. Very rare but serious infection risk; requires prompt antibiotic treatment.
Higher-order aberrations (HOAs) — May cause glare, halos, or reduced contrast sensitivity, especially with large pupils or decentered treatment.
Infectious keratitis — Corneal inflammation due to an infection. Often referred to as microbial keratitis, it can lead to vision loss if not treated promptly.
Interface debris or foreign bodies — Tiny particles (such as glove talc or sponge fibers) may get trapped, but they are often harmless.
Pressure-induced stromal keratitis (PISK) — Fluid buildup due to high eye pressure, often mistaken for DLK.
Punctate epithelial erosions — Small surface scratches linked to dry eye; treated with lubricating drops.
Residual refractive error or regression — Slight under- or overcorrection may occur, sometimes requiring retreatment.
Transient light sensitivity syndrome (TLSS) — Light sensitivity without visible inflammation; responds well to steroids.

LASIK — Laser Eye Surgery - American Academy of Ophthalmology
Small Incision Lenticule Extraction - StatPearls - NCBI Bookshelf
A Look at LASIK Past, Present and Future - American Academy of Ophthalmology
Is LASIK Safe? What you need to Know - Refractive Surgery Council
Complications of small incision lenticule extraction - PMC