Treatments · Laser / Refractive
Laser refractive surgery aims to reduce the refractive errors that create a need for glasses or contact lenses by reshaping the cornea. On this page you will find the LASIK, PRK/transPRK and SMILE methods, who may be suitable, and the steps involved.
The cornea is the clear front layer of the eye and does most of the focusing. By precisely changing the cornea's curvature, the laser brings light to a focus on the retina: in myopia the center is flattened, in hyperopia tissue is removed from the periphery so the center is steepened, and in astigmatism the irregularity is corrected.
The three main methods reach the cornea differently. Select from the tabs to compare.
A thin, hinged flap is created with a femtosecond laser (or microkeratome); the tissue beneath the lifted flap is reshaped with the excimer laser, and the flap is replaced and adheres without sutures. Vision usually recovers quickly.
No flap is created. The surface epithelium is removed (mechanically, with alcohol or with the laser) and the corneal surface is reshaped with the excimer laser; a protective contact lens is worn until it heals. In transPRK the laser treats both the epithelium and the tissue in one step, "no-touch." Recovery is slower than LASIK, but there is no flap-related risk and it is biomechanically robust.
A single femtosecond laser creates a lens-shaped lenticule inside the cornea, leaving the surface largely intact; the surgeon removes it through a small incision. No flap and no excimer are used. Because the upper corneal layers are largely preserved, the corneal nerves are affected less and the rate of dry eye is lower; it is also biomechanically advantageous. It is used mainly for myopia and myopic astigmatism (limited for large astigmatism and hyperopia).
The choice is made according to corneal thickness and shape, the type and amount of refractive error, dry eye, lifestyle and occupation:
General candidacy: over 18, a prescription that has been stable for about a year, sufficient corneal thickness, a regular corneal topography and a healthy ocular surface.
It includes corneal topography and tomography (front/back surface and thickness maps), pachymetry (thickness), tear assessment, pupil measurement, refraction and a detailed eye examination. Tomography is the gold standard for screening the risk of ectasia (thinning).
With a high prescription, a thin/borderline cornea or a suspicious topography, a laser that thins the cornea may not be suitable. In that case an ICL (phakic intraocular lens) is an option: without touching the natural lens, an additional lens is placed in front of it; it is an approach that removes no tissue (and can be removed if needed).
Recovery varies by method: with LASIK most people return to daily life in 1-2 days; in PRK the protective lens stays for a few days and vision clears over weeks; in SMILE mild early blurring improves with time.
Possible side effects include temporary dry eye, halos/glare around lights at night (more likely with a large pupil), under/over-correction or regression, and the rare ectasia (thinning). Results vary from person to person; no procedure guarantees a particular outcome.
Important: This test is for information only; it is not a diagnosis, medical advice or a suitability decision. Whether laser suits you can be determined only with corneal topography, thickness (pachymetry) measurement and a detailed examination. This test is only a starting point.
1. Your age?
2. How has your glasses/contact prescription been over the past year?
3. Have you been told any of the following about your cornea?
4. Do you have serious or persistent dry-eye complaints?
5. Do you have any known active eye disease?
6. Have you had previous eye or corneal surgery (including prior laser)?
7. Are you currently pregnant or breastfeeding?
8. Do you have an uncontrolled systemic disease (autoimmune: rheumatoid arthritis, Sjögren; or uncontrolled diabetes)?
PRELIMINARY ASSESSMENT, NOT A DIAGNOSIS
Remember: Definitive suitability is determined only with corneal topography, pachymetry and an examination. Whatever the result, the decision is made together with your doctor.
On the contrary. In a study of surgeons who perform laser vision surgery (Kezirian et al., J Cataract Refract Surg, 2015), about 62% of refractive surgeons with a treatable refractive error had laser vision correction (LVC) themselves; that rate is roughly 5 times the frequency of refractive surgery in the general population and is higher than almost every profession outside the military. Moreover, more than 90% of the surgeons also recommended or performed the procedure on close relatives such as a parent, spouse or child. In short, those who best know its risks and benefits also choose the treatment for themselves in suitable candidates.
No. With a thin cornea, a very high prescription or keratoconus, laser may not be suitable; other options such as ICL are considered.
In most people the need for glasses drops markedly, but age-related near-vision difficulty (presbyopia) can still appear over time; a small regression is also possible.
Serious vision loss is extremely rare; most side effects are mild and temporary. Still, every surgical procedure carries risk; that is why the pre-assessment matters.
No. Each is preferred for certain profiles: dry eye/biomechanics/contact sports favor SMILE or PRK; high/irregular astigmatism and hyperopia may favor excimer-based LASIK/PRK.
Standard distance correction does not stop age-related near-vision loss. If desired, strategies such as "monovision" are assessed individually.
Suitability is determined only by corneal topography and a detailed examination. Contact me for an appointment.