Refractive surgery very often involves the cornea, the clear outer surface of the eye. At Wilmer, our refractive surgeons are all corneal specialists, experts who routinely perform corneal transplants, treat corneal abrasions and infections, perform corneal research, teach other doctors about the cornea, and handle challenging cornea cases. A refractive surgeon who is a corneal specialist will:

1. See refractive surgery as one of several ways to improve your vision-- not the only way.
2. Detect subtle corneal conditions that may require caution when considering refractive surgery.
3. Know how the cornea ages and recommend refractive surgery with your long-term vision health in mind.
4. Manage your progress after surgery for the best results and satisfaction.

At Wilmer, our refractive surgeons are board-certified ophthalmologists, fellowship-trained cornea specialists, and full-time faculty members of the Johns Hopkins Wilmer Eye Institute. They are highly trained experts who can help you understand refractive surgery and its impact on your long-term vision health; help you have a safe and successful procedure; and help you maintain good vision health throughout your life. Refractive surgery is not the best choice for every patient. Rely on your Wilmer surgeon for information and advice.

To refract means to bend. When you have a refractive error, the light rays going into your eye are bent and focused by the cornea and lens in such a way that they are not focused on the retina and thus form a blurred image.

The four major types of refractive error are myopia (nearsightedness), hyperopia (farsightedness), astigmatism, and presbyopia. The most common refractive error is myopia or nearsightedness, whereby the light rays are focused in front of the retina. In astigmatism, irregular curvature of the cornea and lens results in the image being focused on different planes not coinciding with the retina. Hyperopia or farsightedness occurs when the light rays are not bent enough and the image is focused behind the retina. You can also have a combination of myopic astigmatism or hyperopic astigmatism. Presbyopia is a loss of the elasticity of the naturally occurring crystalline lens whereby individuals cannot focus clearly at close distances and need reading aids. This becomes apparent around the fourth decade of life.

When you read a prescription, a minus sign means nearsightedness and a plus sign means farsightedness. The first number in the prescription indicates the amount of myopia or hyperopia you have. If there are numbers written in the next two columns, these indicate the amount of astigmatism, if any, and the axis where it is present. The unit to measure a refractive error is called a diopter or D. For example, if your prescription says -2 or -2D or -2 sph or -2 sphere, it means that you are nearsighted and require 2 diopters of correction. A diopter is a unit of measurement related to the focal length of an optical system including the human eye. The larger the diopter the shorter the focal length.

The standard method for correction of any refractive error is glasses or contact lenses. For those interested in reducing their dependency on glasses or contacts, there are several surgical options depending on the type of refractive error; some options use lasers, some do not.

There are three laser-based refractive surgeries, which include LASIK (laser assisted in-situ keratomileusis), photorefractive keratectomy (PRK), and KLEx (Keratorefractive Lenticule Extraction). In addition, there are two intraocular refractive surgeries, which include ICL (Implantable Collamer Lens) Surgery and RLE (Refractive Lens Exchange). Your surgeon will discuss which options are best for you.

No. Your vision may be blurry and hazy for a few days, which could make it difficult for you to drive safely. Some people can drive the next day to their follow-up appointment, however. Use your own judgment.

You will have follow-up appointments one day or one week after surgery, one month after surgery, and three months after surgery. The cost of these visits is included in your surgical fee.

The actual procedure takes less than 20 minutes. Depending on your prescription and the amount of correction your eyes require, the laser itself is only on each eye for less than a minute, but plan on being in the refractive suite for two to three hours.

It is safe to fly after surgery, but your eyes may be more dry than normal and require frequent use of artificial tears.

Your eye is numb during the procedure, so no pain is felt, only gentle pressure at most. Most people have only mild irritation for a few hours after the surgery. Some people compare it to wearing old contact lenses. The eyedrops your surgeon will recommend will help in reducing this irritation. We also suggest patients go home and relax with their eyes closed for a few hours after surgery. Taking a nap is a good way to do this. With PRK, patients will experience slightly more discomfort with healing.

We can correct nearsightedness, farsightedness, and astigmatism in most patients.

Yes, usually. When laser vision correction was new, many surgeons chose to treat your eyes on different days as a safety precaution. However, now the technology is so advanced that most patients prefer to minimize the time off work and reduce the amount of healing time they experience after laser vision correction, so they have both eyes done at the same visit. Also, many patients reported headaches, disorientation and other discomforts from having one eye corrected and the other one not. So, if there are no problems when we treat your first eye, we feel comfortable treating the second one right away. However, for ICL surgery and RLE surgery, we typically operate on one eye at a time, with a week between surgeries.

Some patients notice a smell like burned hair while the laser treats the eye. It is normal and passes quickly.

Observers are not allowed in the laser suite. They can wait in our waiting area.

You can leave them in a basket in our office and we will donate them to a vision charity.