Laser eye surgery

In recent years, doctors have adopted new surgical techniques to correct eyesight and reduce the need for wearing glasses.

Most often, the surgery involves reshaping the cornea – the transparent surface at the front of the eye – using a type of laser known as an excimer laser. Different techniques are used to correct short sight (myopia), long sight (hypermetropia) and astigmatism. Laser refractive surgery is generally considered non-essential, therefore it's usually unavailable on the NHS.

The Royal College of Ophthalmologists (RCO) recommends that doctors doing the surgery should be fully trained ophthalmologists and have additional specialist training in refractive surgery. It publishes a detailed 'Patient's Guide to Excimer Laser Refractive Surgery', as well as advice on other refractive surgery techniques.

The guide explains the types of surgery available, the advantages and disadvantages, what happens during the surgery, results and complications. It also contains advice on how to choose a surgeon, and the procedures that surgeons should follow.

Types of surgery

Here's a guide from The College of Optometrists on the most common types of laser surgery: 

LASIK (laser in situ keratomileusis)

LASIK has been performed since the mid-1990s, and is the most common procedure in the UK. Most types of refractive error can be corrected with LASIK, but it may not be suitable for correcting high prescriptions (high degree of short-sightedness). Surgeons cut across the cornea and raise a flap of tissue. The exposed surface is then reshaped using the excimer laser, and the flap is replaced.

PRK (photorefractive keratectomy)

PRK has been performed since the late 1980s, but since the development of LASIK and LASEK, it's now mainly used for correcting low prescriptions (low degree of short-sightedness). The cornea is reshaped by the excimer laser without a flap of tissue being cut.

LASEK (laser epithelial keratomileusis)

LASEK is similar to PRK but the surface layer (epithelium) of the cornea is retained as a flap. Retaining the epithelium is thought to prevent complications and speed up healing. 

Wavefront-guided LASIK

Wavefront-guided LASIK reduces the natural irregularities of the eye (which can cause light rays to focus incorrectly), and improve the visual result of the surgery.

Your optometrist can discuss with you the various methods of correcting your vision, and the advantages and disadvantages of spectacles, contact lenses and refractive surgery.

What are the risks?

Complications occur in less than 5% of cases, but check with your consultant that he has outlined all the risks.

Some people have a problem with dry eyes in the months after surgery. Artificial tear supplements might be needed in the long term. Many patients have experienced glare or halo effects when driving at night, particularly just after treatment. This is more likely if a high correction has been made (correcting a high degree of long- or short-sightedness), but is rarely severe.

In rare cases, too much thinning of the eye wall can make the shape of the eye unstable after treatment. Severe loss of vision is very unusual, but some patients may need corneal surgery or hard contact lenses to restore their vision. Find out how frequently your surgeon has had complications, and why.

You can find more information about the risks associated with having laser eye surgery in the Patient's Guide to Excimer Laser Refractive Surgery, published by The Royal College of Opthamologists (RCO). You can also find information about the risks involved in the appropriate NICE guidance

Page last reviewed: 05/03/2012

Next review due: 05/03/2014


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