What is laser eye surgery?

Laser eye surgery uses a beam of light (a laser) to destroy diseased or unwanted eye tissue. It can reshape your cornea, correcting your vision. In many cases this removes the need for glasses or contact lenses. Like all surgery, it has risks and possible complications.

When is laser eye surgery used?

Laser eye surgery is most often used to correct vision. People with poor vision often have a misshaped cornea. This is the clear layer at the front of the eye. A misshaped cornea is not the correct shape to focus light on the back of the eye. This causes blurred vision, and conditions such as:

• short-sightedness (myopia)
• long-sightedness (hyperopia)
• astigmatism

Laser eye surgery can reshape your cornea and restore your vision. There are many types of laser eye surgery offered for vision correction including:

• LASIK
• LASEK
• PRK
• ASLA
• SMILE

These are also known as refractive, or vision correction surgeries.

Laser eye surgery is also used to treat a range of other conditions, including:

• diabetic eye disease
• cataracts (cloudy vision)
• some cases of glaucoma
• some cases of age-related macular degeneration
• retinal tears
• retinopathy in premature babies

Glaucoma is a disease that can cause damage to the optic nerve. This is a chronic disease which can lead to vision problems. If the glaucoma is not treated it can lead to blindness.

Often high pressure inside the eye causes this damage. High pressure inside the eyeball is a common cause of glaucoma.

Laser eye surgery targets the fluid in the front of the eye, known as the aqueous humour. This surgery lowers eye pressure by:

• lowering the amount of fluid produced
• improving fluid drainage

Laser surgery is one form of treatment available for glaucoma.

Who can get laser eye surgery?

Before having laser eye surgery, you will see a specialist. They will examine you thoroughly and ask about your medical history. This will help them decide whether laser eye surgery is right for you.

Some people should not have laser eye surgery for vision correction. Generally, you should not get refractive laser eye surgery if you:

• are under 18
• are older than 55 years
• have a physical condition that impairs healing
• have very dry eyes
• have unstable vision (your glasses prescription changes often)
• have an autoimmune disease
• have diabetes, uncontrolled rheumatic conditions or keratoconus
• have a history of herpes in the eyes
• use certain medicines
• carry out activities that have a chance of eye injury
• have other vision problems such as glaucoma or cataracts

However, this can vary, depending on the type of surgery you are getting, and the clinic you are attending.

You may be suitable for some laser surgery procedures, and not others. Different types of laser surgery are better suited to different vision problems.

What to ask your specialist before laser eye surgery

It is important to ask your eye specialist which is the best type of eye surgery for you. They may have advice unique to their clinic. Some things you might like to talk about are:

• the risks and side effects of the procedure
• how long it will take to get better
• the cost of the surgery
• whether you will need to use eye drops long term
• whether you will be able to play contact sports
• whether a second operation is needed, and if it is included in the cost
• how to get in touch with your surgeon after your operation

How do I prepare for laser eye surgery?

How you prepare for your surgery depends on the type of surgery, and the clinic you attend. Your ophthalmologist (specialist eye doctor) or optometrist will give you with the best advice. Usually, you will be asked to stop wearing contact lenses before your surgery.

What happens during laser eye surgery?

Before having laser eye surgery, you will get a local anaesthetic. This is usually in the form of eyedrops. These drops will numb your eye so that you don’t feel any pain. Depending on your treatment, you may also receive:

• anti-inflammatory drops
• antibiotic drops
• a mild sedative

These drops may be used to prevent soreness or infection in your eyes. A sedative may be given to help you relax.

These pre-treatments may take some time to work. Once this time has passed, you will be taken to a laser suite.

The laser will already be set specifically to your needs. A lid holder will be fitted to your eyes to stop you from blinking.

The procedure itself depends on which type of laser surgery you are getting:

• In LASIK surgery, a flap is made on the top of the cornea. A laser then shapes the layer underneath before the flap is replaced.
• In LASEK surgery, the top layer of the cornea is removed. A laser then shapes the layer underneath, and the top layer is then reattached.
• In SMILE surgery, a laser removes a disc of tissue from the cornea.
• In PRK and ASLA surgeries, the top layer of the cornea is softened by solution. This is then removed. A laser shapes the surface, before a ‘bandage’ contact lens is put on for healing.

To learn more about your surgery, ask your eye specialist.

After laser eye surgery

Taking care of your eyes

After surgery, it is important to follow the instructions from your ophthalmic surgeon or ophthalmologist. They might ask you:

• to take a few days off work
• to take antibiotics or use eye drops
• not to rub your eyes
• not to play contact sports for a time
• go back for a follow up appointment

Your vision after surgery

The type of surgery you get will affect how long you need to wait to see improvements in your vision. For example:

• LASIK surgery can give vision improvement overnight.
• SMILE surgery gives improvement within a few days.
• PRK/ASLA surgeries usually needs at least a week of rest before you can resume normal activity.

People aged under 50, should not need to wear contact lenses or glasses after your surgery. But the way your eyes change after surgery will depend on:

• the stability of your prescription
• your age

With age comes natural vision problems, such as presbyopia. If you have vision problems past the age of 50, you may need different treatment. These may include a lens-based surgery.

To learn more about recovery after your surgery, ask your eye specialist.

Complications of laser eye surgery

All vision correction laser procedures have temporary side effects, including:

• dry eye or not being able to produce enough tears
• discomfort after the surgery, such as mild pain, burning or itching
• bloodshot or watery eyes
• sensitivity to light
• glare or haloes around light

Most of these symptoms should only last a few days after surgery. But it might take up to 6 months for your vision to stabilise.

To learn more about the risks and side effects of your surgery, ask your eye specialist.

If you have strong pain or your symptoms get worse, see your doctor immediately.