LASIK is widely recognized as the standard procedure for correcting refractive errors, offering millions a rapid return to clear vision. However, this surgery, which involves creating a thin flap in the cornea before reshaping the underlying tissue, is not universally suitable for every patient. Individuals with insufficient corneal thickness, high prescriptions, or certain pre-existing conditions may be excluded. Several distinct and effective alternatives exist to achieve lasting freedom from glasses or contact lenses.
Surface Ablation Techniques (PRK and LASEK)
Photorefractive Keratectomy (PRK) and Laser-Assisted Subepithelial Keratomileusis (LASEK) are surface ablation methods. They reshape the corneal tissue without creating a permanent flap. These procedures are preferred for those with thin corneas, as they conserve more tissue, and for patients in high-impact professions where the risk of a LASIK flap becoming dislodged is a concern.
In PRK, the surgeon completely removes the cornea’s outermost layer, the epithelium, to access the underlying tissue for laser treatment. The excimer laser then precisely reshapes the corneal surface to correct the refractive error. A protective bandage contact lens is placed on the eye while the epithelial layer naturally regenerates over several days.
The LASEK technique is a modification designed to reduce post-operative discomfort. This procedure involves softening the epithelial layer with a diluted alcohol solution before it is gently pushed to the side. After the laser reshapes the cornea, the epithelial layer is repositioned onto the eye’s surface, where it acts as a natural protective barrier.
While both PRK and LASEK achieve final visual outcomes comparable to LASIK, the initial recovery period is significantly longer. Patients typically experience blurred vision and discomfort for the first few days while the epithelium heals. Visual acuity gradually improves, stabilizing over several weeks, which is a slower process than the rapid recovery seen with LASIK.
Small Incision Lenticule Extraction (SMILE)
Small Incision Lenticule Extraction (SMILE) represents a different generation of laser vision correction. The technique uses a femtosecond laser to perform all steps of the surgery beneath the corneal surface, avoiding the creation of a large, hinged flap that characterizes traditional LASIK surgery.
The laser first creates a small, disc-shaped piece of tissue, known as a lenticule, precisely within the corneal stroma. It then creates a small keyhole incision, typically two to four millimeters long, on the corneal surface. The surgeon then extracts the lenticule through this tiny opening, which changes the cornea’s shape and corrects the patient’s vision.
The minimal nature of the incision is a benefit in terms of post-operative comfort and corneal stability. Because the incision is small and the flap is absent, the procedure disrupts fewer delicate corneal nerves. This preservation is why SMILE patients often report a lower incidence of post-operative dry eye symptoms compared to those who undergo LASIK.
Implantable Refractive Lenses
For patients whose prescriptions are too high for safe laser correction, or who have specific corneal issues, lens-based surgery offers a powerful alternative. This approach completely bypasses corneal tissue modification by placing a corrective lens inside the eye to alter how light is focused on the retina. These methods provide a solution for a wider range of refractive errors than is possible with laser ablation.
Implantable Collamer Lenses (ICLs)
Implantable Collamer Lenses (ICLs), also known as phakic intraocular lenses, are designed for younger patients, typically under the age of 45. The ICL is a biocompatible lens surgically inserted through a small incision. It is positioned between the iris and the eye’s natural lens. Because the natural lens is left in place, the eye’s ability to focus at various distances is preserved, which is a significant advantage for younger individuals.
Refractive Lens Exchange (RLE)
Refractive Lens Exchange (RLE), also called Clear Lens Extraction (CLE), involves removing the eye’s natural crystalline lens and replacing it with an artificial intraocular lens (IOL). This is the same surgical procedure used to treat cataracts, but in RLE, the natural lens is removed while it is still clear. RLE is generally reserved for patients over 45 who may be experiencing age-related near vision loss, known as presbyopia.
The replacement IOL can be selected to correct for distance, near, or both. This procedure offers the benefit of permanent vision correction while also eliminating the possibility of developing cataracts in the future. Both ICL and RLE offer a highly predictable and long-lasting solution, particularly for individuals with extreme nearsightedness or farsightedness outside the treatable range of laser surgery.
Non-Surgical Corneal Reshaping (Ortho-K)
Orthokeratology (Ortho-K) provides a non-surgical, reversible method of vision correction. It involves wearing specialized contact lenses overnight. These lenses are made of a rigid, gas-permeable material that is custom-designed based on a topographical map of the patient’s cornea.
Unlike standard contacts, these lenses work to gently reshape the corneal surface during sleep rather than correcting vision while worn. The lenses create hydraulic forces within the tear film beneath them, subtly flattening the center of the cornea. This temporary change corrects the refractive error, allowing the patient to see clearly without glasses or contacts throughout the day.
The effect is not permanent, and the lenses must be worn nightly to maintain the corrected vision. Ortho-K is an attractive option, especially for children who are not yet candidates for surgical correction, or for adults who prefer a non-invasive treatment.