Refractive surgery is the term used to describe eye surgery performed for the purpose of correcting refractive errors (nearsightedness, farsightedness and/or astigmatism) and thereby reduce or eliminate the need for prescription eyeglasses.
Refractive surgery also is used to correct near vision problems caused by the normal age-related change in the eye called presbyopia and can reduce the need for bifocals or reading glasses.
Though the purpose of refractive eye surgery is vision correction, not the treatment of eye disease, modern cataract surgery is sometimes considered a type of refractive eye surgery.
A cataract is a clouding of the lens inside the eye that leads to vision loss. In cataract eye surgery, the surgeon first removes the cloudy lens and then implants an intraocular lens (IOL) in its place to restore vision. Eye measurements are taken prior to cataract removal to determine the IOL power necessary to also correct refractive errors.
Premium IOLs called accommodating IOLs (Crystalens) or multifocal IOLs are sometimes used in cataract eye surgery to correct presbyopia as well as nearsightedness or farsightedness.
If the intent of a cataract operation is to reduce a person's dependence on glasses as well as restore his or her vision by removing cataracts, the procedure sometimes is called refractive cataract surgery to differentiate it from standard cataract surgery that is primarily concerned with cataract removal and IOL implantation, with less regard for fully correcting refractive errors to eliminate the need for glasses after surgery.
LASIK is the most popular type of refractive surgery performed today — both in the United States and worldwide.
In the first step of LASIK surgery, a thin flap is created in the clear front surface of the eye (cornea) with a bladed instrument called a microkeratome. This flap also can be created with a femtosecond laser for an all-laser LASIK procedure, which may increase the laser eye surgery cost.
The LASIK flap is then folded back and an excimer laser is used to reshape the underlying corneal tissue to correct vision.
LASIK surgery is very safe, but some LASIK complications can occur. The most common problem is LASIK dry eyes. This usually is temporary but can last for several weeks or even months after surgery.
Typically, LASIK dry eye is treated with lubricating eye drops called artificial tears. In some cases, medicated eye drops also may be used.
If you have presbyopia as well as nearsightedness or farsightedness, your refractive surgeon may recommend monovision LASIK. In this modification of the procedure, one eye is intentionally made mildly nearsighted by the surgery to help you see things up close with less dependence on reading glasses.
Refractive surgery typically isn't covered as a benefit of medical insurance, but some vision insurance plans offer limited coverage or a discount for LASIK and other refractive procedures. Contact the customer service department of your insurance company for details.
The best way to determine if you are a good candidate for refractive surgery is to visit your eye doctor for a comprehensive eye exam. During the exam, your optometrist or ophthalmologist also can discuss the risks and rewards of refractive surgery with you.
If you choose to proceed with LASIK or other refractive surgery, your eye doctor can refer you to a refractive eye surgeon to perform the procedure after further consultation.