Vision Surgery

a professional optometrist is doing an eye surgery to a woman

/ EYE SURGERY OPTIONS

Vision Surgery in San Francisco

Discover the world of vision surgery with options like LASIK, PRK, Corneal Transplant, and more. Uncover the procedures, understand risks, and find the right corrective surgery tailored to your needs. Whether correcting myopia, addressing presbyopia, or exploring innovative solutions like corneal inlays, embark on a journey to clearer vision with insights into various surgical approaches.

BOOK AN APPOINTMENT

/ REFRACTIVE EYE SURGERY

Corrective Eye Surgery Basics

In recent years there have been tremendous advances in the field of vision correcting eye surgery which is also known as refractive or laser surgery. Corrective eye surgery offers patients clear vision without the use of glasses and contact lenses. There are a number of types of refractive surgeries that are able to correct different vision problems, so if you are considering surgery here are some of the options you should know about.

LASIK (laser-assisted in situ keratomileusis) surgery is perhaps the most well-known refractive surgery today. LASIK can help patients with myopia (nearsightedness), hyperopia (farsightedness) and astigmatism. During the procedure, the doctor makes a flap in the outer layer of the corner to reach the underlying tissue and then uses a laser to reshape the tissue which allows the cornea to then focus light properly. The procedure is usually painless and vision is usually clear within a few hours.

Recent advances in the field have developed subcategories of LASIK surgery such as Bladeless LASIK, which uses a laser rather than a mechanical tool to make the initial flap or Wavefront (custom) LASIK which uses computer mapping to guide the reshaping of the cornea and is able to create a much more precise visual correction for very subtle optical imperfections. There is also a procedure called Epi-LASIK in which following the procedure, the doctor applies a soft contact lens to protect the surgical area, holding the flap in place while it heals.

PRK (photorefractive keratectomy) also uses a laser to correct mild to moderate myopia, hyperopia and astigmatism. PRK was a precursor to LASIK which eliminated many of the complications of prior surgeries such as glare, seeing halos around lights, blurred vision and regression of vision. Unlike LASIK, the procedure only reshapes the surface of the cornea and not the underlying tissue.

Consequently, there is often some discomfort for a couple of weeks until the outer layer of the cornea heals. Additionally, the patient may experience blurred vision during this period of healing. PRK does offer an advantage over LASIK in that there is less risk of certain complications. Wavefront technology is also available for PRK surgeries.

In LASEK or laser-assisted sub-epithelial keratomileusis, the doctor creates a flap smaller but similar but to LASIK, and then uses an alcohol solution to loosen the tissue around the cornea which is pushed aside, and then a laser is used to reshape the cornea itself. In an Epi-LASEK procedure, the doctor may apply a soft contact lens to hold the flap in place to assist in reattaching to the cornea as the eye heals. Patients that undergo LASEK generally experience less discomfort and quicker vision recovery than PRK patients. LASEK may be preferred over LASIK as a safer option for patients with a thin cornea.

Cataract Surgery is a very common refractive surgery that removes the clouded natural lens of the eye and replaces it with an artificial lens called an IOL (intraocular lens). Many patients these days will receive a lens that also corrects any refractive error they have such as nearsightedness, farsightedness or presbyopia.

RLE or refractive lens exchange is a non-laser procedure the replaces the natural lens of the eye. This is the same as the surgery that is used to treat cataracts, ,yet for non-cataract patients, RLE is used to correct severe nearsightedness or farsightedness. The procedure involves the doctor making a small cut in the cornea, removing the natural lens and replacing it with usually a silicon or plastic lens. It is particularly useful for patients with minor corneal problems such as thin corneas or dry eyes.

/ LASIK IN SAN FRANCISCO

LASIK Procedure

LASIK or laser-assisted in situ keratomileusis is a refractive surgery that is used to correct myopia (nearsightedness), hyperopia (farsightedness) and astigmatism as an alternative to eyeglasses or contact lenses. LASIK is currently the most common of the refractive eye surgeries, largely because of the relatively low risk and the quick recovery and improvement in eyesight.

Also known as laser eye surgery or laser vision correction, LASIK uses a laser to reshape the cornea which is responsible for clear vision. The procedure is quick and relatively painless and eyesight is usually improved to 20/20 vision within one day of the surgery.

LASIK is an outpatient procedure, which takes about 15 minutes for the actual surgery on both eyes and an hour total with recovery. A topical anesthetic drop is used and there is no need for bandaging or stitches following the procedure. The doctor will start by stabilizing the eye and then making a small flap in the outer layer of the cornea. Then with access to the underlying tissue, he uses a laser to reshape the corneal tissue and re-closes the flap, which will heal on its own. The nature of the corneal reshaping depends on the type of refractive error.

By 6 months, your baby will begin to move his eyes with more speed and accuracy, seeing at farther distances and focusing well. Color vision should be fully developed and the eyes should be able to work as a team and follow moving objects with relative ease. Hand-eye coordination and depth perception should be greatly improved as your baby will begin to understand the 3-dimensional world around them.

During the procedure you may feel some pressure on your eye while the laser is working. Immediately following you will likely experience some blurriness and may feel burning or itching (be sure not to rub your eyes!). For your journey home you will be given protective shields to guard your eyes and will need someone to drive you. You will also be prescribed medicated eye drops for a week or so to aid in healing and prevent infection. Your doctor may also recommend artificial tears to moisten the eyes and keep them comfortable in the days following the procedure.

While at 6 months, your baby will not be able to read an eye chart, eye doctors can perform an infant eye exam through non-verbal testing to assess visual acuity (for nearsightedness, farsightedness or astigmatism), eye teaming abilities and eye alignment. The eye doctor will also be able to see inside the eye for any signs of disease or problems that could affect eye or vision health.

InfantSEE®

InfantSEE® is a public health program in which participating optometrists provide a free comprehensive infant eye exam to babies between 6 and 12 months of age. The program was initiated to provide accessible eye and vision care for infants to ensure they have the best chances for normal development and quality of life.

For the right candidate, LASIK can offer a lifestyle improvement in giving clear vision without the need for glasses or contact lenses, however, the results are not guaranteed. You and your eye doctor need to weigh the benefits and the potential risks based on your personal needs.

LASIK is the most common refractive eye surgery, partially due to the fact that the risks and complications are low. The majority of patients don’t experience any long term complications as a result of the surgery. Nevertheless, as with any surgical procedure there are some risks, however rare they are and it is important to know them and to discuss them with your eye doctor or surgeon prior to undergoing the surgery.

Flap Complications

Perhaps the greatest risk involved in LASIK is the accurate creation and healing of the flap of the cornea that is lifted to reshape the underlying tissue and replaced after. If the flap in the cornea is not made accurately, cut too thick or too thin and not carefully replaced back on the eye, it can cause complications in the shape of the eye surface and therefore clear vision. Studies indicate that these complications occur usually in under 6% of cases and the experience and skill of the surgeon play a large role.

There can also be complications in the healing process of the flap which include infection or excessive eye tearing.

Vision Loss

There is a chance, albeit small that the surgery can result in a loss of vision or reduction in visual clarity due to complications with the surgery. It is quite rare for any permanent damage or vision loss to occur as a result of LASIK and usually any vision problems can be corrected by a follow-up procedure. However, as with any surgical procedure, there are risks, so it is important to reduce your risks by finding an experienced surgeon and carefully considering your suitability for the surgery in the first place.

Dry Eyes

About half of LASIK patients experience dry eyes, which are usually a temporary side effect that resolves within 3-6 months after the surgery. Your doctor will likely prescribe artificial tears in the days and weeks following the surgery which should be continued as long as the symptoms persist. Because of this, it is usually recommended that patients with a history of chronic dry eyes opt for another type of refractive surgery such as PRK, another style of laser refractive surgery with reduced risk.

Eye Infection or Irritation

While not common due to the eye drops and checkups prescribed post surgery, there is a chance of developing an eye infection. If this does occur, it can be treated with antibiotic eye drops, anti-inflammatories or sometimes may require other treatment such as oral antibiotics. If you are experiencing symptoms of an eye infection such as redness, pain, discomfort, discharge or any change in vision, see your eye doctor immediately. As a precaution, it is imperative to follow your surgeon’s instructions for your post-operative care including prescription medications and doctor’s visits.

Vision Issues

Following surgery, you may experience certain vision issues such as such as poor night vision, double vision, halos around lights or glare. These side effects are common and can last up to a few weeks, but typically go away. Some patients report a lasting reduction in vision in low light conditions and may require vision aids for seeing better at night.

Dry Eyes

Under 18 years old: Children’s eyes are constantly changing and it is only once a child reaches the age of 18, that we can be sure that their vision has stabilized. Patients should experience at least a year of stable vision before scheduling LASIK otherwise they are risking the chance of having to repeat the surgery.
Pregnant or Nursing Women: Hormonal changes during pregnancy can cause changes to your eyes and vision and could take up to a year or so to return to normal. Additionally, some of the medications used during or after LASIK could be harmful to a baby that is in utero or nursing. If you are pregnant, trying to get pregnant or nursing, speak to your eye doctor about if and when you can consider LASIK.
Very High Prescription: Patients with a particularly high myopia or hyperopia may require too much tissue removal to properly fix the vision, increasing the risk of the procedure. In such cases, your doctor may recommend an alternate procedure such as PRK.
Eye Problems or Diseases: If your eyes are not healthy, you can increase your risks of complications and inhibit the process of healing that takes place following the surgery. For chronic issues such as dry eyes, cataracts, glaucoma or other serious problems you may be disqualified from LASIK or any other surgical procedure. Other conditions such as an eye infection or injury may simply require you to wait until your eye is completely healed.
Irregular Eye Anatomy (Such as Large Pupil Size or Thin Corneas): Patients with exceptionally large pupils may be disqualified from LASIK due to a higher incidence of negative side effects such as poor night vision, halos, double vision or glare. For LASIK to be successful, the cornea needs to be a certain minimal thickness. For those with thin corneas, an alternate treatment may be recommended.
Systemic and Autoimmune Medical Conditions: Certain systemic diseases and medical conditions such as diabetes, HIV, immunodeficiency or rheumatoid arthritis that can affect your body’s ability to heal properly can disqualify a patient from LASIK. Certain medications can also disqualify you from being a candidate.
Prior Eye Injury: Certain eye injuries, especially those that result in corneal scarring can pose as a risk for successful LASIK surgery.

Eye doctors and surgeons may have differing opinions as to which conditions and circumstances will disqualify you from LASIK candidacy. Your eye doctor and/or surgeon will complete a thorough exam to assess the risks and potential outcome to determine if LASIK is right for you.

/ CORNEAL TRANSPLANTS IN SAN FRANCISCO

Corneal Transplant

The cornea refers to the clear, front surface of your eye. When a corneal transplant is done, officially termed keratoplasty (KP), the central part of the cornea is surgically removed and replaced with a “button” of clear and healthy corneal tissue donated from an eye bank.

According to the National Eye Institute, approximately 40,000 corneal transplants are performed annually in the United States. The overall success rate for keratoplasty is relatively high, yet up to 20% of patients may reject their donor corneas. Aggressive medical treatment with steroids is generally given in response to signs of rejection, and it is often effective at subduing the negative reaction and saving the cornea. At five to ten years after KP surgery, studies report an encouraging success rate of 95% to 99%.

Corneal transplants are typically done when the cornea becomes damaged or scarred in a way that uncorrectable vision problems occur. These types of vision conditions are not resolved by eyeglasses, contact lenses or refractive laser surgery (such as LASIK). Disease or injury is the usual culprit for the vision loss.

Keratoconus is a common reason for needing a corneal transplant. In this degenerative condition, the cornea thins and bulges forward in an irregular cone shape. Rigid gas permeable (GP) contact lenses can treat mild cases by flattening the cornea, yet contacts are not effective when it comes to advanced stages of keratoconus. The National Keratoconus Foundation reports that 20% to 25% of people with keratoconus will require corneal transplant surgery to restore vision. Other corneal degenerative conditions will also result in a need for keratoplasty.

Keratoplasty is generally done on an outpatient basis, with no need for overnight hospitalization. Depending upon age, health condition and patient preference, local or general anesthesia is used.

Using a laser or a trephine, this is an instrument similar to a cookie cutter, the surgeon cuts and removes a round section of damaged corneal tissue and then replaces it with the clear donor tissue.

Extremely fine sutures are used to attach the donor button to the remaining cornea. The sutures remain in place for months (sometimes years) until the eye has recuperated, healed fully and is stable.

The total healing time from keratoplasty may last up to a year or longer. At first, vision will be blurred and the site of the corneal transplant may be inflamed. In comparison to the rest of the cornea, the transplanted portion may be slightly thicker. For a few months, eye drops are applied to promote healing and encourage the body to accept the new corneal graft.

A shield or eyeglasses must be worn constantly after surgery in order to protect the healing eye from any bumps. As vision improves, patients may gradually return to normal daily activities.

Some patients report noticeable improvement as soon as the day after surgery. Yet a great deal of astigmatism is common after a corneal transplant. A patient’s prescription for vision correction tends to fluctuate for a few months after the surgery, and significant vision changes may continue for up to a year.

Hard, gas permeable contact lenses generally provide the sharpest vision after a corneal transplant. This is due to a residual irregularity of the corneal surface. Even with rigid contact lenses, eyeglasses with polycarbonate lenses must be worn in order to provide adequate protection for the eye.

Once the sutures are removed and healing is complete, a laser procedure such as LASIK may be possible and advised. Refractive laser surgery can reduce astigmatism and upgrade quality of vision, sometimes to the point that no eyeglasses or contact lenses are needed.

/ LASER EYE SURGERY

PRK

Photorefractive keratectomy or PRK is a type of refractive laser eye surgery used to correct a patient’s vision to eliminate or reduce their dependence on glasses or contact lenses. PRK is the style of laser eye surgery that preceded LASIK, having been the former most common type of refractive surgery until LASIK came along.

PRK is effective in correcting nearsightedness (myopia), farsightedness (hyperopia) and astigmatism and has very similar rates of success and outcomes as LASIK. PRK remains a common option for laser eye surgery.

PRK and LASIK both permanently reshape the cornea to improve vision by using a laser (an excimer laser to be exact) to remove part of the tissue underneath the corneal epithelium. The epithelium first needs to be removed in order to get access to the tissue and how this is done is what differentiates the two procedures. While LASIK creates and lifts a flap on the outer corneal layer, reshapes the corneal tissue underneath and then replaces the flap, PRK removes the outer layer of the cornea completely. The outer layer will regenerate usually within a few days.

Since PRK completely removes the outer corneal layer, there is a greater area of the cornea to work with. This is ideal for patients with a thin cornea who would otherwise be at risk with LASIK. It is also usually recommended for patients with chronic dry eyes. With PRK, there is also less risk of infection or issues having to do with the flap and the related healing process. This is an advantage for individuals who lead a lifestyle in which they are at risk for eye injuries (athletes, military, law enforcement etc.) which may subject the flap to injury or complications.

So, Why Is LASIK More Popular?

The main advantages that LASIK has over PRK are two-fold and mainly have to do with comfort and recovery time. First of all, PRK patients usually experience slightly more discomfort during the first couple of days of recovery, mainly because it takes time for the outer corneal layer to heal. They will be prescribed eye drops to be taken for several months to prevent infection, increase comfort and assist the healing process. LASIK patients on the other hand, typically experience less discomfort and if they do, it subsides very quickly.

Additionally, vision recovery takes longer with PRK. While LASIK patients can typically see normally within a few hours after the surgery, with vision gradually continuing to improve within the next few months, PRK patients may experience blurred vision for up to three days and it can take up to six months until they achieve full visual clarity. While patients who undergo LASIK can usually drive and resume normal functioning within a day or two, PRK patients shouldn’t plan on returning to normal for at least several days until the outer layer of the cornea has grown back.

Whether PRK or LASIK is a better option for you depends on a number of factors, including the health and structure of your eye. This is a decision that your eye doctor or surgeon will help you make. Rest assured however, that both procedures have been shown to be incredibly successful in correcting vision, with minimal complications.

Prior to any laser correction surgery, you will meet with a surgeon for a thorough exam to assess your eye health and determine whether you are a candidate and if so, which type of surgery would be best suited to your needs. During this exam it is essential to tell the doctor any relevant medical history (injuries, hospitalizations, diseases etc.) and existing conditions you have. The surgeon will determine if you are currently eligible for surgery and if not, if you will be at a future point, and whether you require any specialized care pre or post surgery.

The surgery itself is an ambulatory procedure. It takes about 15 minutes or less for both eyes and you go home the same day. You will need someone to drive you home from the procedure.

The first step in the procedure is that your eye will be anesthetized using numbing eye drops and then a device will be inserted to prop your eyelids open so you won’t blink. Once the eye is numb, the surgeon will remove the outer epithelial layer of the cornea to expose the underlying tissue. Then the surgeon will use the laser to reshape the corneal tissue. You may feel a small amount of pressure during this step. Lastly, the surgeon will apply medicated eye drops and place a temporary contact lens that is used as a bandage to protect the eye.

Following the surgery you will be instructed to apply medicated eye drops multiple times each day to reduce the risk of infection and you may also be given prescription pain relievers to alleviate any pain or discomfort.

As with any type of surgery, it is critical to carefully follow your surgeon’s instructions after PRK. Make sure that you take your medication as prescribed, get enough rest, and call your eye doctor immediately if you experience any problems.

It is normal for it to take several days or even weeks for your vision to improve and up to 3-6 months for full recovery to clear and stable visual acuity. Usually, your doctor will require you to refrain from driving for a week and up to three weeks depending on how fast your vision recovers.

While serious complications are rare, like any surgery, there are some risks to PRK, and these happen to be very similar to any laser corrective surgery like LASIK. They include:

Dry eyes- this condition usually goes away within a couple of months, but there is a chance that it could become chronic.
Infection or Inflammation- the risk of infection is greatly reduced if you take proper care to follow your doctor’s instructions following the procedure.
Vision Problems- which can include glare, seeing halos around lights poor night vision and sometimes a general haziness.
Incomplete Vision Correction – sometimes an additional procedure might be needed to achieve optimal visual acuity.

In general, PRK is considered to be a relatively safe and effective treatment for vision correction. If you wish to live a life without depending on your glasses or contact lenses, speak to your eye doctor about whether PRK is an option for you.

/ PRESBYOPIA TREATMENT

Surgery for Presbyopia

Presbyopia is a common age-related condition in which near vision worsens due to the hardening of the lens of our eye. It causes people to have difficulty reading and performing other tasks that require sharp and focused close vision.

Symptoms begin around the age of 40 when you begin to see people with untreated presbyopia holding books, magazines, newspapers, and menus at arm’s length in order to focus properly and avoid eye strain. Other symptoms include headaches or fatigue when trying to focus on something at close range.

During our youth, the lens of our eye and the muscles that control it are flexible and soft, allowing us to focus on close objects and shift focus from close to distant objects without difficulty. As the eye ages however, both the lens and the muscle fibers begin to harden, making near vision a greater challenge.

The most common form of treatment for presbyopia is wearing reading glasses, bifocals or progressive lenses. Bifocal and multifocals are also available in contact lenses for those who prefer to be glasses-free. A third option, however, is a number of surgical procedures that allow you the freedom of correcting your near vision without the use of glasses or contact lenses.

Monovision LASIK

Monovision is a technique that began with presbyopia-correcting contact lenses designed for individuals with presbyopia and nearsightedness or astigmatism. Each eye gets a different lens power – one lens is used in the dominant eye to correct for distance vision and the other for near vision. The eyes adapt to the two lens powers by learning to use the appropriate eye for the necessary distance power. Monovision LASIK surgery is based on the same principle of correcting each eye for a different refractive power and has shown just as high if not higher success rates than the contact lens technique. Usually, patients will try out monovision with contacts first to ensure that it works and that the eyes adapt properly.

PresbyLASIK

PresbyLASIK is a procedure that is currently available in Canada and Europe and undergoing clinical trials in the United States. As opposed to monovision LASIK, this procedure is a multifocal alternative in which different rings of refractive power are created on the cornea, similar to multifocal lenses. This provides vision correction at all distances simultaneously.

Conductive Keratoplasty uses radio waves via a hand-held instrument to mold the corneal surface to improve near vision. The procedure can be done on one eye using the monovision principle and is a good solution for those that do not need vision correction for nearsightedness or astigmatism. The effects of CK, however are not permanent and the improvement in near vision will diminish over time.

Corneal inlays and onlays involve surgically implanting a small lens into the eye to increase focus and near vision. The distinction between inlays and onlays is in where the lens is placed on the eye.

In refractive lens exchange the eye’s hardened lens is replaced with an artificial lens called an intraocular lens (IOL) to provide multifocal vision. This surgery is similar to and often done in conjunction with cataract surgery.

/ CORNEAL EYE SURGERY

Corneal Inlays and Onlays

Corneal inlays and onlays are corneal implants that are used to correct presbyopia, a common condition for individuals over age 40 in which the eyes have difficulty focusing on near objects.

Presbyopia occurs as the lens of the eye begins to age and weaken, reducing the ability to focus on close objects without the assistance of reading glasses or another visual aid.

Corneal implants, such as inlays and onlays, offer a treatment solution to correct presbyopia as an alternative to using reading glasses or multifocals to obtain clear vision at a close range. Corneal inlays and onlays are like tiny contact lenses that are inserted into the cornea which reshape it to improve the refractive power and thereby improve near vision. Unlike corrective laser surgery such as PRK or LASIK the actual corneal tissue isn’t touched, but rather the shape of the cornea is changed by the transplanted lens.

Corneal inlays are placed in the stroma, the middle layer of the cornea (thus the name “in-lays”), while onlays are implanted closer to the surface of the cornea, under the epithelium, which is the thin outer layer of the cornea. The procedures for both inlays and outlays are relatively simple and quick, with minimal recovery.

Corneal Inlay and Onlay procedures are still in the early stages of development and with a number of clinical trials in progress, the technology should only improve in coming years.

Crystal Clear Vision Center Optometry, Inc.

Crystal Clear Vision Center Optometry, Inc.

Vision Surgery

/ EYE SURGERY OPTIONS

Vision Surgery in San Francisco

/ REFRACTIVE EYE SURGERY

Corrective Eye Surgery Basics

LASIK

PRK

LASEK

Cataract Surgery

RLE

PRELEX

Phakic Intraocular Lens Implants

Conductive Keratoplasty (CK)

/ LASIK IN SAN FRANCISCO

LASIK Procedure

How does LASIK work?

Wavefront LASIK

What to expect during and after LASIK?

Am I a candidate for LASIK?

LASIK risks and complications

What are the side effects that can happen with LASIK?

LASIK – Criteria for success

/ CORNEAL TRANSPLANTS IN SAN FRANCISCO

Corneal Transplant

Why are corneal transplants done?

Corneal transplant procedure

Recovery from a corneal transplant

What happens to vision post-keratoplasty?

/ LASER EYE SURGERY

PRK

How does PRK differ from LASIK?

Advantages of PRK

What you need to know about PRK

Risks and complications of PRK

/ PRESBYOPIA TREATMENT

Surgery for Presbyopia

Causes of presbyopia

Surgical treatment for presbyopia

LASIK

Conductive Keratoplasty (CK)

Corneal inlays or onlays

Refractive lens exchange

/ CORNEAL EYE SURGERY

Corneal Inlays and Onlays

Advantages of corneal inlays and onlays

How do corneal inlays and onlays work?

Crystal Clear Vision Center Optometry, Inc.