Refractive therapy

An optometrist provides referrals to secondary specialists, such as ophthalmologists, to treat diseases starting in other organs that affects the eye (systemic diseases) or eye surgery when necessary. Optometrists also co-manage the treatment of ocular diseases and pre- and post-surgical patient care with ophthalmologists.

There are several surgical options available when considering refractive eye surgery to reduce your dependence on glasses or contact lenses. An optometrist can offer an informed opinion regarding your candidacy for any of the refractive surgery options available. Following refractive surgery, your optometrist can help manage the use of antibiotics, steroids and artificial teardrops required to help the healing process.

Photo-Refractive Keratectomy (PRK)

With Photo-Refractive Keratectomy (PRK), the outer layer of the cornea (the epithelium) is gently removed. A laser is used to reshape the cornea, which is the clear covering of the eye. The epithelium regrows over the treated area within approximately 3-5 days. 

PRK achieves excellent results, especially for patients who may have a thinner than average cornea. Following healing, the cornea stays clear and visual acuity is usually very good. 

There are some  drawbacks to PRK. This includes, some eye pain or irritation for the first few days after surgery while the epithelium heals, and the prescription may take up to three months to stabilize.

Laser In-Situ Keratomileusis (LASIK)

Laser In-Situ Keratomileusis (LASIK) is a common type of refractive eye surgery. With LASIK, patients experience faster vision recovery and minimal eye discomfort from the procedure. A tiny swinging blade known as a microkeratome is used to create a thin flap of corneal tissue. The flap is folded back and the laser is applied to the exposed inner corneal tissue. The flap is then repositioned, where it bonds tightly without the need for stitches. Rarely, there have been instances where the flap has come dislodged, such as while playing sports.

Intralase SBK

Instead of using a blade to create the flap, a femtosecond laser can be used. Commercially known as Intralase SBK, this procedure creates a thinner, more uniform flap with potentially fewer complications than the microkeratome. 

The laser is then applied to the exposed inner corneal tissue. Then flap is repositioned, where it bonds tightly without the need for stitches. This type of flap can lead to better visual recovery and is more stable.

PRK, LASIK and SBK are very quick and accurate surgeries. However, they may, in limited instances, produce visual issues. Such as, glare or haloes under dim lighting and dry eye syndrome.

Customized wavefront guided lasers (PRK, LASIK and SBK) is an advancement in the standard laser treatment and provides a more personalized treatment to each patient. Advantages of the wavefront treatment include improving the quality of vision after surgery and decreasing glare or haloes around lights. Wavefront guided laser eye surgery is being used quite heavily because of its inherent benefits.

Clear Lens Extraction (CLE)

Clear lens extraction (CLE) does not involve a laser and is actually the same procedure as cataract surgery. Instead of waiting for a cataract to form, the normally clear lens of the eye is removed and replaced with an artificial lens. The artificial lens provides proper focusing power to improve distance vision. CLE is more invasive than the above surgeries and is generally reserved for patients with extremely high prescriptions. Afterwards, reading glasses may be required to see up close.

Implantable Contact Lens Surgery (ICL)

This is when a small contact lens is gently positioned inside the eye. This surgery is mostly done on patients with high prescriptions. Since there is the risk of developing post-operative glaucoma or cataracts, proper screening must be done prior to surgery.