What Is Laser Eye Surgery? Superguide 101

Tired of wearing glasses or having to stick your finger into your eye every day to put on contact lens?

Have high refractive errors and unable to wait for the effect of eye exercises to show?

Laser eye surgery may be able to help.

What is Laser Eye Surgery?

Laser eye surgery is a common and popular form of treatment for vision correction.

Many people choose laser eye surgery so that they can reduce or do away with wearing glasses or contact lens.

In a nutshell, laser eye surgery makes use of a computer system to generate high energy laser pulses to correct the abnormal curvature of the surface of the eye (cornea) by removing portions of the eye tissue.

This process usually takes only a few minutes. 

Sounds scary? 

Well, take heart that one laser pulse removes approximately 1/4000 millilitres of tissue, and it generally takes about 200 pulses to cut through a human hair. 

In addition, no heat is generated by the laser, so surrounding tissue remains unharmed. 

The laser system used by your surgeon is an precise tool as your surgeon will input details of your eye exam into the computer, which will map out exactly the depth and pattern of the tissue that needs to be removed.

Why the cornea, you may ask?

The cornea is crucial as it is the part of the eye that bends and focuses light.

When the curvature of the cornea is abnormal, its refractive power become compromised, causing light from whatever you are seeing to be out of focus on the retina of the eye.

The retina is the bit in our eyes that converts the light into messages to be sent to our optic nerves, which our brain then interprets the image being seen.

Hence, having compromised refractive power in our eyes can lead to vision problems (refractive errors) like blurry images or distortion of images.

What Kind Of Vision Problem Does Laser Eye Surgery Correct?

Generally, laser eye surgery is used to correct refractive errors.

According to the National Eye Institute, the four most common types of refractive errors are:

• Myopia (nearsightedness) is when you can see objects close up clearly, and far away objects blurry.

• Hyperopia (farsightedness) is when you can see objects far away clearer than objects near by. However, for people with severe hyperopia, vision can be blurry for objects, regardless of distance.

• Astigmatism is when images appear distorted (blurry and stretched out)

• Presbyopia is related to the eye aging and affecting its ability to change shape enough to focus close objects clearly

Are You At Risk Of Developing Refractive Errors?

Presbyopia is more prevalent in adults above the age of 35. 

As for the other refractive errors, both adults and children can be affected.

Your risk factors increase when you have or exposed to:

• Family history. Either one or both of your parents have refractive error issues; 
• Existing medical history (for e.g. keratoconus) that affects the normal functioning of your eye; 
• Lifestyle factors (for e.g. marathon drama watching, doing mainly close up work) that causes your eyes to be constantly under strain; 
• Environmental factors (for e.g. smoky environment) that causes constant irritation to your eyes.

Different Kinds Of Laser Eye Surgery Procedure

With advances in laser vision correction technology, newer procedures are being developed to address conditions brought on by refractive errors. 

By and large, the more common laser eye surgery procedures include:

LASIK

LASIK (laser-assisted in-situ keratomileusis) is the most popular laser eye surgery (90% to 95% of all laser eye surgeries) and have the broadest application. 

LASIK changes the shape of the cornea permanently by reshaping it with excimer laser. 

One key feature of LASIK is the creation of a corneal flap to act as a natural bandage for the eye, which results in faster recovery time and lesser discomfort.

The development of newer technology like Intralase allows vision correction for people with higher prescriptions.

PRK

PRK (Photorefractive keratectomy) is the first laser eye surgery performed on human. Newer technology on laser vision correction are usually modifications of the technique used in PRK.

In PRK, the cornea is reshaped when small amounts of the tissue from the outer surface of the eye (epithelium) is gently removed, instead of having a flap created, like in LASIK.

Recovery is typically longer than LASIK because time is needed for the epithelial cells to regenerate. Likewise, if you choose PRK, be prepared that your eyes may feel pain/discomfort for a few days after the procedure.

PRK is mostly proposed as an alternative for people who are not suitable for LASIK (for e.g. people who have very thin cornea, or people who engage in activities that may have higher risks of hurting their eyes).

LASEK

LASEK (laser-assisted epithelial keratomileusis) is a procedure that marries techniques from both LASIK and PRK. 

No cutting of flap is needed, and the surface of the cornea is loosened with a diluted alcohol solution before moving aside to apply the laser.  

You may have heard of Epi-LASIK and Epi-LASEK, and the “Epi” refers to epithelium (the outermost surface layer of the cornea).

Generally, these are derivative procedures that does not utilize alcohol to remove/loosen the epithelium. 

LTK

LTK (laser thermal keratoplasty) is a laser procedure used to treat farsightedness  and astigmatism. 

The heat from the laser is used to reshape the cornea, and LTK is considered a less invasive form of laser eye surgery. 

LTK is considered a very safe procedure with limited complications as it is a no touch procedure, and there is no scarring in the central cornea. 

There is also low risk for dry eye syndrome and vision improvement is usually immediate.

I know what you are thinking. 

If LTK is so wonderful, why is it not as popular as LASIK? There must be a catch!

Well, LTK is not as commonly practiced as the treated vision needs months to stabilize and most importantly, treatment effects tend to wear out over time.

When Is Laser Eye Surgery NOT For You?

Excited at the thought of having laser eye surgery to correct your vision once and for all? 

Hold your horses before you run off to the nearest clinic for a consultation, because you may not be eligible for it.

Yes, not everyone is a suitable candidate for laser eye surgery. 

According to the FDA, you should not consider doing laser eye surgery if:

• You need to change your vision prescription regularly.  This indicates refractive instability.
• You are not an adult. Currently, no lasers are approved for usage of LASIK for people younger than 18 years old in the US. 
• You have eye disorders like keratoconus or glaucoma that affect sight.
• You have immunity disorders that affect wound healing.
• It may jeopardize your career options. Some employers/services ban employing people who have undergone refractive surgery. Check this clearly before proceeding.
• It is too costly for you.
• You actively participate in contact sports that can result in blows in your face (like MMA)
• Your risk tolerance is low. Well, this is afterall a surgical procedure and there can be complications and side effects that may stretch beyond your expectations.

Before Laser Eye Surgery

So you said no to everything in the above list? 

If you are very keen to try laser eye surgery, the next step you need to do is to get your eyes properly examined by the eye doctor.

The array of eye examination includes making sure your eyes are healthy and measuring

• The thickness of your cornea
• The curvature of your cornea
• Size of pupils in light and dark
• Refractive errors of the eyes

If all is good and dandy, you will need to sign a consent form to indicate that you are aware of the procedure’s risks, benefits, possible complications as well as alternative options. 

Financing Laser Eye Surgery

Financing laser eye surgery is an important consideration factor for many people as it can be a significant investment, both financially and time-wise. 

Prices can range from $300 to $5000 per eye, depending on a variety of factors such as procedure opted, technology used, surgeon’s reputation and skill, as well as postal code of clinic. 

Yup, you read it correctly. Postal code.

Just think about it this way.

Having LASIK done in Manhattan, New York will definitely cost more than having it done in Arkansas due to differences in cost of living.

Laser eye surgery for vision correct is generally considered as cosmetic in nature, as it can be easily remedied by wearing glasses and contacts lens. 

As it is typically considered as an elective procedure, health insurance plans tend not cover for it. 

However, if you live in the US, you may want to check if your insurance provides discount for the laser eye surgery that you are considering.

In general, insurance generally does not cover for laser eye surgery, unless you belong to the unfortunate minority that have degenerative sight disorders that may eventually lead to blindness, where in some countries, the country’s health system may provide coverage.

As a result of the lack of coverage, many of the centers that offer laser eye surgery have tie ups with financing companies that provide both short and longer term payment plans that make financing the procedure more manageable.

While finance is an important factor in considering where to do your laser eye surgery, it should not be your only consideration. Do bear in mind that success of the procedure is highly contingent on the skill of the surgeon. 

Cheap may not always equal to good. 

How To Find The Best Laser Eye Surgeons

Seriously, I cannot stress how important it is to find a surgeon with good success rates. 

Laser eye surgery procedures have permanent impacts on your cornea, and you will need to live with the consequences, good or bad.

Thus, finding a great surgeon is the most important thing you would want to do if you are sure you want to go ahead with the procedure to correct your vision.

You should definitely ask around for recommendations from people who have underwent the procedure as the first step in finding your kick ass surgeon.

As you narrow down your choices, here are some questions you may want to ask your potential surgeon

1. How much experience do you have with *type of laser eye surgery?
2. What is your definition of a successful procedure? What is your success rate like?
3. How many of your patients have achieved 20/20 or 20/40 vision?
4. What are my chances of achieving 20/20 vision?
5. What is the percentage of your patients who return for enhancement? 
6. What is involved in my after care?

In addition, you may also want to check the type of laser used, because as of now, the FDA has only approved five lasers that can be used for laser eye surgery in the United States.

The companies that manufacture these lasers are:

• Abbott Medical Optics (STAR S4 IR Excimer Laser System and iDesign Advanced Wavescan Studio System)
• Zeiss (MEDITEC MEL 80 Excimer Laser System)
• Bausch and Lomb (TECHNOLAS 217z Zyoptix System for Personalized Vision Correction)
• Nidek (Nidek EC-5000 Excimer Laser System)
• Alcon (Allegretto WAVE Eye-Q Excimer Laser System)

The Amaris by Schwind Esiris is another excimer laser system that is commonly used worldwide, but do note that it is not FDA approved yet in the US. 

Each system have its unique advantages. 

According to a recent review of all the FDA approved laser system, the Abbott laser outperformed the other commonly used systems in producing clarity of vision at 1 and 3 months interval. 

That being said, most experts agree that an accurate evaluation of your suitability and the surgeon’s skill and experience are two of the most important factors in determining the final outcome of the laser eye surgery.

Satisfaction Guaranteed?

One last question you may want to ask is how effective the laser eye surgery will be in correcting your vision issues.

Most people are generally satisfied with their laser eye surgery outcomes.

Based on a review study published in 2009, an average of 95.4% of patients are satisfied with their outcome after LASIK surgery.

Yet, you also need to be aware that there are possible problems and have to be realistic with your expectations.

The first thing you need to know is that after surgery, vision can often take weeks to months to stabilize, even though vision typically improve within a few days after surgery.

According to Harvard Medical School, about 75% of patients achieve 20/20 vision, with more than 95% achieving 20/40 vision (enough to get your driver’s license) after laser eye surgery.

Although, even if you are tested 20/20 for your vision, you may still NOT have perfect vision in real life. 

This is because you may develop night vision or start seeing “halos” around bright light. These are possible complications of laser eye surgery.

Sometimes, the surgery may not be perfect, and can end up under correcting or over correcting your vision. What that means is, you may still need corrective lens after the procedure to obtain perfect vision.

It is common to experience some discomfort post surgery, and dry eyes is a common complaint of many patients, especially if they had LASIK. There are also the risks of infection on surgical sites, or inflammation, that can result in hazy vision.

Most of the complications tend to resolve within six months, but for some, the symptoms do persist for a longer time.

For instance, more than 20% of patients report long lasting moderate to severe dry eyes post LASIK. 

You really need to make sure that you are aware and understand your possible risks and complications before agreeing to do any procedure.

Afterword

Laser eye surgery procedures are generally considered safe and effective for most people with the common refractive error issues. 

Whether you are suitable for the procedure is dependent on a myriad of conditions. Having a surgeon with high success rates and good experience does make a difference to your final outcome.

Be sure that you are well informed of all possible complications and ask lots of questions before making a decision on whether or not to go for laser eye surgery. 

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