Alternatives to Lasik Eye Surgery if You're a Less Than Ideal Candidate

LASIK eye surgery is elective. It is not cosmetic, like facelifts, or medically necessary, like heart bypasses, but it does correct a physical problem and enhance quality of life. However, if you are comfortable wearing glasses or contact lenses, you don't really have to have any kind of laser eye surgery.

There are a number of reasons why you might not be an ideal candidate for LASIK eye surgery. Not all LASIK surgery alternatives involve the same degree of surgical intervention. For example, intracameral intraocular lenses (ICLs), which are pending approval by the FDA, may become a good option if you are simply too nearsighted or farsighted to benefit from LASIK. A small lens is placed behind the pupil but just in front of the eye’s existing lens, adding another focusing apparatus and changing the orb’s focal point. When approved, this procedure could become quite popular, but probably won’t replace LASIK because of the additional risk.

There are several types of intraocular lenses (IOLs) that can be implanted in the eye, temporarily or permanently, to correct moderate to severe nearsightedness. In nearsighted patients, light rays focus in front of the retina resulting in blurry vision, so the IOL is placed behind the cornea to alter the focus and improve vision. Like LASIK surgery, this is an outpatient procedure than takes little time.

There are several different laser surgery methods available as alternatives if you are not a good candidate for LASIK eye surgery. One of the best known, and most widely performed, is photorefractive keratectomy (PRK), which uses a laser to sculpt the cornea’s exterior surface. (LASIK makes changes inside the cornea.) For patients with low to moderate nearsightedness and farsightedness, with or without astigmatism, PRK has proven extremely beneficial. This procedure is often recommended if you have certain corneal conditions, such as ulcerated areas, scarring, or what is called “recurrent corneal erosion.” It takes longer to achieve a final result from a PRK surgery because there is a greater amount of tissue that requires healing.

A new procedure called laser epithelial keratomileusis (LASEK) - simply a modification of photorefractive keratectomy (PRK) - was developed by an Italian surgeon and first described in the medical literature in 1999. In the LASEK procedure the surgeon loosens the outer layer of the cornea (epithelium); but, unlike PRK, the epithelium is not removed but folded back so the laser can sculpt the cornea as it is exposed. After applying the laser, the surgeon replaces the epithelium over the cornea. Vision recovery following LASEK is usually faster than with PRK, but slower than LASIK.

The LASEK procedure, which utilizes the eye surgeon’s favorite laser (called an “excimer” laser), is not FDA-approved. Surgeons cannot advertise the LASEK procedure except to get subjects for clinical trials. Early results with this procedure are promising, but many additional studies are required before LASEK is accepted as a safe, effective procedure.

Research continues on both surgical and non-invasive vision correction procedures. Using a variety of approaches, from implanting plastic pieces to reshape the cornea to using different heat sources than lasers (like radio waves and probes), doctors and physiologists continue to make progress in the treatment of various eye maladies. Somewhere among the many existing and soon-to-arrive techniques, from LASIK to LASEK, there is bound to be one that matches up well with your diagnosis, goals, expectations and comfort level.