Corneal Associates, PC
840 Walnut Street
Philadelphia, PA 19107-5109
Visual problems, including nearsightedness, farsightedness, astigmatism, and even higher-order aberrations, can be safely and effectively addressed by today’s refractive surgery procedures. The Corneal Associates at Wills Eye Institute offer our patients the most advanced ophthalmologic procedures, such as custom LASIK and advanced surface ablation, as well as RK and AK to surgically correct myopia (nearsightedness) and astigmatism.
While the traditional LASIK procedure is excellent in addressing common problems like nearsightedness or farsightedness, it is unable to precisely address your eyes’ unique visual irregularities. Custom LASIK, also known as Wavefront™-guided LASIK, allows our surgeons to completely individualize your surgery based on your particular visual distortions. The result is an effective correction of even your most minute visual errors and a reduced risk of visual side effects.
Common terms like “20/20” or “nearsighted” refer to how far you are able to see. But what about how well you see? Your visual acuity—your ability to see contrast, fine detail, and the like—is shaped by the presence and magnitude of visual errors known as higher-order aberrations. These higher-order aberrations can especially influence the quality of your night vision, and may cause you to be sensitive to glare and see halos and shadows.
Traditional LASIK is unable to address these higher-order aberrations, and may even induce them as an unwanted side effect. However, the fully individualized treatment afforded by custom LASIK has a double-pronged advantage: it addresses your unique imperfections (the higher-order aberrations that affect your vision), and reduces the risk of negative visual side effects like glare, halos, and shadows. While undercorrection and overcorrection are risks of custom LASIK, just as they are risks of traditional LASIK, custom LASIK is capable of more precise treatment.
The LASIK procedure, whether custom or traditional, is essentially the same. The surgeon uses anesthetic eye drops to numb the eyes and then uses a microkeratome to cut a flap in the cornea, the clear part covering your eyes. This flap is folded back, and an excimer laser is used to reshape the exposed corneal stroma according to your visual needs. If you are nearsighted, your corneas are made flatter; if you are farsighted, your corneas are made steeper. Astigmatism is addressed by making your cornea more spherical.
The excimer laser used during the custom LASIK procedure is the same as that used in traditional LASIK. The difference is that the custom LASIK laser is guided by a detailed, three-dimensional map of your unique visual irregularities, known as a wavefront map. This mapping is made possible by a Wavefront™ device, which precisely registers your visual irregularities by passing a safe beam of light through your eyes, then capturing the distorted waves as they exit.
While custom LASIK costs slightly more than standard LASIK, and involves additional testing, its benefits are clear. Custom LASIK has a better chance of producing 20/20 or better vision. It also has a reduced probability of inducing glare, night-vision disturbances, and other problems with the quality of vision.
Advanced surface ablation (ASA) is a refractive procedure that can treat nearsightedness, farsightedness, and astigmatism.
During the ASA procedure, the surgeon loosens the epithelial cells that cover your eye using an alcohol solution. These epithelial cells are removed, and the corneal surface is treated with an excimer laser, just like in LASIK. As in LASIK, a steeper cornea will be made flatter to correct nearsightedness; a flat cornea will be made steeper to correct farsightedness; and to correct astigmatism, the cornea will be made more spherical. If astigmatism accompanies nearsightedness or farsightedness, ASA can be used to treat both problems.
The key difference between LASIK and ASA is that, in the latter procedure, there is no creation of a corneal flap using a microkeratome. Therefore, no flap complications can occur.
For those who can’t undergo LASIK because of wide pupils, thin corneas, eye pressure problems (such as from glaucoma), or corneal dystrophy, ASA may be an excellent choice. ASA is also a good refractive surgery choice for patients who want to avoid the flap complications or dry eye problems that can arise with LASIK surgery. Overall, ASA is a slightly safer procedure than LASIK.
ASA is performed in about 15 minutes, after anesthetic eye drops are administered to ensure the patient’s comfort. Following the procedure, patients will wear protective contact lenses, and visual improvements will be noticeable within a few days. The final results of the procedure may take up to six months to appear.
Many of the risks of LASIK surgery, including undercorrection or overcorrection, apply to ASA. Still, ASA is an excellent choice for those disqualified from undergoing LASIK surgery, and has many advantages.
RK and AK are other types of refractive surgery. RK (radial keratotomy) corrects myopia (nearsightedness), while AK (astigmatic keratotomy) is used to correct astigmatism.
During RK and AK, a diamond blade is used to create microscopic incisions in the cornea, reshaping it in a way that will improve the patient’s vision. In RK, the incisions are radial, like bicycle spokes, and sufficiently deep to flatten the patient’s cornea. In AK, the slits are made on the steepest part of the cornea, causing it to relax and become more spherical.
For low degrees of correction, RK and AK are safe and effective. They can be performed in conjunction with other refractive procedures. However, they do weaken the eye, making it more vulnerable to trauma and long-term refractive changes. They are also less predictable and precise than LASIK and advanced surface ablation, and have largely been supplanted by these procedures.
Because the refractive surgeons at Corneal Associates are corneal specialists, they are uniquely suited to perform custom LASIK and other refractive procedures that involve the precise reshaping of the cornea. Dr. Rapuano performs LASIK procedures at Wills Eye Institute.
The corneal specialists/LASIK surgeons at Wills Eye Institute are especially skilled at determining candidacy for LASIK. The careful screening of prospective LASIK candidates leads to a decreased risk of complications after surgery. We have found that expert assessments of who is, and who is not, a suitable candidate for LASIK result in patients who end up being happier with their surgery.
Our LASIK surgeons handle all pre- and post-operative care for our LASIK patients, so those who turn to Wills Eye Institute for refractive surgery are assured of receiving care from an experienced doctor familiar with their case. Dr. Rapuano is known for being such a skilled specialist that other LASIK surgeons commonly refer patients to him when complications occur.
At Wills Eye Institute, you will undergo a refractive procedure that precisely and correctly addresses your visual errors the first time. Our LASIK surgeons are also experts in the cornea, so they offer each patient an unparalleled degree of specialized knowledge, skill, and experience in refractive procedures. Contact us today to learn more about refractive surgery.