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LASIK (laser-assisted in situ keratomileusis)

Published by Bupa's health information team, April 2009.

This factsheet is for people who are planning to have LASIK eye surgery, or who would like information about it.

LASIK eye surgery involves using a laser to change the shape of the cornea (the clear covering over the front of the eye).

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

Animation - How LASIK eye surgery is carried out
About LASIK eye surgery
What are the alternatives?
Diagnosis
Preparing for your procedure
About the procedure
What to expect afterwards
Recovering from LASIK eye surgery
What are the risks?
Questions and answers
Related topics
Further information
Sources

How LASIK eye surgery is carried out

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About LASIK eye surgery

LASIK stands for laser-assisted in situ keratomileusis. LASIK eye surgery will change the shape of your cornea using a computer-controlled excimer laser.

Illustration showing the different parts of the eye
The different parts of the eye

Why have LASIK?

LASIK can help to correct:

short-sightedness (myopia)
long-sightedness (hyperopia)
an irregular-shaped cornea (astigmatism)

LASIK can't improve age-related long-sightedness (presbyopia) because this is related to the lens of the eye rather than the cornea.

Who can have LASIK?

If you're aged 21 or over with healthy eyes and stable vision (no changes in your prescription for two to three years), LASIK may be a suitable treatment for you.

LASIK has limitations and isn't suitable for everyone (for example, if you have a condition that reduces healing, such as rheumatoid arthritis). Speak with your optometrist (a health professional who examines eyes, tests sight and dispenses glasses and contact lenses) or ophthalmologist (a doctor who specialises in eye health, including eye surgery) for advice.

What are the alternatives?

The non-surgical alternative to LASIK for correcting short- or long-sightedness or astigmatism is to continue wearing your glasses or contact lenses.

There are a range of alternative surgical techniques that can be used. Your surgeon will discuss these with you.

Diagnosis

You will be asked to have an assessment consultation with a surgeon to find out whether LASIK surgery is suitable for you.

You will have to remove soft contact lenses at least one day before your assessment and hard/gas-permeable contact lenses at least one week before. This is because your contact lenses can affect the test measurements your ophthalmologist will make.

The assessment consultation

Your surgeon will talk to you about the results you can realistically expect from LASIK, as results will vary from person to person.

You may have:

a test that produces a computerised image of the surface of your eye to 'map' the cornea - this determines whether LASIK is suitable for you
a full eyesight test
diagnostic tests, such as measurements of the thickness of your cornea and the size of your pupils in various light conditions

Preparing for your procedure

If LASIK is suitable for you and you decide to go ahead, an appointment will be made for you to have the procedure.

Your surgeon will explain how to prepare for your operation. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a wound infection and slows your recovery.

You won't be able to wear contact lenses for a certain amount of time before LASIK eye surgery. Your surgeon will tell you how long this will be.

The operation is usually done as a day case under local anaesthesia. This completely blocks feeling from around your eye and you will stay awake during the operation. The procedure usually involves a total stay of around an hour.

You may be asked to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

About the procedure

You can either have each eye operated on separately or both eyes at the same time. During the operation, you will lie back in a special chair.

Your surgeon will place anaesthetic drops into your eye and may use a special eyelid clip to stop you blinking during the procedure. It won't be possible to see out of your eye while it's being treated, so you won't be able to see any instruments coming towards your eye, although you may be able to see a red or green light.

Once the anaesthetic has taken effect, a highly precise instrument called a microkeratome will be used to make an extremely thin flap in your cornea. The flap will be opened (like the cover of a book) so that the computer-controlled laser can be used to shape the cornea underneath. It will take about 30 seconds to remove precisely the right amount of your cornea.

The flap will then be repositioned and will bond to the rest of your cornea within minutes. You won't need any stitches.

Your surgeon will place antibiotic eye drops in your eye to prevent you getting an infection.

What to expect afterwards

After the procedure, your eye is likely to be covered with a protective pad. You will need to wear this for around 24 hours.

You may feel mild pain and your eye may feel uncomfortable for a few hours. You will be given painkillers if you need them. Very occasionally, you may need stronger painkillers.

Directly afterwards, your vision may be blurred. This should improve gradually over one to two days and your vision will usually stabilise after one week to one month.

It may be helpful to wear sunglasses or a hat when you leave the clinic or hospital as your eyes may be sensitive to the sun.

You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours, especially if you have had both eyes treated.

Your nurse will give you eye drops to help prevent infection and promote healing. He or she will also give you some advice about how to use the eye drops before you go home. You will be given a date for a follow-up appointment.

Recovering from LASIK eye surgery

For the first few days after having LASIK eye surgery, you should:

have baths rather than showers
keep soap and shampoo out of your eyes (it's sensible not to wash your hair for the first few days)
try not to touch or rub your eyes, or screw your eyes up
try not to get anything in your eyes - wearing sunglasses may help
not wear eye make-up
not play contact sports, swim or play racket sports, such as squash or tennis, for at least four weeks after the procedure

You should be able to return to work after two to three days. If you have questions about what you can and can't do, such as when you can drive, ask your surgeon or nurse for advice.

If you experience more than mild pain, or you have a loss of vision or increasing redness of your eye, you should contact your clinic or hospital for advice.

If you need them, you can take painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

What are the risks?

LASIK is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

There is little evidence of the long-term effects of this procedure as the treatment is relatively new.

Side-effects

These are the unwanted, but mostly temporary effects of a successful treatment.

After LASIK eye surgery you may have:

dryness of your eye(s) for up to a year after the procedure
glare around bright lights, causing a "halo" or "starburst" effect that makes night-time driving difficult - this shouldn't last more than six weeks
a drooping eyelid - but this should stop within a few weeks

Complications

This is when problems occur during or after the operation. Most people aren't affected. The possible complications of any operation include an unexpected reaction to the anaesthetic or excessive bleeding.

Very rarely, complications can lead to reduced vision or blindness.

Specific complications of LASIK are rare but can include:

mild or moderate haziness or scarring of your cornea
slight over- or under-correction of short-sightedness
some return of short-sightedness
accidental damage to your cornea - if this happens, you might need stitches
problems with the flap that is made in your cornea
your vision getting worse - but this is rare

The amount of improvement in your eyesight depends on how well your eyes heal - it can't be absolutely guaranteed. If the operation doesn't achieve the result you hoped for, you may need further LASIK treatment.

The exact risks are specific to you and will differ for every person, so we haven't included statistics here. Ask your surgeon to explain how these risks apply to you.