Refractive Eye Surgery Options

In New York City


There are several vision correction procedures available that are suitable for different patients. The procedure that is best for you can depend on a variety of factors, including cornea shape/thickness, prescription, lifestyle, and age. Dr. Rapoport customizes each refractive plan to each patient.

Refractive Surgery Guide

LASIK – Laser- Assisted In Situ Keratomileusis

LASIK is a laser eye surgery that changes the shape of the cornea to correct the patient’s vision. This surgery is an option for patients with nearsightedness/myopia, farsightedness/hyperopia, and astigmatism. 
The procedure is as follows. A flap is created in the epithelium, or the front layer of the cornea. This flap is folded back, and the laser reshapes the cornea by removing corneal tissue. The flap is then repositioned- healing in the following weeks and months. Immediately following the procedure, you may feel that your eyes are itchy, watery, gritty. Your vision can also be blurry. In the following few months, as your eyes heal, you can notice an improvement in vision. 
Some of the risks or side effects of this surgery are dry eye or seeing glares or halos. These tend to clear up within weeks or months. However, for those already experiencing severe dry eye, it could worsen with LASIK. You could be a more appropriate candidate for an alternate vision correction procedure. LASIK is also not suitable for those with thin corneas, corneal diseases, large prescriptions, or those who participate in certain high contact sports. 

PRK – Photorefractive Keratectomy

PRK is similar to LASIK in the sense that it is also a laser eye surgery that changes the surface of the cornea. Like LASIK, it is appropriate for patients with nearsightedness/myopia, farsightedness/hyperopia, and astigmatism. It is different, however, in the technique. Unlike LASIK, there is no flap created for PRK. The surface epithelial layer is removed and the laser is applied. Apart from this difference, the general procedure follows that of LASIK. 
Patients can anticipate a longer healing time than with LASIK due to this removal of the surface layer. This healing time may be a period of discomfort, and it can take a week to experience clearer vision. This procedure may be better suitable than LASIK for those with thinner corneas, higher prescriptions, or those who participate in certain high contact sports. It may also be a better alternative to LASIK for patients with severe dry eye. 

SMILE – Small Incision Lenticule Extraction

SMILE is another technique of laser eye surgery.  Unlike LASIK and PRK, it is only appropriate for patients with nearsightedness/myopia or myopia with astigmatism. It cannot correct hyperopia. Newer than PRK and LASIK, it uses the Zeiss femtosecond laser to create a lenticule- a tiny, lens-shaped piece of corneal tissue- which is then removed by the surgeon. The incision made on the cornea surface is microscopic- making it relatively less invasive than PRK and LASIK. It can also treat prescriptions higher than LASIK can, up to a -10.
SMILE can take slightly longer to complete than the other two procedures, but it is still a one day procedure for both eyes. The recovery period, in contrast, is slightly faster. Since it disturbs less of the cornea, there is a reduced chance of post-op dry eye and any negative effects on the cornea nerves. Thus, it may also be a better alternative to LASIK for patients with severe dry eye. 
Like PRK, this procedure may be suitable for patients involved in high contact sports since they both avoid the risks associated with the creation and healing of a corneal flap. It is not suitable for those with conditions such as glare or halos since the procedure can worsen these. 

ICL – Implantable Collamer Lens

An alternate option is an implantable contact lens. During an ICL procedure, a lens is inserted behind the iris, or colored part in the eye, and in front of the actual lens. This lens functions much like a contact lens and can correct nearsightedness/myopia and astigmatism.
Since a lens has to be inserted, this procedure is more invasive than LASIK, PRK, or SMILE. However, since corneal tissue is not being removed, the complication of dry eye is avoided. The quality of vision with ICL can be better than that of LASIK, PRK, and SMILE, because the cornea is not touched, and there is no risk of glare and halos. ]  
The recovery period is around 1 to 2 days. This procedure may be suitable for those with too thin corneas to do LASIK or PRK and those with very large prescriptions. Additionally, patients are generally required to be above 21 years, under 40-45 years and have otherwise healthy eyes. The size of the eye must also be suitable for the placement of the ICL. 
This procedure is excellent for patients who have very high near-sighted prescriptions (over a -8 but can treat up to -15 and sometimes higher). It can also be an option for correcting the vision of patients with keratoconus, and safe to do so when they have already had cross linking performed.

RLE – Refractive Lens Exchange

Similar to ICL, refractive lens exchange also involves the insertion of a custom lens. Because of this, they share similar risks and possible complications. However, unlike ICL which places the new lens in front of the existing one, this lens replaces the natural lens completely. This procedure can thus correct for hyperopia and myopia. 
This procedure is typically suitable for patients older than 45 since it can help with both distance and reading vision, and the lens that is implanted corrects for all distances and corrects for astigmatism as well. It is also suitable for patients in their 60s or older since RLE and cataract surgery follow the same procedure. Having this procedure will prevent the possible development of a cataract in the future, which is an important benefit to this procedure.