Ask the Expert: Is Corrective Eye Surgery Right for You?

Corrective eye surgery has become a more accepted option for people looking to improve their vision in the last 20 years. The Johns Hopkins Wilmer Eye Institute is considered a leader in eye care and offers a wide spectrum of vision correction treatments.

Wilmer Eye Institute ophthalmologist and cornea specialist Christina Prescott specializes in medical and surgical management of corneal diseases, laser vision correction and cataracts. Prescott earned her M.D. and Ph.D. from the University of Colorado. After performing her ophthalmology residency at Yale, she completed a fellowship in cornea, refractive surgery and external disease at the Massachusetts Eye and Ear Infirmary of Harvard University before joining the Wilmer faculty in 2012. In this edition of Ask the Expert, she discusses laser vision treatments and how you can determine if a corrective eye procedure is right for you.

How does someone know if laser vision correction is the right procedure for them?

People pursue laser vision correction for a variety of reasons. Those who have good vision with glasses or contact lenses but have trouble tolerating them are usually great candidates. Others, such as pilots or police officers, may need to improve their vision for professional reasons. Some athletes may choose to improve their vision so they can excel at their chosen sports, such as swimming or martial arts. One woman wanted to be able to see her baby when she woke up in the middle of the night. Many patients tell me after surgery that they love being able to wake up and see their alarm clock. Everyone has his or her own reasons for wanting to see clearly.

Unfortunately, not everyone is a good candidate for refractive surgery; those who do not see well even with glasses or contact lenses are usually not good candidates for refractive surgery. Additionally, there are both medical and ophthalmic contraindications to refractive surgery, which is why it is so important to have a complete ophthalmic exam as part of your refractive surgery evaluation.

What are the main differences between LASIK (laser-assisted in situ keratomileusis) and PRK (photorefractive keratectomy) procedures?

The main difference between LASIK and PRK is the site of the excimer laser treatment. In LASIK, a femtosecond laser—previously, a microkeratome—is used to make a flap. The flap is lifted, and an excimer laser is used to treat the central cornea. The flap is then replaced. In PRK, the epithelium—front layer of tissue covering the cornea—is removed, and the surface is treated with the excimer laser. The epithelium then heals over the treated area. At Wilmer, we offer LASIK, PRK and today’s other advanced surgical technologies for vision correction.

How do you determine the preferred procedure?

A complete ophthalmic exam, including wavefront imaging and topographic mapping of the cornea, is performed. Specific findings on exams or imaging may lead your ophthalmologist to recommend one procedure over another; patient occupation and lifestyle considerations are also important. Ultimately, after a discussion with a surgeon about specific options, patients choose which procedure is right for them.

What is the recovery process like?

The recovery process varies depending on the surgical procedure chosen. One of the reasons for the popularity of LASIK is that there is virtually no pain, and the visual improvement is almost immediate. With PRK, there is some discomfort for three to five days, and the vision can fluctuate for several days to weeks following the surgery. Patients may experience some dry eye symptoms following either procedure, especially if they had problems with dry eye prior to surgery, so use of artificial tears is often recommended.

How long does corrective sight last following the procedure?

Refractive correction is permanent, and the vast majority of patients will enjoy their new vision as long as they do not develop any other ophthalmic pathology, such as cataracts, glaucoma or macular degeneration. Approximately 5 percent of patients, most often patients who had a high refractive error prior to surgery, may experience some regression and may choose to have an enhancement. One unique aspect of refractive surgery at Wilmer is that we include two-year follow-up care, including complimentary enhancements if needed, for all of our patients.

Make an appointment with Prescott by calling 410-893-0480 or by visiting the Wilmer Eye Institute at hopkinsmedicine.org/wilmer/.

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Ronette Opher January 8, 2015 at 7:36 am

This is information was very helpful. I am one who has been wearing glasses since 4th grade and contacts on and off half of my life. I might consider this procedure later on in the future.

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