What is LASIK Eye Surgery?

LASIK, which stands for laser-assisted in situ keratomileusis, is a type of refractive eye surgery. This procedure can correct nearsightedness (myopia), farsightedness (hyperopia), and astigmatism.

Many patients choose LASIK because it is a quick and safe procedure with minimal downtime. If you wear glasses or contact lenses, LASIK eye surgery may be a potential way to improve your vision.

According to the American Refractive Surgery Council, over 20 million LASIK surgery procedures have been performed in the United States. LASIK patients are generally very satisfied with their improved vision after laser eye surgery.

"The latest research reports 99 percent of patients achieve better than 20/40 vision and more than 90 percent achieve 20/20 or better. In addition, LASIK has an unprecedented 96 percent patient satisfaction rate – the highest of any elective procedure"

—American Refractive Surgical Council

Types of LASIK

There are a few different LASIK treatment options to choose from, including:

Traditional Versus Bladeless LASIK

During LASIK, the surgeon operates on your cornea, which is the clear covering on the front of your eye. The cornea controls the way light rays enter your eye.

There are two ways the surgeon can cut a flap in your cornea:

• Traditional LASIK uses a surgical blade called a microkeratome to cut a flap.
• Bladeless LASIK uses a femtosecond laser instead of a surgical blade. 

The results of bladeless LASIK are generally more accurate, reproducible, and cause fewer side effects, such as dry eye. Overall, surgeons consider LASIK an extremely safe medical procedure, whether it is traditional or bladeless. 

Customized LASIK

Customized LASIK gives you sharper, higher quality vision than conventional LASIK. Conventional LASIK uses measurements based on your eyeglass prescription, while customized LASIK is much more detailed. The surgeon can combine customized LASIK with either a traditional or bladeless flap procedure.

There are different types of customized LASIK procedures:

• Wavefront-guided LASIK — This procedure utilizes detailed measurements to create a 3D map of your eye. The laser uses this information to correct your vision while minimizing any optical irregularities, called aberrations. 
• Wavefront-optimized LASIK — This procedure is customized to help your cornea maintain its natural shape and curvature post-surgery. Doing so typically results in better quality vision, including fewer night vision problems.
• Topography-guided LASIK — This procedure uses detailed measurements over the entire surface of your cornea, which helps correct vision problems related to irregularities in your cornea.

Monovision LASIK

Monovision is a special LASIK technique for patients who need reading glasses, typically those in their 40s or older. This procedure corrects one eye to see distance and the other eye to see near. Your eye doctor will test your eye dominance to determine which is which. 

Ask your eye doctor to try monovision with contact lenses first to see if you can adapt.

There are some potential drawbacks to consider:

• Vision imbalance —  If your brain has difficulty adapting to monovision, your vision may feel imbalanced. You can experience discomfort or temporary double vision. This sensation usually improves over time.
• Blur at a distance or near — Your distance or near vision will generally be slightly less clear than with both eyes viewing at the same time.
• Reduced depth perception — Monovision can affect activities that require depth perception, such as driving or sports. If you perform many of these activities, consider monovision carefully.

Potential monovision patients should consider their type of refractive error:

• Farsighted (hyperopic) patients have more trouble seeing up close with age. These patients can elect monovision LASIK. They cannot correct both eyes to see up close. Otherwise, their distance vision will be blurry.
• Nearsighted (myopic) patients have difficulty seeing far but see well up close without glasses. Myopic patients should know that a standard LASIK procedure will correct their distance vision in both eyes, but takes away the ability to see up close. You have to decide whether to have a standard LASIK procedure, and wear reading glasses afterward or to have monovision LASIK.
• Emmetropic patients are neither hyperopic or myopic. They only need reading glasses with age. These patients only require surgery in one eye to correct their near vision.

LASIK Procedure (Step-by-Step)

The entire LASIK surgery procedure usually takes less than 30 minutes for both eyes. Approximately 10 minutes is needed 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.

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

Here's what to expect during LASIK surgery:

Step 1: Your eyelids are held open with a tool so the eye surgeon can work. First, your eye doctor places eye drops that contain a numbing agent in your eyes.

Step 2: The surgeon uses a small blade or special laser to cut a thin flap in your cornea. This is the part that may cause some discomfort for the patient. 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, along with detailed instructions for recovery.

Post-LASIK Recovery

There is minimal downtime after LASIK eye surgery. Many patients can see well within a day. If you feel comfortable, you may even drive and go back to work or resume normal activities the next day.

You will take a regimen of antibiotics and steroid eye drops for a few weeks after surgery. Your doctor will also recommend lubricating eye drops to help with any dryness.

The most common side effects include:

• Dry eyes — Symptoms include burning, itching, gritty sensation, pain, redness, or watering.
• Halos — Halos are bright rings around a light source such as a street lamp. They are usually more apparent in dim lighting conditions.
• Glare and light sensitivity — Bright lights can cause visual discomfort or difficulty seeing.
• Difficulty with night vision — Halos and glare are more pronounced in dim lighting, making night vision more difficult.
• Hazy vision — As your corneas heal after surgery, any cloudy vision will improve over time.

Most patients' side effects clear up within a few hours or a few days of the surgical procedure. If you experience fluctuating vision for a week after surgery, consult your eye doctor.

7 Requirements for a Good LASIK Surgery Candidate

Here are seven conditions that good candidates for LASIK eye surgery have:

1. Your eyes are healthy

Your overall eye health determines how well your eyes heal after surgery and whether or not you are at risk for certain complications. In general, any active eye infections, inflammation, or abrasions must be resolved before you get LASIK.

If you have an eye disease that affects the function or shape of your corneas, such as keratoconus or corneal dystrophy, you are most likely not a good candidate for LASIK. Tell your surgeon if you have a history of herpes-related eye infections since LASIK can reactivate the herpes virus. 

LASIK can also affect your eye pressure. If you have glaucoma or are at risk for glaucoma, your eye doctor can determine whether or not LASIK surgery is safe for you.

2. Your prescription is within range

LASIK procedures can treat a wide range of prescriptions, including myopia (nearsightedness), hyperopia (farsightedness), and astigmatism. The treatment range varies between different types of LASIK procedures. Your eye surgeon can help you determine which type of LASIK is right for you. 

3. Your corneas are thick enough

The higher your prescription, the more corneal tissue the laser must remove to correct your vision. When undergoing LASIK, the surgeon cuts a flap on your cornea, then uses a laser to remove tissue underneath the flap. If your corneas are thin, LASIK can increase your chances of corneal ectasia, which is a vision-threatening condition that causes abnormal corneal thinning. 

4. You are within the proper age range

Typically, you must be at least 18 years old to have LASIK. However, it is best to wait until you are in your mid-20s, which is when your vision stabilizes for the most part. 

There is no upper age limit for receiving LASIK, although there are some important considerations. After age 40, presbyopia begins to set in. This process affects your ability to focus up close and continues until about age 60.

5. Your vision is stable

If you have stable vision for at least 1-2 years before LASIK, this reduces your chances of regression and needing a touch-up procedure. Stable vision does not necessarily mean your prescription cannot change at all. In most cases, a change of 0.25 or 0.5 Diopters is acceptable. Diopters are the units used to measure your prescription.

6. Your pupils are not too large

Common post-LASIK symptoms include glare, halos, and starbursts at night. Previously, eye doctors linked these symptoms to pupils that were larger than the LASIK treatment zone, particularly in dim light. However, many studies show that with modern LASIK procedures and wider treatment zones, large pupils do not significantly affect visual outcomes. 

7. You have realistic expectations

Although LASIK success rates are very high, it may not be realistic to expect perfect vision. Even the refractive surgeon cannot predict with complete certainty how your eyes will heal after surgery since everyone is different. Also, keep in mind the possibility of needing to wear glasses after surgery, such as for reading or night driving. 

6 Reasons People Can't Get LASIK

You may not be a good candidate if one or more of the following applies to you:

1. Pregnancy or nursing. Many women experience fluctuations in their vision during pregnancy related to hormonal changes. Also, the medications you may take for the LASIK procedure are not safe for the baby. It is best to wait until you have your baby and are finished nursing.

2. General health problems. People with certain medical conditions, such as autoimmune or immunodeficiency diseases are at higher risk for healing complications and generally should not receive LASIK. Diabetic patients may experience delayed wound healing after LASIK and may experience visual fluctuations related to blood sugar changes.

3. Cataracts. Age-related cataracts usually start to develop around age 60 and cause the lens inside your eye to become cloudy. Generally, LASIK is not recommended if you already have cataracts. LASIK cannot correct your vision entirely, and your vision will continue to change as the cataracts progress. 

4. High-impact activities. If you engage in contact sports such as basketball or martial arts, consider your options carefully. Although this complication is rare, eye trauma can potentially dislodge the corneal flap, even long after your surgery. 

5. Medications. Certain drugs are not safe to use if you are having a LASIK procedure. Immunosuppressants and anti-inflammatories can affect the healing process. Some medications that should not be taken before LASIK include steroids, isotretinoin (Accutane), and amiodarone. Your eye surgeon can advise you how long you need to discontinue the medications before surgery. 

6. Previous eye injury or surgery. If you had an eye injury that left a significant corneal scar, you might not qualify for LASIK. Previous eye injury or eye surgery may increase your risk for LASIK complications, so be sure to give the eye surgeon your complete health history.

How Much Does LASIK Cost?

The average cost of LASIK surgery in the United States is approximately $2,200 per eye or $4,400 for both.

Unfortunately, most health insurance plans do not cover LASIK surgery. Most health insurance companies deem laser eye surgery an elective procedure — meaning not medically necessary. Neither Medicare nor Medicaid pays for elective eye surgery like LASIK surgery.

Some larger vision insurance carriers offer laser vision correction benefits, including discounts on laser vision correction procedures with specific providers and frame benefits for non-prescription sunglasses after vision correction surgery. UnitedHealthcare vision insurance offers its members 35% off LASIK at over 900 locations.

Alternatives to LASIK

There are some alternative laser eye surgeries to LASIK, including photorefractive keratectomy (PRK) and small incision lenticule extraction (SMILE). Your eye surgeon will determine if you are a candidate for LASIK or an alternative procedure. There are some key differences between LASIK, PRK, and SMILE.

LASIK Versus PRK

Below is a comparison of these two procedures:

• PRK does not involve creating a flap in the cornea, unlike LASIK. The laser directly reshapes the surface of the cornea, requiring less corneal tissue.
• PRK may be more suitable for patients with thin corneas because the surgery requires less tissue.
• PRK may be better for those with higher prescriptions since more corneal tissue must be removed.
• Since there is no flap, PRK may be safer for patients who engage in high-impact activities or are susceptible to eye trauma. Direct eye trauma can potentially dislodge a LASIK flap. PRK is an excellent option for professional athletes or military personnel.
• LASIK provides a faster recovery time. Many patients return to work the next day after LASIK, while PRK patients may need several weeks to recover before resuming normal activities.
• PRK recovery is more painful than LASIK. Because there is no corneal flap, PRK essentially creates an open wound on your cornea. The healing process can be uncomfortable, often requiring over-the-counter pain medications to ease the pain.
• PRK has a higher risk of infection because there is an open wound on your cornea after the surgery. The risk is approximately six times more than LASIK. However, the overall chances of getting an infection with refractive eye surgery are low. Your surgeon will also prescribe you antibiotic drops to use after surgery.
• PRK and LASIK visual outcomes are similar. Research shows no significant difference in quality after the one-year mark.

LASIK Versus SMILE

SMILE is a newer type of refractive eye surgery that is gaining popularity. Below is a comparison of SMILE versus LASIK:

• SMILE does not require a corneal flap. Instead, a laser targets the inner layer of the cornea, creating a lenticule, which is a thin, round piece of tissue. The surgeon then removes this lenticule via a small incision on the side of your cornea.
• SMILE has less risk of dry eye. Since SMILE does not affect your corneal nerves as much as LASIK, this helps your cornea maintain normal tear function post-surgery.
• SMILE is less invasive because the surgeon only needs to make a tiny incision in your cornea, as opposed to cutting a flap.
• LASIK can correct a more extensive range of prescriptions. SMILE is only approved in the United States to treat certain amounts of myopia. SMILE does not correct hyperopia or astigmatism at this time, at least in the United States.
• LASIK and SMILE have similar recovery times. Both surgeries have little downtime, often just 1 to 2 days.
• LASIK and SMILE provide similar outcomes. Research shows the two procedures yield comparable results. However, many of these studies had a limited amount of participants and only followed patients over a short postoperative period. More studies are needed to evaluate the long-term outcomes of SMILE. For this reason, many surgeons still recommend LASIK over SMILE.