Chapter One:
Refractive Surgery: What Is It?

The world of ophthalmology (medical, surgical and optical care of the eyes) is one of the fastest evolving fields of medicine. Never before have so many new surgical and diagnostic techniques and scientific breakthroughs been brought before the public in such a short period of time. A host of new procedures, including LASIK, and Custom Wavefront LASIK as well as implantable corneal rings and lens replacement surgery with Crystalens™ and ReStor® now offers millions of people the opportunity to see without the use of glasses or contact lenses.

The media is filled with amazing stories about laser eye surgery and how it painlessly corrects vision. What is LASIK this marvelous new laser eye procedure? Is this ultramodern laser eye surgery really safe? How do I know if I'm a good LASIK candidate? Who should perform my LASIK eye surgery? This book is designed to help you answer all of these questions.

Refractive Surgery

Refraction: This word as it relates to vision has to do with the ability of your eye to refract (bend) rays of light. In order to see clearly, light that enters the eye must be bent in such a way that it is focused on the retina (the nerve lying on the back surface of the eye). If the light is not bent properly and is focused instead in front of or behind the retina, then we will not see clearly, and what we have is a refractive error. Refractive surgery is any surgical technique or procedure that may safely be used to help the eye bend the light rays properly, focus them on the retina, and restore clear vision.

Refractive Surgical Procedures

The most common refractive surgical procedures performed today are:

• LASIK (Laser In-Situ Keratomileusis)
• Custom Wavefront LASIK
• PRK (Photorefractive Keratectomy)
• Custom PRK
• Corneal Ring Segments (Intacs™)
• AK (Astigmatic Keratotomy)
• CK (Conductive Keratoplasty)
• CLE (Clear Lens Extraction)
• Lens Replacement Surgery with Crystalens™ Accommodating Intraocular Lens
• Lens Replacement Surgery with ReSTOR® Pseudoaccommodative Intraocular Lens
• Lens Replacement Surgery with ReZOOM Multifocal Intraocular Lens
• Verisyse Intraocular Lens for Extreme Myopia
  
• Phakic Intraocular Lens Implants (PIOL)
• Bioptics

New refractive procedures currently under development or refinement include Surgery for Presbyopia:

• Anterior Ciliary Sclerotomy (ACS)
• Scleral Expansion Bands (SEB)

These procedures may be combined to suit your particular needs. For example, if you have extremely high myopia, you might receive a phakic intraocular lens followed later by a refinement with LASIK--a combination commonly called Bioptics.

The names of these procedures may be hard to pronounce, but the results in correcting poor vision due to refractive errors have been excellent. The high rates of success reported with these procedures--and LASIK in particular--have led to their widespread acceptance within the ophthalmologic community throughout the world. Which procedure is right for you depends on multiple variables, all of which will be presented in this book.

The increasing number of refractive procedures developing throughout the world is testimony of the enormous number of people seeking relief from glasses and contact lenses. In some parts of the world, the incidence of nearsightedness is more than fifty percent. In the United States alone, as many as seventy million people are believed to be afflicted with myopia. Estimates by the National Institutes of Health report that in the United States as many as one adult in four suffers from myopia.

While there are many types of refractive surgery, this book focuses primarily on LASIK, which is performed with the excimer laser. This procedure has proved to be highly effective and safe for most ranges of nearsightedness, farsightedness, and astigmatism and is readily accepted by ophthalmologists today.