Laser refractive surgery

The purpose of this article is to update the reader on the latest visual and refractive outcomes of laser refractive surgery. Subsequent articles will deal specifically with potential complications and their management.

The arena of refractive surgery is a rapidly advancing subspecialty with constant modifications and developments. There are an estimated 105 clinics in the UK providing laser refractive surgery.1 Refractive surgery can be broadly separated into keratorefractive, lenticular and scleral refractive procedures.

Laser refractive surgery is a kerato-refractive surgery where the corneal shape is modified either by flattening in the case of myopia or steepening in the case of hyperopia. The modification of the cornea is achieved by ablation with the excimer laser (193nm argon fluoride beam) which is used in all forms of laser refractive surgery due to its ablative precision.2 There are a range of different procedures available with the correct procedure depending on many factors. Principally, two main laser refractive procedures exist - surface treatment and laser in situ keratomileusis (Lasik). Surface treatment can be further divided into photo-refractive keratectomy (PRK), laser subepithelial keratomileusis (Lasek) and epi-laser in situ keratomileusis (epi-Lasik) as displayed in Figure 1.