Refractive Surgery

Refractive surgery is eye surgery to correct common refractive errors that affect your vision. It changes how your eyes focus light to improve how well you can see. That’s why it’s also known as vision correction surgery.

Most vision issues happen because of changes in either your corneas or your lenses. An ophthalmologist will adjust how these parts of your eyes work to correct the issues.

Refractive surgery can correct the common vision issues, including:

• Nearsightedness (myopia)
• Farsightedness (hyperopia)
• Astigmatism
• Presbyopia

Types of refractive surgery

There are two main types of refractive surgery:

• Laser procedures: Laser vision correction uses a laser to make tiny changes in the shape of your corneas. Examples include LASIK, PRK and SMILE.
• Lens placement or replacement procedures: Your eye surgeon will add an artificial lens to your eye. They may remove the natural lens or add the replacement to work along with it. IOL placement and refractive lens exchange are examples of this type.

Your eye doctor will suggest the type of surgery that’s best for you. Some surgery types are better than others for specific refractive errors.

How should I prepare for refractive surgery?

Surgery prep steps can vary. It depends on which kind of surgery you’re having. But you may need:

• A vision test: This will measure your vision before any correction surgery. Your eye doctor will make sure your vision isn’t changing a lot over time. If it is, you may have to wait until it stabilizes before having surgery.
• An eye exam: Your eye doctor will make sure your eyes are healthy enough for surgery. Certain eye conditions or issues can make it unsafe for you to have refractive surgery.
• Eye surface mapping and eye measurements: These are detailed scans of your eye. They‘ll show your eye doctor which changes you need, and exactly where the refractive errors are. This will help them plan and complete the surgery.
• Antibiotic eye drops: Your eye doctor may prescribe these to help prevent infections after surgery. They’ll tell you when to start taking them and how often you’ll need them.

Your eye doctor will tell you anything else you need to do to get ready for surgery. Tell them all the medications and over-the-counter supplements you take. They’ll let you know if you should stop or change your routine.

You may need to fast for several hours before a lens placement or replacement. Your ophthalmologist will tell you when to stop eating solid food before your appointment.

Arrange for someone to drive you to and from your surgery appointment. You won’t be able to drive yourself home.

What happens during refractive surgery?

Your ophthalmologist will put numbing drops in your eyes. This will prevent you from feeling any pain during the procedure. Then, they’ll have you look up so they can place a special holder on your eye. It will keep your eyelid open and hold your eye still. Once your eye is secure, they’ll start the surgery.

Laser surgeries usually follow these steps:

1. Your eye doctor may make a small cut to create a flap on the surface of your eye.
2. They’ll move the flap back so the laser can target the correct layers.
3. Your eye doctor will tell you to focus on a light from the laser device.
4. Once you’re looking at the light, they’ll use the laser to make any changes to your eye. You won’t feel any pain during the surgery, but you may hear a tapping or clicking noise.

The steps will be slightly different if you need lens placement or replacement:

1. Your eye doctor will make a cut in the surface of your eye.
2. They’ll move layers of tissue out of the way to reach your eye’s lens.
3. If you’re having a lens replacement, they’ll take out your natural lens and insert the artificial replacement.
4. For IOL placement, they’ll put the artificial lens in front of your natural one.

For both types, your surgeon will close the flap once they’re done. They may put a bandage that looks and feels like a contact lens on your eye. They might put medicated eye drops in your eye, too.

Refractive surgery is very quick. The procedure itself usually only takes around 30 minutes. Preparation and post-operation steps can take longer. You may need to be at your appointment for a total of a few hours.

What are the potential benefits and risks?

Refractive surgery’s main benefit is that it can improve your vision. It will make your vision clearer, even when you’re not wearing glasses or contacts.

There’s a chance you may still need to wear some kind of corrective lenses, even after surgery. It depends on how far you originally were from 20/20 vision. Your eye doctor will help you set realistic goals and expectations.

Almost everyone who has laser surgery ends up with at least 20/40 vision. Around 9 in 10 people achieve 20/20 vision or better after they heal.

Lens placement or replacement is also very successful. Around 8 in 10 people end up with at least 20/40 vision.

Refractive surgery can’t fix presbyopia directly. Instead, your surgeon will give you monovision. One eye will be adjusted so it can see farther away. The other will see up close. Talk to your eye doctor if this worries you. They’ll explain everything you need to know to make the right choice.

You’ll have some side effects after surgery. These are usually temporary, and can include:

• Dry eye
• Light sensitivity
• Eye pain
• Double vision
• Decreased low-light vision

Your eye doctor may prescribe antibiotics to help prevent eye infections while you recover.

What happens after this procedure?

Refractive surgery is an outpatient procedure. That means you can go home the same day. You may have a short recovery period in the surgery facility. Your care team will monitor your eye while it starts to heal. You should be able to go home within an hour after your surgery.

What is the recovery time?

Laser procedures usually heal quickly. It may only take a few days. Lens placement/replacement procedures may take a few weeks to heal fully.

Follow these tips to protect your eyes while they heal:

• Don’t rub your eyes: Resist the urge to rub your eyes. The tiny layers inside them need time to heal. Rubbing can tear the layers and cause other damage. Ask your eye doctor how you can manage dry eye.
• Wear sunglasses: Your eyes are extra vulnerable to UV rays after refractive surgery. You may need to wear sunglasses or another kind of eye shield from your eye doctor to block those rays.
• Take it easy: Rest is important after any kind of surgery, even on your eyes. Your eye doctor will tell you how long to avoid exercise or other intense physical activities. Ask them when it’s safe to resume your normal routine.
• Don’t drive before it’s safe: You won’t be able to drive right after refractive surgery. Your vision will be temporarily blurry. You’ll notice improved vision as your eyes heal. Your eye doctor will tell you when it’s safe to start driving again.

When should I call my healthcare provider?

Call your eye doctor right away if you notice any of these issues after refractive surgery:

• Sudden changes in your vision, including double vision, blurred vision or vision loss
• Symptoms of an eye infection, including eye pain, swelling, oozing or discharge
• Burning or itching that doesn’t get better after a few days

Can eyesight be corrected by surgery?

Yes, it’s possible to correct your vision with surgery. But it’s important to remember that sometimes, the changes don’t fully resolve your vision issues. You may still need to wear glasses or contacts in some situations. But even when vision correction surgery doesn’t completely fix refractive errors, it almost always improves vision significantly.