Eye correction surgery, also known as vision correction surgery, is done to correct or improve the vision permanently.
Laser vision correction (LVC) is considered the safest eye correction surgery to obtain a “specs-free” life for patients with myopia (nearsightedness), hyperopia (farsightedness), and astigmatism (blurring of vision due to improper shape of the eye).
3 best options for laser vision correction
- Small incision lenticule extraction (SMILE)
- Laser-assisted stromal in situ keratomileuses (LASIK)
- Photorefractive keratectomy (PRK)
What is laser vision correction (LVC)?
Laser vision correction (LVC) is an alternative to spectacles and contact lenses that can help a patient see better.
- Laser vision correction reshapes the cornea to adjust its focusing power.
- These operations are both safe and have a high success rate.
- Though they sound simple to perform, a lot of thought and customizations are needed to obtain good results.
LVC may not suit everyone. A complete preoperative assessment can decide whether the surgery is right for you and, if so, which laser vision correction technique is best.
What is SMILE?
Small incision lenticule extraction (SMILE) is the third generation of laser vision correction, which is considered the most advanced laser vision correction (LVC) approved by the U.S. Food and Drug Administration (FDA).
SMILE is a more minimally invasive procedure than other LVC techniques. A femtosecond laser is used to cut and remove a very small piece of the cornea, and then, the cornea is reshaped to improve vision.
SMILE takes one to two days for visual recovery, which is longer than LASIK.
3 advantages of SMILE over PRK and LASIK
- A keyhole corneal incision of 3 mm is done to perform SMILE, whereas a flap with a circumference of 20 mm is created for LASIK and 8 mm diameter removal in PRK.
- The excimer laser is used to reshape the cornea in LASIK and PRK, which produces some odor. SMILE procedure does not use excimer, so there will be no production of burning odor.
- A flap is not created during SMILE unlike LASIK, so flap-related complications are absent in the SMILE procedure.
What is LASIK?
Laser-assisted stromal in situ keratomileuses (LASIK) is the second generation of laser vision correction, which has the same result as photorefractive keratectomy (PRK), but the recovery time and postoperative complications are less than PRK.
LASIK is the most commonly done laser vision correction (LVC).
- LASIK involves creating a tiny flap of corneal tissue using a femtosecond laser and then folding it back.
- To correct the eyesight, the surgeon subsequently utilizes an excimer laser to remodel the underlying corneal tissue.
To get the LASIK procedure done, the patient must have an appropriate corneal thickness. Due to the creation of a flap during this surgery, a specific degree of corneal thickness is necessary, and patients with thin or uneven corneas may not be able to get the surgery.
Though LASIK is a very successful, safe, and dependable procedure, it is a more complicated technique. The vision recovers immediately after the procedure.
LASIK employs two lasers and generates a flap during surgery, which has a risk of flap-related problems following the procedure, such as:
- Striae (tiny wrinkles due to uneven alignment of the flap)
- Uneven astigmatism
- Epithelial ingrowth
- Dry eye syndrome
LASIK is known to raise the incidence of postoperative dry eye symptoms and can worsen previously existing chronic dry eye.
What is PRK?
Photorefractive keratectomy (PRK) is the first generation of laser vision correction.
PRK is considered a better option for patients with thin or irregular corneas and dry eyes and who have high-risk occupations where there is direct contact to the eyes, such as boxers.
- During the PRK procedure, the outer layer of the cornea (also called the epithelium) is gently removed using a hand device during PRK surgery.
- The surgeon will reshape the cornea and fix the eyesight with a cold excimer laser.
The recovery time after a PRK is two to six weeks, which is the longest recovery period than the other laser vision correction (LVC). It takes roughly a week for the cells on the upper surface of the cornea to regenerate.
There is an increased risk of postoperative discomfort with PRK.
Which LVC procedure is right for you?
- Patients with thin or uneven corneas or candidates with high-risk occupations, such as boxers and fighters, are more likely to benefit from small incision lenticule extraction (SMILE) or photorefractive keratectomy (PRK).
- A higher chance of postoperative discomfort is seen with PRK than laser-assisted stromal in situ keratomileuses (LASIK) and SMILE.
- If a patient has a history of persistent dry eyes, SMILE or PRK may be a better alternative.
- LASIK is more complicated than SMILE.
- Discuss with your ophthalmologist the best option for your eye condition.
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University of Rochester Medical Center. LASIK & Advanced Vision Correction. https://www.urmc.rochester.edu/eye-institute/lasik/procedures/prk.aspx
Hatch K. Small Incision Lenticule Extraction (SMILE): It’s what’s new in laser vision correction. Harvard Health Publishing. https://www.health.harvard.edu/blog/small-incision-lenticule-extraction-smile-its-whats-new-in-laser-vision-correction-2020051419765
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