Laser Eye Surgery Safety: 3 things you must know

Laser eye surgery safety

For LASIK laser eye surgery safety, there are 3 things you must look for when you plan to go ahead. This LASIK safety trio means a more accurate result and the safest procedure we know of today:

  1. Choose a blade-free all laser LASIK technique – using the latest femtosecond lasers means no blade is used in the surgery. Check with any clinic you talk to that they can offer blade-free LASIK – if they can’t then they are out of date and should be avoided.
  2. Wavefront-based LASIK is a must today, so make sure you go for that option. For example, at FOCUS Laser Vision we only do wavefront treatments so that is taken care of. At other centres such as Optical Express, do not choose their non-wavefront option.
  3. Get the safety and reassurance of NHS consultant corneal specialist surgeons to do your treatment – the three laser eye chains do not offer this for the great majority of their treatments. Premier centres like Moorfields Eye Hospital, Centre for Sight and FOCUS Laser Vision do.

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About the Author: Mr. Dave Allamby FRCS FRCOphth is a leading London-based laser eye surgeon. You may have seen him on the This Morning TV show with Phillip Schofield and Fern Britton or read one of several articles in the national press, recently for treating Denise Van Outen, rock giant Rick Wakeman and broadcaster Paul Ross. David is Medical Director at Focus Laser Vision, known as a world-leading clinic in the treatment of presbyopia, or age related loss of close vision. Focus Laser Vision is also London's only clinic to offer next-generation Z-LASIK laser eye treatment for short sight, long sight or astigmatism.

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  1. Adam says:

    I’m a lifelong myope, aged 45 and recently have moved to progressive lenses for presbyopia (-2.5 SPH, +1.0 CYL 180, +1.25).

    Assuming correction of the myopia is straightforward with lasik/lasek, can you offer any information comparing the results / implications of the blended technique vs. the KAMRA implant?

    I think KAMRA is much more recent. Is there a good enough volume of research / results on this technology yet to compare it?

    Also, presumably my presbyopia will continue to deteriorate significantly during the next 20 – 30 years. Does this mean further surgery or changing the implant etc?

    • Dave Allamby says:

      Hi Adam. Thanks for your interesting question. You are right in that a corneal approach is less risking at age 45 than any intra-ocular lens based procedure, and Blended Vision and KAMRA are the front runners. We are learning a lot about KAMRA as increasing numbers of patients have this treatment in various centres globally. It does take several years though to gain a full understanding of how well any corneal inlay will perform over time. We will have much larger numbers for analysis and from various centres around the world in the next few years.

      We do have much more knowledge on Blended Vision which gives a stable result in myopic patients such as yourself. At 45, your presbyopia will progress for around 15 years, stabilising in your early 60s. You would likely need on additional top-up treatment (on one eye) in your 50s to boost reading vision keep up with ageing.

      Hope that helps.

      David

  2. Edmon says:

    Hi Dr. Allamby:
    I am considering a LASIK (IntraLase Femtosecond (FS) laser). My right eye is -8.5 with 0.5 astigmatism, while my left one is -7.75 with 0.25 astigmatism. My cornea thickness is 577 microns (right) and 563 microns (left). I am worrying about ectasia post surgery, as they may remove quite a bit of my cornea due to my high prescription. Would you let me know if I am a good candidate for the surgery and if ectasia will be a problem for me? Based on my prescription, how much cornea will be left after surgery with this technology? What else possible complications could be resulted from the operation?
    Your response is very much appreciated.

    Thanks.

    Edmon

    • Dave Allamby says:

      Hi Edmon
      I cant advise on your suitability as only your examining surgeon should do that. What I can say is that using the WaveLight laser and a 100 or 110 micron femtosecond thin flap (as at my clinic) there is enough tissue for your prescription to be treated using a full 6.5mm optical zone and leaving over the recommended 300 microns in the corneal bed. A key factor for determining risk of ectasia is the appearance of the corneal shape on your eye scans. Again any good clinic should have discussed all this with you, including other possible complications – thats a bigger discussion and needs to be with your surgeon.
      With regards
      David

  3. Iamgr8 says:

    Doctor, I am going for PRK/LASEK treatment in a month for my -3.00 / -4.00 correction. I don’t want to have a permanent cut in my eyes hence decided to go with PRK but I found out in PRK or surface treatment the bowman’s layer is removed permanently. Whats the function of bowman’s layer? Will it cause corneal bulging if there is no bowman’s layer?

    Btw, I know ultraviolet radiation is harmful for eyes. Excimer is also an ultraviolet laser. Isn’t it harmful for eyes when a patient directly look at an ultraviolet laser?

    • Dave Allamby says:

      hi Mahnud. No corneal bulging if Bowman layer is removed. After 25 years of PRK we havent seen any effect from lasering it away.
      The excimer UV is very weak and doesnt enter the eye, so no worry needed on that point.
      Regards
      David

  4. Kat says:

    Hello,

    I live abroad and am being offered c-Ten to correct my short-sightedness.

    I am wondering why it is not available in the UK – do you know? I’m just afraid that it may be unlicensed there for safety reasons or some such.

    Also, if I came to the UK for the procedure, what is the nearest equivalent to c-Ten?

    Thanks in advance
    Kat

    • Dave Allamby says:

      hi Kat
      c-Ten is just another variant of surface laser, and the vision results are similar as with PRK or LASEK. The difference offered is that the laser is used to remove the surface skin layer, rather than softening and brushing it away with a sponge. FYI, all laser clinics can do all-laser PRK and remove the surface skin with the laser too, just as in c-Ten. Studies showed laser removal of the skin cells showed slight faster healing (2.6 vs 2.9 days, or about 8 hours), so a minimal benefit. The potential down side is that we know there are small variances in the thickness of the epithelium (skin) layer across the cornea that can introduce some irregularity compared to using a sponge to brush the full layer away, as the laser removal section assumes the epithelial thickness is the same all the way across, (which it isn’t) and whereas with the brush method knowing you have a guaranteed smooth surface to laser on. Most of us thus use a brush method to remove the skin.

      However, thin flap femtosecond all-laser LASIK is still the most preferred method by far around the world, for doctors and patients. In Italy though, surface laser is quite popular, perhaps because one of the pioneers of a surface laser technique, LASEK, is from Italy, and the c-Ten company is Italian.

      So the equivalent of c-Ten is all-laser PRK which any laser clinic could offer you, where is it usually referred to as laser trans-epthelial PRK (admittedly that isnt quite as catchy name as c-Ten), but the end results will be very similar.

      David

      • Kat says:

        Thanks David for your quick and detailed response!

        I feel bad tapping you for information like this but I do have two other questions…

        1) I am 38, -4.50 and -4.25 and with a good thick cornea (I’m told – 600+). Eyes have been this bad for 20 years, little change if any. If I have the laser surgery (any method), how long is the gain likely to last? In other words, am I now too old to bother?

        2) If I am pregnant or likely to be soon, should I wait until after I have the baby to do the procedure? I’ve heard the pregnancy can alter one’s prescription (though I’ve had 3 children already and not seen any change)?

        Thanks! (If I do it, I will come to your clinic, I promise!)

        • Dave Allamby says:

          hi Kat. certainly not too old! Your myopia should be stable by now so I would expect the change to your distance vision to be permanent. Be aware that most people need to wear reading glasses, typically starting between 45-50. So you should get 9-10 years glasses free. You can also have further treatment if you later want to not wear reading glasses.
          If you are pregnant then you will have to wait until delivery and breast feeding are all complete, plus wait another 3 months. If not yet pregnant, you can go ahead with treatment now and then its OK to get pregnant after. (During pregnancy and breast feeding the prescription can change).
          thanks
          David

          • Kat says:

            Thanks. I suppose what I’m wondering is whether if I had the treatment when not yet pregnant, and then my prescription changed during pregnancy, wouldn’t that mess up the effect of the treatment?

          • Dave Allamby says:

            hi Kat. Opinions vary as to how long to wait pre and post pregnancy. Post, it is best to wait 3 months after delivery and breast feeding are over so that your hormones and prescription can settle back to norma.. Of course many women who have had LASIK or PRK have gone on to have children, and without adverse effects on their vision.

            During pregnancy vision can change, although usually mildly and temporarily. It can change permanently in less common cases (with or without LASIK/PRK). You can expect your eyes to be drier and you may not tolerate your contact lenses. But how long to wait after the procedure before trying to have a baby? Most laser eye surgeons will have patients who had the procedure and then found out they were pregnant soon after. I havent’ seen, or heard of, adverse effects in such cases. My general advice however is to wait 1 month after the procedure before trying to conceive.

            Thanks
            David

  5. Hazel says:

    Hi Dave

    I’ve been reading all the posts and they sound very helpful. I’ve been very tempted to get lazer eye surgery as I dont like wearing glasses and pay for contact lenses occationally only wearing them on the weekends as it gets expensive. Both my eyes are -2.5 (in contact lenses) and I’m not sure if after reading all the worries, if I should go ahead or not. There are so many websites for and against its hard to make a choice. I’m only 28 and I’d hate anything to go wrong… I want to be able to see much better all of the time and not when I’m wearing glasses or contacts, but again, its a worry the police and army still dont allow lazer treatment? You’ve been asked this many times before, but what do you think?

    • Dave Allamby says:

      Hi Hazel. With the technology and skill available now, there is no need for most people to wear glasses. The UK authorities are very slow to adopt, unlike in the States. Compare the CAA and FAA. The US have adopted LASIK for soldiers, pilots, NASA. I expect the UK will catch up eventually, but don’t hold your breath.
      The Internet is full of information and misinformation. The next step is to have a consultation or two at various clinics and see if you are suitable. Your prescription is very standard, but there are others factors in the assessment. If you aren’t suitable then you can stop wondering whether to get it done or not!
      Best regards, Dave

  6. Daniel says:

    Hello Dave
    I have just had a consultation with one of the larger laser companies and have a concern around my lazy eye. Even with glasses, if I just look through the lazy eye alone, the image is quite fuzzy and flashy (although better than without glasses). The company that I went to said that I am fine to go with Intralase Lasik / Lazek with wavefront on both eyes next week. Thought Lazek was the best for me as I play squash (is that trues?) although I would prefer Lazik given the shorter heal time and that I have no holiday time left!!. My main question though is that I was looking to move forward as the cost was very good with their half-price discount, but am slightly concerned about anything going wrong with my good eye (which is slightly short-sighted mainly due to compensation of the lazy eye from what opticians have said in the past). What would you recommend in general in such circumstances – although I realize you would need to see me for a more definate recommendation. My last prescription is Right (SPH -1.50; CYL -1.50; AXIS 90) & Left (SPH -0.75; CYL -1.00, AXIS 90.0) and I am 36 having had a lazy right eye since being a child.
    Thanks, Daniel

    • Dave Allamby says:

      Hi Daniel.
      It will depend on how lazy the eye is and how well you can function if you had to depend on that eye alone. If in doubt, do not have the surgery.
      If you do decide to have treatment, then cost should not be the main factor in your choice so do think carefully and look at other clinics too. I think surgery on your eyes is an extremely important decision and you want the best option and surgeon you can find, particularly as you have one weak eye.
      Also, always wear goggles if you play squash, as you cannot afford a serious eye injury from the ball in your good eye.
      Best regards, Dave

  7. Anne says:

    Hi Dave,

    I have been to Optical Express and Ultralase for consultations. I am -4.5 (-5 for laser surgery) in both eyes, with a very slight asigmatism in one, and very thick corneas, making me a good candidate for Lasik Wavefront.

    I am leaning towards Ultralase, but am still unsure (I would prefer to have it carried out close to home (Cheshire) in case any complications arise). You advise, on your three-point checklist, to get have an NHS consultant corneal specialist surgeon perform the procedure.

    The surgeon I would be having at Ultralase is said to have ‘a very strong NHS background’, having been ‘a locum NHS Consultant in Ophthalmology at The Stonehouse Hospital, Lanarkshire, The Whitehaven Hospital, Cumbria, and The Royal Oldham Hospital, Oldham’. Also, his biog says he has extensive experience in ‘sutureless phaco-emulsification cataract extraction and intra-ocular lens (IOL) implantations, as well as trabeculectomies for glaucoma, squint surgeries and laser treatment for diabetic retinopathies, retinal tears and retinal vascular accidents’. I was told that he still does a lot of work for the NHS.

    It all sounds very impressive (they pretty much all do), but not being an expert on the subject, is this on a par with what you recommend?

    Your comments would be greatly appreciated.

    Thanks,

    Anne

    • Dave Allamby says:

      Dear Anne
      What is most important is the depth of a doctors experience with LASIK. Actually, the NHS experience in non-LASIK areas counts for little when it comes to performing superb LASIK, as the NHS does not offer laser eye surgery or indeed training in laser eye surgery. So while a consultant may have broad experience in other ophthalmic areas it doesn’t really say anything about refractive surgery, which is a very particular sub-speciality, and so can’t be used as a guide to how good a job they will do with your LASIK.
      However, when I talk about NHS consultant corneal surgeons as a good possible choice as your surgeon, I mean those who have 1) been appointed to an NHS consultant permanent position (not locums) specifically for corneal surgical disease, AND (crucially) 2) also specialise in laser refractive surgery (LASIK and PRK/LASEK).
      They are not the only option, you must also look at doctors dedicated to full-time, or near full-time, laser eye surgery (who will therefore not hold NHS positions as the NHS work excludes doing full-time LASIK) and who have e.g. demonstrated excellence in the field, innovated, carried out research etc.
      You can find such surgeons at the clinics you mention. However, I cannot comment on whether the surgeon you have in mind fits in with the above. Certainly ask how many LASIK (not others such as PRK, cataract ops etc) procedures a surgeon has done (I would look for not less than 2,000 LASIKs). Also I like a surgeon who has being doing this for several years or more, as it takes time to accrue the breadth of experience.
      Best regards, Dave

      • Anne says:

        Hi Dave,

        Thanks for your speedy reply. This website is a truly amazing resource. I am still undecided, after all it’s my eyes we are talking about and I would be livid if I payed the huge sum I’ve been quoted only for my eyesight to be made worse.

        I recently read feedback on the Lasik-Eyes website from someone who was treated by a very experienced surgeon at Ultralase, but that it has totally ruined his life as he now needs several pairs of glasses for varying distances and has been sent to Moorfields for it to be sorted out, although they have told him it will never be what it was before treatment (when I questioned the Ophthalmologist who assessed me, he even admitted that this was one of, if not the most, experienced laser surgeon they had and was therefore more likely to attempt the more complicated surgeries that other less experienced surgeons were perhaps not prepared to) .

        The surgeon who it is proposed will treat me has carried out 16,000+ treatments my Personal Advisor told me (although it says 12,000+ on his web profile)

        The profile of this surgeon also says he holds the “Certification in Refractive Surgery” qualification from the Royal College of Ophthalmologists (which reportedly only 54 surgeons in the UK and Ireland have attained), and he has had training at the Royal Manchester Eye Hospital.

        It also says, “His work has been published in the Journal of the Royal College of Ophthalmologists “Eye” and he has presented to his fellow surgeons at major congresses in the UK, Europe and US. He has also presented to the esteemed Royal College of Physicians in London and is a past Council Member of the British Society for Refractive Surgery.

        Also mentioned is that he is on Ultralase’s Medical Advisory Committee “ensuring clinical standards for the company”.

        He has DO, FRCSEd after his name, but I notice there are surgeons with these and more qualifications.

        I have to ask, does all this make him someone I can really trust my eyes to?

        Also, out of interest, what would Focus charge for my prescription?

        Thanks,

        Anne

        • Dave Allamby says:

          Hi Anne
          The descriptions provided by companies all sound very positive to the lay person and so hard to distinguish between doctors. But I can’t discuss an individual surgeon in an open forum so I hope you can appreciate that.
          Ultralase say on their website that “All Ultralase laser eye surgeons are certified by the Royal College of Ophthalmologists” and that “There are just 54 surgeons in the UK and Ireland who have attained the Royal College Certification in laser eye surgery”. While technically correct is still quite misleading, as it makes it sound like the height of achievement in this speciality. Actually I feel it is more of an entry level qualification that many refractive surgeons in the UK have not felt the need to take. Ultralase surgeons all do the exam and so perhaps that is why they write about it in that way.
          Incidentally, I am asked about the stories about Ultralase in the business press recently. The stories did not say that Ultralase are in financial difficulties, although ownership was seized from private equity group 3i by the banks who put up part of the money in 3i’s purchase from a Spanish company. 3i wrote down £100 million on its books last year and so it was a bad deal for them. The company technically went into administration on one day in February, as part of a so-called “pre-pack” administration deal. You can see more on that story here called 3i-backed Ultralase seized by banks.
          For Focus pricing for your -5.00D prescription, for blade-free wavefront Z-LASIK (the most advanced treatment), we charge £1597 per eye (incl. lifetime care guarantee etc). We do have an optometrist in Cheshire who does pre and post op work for our North-West patients.
          Best regards, Dave

  8. Jackie Brown says:

    A few years ago, I had acanthamoeba that left a small scar. I have been told I am unable to have laer eye surgery because of this. My eyes are quite bad -10. Can you give me any advice as I am desperate not to wear glasses or contatc lenses.
    Thank you

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