Refractive Lens Exchange
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What is Refractive Lens Exchange
LASIK stands for Laser-Assisted In Situ Keratomileusis. It is a type of laser eye surgery that uses a cool-beam laser to reshape the cornea and improve vision. It is the preferred treatment of laser eye surgeons and patients. Far more LASIK eye surgery procedures are performed than other laser treatments.
If you have wanted to know how laser eye treatment achieves clear vision, this is the page for you.
LASIK belongs to the family of procedures called refractive surgery, which are treatments designed to remove a refractive error, the medical term for needing glasses or contact lenses.
Laser refractive surgery procedures:
- LASIK
- PRK aka LASEK
- Lenticule extraction (SMILE, SILK, CLEAR)
Results are very similar for all treatments, and each has benefits, although the healing process will vary.
Key Takeaways
Table of Contents
LASIK Surgery Steps
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01
Your eye is first numbed with anaesthetic drops to ensure you feel no pain during the procedure. The drops work within seconds.
02
A speculum keeps your eye gently open during the procedure. It feels like you are still blinking, so just relax and blink normally!
03
A femtosecond laser creates a thin flap in using millions of microscopic bubbles, which your eye surgeon lifts to expose the interior corneal tissue.
04
You will look at a small target light while your eye surgeon uses sophisticated tracking technology to ensure a perfectly centred treatment.
05
An excimer laser vaporises tiny amounts of tissue in 5-10 seconds in a highly controlled manner, altering the cornea’s curvature.
06
Once the proper corneal shape has been achieved, your surgeon smoothly repositions the flap back to its original place. That’s it!
The protective flap typically takes about 24 hours to re-adhere naturally. LASIK takes 5-7 minutes per eye and is done as an outpatient procedure under numbing drops. Patients can usually return to their normal routines within a couple of days. Patients are counselled not to expect perfect vision. However, most patients achieve eyesight that matches or exceeds what they could see with their glasses or contact lenses.
How Does LASIK Work?
By reshaping the cornea, LASIK helps focus light rays correctly on the retina for clear vision. It treats all common vision disorders. Rather than compensating for refractive errors with lenses like glasses or contacts, LASIK aims to permanently correct vision by treating the anatomical cause.
Benefits of LASIK Eye Surgery
The independence and freedom gained from LASIK have changed millions of people’s lives for the better. Many advantages attract people to get LASIK vision correction:
Risks of LASIK
Although laser eye surgery is generally safe and highly effective, there are potential risks to consider, including:
Who is a Candidate for LASIK?
Age
Is at least 18 years old with documented vision stability over 1-2 years and no significant vision changes.
Eye health
Has good general eye health with no diseases like advanced glaucoma, cataracts, keratoconus or uncontrolled diabetes.
Eye lubrication
No significant dry eye disease. Your eye doctor will confirm this at the consultation
Immune status
No autoimmune disorders like rheumatoid arthritis that could impede healing
Cornea
No signs of corneal abnormality and meets corneal thickness requirements.
Who is Not Suitable for LASIK?
Other vision correction options
Alternatives to LASIK
If you are not suitable for LASIK, other laser eye surgery procedures are available: PRK and lenticule extraction (SMILE).
Another non-laser alternative for patients aged 20-60 is an implantable contact lens (ICLs), especially for higher or extreme prescriptions.
For patients aged 50+, refractive lens exchange (RLE) could be the best option.
PRK or lenticule extraction (SMILE)
Laser eye surgery options. PRK is better for thinner or weaker corneas. Lenticule extraction (SMILE, SILK) may be an option for short-sight and astigmatism but not for long-sightedness.
Implantable Contact Lenses (ICLs)
Miniature soft lens implants that are placed between the iris and the natural lens. The implants can remain in place for 10-20 years.
Refractive Lens Exchange (RLE)
Your natural lens is removed and replaced with an intraocular lens (IOL). RLE can treat all kinds of prescriptions with premium multifocal implants.
Thinking about having treatment? Get in touch now.
LASIK vs PRK: Comparison Table
LASIK and PRK are the two most common laser vision correction surgeries that reshape the cornea to reduce dependency on glasses or contacts. Both use the excimer laser and are equally effective, but key differences exist in the procedures, recovery, risks, and results.
LASIK Advantages
- Much less postoperative discomfort
- Immediate vision improvement – within 4-24 hours
- Treats a broader range of short-sight and astigmatism
PRK Advantages
- Less risk of ectasia
- No flap complications
- Better for thin corneas
| PRK | LASIK |
Up to -12D (dioptres) | Up to -12D (dioptres) | |
Yes | No | |
1 in 7,000 | 1 in 21,000 |
Talk to me about your specific vision goals and eye health to determine if LASIK or PRK is most appropriate. Both procedures are effective vision correction options with proper patient selection and technique.
LASIK vs SMILE: Comparison Table
LASIK and SMILE (Small Incision Lenticule Extraction) are two popular laser vision correction options that reshape the cornea. Both have advantages depending on the patient’s specific needs and eye profile.
LASIK Advantages
- Quicker visual recovery within 24 hours
- Treats a wider range of nearsightedness and astigmatism
- Much easier to enhance if needed
- Extremely high success rate of over 98%
SMILE Advantages
- No flap complications
- Potentially better tensile strength preservation
- Lower dry eye symptom rate in first months
| SMILE | LASEK |
Up to -10D (dioptres) | Up to -14D (dioptres) | |
5 dioptres | 6 dioptres | |
1-7 days | 4-7 days | |
No | Yes | |
Yes, rate unknown | Rare = 1 in 7,000 |
For mild to moderate nearsightedness, both SMILE and LASIK offer excellent safety. However LASIK remains superior for higher prescriptions with astigmatism correction and ease of re-treatment if required. Consult me as an experienced refractive surgeon to determine which procedure best meets your vision needs.
How to Prepare for LASIK Surgery
Proper physical and mental preparation helps everything go according to plan before, during and after your LASIK treatment. Taking the following steps helps set the stage for the smoothest LASIK experience and recovery:
Learn If You Are Suitable
Have a comprehensive eye exam to determine if LASIK is appropriate and meets the criteria set by your eye surgeon.
Contact Lenses
If you are a contact lens wearer, you must discontinue wearing contact lenses for 1 to 4 weeks before your treatment, depending on the lens type.
Dry Eyes
Follow your ophthalmologist’s instructions on treating eye dryness before surgery.
Getting Home After
Make arrangements for transportation on the day of surgery, as you cannot drive immediately after.
Rest Your Eyes
Limit your screen time and get good sleep in the days leading up to surgery to rest your eyes.
No Products!
Avoid wearing cosmetic products like eyeliner, mascara and perfume around your eyes before the procedure.
Preparing for LASIK Surgery
Proper physical and mental preparation helps everything go according to plan before, during and after your LASIK treatment. Taking the following steps helps set the stage for the smoothest LASIK experience and recovery:
What to Expect After LASIK Surgery
In the first few hours after your LASIK procedure, you can expect:
- Improved vision, though still blurry, hazy and variable. Some degree of blurred vision is normal in the first few hours.
- Mild burning or stinging sensation as the anaesthetic eye drops wear off.
- Watery eyes, sensitivity to light and difficulty keeping eyes open. Wear the provided sunglasses.
- Instructions to use medicated eye drops to prevent infection and reduce inflammation.
- Follow-up appointment with your surgeon the very next day to check your eyes.
Over the first week following LASIK:
- Vision continues to improve after your eye surgery but may fluctuate day-to-day.
- Avoid rubbing your eyes for the first month to prevent flap displacement.
- Use preservative-free artificial tears frequently to minimize dryness and irritation.
- Wear protective shields at night to avoid accidental rubbing while sleeping.
- Limit visual activities like reading and screens to prevent overexertion.
- Take over-the-counter pain medication like paracetamol (acetaminophen) as needed for discomfort.
Complete healing and vision stabilization takes 1-3 months on average. Attend all prescribed follow-up visits for monitoring.
Types of LASIK Surgery
All-laser or Bladeless LASIK
This is the gold-standard LASIK, which utilises a femtosecond laser instead of a blade to create a more precise, customizable flap with less corneal trauma.
Custom LASIK
Including wavefront-guided and topography-guided LASIK, incorporates detailed 3D mapping of the eye’s unique aberrations or shape to personalise the laser vision correction.
Conventional LASIK
Uses a surgical blade called a microkeratome to create a protective corneal flap that is gently lifted during the laser treatment. This treatment is inferior to all-laser LASIK and is best avoided.
LASIK Recovery Tips and Timeline
The typical LASIK recovery timeline is:
- 1-2 days – vision improves but varies, eyes sensitive
- 1 week – eyes start to feel normal, vision stabilises
- 1 month – generally comfortable. Dryness is common in the first few weeks
- 3 months – fully healed with stabilised vision. The patient can resume contact sports.
Closely following your surgeon’s post-op instructions facilitates rapid recovery.
LASIK Results and Patient Satisfaction
Various studies confirm LASIK provides some of the highest patient satisfaction rates of any elective surgery based on visual outcomes. Our published results at Focus Clinics at here.
Of course, individual results depend on the patient’s pre-operative prescription and eye anatomy. Your ophthalmologist will determine your likely outcomes.
Frequently Asked Questions
Is laser eye surgery safe?
Following a high degree of technology development, better patient selection and improved surgical technique over the past 30 years, LASIK eye surgery is considered safe and serious complications are very rare.
The femtosecond laser has ensured a highly reliable and repeatable method to create a LASIK flap and eliminated epithelial ingrowth from the primary procedure (this was a common complication with the old blade-cut devices).
The risk of vision loss is lower than occurs with regular use of contact lenses.
Does laser eye surgery hurt?
Using anaesthetic eye drops ensures you feel no pain from the corneal surface. You may be aware of a sensation of pressure while the LASIK flap is created. Most patients consider laser treatment to be less painful than the dentist!
How much does laser eye surgery cost?
Refractive surgery does entail a large upfront cost. However, studies have confirmed that laser surgery is cheaper than glasses and contact lenses in the long term.
Financing options are routinely available. You can learn more on our eye treatment Pricing page.
Alternatives to LASIK Surgery
The most common alternatives to LASIK are the surface laser treatments: PRK or LASEK eye surgery. These procedures are identical in recovery and results and can be considered the same surgery.
Photorefractive Keratectomy (PRK)
No LASIK flap. The final vision is the same as LASIK but with more discomfort or pain during healing. PRK is better for thinner or weaker corneas.
LASEK
LASEK is an almost identical procedure to PRK, but the epithelial layer is returned rather than removed. The recovery and final vision are the same as PRK.
SMILE
Small incision lenticule extraction is a laser eye treatment for short-sight, aka SMILE, CLEAR, and SILK. These are all lenticule extraction procedures.
ICLs (Implantable Collamer Lenses)
Where a special contact lens implant is placed behind the iris to correct vision without reshaping the cornea.
RLE (Refractive Lens Exchange)
Exchanging the eye’s natural lens with a premium intraocular lens implant to restore vision. Suitable for ages 50+.
Glasses or contact lenses
The final option is to continue with glasses or contact lenses. The risk of vision loss is higher with contacts than with LASIK.