Alternatives to Traditional LASIK: Surgical & Alternative Options

While LASIK works for most people, there are many alternatives available as well, including both surgical and nonsurgical options.

LASIK is the most popular and recognized surgical option to fix refractive errors, and it works well for the majority of those who have received it. However, some people are not good candidates for LASIK. Maybe they have thin corneas, a cataract, or a high level of refractive error like myopia, which means they are less likely to benefit from LASIK.

There are many other refractive surgeries available that might suit your needs better than LASIK. If you are not interested in managing postsurgical healing or side effects, there are nonsurgical options available as well.

Refractive Surgery: Options Beyond LASIK

LASIK is one of the most popular eye surgeries in the world, helping millions of people with refractive errors like myopia, hyperopia, and astigmatism get clearer vision.

Although more than 90 percent of patients achieve 20/20 vision, LASIK specialists note that they aim for at least 20/40 vision, which is strong clarity without glasses or contact lenses. More than 95 percent of LASIK recipients report high satisfaction with the results, even when it doesn’t result in “perfect” eyesight.

Laser-assisted in situ keratectomy, or LASIK, was approved for commercial use in the United States in 1999, by the U.S. Food and Drug Administration (FDA). Although it has the most name recognition, there are other surgeries to correct refractive errors that might be a better fit for someone seeking to improve their vision.

There are many reasons someone might not be a good fit for LASIK. This article can help you find alternatives to LASIK.

Looking for the Best LASIK Near You?

Find a LASIK Surgeon

Surgical Alternatives to LASIK

Photorefractive keratotomy (PRK)

This procedure was developed in the 1980s, around the same time LASIK was developed, but it was approved before LASIK, in 1995. PRK is very similar to LASIK.

It uses guided femtosecond lasers to create a flap in the epithelial layer of the cornea. It also uses another laser to reshape the cornea to correct the refractive error, and it takes 15 minutes or less per eye. PRK requires a few weeks to heal, which many people find inconvenient, while LASIK allows the recipient to return to work the next day.

PRK is a better option for people who have naturally thin corneas, chronic dry eye, or high levels of myopia.

Refractive lens exchange (RLE)

People who have cataracts and a high refractive error are not good candidates for either LASIK or PRK. Additionally, people with presbyopia, or age-related farsightedness, are not good candidates for laser eye surgeries. However, they may find that refractive lens exchange works well for them.

This procedure involves removing the natural lens (removing any cataracts in the process) and replacing it with a lens that reshapes the cornea. This can refract light more clearly to the retina, to improve vision.

This procedure is especially helpful for older adults who have developed presbyopia and either are in the early stages of cataracts or at higher risk for cataracts.

Phakic intraocular lenses

Sometimes called permanent contact lenses, phakic IOLs are artificial lenses that are implanted into the eye, leaving the natural lens in place but adjusting how light is refracted through the eye.

The FDA has approved all types of phakic lenses to correct myopia (nearsightedness). Some also work well for astigmatism or farsightedness. These lenses are intended to be permanent, unlike contact lenses, which work similarly but are removable.

Radial keratotomy (RK)

This procedure was developed in the 1970s and became popular throughout the 1980s and 1990s until laser-based refractive surgeries replaced it. RK is only approved to correct myopia, which is defined as the focusing power of the eye being too strong, leading to blurry distance vision.

Radial keratectomy is a series of incisions on the surface of the cornea in a wheel-like or radial pattern that flattens the cornea to improve visual acuity. This process does not work for astigmatism or farsightedness, while both PRK and LASIK are good options for these refractive errors.

Intacs

This is an implantable, biocompatible plastic lens that is designed specifically for the treatment of keratoconus, a condition causing the surface of the cornea to bulge out in a cone-like shape. Keratoconus causes blurry vision that is difficult to treat with contact lenses and laser procedures like LASIK.

There are two lenses that are implanted into the eye, like an RLE procedure, but these devices serve to flatten the cornea, improving keratoconus and vision overall.

Nonsurgical Alternatives

Orthokeratology (Ortho-K)

This approach to vision correction might be a good option for those who are averse to surgery but do not want to wear contacts or glasses all day. Ortho-K predominantly corrects myopia, so those with other refractive errors may not be suitable.

The process works somewhat like braces. Specially-fitted lenses are worn while you sleep, subtly adjusting the shape of your cornea. When you take them out in the morning, these lenses have corrected your nearsightedness to 20/40 vision or better.

The effects wear off during the day, so you will need to continue to wear the special lenses at night, but you will not need to use corrective eyewear while you are awake. In some instances, Ortho-K is used to correct children’s nearsightedness, but this is rare.

Glasses and contact lenses

These are the traditional methods of correcting refractive errors, and these options are most effective for people who have consistently changing refractive errors. Glasses are the oldest form of vision correction, while contact lenses have been developed since the 20^th century.

Both options need routine cleaning and maintenance, including regular visits to an optometrist to monitor any changes in the prescription. Glasses can feel bulky or get lost or broken easily, while contact lenses can also get lost, be difficult to clean, or cause dry, itchy eyes.

However, these corrective lenses are the default options for people with refractive errors. They may still be used by people who have had refractive surgery, if their eyes begin to change again.

Are These Options More Effective Than LASIK?

Each option to correct a refractive error has positives and negatives. For example, surgical options still require some healing time and have a low risk of postsurgical complications, like under-correction or infection. Nonsurgical options carry fewer risks but require consistent maintenance.

LASIK is the most recognized surgical option to correct a refractive error and is a great option for most people. Understanding that there are other options that might work better for you, especially if you have other types of vision problems, can help you make the best choice for yourself. If you decide you are not interested in surgery due to risks or other factors, glasses and contact lenses are a viable option, and they are usually covered by vision insurance.

References

1. The 25^th Anniversary of Laser Vision Correction in the United States. (March 2021). Clinical Ophthalmology.

2. LASIK. (March 2018). US Food and Drug Administration (FDA).

3. What Is Photorefractive Keratectomy (PRK)? (September 2017). American Academy of Ophthalmology (AAO).

4. Photorefractive Keratectomy. (January 2022). EyeWiki, American Academy of Ophthalmology (AAO).

5. Refractive Lens Exchange in Modern Practice: When and When Not to Do It? (December 2014). Eye and Vision, BMC.

6. What Are Phakic Lenses? (January 2018). U.S. Food and Drug Administration (FDA).

7. Radial Keratotomy, Surgical Procedure. Britannica.

8. Intacs for Keratoconus. (Summer 2006). International Ophthalmology Clinics.

9. What Is Orthokeratology? (September 2018). American Academy of Ophthalmology (AAO).

10. Eyeglasses and Contact Lenses. University of Rochester Medical Center.