The advent of Excimer laser in 1988 ushered in a new revolutionary era in vision correction. It provided added lifestyle choices made possible by the freedom from, or dependence on, prescription eyewear. That important technological advance resulted in major treatment modalities not possible before then. The three popular procedures for refractive surgery today are LASIK (Laser Assisted In-Situ Keratomileusis or Laser Vision Correction), PRK (Photorefractive Keratectomy) and Intacs (Corneal Ring Segments) implants.

Excimer laser is a computer-controlled ultraviolet beam of light that reshapes the cornea (outer window of the eye), resulting in the light focusing more directly on the retina at the back of the eye. Excimer laser gives out a cool or non-thermal (not hot) light beam, making it ideal for corneal surgery, eliminating the possibility of thermal burns to the surrounding tissues. Each laser pulse is so accurate it achieves disruption and removal of the molecular tissue bonds between the corneal cells up to 0.25 micons (or 0.00004 of an inch), which improves the vision. Usually, only about 50 microns of tissue (about half the thickness of human hair) are removed to achieve the correct amount of vision correction.

In LASIK, a thin layer of the corneal (outer covering) stroma is fashioned using a microkeratome (cutting) instrument and this tissue is set back in place after the laser procedure is done. LASIK reshapes the corneal tissue underneath the surface of the cornea, while PRK uses laser to remove the epithelium, a thin protective "skin" on top that covers the cornea, before the actual corrective treatment is performed. For Intacs, two tiny incisions and tunnels are made on the outer edges of the cornea and the Intacs (half-moon or C-shaped) ring segment is implanted in each tunnel and a suture is placed.

Intacs are two mini half rings, made of biocompatible plastic that has been safely used for about five decades in cataract operations and in contact lenses. Intacs permanently corrects error of refraction when placed within the outer edges of the eyes as described above.

The corrective surgery decreases or eliminates the dependence on glasses or contact lenses, increases safety while indulging in outdoor or sports activities, provides more convenience, improves vision 24 hours a day, and in some people, it may improve self-esteem, the look, or satisfy vanity.

No, only topical anesthesia is used for these procedures. Eye drops to numb the eyes are instilled prior to the surgery. This is enough to prevent the patient from feeling any pain during the operation.

Error of refraction in the elderly, usually starting from age 40, is called Presbyopia. The three procedures mentioned above will not correct Presbyopia. Those undergoing any of those vision correction surgery will still need reading glasses.

Just like any surgery, these vision correction procedures have possible risks and side effects. Following the surgery around 5 to 25 percent of patients will have some haziness of vision that is aggravated at night. It peaks at 8 to 12 weeks after treatment and in almost all of the cases, this problem resolves with eye drops and the natural healing process. Some patients may notice halos or glare when looking at bright lights or at night. A few of them may feel increased intraoccular pressure, and many will experience some discomfort that is relieved by home pain killers like acetaminophen (Tylenol). Infection is rare but possible. It is best to discuss all the details about the recommended procedure, advantages and disadvantages, timing and sequence of surgery, possible risks and complications with your Ophthalmologist performing the procedure.

Because of the nature of the procedure, these laser-assisted procedures may NOT be done during pregnancy, until three months after delivery and breastfeeding. After the procedure, the patient should wait six months before becoming pregnant.

The statistics from the Department of Ophthalmology and Visual Sciences of the University of Iowa Hospital in Clinics (6th on the top ten list of Best Hospitals in America), according to Assistant Clinical Professor Emily C. Greenlee, M.D., show that their results at UIHC provided 95 percent of eyes treated improved 20/40 vision, the legal driving limits in most states, following the procedure. One half to 2/3 of the patients obtained a 20/20 vision (normal without prescription eyeglasses) after the surgery.

The package fee is about $1,800 per eye for LASIK and PRK, and $2,000 per eye for Intacs. This includes the hospital and physician charges and follow-up visits for one year.

Those age 18 or older, with otherwise healthy eyes, with mild to moderate nearsightedness (-1.00 to -14.0 dopsters), farsightedness (+1.50 to +4.00 diopters) and astigmatism are good candidates for LASIK or PRK. For Intacs, the best patients are those with nearsightedness (-1.00 to -3.00 dopters). These procedures will provide better vision without eyeglasses or contacts, but none of them will give perfect vision. A realistic expectation is very essential with this refractory surgery.