FAQ – Refractive (Vision Correction) Surgery

About the laser vision correction procedures

What is LASIK surgery?

LASIK surgery is a surgical procedure that corrects a wide range of near-sightedness (myopia), farsightedness (hyperopia) and astigmatism. It is designed to reduce or eliminate the need for glasses or contacts. An excimer laser gently reshapes the cornea with computer-controlled precision to correct near-sightedness, farsightedness and astigmatism.

What does LASIK mean?

LASIK is the acronym for laser in situ keratomileusis. The name refers to the use of a laser to reshape the cornea without invading the adjacent cell layers. In situ is Latin for “in the natural or normal place”. Medically, in situ means “confined to the site of origin without invasion of neighbouring tissues”. Kerato is the Greek word for “cornea” and mileusis means “to shape”.

How long has LASIK been performed?

LASIK vision correction has been performed around the world for over 25 years. It was first performed in the U.S. in 1991, while PRK was first performed there in 1989. In Canada, both LASIK and PRK were first performed in 1990. The major components of the procedure have a long history. Ophthalmologists have been reshaping the cornea for over 50 years, creating a protective layer of tissue over the cornea for over 35 years, and using the excimer laser since the 1980s.

Is LASIK a safe procedure?

Since being FDA approved in 1995, laser vision correction surgery complications are very rare today. Although LASIK surgeons can provide you with the potential outcome of your surgery, no surgeon can guarantee a specific visual acuity. In making the decision to undergo LASIK surgery, be sure to have a list of questions to ask about the procedure. Those with certain medical conditions and women who are pregnant or nursing (within the last 3 months) are not candidates.

Why is LASIK eye surgery considered an advancement in refractive surgery?

LASIK eye surgery combines the precision of the excimer laser that is used in PRK surgeries with the corneal flap technique. It has greater precision than PRK vision correction, less complications, quicker recovery time, requires less post-operative eye drops and is more comfortable.

Will having LASIK prevent me from getting other eye diseases?

No. LASIK does not prevent cataracts, glaucoma, macular degeneration, or any other eye disease. Ophthalmologists term LASIK as disease neutral, meaning it doesn’t cause disease, doesn’t prevent disease, and doesn’t prevent diseases encountered in the future from being treated.

What is PRK laser eye surgery?

PRK, or photorefractive keratectomy, laser eye surgery is similar to LASIK eye surgery in the sense that both procedures employ a computer-controlled excimer laser to reshape the cornea of the affected eye. However, during the LASIK procedure, the surgeon preserves the epithelium (the outermost protective layer of the eye) by creating a flap. During PRK vision correction, the epithelium is removed by gently scraping the surface (i.e. no flap is created). Anaesthetic drops in the eye ensure that the patient experiences as little discomfort as possible. PRK laser eye surgery is also characterized by a lengthier healing process and greater discomfort than LASIK eye surgery.

How do PRK and LASIK differ?

 PRK offers patients an excellent option to achieve their desired vision correction but recovery of vision is delayed until the surface layer of the cornea heals.  Your doctor may recommend separating the treatment of each eye by one week. LASIK involves less initial discomfort and allows patients to see better sooner after surgery. Both PRK and LASIK produce about the same final visual result. 

How is eye laser surgery different from previous types of refractive eye surgery?

Current FDA-approved laser vision correction methods, such as LASIK (laser-assisted in situ keratomileusis), have a higher predictability of the final result with a lower incidence of complications. Additionally, older techniques typically involved manually performed incisions rather than automated lasers for correction.

Eligibility

Who benefits from LASIK?

LASIK eye surgery can benefit a great number of people with myopia, hyperopia and astigmatism.

Who is a potential candidate for laser (refractive) eye surgery?

 People considering refractive surgery should be at least 18 years old, have a record of stable eye exams for at least 18 months, have no corneal disease, and have otherwise healthy eyes.

 Most patients with low or moderate degrees of near-sightedness will have near normal uncorrected vision after surgery. Those with higher degrees of near-sightedness may be better suited for Non-Laser options of vision correction.

What could disqualify me from getting LASIK?

The majority of patients that come to LASIK MD are candidates for some type of vision correction. However, there are some factors that could potentially affect your eligibility, including:

• YOUR EYE’S HEALTH
  Certain eye conditions may be limiting, such as severe dry eye syndrome, conjunctivitis (commonly known as pink eye) or other types of eye infection.
• YOUR CORNEAL THICKNESS
  If your corneas are too thin, then this physiological trait may impact your potential to get a laser vision correction procedure. And while you can’t see just how thick or thin your corneas are just by looking at them, one of our eye care professionals will take accurate measurements at your consultation. In the event that this is your situation, we do offer other treatment options to help correct your eyesight that are not conventional LASIK.
• PREGNANCY
  Pregnant women are not eligible for surgery. Please advise us if you are pregnant—or are planning on becoming pregnant—at your pre-operative consultation. At this appointment, your eye care professional will determine what is an appropriate timeframe for you to safely undergo the procedure. Nursing moms, on the other hand, may be candidates, but should speak to their doctors beforehand to rule out any risk.
• PRE-EXISTING CONDITIONS
  If you have certain pre-existing conditions, like rheumatological conditions (such as lupus or rheumatoid arthritis), then you are unfortunately not permitted to undergo this procedure.

The above are just some things we look at before you are given the go-ahead to get LASIK. Ultimately, the best way to know if you are a definite candidate for this procedure, however, is to book a pre-operative assessment with our knowledgeable staff.

Who is not a good candidate for LASIK surgery?

• Anyone whose prescription is actively changing more than one dioptre per year.
• Anyone who feels that he or she must absolutely gain 6/6 vision without glasses or contact lenses. (No surgeon can guarantee 6/6 vision without correction. Think of it instead as achieving a vastly decreased dependency on glasses and contact lenses.)
• Anyone unwilling to accept the possible risks and complications of LASIK surgery.
• Anyone with an uncontrolled or untreated eye disease.
• Certain corneal dystrophies or a history of herpetic keratitis (a herpes infection in the eye) may be relative contraindications, as are certain arthritic syndromes

I am happy with my contact lenses. Why should I pursue having LASIK eye surgery?

Most surgeons agree that if you are comfortable wearing contact lenses and are not bothered by being dependent on them, you should carefully evaluate the risks and benefits of LASIK. Ultimately, it will depend on your needs and lifestyle.

Not everyone can have LASIK surgery, but can anyone have PRK surgery?

Patients who have autoimmune disorders (Lupus, rheumatoid arthritis), a history of aggressive scar formation after a skin incision (called Keloids) or those with certain degenerative eye disorders are not eligible for PRK surgery. Your candidacy for PRK surgery will be determined at your preoperative evaluation.

Price & payment options

How much does LASIK cost?

As prices may vary, depending on each patient’s specific condition(s), the final quote will be established during your preoperative consultation. The quoted amount includes Advanced Custom Wavefront LASIK and Trans PRK surgery, as well as all post-operative visits up to 2 months.

Does insurance cover laser eye surgery?

Although LASIK vision correction is not a cosmetic procedure, it is considered an elective surgery. Such surgeries are usually not covered by the insurance. You will need to find out from your insurance company if they cover the procedure.

Surgery process

Does LASIK hurt?

Patients are given a topical anaesthetic (eye drops) to numb the eye, so they experience no pain during the procedure. When the surgeon applies the vacuum ring, the patient experiences a sensation of slight pressure just before his or her vision fades away for a few seconds. Neither the precision flap-making instrument – nor the laser cause any pain or discomfort. For several hours after the procedure, many patients describe a mild “foreign body” sensation, such as after opening the eyes while swimming in chlorinated water. After the first few hours, this uncomfortable feeling usually subsides.  Afterward, the doctor may prescribe pain medication if necessary. Many LASIK patients report no more than mild discomfort for a day or so after surgery. There is more discomfort after Trans-PRK because the procedure exposes the deeper layers of the cornea. For clear and comfortable vision after PRK, protective surface cells have to grow back over the treated area. This process can take a week or two.

How long will the LASIK procedure take?

The whole procedure takes about 10 minutes for two eyes, including creating the flap and performing the laser procedure. The actual laser is used on average less than 20 seconds per eye.

What type of anaesthetic is used for the LASIK procedure?

The procedure is performed with a topical anaesthetic (eye drops) that numbs the eye. Patients may be given a small amount of oral sedative to help them relax.

Can I have both eyes done with LASIK eye surgery at the same time?

You can have bilateral simultaneous LASIK eye surgery (both eyes done at the same time). In the vast majority of cases, bilateral LASIK eye surgery has been shown to be safe and effective. In fact, more than 95% of people choose to have both eyes done at the same time. If the surgery of your first eye is not perfect, your doctor will likely hold off on proceeding with the second eye.

What is “All-Laser LASIK” and how does it compare to traditional LASIK surgery?

A: The difference between traditional LASIK and “All-Laser LASIK” (also known as “Bladeless LASIK”) is the method by which the LASIK flap is created. In “All-Laser LASIK”, a laser device called a laser keratome, is used to cut a corneal flap for LASIK surgery. This is a newer method to create a corneal flap than the traditional method of using a microkeratome, a mechanical device with a blade. There is no absolute agreement among eye surgeons on the better choice for flap creation. Some of the factors a surgeon considers when choosing a preferred method of flap creation during LASIK are as follows:

• Quality of vision
• Rate of complications
• Pain during and after surgery
• Precision of flap size and thickness
• Time to recovery of vision
• Expense

Discuss with your doctor any questions and concerns you have about how they chose their preferred method of flap creation.

How does the corneal flap adhere onto the eye after surgery?

During the healing process, a number of factors occur that allow the corneal flap to stick back onto the eye.

• The corneal flap made during the LASIK procedure is able to lay flat and aligned for 2 reasons:

1. The hinge: The corneal flap is created with a superiorly located hinge. When the flap is laid back down (after the procedure is completed), this hinge allows the flap to remain attached and aligned.
2. The “trough”: When the corneal flap is created, a trough (the “bed”) is created in the cornea which is the exact same size as the flap. A flap that is replaced properly will lie perfectly in this trough. This is more stable than a contact lens which sits on top of the cornea and moves with each blink.

• The sequence of events for corneal flap adherence is as follow:

1. Negative suction: During the first few seconds to the first few hours after surgery, the corneal flap begins to stick with the help of negative suction pressure exerted by the cornea. This is the same suction that allows contact lenses to stick to your eyes. If the eye is too dry during this time, the eyelid can spontaneously stick to the flap. Friction with the surface can cause the flap to move. This can occur in about 0.1-0.5% of patients. For this reason, it is important that patients ensure that their eyes are well lubricated with artificial tears. Hitting the flap can also gently move it. This is why it is important not to rub your eyes after surgery.
2. Epithelial sealing: During the first few minutes and up to 24 hours after the surgery, the surface epithelium (the transparent surface skin) grows over the incision and seals the flap. Simple lid contact with the flap should not move a flap with sealed epithelium. Moderately hitting the flap (with a finger, mascara, or a drop bottle) will move it.
3. Cornea stromal scarring: Finally, after a few weeks to a few months, a scar begins to form around the edge of the flap. This results in the flap being well sealed. Only a severe blow (punch, squash ball) can now move the flap. After 6 months, surgical instruments are required to move a flap.

Results & safety

How safe is the LASIK procedure?

Most studies show that the LASIK procedure poses minimal risks of complications. The overall complication rate is a fraction of one percent. Even if complications do occur, most of the complications are resolved within three months and do not result in long-term interference with vision. More precisely, the complication rate cited in large studies is between 0.001% and 0.05%. LASIK surgery is a surgical procedure done on a delicate part of the eye and therefore, complications can occur. 

What kind of results can I expect from having a LASIK procedure?

LASIK surgery improves the uncorrected vision—one’s visual capacity while not wearing corrective lenses—in most patients who have the procedure. At LASIK MD, over 96% of patients with low to moderate myopia achieve 20/20 vision or better after the initial laser procedure, which is the visual acuity similar to that with contact lenses. This number increases to over 99% when an enhancement procedure is included, if needed.

However, there are no guarantees that you will have perfect vision. Patients with high myopia (more than -8D) and high hyperopia (more than +4D) should have realistic expectations. People who are most satisfied with the results of laser correction clearly understand the potential risks and complications and possess realistic expectations as to what their vision will be like after surgery.

Are the results achieved from LASIK permanent?

The effects of the LASIK procedure are permanent. However, it is important to realize that a person’s eye can still change internally. That is why many vision correction surgeons recommend having the procedure done after the major eye changes have occurred in one’s life. For instance, LASIK eye surgery is not recommended on children because their eyes change a great deal and their vision would need to be fine-tuned in a few years. If the procedure is performed after the age of 18, the chance of long-term stable correction is more likely. Even the eyes of patients over the age of 18 can still change. Therefore, we recommend a good conversation with your eye surgeon so that they can review the changes you have undergone and, if applicable; they can help you make a decision in regards to whether or not you should wait until the changes have slowed down.

Patients should also note that while results are usually stable, they can be modified by enhancement procedures – procedures performed after the initial one – if necessary.

If I have LASIK eye surgery and my vision changes later in life, can it be redone?

Retreatment may be a viable solution to vision changes later in life. However, it is important to be aware that other treatment options also exist. In due course, you should consult your eye doctor to determine the cause of the change and to determine which option is best for you. If a retreatment is required, a patient must wait at least 3 months after the initial laser eye surgery. Only 1 eye is done at a time (4 weeks between each eye.)

Will I need to wear glasses once my eyes have healed?

Most patients who have the LASIK procedure do not wear glasses for their daily activities. However, patients may need to wear reading glasses if they are over the age of 40. This is caused by the normal aging of the eye, also known as presbyopia. It is important to note that this condition occurs with or without LASIK vision correction. It is also possible that some patients need a minimal prescription for certain activities, such as night driving.

I wear bifocals now, why will I still need my reading glasses after LASIK?

Most people in their 40s or older will need reading glasses whether or not their eyes are corrected for distance vision. As we age, our eye loses its lens flexibility, causing blurred vision. This condition, called presbyopia, cannot currently be treated by the LASIK procedure.

If I am corrected for distance, will I lose my ability to see well up-close?

If you undergo LASIK eye surgery to correct your distance vision, you can expect clear overall vision. However, images close to you may not appear as clear after having LASIK eye surgery if you are over 40. After the age of 40, expect to need reading glasses for up-close work.

After LASIK surgery, how will my vision be at night or in low light?

With LASIK eye surgery, the vast majority of night vision disturbances are eliminated since the area of cornea treated is larger than the dilated pupil size. Some patients may see mild glare, halos or starbursts around lights in dim or low-light conditions temporarily following surgery. These symptoms do not usually interfere with driving at night, or night time activities. For the vast majority, these symptoms are temporary, usually lasting a few days to a week. With newer laser technology, it is extremely rare for these symptoms to be permanent.

Will my eyes be dry after LASIK eye surgery?

Although occurring very rarely, all patients should be aware that dry eyes are a possible complication following LASIK eye surgery. Laser vision correction makes everyone’s eyes somewhat dryer afterwards, but only temporarily. Your surgeon will carefully test you for the potential of developing this complication after surgery if you suffer from a history of dry eyes or are bothered by contact lenses. After surgery, all patients should use tear drops as required.

Are dry eye symptoms better after LASIK, or PRK?

Research has shown that dry eye symptoms are virtually the same for LASIK and PRK patients. Studies have yet to prove that one procedure causes more dryness than the other.

Research suggests that post-operative dry eye symptoms are best managed by ensuring a healthy ocular surface prior to laser vision correction, and following the post-operative drop instructions.

Recovery from the procedure

How long will I be out of work after having LASIK?

It depends on your occupation. Certain jobs that require intense clarity of vision (dentistry and surgery, for example) may be difficult to perform for one or two days. Most patients can return to work the next day, assuming their vision is adequate for their job. However, some people may feel fatigued for a day or so following surgery. 

With Trans-PRK, you should plan on taking off at least two days if you have both eyes done simultaneously, as you will experience some discomfort and your vision will be fairly blurry. With LASIK, the majority of patients can return to work the next day, although it is advisable to take 24 hours off following surgery on both eyes. If you work in a dusty environment, you should wait 48 hours prior to returning to work.

While most patients can function normally at work the day after LASIK and CK procedures, we recommend that you not schedule any unbreakable appointments or meetings on that day. If your recovery is delayed slightly, you will still be able to accommodate the delay without any undue stress.

Can I drive immediately after having LASIK?

Patients may experience some discomfort and/or blurred vision for a few hours after laser eye surgery. In addition, most patients receive a sedative prior to vision correction surgery. Therefore, you cannot drive home after undergoing the LASIK procedure and you should plan not to drive for at least 24 hours. 

When can I drive?

With LASIK, you can usually drive within one to three days. With Trans-PRK, you should probably not drive for a week. This recovery time depends on whether you have one eye done at a time or have simultaneous surgery on both eyes. The Department of Motor Vehicles typically grants unrestricted driving privileges to individuals who possess 20/40 or better vision. Over 90 percent of all patients who undergo LASIK surgery have this level of vision or better by the first day after their procedure.

Can I play sports after LASIK surgery?

You can resume most normal activities immediately after laser eye surgery. However, for at least two weeks you will need to avoid activities that could cause perspiration to run into your eyes. You should wear safety glasses while playing contact sports whether or not you have had surgery. If you do not routinely wear safety glasses, your eye surgeon may recommend wearing them for at least one month after LASIK surgery. You will also need to avoid certain activities, such as contact sports and swimming, for at least 1 week. It is important to consult your doctor in regards to the limitations on specific activities following LASIK eye surgery. 

How long will it take before I can see well and how long will it take before I experience my best vision?

Fast visual recovery characterizes this operation. Most patients achieve good vision the day of surgery and find that their eyes feel fairly normal within a day. However, vision can continue to improve and best vision can still take two to three months to occur, particularly with higher prescriptions. If necessary, adjustments to the surgery, called enhancements, can be done. Hyperopic patients who undergo LASIK vision correction often need to wait longer to see clearly. Typically, it takes one or two weeks to see very fine details, with the final result arriving several months following surgery.

Will my eyes look different after LASIK vision correction?

No. Your eyes will look exactly the same.

How soon can I use eye make-up?
It is recommended that you avoid using eye make-up for the first 2 weeks after surgery to reduce the risk of infection.

Long Term Results, Sequelae and Complications

Is post-surgical correction stable?

Eye correction generally remains stable. During the first three months after surgery, eye reaction will be evaluated. Around 3% of patients who have undergone laser operations and 5% of patients who have undergone operations with multifocal lenses may require additional laser treatment in order to maximise the results. Over time there may be patients who suffer varying degrees of visual strain due to natural changes in the eye, rather than as a direct result of surgery. In such cases the situation is re-evaluated in order to assess the need for further surgical correction.

What are enhancements (touch-ups)?
Your vision after surgery either will be perfect, or under- or over- corrected. This can be fixed with a minor procedure called an enhancement or touch-up. This procedure typically is performed approximately three months after the initial surgery if visual improvement has not been attained. These enhancements are only necessary in about 2-5 percent of all cases

What are the most common post-surgical complaints?

The most common is either over-correction or under-correction, both of which can be treated. Individual variation is part of any refractive surgical procedure. While everyone hopes for perfect vision, perfection is not always the result. Your expectation should be reduced dependence on glasses and contact lenses, realizing that they may still be needed for some activities. Dry eyes are also common in the early post-operative period.

Although post-surgical discomfort is rare, some patients may experience some dryness, and some glare or halos at night. In both cases treatment is available, and in general these side effects improve over time and ultimately disappear.

What about severe complications?

Sight-threatening complications are very rare. There is always a small risk of infection, scarring, abnormal healing patterns, or cell growth underneath the corneal flap. This may cause partial loss of vision and require further medical or surgical treatment.

Can complications occur?

Despite using probably, the safest and most secure methods of treatment available, complications can sometimes occur, although statistically speaking this is very infrequent. The primary complaint is that of an infection, which despite being treatable can sometimes present visual side effects which vary depending on the severity of the infection. All appropriate measures are taken to avoid such cases.

Is it possible to undergo cataract surgery after previous refractive laser surgery?

Yes, and it does not present any complications. The surgeon should be aware of the medical history of the patient with regards to previous refractive surgery in order to effectively plan the cataract surgery, and above all to calculate and select the most suitable intraocular lens to be implanted upon extraction of the cataract.

Can there be a problem with my eyes 20 years from now because I had LASIK?

Highly unlikely. LASIK is a form of lamellar refractive surgery, and lamellar refractive surgery (myopic keratomileusis) has been performed since 1949. Patients who have undergone these related, but less accurate and more invasive, procedures 50 years ago have not had any unusual problems.

I have more questions about LASIK. Who should I ask?

The absolute best source of information about LASIK is a LASIK surgeon, and most provide free consultations. All you have to do is make an appointment.