LASIK and Beyond: Newest Advances in Technology and Surgery Options to Correct Nearsightedness, Farsightedness and Presbyopia

Think about how fast the technology in your personal world has developed. A dozen years ago, there was no Twitter[i] or YouTube[ii], and Facebook was still just a college website founded by a 19-year-old.[iii] The iPhone was yet to be invented,[iv] tablets were still made of paper, and the only clouds you talked about had to do with the weather.

OK, you say, but what does all that have to do with my eyesight?

The answer is this: Developments in technology have revolutionized every industry, and medicine – including eye care and surgery – is no different. Techniques and tools that were at the forefront a decade ago are giving way to even newer and more progressive approaches today.

Technology evolves in three stages, said Czechoslovakian philosopher Radovan Richta in 1967[v]: The invention of tools, followed by the progression of machines, followed by the precision of automation.[vi] Each evolution, Richta said, gave us more control over the natural environment – and therefore more ability to change it in ways that benefit us.

What that means for your eyes is this: Pre-eminent eye surgeons now have access to technology superior to that in the past, which means surgery techniques have changed and outcomes can be even better. The LASIK surgery you may be familiar with has grown into an even more sophisticated version, while new procedures now exist for when LASIK is not appropriate. Implantable Contact Lenses (ICL), for instance, help those who have dry eye syndrome or severe nearsightedness, and new implants called Raindrop Near Vision Inlays can help those with presbyopia, the farsightedness caused by aging.

Read on to learn about these and other developments in the eye-care industry. Remember, you and your doctors have the same objective in mind: the clearest vision possible. One place to begin is with a LASIK questionnaire, which you can find here. It will ask whether you are nearsighted, farsighted or have an astigmatism, whether you wear glasses, contacts or reading glasses, whether you have had any previous eye surgeries and more, and will give you an opportunity to request more information.

Why New Technology Matters

Refractive surgery is surgery that corrects your vision so that you no longer need glasses or contacts, and LASIK – the term stands for laser-assisted in-situ keratomileusis[vii] – continues to be the most popular refractive surgery, due to its wide acceptance and patients’ satisfaction with their surgical outcomes.[viii]

Leading-edge technology today begins with the laser that a surgeon uses. Barnet Delaney Perkins uses the WaveLight Allegretto Wave Eye-Q laser[ix], a laser approved by the FDA for topography-guided laser vision correction. Its advancements include a super-fine laser beam that centers automatically and an eye-tracker that notes even minuscule eye movements before laser pulses begin. [x]

If you first learned about LASIK years ago, you probably are more familiar with previous versions of the surgery. In earlier years of LASIK, surgeons numbed the eye with anesthetic eye drops and then used a tool called a mechanical microkeratome[xi] to cut a thin, hinged flap into the cornea. The flap was folded back, and the surgeon guided an excimer laser over the middle of the cornea to reshape it. (Unlike earlier lasers, excimer lasers could make vision corrections without harming nearby tissue.) When finished, the corneal flap was laid back into place, where it would heal on its own.

Another technological innovation changed LASIK when doctors began using laser energy to replace the microkeratome blade in cutting the corneal flap. This femtosecond laser was called IntraLase[xii], and was even more precise in many situations.[xiii] This meant, among other things, that even people with very thin corneas – some who were previously unable to have LASIK – were now candidates for the procedure.[xiv]

Newer yet was a machine called a “wavefront guided laser,” which offered surgeons eye measurements in smaller increments and actually mapped how light traveled through the eye and landed on the retina.[xv] With this information, the laser had a path as individual as a fingerprint to follow.

Today, the surgeons at Barnet Dulaney Perkins use Contoura Vision/Topography-Guided LASIK, which measures the curvature and characteristics of the surface of your eye to a degree not possible with previous technology. Think of a topographic map of the United States – the layers build up where there are hills and mountains, recede where there are valleys or lakes, and curve where the landscape has sculpted itself around a fixed object. The topography of your eye is similar, in miniature, and topography-guided LASIK can follow that individual map of your eye. It is customization to the extreme.

When Contoura Vision/Topography-Guided Lasik was studied in clinical trials, researchers saw the following results:[xvi]

The new technology reduced the number of post-operative complaints about glare, sensitivity to light and difficulty with night driving due to a halo effect;
92 percent of patients had 20/20 or better vision after their procedure; and
98 percent of patients said they would choose the procedure again.

Technological progress always brings with it the question of what went before – were old procedures bad? No. In LASIK’s case, there have long been high success rates and high numbers of satisfied patients. But when a technological development makes an even more sophisticated and precise result achievable, it is the option a surgeon will favor. The surgeons at Barnet Dulaney Perkins use only topography-guided LASIK now, consistent with their belief that it is the best and safest tool available.

When ICL Is Needed Instead

Not everyone is a candidate for LASIK surgery. People with extremely thin corneas, for instance, those prone to dry eye syndrome or those who have extreme prescription correction needs may not get the vision correction results they seek. But there are significant technological developments in other aspects of eye surgery that can help these and other patients.

One of the newest technologies available actually has its roots in the treatment of an old condition: cataracts. A cataract happens when the natural lens we are born with get clouded over, affecting the clarity of our vision and our impressions of light and color. In cataract surgery, tiny incisions are made near the edge of the cornea, allowing the surgeon to remove the clouded lens and insert a new, clear lens, called an intraocular lens (IOL)[xvii]. The lens takes over where your old lens was, refracting light back toward the retina. Your sight improves immediately, because the clouded lens is gone.

For a long time, the only lenses used in cataract surgery were monovision lenses – in other words, “single vision,” or lenses that simply focused on one focal point, that being distance.[xviii] This meant that after surgery, people still needed corrective lenses – eyeglasses or contacts – for their near vision. But the development of multifocal lenses – lenses which improve vision at all distances – actually made it possible for cataract patients to leave their surgeries needing no further vision correction at all. It was the equivalent of having a prescription contact lens implanted in your eye instead of wearing it on the outside.

Now, these implantable contact lenses (ICL) are available to people who do not have cataracts, but want to improve their vision. Instead of altering the outer surface of the eye, as in LASIK surgery, implantable contact lenses correct a patient’s vision from inside the eye. No change takes place on the cornea.

Why are Visian implantable contact lenses suitable in patients where LASIK surgery is not?

It will help if you understand the cornea a little bit. Your cornea is the transparent, outer, dome-shaped, protective surface of your eye. It is made up of membranes, tissue and fluid.[xix] Your cornea has a curvature that, in the best possible circumstances, bounces light back through the pupil and through the natural lens toward the retina, focusing it at exactly the right angle. However, if the curvature of your eye is off, your cornea can bounce light too far in front of or too far in back of the retina to focus clearly. If your eye focuses the light before it reaches the retina, you are nearsighted. If your eye focuses the light behind where it hits the retina, you are farsighted.[xx]

LASIK surgery, therefore, adjusts that outer surface of the cornea, making the light refract properly. In the following cases, however, LASIK may not always be appropriate[xxi]:

Patients with thin corneas: The concern about whether a patient’s corneas are too thin for LASIK surgery is logical; since a flap must be cut in the cornea and folded back before the laser is used, there will be less corneal tissue for the surgeon to work with. Because Visian implantable lenses are placed inside the eye, there is no change to the cornea at all.
Patients with dry-eye syndrome: A person gets dry-eye syndrome when their eyes fail to naturally produce enough tears. It sometimes happens with aging, but also can accompany some medical conditions, such as Sjogren’s syndrome, diabetes and lupus, and some medications.[xxii] Because LASIK surgery often can produce temporary dry-eye symptoms, doctors don’t want to make an already uncomfortable condition worse.[xxiii] Implantable contact lenses, however, do not contribute to dry eye syndrome.[xxiv]
Patients needing extreme prescription correction: Because LASIK corrects vision by altering the surface of the cornea, there are limits to the degree of myopia, or nearsightedness that can be corrected. The United States has approved LASIK treatment for a prescription up to -12 diopters (D), but some doctors believe -8 D should be the limit. Visian implantable lenses, however, can be used in cases of extreme refractive error.[xxv]

Like cataract surgery, vision improvement with implantable contact lenses will be immediate.

Unlike the procedure in cataract surgery, the patient’s natural lens is left in the eye. The Visian Implantable Contact Lens works with that lens to improve your sight. The implant is permanent, and most patients never need further adjustment or surgery on it. In a case where a patient’s prescription needs are drastically altered, however, the ICL is removable and replaceable.

What if I Wear Reading Glasses?

Right around age 40, it begins to happen. Menus seem harder to read; are all restaurants so poorly lit? The information on the back of a bottle of medication seems impossible to decifer; have they made the type even tinier? Even the newspaper text looks blurry. Why do they use such a small type size?

It’s presbyopia. It’s normal. And it’s why there are display racks of reading glasses in every pharmacy and grocery store. A natural part of aging, presbyopia makes it harder to focus on close objects – like that menu or medicine bottle. In presbyopia, the natural lens is hardening, and becomes no longer able to precisely focus light back to the retina as needed.[xxvi]

The need for reading glasses is so common – and the task of buying them for a few dollars without a prescription is so simple – that we tend to think of presbyopia as minor.

But when you really need them, dealing with reading glasses can seem frustrating and constant. You’re always putting them on, then taking them off; putting them on, taking them off. One defense mechanism is to buy several pairs and leave them all over – at work, another in your car, at home on your desk, in the kitchen and on your nightstand. It’s a good strategy, but there are still times you can’t find a pair.

It’s always been a hassle, with little to do except buy more pairs of readers. But a new technology called Raindrop[xxvii] Near Vision Inlays is addressing presbyopia.

The inlays are small, round, transparent discs; their appearance is similar to that of a soft contact lens, only much, much smaller: it is the size of the head of a pin, and half as thick as a human hair.[xxviii]

As in LASIK, a small flap is created in the cornea of your non-dominant eye. (Your eye doctor can easily help you figure out which of your eyes is the dominant one). The flap is folded back, and the Raindrop Inlay is centered over your pupil. The flap is then closed, and the eye heals naturally.[xxix]

The inlay changes the shape of your cornea, compensating for your natural lens.[xxx] While the inlay is only in one eye, that’s not a problem; your brain already combines the different images it receives from your left eye and right eye into one panoramic view. With the inlay, your brain simply will add the near-vision information it now receives from your non-dominant eye into that overall view. And that’s what then allows you to read that tiny type on the medicine bottle, or show off in the restaurant by telling your friends what’s on the menu while they look for their reading glasses.

Why do LASIK costs vary so much? Does insurance cover it?

This can be confusing to anyone. Maybe you’ve had a consultation with an eye surgeon for LASIK who quoted you one cost, and later that day you see an advertisement for “Cheap LASIK,” or “Low-Cost LASIK,” or “LASIK starting at $299 per eye.” How can the cost vary so widely?

There are multiple factors here:

What’s behind the advertising: We all understand the concept of a low price on a car that gets someone in the front door of a dealership, but once they get there the specific the car is gone. Other cars are available, but all are more expensive. It’s called baith-and-switch, and it can be the same with LASIK advertisements. You may walk in the door hoping to pay $600 to have LASIK on both eyes, but walk out with a much higher cost because your eyes require a higher level of correction, because you choose a specific kind of procedure or because of add-on fees.. (The advertised cost may not include all required pre- and post-op visits.)[xxxi]
The technology: Is your surgeon using the latest, most precise laser machines available? Due to the fact that LASIK technology has been upgraded several times over the years, there may be many older machines still in use that, while still operable, may not give you the results available with newer technology today.[xxxii] The cost of new technology does bring the price up, but the improvement in the procedure and in your resulting vision are what matter most.
The experience of your surgeon: New surgeons must start somewhere, but you’d rather it not be on your eyes. An experienced LASIK surgeon may have done 10,000 to 25,000 procedures or more. (And those numbers happen after proper industry screening standards are met, which means somewhere between 10 percent to 25 percent of patients ended up not being good candidates for the procedure.[xxxiii])

The amount you pay for your LASIK surgery doesn’t start or stop with the 10 or 15 minutes you are in surgery. It includes pre-op consultations, tests and examinations; prescription eye drops; the procedure itself; post-op consultation and checks, and surgery enhancements if needed.

Some insurance companies may cover the cost of LASIK, but most do not, primarily because it is seen as an elective procedure. However, some of the nation’s biggest insurance providers have negotiated with LASIK providers for a discount, so ask your surgeon if this is available with yours.

Very occasionally, if it can be proven that superior eyesight without eyeglasses or contacts is needed for your occupation, insurance may cover the cost. It’s certainly worth asking.[xxxiv] If you have flexible spending accounts with your employer – accounts where you can set aside pre-tax dollars for medical costs – it’s worth using that advantage to help pay for your eye surgery.

In any case, should the cost of your LASIK surgery exceed your flexible spending or insurance coverage, most eye surgery centers make financing options available. One such option is Care Credit, a healthcare financing company that offers payback programs (such as reduced APR or longer-term fixed monthly payments) that are not available through an ordinary credit card.[xxxv]

You have to choose based on what’s best for your eyes, not just the bottom line. Your vision is worth that.

Making Your Decision

Will LASIK surgery continue to evolve? Of course, as it should. Each advancement paves the way for the next. On the horizon, it may be possible for a femtosecond laser to flapless laser surgery, entering the eye as though through a keyhole.[xxxvi] [xxxvii]

But If you are considering vision correction surgery today, you want surgeons with the most experience, state-of-the-art technology and peerless aftercare. For LASIK surgery, that choice right now is topography-guided LASIK, where even the infinitesimal characteristics of your unique eye are factored into the machine’s calculations about how to improve your eyesight.

The cost may seem substantial, but the payoffs are moreso. Being able to do such things as wake up in the morning and see what time it is, read the paper, watch the television, drive to work and go to the gym at lunchtime – all without glasses – pay everyday dividends that reach far into the future.

When you get right down to it, the eye is a complex, multi-faceted little miracle. Any single thing about it – Its complicated structure, the way it processes light or the way it sends information to the brain – is amazing. It deserves to be taken care of.

If you have more questions or are interested in more information about LASIK surgery, implantable contact lenses or vision inlays to correct presbyopia, the staff at Barnet Dulaney Perkins wants to help. Call us at 800-966-7000 to speak with a patient representative, or submit a form here online. [xxxviii]

[i] The Wall Street Journal, Twitter’s Founders: Where Are They Now?

[ii] Mashable, The Revolution Wasn’t Televised: The Early Days of YouTube

[iii] Business Insider, At Last – The Full Story of How Facebook Was Founded

[iv] The Guardian, The History of Smartphones: Timeline

[v] Amazon, publication date for Civilisation at the Crossroads: Social and human implications of the scientific and technological revolution

[vi] Technology and Society, 3^rd Edition, Study Guide, Chapter 1, Chapter Highlights, Page 6, Technological Evolution

[vii] PubMed.gov, U.S. National Library of Medicine, Laser-assisted in-situ keratomileusis (LASIK) versus photorefractive keratectomy (PRK) for myopia

[viii] American Refractive Surgery Council, Why LASIK Remains the Most Popular Vision Correction Procedure

[ix] My Alcon, WaveLight Allegretto Wave Eye-Q Laser

[x] My Alcon, Flexible Performance From Your Excimer Laser System

[xi] Review of Ophthalmalogy, Is Intralase Better than Microkeratomes?

[xii] All About Vision, Bladeless LASIK: Femtosecond Laser eases LASIK Fears