Brief report: a hypothetical construct based on limited data visual system recovery after refractive surgery

Laser refractive surgery, involving the computer-controlled application of a 193-nm beam of excimer laser "light," is utilized to resculpt the central cornea, thus reducing its apical thickness. On casual inspection, this simple matter of removing or excising a specific amount of central corneal avascular tissue is a smooth, seamless alteration with few apparent secondary issues or sequelae. Normal postoperative recovery is typically gauged by the recovery of high-contrast visual acuity to the same (or better) degree as was previously obtained with a spectacle correction. However, although this is an acceptable means of determining operative success, it is not indicative of the complex challenges imposed upon the neurosensory system. The secondarily imposed strain upon the visual system, regarding the return to its pre-existing visual line-of-sight organization occurs only by bringing multiple adaptations into subtle and seamless play. This process is initiated and completed in a relatively short time period, such that most patients (but not all) are not even marginally aware of the challenges imposed to the visual system. This article is meant to probe those system challenges, serving to highlight this postoperative plasticity, seeking to gain a broader understanding and appreciation of the perceptual range of the visual recovery process.