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What is LASIK?
LASIK, or laser-assisted in-situ keratomileusis, is the most popular laser vision correction procedure. It can eliminate completely the need for glasses or contact lenses by correcting short-sightedness (myopia), long-sightedness (hypermetropia) and astigmatism.
It has a track record of over 30 years and is the most investigated and safe elective procedure worldwide. LASIK involves the creation of a flap, a thin layer of corneal tissue, with a femtosecond laser; once the flap is lifted excimer laser sculpts the cornea to match your refractive prescription. The flap is finally repositioned.
Just over 15 years ago, a keyhole procedure that does not involve creating a flap, called SMILE, was introduced; its advantages over LASIK include less potential for dry eye, better preservation of the corneal nerves and better biomechanical stability.
What are the benefits of LASIK laser eye surgery?
An active lifestyle without the hassle of glasses or contact lenses.
- Improved quality of vision compared to strong spectacles.
No contact lens risks.
Less dry eye than with contact lens wear.
Quick improvement in vision following the procedure.
Laser eye surgery, also known as laser vision correction or refractive surgery, is a procedure that uses laser technology to correct short-sightedness (myopia), long-sightedness (hypermetropia), astigmatism and the need for reading glasses (presbyopia). It achieves this by changing the shape and thus refractive power of the cornea of the eye; this focuses light rays on the retina, resulting in a sharply focused image. The most common types of laser eye surgery include LASIK (Laser-Assisted In Situ Keratomileusis), LASEK or PRK or ASA (Advanced Surface Ablation), SMILE (Small Incision Lenticule Extraction) and variants of these.
ReLEx SMILE (Small Incision Lenticule Extraction) is a keyhole laser eye surgery procedure that was developed exclusively by ZEISS (Carl Zeiss Meditec AG). More than 5 million procedures have been performed over the past 15 years. Currently, SMILE can eliminate the need for glasses or contact lenses by treating short-sightedness (myopia) and astigmatism, though indications are currently being expanded to the treatment of long-sightedness (hypermetropia). Its key difference to LASIK is that it does not involve the creation of corneal flap. This has 2 advantages over LASIK. Better preservation of the corneal nerves, resulting in less potential for dry eye. In addition, better conservation of the biomechanical stability of the cornea. Only one type of laser is involved in this procedure, the femtosecond laser. This creates a disc of corneal tissue, called the lenticule, that is removed through a small 3mm incision and opening. LASIK has a larger incision opening, typically 18-20mm.
PRESBYOND LASIK, also known as PRESBYOND laser blended vision is a variant of LASIK that treats the need for reading glasses. It is a less invasive and preferable alternative to refractive lens replacement, especially under the age of 60 years. In addition to improving the reading and near vision, PRESBYOND LASIK most commonly also improves the distance vision as it simultaneously corrects any short-sightedness (myopia), long-sightedness (hypermetropia) and astigmatism that may be present. As it is a variant of LASIK, it involves the creation of a corneal flap with a femtosecond laser and then the reshaping of the cornea with the excimer laser. All patients above the age of 40 years should consider PRESBYOND LASIK as their preferred LASIK procedure.
A slight pressure feeling may be noticed during the procedure but no pain. Your eyes will be slightly gritty and sensitive to light for the first day or two.
The recovery after LASIK or ReLEx SMILE is usually rapid. There is no pain following the procedure, only a mild gritty sensation and a heaviness of the eyes. Some sensitivity to light may be experienced the first 2-3 days. Immediately after the procedure, your eyesight is slightly blurred, like looking through frosted glass, but improves rapidly within a few hours. By the next day, the eyesight is very clear, usually to driving standards. You can carry on with most of your normal activities, but care is required not to get shower or tap water in your eyes for the first week and to avoid touching or rubbing your eyes. You will need to use eyedrops for at least 2 weeks following the procedure to help the eyes settle.
It is not uncommon to notice some glare, haloes or starburst in the early days following laser eye surgery. These improve over days to weeks and it is very unusual for these visual side effects to be long lasting. Due to the non-invasive nature of the surgery, it is very rare for permanent loss of vision following laser vison correction. Infections can develop in less than 1 in 3000 patients and the majority can be treated well with no serious loss of eyesight. In rare cases, less than 1 in 5000 patients, a corneal transplant may be performed to restore the vision lost due to infection, scarring or other complication.
Permanent serious loss of vision following laser vision correction is extremely rare, as the procedure is not carried out inside the eye but on the outside.
Poor vision may be caused if an infection were to develop following the procedure; the risk of this occurring is less than 1 in 5000 patients. In the worst likely scenario, a form of corneal transplantation may be required to replace a damaged block of tissue in the cornea, restoring vision usually to driving standards. Problems that can lead to the need for transplantation include scarring after infection or an abnormal healing response, and an unstable corneal shape, also called corneal ectasia. These problems occur infrequently, and can often be corrected without transplant surgery.
For patients with a healthy eye surface prior to the procedure, lasting dry eye symptoms are unusual. Dry eye symptoms and intermittent blurring (variable vision) can be caused by reduced stability of the tear film between blinks.
Tear film stability and dry eye symptoms improve over the first two to three months after the procedure. During this period, most patients require the use of frequent tear supplements. Contact lens wearers usually experience an improvement in dry eye symptoms compared to before the procedure!
ReLEx SMILE has less potential for dry eye compared to other laser vision correction procedures.
The effects of laser vision correction on the cornea and your vision are permanent. However, in your fifth decade of life and later the natural lens inside your eye undergoes changes that may change your prescription and need for reading glasses.
Depending on the procedure required for your eyes and prescription, the cost will usually range between £2000 to £2500 per eye. This will include all medication (drops) and consultations before and after the procedure. Most detailed costing can be found at https://arisvisioncorrection.co.uk/pricing/
Age itself is not necessarily a limiting factor to having laser eye surgery, provided the eye surface is healthy and there are no significant eye health conditions. In fact, PRESBYOND LASIK is designed to improve vision in individuals with age-related need for reading glasses. Refractive lens exchange, also known as lens replacement surgery, is an alternative to PRESBYOND laser blended vision but this is usually recommended over the age of 60 years or when early cataract is present with a reduction in quality of vision.
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