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Ophthalmology: Refractive Surgery

As part of UF Health Ophthalmology at Jacksonville, University of Florida ophthalmologists perform corrective eye surgery on patients with state-of-the-art technologies and equipment. The physicians guide patients through the surgery, helping them to understand the assessment, the procedures and care after surgery.

Services

LASIK, LASEK and Lens Implants

There are numerous factors to consider when deciding if you are a good candidate for refractive surgery. Is your vision correctable within the range of current refractive surgery technology? Is your pupil the right size? What type of astigmatism do you have? Is your cornea thick enough for the procedure? These are among the issues that must be addressed. A screening examination is needed to evaluate the efficacy of refractive surgery for each patient.


Refractive Surgery Evaluation

Refractive surgery has been successfully performed on thousands of patients, but it's not for everyone. There are generally accepted medical criteria that make some patients better candidates than others. Ultimately, the doctor will determine if you are a suitable candidate. Some questions doctors consider:

  • Are you over 18 years of age?
  • Are you farsighted, nearsighted or have astigmatism?
  • Has your prescription for corrective eyewear remained the same for at least two years?
  • Do you have problems with dry eyes?
  • Are you pregnant or nursing?
  • Are you taking steroids or immunosuppressant medication?
  • Do you suffer from autoimmune disorders?
  • Have you had ocular herpes within the last year?
  • Do you have any preexisting eye diseases, such as cataracts, glaucoma, corneal disease or other conditions that threaten your vision?
  • Do you have a thorough understanding about the procedure and realistic expectations about the outcome?

In addition, there is extensive preoperative testing and evaluation that helps determine successful refractive surgery candidacy. Among other things, the doctor will:

  • Take a medical history
  • Determine the magnitude of visual error
  • Screen for external and internal eye disease
  • Map the shape of your cornea
  • Measure your pupil size, the thickness of your cornea, intraocular pressure, etc.

What to Expect

LASIK, or laser in-situ keratomileusis, is the most widely performed laser eye surgery for treating a wide range of common vision errors. LASIK involves cutting a thin flap on the cornea and using the precise, concentrated energy of the excimer laser to reshape the corneal surface so it can better focus the image on the retina.

While the act of reshaping the cornea to improve vision has been around for half a century, LASIK is a relatively new technology (starting roughly in the mid 1990s) that is constantly improving. Similar procedures include epi-LASIK and advanced surface ablation.

LASEK eye surgery, or laser epithelial keratomileusis, is similar to LASIK but without cutting a corneal flap. It is a modified form of the earlier PRK (photo refractive keratotomy).

In addition to LASIK and LASEK, UF Health Ophthalmology at Jacksonville also performs lens implant surgery, typically reserved for patients who also have age-related refractive errors. Also called natural lens replacement, this surgery does not reshape the cornea like LASIK and LASEK. Instead, the procedure involves replacing the natural lens of the eye with an intraocular lens to correct vision.

More about LASIK

Anesthetic eye drops are administered to numb the eye for surgery. Then, a vacuum-like suction ring is applied to hold the eye steady. Using a microkeratome, a thin flap is cut from the surface of the cornea. This is called keratectomy. The flap is lifted to expose underlying tissues.

A concentrated beam of energy called the excimer laser precisely reshapes the cornea based on preprogrammed information.

The surgeon replaces the flap to its original position. Then observes the eye for several minutes to allow proper bonding to occur, eliminating the need for sutures.

Most patients can return to work one to three days after surgery. Active sports, swimming or using saunas should be avoided until the eye is fully healed, which takes approximately three weeks.

More about LASEK

Instead of using a microkeratome tool to cut the cornea, the LASEK surgeon uses a diluted alcohol solution or a fine blade to move tissue in order to expose it to the laser, which precisely reshapes the cornea based on preprogrammed information. After the surgery, a contact lens is placed on the cornea for protection and to aid healing for the next several days.

Most patients can return to work one to three days after surgery. Active sports, swimming or using saunas should be avoided until the eye is fully healed, which takes approximately three weeks.

More about Lens Implant Surgery

The eye is numbed, then the surgeon removes the lens using ultrasound and replaces the lens with an implant. The lens implant is positioned in the same place as the previously removed natural lens.

Most patients can return to work one to three days after surgery. Active sports, swimming or using saunas should be avoided until the eye is fully healed, which takes approximately three weeks.


Frequently Asked Questions

What can be corrected by LASIK, LASEK or lens implants?
LASIK corrects astigmatism, hyperopia (farsightedness), myopia (nearsightedness) and age-related refractive errors (presbyopia). In the great majority of cases, the use or the strength of prescription of glasses and contact lenses are dramatically reduced.

Who is a candidate?
Most of the patients who wear glasses or contact lenses for distance vision are candidates for LASIK. Patients with high degrees of hyperopia (greater than +7.00 D) or myopia (greater than -15.00 D) might benefit from other refractive procedures, such as intraocular lens implantation.

How safe is the treatment?
This surgery is very safe and the results are truly remarkable. Remember, experience and meticulous surgery and care result in an amazing statistical success rate.

What options do I have?
There are many surgical options available to qualifying patients. Understanding the appropriate procedures is an integral part of the process.

Refractive surgery refers to laser vision correction as a whole, which includes LASIK, LASEK and lens implants. The options, including risks and benefits of each approach, will be discussed during the initial evaluation. It is important to have realistic expectations about the outcome of any corrective surgery. After surgery, most patients notice a significant and almost immediate improvement; however, there is no guarantee that corrective eyewear will not be required at least some of the time under certain conditions. Finally, laser vision correction is not for everyone. While technologies are continuously improving, certain factors like corneal thickness, refractive error severity and other issues may exclude certain patients from being appropriate candidates.

I have astigmatism. Is LASIK for me?
Laser correction is possible for patients with astigmatism. This involves reshaping an oval cornea to be more rounded.

What are some guidelines for evaluating a surgeon?
At a minimum, a refractive surgeon should be board certified by the American Board of Ophthalmology and have completed a fellowship in corneal and refractive surgery. The industry is booming and more doctors are becoming certified to perform LASIK, so it's important to keep skill and experience above price when choosing a physician. Patients should also feel a high level of confidence in the physician's ability to explain the process, possible risks and expected outcomes.

What can I expect from the refractive surgery consultation?
At UF Health Ophthalmology at Jacksonville, your consultation includes a series of tests that will determine the appropriate refractive surgery procedure. The consultation is free.

Can I lose my eyesight during LASIK surgery?
As with all surgical procedures, LASIK does have risks, although the likelihood of losing vision is extremely rare. Statistically, less than 1 percent of patients have experienced serious problems, including vision loss. To ease any concerns, it's important to talk to your doctor about potential risks.

Does LASIK surgery hurt?
Prior to the operation, the eye is numbed with a topical anesthetic. Most patients feel a little pressure and report slightly dry eyes after the procedure.

What if I'm nervous before the surgery?
A mild sedative is offered for relaxation.

What if I blink during surgery?
A device is used to keep the eyelid open during the procedure and the eye is held steady by a suction device, so involuntary blinking is not a concern. The equipment has a high-speed laser tracking device that moves with the eye during treatment. The physician has total control over the laser at all times.

How long does the procedure last?
LASIK and LASEK take approximately seven to ten minutes per eye. Lens implant surgery takes about 30 minutes per eye.

When will I see results?
Results are immediate; however, as the eye heals, improvements will be seen over several weeks.

Will I have perfect vision after surgery?
There is never a guarantee for perfect vision after any corrective eye surgery, although most patients see well enough to pass the standard vision test for driving without using corrective lenses. Unless the procedure includes monovision or blended vision correction, the eyes' natural aging process will continue. Beginning at about age 40, patients may have to wear reading glasses or bifocals.

How long does the correction last?
Laser correction is a permanent procedure, but in some cases, a second procedure may be necessary if vision changes over time.

Can I get both eyes done at the same time?
LASIK and LASEK can usually be performed on both eyes during the same visit. Lens implant surgery is performed on one eye at a time.

How much does refractive surgery cost?
The cost varies by treatment. Most insurance companies consider refractive surgery an elective procedure, so it is likely you will be responsible for much of the cost. However, UF Health Ophthalmology at Jacksonville offers flexible financing plans for qualified patients.