Nearsightedness (Myopia)

Surgery

Several types of surgery for nearsightedness (myopia) are available to change the shape of the cornea and refocus light directly on the retina. However, surgery cannot correct pathological myopia.

The goal of surgery is to allow people who are nearsighted to see clearly without corrective lenses or to be less dependent on corrective lenses. Most doctors consider 20/40 vision or better after surgery a satisfactory result. People with 20/40 vision or better are allowed to drive a car without corrective lenses. Overall, most people who have surgery achieve 20/40 vision or better after surgery.

Laser surgeries include:

• LASIK (laser in-situ keratomileusis), which is currently the most commonly used corrective surgery for nearsightedness in Canada. LASIK has a high success rate and low complication rate for low to moderate nearsightedness. It may also be used to correct more severe nearsightedness. In general, it requires less healing time, is less painful, and offers a faster visual recovery than photorefractive keratectomy (PRK).
• PRK (photorefractive keratectomy) and LASEK (laser epithelial keratomileusis), which are similar surgeries. They are another type of corrective surgery for nearsightedness that is used frequently. Like LASIK, PRK and LASEK have high success rates and low complication rates for low to moderate nearsightedness. They may be used instead of radial keratotomy (RK) to correct severe myopia.

RK (radial keratotomy)

Radial keratotomy (RK) is very successful and safe for people who have mild to moderate nearsightedness (less than 3 dioptres). Although it is still used in some cases, it has been replaced in most cases by LASIK and PRK.

Corneal ring implants

This type of surgery to correct mild nearsightedness uses corneal ring implants to change the shape of the cornea.

Intraocular lens implants

Intraocular lens implants (IOLs) may be used to correct severe myopia. IOLs, also called implantable contact lenses (ICLs), have been shown to be a safe and effective means of correcting moderate to severe myopia.⁵

Surgery Choices

Laser surgery for nearsightedness changes the shape of the cornea to refocus light directly on the retina. There are three main types of laser surgery used to treat nearsightedness.

LASIK (laser in-situ keratomileusis) makes a small flap in the cornea and removes some of the tissue exposed by the flap.

PRK (photorefractive keratectomy) and LASEK (laser epithelial keratomileusis) use a laser to reshape the cornea. The laser is applied to the cornea after the surface layer has been removed.

Radial keratotomy (RK) uses several incisions on the cornea to change the curve of the cornea over the pupil.

Other types of surgery for nearsightedness involve the surgical placement of implants to either change the shape of the cornea or replace or assist the eye's natural lens.

Corneal ring implants are clear pieces of acrylic that can be surgically implanted to flatten the cornea and reduce nearsightedness.

Intraocular lens implants replace the eye's natural lens with a clear plastic implant.

What To Think About

Of the three main types of refractive surgery, RK has been in use the longest time, but PRK and LASIK are now more commonly used. Studies suggest that laser surgery such as PRK and LASIK is at least as accurate as radial keratotomy (RK) and has less risk of overcorrection or troublesome side effects. But some people may choose to wait for more information about the long-term outcomes of laser surgery before they decide to have it.

If you find that glasses or contact lenses are inconvenient, surgery to correct nearsightedness may be appropriate. But nearsightedness is not a disease, and a nearsighted eye is otherwise normal and healthy.

Weigh your desire to have clear vision without glasses or contacts against the risks of surgery. Ask your eye doctor any questions about surgery that you have (for example, what are the risks, benefits, possible outcomes, and alternatives to surgery) so that you have a good understanding of your options and can make the best decision.

Should I have laser surgery for nearsightedness?

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Author:	Robin Parks, MS	Last Updated: August 22, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Carol L. Karp, MD - Ophthalmology Andrew Swan, MD, CCFP, FCFP - Family Medicine
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