What Is LASIK Eye Surgery?

Are you tired of the daily struggle with glasses or contact lenses just to see clearly? Imagine a life without the hassle of reaching for your glasses every morning or dealing with the inconvenience of contacts. If you are looking for an alternative solution to a clearer vision that gives you more freedom, LASIK might be your solution.

LASIK is a refractive eye surgery which uses a laser to precisely reshape your cornea and improve your vision. Read on to learn about how LASIK eye surgery works, a step-by-step guide to the procedure, possible risks and complications of the surgery, and more.

Overview

LASIK, or laser-assisted in situ keratomileusis, is the most commonly performed laser refractive eye surgery and is designed to fix problems with your vision using lasers. By reshaping the cornea, LASIK aims to correct refractive errors and eliminate or reduce the need for corrective glasses or contact lenses. “In situ” means “in position” or “in place”, while “keratomileusis” is the medical term for corneal reshaping, thus LASIK means reshaping of your cornea within the cornea itself (i.e. not removing it from the eye to perform surgery) using lasers.¹

This is a routine and simple procedure done under local anaesthesia, typically as an outpatient procedure, meaning you can go home the same day. Recovery is relatively quick with your vision normally improving soon after surgery with mild and temporary discomfort.

The ability to see is vital for our daily lives. LASIK offers the opportunity for you to achieve better vision and enhance your quality of life through a minimally invasive surgical approach. It might be a treatment option for people who do not want to rely on glasses or contact lenses to improve their vision. If you are considering LASIK surgery, it is important to understand how this procedure works and the possible complications of this surgery so that you can make an informed decision. 

How does LASIK eye surgery work?

The cornea is the transparent dome-shaped outermost layer of your eye. It plays a crucial role (along with the lens) in focusing light onto the retina at the back of the eye, helping you to see clearly. 

Irregularities in the shape of the cornea can cause refractive errors, when your eye cannot refract (or bend) light rays to focus them on the retina as it should, leading to blurry vision. There are 3 common types of refractive errors that LASIK can correct for:

• Myopia (short-sightedness): far-away objects look blurry
• Hyperopia (long-sightedness): nearby objects look blurry
• Astigmatism: far-away and nearby objects can look blurry or distorted

Image source: Sutherland C. Biorender.

LASIK works by reshaping the cornea to redirect the light to focus precisely onto the retina, correcting these refractive errors. This is done by using advanced laser technology for precise control. A thin flap is created on the cornea to expose the underlying tissue. The laser is then used to precisely remove microscopic layers of the corneal tissue, reshaping it to improve its focusing ability without affecting the rest of the eye.²

What to expect before you get LASIK eye surgery?

Before you get LASIK eye surgery, a preoperative assessment will be conducted by reviewing your ophthalmic history along with your general medical history to ensure you are suitable for surgery.¹

Eye examination

A thorough eye examination will be conducted to assess the overall health of your eyes and, among several other tests, measure the curvature of your cornea and the refractive errors to be corrected.

Discussion with ophthalmologist

Your ophthalmologist will discuss the possible outcomes, potential risks and complications of the surgery, and address any questions you might have. It is important to understand that you might not get perfect vision from LASIK surgery and may have to continue using glasses.

Avoid makeup or lotions

You should avoid using makeup or lotions on your face the day before your surgery as these can get into your eyes and increase the risk of developing an infection.

Arrange transportation

You cannot drive immediately after LASIK surgery so you will have to arrange for someone to drive you to and from your surgery. 

What happens during the LASIK procedure?

LASIK eye surgery is a quick outpatient procedure which typically takes about 15 minutes per eye. The LASIK surgery procedure consists of:³

1. Numbing of the eye: Topical anaesthetic drops are used to numb your eye. Discomfort is minimal during the surgery. 
2. Devices to keep your eye open: A suction ring and an eyelid speculum are used to keep your eye in the correct place and stop you from blinking. These devices are harmless and do not hurt, although you might feel a slight pressure on your eyelid.
3. Creation of the corneal flap: A thin flap in the cornea is created, typically using a microkeratome or a femtosecond laser. This flap is gently lifted and folded back to expose the underlying corneal tissue.
4. Corneal reshaping: An excimer laser is guided by a detailed map of your eye to precisely reshape your cornea. This step corrects the refractive errors by removing microscopic amounts of tissue, precisely changing the curvature of the cornea. During this part of the procedure, you might hear a clicking sound or smell the chemicals created by the laser. Don’t worry - the position of your eye is constantly measured and the laser will automatically stop if you move too much.
5. Flap reattachment: Finally, the corneal flap is carefully repositioned. The flap naturally adheres back to the cornea, allowing for quick healing without the need for stitches.

Patients should have follow-up appointments after surgery to monitor the healing process, address any concerns of the patient, and ensure optimal vision correction.

Recovery and post-operative care

Following LASIK eye surgery, you might experience temporary discomfort which usually subsides within a week. Your vision will be relatively clear and, after recovery, more than 90% of people achieve excellent uncorrected vision (i.e., glasses/contact lenses are no longer required).⁴ To promote quick recovery you might be given:

An eye shield

This will help to protect your eyes and stop you from touching or rubbing them as this could disrupt the healing of the corneal flap.

Eye drops

You might be given a combination of lubricating eye drops to manage dry eye symptoms, anti-inflammatory (steroidal) eye drops to prevent inflammation, and antibiotic eye drops to prevent infection during the initial healing period.

You might be recommended to temporarily avoid certain activities, such as swimming, strenuous exercise, or contact sports, after LASIK surgery to minimise the risk of any complications.

What are the side effects and complications of LASIK?

The benefits of LASIK are clear: to improve your vision and reduce the need for corrective glasses or contact lenses. However, there are several common side effects and much rarer but more serious complications associated with LASIK eye surgery, which need to be understood before you undergo this surgery. 

Common side effects are normal and typically go away on their own a few months up to a year after surgery; these might include:¹

Dry eyes

Temporary dry eyes are a common side effect of LASIK. This can be managed using artificial tears or lubricating eye drops. However, dry eyes can persist for over a year in up to 20% of patients.⁴

Glare and halos

Some patients experience starbursts or glare around lights after LASIK. This can be particularly disruptive when driving at night.

Discomfort

You might experience discomfort or mild pain, such as a burning or itching feeling, after surgery. However, it is vital to avoid touching your eyes for at least the first week after surgery.

More serious complications are rare (only reported in <1% of patients) but may include:^1,5

Inflammation or infection

There is a small risk of infection or inflammation of the eye which, although rare, can cause serious complications if left untreated. Your healthcare provider can prescribe you further antibiotics or anti-inflammatory eye drops to treat this.

Corneal ectasia

Surgery can cause weakening of the cornea in a small number of patients with abnormal cornea tissue. This can cause progressive bulging of the cornea (cornea ectasia) 1-2 years after surgery, leading to myopia and astigmatism which worsens vision.

Under correction or overcorrection

Removal of too little or too much of your cornea by the laser can result in your vision not being fully corrected and potentially being worse than it was originally. These residual refractive errors can normally be resolved with a further enhancement procedure.⁶

It is also important to consider the long-term outcomes of LASIK. As you age, many people are affected by presbyopia, an age-related refractive condition which affects your ability to see things up close (e.g., reading a book). This vision loss will not be prevented by LASIK and additional vision correction measures, such as reading glasses, might be required as you get older, despite getting LASIK surgery. 

FAQs

Am I suitable for LASIK eye surgery?

You will likely be suitable for LASIK if you are over 21 years old and have had stable vision (the same prescription) for 1-2 years. You must also meet certain vision criteria: a refractive error up to -10.00D if you have myopia, up to +4.00D if you have hyperopia, and up to +/-6.00D if you have astigmatism. 

You should also have good overall health. Certain health conditions, such as autoimmune disorders, taking immunosuppressant drugs, or particular eye conditions (e.g. uveitis, glaucoma, cataracts, keratoconus), can increase the risk of serious complications after LASIK surgery. Therefore, LASIK might not be suitable for you if you are affected by any of these conditions. 

Your healthcare provider or ophthalmologist should be able to assess whether you are suitable. 

Is LASIK eye surgery painful?

LASIK eye surgery is usually a painless procedure. Anaesthetic eye drops will be applied to your eyes just before surgery to ensure they are completely numbed for the procedure.  However, you might experience a feeling of slight pressure on your eyes during surgery caused by the devices used to keep your eyes in place. 

Will I be awake during LASIK?

Yes. LASIK eye surgery is done under local anaesthesia, just using topical eye drops to numb your eyes before the procedure. This means that you will be awake during the procedure, but don’t worry you shouldn’t feel any pain or discomfort. Being awake is important as your surgeon will ask you to focus on a bright light during surgery to ensure proper eye positioning for the laser. 

Summary

LASIK eye surgery is a refractive eye surgery that uses lasers to precisely reshape your cornea and fix problems with your vision caused by refractive errors. This surgery is a routinely performed outpatient procedure with minimal pain and discomfort involved. Temporary side effects such as discomfort, dry eyes, and glare or halos around lights are common but typically do not last more than 6 months. More serious complications such as eye infection, inflammation, and vision worsening, are extremely rare. The precision of the LASIK procedure has made it a reliable and widely used option for those seeking freedom from glasses and contact lenses. If you are interested in LASIK eye surgery, talk to your healthcare provider or ophthalmologist to discuss whether this is the right procedure for you.

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Charlotte Sutherland

Master of Science – MSc Translational Neuroscience, Imperial College London

Charlotte is a recent MSc Translational Neuroscience graduate from Imperial College London where she undertook research investigating antidepressants and Alzheimer’s disease. She has a strong interest in translational research and is aiming to pursue a PhD in the field of neurodegenerative diseases.

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