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What it is, how it’s done and what to expect

LASIK, which stands for ‘laser-assisted in situ keratomileusis’ is the most commonly performed surgical procedure for correcting refractive errors of the eye like myopia, astigmatism and hypermetropia. With such a long jargony name coupled with the scary fact that it involves applying a laser to the eye, it is no wonder that many people have some negative preconceptions and shy away from the procedure at all costs.

It is true that some of the concerns around LASIK are justified as it does carry some level of risk of complications just like all medical and surgical procedures. But in reality, LASIK has become so routine and largely automated that the chances of anything going seriously wrong have become very low. Recent data suggests that 99% of patients who undergo LASIK come away feeling happy with the results, and for most of the remaining 1%, their concerns can be addressed with a follow-up touch-up procedure. Of course, there is the very small minority for whom the procedure does not go as planned, and problems have been reported.

Regardless, having a high-powered laser burning holes into your eye sounds like something crafted by a villain in a spy movie, and it is perfectly understandable that most people would have some questions and concerns before undergoing the procedure.

So let’s focus on the facts about LASIK to dispel any lingering misconceptions. How is it performed and what does it involve? What are the pros and cons of the procedure? Who should get it?

How is LASIK performed?

LASIK is typically a day procedure and can be performed at a specialist ophthalmologist’s clinic without the need for hospital admission. Usually, you can walk out and go home just minutes after the operation is completed.
Before the procedure, an ophthalmologist uses imaging technology to take precise measurements of the eye to determine precisely the best approach and requirements for each patient.

At the very start of the procedure, the surgical team prepares and sterilises the eye to keep everything safe from contamination. Anaesthetic eye drops are applied, which is why the rest of the surgery is completely pain-free. Once the eye is numb, a stabilising suction ring is used to prevent blinking, to hold the eyes open and to keep the eye in place, so that a super precise laser called a femtosecond laser can work its magic without obstruction and without the eye darting around.
Onto the exciting part: the femtosecond laser is used to cut a thin circular flap in the cornea which is the outer surface of the eye. The patient will feel some pressure during this part of the procedure, but it should be pain-free.
During the second stage of the surgery, a speculum holds the eye open. The newly-formed corneal flap is lifted to expose the layer underneath, and a second laser is used to re-shape the cornea according to the specifications determined prior to the surgery. This is a very precise and delicate process, and modern lasers use automated guidance systems that shut off instantly if there are any sudden or large movements to ensure that no unwanted corneal damage occurs. Once that is done, the flap is repositioned, and heals naturally (no stitches needed!). All in all, the entire LASIK procedure only takes around 20 minutes for both eyes.

What happens after?

Most patients are usually impressed by how quick the procedure is but report that they were quite nervous throughout. Of course, some nerves are normal, so don’t stress about the fact that you are stressed!
Immediately after the procedure, there may be a temporary burning or itching sensation that will last for a couple of hours. You will undergo a brief exam after the operation, after which you should be free to go home, usually with a pair of protective goggles over your eyes. Just be sure to have somebody to drive you home.

Some people experience blurry vision on the day of the surgery, but some instantaneous improvement is common. Clarity usually improves the morning after. The day after the op, you will most likely have to visit your doctor again for a check-up. By this point, you will probably already be marvelling at the fact that you can see street signs and the individual leaves in the trees without needing to put on your glasses!
LASIK truly has changed the face of treatment of refractive errors like myopia. Where once we had no choice but to use glasses for life, this technology has changed the lives of millions, with up to 90% of patients achieving perfect 20/20 vision overnight, and 99% achieving vision at least good enough to pass a driving exam.

It is important to note that in many cases, your miraculously restored vision may begin to deteriorate over several years. Some people may notice that their vision has gotten a bit worse after about 10 years post-surgery and may need some glasses. Also, LASIK does not prevent the onset of presbyopia later in life (usually in your 40s or 50s) which is a condition that results in difficulty seeing near objects like books due to the muscles in the eye’s lens become weak with age. So you will probably still need to get some reading glasses at some stage. Also importantly, LASIK only reshapes the structure right at the front of the eye, and does not correct the overall structure or length of the eye. So people with high myopia are still at risk for certain diseases such as myopic macular degeneration even after LASIK.

Great, but what are the risks?

The main side effects of LASIK are dry or burning eyes or the feeling that there is something in the eye. This might affect up to 20% of patients, but these symptoms typically resolve after a few months. Although for a minority, these symptoms may persist for longer.

Another risk is that LASIK may not work as well as was hoped, especially for those with higher levels of refractive error such as high myopia, but sometimes a second surgery can help get you closer to the desired outcome.
But the greatest risk is that LASIK can very rarely make your vision worse, and may even causes permanent vision loss, but this usually occurs from scarring or infection and is extraordinarily rare.

LASIK is not for everybody, and it is very important to ensure that you are eligible for the procedure to ensure the best outcome and to minimise the risk of complications. For example, people whose vision has not stabilised or those with very thin corneas may not be eligible.
It is always good to do your research and find the most reputable clinic in your area. And good luck with your new-found vision!