Chances are you've seen LASIK performed on ABC's Extreme Makeover^tm, read about it in a magazine, or have a friend who had it done, and now you've decided, "It's my turn." You schedule a consultation, take time off from work, and sit through an entire eye exam just to find out that LASIK isn't for you. Although this can be frustrating, technological advancements have made some type of eye surgery, even if it's not LASIK, available to almost everyone. So what's out there, and what type of surgery can help improve your vision? Dr. Robert K. Maloney, American Academy of Ophthalmology (AAO) spokesperson and Extreme Makeover's^tm LASIK doctor, spoke with LocateADoc.com about eye surgery now and what's coming in the future.

How Vision Problems are Measured

Any type of abnormality in eyesight (nearsightedness, farsightedness, or astigmatism) is called a refractive error. Refractive error is measured in the eye with a unit called a diopter, negative diopters for nearsightedness (-5) and positive for farsightedness (5): the higher the number in diopters, the worse the eyesight. Typically, Dr. Maloney uses LASIK to correct nearsightedness in patients up to -10 or -12 diopters of refraction. While this is well above the average amount of refraction, which is about -5 to -6, refraction can range well in to the -20's.

When LASIK Isn't an Option

Dr. Robert K. Maloney

So what happens if your eyesight ranges above the capabilities of LASIK? An implantable lens called an IOL has recently been FDA approved for refraction up to -20 diopters (about 20/10,000 on vision charts). Currently, IOL procedures to correct farsightedness can only be performed by ophthalmologists like Dr. Maloney, who is participating in FDA clinical trials. In the future, it is expected that IOLs for this purpose will receive FDA approval.

Of course, there are other patients that fall within the range that LASIK can correct, but are still not good candidates. These types of patients include ones with corneas that are too flat or thin. Because LASIK is performed after a flap is cut from the surface of the eye, a thinner cornea means a greater chance for risks, and the blade could cut too deep into the eye. For these types of patients there is LASEK and PRK. Dr. Maloney describes PRK, of which LASEK is a slight variation, as "LASIK on the surface of the eye." Instead of cutting a flap to expose the second layer of the cornea, PRK uses a laser to sculpt the surface of the eye. Though this procedure involves less risk because no flap is cut in the eye, recovery time and post-operative discomfort are longer in duration.

Dr. Maloney, like almost all ophthalmologists, will only perform refractive eye surgery on patients over the age of 18, and you should have no drastic prescription changes in the past year. In addition, certain eye diseases, including keratoconus, protrusion of the cornea, can affect whether or not surgery is an option, and what type is necessary.

LASIK: Increasing Technology, Increasing Popularity

Of course LASIK is still the number one procedure in vision correction, and has seen an increase in procedures performed this year, up about 17-22% from 2003. Technological advancements have made it easier for doctors to customize LASIK to each patient's particular vision problems. In addition to a regular LASIK laser, Dr. Maloney also has a CustomVue^tm Wavefront laser at his Maloney Vision Institute in Los Angeles, CA. "I use it (CustomVue^tm) on everyone that's a candidate for it."

What makes Wavefront LASIK different from traditional LASIK? Wavefront technology sends a wave of light to the retina. The light then bounces back to a sensor, and the data received is translated into a mathematical formula that the doctor uses to program the computer that controls the laser. Because with the Wavefront laser a slightly deeper flap is required, some patients are not eligible for this type of LASIK.

Much to Do About Reading Glasses

LASIK can also be used to treat presbyopia, the eye problem that causes the dependence on reading glasses of people of middle age or older. To treat this problem, Dr. Maloney uses monovision LASIK. This means that one eye is corrected for near-vision, so that patients can focus on objects up close, while the other is used for focusing objects that are farther away.

This is not the only option, however, for the correction of presbyopia. Some patients will instead opt for conductive keratoplasty (CK), which, using the same monovision technique, corrects for near-vision with a pen-shaped probe, heated by radiofrequency energy, instead of a laser. Vision correction as a result of CK usually wears off within 2-5 years, but because it is a minimally invasive procedure, produces less pain, and is essentially risk free, Dr. Maloney says some patients will choose to undergo CK and accept that they will need touch-ups or another procedure in the future.

What to Expect After Vision Correction Surgery

There are many factors that will determine how well your vision will be corrected after surgery, including the type of surgery performed, technology used, skill of the surgeon, and presence of coexisting eye diseases. For the most part, however, patients who require only small amounts of correction can enjoy better vision post operatively. Dr. Maloney uses the analogy of throwing darts at a dartboard: "If you stand two feet away you have a better chance of hitting a bull's-eye than if you are twenty feet away." This does not mean that patients with high levels of refractive error cannot enjoy 20/40 or even 20/20 vision after surgery, but the percentage of people that achieve such vision goes down when the amount of error is higher.

Wrapping Up

Vision correction surgery has seen a tremendous boom in recent years, and new technology has been able to keep up. One concern that has garnered some attention in the press, however, is that heightened attention and TV reality shows are creating unrealistic expectations in patients. About that, Dr. Maloney had this to say: "Patients have always had unrealistic expectations. Part of our job as surgeons is to make those expectations realistic."