Refractive Surgery

The UPMC Eye Center has a long history of doing refractive surgery. In fact, it was part of a pivotal FDA trial that resulted in LASIK approval – back in 1995.

“The UPMC Eye Center is the oldest continuously running refractive surgery center,” said Deepinder K. Dhaliwal, MD, LAc, Professor of Ophthalmology at the University of Pittsburgh School of Medicine and Director of Refractive Surgery in the Eye & Ear Foundation’s March 25th webinar, “Refractive Surgery: Everything You Need to Know About Surgically Correcting Your Vision.” “We love performing refractive surgery, and love teaching and sharing our research and expertise with our colleagues.”

The webinar focused on refractive surgery for people who want to reduce their dependence on glasses and contact lenses and do not have conditions like glaucoma, cataracts, or macular degeneration. They have healthy eyes and want to explore options, so they do not have to wear glasses or contacts every day.

Unfortunately, there is no surgery yet for people who want to stop wearing reading glasses. An eye drop was recently approved, however, that can help decrease dependence on reading glasses.

Refractive Surgery: A Primer

Gaurav Prakash, MD, Assistant Professor of Ophthalmology at the University of Pittsburgh School of Medicine, provided a primer on refractive surgery and elective vision correction. He has performed and supervised more than 10,000 LASIK and refractive procedures.

Glasses are needed in cases of myopia, when the power of convergence is more than required, or hypermetropia, when it is less than required. Elective vision correction is a collaboration between optics and surgery.

  • Measurements for more than 2,000 data points on the eye
  • Advanced wavefront & adaptive optics: same as used in astronomy
  • Robust safety & efficacy algorithms
  • Stringent “rule in” protocols
  • Evolved into the most performed surgeries

Only 70 percent of people are good candidates because the criteria is so stringent, Dr. Prakash said. The screening process is extremely important. Even if it involves a laser, it is still surgery, and the goal is to make it as safe as possible.

Patient criteria includes:

  • Being well informed, willing with realistic expectations
  • Stable glasses prescription
  • Age >21 years (18 in some countries)
  • Good health: no long-term uncontrolled diseases (autoimmune, diabetes, each case varies)
  • Good vision currently with glasses or contact lenses
  • Good ocular health and healing
    • No corneal “outliers”: weak, thin, suspicious cornea
    • No dry eyes
    • No cataract, glaucoma

Women who are pregnant or lactating should avoid any elective eye surgery, including LASIK. Their hormone levels can fluctuate, and corrections can vary.

Contraindications (patients with these conditions should not be treated):

  • Patients with collagen vascular, autoimmune, or immunodeficiency disease
  • Women who are pregnant or nursing
  • Patients with signs of keratoconus (corneal thinning and bulging)
  • Patients with unrealistic expectations
  • Patients with severe dry eye, guttae, or cataract
  • Patients with history of viral infections in their eyes (HSV, VZV)

Treatment Options

There are several treatment options for multiple situations, and they all have similar sounding names. “The premise is that we can either correct your collective prescription by using glasses and contact lenses, or by reshaping the cornea,” Dr. Prakash said.

When correction is done at the cornea, it is extraocular (outside the eye). This is done for low to moderate myopia. Examples are LASIK, PRK, and SMILE.

When correction is done at the lens, it is intraocular (inside the eye), for moderate to high myopia. Examples are ICL (Implanted Collamer Lenses) or cataract surgery.

LASIK – Laser Assisted in Situ Keratomileusis

No needles are used for LASIK, in which a flap is created with a laser. “The beauty of the cornea is that the flap will adhere to the underlying cornea without any sutures,” Dr. Dhaliwal said. “Every time we do this procedure, it’s like magic. After about three minutes, the flap reattaches on its own without the need for sutures.”

Dr. Dhaliwal played a video of a LASIK procedure, walking viewers through the steps. The technology is so advanced that custom treatments can actually correct more than glasses or contacts, she said. This is why surgeons are so particular about the surface of your eye. Because contact lenses can warp the cornea and change its shape, patients are told to avoid wearing contacts for two to three weeks. This way, precise measurements can be taken to design the custom treatment.

PRK – PhotoRefractive Keratectomy

During this procedure, surface epithelial cells are removed with a sophisticated brush. An excimer laser sculpts the surface, and a bandage contact lens is put on to help heal the cornea, since there is no flap.

ICL – Implantable Collamer Lens Insertion

This is a non-laser-based procedure for patients who have moderate to high degrees of nearsightedness. Unlike in LASIK or PRK, candidates are not excluded if they have dry eyes or a thin cornea. A special collamer lens implant is placed in the eye, like implanting a contact lens. Nothing is removed or altered. This procedure is essentially reversible, unlike the others.

SMILE – Small Incision Lenticule Extraction

In this procedure, a laser is used to create a lentucule of cornea that is removed through a tiny laser incision. Some people refer to this as “flapless LASIK.” People who are nearsighted and have astigmatism might benefit from this procedure.

Concluding Pearls

  • Refractive surgery can provide excellent visual results
  • It is important to seek consultation with a comprehensive refractive surgeon who can assess whether you are a good candidate for surgery and the best surgical option for you
  • Not one size fits all!
  • If you have healthy eyes (no signs of cataract, etc) and would like to inquire further, please call 412-647-4797 to speak to our refractive coordinator about a complementary evaluation

The consultation involves a lot of testing. The surgeon will listen to your goals and have you write them down. They will see if they have procedures that can match your goals. Then there will be a long, personalized discussion about what is possible and based on that, a conclusion will be reached as to whether refractive surgery is a good idea. “At the end of the day, it’s something that’s very exciting and can really enhance your life if you’re a good candidate,” Dr. Dhaliwal said.


In a typical LASIK procedure, the actual laser time is less than two minutes. The actual procedure takes around 10 minutes. For the preoperative work up and testing, patients are asked to keep at least half a day free.

Depending on the surgery, results are fairly rapid. “We expect that your vision will significantly improve the next day,” Dr. Dhaliwal said, “but may take some days to weeks to reach the final level.”

It is important to rest after your surgery. You have to let your eyes heal to avoid irritation. Staying calm and keeping your eyes closed as much as possible will help.

While it is natural to feel anxious about refractive surgery, the procedure is essentially painless. The laser does not hurt your eyes. There is an eyelid holder, which may feel like the eyelids are being stretched. Patients who have PRK take a little longer to heal. The bandage contact will be in for about a week, so it may be a little more uncomfortable.

LASIK should not affect future eye surgeries. In fact, Dr. Dhaliwal said she is doing cataract surgery on patients she did LASIK on years ago.

While there are five surgeons currently doing refractive surgery at UPMC Eye Center, there is a lot of backlog from the pandemic. There have also been staffing changes, so the office will do its best to accommodate you. The important thing is to remember this is an elective surgery.