A Guide to Laser Eye Surgery
Learn more about laser eye surgery - what it is, its types, uses, suitable candidates, procedure involved, risks, costs, and more.
Contents
What Is Laser Eye Surgery?
Laser eye surgery, also known as refractive surgery, refers to a group of surgical procedures that use laser technology to reshape the cornea of the eye, with the goal of correcting common refractive errors.
The cornea, the transparent front part of the eye, plays a crucial role in focusing light onto the retina to form clear images. When the cornea is not properly shaped, vision problems occur.
What Does It Treat?
Laser eye surgery is primarily used to treat common refractive errors, which are conditions that affect the eye’s ability to focus light properly onto the retina. The most common refractive errors corrected by laser eye surgery include:
- Myopia (Nearsightedness) – A condition where distant objects appear blurry, while close objects can be seen more clearly. It occurs when the eyeball is too long or the cornea is too steep, causing light to focus in front of the retina instead of directly on it.
- Hyperopia (Farsightedness) – A condition where close objects may appear blurry, while distant objects are seen more clearly. It occurs when the eyeball is too short or the cornea has too little curvature, causing light to focus behind the retina.
- Astigmatism – A condition where the cornea or lens of the eye has an irregular shape, leading to blurred or distorted vision. It can occur in combination with myopia or hyperopia.
Aside from vision correction, laser eye surgery may also be used to treat other conditions such as:
- Cancer.
- Cataracts.
- Glaucoma.
Types Of Laser Eye Surgery Or Refractive Surgery
There are several types of procedures, each with its own techniques and considerations. Some of the common types are:
SMILE (Small Incision Lenticule Extraction)
SMILE is a newer and less invasive procedure compared to LASIK. It involves the use of a femtosecond laser to create a small disc-shaped piece of tissue (lenticule) within the cornea. The lenticule is then removed through a small incision, reshaping the cornea. It is a known treatment for those seeking a permanent solution for myopia.
LASIK (Laser-Assisted In Situ Keratomileusis)
LASIK is the most common and widely performed laser eye surgery. During LASIK, a thin flap is created on the cornea using a microkeratome (a small blade) or a femtosecond laser. The flap will be lifted, and the underlying corneal tissue will be reshaped using an excimer laser.
LASEK (Laser Epithelial Keratomileusis)
LASEK is a combination of LASIK and PRK. During LASEK, a thin flap of epithelial tissue is created using a special alcohol solution. The flap will be lifted, and the laser treatment will be applied to reshape the cornea. Similar to LASIK, the flap will be repositioned.
PRK (Photorefractive Keratectomy)
PRK was one of the first laser eye surgery procedures and is an alternative to LASIK. During PRK, the corneal epithelium (the outermost layer) is removed entirely before the laser treatment. The excimer laser then reshapes the cornea to correct the refractive error and the epithelium will regenerate over time.
Laser Eye Surgery Comparisons
Destination | LASEK (First Generation) | LASIK (Second Generation) | SMILE (Third Generation) |
Myopia Degree Range | Suitable for patients with myopia above +10.0 D | Up to -15.0 D | Up to -10.0 D |
Astigmatism Degree Range | Up to -4.0 D | Up to -5.0 D | Up to -5.0 D |
Surgery Time | 1 hour per eye | 15 minutes per eye | 5 minutes per eye |
Recovery Time | Several months | Several weeks | Several days |
Odor produced during the operation | No | Yes | No |
Discomfort in post-surgery | 🔴🔴🔴 | 🔴🔴 | 🔴 |
Requirement of Corneal thickness | Patients with thin or flat corneas | Good for patients with normal and thick corneas | Good for patients with normal and thick corneas |
Corneal Flap | No corneal flap. To remove the corneal epithelium | Create a flap on the cornea | No flap on the cornea; minimal incision on the cornea |
Laser adopted | Excimer laser | Excimer laser and femtosecond laser | Femtosecond laser |
Reference: HK Ophthalmic Association
Cost Of Laser Eye Surgery
Take the most updated technology, SMILE Pro as an example, here is the cost information in key markets in the APAC region:
Market | Country | Cost |
SMILE PRO Surgery | Singapore | USD 4500 for 2 eyes |
Hong Kong | USD 4000 for 2 eyes | |
China | USD 3000 for 2 eyes | |
Thailand | USD 2500 for 2 eyes | |
Korea | USD 3800 for 2 eyes |
Cost for reference only, the price may vary with exchange rates
Procedure Involved
The laser eye surgery procedure involves several steps, and the specific details can vary depending on the type of surgery performed (e.g., LASIK, PRK, LASEK, SMILE).
A typical procedure involves numbing the eye, creation of a flap (for LASIK, for example), laser reshaping, flap replacement (LASIK) or healing (LASEK or PRK).
The actual procedure time is usually very short, often lasting only 15 to 20 minutes for both eyes.
Suitable candidates for laser eye surgery are those who meet specific criteria and have certain characteristics that make the procedure likely to be safe and effective for them. While each person’s eligibility is determined on a case-by-case basis by an ophthalmologist or refractive surgeon, general criteria for suitable candidates often include:
- Stable Refractive Error – The prescription for glasses or contact lenses should have remained stable for at least a year (ideally two years) before considering laser eye surgery.
- Good General Health – Candidates should be in good overall health, free from conditions that may affect the healing process or increase the risk of complications.
- Age – LASIK is typically FDA-approved for individuals aged 18 and older. However, the ideal age range is often considered to be between 20 and 40 years, as refractive errors tend to stabilise during this period.
- Corneal Thickness – There should be sufficient corneal thickness to allow for the creation of a corneal flap (in LASIK) or the removal of tissue (in PRK or SMILE) without compromising the structural integrity of the cornea.
- No Eye Diseases or Conditions – Candidates should not have certain eye conditions or diseases, such as glaucoma, cataracts, keratoconus, or severe dry eye syndrome.
- Pregnancy and Breastfeeding – It is generally recommended that women postpone laser eye surgery until after pregnancy and breastfeeding, as hormonal changes during these times can affect vision stability.
Recovery And What To Expect After The Surgery
After undergoing laser eye surgery, whether it’s LASIK, PRK, LASEK, or SMILE, patients may expect a period of recovery and adjustment as their eyes heal and vision stabilises. Immediately after the procedure, some discomfort, tearing, and light sensitivity may be experienced, and vision could be initially blurry.
LASIK patients may notice rapid improvement, often within the first 24 hours, with continued enhancement over the following weeks. PRK and LASEK patients may experience a slower initial recovery as the corneal epithelium regenerates, taking several days to a week. SMILE patients typically enjoy a quick initial improvement, with optimal results achieved within days to weeks.
Regardless of the specific procedure, it is crucial to follow postoperative instructions diligently, including the use of prescribed eye drops, attendance at follow-up appointments, and adherence to activity restrictions. Protective eyewear and limited screen time are often recommended during the initial healing phase.
Possible Risks And Complications
While laser eye surgery or refractive surgery is generally considered safe and effective, like any surgical procedure, it carries potential risks and complications. Some potential risks and complications include:
- Corneal Dystrophy.
- Dry eyes.
- Undercorrection or overcorrection.
- Visual disturbances such as glare, halos, or starbursts, especially at night.
- Infection.
- Flap complication, epithelial ingrowth
- Regression.
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