Laser Eye Surgery: The Cutting Edge?

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How do these procedures work to correct various vision defects?

To treat nearsightedness, the cornea is made flatter by removing tissue from the center of the cornea. To treat farsightedness, the central cornea is made steeper by using the laser to remove tissue from around the center of the cornea. To treat astigmatism, the cornea must be made more spherical. Tissue is removed in one direction more than the other by changing the pattern of the laser beam.

What is the success rate?

Most PRK facilities report that 65 percent to 70 percent of patients can expect 20-20 vision, with most of the remainder experiencing 20-40 vision (which still allows driving without glasses). Studies show that 70 percent of patients who undergo LASIK will have perfect 20-20 vision; 90 percent will see at least 20-40. For the other 10 percent, improvement is less to none. In each surgery, the outcomes are far more positive for patients who have low amounts of nearsightedness.

How long is the recovery time?

For LASIK, one to two days. For PRK, four to five days.

Which procedure is better?

It depends on the patient. LASIK requires an additional surgical step—the creation of the flap—but recovery is faster, and there is minimal postoperative care because no removal of the corneal surface tissue is necessary. PRK requires no incisions, but it can take up to four months for the epithelium to regenerate itself. During that time, eye medications are used to promote healing and prevent infections.

Doctors say both methods have roughly the same success rates, although patients with thin corneas may not be candidates for LASIK. Friedlaender says he likes both procedures equally, but because LASIK gets so much more hype, his LASIK surgeries outnumber PRKs 10 to 1.

Can anyone have laser eye surgery?

No. There are certain conditions, such as active ocular disease, under which PRK or LASIK is not recommended. These conditions are detected during the preoperative exam, when the corneal map is done.

What does it cost?

Prices range from $750 to $2,000 per eye. The average going rate is $1,500 for PRK and $1,700 for LASIK.

Is laser eye surgery covered by insurance?

Generally, no. “It’s still considered more of a cosmetic procedure,” says Friedlaender, “so people usually pay out of pocket.”

How do these laser eye surgery procedures relate to radial keratotomy (RK)?

RK, a surgical procedure to improve myopia by changing the curve of the cornea over the pupil, is the grandparent of them all. Radial incisions are made in the cornea of the eye, like spokes on a wheel, with a highly precise diamond blade. These incisions allow the sides of the cornea to bulge outward and thereby flatten the central portion of the cornea—thus bringing the focal point of the eye closer to the retina for improved distance vision. Modern RK was developed by a group of Russian ophthalmologists and imported to the United States in 1978.

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