There are several laser eye surgery options, but LASIK (laser-assisted in situ keratomileusis) surgery is by far the most common method and, for most patients, the best option.

LASIK comes in several flavors, including conventional, monovision, bladeless, and custom “wavefront-guided” LASIK. The differences among these approaches lie mostly in the technology used. But it’s most important for patients to carefully choose their surgeons—and to consider whether to have any surgery at all.

All the LASIK options involve making precise measurements of your eye that enable the surgeon to slice open and pull back a small flap in the cornea, then use a computer-guided laser to reshape the cornea. This reshaping causes the cornea to re-bend the light entering the eye to correct for the refractive errors present in the eye at the time of surgery.

PRK (photorefractive keratectomy) and LASEK (laser epithelial keratomileusis), or Epi-LASIK, are other laser-surgery options. PRK was one of the first laser-eye-surgery methods developed for vision correction and is still used for patients whose corneas are too thin to undergo LASIK or who have jobs (police, firefighters, military, construction) or play sports that carry a high risk of eye injury.

Unlike LASIK, PRK does not involve slicing and temporarily lifting away corneal surface tissue. Instead, the surgeon uses a laser to reshape the surface of the cornea directly. After surgery, a contact lens is placed on the eye to act as a bandage for three or four days; eventually the raw surface of the cornea heals on its own.

The long-term results from PRK are as good as those of LASIK, and PRK costs about the same. But while PRK requires no cutting, it may take two months or more for the cornea to heal sufficiently to restore normal vision—which explains why it’s performed only on patients who specifically need it.

Small incision lenticule extraction (SMILE) is a newer type of refractive surgery that uses a laser to create a disc of tissue, called a “lenticule,” within the inner layers of the cornea. After the lenticule is created, it is removed through a small incision, leaving a newly shaped cornea behind.

Intraocular lenses (IOLs) also can be a surgical option for those who aren’t good candidates for LASIK. They’re also offered to age 40+ patients seeking LASIK and those heading into cataract surgery to replace the clouded lens with a clear one and correct vision impairments in one fell swoop. To place phakic IOLs, a surgeon makes an incision in the side of the eye and places a lens either between the cornea and iris, or between the iris and the lens. Regular IOLs also require an incision, but they involve removal of the natural lens and replacement with an artificial one. Both types use prescriptions that bend the light entering the eye to correct for the refractive errors present in the eye.

IOL surgery’s main drawback is price: $4,000 to $6,000 per eye. It’s also a more invasive procedure than LASIK, which means a higher chance of serious complications.

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