Laser Eye Surgery (LASIK)
LASIK eye surgery aims to achieve clearer, sharper vision by physically correcting nearsightedness, farsightedness, astigmatism, and the vision problems associated with ageing.
Normal vision is only possible when the light entering the eye becomes focused on the retina at the back of the eye. When vision fails, surgery to correct the specific refractive error may help.
LASIK stands for laser-assisted in-situ keratomileusis. This surgery helps focus light on the retina by reducing or increasing the curvature of the cornea—the clear dome-shaped tissue covering the front of the eye.
The procedure is a type of refractive surgery that changes the shape of the cornea. This change of shape helps to bend or refract rays of light so they focus on the retina rather than beyond it or in front of it. Focusing the light on the retina can reduce or eliminate the need for contact lenses or eyeglasses.
There are different types of LASIK surgery, using different techniques and technology. Traditional LASIK, Trans PRK and Wavefront laser surgery are some of the options.
Reasons for choosing to have LASIK surgeryClick to collapse
You are a candidate for LASIK surgery if you have vision problems associated with how light moves within your eyes.
In particular, LASIK surgery is useful for correcting the following:
- Nearsightedness or myopia – When the cornea is sharply curved or the eyeballs are longer than normal, light rays tend to focus at a point in front of the retina rather than on it, resulting in blurring of distance vision.
- Farsightedness or hyperopia – A less curved or flat cornea, or eyeballs that are shorter than normal, can give rise to farsightedness. The rays of light focus on a point behind the cornea rather than on it. This results in blurred near vision and, in some cases, blurred distant vision as well.
- Astigmatism – A condition that occurs when the cornea is uneven—either flat or curved in places—and, as a result, fails to focus light clearly on the retina. Astigmatism disrupts both near and distant vision.
- Presbyopia – Certain eye changes that occur with age—typically arising around the age of 40—may result in the gradual loss of the eye’s ability to focus light on nearby objects.
If you have any of the above conditions affecting your vision, your ophthalmological surgeon may recommend a number of options including using contact lenses or spectacles before recommending LASIK or any other type of refractive surgery.
The key benefit of LASIK surgery as compared to spectacles or contact lenses is that it makes life more convenient. It is a one-off procedure and does not require changing contact lenses or buying new glasses. Usually both eyes are operated on simultaneously.
A research paper published in the Journal of Refractive Surgery in January/February 2006 shows that refractive surgery patients had a better quality of life compared to both spectacle wearers and contact lens users, even when a small risk was present due to postoperative complications. The study, a collaborative effort between the Flinders University in Adelaide and the University of Bradford in the United Kingdom, involved 312 participants between the ages of 16 and 39. The quality-of-life comparison was done using a new Quality of Life Impact of Refractive Correction (QIRC) Questionnaire.
Things to consider once you've decided to have LASIK surgeryClick to expand
LASIK surgery does not provide a solution for everyone and is not recommended under the following circumstances:
- Severe nearsightedness – For people who are nearsighted and have a high refractive error, the risks involved may not justify the surgery.
- People with reasonably good vision – People who can see well enough not to need glasses or contacts may not benefit much from the surgery.
- People with large pupils - Those with large pupils may end up with debilitating symptoms such as haloes, ghost images and starbursts after LASIK surgery because their pupils open widely in dim light.
- People who take part in contact sports – LASIK surgery is not suitable for people who play contact sports. Sports like martial arts or boxing, which may result in blows to the eyes, can be dangerous, especially after surgery.
- Those with conditions that impair the body’s healing ability – Diseases of the immune system can impede healing and increase the likelihood of infection and other complications after LASIK surgery. These include autoimmune diseases and immunodeficiency diseases such as HIV.
Around 1 in 20 people in Australia have some form of autoimmune disease.
Common diseases in this group include diabetes, thyroiditis and rheumatoid arthritis.
- People taking immunosuppressive drugs face the risk of less than ideal outcomes after LASIK surgery.
- People with dry eyes – LASIK surgery may make the condition worse for those who have persistent dry eyes, particularly women over the age of 50.
- Specific features of the eye – LASIK surgery may pose an additional level of risk for those who have very thin corneas or a highly irregular corneal surface. It is also not recommended for those who have keratoconus, a condition that leads to thinning and gradual bulging of the cornea. Deep-set eyes, abnormal eyelids or other anatomic issues may increase your level of risk. Your eye surgeon can provide more details about specific conditions that may apply to you.
- Unstable vision – Fluctuating vision, progressively worsening vision, or a high level of pressure inside the eye may make you ineligible for LASIK surgery.
- During pregnancy or breast-feeding – Because vision fluctuates during these periods, LASIK surgery is best avoided during pregnancy and while lactating.
- Those in jobs that require precise vision may have problems after LASIK surgery that could jeopardise their career prospects. Some sportspeople and precision equipment operators have lost their careers due to LASIK surgery complications.
- Medications – Those who are on steroids and some other types of drugs that impede healing may not be good candidates for LASIK surgery.
What to expectClick to expand
During LASIK eye surgery, a laser beam (usually programmed) is used to remove a defined amount of tissue from the cornea with every laser pulse. Depending upon the correction needed, your eye surgeon will alter the curve of the cornea to either flatten or make it steeper.
Expect the surgery to last 30 minutes or less. During the procedure, you will be lying on your back in a reclining chair and may be given medication to help you relax. Numbing eye drops will be used on your eyes and a special instrument used to hold your eyelids open. You may experience a dimming of your vision and a feeling of pressure as a suction ring is placed on your eye before cutting into the corneal flap.
A cutting laser or a special blade will be used to cut a contact-lens sized hinged flap from the front of the eye. The surgeon will then reshape the cornea through this opening. Once the reshaping is complete, the flap is restored, and usually heals without stitches.
You will be required to focus on a point of light during the surgery. Staring at it helps keep your eye fixed while the laser reshapes your cornea.
Before and after surgeryClick to expand
Before the surgery, a pre-surgical eye examination will be scheduled. The eye surgeon will take a detailed record of your medical history, measure the cornea, the shape of your eyes, and take note of any irregularities of your eyes.
Specialised equipment will help your surgeon determine the areas of your cornea that need reshaping or removal.
The latest in LASIK surgery uses wave-front guided technology that employs a scanner to create a highly detailed chart of the eye. The detailed measurements improve accuracy levels for corneal surgery.
Here’s how you can prepare for LASIK surgery:
- Stop wearing contact lenses. Because contact lenses can distort the shape of the cornea, you will be asked to switch to glasses a few weeks before surgery. A distortion can cause inaccuracy in critical eye measurements and lead to less than ideal results after surgery. Talk to your eye surgeon for detailed instructions.
- Avoid eye cream and eye makeup both on the day before surgery and on the day of surgery.
- Clean your eyelashes daily or more frequently according to your doctor’s instructions. Cleaning helps remove debris and reduces the risk of infection.
- Arrange for someone to accompany you and to drive you home after the surgery. You may need some help until the effects of medication wear off. Your vision may also be blurred, so you must avoid driving soon after the procedure.
Before you have surgery, make sure you have everything that you need to stay at home during the recovery process.
Your eyes may water, itch or burn immediately after surgery. Your practitioner may give you eye drops and pain medications to use for several hours following the procedure. You may also be given a shield to wear over your eyes at night until healing is complete.
People can see right after surgery, but vision will not be clear immediately. It takes two to three months for the eye to heal and your vision to stabilise. How well you can see following surgery will depend somewhat on how good your eyesight was before the procedure.
Expect a follow-up appointment with the eye surgeon a day or two after surgery. The surgeon will want to see how your eyes are healing and ensure there have been no complications. Your surgeon may ask you to come for an additional follow up visit six months after the surgery.
Possible risks and complicationsClick to expand
As with any surgical procedure there are risks involved in LASIK eye surgery. You should be fully aware of these before you elect to have the procedure.
LASIK surgery is considered a safe procedure in the hands of trained eye surgeons. Statistics from the US show over 95 percent patient satisfaction rate. Each patient heals differently, so results will vary among individuals.
The following are the more common risks and complications that may arise as a result of LASIK surgery:
- Dry eyes – This is a major after-effect of the surgery. While it is very common to experience dry eyes immediately after surgery, the condition usually goes away. In some people, however, dry-eye symptoms may worsen. They may experience burning eyes, redness and decreased vision if the cranial nerves which induce tear production have been damaged during surgery. People with the condition before surgery may find it worse afterwards. In a few people, dry-eye may become permanent, requiring medication to improve tear production, or temporary closure of the drainage system for tears with punctal plugs.
- Over- or under-correction – People whose vision has been over- or under-corrected may need a second procedure to sharpen their vision. The enhancement surgery cannot take place until the eyes heal and vision stabilises, a process that may take many months. Revision will not be possible if the cornea is too thin or has an abnormal shape after the initial surgery.
- You might have to wear glasses or contacts after surgery – Although it is very rare, some people still need eyewear to achieve sharp vision after surgery. Talk to your surgeon about this possibility. When both eyes are corrected, glasses might be needed for close work, especially after age 40, when age-related vision deterioration generally commences.
- Regression – While relatively uncommon, in some people the results of the LASIK surgery may not be permanent. The regression may occur years afterwards, especially in those with farsightedness. Additional LASIK surgery may help at that stage to correct the regression.
- Visual aberrations and issues with night vision– Some people who undergo LASIK experience various effects that impede the quality of their vision, especially at night and in dim light. Hazy or double vision, vision fluctuations during the day or from day to day, differing refractive powers between the two eyes (anisometropia) and seeing images of different sizes from the two eyes (aniseikonia) are possible complaints. People sometimes experience haloes around light sources. These effects collectively make it difficult to drive and see well at night or in dimly lit conditions.
- Ectasia – A condition known as ectasia or keratectasia may develop, causing the vision in the affected eye to deteriorate, either soon or many years after LASIK surgery. Ectasia occurs when the surgery permanently weakens the cornea, resulting in a progressive corneal steepening or bulging that compromises vision.
- Loss of vision – Although rare, in some people LASIK surgery causes the vision to worsen to such an extent that it cannot be corrected with glasses or contact lenses. Loss of vision can result from equipment malfunction, laser burns or scarring, flap-related complications, infection or extreme changes in the shape of the cornea after the operation.
The best way to reduce risk in any surgery is to find a surgeon who is fully qualified, has received formal training in LASIK surgery, and has performed the procedure many times. However, even the best surgeons cannot completely remove your chance of risk and complications. As with any surgery, the outcome also depends on how each person’s body responds to the procedure.
Just as you would discuss potential benefits before surgery, it is always advisable to ask your surgeon to address the potential risks as they apply to you. Your surgeon can also advise you how to avoid or minimise some types of risk.
Rough costs involvedClick to expand
Usually you will need a referral from your optometrist or GP for the initial assessment with your chosen eye surgeon.
Different types of LASIK surgery come with different price tags. Traditional LASIK surgery and Trans PRK laser eye surgery costs upwards of $2,500 for each eye. Wavefront LASIK surgery costs more, from $ 3,000 (AUD) per eye. Practices with the latest lasers tend to charge more (to recoup the cost of the very expensive equipment) as well as surgeons with more experience.
Because LASIK is an elective procedure, Medicare and most insurance plans will not cover the costs of surgery. However, some plans do cover some expenses.
You should expect the costs to be higher if you are having combined procedures at the same time.
This information is correct as of 2019.