Dr. Dean Dornic: Hi, I am Dr. Dean Dornic of the Laser Eye Center of Carolina. We are talking about ways to reduce your dependence on eye glasses and contact lenses. So what if you are not a good candidate for LASIK?

Well, there are some alternatives to the LASIK procedure for you and we will talk about that now. Most individuals don't realize this, but there are actually 11 different surgical procedures to correct nearsightedness, farsightedness and astigmatism. We tend to think about LASIK because it is the most common procedure performed today and for most individuals, it has the highest chance of success, but there are other procedures that are out there including PRK, LASEK, Epi-LASIK, CK, PRK and Refractive Lens Exchange. Refractive Lens Exchange refers to the removal of a person's natural lens in the eye, that same lens that we talked about that becomes stiff and doesn't want to focus up-close can actually be removed and replaced with an artificial lens and implant. This is the exact same procedure that's performed when we do a cataract surgery. In cataract surgery, we remove the patient's natural lens because the lens has become cloudy. In refractive Lens Exchange, we are doing it because we want to insert a lens that has a different power into the eye to correct refractive error. Another procedure that can be used to reduce your dependence on eye glasses or contact lenses is using a contact lens to reshape the cornea or Orthokeratology.

What's commonly done here is the cornea is purposely misfit with a hard contact lens and we find that it will reshape to the shape of that rigid contact lens. Orthokeratology is really a temporary solution to the need for eye glasses or contact lenses because after a period of time, the cornea will return back to its original shape. So most patients who correct their vision with Orthokeratology have to sleep with a retainer lens in at night. LASEK is often confused with LASIK. LASEK is L-A-S-E-K. It is the use of a solution to create an epithelial flap on the surface of the cornea instead of cutting it with a laser or a microkerotome.

LASEK has a similar recovery period to PRK and in that, patients are uncomfortable and have blurry vision for four or five days after the procedure rather than the four or five hours that we see after a LASIK procedure. PRK is actually the original procedure that the Excimer Laser was used for to correct refractive error and in PRK, the laser is applied to the surface of the cornea. There are still a few occupations in which LASIK is not allowed or for which a patient may not be a good candidate for LASIK in which we do still perform the PRK procedure. Patients who want to undergo PRK have to be prepared to go through a four or five day recovery period. That is they have to have an individual who can drive for them . Of course, they probably wouldn't be able to carry on their daily work activities during that recovery period. CK or Conductive Keratoplasty is using a radio frequency probe to reshape the cornea. The most common indication for CK is the over 40 crowd, the Presbyops that we talked about earlier whose arms aren't long enough anymore to be able to read. The CK procedure is done by creating a series of usually 8-16 spots on the cornea to reshape the cornea to make that individual less farsighted or a little bit nearsighted. One of the more exciting developments in refractive surgery is the use of implantable lenses or implantable contact lenses. This is a great option for patients who aren't good candidates for the LASIK procedure. For instance, they might be too nearsighted for the LASIK procedure or the cornea might be too thin or it might be unsafe to do a LASIK procedure because of the shape of the cornea. In implantable contact lenses or implantable lenses, what we do is we use an implant similar to the ones that we use during a cataract surgery, but instead of removing that person's natural lens, we simply place an additional lens inside the eye. This lens has a power and it is just like a contact lens does, except, since it is inside the eye, the person doesn't feel it, doesn't know what's in there, the contact never has to be removed or cleaned. So it is an exciting option for patients who just aren't good LASIK candidates or who can't wear regular contact lenses for whatever reason.