LASER EYE SURGERY

Laser eye surgery (also called refractive surgery) is an excellent alternative to glasses or contact lenses for patients with myopia (short-sightedness), hyperopia (long-sightedness), and astigmatism.

LASIK and PRK are the most used techniques to correct mild to moderate cases of myopia, hyperopia, and astigmatism. They are highly effective and safe procedures.

Laser eye surgery is brief and painless. It lasts 10 to 15 minutes, and it is done under local anaesthetic. The patient doesn’t even need to be hospitalized!

Medically reviewed by Dr Osama Bahsas Zaky
Written by Joaquín Pineda
Updated on October 18, 2021

What do Myopia, Hyperopia, and Astigmatism Mean?

Which Technique is Better? Lasik or PRK?

Which Patients can Have Laser Eye Surgery?

Advantages and Disadvantages of the PRK/Lasek Technique.

Advocates of Lasik.

Patients with High Myopia.

What Benefits and Risks are Involved in Laser Eye Surgery?

Positive Aspects of Laser Eye Surgery.

Negative Aspects About Laser Eye Surgery.

Laser Eye Surgery Considerations.

How is the Recovery After Laser Eye Surgery?

How much does Laser Eye Surgery Cost?

FAQ About Laser Eye Surgery.

WHAT DO MYOPIA, HYPEROPIA, AND ASTIGMATISM MEAN?

There are some refractive errors or eye issues that could impair your vision, such as:

Myopia (short-sightedness) : inability to see distant objects clearly.
Hyperopia (long-sightedness) : inability to see close objects clearly.
Astigmatism : blurry vision due to an irregular eye shape.

Myopia and hyperopia are the most common refractive eye errors. They are caused by eye abnormalities that affect the ability to focus light on the back part of the eye called the retina.

Light is bent (refracted) by the cornea, the clear surface at the front of your eye, and the crystalline lens inside it. Then, it ends up back at the retina, a fine layer of light-sensitive cells.

When the light doesn’t focus correctly or hit the retina properly, our brain interprets a blurred image.

Myopia is the most common refractive eye problem worldwide.

If you suffer from short sight, you will have difficulty seeing distant objects clearly but will be able to perform close-up tasks, such as reading and using the computer.

Myopia occurs when the eyeball is too long. It causes light rays to focus in front of the retina instead of directly on the surface.

Short sight can also be caused by the cornea being too curved for the length of the eyeball.

Conversely, hyperopia is better known as far-sightedness and is the opposite of myopia. The eyeball is too short, causing light rays to be refracted behind it.

If you’re shortsighted, the first number on your eyeglasses prescription is preceded by a minus sign (–). The opposite applies to hyperopia.

Both refractive errors can be corrected using eyeglasses, contact lenses, or having refractive surgery. The latter includes laser eye surgery and lens surgery.

WHICH TECHNIQUE IS BETTER? LASIK OR PRK?

Laser eye surgery changes the cornea’s curvature, altering the way the light bends to ensure it is focused correctly. There are two main types of laser eye surgery.

Laser-assisted in situ keratomileusis (LASIK surgery) and Photorefractive keratectomy (PRK/LASEK) are the two laser techniques used to solve refractive problems (myopia, hyperopia, and astigmatism).

Both PRK and LASIK surgery modify and reshape the cornea surface. However, the surgical procedures are performed differently.

With PRK, your eye surgeon removes the thin external layer of the cornea (epithelium) to get access. Your surgeon then uses lasers to reshape the layers of the exposed cornea and fix any irregular curvature in your eye to achieve the required correction.

Conversely, in LASIK surgery — the most common refractive procedure — the surgeon uses a laser to separate the corneal epithelium and create a corneal flap. This flap is raised up, and your surgeon uses the laser to reshape and remove part of the corneal tissue.

Then, the flap is lowered back down, and the cornea should repair itself over the next few months without using stitches.

Ultimately, the choice of technique depends on the results of the eye tests during the first preoperative consultation.

It should be the specialist in laser eye surgery who personally evaluates you and has the last word on the best technique for your particular case.

WHICH PATIENTS CAN HAVE LASER EYE SURGERY?

Currently, laser eye surgery can correct myopia to a maximum of -10D and long-sightedness up to +6D. Astigmatism can be fully corrected up to 3D, but higher levels may achieve partial correction or need follow-up surgery.

Ideally, your eye prescription should have stayed more or less the same for nearly two years.

Before undergoing laser eye surgery, it is necessary to evaluate the patient’s cornea and its thickness.

In cases where short-sightedness (myopia) is high, the cornea is thin, and the patient is not young, cataract surgery with refractive correction purposes is suggested as a first choice.

Indeed, age is an important factor when deciding if a patient can undergo laser eye surgery for myopia or hyperopia. The minimum age is 18, and the maximum is about 45 years old.

Often, younger patients will not have completed the development of short-sightedness or long-sightedness.

Conversely, over a certain age (patients aged 40), it is possible to develop cataracts in the following years. Therefore, it may be preferable for these patients to consider exchanging the crystalline lens for an IOL (intraocular lens).

ADVANTAGES AND DISADVANTAGES OF THE PRK/LASEK TECHNIQUE

The PRK/LASEK technique is the only option available for patients who, due to certain disorders or certain personal circumstances, are not candidates for LASIK surgery.

This applies to corneal scarring, a previous eye infection, or eye injury in the last year.

However, recovery after PRK surgery is slower. Furthermore, after the procedure, it is necessary to use therapeutic contact lenses to encourage the epithelium to heal.

Another disadvantage is that the recovery period is more painful and more uncomfortable. The first days after the surgery, the patient may experience moderate pain as the epithelium heals and covers the treated zone.

Conversely, even though LASIK is usually painless and entails a speedy recovery, it could result in flap complications and loss of corneal stability, known as post-LASIK keratectasia.

ADVOCATES OF LASIK

These days, almost all of the specialized ophthalmologists in laser eye surgery are advocates of LASIK for two basic reasons:

It causes less discomfort for the patient
Recovery is faster

But sometimes, it is necessary to turn to the PRK technique.

LASEK is an alternative treatment to LASIK and is effective for patients who aren’t suitable for LASIK surgery. It is the recommended treatment for patients with thinner corneas.

PATIENTS WITH HIGH MYOPIA

In the case of patients with high myopia, LASIK surgery is contraindicated.

If the patient is young and has high myopia, they should also avoid cataract surgery. The idea is to preserve the crystalline lens, which is still young.

In patients under 50 years old with high myopia (between -10 and -20 dioptres), high hyperopia, or thinner-than-normal corneas, the best solution would be an ICL surgery (Implantable Collamer Lens).

A phakic intra-ocular lens (IOL) is implanted behind the pupil, in the space between your natural lens and your iris. The ICL lens is inserted through a microincision that doesn’t need stitches.

Instead of reshaping the corneal surface, as in laser vision correction (LVC), this procedure involves implanting an additional lens inside the eye to help refract light on the retina, producing clearer vision.

Unlike IOLs used in cataract surgery, the crystalline lens of the patient remains intact. Phakic IOLs work exactly like contact lenses, except they are surgically placed and are permanent.

This procedure is done as outpatient surgery and under local anaesthetic.

WHAT BENEFITS AND RISKS ARE INVOLVED IN LASER EYE SURGERY?

Laser eye surgery is highly effective and safe to correct low to moderately high cases of myopia, long-sightedness, and astigmatism.

Corneal refractive surgery with laser is highly safe. According to the Royal College of Ophthalmologists, flap complications with LASIK surgery arise in less than 5% of cases and can usually be corrected with little or no vision loss.

Also, some patients have a problem with dry eyes in the months after surgery, and artificial tear supplements may be needed long term.

Many patients have experienced glare or halo effects when night driving the first months.

POSITIVE ASPECTS OF LASER EYE SURGERY

Laser eye surgery greatly reduces, often completely, the use of glasses or contact lenses for patients with myopia (short-sightedness), hyperopia (long-sightedness), or astigmatism.
LASIK is a low-risk intervention, and complications are rare.
It is a quick and painless outpatient surgery.
Almost immediate visual recovery. The definitive and stable optical result is usually obtained a few weeks after the intervention.
The postoperative treatment and visits are straightforward and allow the patient to restart their daily activities quickly.
When necessary, the results can be adjusted relatively easily.
LASIK laser surgery can be performed on one or both eyes in the same session.

NEGATIVE ASPECTS ABOUT LASER EYE SURGERY

No current surgical procedure cures myopia or hyperopia.
The eye of the patient with myopia or hyperopia will continue to be at higher risk of developing cataracts or glaucoma.
The surgery does not stop the possible progression of short-sightedness or long-sightedness. This is more likely to occur in young patients with higher refractive errors.
It is not possible to guarantee that all patients will get rid of reading glasses or contact lenses. Some patients may need them for certain activities (for example, driving at night).
Visual acuity may change again if you develop age-related long sight (presbyopia) or a cataract.
There are some cases of patients with myopia (short-sightedness) who may need follow-up laser eye surgery to get the desired result.

LASER EYE SURGERY CONSIDERATIONS

Preparation for the surgery

Once your surgery is scheduled, you should go a few days before to the facilities of Barraquer Eye Hospital to have an eye exam and a series of preoperative tests. This will help decide the exact method of treatment for patients with myopia or hyperopia.

It is important to stop using contact lenses at least three or four weeks before as they can alter the results. Also, to prevent the growth of bacteria around the eyes, you should avoid wearing make-up for a few days.

Fasting is not strictly necessary before surgery. And you can take medication if you normally do so, although you should tell the nurse about it.

During the procedure

Your eye doctor will apply topical anaesthetic, meaning eye drops.

It is advisable to keep your eyes closed as much as possible before the intervention to avoid possible drying of the eyes.

Depending on the need, a mild oral/intravenous sedative may be administered.

Laser application only lasts a few seconds. During this time, you should try and keep your eyes fixed on a single point/light.

The only thing you will notice of the laser is the sound, as it is invisible and doesn’t cause a heating effect. With LASIK, you may feel a slight pressure as the surgeon cuts the corneal flap.

How long does laser eye surgery last?

The surgery lasts only a few minutes (from 10 to 15 minutes per eye).

It is important to remain calm and relaxed.

After 30 minutes, including a brief rest and the first postoperative examination, the patient can leave the clinic.

Is laser surgery painful?

The surgical procedure is brief and painless. It is an outpatient surgery without the need for a stay in the hospital.

You will immediately return home after surgery.

HOW IS THE RECOVERY AFTER LASER EYE SURGERY?

During the first 6 hours, you should keep both eyes closed as much as possible. This reduces the discomfort and helps the patient’s recovery.

Before leaving Barraquer Hospital, specialists will give you the necessary instructions and aftercare medication.

You must protect the eyes with protective glasses even when at home to avoid rubbing them or involuntary knocks.

Also, after the surgery, you may note a burning or itching sensation or the feeling that there is something in your eye. In most cases, this feeling doesn’t last more than 6 hours.

The doctor may prescribe medication for mild pain and a sedative to ease any discomfort.

Vision is generally blurred or cloudy the same day of the operation, but this blurriness will improve the following days.

Although visual recovery is quick, it is recommended to have a few days of rest and off work. However, this process is longer with LASEK surgery, and the first 24 hours can be slightly painful.

HOW MUCH DOES LASER EYE SURGERY COST?

Laser eye surgery cost depends on the technique performed.

Please, fill in the contact form. If you have any medical reports or examination results from other centers, we would appreciate it if you could send these tests to us by email.

You can be sure that this information will always be treated with maximum confidentiality, and we will offer you the solution that best suits your needs.

FAQ ABOUT LASER EYE SURGERY:

Is the postoperative period very complicated?

The procedures require very little postoperative medication: some eye drops and artificial tears that have to be used briefly.

How long will it take me to resume my normal activity?

After an intervention with laser, the patient’s visual recovery is very fast. In most cases, normal activities can be resumed the day after the surgery. The final result is usually achieved after a week.

If I am not a candidate for laser eye surgery, what alternative is there to remove my vision problem?

Suppose specialists decide that a patient cannot be treated with laser refractive surgery because of high myopia or special eye conditions. In that case, the alternative could be the implantation of an intraocular lens.

Is laser eye surgery permanent?

Surgery is permanent, but it won’t prevent aging of the eyes. Hence, a very small percentage of patients might need additional minor adjustments, aka follow-up surgery.

What happens if I move my eye during the intervention?

It is necessary to understand that the patient must not move the head or body as it is a microsurgical operation. However, during the laser application, the system has a device that can correct small eye movements.

I am pregnant; can I have laser surgery?

No. It is necessary to wait until after childbirth and the breastfeeding period. During pregnancy, there could be slight changes in eye strength. Also, there is a risk that the postoperative medication could get into the breast milk during the breastfeeding period.

BEST LASER EYE SURGERY SPECIALISTS AT BARRAQUER HOSPITAL

Doctor Juan P. Alvarez de Toledo Elizalde

Doctor Paola Sauvageot

Doctor Andrés Picó García

Doctor José Lamarca Mateu

Doctor Marinka Kargacin

Doctor Milan Pesic

External links – Bibliography

Lasek Vs Lasik: Which One Is Better? Pros & Cons, Procedure & Aftercare.

Phakic intraocular lenses: Recent advances and innovations. Martínez-Plaza E, López-Miguel A, Holgueras A,Barraquer RI, Alió JL, Maldonado MJ.Arch Soc Esp Oftalmol. 2020 Apr;

Safety and visual outcomes following posterior chamber phakic intraocular lens bilensectomy. Vargas V, Alió JL,Barraquer RI, D’ Antin JC, García C, Duch F, Balgos J, Alió Del Barrio JL.Eye Vis (Lond). 2020 Jul 1

WOULD YOU LIKE TO RECEIVE MORE INFORMATION ABOUT LASER EYE SURGERY AT BARRAQUER HOSPITAL?

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Click here if you want more information about Barraquer Eye Hospital (Barcelona, Spain).

Barraquer Eye Hospital

Carrer de Muntaner, 314, 08021 Barcelona (Spain)

Nearest Metro Stations:: Muntaner/ Gràcia