Vision Correction

In the late 1990’s Laser-Assisted In Situ Keratomileusis, or LASIK, burst onto the scene and quickly became the most popular vision correction surgery. LASIK has maintained this position for over 20 years. With recent developments in surgery, the term LASIK is often incorrectly used as a blanket for all corrective surgeries. To better understand, let’s compare this topic to facial tissues. The word “tissue” is used to describe facial tissues, but people often use “Kleenex” interchangeably. Kleenex is just one of many brands of facial tissues, just like LASIK is one of many refractive surgery options. Our doctors are experienced and educated on all of the newest refractive surgery options and will give you an honest assessment of which options would work best for you. We work with the most state-of-the-art and experienced vision correction surgeons in the region. Below you will find a brief description of the many different vision correction surgeries offered through the Koetting Associates Eye Center. These options include:

      Laser-Assisted In Situ Keratomileusis (LASIK)

      Photorefractive Keratectomy (PRK or ASA)

      Small Incision Lenticule Extraction (SMILE)

      Implantable Collamer Lens (ICL)

      Refractive Lens Exchange (RLE)

      Custom LASIK

Custom LASIK

Lasik is the most common refractive surgery today. Since the late 1990’s our optometrists have co-managed hundreds of successful LASIK surgeries. Our surgeons employ custom wavefront LASIK technology to treat all types of prescriptions (nearsightedness, farsightedness, and astigmatism) with extreme precision and help reduce glare and nighttime halos. In LASIK, a flap is created on the surface tissue of the cornea. The surgeon then uses a guided laser to reshape the stromal, or central, tissue of the cornea. After this, the surgeon carefully repositions the flap to protect the underlying cornea and promote healing. The reshaping only takes about 15 seconds, while the whole procedure can be done in under 10 minutes per eye. Recover time after LASIK is usually very quick, with most patients feeling and seeing well by the next day. After the surgery drops are prescribed to help with temporary dry eyes, prevent infection, and promote healing.

LASIK is not for everyone. To be a good candidate for LASIK patients need to have adequate corneal thickness to support the procedure. Higher prescriptions require thicker corneas. Poor candidates may have prescriptions that are excessively high, corneas that are excessively thin, or suffer from chronic dry eye disease. Fortunately for these patients, we now have other refractive surgery options that may better suit them. Also, patients with chronically dry eyes before the procedure are not good candidates, as LASIK can worsen the condition.

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Photorefractive keratectomy (PRK), now also known as advanced surface ablation (ASA), is similar to LASIK in that it uses the same excimer laser to reshape the cornea to correct for farsightedness, nearsightedness, and astigmatism. However, unlike LASIK, in PRK there is no flap created. Instead, the surface corneal tissue, called the epithelium, is removed entirely before the laser is used to reshape the underlying tissue. The flap created in LASIK has potential to tear or loosen during recovery. Athletes, law enforcement officers, and others with active lifestyles can benefit from PRK over LASIK because there is no flap; therefore, no risk of flap complications. Another benefit of ASA over LASIK is it can be done on corneas too thin for LASIK. Also, there are less post-operative dry eye complications after PRK compared to LASIK.

Because the protective outer layer of the cornea is removed during ASA, a bandage contact lens is applied and worn until the cornea’s own protective layer has regenerated. Before this layer heals entirely patients may experience burning, stinging, watering, and foreign body sensation. Recovery time is typically 7-14 days with PRK and vision improvement is gradual over that time.


Small Incision Lamellar Extraction, or SMILE, is a relatively new addition to the refractive surgery family. SMILE is a minimally invasive procedure designed to correct low to moderate amounts of nearsightedness. SMILE offers a quick procedure time and limits inflammation and may drastically reduce post-operative dryness.


Implantable Collamer Lens, or implantable contact lens, is intended to offer a vision correction to those with high amounts of nearsightedness or corneas too thin for LASIK or ASA. In this procedure, a micro collamer lens is implanted behind the iris. The lens material is a biocompatible combination of collagen and water that will not deteriorate and offers a very low risk of complications. In September 2018 a new ICL was approved by the FDA to correct for nearsightedness and astigmatism.


Refractive Lens Exchange is another new procedure gaining popularity as a LASIK alternative amongst middle-aged adults. During RLE, the eye’s natural lens is replaced with an artificial lens. This procedure corrects nearsightedness, farsightedness, astigmatism, and presbyopia, all while preventing the development of cataracts in the future. Presbyopia is the condition everyone begins to experience in their mid-40’s when they begin to need reading glasses. What’s causing this slow (or sometimes not so slow) change in vision is the natural lens of the eye beginning to lose flexibility as it ages. As the flexibility decreases the eye’s ability to focus on items up close weakens. By replacing the natural lens with an artificial lens, doctors can restore both near and far vision without the need of glasses. This new, artificial lens will not undergo the aging changes that affect the natural lens.


  2511 South Brentwood Blvd.
St. Louis, Missouri 63144

    (314) 863-0000




 113 Old State Road Suite 101
Ellisville, Missouri 63021

    (636) 256-7800