Plenty of Toronto residents who thought they were going to be stuck wearing glasses or contact lenses for the rest of their lives breathed a sigh of relief when they learned about corrective eye surgery, which was first introduced sometime in the 1980s. Over the course of just a few decades, corrective vision procedures have advanced by leaps and bounds.

Learn more about the types of vision surgery available and whether corrective eye surgery is a good option for you.

Who Is a Candidate for Corrective Eye Surgery?

Corrective eye surgery isn’t right for everyone. Some people have eye conditions or other medical conditions that would complicate the surgery or the healing process. Here are a few people for whom corrective eye surgery wouldn’t be an option:

• People under the age of 18. Children aren’t good candidates for vision correcting surgery, as their eyes might continue to change shape as they grow, potentially undoing or changing the results of the operation.
• People with glaucoma. About a quarter million people in Canada have glaucoma, which causes increased pressure in the eyes and can lead to vision loss. Those who don’t have glaucoma under control are usually not good candidates for laser eye surgery, as the procedure can increase the pressure in the eye.
• People with large pupils. If your pupils are larger than average, even in bright conditions, corrective eye surgery is most likely a no-go. The laser might cause damage that leads to halos, ghosts or other vision issues.
• People with cataracts. Cataracts will interfere with the laser’s ability to reshape or improve the eye. You might need surgery to remove cataracts before you have surgery to correct your vision.
• People with dry eye. Corrective eye surgery can make dry eyes worse.
• People who are pregnant. Laser eye surgery isn’t recommended for women who are pregnant.

Along with people for whom corrective eye surgery is a no-go, there are a few who should proceed with caution before deciding to have surgery. In some cases, having certain conditions, such as diabetes, might rule out one type of eye surgery, but not others.

What Does Corrective Eye Surgery Correct?

When a person has perfectly healthy vision, the eye produces images by focusing them on the retina at the back of the eye. Vision problems that are caused by refractive errors occur when the images are produced or focused in another part of the eye.

Initially, laser or corrective eye surgery could only correct certain types of vision problems. But advances in technique mean that it is now possible to fix a full range of issues. Those issues include:

• Near-sightedness (aka myopia). People with myopia can see items that are close by. Things that are farther away look blurry to a myopic person. The condition is caused by the shape of the eye. A near-sighted person usually either has a cornea that curves sharply or an eye that is longer than usual. The shape of the eye or cornea causes light to focus in front of the retina, which makes things in the distance look blurry.
• Far-sightedness (aka hyperopia). People with hyperopia have pretty much the opposite problem as people with myopia. Their eyes are shorter than average, or their corneas are flatter than usual, which causes light to focus just behind the retina instead of on the retina. As a result, items in the distance are usually clear and easy to see, while close-by objects end up looking blurry. Some people with hyperopia also have difficulty seeing things in the distance.
• Astigmatism. When a person has astigmatism, the shape of his or her cornea isn’t even or smooth. It might be curved where it should be flat or flat where it should curve. Objects near and far end up looking blurry.
• Presbyopia. Presbyopia is a condition that typically occurs with age. The crystalline lens on the eye becomes less flexible and less elastic as people get older, making it difficult for them to focus on objects that are close. To counteract the effects of presbyopia, many people wear reading glasses. Recent updates to laser eye surgery have meant that the procedure can now correct presbyopia as well as other common vision problems.

How Corrective Eye Surgery Has Changed Over Time

Admittedly, the history of corrective eye surgery is short. One of the first types of vision correcting surgeries available came about in the 1980s. It was known as radial keratotomy, and it involved making incisions in the eye to flatten the surface. The primary issue the surgery fixed was myopia or near-sightedness.

The big issue with radial keratotomy was that, for some people, at least, it caused more problems than it solved. Some patients ended up experiencing side effects such as glare, fluctuating vision, and regression. Patients who had higher prescriptions and underwent surgery often ended up with difficulty seeing at night.

The likelihood of unpleasant side effects and the evolution and development of more advanced and more efficient laser vision surgeries pretty much-caused radial keratotomy to go the way of the dinosaur.

Modern-Day Corrective Eye Surgery Options

Fortunately for people with myopia, hyperopia, astigmatism or presbyopia today, corrective eye surgery has come a long way. The differences between the procedures available today and those available in the 1980s and 1990s are like the differences between night and day.

Today’s corrective eye procedures have fewer side effects, less pain after surgery, and a faster healing time. Residents in Toronto have a range of procedures to choose from, based on their particular vision problem.

Photorefractive Keratectomy

Also known simply as “PRK,” photorefractive keratectomy changes the curve of the cornea by removing tissue directly from the surface of the eye. At the start of the surgery, a surgeon uses either a blunt instrument or a blade to remove the epithelium or the outer layer of the cornea.

Next, a laser destroys small pieces of tissue beneath the cornea’s surface. The entire procedure helps to reshape the cornea to improve vision. Healing and recovery after the surgery take about a week.

PRK has some advantages when compared to other modern-day corrective vision procedures. For one thing, there is less of a risk for dry eye and specific other complications after the surgery, since the nerves on the surface of the eye heal quickly afterward.

Usually, PRK is the recommended procedure for people who haveafterwardsthan average corneas. Since the surgery is entirely on the surface of the eye, the risk of surgical flap problems is eliminated as well.

PRK is appropriate for patients with near-sightedness, far-sightedness or astigmatism.

LASIK

LASIK, or Laser-Assisted in situ Keratomileusis, is probably the surgery that comes to mind when people think of corrective vision procedures. In fact, you could argue that “LASIK” is like “Xerox” or “Kleenex” when it comes to corrective eye surgeries. People use the term, even when they are talking about something else entirely.

That said, during a LASIK laser eye surgery procedure, the surgeon first cuts a flap in the cornea, using either a laser or a sharp blade. The surgeon next directs a laser at the tissue beneath the cornea to reshape it. Once the reshaping is complete, the surgeon replaces the flap.

The significant advantage of LASIK over PRK is that the recovery is much shorter — just a day or two, compared to a week.

A few different types of LASIK procedures exist, which offer some distinct advantages of improvements over the traditional procedure. They include:

• LASEK. LASEK stands for Laser Epithelial Keratomileusis. During the procedure, the surgeon cuts away the outer layer of the cornea with a blade (as during LASIK). Next, he or she uses alcohol to lift the layer away, then directs a laser at the tissue beneath it before replacing the outer layer Typically, LASEK is reserved for minor vision problems. Recovery takes about two weeks.
• Epi-LASIK. Epi-LASIK is similar to LASEK. The big difference is that a blunt object, rather than a blade, lifts away the epithelium.
• Wavefront LASIK. Perhaps the most advanced form of LASIK, wavefront LASIK uses a special machine to analyze the eye, measuring how light travels through it. The lasers are then able to pick up on and adjust for specific, subtle errors in vision while the cornea is reshaped. One of the benefits of wavefront LASIK compared to other forms is that it has a lower risk of night glare following the procedure.
• Bladeless LASIK. As you might guess, bladeless LASIK replaces the sharp blade that typically cuts away the flap with a laser.

Conductive Keratoplasty

Conductive keratoplasty is a relatively new form of corrective eye surgery. During the procedure, a small probe and low-heat radio waves place spots around the eye’s clear front surface. The result is an increase in the curve or angle of the cornea. Typically, the surgery is performed on people with hyperopia, but it can also help those with presbyopia or those who have had LASIK but still have trouble seeing close objects.

Implantable Lenses

Not all types of corrective eye surgery involve lasers. Some involve surgically implanting lenses into the eye to help correct vision issues, including near-sightedness, far-sightedness, presbyopia, and astigmatism.

Some types of intraocular lens procedures completely replace the internal lens in the eye. One option, Visian ICL, doesn’t require that the lens of the eye be removed. Instead, it is placed in front of the lens, sort of like a permanent contact lens.

Refractive Lens Exchange is another type of implantable lens. The procedure is often compared to cataract surgery, but with one significant difference. While cataract surgery involves removing a cloudy, damaged lens, Refractive Lens Exchange involves taking out a clear lens. The replacement lens is usually a different shape from the one removed, which helps to correct hyperopia.

Choosing the Best Corrective Eye Surgery for You

Which type of corrective vision surgery is most appropriate for you depends on a variety of factors. The kind of vision problem you have is one concern,  but so is your age.

Often, LASIK and similar procedures are recommended for people who are relatively young (20s and 30s) and who haven’t started to notice age-related vision changes.

Older people, usually people over age 40, might have to take a multi-pronged approach when it comes to correcting vision issues. That can mean having LASIK or a similar surgery early on to fix mild near-sightedness or far-sightedness. If a person is beginning to develop presbyopia, he or she can undergo a conductive keratoplasty or other procedure to eliminate the need for reading glasses.

What Else You Need to Know Before Scheduling Corrective Eye Surgery

Before you schedule corrective eye surgery, it helps to know the potential side effects and risks and what you can expect from the procedure in the long run. While LASIK, PRK, and corrective lenses will help to fix particular vision problems, it’s important to understand that they might not provide results that last for the rest of your life.

Additionally, even when performed by highly trained and expert surgeons in the Toronto area, there are still a few risks associated with the surgeries. For example, some of the more common side effects of LASIK surgery are dry eyes and poor night vision. People sometimes develop “halos” or experience glare, which can make it difficult for them to drive at night.

Also, it’s fairly common for people to have hazy vision while they recover, particularly after PRK. People who have PRK might also have regression, meaning their eyes develop the same refractive error again. If that occurs, a patient might need a second surgery.

In the long run, though, most people are happy that they sought out corrective eye surgery. Carefully weighing your options and working with an eye doctor with plenty of experience in refractive laser and other corrective vision surgeries can help you get the best results possible, no matter which option you end up choosing.

Laser eye surgery, also known as refractive eye surgery, is a surgical procedure used to treat common vision problems, such as nearsightedness, farsightedness, and astigmatism. It helps to improve vision and reduce your dependency on prescription eyeglasses or contact lenses.

LASIK eye surgery is the most common refractive surgery used today, and it has an excellent track record. That said, it may not be for everybody.

We’re going to give you all the ins and outs in this LASIK eye surgery Toronto guide to help you determine if it’s the right procedure for you.

LASIK Versus Other Laser Eye Procedures

All refractive eye surgeries work by reshaping the cornea, the clear front part of the eye so that it properly focuses light onto the retina, a group of cells located at the back of the eye that helps convert light into images

The desired shape of the cornea is dependent upon the eye condition. With nearsighted people, the goal is to flatten the too-steep cornea. With farsighted people, the goal is to steepen the too-flat cornea. In astigmatism, the goal is to smooth out the cornea into a more normal shape.

The difference between LASIK and other surgeries comes with the method used to reshape the cornea. During LASIK surgery, the surgeon creates a flap in the cornea, which can be lifted up to remove underlying corneal tissue.

While LASIK is the most well-known procedure, other laser treatments are known to work very well and may be a better choice for you, depending on your needs.

Other common procedures include:

• Photorefractive keratectomy (PRK). PRK is similar to LASIK, but rather than forming a flap, the top surface (called the epithelium) is scraped away.
• Laser-assisted subepithelial keratectomy (LASEK). LASEK is also similar to LASIK, but the flap is created using a special cutting device which allows less of the cornea to be removed. This method is a good option for people with thin corneas.
• Epithelial laser-assisted in-situ keratomileusis (epi-LASIK). Epi-LASIK is very similar to both LASIK and LASEK. Just like with LASEK, it’s a good option for people with thin corneas. The difference lies in the tool used to create the flap.

There are also non-laser vision repair procedures available. Your doctor will help you to determine what is best for you by considering your prescription and eye structure.

What to Expect Before LASIK Eye Surgery in Toronto

The first step in determining if LASIK surgery is right for you is to meet with your eye doctor. He or she will perform a thorough eye exam to determine if your eyes are healthy enough for the procedure, and if so, which procedure would be best for you.

They will evaluate things like the shape and thickness of your cornea, your pupil size, and any refractive errors.

Aside from examining your eyes, they will ask you a variety of questions regarding your current health and your medical history. These questions will help them conclude how safe the procedure will be for you.

Your doctor may give you specific instructions to follow before the procedure. They may ask you to stop wearing contact lenses for a period of time (usually around two weeks) before the surgery.

What to Expect During Your Toronto LASIK Eye Surgery

Before your surgery begins, eye numbing drops will be applied to your eyes to prevent any discomfort. Your doctor might also give you medication to help you relax if needed.

During the procedure, an instrument called a microkeratome or femtosecond laser is used to create a thin flap in the cornea. The flap is painlessly peeled back, after which the underlying corneal tissue is reshaped using another laser. The corneal flap is then put back into place, and the surgery is complete.

LASIK is an outpatient procedure, so you don’t have to spend the night in the hospital. The entire procedure is painless and generally takes around 10 minutes to complete.

What to Expect After LASIK Eye Surgery

Immediately after LASIK surgery, your surgeon will have you rest and will perform a brief postoperative exam.  If all is good, you can have someone drive you home.

You should expect to experience some blurred and cloudy vision after the procedure. You might also experience a feeling of dryness, or temporary burning or itching. Your doctor will give you prescription eye jobs to help. These symptoms should improve by the next morning.

Advantages of LASIK Eye Surgery Toronto

LASIK has many benefits including:

• It works! More than 95% of patients experience their desired vision after treatment.
• LASIK surgery is pretty painless, aside from a few mild and temporary symptoms.
• The procedure is quick and does not require an overnight stay in the hospital.
• The surgery requires very little to no downtime.
• Results appear rapidly – usually immediately after surgery or the next day.
• It is non-invasive – no bandages or stitches are required.
• Many patients have a dramatic decrease in their dependency on glasses or contact lenses.

Disadvantages of LASIK Eye Surgery

While there are a great many benefits to LASIK, it’s important to be aware of the disadvantages as well.

• Rare problems can occur when the doctor creates the flap, which can permanently affect vision. This is why it’s essential to choose a reputable and good surgeon.
• Some patient’s experience mild discomfort for a day or two following surgery.
• Possible side effects of the procedure include glare, sensitivity to bright lights, difficulty seeing at night, and dry eyes.
• It can be costly – insurance usually doesn’t cover the procedure.
• Vision loss is a rare but possible side effect. Alternately, you may not see as clearly as previously.

The Final Decision

When it comes to LASIK eye surgery, there is no right or wrong answer. It’s all about determining what is best for you.

Be sure to talk with your eye doctor in Toronto and get his or her professional opinion. Weigh the pros and cons, consider the cost, and have realistic expectations about the outcome.

In the end, it’s all about what feels right for you.

What is the cornea, and what does it do?

Despite its clear appearance, the cornea is actually a highly organized tissue comprised of five layers that, unlike most other bodily tissues, has no blood vessels whatsoever – it is protected and nourished instead by the tears, and by the fluid that lies behind it. The cornea, in turn, protects the eye from damaging UV rays, particles of dirt, and invasive germs that could harm it. It also focuses light onto the retina, which is then translated into electrical impulses that ultimately lead to image perception. The cornea is basically the eye’s camera lens, putting things into proper focus so the retina can produce vision.

What can go wrong with the cornea?

Unfortunately, corneal tissue is delicate and susceptible to several common problems. The cornea has strong healing powers that allow it to quickly repair itself after sustaining minor injuries, but a deeper injury can cause scarring, which can result in:

• Blurred, impaired vision
• Eye pain
• Sensitivity to light
• Eye redness and inflammation
• Chronic headaches and fatigue
• Nausea and disorientation when focusing

Disease is also a major factor affecting the cornea. The most common corneal disease is keratoconus, a progressive thinning of the cornea that, rather than occurring with age, is most prevalent in teenagers and young adults. Keratoconus causes the cornea to curve and bulge abnormally, leading to blurred vision, nearsightedness, astigmatism, and increased light sensitivity. Optometrists use a slit lamp exam and to diagnose keratoconus. Distorted vision resulting from keratoconus can usually be corrected with glasses or contacts.

Other corneal diseases include various corneal dystrophies, tissue growths and shingles. Current treatments for ocular problems are conducted with lasers or conventional surgery, but research offers hope for a better tomorrow for those with corneal damage.

Corneal research by the U.S. National Eye Institute

Researchers at the NEI are currently conducting studies into wound healing of the cornea, which could lead to new treatments and improved outcomes for corneal transplants and grafts. Because the need for donor corneal tissue habitually outstrips supply, research is being done into more refined artificial corneas that are engineered in the lab and can actually be injected into the eye, as opposed to making a larger surgical incision. Research is also being done into a procedure that uses low doses of UV light to strengthen the collagen bonds of the cornea, promoting faster wound healing. To learn more about the specific types of research being conducted into corneal health, visit the National Eye Institute here.

One essential element of eye health is to maintain a regular schedule of visits to your eye care professional. If you do not already have a family optometrist in Toronto, Toronto Eye Care would be pleased to step into that role to assess the health of your corneas and ensure optimum eye care at all ages and stages.

Maybe.

Will it the injury request vision-correcting laser eye surgery?

Depends.

Perhaps you’ve been lucky enough to never have had a shiner – a swollen bruise that occurs when fluids collect around the eye after an injury such as blunt force trauma to the eye area.

Like any other kind of bruise, the dark blue/purplish/black colour is caused by broken blood vessels under the skin, and is characterized by swelling and discoloration all the way around, or just underneath, the eye socket.

But because it surrounds arguably the most delicate area of the body – the eye – should you be more worried about this type of bruise than any other?

The Good News About Black Eyes

You know how a forehead or tongue wound bleeds a lot, even if it is a very shallow, minor cut?

The eye area is similar, because the skin is very thin and transparent around the eyes. That means that even minor damage can cause a big bruise combined with the accumulated fluid that causes swelling, making the injury appear severe when it is not.

While trauma from being struck with an object or walking into a door can easily cause a black eye to appear, and can even cause blood vessels to burst inside the eyeball for a disturbingly red-eyed appearance, there are other very benign causes as well, such as surgery to the eyes or nose, sinusitis, and even certain kinds of dental work!

Since most black eyes fall into one of the above categories, as severe as they look, they are often not a serious condition and will simply heal on their own.

Treatment for a ‘regular’ black eye mainly involves cold – compresses, ice packs – to bring down the swelling and reduce bruising.

Putting a piece of raw liver or steak on a black eye is an old wives’ tale that can do more harm than good, because there may be minor lacerations around the eye area that can pick up bacteria from raw meat, causing infection.

Tylenol is good to take for the pain; aspirin can make your black eye look worse, because of its blood-thinning action.

Once a couple of days have passed, you can switch to warm compresses to get the healing blood flowing again, and consume lots of fruits and veggies that contain Vitamin C, which speeds healing.

You can also gently massage the eye area.

The Bad News About Black Eyes

Although most black eyes are mere bruises that must heal like any other, there are some causes of black eyes that do indicate something much more serious that can compromise vision, among other things.

These include:

• Cellulitis – a serious infection
• Hyphema – a medical emergency wherein there is bleeding inside the eye. Left untreated, hyphema can cause increased eye pressure resulting in permanent vision loss.
• Skull fracture – can cause ‘raccoon eyes’ or two black eyes at once

When to See the Optometrist About a Black Eye

How to know when a black eye is serious enough to visit your Toronto optometrist and seek urgent medical treatment? Look for these signs and symptoms:

-Blood flowing from eyes or nose

-Loss of consciousness

-Dizziness

-Vision changes like double vision, blurriness or sudden vision loss

-Seeing floaters or light spots

-Severe pain and/or headache

-Inability to move your eyes

-Flu-like symptoms like fever, lethargy or vomiting

-Signs of infection like warmth, pus and redness

-Both eyes blackened

If your black eye has you worried, call us immediately at (416) 966-1955. A friendly member of our highly trained staff will be pleased to discuss your injury and quickly schedule an appointment to have it checked.

Eye floaters: Fast Facts

What exactly are eye floaters, and where do they come from?

• Eye floaters are also known as vitreous floaters and ‘flying flies’ because they float within the jelly-like vitreous humour that lies between the optic lens and the retina.
• The ability (or curse!) to see eye floaters is known as myodesopsia.
• Some people are born with floaters and they will usually have them for life.
• As we age, the once-transparent vitreous humour begins to develop imperfections and accumulate build-up in the form of minute particles. Vitreous humour cells can also begin to clump together in the aging process.
• It is these imperfections, clumps and tiny external objects that cause shadows to be projected onto the retina, where you see them as floaters.
• Floaters are considered both common and benign. Most people learn to live with floaters, or the floaters eventually go away on their own.

When floaters become severe

The Mayo Clinic states that it’s rare for eye floaters to cause serious vision impairment, however, it does happen. If floaters are causing problems in your life, it’s important to book an appointment for an optometrist visit right away, because sudden onset of floaters could be indicative of a serious condition such as a retinal tear or posterior vitreous detachment (PVD).

While floaters are often easily observed by an optometrist with the use of simple diagnostic tools like an ophthalmoscope or slit lamp, floaters may sometimes be difficult to observe depending on what position they’re in – even if the patient complains of their severity. That’s why a thorough examination by a specialist as opposed to a GP, is necessary.

Treatment options for floaters

Unfortunately, there are as of yet no medications or eye drops that will make floaters disappear. Currently, there are two recognized treatment options for severe floaters: surgery and laser techniques. Both are generally used only in the worst cases, as there are considerable risks involved. In the case of surgery, the vitreous humour is surgically removed and replaced with saline solution – but this may not permanently eradicate all floaters, and as well, there is a risk of intraocular bleeding, cataracts, and retinal tears.

With laser surgery, performed by an ophthalmologist, a laser is used to break up larger floaters so they become less noticeable. Not very frequently used, this surgery has the risk of human error if the laser is not aimed with sufficient accuracy, as well as conditions such as retinal detachment or macular edema.

While researchers continue to look into the problem of eye floaters and attempt to develop more effective solutions, it’s recommended not to be alarmed if you occasionally see a tiny floater or two; your brain will eventually learn to ignore them. If floaters have become a concern, please visit the Toronto Eye Care clinic for a comprehensive assessment to rule out more serious causes of the floaters you are seeing.