Refractive surgery is the term used to describe surgical procedures that correct common vision problems (nearsightedness, farsightedness, astigmatism, and presbyopia) to reduce your dependence on prescription eyeglasses and/or contact lenses. Currently, a laser procedure called LASIK (LAY-sik) is the most popular refractive surgery performed in the United States.
LASIK, or "laser-assisted in situ keratomileusis," is designed to reshape the cornea to enable light entering the eye to be properly focused onto the retina for clearer vision. When performed by a skilled surgeon, LASIK provides satisfying results, including improved vision with less or no dependence on glasses and contacts.
In most cases, the procedures is completed within 15 minutes for both eyes. Patients usually see the results in as little as 24 hours.
How is Wavefront technology used to enhance LASIK?
Wavefront technology measures precisely how light travels through the eye. Excimer lasers with built-in wavefront analysis can detect and automatically adjust for subtle vision errors when laser energy is applied to reshape the cornea. Studies suggest wavefront-guided LASIK reduce the risk of night glare after surgery.
Who is a candidate for LASIK laser vision correction?
- You must have healthy eyes — no glaucoma, infection, cataracts, severe dry eye or any other condition that would affect postoperative healing.
- You must be an adult: age 21 or older (with some exceptions).
- Your vision must be stable for at least a year before surgery.
- If you're pregnant or nursing, your hormonal levels can affect the shape of your eye. You'll need to wait until your hormones are back to normal levels.
- You cannot have a degenerative or autoimmune disease, since this would affect healing.
What if I am not a LASIK candidate?
Over the past 25 years, surgical techniques, tools, and procedures for vision correction have evolved rapidly. If you're not a good LASIK candidate, a number of other vision correction surgeries are available. Your eye doctor will determine if one of these procedures is suitable for your condition and, if so, which technique is best. Some of these alternative vision correction options include:
- Photorefractive Keratectomy (PRK)
- Conductive Keratoplasty
- Refractive Lens Exchange
Who should I talk to about LASIK and refractive surgery?
The absolute best source of information about LASIK is a LASIK surgeon, and ours provide free consultations. All you have to do is make an appointment.
Corrective Eye Surgery Basics
Over the past 25 years, surgical techniques, tools, and procedures for vision correction have evolved rapidly.
Radial Keratotomy (RK), used in the United States primarily during the 1980s, involved cutting spoke-like incisions to flatten the eye's surface mainly to correct nearsightedness. But results, especially long-term, created problems for some individuals. Significant glare, regression, fluctuating vision, and other side effects such as night vision problems were common in patients who had RK for higher prescription strengths, while such side effects were less frequent in patients with lower prescriptions.
RK is now virtually obsolete as a primary vision correction procedure for these reasons and because of advances in laser vision correction procedures.
Photorefractive Keratectomy (PRK) was the first successful laser vision correction procedure used to remove (ablate) tissue directly from the eye's surface to change the curvature of the cornea. PRK, also known as surface ablation, was performed outside the United States during the 1980s and received FDAapproval in 1995. PRK is still commonly used, but LASIK (see below) is by far the most popular laser procedure today.
However, PRK has made somewhat of a comeback in recent years because of studies indicating that PRK and LASIK produce similar outcomes. Also, nerve regeneration in the eye's surface appears to take place faster with PRK than with LASIK following a procedure, which could have implications for reducing dry eye and other complications that might occur until the healing process is complete.
Because PRK is a surface procedure, there also is no risk of surgical flap complications. PRK does not involve creating a thin, hinged flap on the eye's surface, as occurs with LASIK. PRK also appears to be a safer procedure in cases when a person's cornea may be too thin for LASIK surgery.
Recent technological advances have given eye surgeons better methods of creating thinner flaps in a predictable way, meaning that people with thin corneas now might be candidates for a LASIK procedure.
However, you probably should consider a different type of vision correction procedure if you have a thin cornea and high degree of myopia that would require extra ablation to reshape the eye.
Wavefront technology used for measuring vision errors in custom LASIK helps achieve very precise outcomes. (Top: Abbott Medical Optics WaveScan. Bottom: Alcon LADARVision CustomCornea.)
LASIK's main advantage over PRK is that there is little or no discomfort immediately after the procedure, and vision is usually clear within hours rather than days. Different forms of LASIK exist, many that depend on how the flap is created:
- LASEK involves creating an ultra-thin hinged flap in the thin outer covering (epithelium) of the eye and floating it away from the eye's surface with alcohol so that laser reshaping of the eye can occur.
- Epi-LASIK is like LASEK, except that a special cutting tool is used to lift the flap.
- Bladeless, Blade-Free, or All-Laser LASIK involves use of another laser rather than a mechanical cutting tool to create the flap in LASIK. Because the laser used for this purpose originally was made and marketed by IntraLase Corp., all-laser LASIK was sometimes also called IntraLASIK. In 2007, Advanced Medical Optics (now Abbott Medical Optics) obtained the IntraLase technology and integrated it into the company's CustomVue excimer laser platform (iLASIK). Other brands of bladeless LASIK now are available, including the Ziemer Femto LDV, marketed as zLASIK.
- Wavefront LASIK or PRK (also known as wavefront-guided, wavefront-assisted, or custom LASIK/PRK) incorporates ultra-modern analysis, known as wavefront, to measure precisely how light travels through the eye. Excimer lasers with built-in wavefront analysis can detect and automatically adjust for subtle vision errors when laser energy is applied to reshape the cornea. Studies suggest wavefront-guided LASIK helps maintain contrast sensitivity and reduces the risk of night glare after LASIK surgery.
- Conductive Keratoplasty (NearVision CK by Refractec) uses a tiny probe and low heat radio waves to apply "spots" around the periphery of the eye's clear front surface. This relatively non-invasive method steepens the cornea, to provide near vision correction for people who are farsighted. CK also can be used to correct presbyopia or enhance near vision for people who have had LASIK or cataract surgery. CK received initial FDA approval in 2002.
Implantable lenses are another option for vision correction surgery
- Refractive Lens Exchange is another non-laser, internal eye procedure. RLE is much like cataract surgery. But instead of removing the eye's natural lens that has grown cloudy due to cataract formation, RLE involves removing a clear natural lens and replacing it with an artificial lens of a different shape, usually to reduce or eliminate high degrees of farsightedness.
RLE also might be considered as an option for correcting other types of vision problems, such as nearsightedness. But RLE has a higher risk of complications, compared with other vision correction procedures. For these reasons, RLE typically is used only in cases of severe vision correction needs.
- Cataract surgery also can now be considered a vision correction procedure. New lens implants developed for cataract surgery can partially restore a person's near vision in addition to correcting nearsightedness and farsightedness. These lenses, calledmultifocal IOLs or accommodating IOLs, currently are being used by many cataract surgeons, with promising results.
While Medicare and health insurance will cover basic costs of cataract surgery, you can elect to pay out-of-pocket for the extra costs of these more modern lenses that potentially can restore a full range of vision. This is why cataract surgery now also can be viewed as a refractive surgery procedure, but only when you opt to pay extra for full vision correction.
Which Corrective Eye Surgery Procedure Is Right for You?
Because our eyes change as we age, the type of laser eye surgery or other vision correction we need also may change. Certain approaches to LASIK or other procedures that work well for younger adults, for example, may be inappropriate for older individuals.
In some cases, vision correction surgery may be ruled out entirely. Children under age 18 rarely would be considered candidates for laser vision correction because their eyes change too rapidly as their bodies grow and mature.
Also, some people have certain conditions or diseases that would make them poor candidates for certain vision correction procedures and better candidates for other procedures.
- If you have diabetes or other diseases that affect wound healing, you might be a better candidate for PRK or LASEK than certain types of LASIK.
- If you have uncontrolled glaucoma, you likely would not qualify for LASIK or certain other procedures.
Keep in mind that, generally, anyone who is pregnant should not undergo any form of elective vision surgery, because hormonal changes might affect the treatment's accuracy.
Lifestyle also can make a big difference in the type of vision correction you need. A seamstress requires keen near vision. Computer users need good vision at intermediate ranges. And a pilot needs to preserve depth perception to make good spatially oriented judgments while flying. Generally speaking, however, people in their 20s or 30s with mild to moderate farsightedness, nearsightedness, and/or astigmatism are usually excellent candidates for LASIK, PRK, Visian ICL, and other laser vision correction.
Severe Vision Errors and Corrective Eye Surgery for Older People
If you are 40 or older or have severe vision problems, you may want to discuss these options with your eye surgeon:
Monovision. With this approach, LASIK may be used to correct one eye for distance vision and the other eye for near vision as a solution for presbyopia, a focusing problem that affects all people beginning at around age 40.
However, some people cannot adjust to monovision. You might first consider wearing contact lenses providing monovision or trying it with "trial lenses" in your doctor's office, to make sure this approach works for you.
CK also provides a type of monovision, but with a more full range of vision in the corrected eye.
Examples of multifocal and accommodating intraocular lenses for cataract surgery and refractive lens exchange include (top, from left) the AcrySof IQ ReSTOR (Alcon),ReZoom (Abbott Medical Optics or AMO) and Crystalens (Bausch + Lomb). At bottom is the Tecnis(AMO).
•Multifocal or Accommodating IOLs. If you choose this type of lens for a refractive lens exchange or cataract surgery, your eye's natural lens will be replaced permanently.
These artificial lenses potentially can restore a full range of vision, but can also produce side effects such as decreased depth perception or night vision problems in the form of halos or glare.
Also, you may still need to wear eyeglasses or contact lenses or have a "laser touch-up," because it's possible the lenses will fall short of restoring a full range of vision. Be sure and discuss the pros and cons of these new lenses with your eye surgeon.
•Vision Correction for Severe Nearsightedness or Farsightedness.LASIK, PRK and other laser vision correction procedures do have their limitations and may not be the best option for you if you have severe nearsightedness or farsightedness. Some eye surgeons consider implantable lenses (Visian ICL and Verisyse) the best option for extreme nearsightedness.
Refractive lens exchange, in which the eye's natural lens is replaced with an artificial one, is a possible option for extreme farsightedness.
Particularly if you are older than 40, you also might need to consider multiple vision correction solutionsto achieve the very best possible vision for your age and lifestyle.
For instance, you might choose LASIK or PRK in your 30s to correct distance vision. Then, when you reach your mid-40s and your near vision is affected by presbyopia, you might follow up with an "enhancement" using conductive keratoplasty.
With CK in one eye, you may be able to sharpen near vision blurriness caused by the age-related condition of presbyopia.
Most eye surgeons will tell you it's unlikely that any vision correction procedure can give you permanent, optimal vision for a lifetime. Just as you probably needed to change out eyeglasses and contact lenses in the past, you very likely will need a LASIK enhancement or other surgical correction as you grow older, to maintain good vision.
Also, keep in mind that all vision correction procedures have the usually slight risk of side effects that can range from mild to severe. So be sure you discuss all options and potential risks in detail with your eye surgeon or eye care provider before making any final choices.
LASIK and Age
Even if you undergo LASIK or PRK as a young person and achieve perfect vision, you still will develop a condition called presbyopia, typically beginning between the ages of 40 and 50.
Presbyopia is the inability of the eye to focus at all distances, usually noticed when fine print starts to blur.
Some eye doctors disagree about what causes presbyopia. Most believe stiffening of the eye's lens contributes to the condition. Other theories suggest that presbyopia also could be related to continued growth of the lens or atrophy of the muscles controlling the lens.
In the past, the usual remedy was to wear reading glasses or special multifocal lenses (bifocal or progressive lenses) for presbyopia. But in modern times, surgical remedies for presbyopia also are available for qualified candidates. Ask you Surgeon about other available options for qualified candidates.
PRK (photorefractive keratectomy) is a type of refractive surgery to correct myopia (nearsightedness),hyperopia (farsightedness) and astigmatism.PRK was the first type of laser eye surgery for vision correction and is the predecessor to the popular LASIK procedure.
Though PRK recovery takes a bit longer than recovery from LASIK eye surgery, PRK is still commonly performed and offers advantages over LASIK for some patients.
Like LASIK and other types of laser eye surgery, PRK works by reshaping the cornea using an excimer laser, allowing light entering the eye to be properly focused onto the retina for clear vision.
myopia, hyperopia and/or astigmatism, ineligible for LASIK
•Procedure time: about 10 minutes per eye
•Typical results: 20/20 vision without glasses or contact lenses
•Recovery time: several days to several weeks
•Cost: about $1,500 to $2,500 per eye
The main difference between PRK and LASIK is that in LASIK surgery a thin, hinged flap is created on the cornea to access the treatment area, whereas in PRK the cornea's entire epithelial (outer) layer is removed to expose the area and no flap is created. For both PRK and LASIK, the excimer laser then sculpts the stromal layer of the cornea to correct your refractive error.
A variation of PRK, called LASEK, also is available. Instead of removing the outer epithelial layer of the cornea as with PRK, LASEK involves lifting the epithelial layer (using a surgical instrument called a trephine), preserving it during surgery and then replacing it on the eye's surface at the end of the procedure.
LASEK has decreased in popularity due to the slower recovery of vision compared with PRK, as the replaced epithelial layer takes longer to recover in LASEK than the growth of a new epithelial layer in PRK.
PRK vs. LASIK
The final results of PRK surgery are comparable to LASIK outcomes, but initial PRK recovery is slower because it takes a few days for new epithelial cells to regenerate and cover the surface of the eye.
There also is a slightly increased risk of eye infection and haziness of vision in the first few days after surgery. LASIK patients generally have less discomfort, and their vision stabilizes more quickly, whereas vision improvement with PRK is gradual and the final outcome can take several weeks.
PRK does, however, offer some distinct benefits. Because PRK surgery does not create a corneal flap (which contains both epithelial and the deeper stromal tissues), the entire thickness of the underlying stroma is available for treatment.
his is of particular benefit if the cornea is too thin for LASIK or if you have undergone LASIK previously and therefore have a thinner residual cornea. There also is no risk of flap complications, and the risk of removing too much of the cornea with the excimer laser is reduced.
How Is PRK Performed?
First, your eye surgeon removes a central area of corneal epithelium with an alcohol solution, a "buffing" device or a blunt surgical instrument. Next, an excimer laser is used to precisely reshape the curvature of your cornea's surface. This computer-controlled, highly specialized laser delivers pulses of cool ultraviolet light that remove microscopic amounts of tissue in a precise pattern.
A soft contact lens "bandage" is then placed on the cornea to help protect your eye. New epithelial cells grow back in five days typically, after which the bandage contact lens is removed by your eye doctor.
What To Expect From PRK Surgery
Before. You must first choose an eye surgeon experienced in PRK surgery. You will then undergo a thorough eye exam to ensure your suitability for laser eye surgery. This will include an evaluation of:
•The size of your pupils.
•The moistness of your eyes, to evaluate the risk of developing dry eyes after laser eye surgery and treat accordingly.
•Corneal curvature, using a corneal mapping device to precisely measure the contours of the front surface of your eye.
Your eye doctor also will assess your general health and medical background, as well as any medications you are taking, to determine if you are a suitable candidate. If you wear contact lenses, you may need to stop wearing them for a period of time before your eye exam, as contacts can change the natural shape of your cornea. (Ask your eye doctor for specific advice about this.)
While LASIK is used more often for vision correction surgery, PRK may be the best procedure in certain circumstances.
During PRK eye surgery is an ambulatory procedure, meaning it is performed on a walk-in, walk-out basis. In fact, the actual surgery generally takes only 15 minutes. You will be awake during the procedure, but your eye surgeon may give you a mild oral sedative to help you relax.
Numbing eye drops are applied to your eyes, and an instrument called a lid speculum is used to keep your eyelids open. Your surgeon then directs the excimer laser over your eye, which is programmed for your exact prescription.
You will be asked to look at a target light for a short time while your surgeon watches your eye through a microscope as the laser sends pulses of light to your cornea.
The laser energy removes microscopic amounts of tissue and reshapes the cornea. Most people do not feel any discomfort, although you may feel some pressure on your eye. Your surgeon has full control of the laser and can turn it off at any time.
PRK is performed on each eye separately (often one after the other on the same day), with each procedure taking only about five minutes. While some patients have both eyes treated on the same day, others choose to have the surgery on their second eye a week or two later.
Your surgeon covers the treated cornea with a bandage contact lens. Within days, new epithelial cells grow back, and the bandage contact is removed.
Immediately After. You will be asked to rest for a short period after your surgery, after which you can return home (someone else must drive you).
Your surgeon will prescribe topical antibiotics as well as anti-inflammatory and pain medications to reduce post-operative discomfort, minimize any swelling and expedite healing. As with any other surgery, it is imperative that you follow your doctor's instructions to help ensure optimum results. You will need to attend frequent follow-up appointments with your doctor over the next several weeks to monitor the healing process.
PRK recovery takes longer than recovery from LASIK surgery. It may be days or a couple of weeks before your eyesight improves, and even longer for your vision to stabilize. Most PRK patients usually can resume driving a car one to three weeks after surgery, but it can take three to six months before vision is completely clear and stable.
Long-Term Results of PRK
PRK laser eye surgery has been performed overseas since the 1980s and in the United States since 1995 and has a very high success rate. It has undergone significant advancements during this time and remains the treatment of choice in certain circumstances.
PRK and LASIK results are similar. Most people achieve 20/20 vision after PRK surgery, and nearly all patients achieve 20/40 visual acuity or better. Some patients may still need to wear eyeglasses orcontact lenses, but the prescription will be significantly lower than before the procedure.
Post-operative PRK and LASIK complications are rare and can include infection and glare (starbursts or halos that are most noticeable when you're viewing lights at night, such as while driving).
While unlikely, you may need additional or enhancement surgery to improve your vision further or to correct a gradual worsening of your eyesight over time. Reading glasses also may still be required after PRK surgery once you hit your 40s, due to an age-related loss of near vision called presbyopia. The FDAcurrently is monitoring clinical trials for a permanent surgical correction of presbyopia.
While LASIK is by far the most popular laser eye procedure today, it's important to follow the guidance and judgment of your eye surgeon to determine whether PRK or LASIK is best for your individual circumstances.
The LASIK Guide
LASIK, or "laser-assisted in situ keratomileusis," is the most commonly performed laser eye surgery to treat myopia (nearsightedness), hyperopia (farsightedness) and astigmatism.
Like other types of refractive surgery, the LASIK procedure reshapes the cornea to enable light entering the eye to be properly focused onto the retina for clearer vision.
In most cases, laser eye surgery is pain-free and completed within 15 minutes for both eyes. The results — improved vision without eyeglasses or contact lenses — can usually be seen in as little as 24 hours.
If you're not a good LASIK candidate, a number of other vision correction surgeries are available, such as PRK and LASEK laser eye surgery and phakic IOL surgery. Your eye doctor will determine if one of these procedures is suitable for your condition and, if so, which technique is best.
How Is LASIK Surgery Performed?
First, your eye surgeon uses either a mechanical surgical tool called a microkeratome or a femtosecond laser to create a thin, circular "flap" in the cornea.
The surgeon then folds back the hinged flap to access the underlying cornea (called the stroma) and removes some corneal tissue using an excimer laser.
This highly specialized laser uses a cool ultraviolet light beam to remove ("ablate") microscopic amounts of tissue from the cornea to reshape it so it more accurately focuses light on the retina for improved vision.
For nearsighted people, the goal is to flatten the cornea; with farsighted people, a steeper cornea is desired.
Excimer lasers also can correct astigmatism by smoothing an irregular cornea into a more normal shape. It is a misconception that LASIK cannot treat astigmatism.After the laser reshapes the cornea, the flap is then laid back in place, covering the area where the corneal tissue was removed. Then the cornea is allowed to heal naturally.
Laser eye surgery requires only topical anesthetic drops, and no bandages or stitches are required.
Before LASIK Surgery
Your eye doctor will perform a thorough eye exam to ensure your eyes are healthy enough for the procedure. He or she will evaluate: the shape and thickness of your cornea; pupil size; refractive errors (myopia, hyperopia and astigmatism); as well as any other eye conditions.
mild/moderate myopia, hyperopia and/or astigmatism, adequate corneal thickness
•Procedure time: about 10 minutes per eye
•Typical results: 20/20 vision without glasses or contact lenses
•Recovery time: a few days to several weeks for vision to stabilize
•Cost: about $1,500 to $2500 per eye
The moistness of your eyes will also be evaluated, and a precautionary treatment may be recommended to reduce your risk of developingdry eyes after LASIK.
Usually, an automated instrument called a corneal topographer is used to measure the curvature of the front surface of your eye and create a "map" of your cornea.
With wavefront technology associated with custom LASIK, you also are likely to undergo a wavefront analysis that sends light waves through the eye to provide an even more precise map of aberrations affecting your vision.
Your eye doctor will also note your general health history and any medications you are taking to determine if you are a suitable candidate for LASIK.
You should stop wearing contact lenses for a period of time advised by your doctor (typically around two weeks) before your eye exam and before the LASIK procedure, as contacts can alter the natural shape of your cornea.
How LASIK Works
Before your surgery begins, numbing eye drops are applied to your eye to prevent any discomfort during the procedure. Your doctor may also give you some medication to help you relax.
Your eye will be positioned under the laser, and an instrument called a lid speculum is used to keep your eyelids open.
The surgeon uses an ink marker to mark the cornea before creating the flap. A suction ring is applied to the front of your eye to prevent eye movements or loss of contact that could affect flap quality.
After the corneal flap is created, the surgeon then uses a computer to adjust the excimer laser for your particular prescription.
You will be asked to look at a target light for a short time while he or she watches your eye through a microscope as the laser sends pulses of light to your cornea. The laser light pulses painlessly reshape the cornea, although you may feel some pressure on your eye. You'll also hear a steady clicking sound while the laser is operating. LASIK is performed on each eye separately, with each procedure taking only about five minutes.
Immediately After LASIK Surgery
Upon completion of your LASIK surgery, your surgeon will have you rest for a bit. You may feel a temporary burning or itching sensation immediately following the procedure. After a brief post-operative exam, someone can then drive you home. (You cannot drive yourself until your eye doctor confirms your uncorrected vision meets the legal standard for driving.)
LASIK SURGERY CHECKLIST
1.Choose an experienced LASIK surgeon. How many LASIK procedures has your doctor performed? Does he or she use state-of-the-art equipment and technology?
2.Be honest with your doctor. Have you alerted your eye doctor about any health issues you have or medications you are taking?
3.Know your stuff. Are you well-informed about the procedure? And the cost of LASIK surgery?
4.Weigh it up. Are you aware of the potential complications and limitations of LASIK?
5.Be real. Do you have realistic expectations of what LASIK surgery can achieve for you?
Take our free two-minute screening test to see if LASIK eye surgery is right for you.
You should expect some blurry vision and haziness immediately after surgery; however, clarity should improve by the very next morning.
Your eyesight should stabilize and continue to improve within a few days, although in rare cases it may take several weeks or longer. For most people, vision improves immediately.
You may be able to go to work the next day, but many doctors advise a couple of days of rest instead.
Also, it is usually recommended that you refrain from any strenuous exercise for at least a week, since this can traumatize the eye and affect healing.
Generally, you will return to see your eye doctor or your LASIK surgeon the day after surgery.
At this initial check-up, he or she will test your vision to make sure you are legal to drive without glasses or contact lenses. In most states, this requires uncorrected visual acuity of 20/40 or better.
As with any other surgery, always follow your doctor's instructions and take any medication prescribed. Also, avoid rubbing your eyes, as there's a small chance this could dislodge the flap until it heals and adheres more securely to the underlying cornea.
Laser eye surgery offers numerous benefits and can dramatically improve your quality of life. Most people achieve 20/20 vision or better after the surgery, but LASIK results do vary. Some people may achieve only 20/40 vision or less.
You may still need to wear glasses or contact lenses following laser vision correction, though your prescription level typically will be much lower than before.
While the procedure has an excellent safety profile, LASIK complications can occur and may include infection or night glare (starbursts or halos that are most noticeable when you're viewing lights at night, such as while you're driving).
A small percentage of people will need a LASIK enhancement, or "touch up" procedure, a few months after the primary LASIK surgery to achieve acceptable visual acuity.
You also may still need reading glasses once you reach your 40s, due to a normal age-related loss of near vision called presbyopia.
While LASIK surgery has a high success rate, it is important that you discuss all facets of the procedure with your surgeon prior to consenting to the surgery.
LASIK Questions and Answers:
What is laser vision correction?
It is a surgical procedure that uses a cool (non-thermal) beam of light to gently reshape the cornea — the surface of the eye — to improve vision. The laser removes microscopic bits of tissue to flatten the cornea (to correct nearsightedness), steepen the cornea (to correct farsightedness) and/or smooth out corneal irregularities (to correct astigmatism).
The goal of laser eye surgery is to change the shape the cornea so it does a better job of focusing images onto the retina for sharper vision. LASIK and PRK are two types of laser vision correction.
Are LASIK and PRK safe?
The FDA recognizes LASIK and PRK as proven, safe and effective. Laser vision correction uses a cool (non-thermal) beam of light that is computer controlled. The surgeon turns the laser on and is able to turn it off at any moment. Many safeguards are in place to reduce the risk of error. However, risks are associated with any surgical procedure.
Although no one knows the exact number of complications, studies suggest that the incidence of minor difficulties such as dry eyes and nighttime glare is around 3 percent to 5 percent, while the risk of serious incidents such as lost vision is thought to be less than 1 percent. There are no known cases of blindness from LASIK or PRK. Again, outcomes generally are very good.
Can I have both eyes done at the same time?
Most surgeons perform a LASIK procedure on both eyes at the same time. Because it takes longer for clear, comfortable vision after PRK, many surgeons will wait a week or two between eyes for PRK.
How is eye laser surgery different from previous types of refractive eye surgery?
Current FDA-approved laser vision correction methods, such as LASIK (laser-assisted in situ keratomileusis), have a higher predictability of the final result with a lower incidence of complications. Additionally, older techniques typically involved manually performed incisions rather than automated lasers for correction.
Does laser vision correction hurt?
You won't feel pain during LASIK or PRK, because your surgeon will place anesthetic eye drops in your eye first. Afterward, he or she may prescribe pain medication if necessary. Many LASIK patients report no more than mild discomfort for a day or so after surgery. There is more discomfort after PRK because the procedure exposes the deeper layers of the cornea. For clear and comfortable vision after PRK, protective surface cells have to grow back over the treated area. This process can take a week or two, sometimes longer.
How long does LASIK take?
The laser treatment itself usually takes less than a minute, while the entire procedure takes approximately 15 minutes per eye.
How do I know if I'm eligible for laser vision correction?
Your eye care practitioner can help you decide, but here are some general guidelines:
•You must have healthy eyes — no glaucoma, infection, cataracts, severe dry eye or any other condition that would affect postoperative healing.
•You must be an adult: age 21 or older (with some exceptions).
•Your vision must be stable for at least a year before surgery.
•If you're pregnant or nursing, your hormonal levels can affect the shape of your eye. You'll need to wait until your hormones are back to normal levels.
•You cannot have a degenerative or autoimmune disease, since this would affect healing.
What happens before laser eye surgery?
Your eye care practitioner will give you a thorough eye exam to make sure your eyes are healthy and you're a suitable candidate for laser vision correction. He or she will test for glaucoma, cataracts and other disqualifying conditions. He or she also will use a machine called a corneal topographer to photograph and electronically map your eye. The surgeon will use this map to plan your surgery for the most precise results possible.
What happens on the day of treatment?
LASIK and PRK are outpatient procedures, which means you'll spend around an hour at the surgeon's office and walk out afterward. Someone else must drive you home, because your vision will be a little blurry right after surgery.
You'll lie down in a reclining chair. The surgeon will place anesthetic drops in your eye, position your head under the laser and place an eyelid speculum (retainer) under your lids to hold your eye wide open.
In LASIK, the surgeon creates a thin flap in the top of the cornea, folds it back out of the way, uses the laser to remove some corneal tissue and then puts the flap back in place. If you're having PRK, no flap is created: The laser simply removes the outer layer of the cornea (epithelium), which grows back after surgery.
What happens afterward?
The surgeon will place eye drops or ointment in your eye. You may relax for a little while then go home and rest. You'll probably notice clearer vision immediately, and typically it will improve even more as the weeks go by.
When may I resume driving?
You may begin driving as soon as you see well enough, excluding the day you had LASIK or PRK performed.
Can I go back to work right away?
Most people who have LASIK return to work the next day. With PRK, many surgeons recommend two or three days of rest instead.
When may I go back to wearing makeup?
You may resume wearing makeup about one week after your surgery. However, throw out your old makeup and buy new to decrease your risk of infection.
Are there any side effects?
Some people experience dry eye after LASIK, which usually is relieved with eye drops and disappears over time. Others may experience starbursts or halos around lights, especially at night. Usually this effect lessens or disappears over time, too. In a small number of people (probably fewer than 1 percent), their vision worsens rather than improves.
How many checkups will I need after LASIK?
Depending on your surgeon, you will probably return the next day, then one week or one month later and then three months later. Your doctor will let you know if more visits are necessary.
What if time passes and I'm not seeing better?
A small number of patients see well after surgery then experience regression, a gradual worsening of vision. If this happens, consult with your eye care practitioner to determine the cause and to see if retreatment (enhancement) is appropriate.
How much does laser vision correction cost?
There is no one answer regarding what LASIK costs, since fees vary from one surgeon to the next. Prices range from less than $1,000 per eye to more than $3,000 per eye. The average cost for all laser-based vision correction procedures is about $2,150 per eye. You also can ask your eye surgeon's staff about the possibility of financing a procedure.
I have more questions about LASIK. Who should I ask?
The absolute best source of information about LASIK is a LASIK surgeon, and most provide free consultations. All you have to do is make an appointment.