LASIK Eye Surgery - Procedure, Aftercare, Risks & Costs

Laser in-situ keratomileusis, or LASIK eye surgery, is an outpatient procedure used to correct the following refractive errors:

•  Myopia (nearsightedness)
•  Hyperopia (farsightedness) 
•  Astigmatism (an imperfection in the corneal curvature)
•  Presbyopia (age-related farsightedness)

How Does LASIK Work?

LASIK surgery involves reshaping the cornea (clear front part of the eye) using laser technology. This enables light to focus correctly on the retina.¹ 

The retina is the light-sensitive tissue at the back of the eye. It receives light and sends signals to the brain for interpretation, enabling clear vision.

Some of the tools used in LASIK surgery include:²

• Femtosecond laser. Creates a corneal flap and exposes tissues below
• Excimer laser. Alters the underlying tissues based on your surgeon’s measurements

Types of LASIK

Over the years, the LASIK procedure has seen improvements. These improvements helped promote procedure safety protocols, minimize pain, and maintain a high success rate. 

The types of LASIK include:

Bladed LASIK

Traditional LASIK surgery uses a handheld blade called a microkeratome to create a flap. Afterward, the doctor uses an excimer laser to reshape the cornea.

The handheld blade carries an elevated risk of concentration, flap wrinkles, and other flap complications. However, the overall rate of complications is still very low.

Bladeless LASIK

Blade-free LASIK uses a device known as a femtosecond laser to create the flap and an excimer laser to reshape the cornea. It’s considered safer than conventional LASIK because it uses laser beams instead of a hand-held sharp blade. 

An example of bladeless LASIK is IntraLase LASIK or iLASIK. 

Your surgeon may combine bladeless LASIK with the computer-guided WaveScan™ Wavefront Technology. This allows the surgeon to accurately map your eyes, create the flap, and reshape your cornea with minimal risks. 

Ideal Candidates for LASIK Surgery

LASIK surgery is not ideal for everyone. Your doctor will ensure you meet specific requirements before recommending LASIK as a vision correction option. 

A perfect candidate for LASIK:

• Is 18 years or older, since many surgeons recommend the mid-20s as the ideal age for eye stability³
• Has healthy eyes. Eye health will determine how effectively your eyes will heal after surgery.
• Has a refractive error (myopia, hyperopia, or astigmatism)
• Has a stable prescription (at least 1-2 years) to reduce the chances of regression
• Has a thick cornea. This reduces the chances of corneal ectasia
• Wants to eliminate dependence on contacts or eyeglasses
• Has realistic expectations

Reasons that may disqualify a patient from LASIK include:

• Pregnancy or nursing
• A thin cornea
• Underlying health issues such as immunodeficiency or autoimmune diseases
• Presence of cataracts (cloudy eye lens)
• Previous eye injury or surgery
• Taking certain medications, such as immunosuppressants and anti-inflammatories (NSAIDS) that can affect the healing process

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What to Expect at Your LASIK Consultation

If you're interested in laser vision correction, the first step is to schedule a consultation with a qualified LASIK surgeon. Most LASIK institutes offer free consultations to discuss the LASIK process and determine if you are a good candidate for the procedure.

A typical LASIK consultation lasts 2 to 3 hours. During this time, the surgeon assesses your eye health to determine your suitability for LASIK. If you qualify, the surgeon uses these measurements to set up the laser for your surgery.

Here’s what you can expect at a LASIK consultation:

1. Medical history review. First, your eye doctor will go over your medical history. Certain eye and general health conditions may disqualify you from LASIK.
2. Comprehensive eye exam. The next step is a comprehensive eye exam to analyze your refractive error, dominant eye, the health of your eye’s interior, front, and surface, eyelid health, and tear film.
3. Corneal mapping. A corneal topography will map the shape and thickness of your cornea in extreme detail. If your cornea is thick enough, your surgeon will use this data to program the laser for your surgery.
4. Discussion of the procedure. Once your exams are finished, the surgeon will discuss the entire process with you. They will instruct you on how to prepare, including when to stop wearing contacts and if you should stop taking certain medications. They should also discuss costs and payment options.
5. Time for questions and concerns. Following this discussion, there will be a time for questions. Here, you can clarify any confusion about preparation, the day of surgery, recovery, or costs.

If you don’t qualify for LASIK surgery, your surgeon may recommend another type of refractive surgery to correct your vision.

LASIK Procedure (Step-by-Step)

The entire LASIK surgical procedure lasts 30 minutes or less for both eyes. Doctors need approximately 10 minutes to complete the surgery on each eye.

You are awake and alert during the procedure. Surgeons often offer a mild sedative to help you relax before the surgery.

Here's what to expect during LASIK surgery:

• Step 1. First, your eye doctor places eye drops that contain a numbing agent in your eyes. Your eyelids are held open with a tool so the eye surgeon can work.
• Step 2. The surgeon uses a small blade or special laser to cut a thin flap in your cornea. This step may cause discomfort for the patient since a suction ring is placed on the eye just before cutting the flap. Many people report feeling "a sensation of pressure" during this part of the surgery.
• Step 3. The excimer laser gently reshapes your cornea. It is guided by a computer that has a map of your eye preloaded into it.
• Step 4. After the excimer laser finishes, the surgeon smooths the corneal flap back into place.
• Step 5. If you are getting both eyes operated on, this process will immediately be repeated on the other eye.
• Step 6. That's it – your LASIK eye surgery is complete! Once you're finished, your eye surgeon or a team member will provide you with an eye shield and detailed recovery instructions.

LASIK Aftercare

After surgery, your doctor will provide you with post-op care instructions.⁶ You must prioritize the following:

• Rest your eyes. First, you must give your eyes plenty of rest to promote healing. Most surgeons will recommend a few hours of sleep to help you avoid some initial pain and discomfort. 
• Wear your eye shield. Keep your eye shield in place to avoid unconscious touching or accidental trauma.  
• Take time off work. Take a few days off, especially if you work in a role that requires intense eye use, such as typing or reading on a computer screen. 
• Manage discomfort. You may experience some mild pain or discomfort in the eyes. You can address these using antibiotic eye drops and ointments provided by your doctor. 

Avoid the following during recovery:

• Rubbing your eyes
• Swimming (for about a week)
• High-impact activities, e.g., contact sport
• Eye-straining activities such as excessive reading

Continuous monitoring of the healing process is very important. It’s advisable to make your first follow-up appointment at least 24 hours after surgery and plan regular visits. 

Does Lasik Hurt?

LASIK causes little to no pain during the procedure. Your surgeon will administer local anesthetic eye drops to numb your eyes before the LASIK eye surgery begins.

Many people describe feeling a "slight pressure sensation" during the surgery. However, in most cases, patients feel no pain throughout the procedure.

Risks and Side Effects of LASIK

Like other eye procedures, LASIK also has side effects and risks. 

The side effects of LASIK include:

• Increased sensitivity to light (photophobia)
• Blurred vision
• Gritty or burning sensation
• Bloodshot eyes

Some risks of undergoing the procedure include:

• Bacterial, viral, or fungal infections
• Overcorrection or undercorrection 
• Regression
• Decentration (when the laser centers incorrectly during surgery)
• Wrinkled flap
• Epithelial ingrowth
• Corneal ectasia (rare)
• Temporary vision loss
• Decreased visual clarity immediately after surgery
• Vision loss or serious changes (rare)
• Flap healing problems

Following your doctor’s post-treatment instructions can help prevent these risks and side effects. 

LASIK Success Rates

LASIK is one of the most effective refractive surgeries available. According to the American Refractive Surgery Council, LASIK patients show a 96% satisfaction rate.⁷ 

Statistics also show that:

• About 99% of LASIK patients achieve 20/40 vision or better
• About 90% achieve 20/20 vision
• Less than 1% of patients may lose two lines of best-corrected visual acuity (BCVA)

Surgeons can address dissatisfactory LASIK outcomes through a second laser treatment (LASIK enhancement). LASIK enhancement is easy and quick since it only involves re-lifting the initial flap for further correction.⁸

Cost of LASIK

LASIK surgery will cost an average of $1,500 to $2,000 per eye. The extent of correction may also affect pricing. 

LASIK surgery is an elective procedure, and many insurance providers may not cover it. The cost may vary depending on your location, available facilities, and surgeon’s experience. 

Pros and Cons of LASIK

Below are the benefits and downsides of LASIK eye surgery:

Pros of LASIK

• Quick and long-lasting outcomes 
• Results in 20/20 vision or better
• A relatively safe and painless procedure
• Reduces or eliminates dependence on glasses or contact lenses
• Enhancements are available to improve vision
• No need for bandages after surgery
• Low risk of dry eyes
• Customizable for every patient

Cons of LASIK

• Not everyone is eligible (18 years or older only)
• Risk of flap complications
• Not covered by insurance
• Risk of over or undercorrection, especially with bladed LASIK
• Risk of regression

LASIK Alternatives

Although LASIK surgery may not work for everyone, there are equally effective LASIK alternatives you can discuss with your doctor. 

Photorefractive Keratectomy (PRK)

Unlike LASIK, PRK doesn’t create a flap in the cornea. During PRK, the laser directly removes the corneal epithelium (thin outer layer) to allow for corneal reshaping using an excimer laser. 

PRK is ideal for people with thin corneas because they lack enough tissue for flap creation.

Epithelial Laser In-Situ Keratomileusis (Epi-LASIK)

Epi-LASIK involves the formation of a thin epithelial flap instead of a corneal flap. This procedure is less invasive than traditional LASIK surgery. 

Laser Epithelial Keratomileusis (LASEK)

LASEK also involves the epithelium, making it a great alternative for LASIK. It’s a minimally invasive procedure, just like PRK. 

However, unlike PRK, LASEK preserves the epithelium flap using diluted alcohol. The epithelial flap is repositioned after laser treatment.

Small Incision Lenticule Extraction (SMILE)

SMILE eye surgery doesn’t require a corneal or epithelial flap. Instead, a femtosecond laser targets the cornea's inner layer. 

The laser creates a lenticule, a thin, disc-shaped piece of tissue. The lenticule is then removed via a small incision on the side of your cornea to reshape it. Research shows that LASIK and SMILE yield comparable results.

Intraocular Lenses (IOLs)

Intraocular lens implants (IOLs) are artificial lenses inserted into the eye to replace the natural lens. They’re common during cataract surgery. 

These IOLs are categorized into mono-focal lenses, multifocal lenses, accommodating IOLs, and toric IOLs.

Summary

• LASIK is a popular vision correction procedure that involves reshaping the cornea with a laser.
• It involves various steps, including a consultation with a professional to determine your eligibility for the treatment.
• While it's one of the most successful and safe eye surgeries, LASIK isn't suitable for everyone. 
• Remember to discuss potential risks with your eye doctor before the procedure.

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