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Joyce Ferrara, now 58, reclined on a surgeon’s chair at University Ophthalmic Consultants of Washington in Chevy Chase, Md., a small plastic ring holding her left eye open. "You’re the perfect patient," surgeon Thomas E. Clinch, M.D., told her as he cut a flap in her cornea with a silent, fast-firing laser.

After cutting an identical flap on Ferrara’s right eye, Clinch peeled back the first flap and switched to a second laser that fired a beam of ultraviolet light into the corneal tissue to eliminate the irregularities that had impaired her distance vision. He then replaced the flap and, having completed the vision-improving Lasik procedure on one eye, moved on to the other.

Until recently, Clinch would have cut the corneal flap with a precise and relatively safe oscillating blade called a microkeratome. But the cutting laser he used, called IntraLase, is considered to be even more accurate and safer. He also used new technology called wavefront mapping to guide the laser that reshaped the cornea. Wavefront mapping uses light bounced off the retina to provide an accurate, three-dimensional image of the cornea.

These techniques are only two of a dizzying array of new tools and treatments being used to improve vision by reshaping the cornea to increase its focusing power. Some 15 million laser eye surgeries have been performed since the early 1990s, when the first procedures for correcting nearsightedness, farsightedness and astigmatism (an irregularly curved cornea) were introduced in the United States.

Lasik is the most popular of these procedures. But even as Lasik technology continues to advance, alternative methods of correcting vision are becoming more popular.

Lasek, an updated version of the first laser-assisted eye surgery, is regaining standing, especially if a cornea’s outer layer is too thin for cutting the deeper Lasik flap. In Lasek a small surgical tool loosens the circumference of the cornea’s outer layer, which is then soaked in alcohol before being rolled back. After the cornea has been reshaped with a laser, the outer layer is returned to its place. Lasek is typically more painful during recovery and takes longer to heal than Lasik, but new painkilling eye drops make it more comfortable.

Conductive keratoplasty is a nonsurgical procedure that uses radio waves and heat on the outer cornea, shrinking small areas of collagen, a fibrous protein found in connective tissue, bone and cartilage. The treatment steepens the curve of a cornea, improving near vision. It has been approved to treat presbyopia—the inability to focus on near objects, common among middle-aged people—which is routinely corrected with reading glasses or graduated lenses. The procedure is performed on only one eye, which can complicate depth perception.

Intraocular lenses (IOL), historically used to treat cataracts, now have approval by the Food and Drug Administration to treat severe nearsightedness but not astigmatism. During cataract surgery the natural crystalline lens is removed; IOL surgery places a corrective lens between the cornea and the natural lens.

Intacs are two thin, clear, crescent-shaped plastic inserts implanted along the outer edges of the cornea to flatten the central area. The procedure, which corrects mild cases of nearsightedness, removes no tissue, and the inserts can be replaced if vision changes, or removed if the results aren’t satisfactory.

Things to Consider

There are risks. Surgery doesn’t necessarily result in 20/20 vision, and repeat surgeries are sometimes necessary. Some patients may experience dry eyes, light sensitivity and blurred or double vision—postoperative side effects that are almost always temporary. Rarer complications are halo effects during night vision, the onset of astigmatism and even regression of vision. Eye infections are less common because the procedures have become less invasive.

Of the handful of lawsuits filed against laser eye centers, many are related to deceptive pricing rather than shoddy medical techniques or injuries resulting from the surgery. The incidence of serious—or irreparable—side effects from surgery is extremely low.

Prices for laser eye surgery range from $300 to almost $3,000 per eye. Insurance plans don’t normally cover it; Medicare doesn’t.

Look for an ophthalmic surgeon who has performed at least 50 Lasik procedures or 20 Lasek cases, says Marguerite McDonald, M.D., a clinical professor of ophthalmology at Tulane University School of Medicine.