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.

Refractive eye surgery can improve your eyesight and decrease your dependence on glasses or contacts.

What Is Refractive Surgery?

Refractive surgery adjusts where light focuses in the back of your eye so it more precisely hits your retina. This technique 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 Eye Conditions Can Refractive Surgery Help Correct?

It can help correct:

Astigmatism. A condition in which the surface of the cornea has different curvatures (similar to a football). It causes blurry vision or ghosting.
Farsightedness. A condition when 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.
Nearsightedness. A condition when the length of the eye is too long for the optical power. It causes far-away 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 near objects to appear blurry. Presbyopia is common after age 45 and results in the need for reading glasses.

What Are the Types of Refractive Surgery?

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.

The types of laser eye surgery include:

LASIK (laser in situ keratomileusis). The most common laser eye surgery, LASIK 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. They use LASIK to correct near- or farsightedness and astigmatism.
PRK (photorefractive keratectomy). The doctor uses eye drops to numb your eyes and then removes 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.

Ways to correct vision without using lasers include:

Implantable Collamer® lens (ICL) surgery. The surgeon will insert a very thin and flexible collamer lens (like a contact lens) under the iris. This 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.

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 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 every person.

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

Other factors include if you:

Are at least 18 years old.
Aren't pregnant or nursing.
Are healthy.
Have had stable vision for the past year.
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.
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.
Know that any surgery carries risks and can have side effects.

What to Expect Before, During, and After Refractive Surgery

Refractive surgery is an outpatient technique, 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 2-3 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:

Wearing eye makeup.
Using perfumes.

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:

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.
Be sensitive to light.

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

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

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

For at least 6 months after surgery, you'll have routine visits with your eye doctor. They will check your eyes and test your vision.

Contact the UPMC Vision Institute

Questions about refractive eye surgery?

Call us at 412-642-5421 or 412-642-5422.