LASIK Eye Surgery
OverviewAre you tired of being dependent on eyeglasses or contact lenses to see? If yes, you might want to consider getting vision correction surgery. One such surgery, LASIK (Laser-Assisted In Situ Keratomileusis), was first performed in the early 1990s and has since become one of the most popular vision correction surgeries thanks to its quick healing time and minimal postoperative pain. (1) If you have nearsightedness, farsightedness or astigmatism and are looking to make a change, here is some information that will help you decide whether LASIK is right for you.
The cornea is the outermost part of your eye that helps you see objects clearly. It does this by bending light that is reflected off of objects directly onto the retina, which turns light into neural signals that the brain uses to create images of objects. An improperly shaped cornea can affect where light is focused and can lead to what is called a refractive error. (1, 2) Nearsightedness is a type of refractive error that occurs when the cornea is too curved. Instead of light focusing directly on the retina, it gets focused in front of the retina. This results in nearby objects appearing clear and far away objects appearing blurry. On the other hand, farsightedness occurs because the cornea is too flat, so light focuses behind the retina. People with farsightedness see distant objects more clearly than nearby objects. (1, 2) LASIK corrects vision by changing the shape of the cornea. It does this by using a blade or laser to create a “flap” from the outermost layers of the cornea. The “flap” gets pushed aside and a laser is used to remove small pieces of tissue from either the center or the edges of the underlying cornea to make it more or less curved. Following the reshaping process, the “flap” is replaced, allowing the eye to heal. (1)
Good candidates for LASIK have mild nearsightedness, farsightedness or astigmatism. To be considered for LASIK, you must be over the age of 18 and not have any of the following: (3, 4)
- A prescription that has changed in the last year
- Uncontrolled diabetes
- Pregnant or nursing
- Use high dose steroids
- Cornea abnormalities
- Thin cornea
- Dry eye
- Uncontrolled glaucoma
- An autoimmune disease or any disease that can result in slow wound healing
- A higher risk of head trauma due to an active lifestyle
Before surgery, your eye doctor will go over your medical history and take measurements of your cornea, your pupil and your refractive error to determine your eligibility for the procedure. (2) You will be asked to stop wearing soft contact lenses 1 to 2 weeks and hard lenses 3 to 4 weeks before the procedure so that your doctor can get the most accurate measurements of your cornea. (3)
The procedure will usually take place in your eye doctor’s office or an outpatient surgery center. You will be awake for the procedure but will be given drops that will numb your eyes so you should not feel any pain. (2) It is a relatively short procedure that lasts for 30 minutes, which includes prep time. (5) Your eye will be in an eyelid holder and you will be instructed to look at a light to prevent your eye from moving. A suction ring will be placed on your eye as well, which may cause you to feel some pressure. (2) LASIK consists of the following steps: (1)
- The doctor will use a mechanical blade or laser to create a “flap” from the outer layers of the cornea
- The “flap” is pushed aside and a laser that has been preprogrammed with your measurements will precisely remove pieces of tissue from the cornea to alter its shape
- The “flap” will be replaced and reattach itself
After surgery, your doctor will give you an eye covering to help with the healing process. You may feel burning for a few hours after surgery, but you will be given eye drops to help reduce this feeling. (2) You should have someone pick you up and drive you home. You will likely begin to see improvement in vision the next day. Most people resume daily activities within 24 hours of surgery. (2) Your doctor will want to see you for a follow-up typically the next day and week and multiple times throughout the year following surgery. (5) You can expect your vision to be stable by 6 months after surgery. (2)
LASIK is considered to be a safe procedure, but like with any surgery, it comes with possible risks. Some of the side effects you may experience are dry eye, hazy vision, eye pain, scratchy eye, glare, halos and light sensitivity, but these symptoms typically resolve within a few weeks or months. (2, 3) Some other more serious risks include: (1, 2, 3)
- Vision blindness
- Under or overcorrecting vision
- Flap displacement, flap wrinkles and flap melt
- Lamellar keratitis (inflammation between the cornea “flap” and underlying tissue)
- Keratectasia (thinning of the cornea)
- Epithelial ingrowth (epithelium growing into flap)
However, it is important to note that the risk of experiencing these complications is very low.
The healing time with LASIK is relatively short compared to other similar procedures. You can expect to see improved vision within just 24 hours of your procedure and stable results by 6 months. (2) People who have received LASIK have very good outcomes and results that last for years or decades. For example, 98% of people reportedly have a 20/40 vision, yet 90% of people have a 20/20 vision following LASIK surgery. (6) As you age, your vision may change and you may require a second procedure called an enhancement. However, few patients require this procedure. (3)
LASIK has many benefits that make it the preferred choice for many people. It typically allows for a shorter healing time and causes less postoperative pain compared to similar alternatives. (1) However, because LASIK involves using cornea tissue to create a “flap,” it is not ideal for people with thin corneas. People who live more active lifestyles and are prone to head trauma may also be at risk for “flap” dislodgement. In these instances, alternative treatments are available. Alternative laser treatments that are similar to LASIK and produce comparable results include: (1) Photorefractive keratectomy (PRK): Instead of using part of the cornea to create a “flap,” PRK surgery removes the outermost layer of the cornea called the epithelium completely. Because no “flap” is created, PRK eliminates the risk of “flap” complications. (1) LASEK: Instead of creating a thick “flap” using cornea tissue, LASEK creates a thin “flap” with just the epithelium. Because of this, this procedure can be used in people with thin corneas. (1) Here are some advantages and disadvantages of each treatment: (1)
|Faster visual recovery||Not recommended for people with thin corneas|
|Less postoperative pain and incidence of haze because epithelium remains intact||Can cause “flap” complications|
|A good alternative for people with thin corneas||Increased incidence of corneal haze and pain|
|Preferable for people prone to head trauma||Longer postoperative recovery|
|A good alternative for people with thin corneas||Longer postoperative recovery compared to LASIK|
|Less postoperative pain compared to PRK||Thin “flap” can lead to displacement|
LASIK is considered to be an elective surgery and is not typically covered by insurance. The cost of LASIK varies by where you live, the type of technology that is used for the procedure and the surgeon’s level of expertise. You can expect the cost to range from $1500 to $2500 per eye. (3)
Ready to take the next step?
Contact an ophthalmologist near you to setup a LASIK consultation.
- Kuryan J, Cheema A, Chuck RS. Laser-assisted subepithelial keratectomy (LASEK) versus laser-assisted in-situ keratomileusis (LASIK) for correcting myopia. Cochrane Database Syst Rev. 2017;2(2):CD011080. Published 2017 Feb 15. doi:10.1002/14651858.CD011080.pub2
- Boyd, K. LASIK-Laser eye surgery. American Academy of Ophthalmology website. Updated October 21, 2020. Accessed October 21, 2020. https://www.aao.org/eye-health/treatments/lasik
- Wilkinson JM, Cozine EW, Kahn AR. Refractive Eye Surgery: Helping Patients Make Informed Decisions About LASIK. Am Fam Physician. 2017;95(10):637-644.
- LASIK: What You Should Know. Am Fam Physician. 2017;95(10): Online. PMID: 28671411.
- Kaiser Permanente. PRK, LASEK, and Epi-LASIK for Nearsightedness. Kaiser Permanente website. Updated December 18, 2019. Accessed October 21, 2020.
- Eydelman M, Hilmantel G, Tarver ME, et al. Symptoms and Satisfaction of Patients in the Patient-Reported Outcomes With Laser In Situ Keratomileusis (PROWL) Studies. JAMA Ophthalmol. 2017;135(1):13-22. doi:10.1001/jamaophthalmol.2016.4587