In this blog post, we take a detailed look at the types of vision correction surgery, their safety, and considerations for those seeking to escape the inconvenience of glasses and contact lenses.
Vision correction surgery: Is it the right choice for me?
“Contact lenses aren’t like instant noodles—they’re like cigarettes!” That’s what my doctor told me when my corneas swelled and my eyes hurt from wearing lenses for too long. It meant lens wear was harmful to my eyes, and I should cut back. While getting treatment at the hospital, I wore glasses for two weeks. Having worn lenses for so long, glasses felt uncomfortable. During that time, I started thinking about getting vision correction surgery. I searched extensively online and listened to people around me. Most who had surgery in my circle experienced no major side effects and encouraged me to get it done. Despite many recommendations, I couldn’t bring myself to undergo the surgery right away. The reason was the serious side effect cases I encountered online. Seeing those cases amplified my fear of the surgery and made me very anxious about choosing a hospital. If you’re planning vision correction surgery, you might share similar thoughts. While many people undergo different types of vision correction procedures today, they often don’t know the differences between them. Here, we’ll explore the main vision correction surgeries: LASIK, LASEK, and intraocular lens (IOL) implantation, and discuss factors to consider before surgery.
Vision Correction Surgery Methods and Process
Vision correction surgery is broadly divided into two types based on laser use. LASIK and LASEK surgeries utilize lasers, while intraocular lens implantation does not. Lasers are used to reshape the cornea, thereby adjusting how light is refracted. For myopia, the laser flattens the central part of the cornea to reduce the degree of refraction. For hyperopia, the laser shaves the peripheral part of the cornea to make it more convex, thereby increasing the degree of refraction.
LASIK surgery was developed in the 1980s to address the shortcomings of the existing laser-assisted in situ keratomileusis (LASIK) procedure. The original excimer laser surgery involved removing the corneal surface epithelium and directly irradiating the corneal stroma, resulting in significant postoperative pain and a relatively long recovery period of about 4 weeks. LASIK surgery addresses these drawbacks by creating a corneal flap using a laser or microkeratome, lifting it, treating the target area with the laser, and then repositioning the flap. The flap repositioning requires no sutures, relying instead on the eye’s natural suction force. LASIK offers faster recovery and less haze and pain compared to excimer laser surgery.
While LASIK improved upon traditional excimer laser surgery, complications related to the corneal flap could still occur. To address this, LASEK surgery emerged, combining the advantages of excimer laser surgery and LASIK. LASEK is similar to LASIK, but the key difference is the use of alcohol. The procedure involves thinning and lifting the corneal epithelium with diluted alcohol, then treating the exposed area with a laser before repositioning the epithelium to complete the surgery.
Intraocular lens implantation surgery involves inserting a lens into the eye while leaving the natural lens intact. Representative procedures include ICL (Implantable Contact Lens) implantation and Altis lens implantation. The two procedures differ in the lens placement location. ICL insertion places the lens in front of the natural lens, while AltiSan lens implantation fixes the lens to the iris. The surgery is completed by making an incision in the cornea to insert the lens, then suturing the cornea closed.
Side Effects and Risks of Vision Correction Surgery
According to data from the Ministry of Health and Welfare, approximately 200,000 people undergo vision correction surgery annually in Korea. This indicates that many people believe vision correction surgery is safe. With technological advancements, surgical instruments have also improved, significantly reducing side effects. According to a survey by the Korea Institute of Health and Social Affairs, the rate of patients experiencing serious side effects after LASIK or LASEK surgery is less than 1%. While many doctors assert the surgery itself is safe, inadequate preoperative examinations can lead to complications.
It is impossible to predict with certainty what will occur before surgery. Postoperatively, minor side effects such as dry eye, blurred vision, corneal haze, decreased visual acuity, and glare may occur. In severe cases, it could lead to blindness. However, while serious side effects like blindness are difficult to treat, minor side effects are treatable. For example, dry eyes after surgery gradually subside within 3 to 6 months, and blurred vision naturally resolves once the corneal epithelial cells fully regenerate. Corneal haze can be addressed with steroid eye drops or corneal irrigation. If the corneal flap becomes uneven or wrinkled, causing vision loss, it usually recovers over time. Glare when looking at light also disappears once the corneal flap settles into place. Overcorrection or undercorrection of vision can be treated with a supplementary procedure.
However, one cannot be complacent just because these side effects are mostly minor. Recently, a post by a father of a 21-year-old daughter on Facebook caused a significant stir. After LASEK surgery, his daughter could not distinguish objects and saw everything blurry; ultimately, she became so despondent that she took her own life. This incident serves as a stark warning about the risks of vision correction surgery and reminds us once again that it must be approached with caution.
Considerations Before Vision Correction Surgery
The most critical priority before undergoing vision correction is selecting the right hospital and surgeon. While it would be ideal if all hospitals employed experienced and skilled surgeons, reality is different. This is evident even in the less than 1% complication rate. The CRSQA (Refractive Surgery Quality Assurance Committee) provides a checklist of items to verify with surgeons before vision correction surgery. It is preferable if the surgeon has at least 3 years of experience in vision correction surgery and has performed surgery on over 400 patients in the past year. Additionally, you should verify whether the surgeon achieves a visual acuity of 1.0 or better in at least 50% of their patients, uses FDA-approved lasers, and does not employ exaggerated advertising. Hospitals offering excessively low costs should be viewed with suspicion.
After selecting a hospital and surgeon, choose the procedure best suited to you. LASIK offers stable vision and quick recovery but is unsuitable for those with thin corneas. In such cases, LASEK is recommended, as it is also for individuals with small eyes or long-term contact lens wearers. Patients with severe myopia ineligible for both LASIK and LASEK may opt for intraocular lens implantation. Intraocular lens implantation offers advantages such as minimal pain and the ability to remove the lens if results are unsatisfactory, but it is more expensive.
Vision Correction Surgery and Quality of Life
The reason for choosing vision correction surgery over glasses or contact lenses is to enhance quality of life. One study found that myopic patients who underwent LASIK surgery reported a higher quality of life than those who did not. This study used the QIRC questionnaire, developed by the Department of Optometry at Bradford University in the UK in 2004, to measure quality of life. Glasses are safe for eye health but come with various inconveniences. Contact lenses solve these inconveniences but are not good for eye health. For this reason, many people choose vision correction surgery, and careful consideration is necessary to achieve satisfactory results.
