What kinds of laser eye surgery are there? Part 1
Dave Allamby | May 19, 2008 | Comments 39
There are three main treatment choices for anyone thinking of having laser eye surgery. But which one will be right for you?
The final choice will be determined between you and your laser eye surgeon. BUT, of course, you have the eyes and your surgeon has the expertise so you will be heavily influenced by what the doctor or another clinic staff member says. It will be better to be prepared. With just a little knowledge you can be actively involved in making the right choice.
I will outline the 3 main options to help you have an informed discussion when the time comes to select which approach is best for your individual eyes. After all, you only have one pair so you want to get it right.
You will be overwhelmed at first by all the terminology, treatments and brand names. Don’t worry. There is no need to be blinded by science or some of the frankly misleading marketing information that is out there.
Firstly, whichever of the 3 treatment types (more on these coming in a couple of days in part 2) you go for, you must go for the wavefront option. The wavefront (or custom) technology has made a huge improvement in vision success rates with many more people getting 20/20 sight or even better.
Different clinics use different names for this technology: custom, wavefront, wavefront guided, wavefront optimised, CustomVue.
Many clinics will charge you more for wavefront based treatments over older non-wavefront options. Is it worth it? Definitely.
Back in 2000 when we were doing LASIK without wavefront, the benchmarks for success were getting 65% of patients to 20/20. In 2008 we expect more than 95% of patients to see 20/20 or better. This improvement has come from better technology, in large part from custom or wavefront based corrections.
Also wavefront laser eye treatment will give better vision at night or in low light situations. Patients will notice less halos and glare from light sources such as car headlights. It is like buying a more expensive camera with a much, much better lens.
This is the year 2008, so get the best current technology for your sight correction – you only will have this done once and you will live with the results for the rest of your life. Think about the computer you had back in 2000 and what is now available in 2008 – that is the level of difference in laser technology too. No brainer, really.
If you can’t afford the price, either don’t have it done yet and save up until you can afford it, or think about financing.
So if you go to Optical Express, go for the more expensive CustomVue wavefront version. Without it, the results really are not at a level that is satisfactory in 2008. If you go to Optimax or Ultralase, pay and get their wavefront guided option.
If you go to FOCUS Laser Vision, wavefront is already included in the quoted price. They don’t do any non-wavefront treatments.
Come back in a couple of days to read part 2 where we will finish this post by looking at safety and healing in laser eye surgery.
Filed Under: Education • LASIK • Safety • Technology
hi Stevie
People should not be guided by £395 headline prices. The reality is that quality laser eye surgery cost £3-4,000+, ...
Dear Dave,
Like most, I've been researching the possibility of surgery for some time, and have slowly noticed the high street ...
hi my husband went to have his eyes done today and the exact same thing happened!
i complained bitterly and pointed ...
Hi Dave,
My girlfriend has just been for a consultation today with a view to undergoing laser eye surgery. Unfortunately owing ...
Hi Terry, I have had a Lasik eye surgery to correct my vision about a year ago. I have been ...
Hi Dave,
I had Lasik treatment on both eyes three months ago. I now need a recorrection. My surgeon told me ...
I also have TLS and am just now (2 years after surgery) getting treated for it. It's common for it ...
I am in the Canadian army and can't decide on which procedure to go with because I am going to ...
Hi Dave
I've been reading all the posts and they sound very helpful. I've been very tempted to get lazer eye ...
I am 17 and would love to be a pilot in the RAF but am myopic. Do you know if ...
Thank you very much for your answer, it really calmed me down a bit.
Best regards,
Eleonora 
Hi Marie
The Clinical Suitability Guidelines followed when patients are assessed for Laser Eye Surgery at Optical Express are set and ...
Dear Dave
Thanks for the reply and the information you have put my mind at ease and my glasses dont have ...
Hi Dave, Thank you for the information; it has certainly given me food for thought and I'm so glad I ...
Dear Dave
That's really helpful - thank you. I plan to book an appointment at your clinic so that I ...
Hi, I’am planning on getting LASIK intralase and have been looking at Ultralase and Optical Express – you mentioned in an earlier post that you would recommend VISX S4 and iFS for this, as used by Optical Express. Which laser does your company-Focus- use and how does this compare?Very confused!
Cheers,
Emma
Hi Emma, What is your prescription please, approx is fine.
Thanks
Dave
Hi
We have been quoted amounts for Lasik, Intralase wavefront surgery from two well known comapnies. Their quotes differ by £900.
The more expensive comapny uses equipment called VISX S41R and the cheaper uses Bausch & Lomb technology. For intralase, the more expenive use IFS Femtosecond laser and the cheaper uses an older version of this technology.
And finally, the more expensive company mentions that their equipment is FDA approved whilst the cheaper company’s kit is not.
Whew!!
Do you have any views on this, bearing in mind that the very nature of technology is that new and improved releases are always coming out. What would sway your descision if faced with all of this?
Many thanks
Michael
Hi Michael
Yes, its pretty confusing, isn’t it. The Visx S4 produces good results. I hear the brand new version of the B&L laser produces good results, significantly better than the older version so look out for that. B&L havent completed FDA approval for their newer system as far as I am aware. For Intralase, either the 60Hz FS60 or the newer iFS should do the flap creation well, and I would avoid the older FS15 or FS30 (although I do prefer the Ziemer femto laser overall).
Between those two, I would chose the Visx S4 and the iFS. You also need to look at the surgeon, and of course also the clinic. For obvious reasons, I recommend the doctor/consultant owned single clinics, rather than the higher volume chains.
Best regards
Dave
Hi,
Back in 2001, I had LASIK on my left eye (blade, tracking laser). However it only succeeded in correcting 50% my prescription and I was border line for re-treatment. However, as my left eye was fairly good and not recommended for any corrective surgery, this greatly improved my vision in day light sadly not so much at night as I still needed glasses for night driving.
Today I really need to either have further treatment of use glasses in all but bright conditions, because if the light dims my vision rapidly becomes blurred. I have a prescription of:
L -0.5 -0.75
R -0.25 -100
I have been advised that LASEK with wavefront (just happens to be a VISX S41R) is my best option on my left eye. Issue being I am extremely worried about the recovery time, plus the risk of hazing or corneal scarring?
I have been told it is 5 days recovery, with a ‘contact lenses’ bandage?
Also that I should have both eyes treated at once, the right with LASIK.
To be cautious I would only have the left eye re-treated and then the right at a later date. However, as I actively participate in martial art type sports, would LASEK also be the best option for my right eye or LASIK (Intralase Wavefront)?
I would be extremely grateful for your opinion please.
Thank you,
Peter.
Hi Peter
Yes, LASEK/PRK to both eyes would be your best option, and avoid LASIK in the right eye. Always get the wavefront option. You should get a great result.
I would not worry personally about haze risk from LASEK on left old LASIK flap. Have done lots of those without problems.
With best regards
Dave
Hi,
I have been doing substantial research over the past few weeks into this as I have been hoping to have laser sight correction for a number of years now. My contact lense prescription is L-2.00 R-1.50 and has been consistent for about 3 years now. Unless there is any issue shown up at the consult, is blade free LASIK the best option to go for? What would the cost of such a thing be and is it done in one go or separate visits for each eye?
In the event of halos or other problems, what are the corrective procedures available?
Thank you!
Adam
Hi Adam
Yes, 95% of our treatments are now blade free wavefront LASIK – superbly accurate, no blade risks, almost no down-time. The consultation would be a separate visit, and then we would do both eyes together at your next visit for treatment, unless you specifically wanted each eye done at a time. But I can’t even remember the last time I did that actually, but it remains the patient’s choice, of course.
Corrective procedures are available and depends on the kind of correction required. For haloes and glare, I really just don’t see these anymore with the modern WaveLight laser for distance vision correction. Around 1% of patients though are slightly long or short sighted still after treatment and we then do an enhancement often 12 weeks after initial LASIK.
For you right eye blade free wavefront Z-LASIK should be £845 and £1045 for the left, assuming we measure you the same as your contacts. Will be very close to that anyway and we will confirm your prescription at the consult
Thanks
Dave
Thanks for your help!
Hi there,
Not sure if this is the right place to ask this. I’m looking into having laser eye surgery and enquiring about the weekly checkup. As I understand it, surgery is only performed on a Tuesday at Focus Laser Vision, with a week checkup the following Tuesday. Can the weekly checkup be on the Wednesday after surgery? I’m having trouble getting all the time off work and being able to book an appointment on the wednesday after surgery would help!
I would ring the clinic directly, but I’ve lost the number!
Thanks for your help
Marc Nicholson
Hi Marc
No problem, happy to help. Yes, the one week check up can be at 8 days rather than 7. I also operate on other days, but the Tuesdays have the best availability at the moment and we can usually accommodate within a couple of weeks for surgery.
See you soon!
Dave
Hi, My wife would like to get her vision corrected. We have been to another clinic and she is suitable for treatment but the cost seems very high.
What would it cost for the following prescription for wavefront blade free lasik.
Right -3.25 , -0.25
Left -3.0 , 0.0
If we went for the treatment I would have to travel some distance to London. It is possible to have a consultation one day and treatment the next day. What would be the minimun stay in London required for the treatment. And then what after care appointments are required.
Regards
Hugh.
Hi Hugh
thanks for the mail. Yes, be happy to let you know prices. And you could stay over for 2 nights with consult first day, treatment the next and morning after check up to follow. We can help with a discount at local hotels if you wish. The next visit is one week later, than about 2 months after correction.
Prices for distance vision correction for your wife’s prescription for wavefront blade-free LASIK would be £1145 per eye, saving £700-£1800 compared to other clinics. If you want to book in, just let me know and I will get one of my staff to email to you directly.
Best regards
Dave
Hi,
Sorry, another question! Do you do treatments and consultations on the same day? i.e. If I came for a consultation in the morning, how likely is it to then be able to have the treatment afterwards if we were both satisfied to go ahead? Also, do you have parking or is there parking near by?
Thanks,
Daniel
Hi Daniel
We like to do the consultation on a different day to treatment. Its better to dilate the eyes and have a thorough examination, plus have time to feel no pressure to go ahead, even if you are pretty sure it’s right for you. For parking, yes, plenty of metered bays on the road, plus multi-level car park nearby.
Regards, Dave
yes sorry that is correct it is minus, I have no long sighted problems
OK, thanks Mo. For the same advanced treatment (dual laser wavefront LASIK), assuming low astigmatism, we would charge £2,390, confirmed when you come along for a consultation. So you should save yourself £600 with Focus. Plus we give a lifetime care guarantee which Optical Express don’t offer. Easy choice!
Best regards
Dave
Hi Doctor
I have just came back from optical express and they have qouted me just under 3000 for both eyes for best treatment (Intrlase + Wavefront), my prescription is R: 4.00 and L:3.75, I also have astig: 90, what will be your price approx? I understand that your lower prices are not available for these prescriptions?
regards
Mo
Hi Mo
Are you short-sighted? So your prescription says -4.00 and -3.75 (minus, not plus)?
Thanks
Dave
Thanks for the quick responce. I’m guessing the answer will be no as it is a great price but, well you don’t get if you don’t try! I don’t suppose you do discounts for civil servants? : )
Thanks,
Daniel
Yes, it’s a nice try!! It costs us more than £295 to do the treatment so I’d rather not lose any more!
Best wishes
Dave
Hi,
Is your price of £295 per eye (luckily I have a basic prescription!) the same for wavefront epi-lasek?
Thanks,
Daniel
Hi Daniel
Yes, its only £295 for wavefront surface laser (LASEK/PRK) if you are within the lowest band. And £595 if you opt for blade-free wavefront Z-LASIK. We susbisidise these low treatment prices from our higher ones, so a great deal for you.
Best regards
Dave
Hi,
I just got a letter in the post today from “Optimax” offering me £1000.00 off surgery if I undertake their “most advanced treatment” namely “lasik Intralase Wavefront”.
Match this offer and I’ll be up to see you,not them, like a shot.
Tim
Hi Tim
Thanks for your mail. But sorry we don’t do price matching as we are pretty fully booked with our current prices.
With regards
Dave
Hi Doctor
I had LASIK Intralase Wavefront on both eyes in July 2008 after being advised by Optical Express that this was the best in the world and would give me back better than 20/20 vision and rectify my “halo effect” night vision.
One eye was infected post op and I had to have daily visits for 8 days then weekly for a futher month.
My left eye never repaired fully and I was told within the first month that at 3 months post op it would be re-assesed for re-treatment. My right eye started to fail around the 3 month post op mark too and my night vision has never improved – to which I am told, can take up to 6 months+ to start to improve.
I have been told today at my 6 month check up that my left eye will be re-treated first but that I will need to take a further week off work as LASIK to too expensive an option to use in re-treatment and no longer offered by Optical Express. My T&C that I signed when having my laser treatment states “enhancement procedures for prescription adjustments are offered free of charge utilising the same level of laser technology as your original procedure” – for which I might add, I paid just short of £3,000 for.
Am I right to push to have the LASIK (quick, relatively painless and fast recovery) or do as they say and accept LASEK with the week off work, bandage and gritty feeling?
Any comments would be greatly appreciated.
Thanks
Hi Jane
Thanks for your mail. Could you let me know your original prescription before you had laser eye treatment?
Thanks
Dave
Hi Yvonne
For our blade free wavefront Z-LASIK we do a lifetime care guarantee for distance vision. So if you have Z-LASIK for distance vision correction, all aftercare and enhancements are free for life, assuming of course it is safe to enhance following an examination. I believe only ourselves and Ultralase offer this kind of guarantee.
Best regards
Dave
Hi Dave
Do you charge for subsequent treatments after the wavefront op, if needed, or are these free of charge, i.e. included in the quoted price?
Thanks
Yvonne
HI Dali
We use the Moria disposable keratome if we (rarely) do a blade LASIK. Almost everything we do is blade-free now. We use the newer Ziemer system from Switzerland. It has a more accurate focus of laser energy compared to the American Intralase and the separation of the flaps is easier and more complete. But both the Ziemer and the Intralase will do a good job of flap creation.
There is increasing evidence of the better results from femtosecond lasers compared to blade LASIK. Since we upgraded to femtosecond flaps at the beginning of 2008 we have amazingly few cases of needing to enhance a Z-LASIK result. i have only done one out of the last 200 cases that have come through the post op period.
FYI I expect we will phase out the keratome in 2009 as we gather more hard comparison data. I would recommend you use the financing option or pay over a longer period and go for blade free LASIK.
Best wishes
Dave
Hi, not that it will mean much to me before I research, but what equipment do you use for Microkeratome and intralase flaps, and are there stats on line for which are better than others?
I would prefer intralase but the cost difference means I’ll go with the blade, do you have stats on the success rates at your clinic? Thanks, Dali
Hi Prie
OK, interesting case! Here is what I can add. The main choice here is whether to treat this with laser eye surgery or through a lens implant.
A lens implant can do well for patient in the -11/12 range but the retinas are weaker in these patients and so there is some increase of risk because of that. The main point though is ( I am assuming from your letter) that you may have a reduced number of cells on the back of the cornea, which are essential to the health of the cornea. Inserting a lens will knock out some of these cells and can lead to complications. You need a cell count test done to confirm the actual numbers (done privately, around £140).
Yes, the choice of laser will make a BIG difference for this high prescription, so you need to choose very carefully on treatment you can receive.
Hi
I am very keen to get eyes lasered but very confused on which company I should go for. I had my cosultation at Unltralase and Optical Express. i have been informed by Ultralase that I am able to get my eyes lasered by doing lasek, but cannot gurantee 20/20 vision, but most likely to get it down to -1.They use Zyoptix laser from Bausch and Lombtechnology. i have been informed that I have enough cells in my cornea to carry out the procedure.
As for optical express, they mentioned that i am not suitable for Lasek, and had adviced me to go for intraocular len treatment. The reason for it is cos my number were high and could not gurantee 20/20 vision and also I am in the border line regards to the Cells i have in my eyes which they take away. They use VISX S4IR laser, which is Advanced CustomVue Wavefront. The maximun they treat is patience with numbers that goes up to -13.
This is has cause more confusion on my decision regards to what i should do. so please help me answer the following questions:-
1) What is the parameter of cells that needs to be scraped off my retina in order for it to be successfully for me to have some cells left over so more then one zapps can be carried out.
2) Does it matter on what type of Laser is used? Which one will be suitable for my eye. I am -11.25 in my right eye & -11.45 in my left eye which has a bit of astigmatism.
3) What are the main factors I should consider when choosing the correct procedure for me. I looked into type of lasers, review, web sites, spoke to people, but still not sure what I should do.
4) If I had got laser done, can there but some form ogf gurantee that i will not have any problem for night vision as well as day vision?
Can you possibly shade some light
Cheers
Hi Thomas
Glad you like the website. Regarding halos and glare, I just don’t see these problems anymore with our laser, which is a new model WaveLight 400Hz system. The wide optical treatment zone and wavefront optimised profiles seem to have eliminated this issue. I am not sure how other lasers perform (in 2008) and you would need to try to get this info from other clinics directly. It was a problem for some patients in years past on older systems with smaller treatment zones.
I don’t see big tech changes coming here as it isn’t really a problem now. However, at FOCUS as a specialised centre we do have the capability to address these issues in patients treated on older systems at other clinics.
For measuring vision, we measure that SIX different ways at your consultation, 2 of which are manual refractions by clinicians plus another 4 times by computerised systems. On the treatment day these measurements are repeated another THREE times by clinician and computer scans. So we never treat until we have rock solid evidence of an accurate prescription.
Hope that helps!
Dave
Hello Doctor,
To begin with – thank you for this website!
I’ve got a small astigmatism and myopia (about -1.50) and a few questions, which I hope you’ll find interesting.
I’m wondering about the risks of experiencing permament side-effects such as halos & glares:
1. How frequently does it occur today? How fast is technological progress here?
2. Is it possible to have a follow-up surgery to address this problem?
Another question is about how you examine sight (I mean the numbers, which will later be used to guide the laser).
3. Is it done in a similar way like when you get glasses or contact lenses, whene you try different lenses/positions and the patient gives you feedback to select the best ones?
You see, last couple of times when I had my sight checked, I felt confused when deciding if I see best “now” or a few moments later. Basically I had the feeling that my sight could have been measured better. I wonder if you use a different technology (e.g. computer-based) that helps to measure sight in a more consistent/accurate fashion.
Thank you in advance and good luck!
Thomas
Hi Mrs Daniel, thanks for the message. I can offer my personal perspective here but of course will be generalizations as I don’t know any details!
I understand from your mail that the result is still under-corrected in both eyes. This certainly does sometimes happen for every clinic and every surgeon. Most patients are at or very close to target, but a small number are either under or over-corrected by the laser treatment and would so require an enhancement to reach the target vision. This seems to be where your daughter is right now.
Most clinics quote around up to 5% chance of enhancement but the reality for most centres is usually a bit less than that with modern lasers. At my clinic we find only about 1-2% of short sighted patients overall need any adjustment. We are still gathering data on this from our dual laser Z-LASIK techique.
So I think in your case that needing some enhancement (which is usually done around 3-6 months after the first procedure for short-sight) is not so unusual, especially as your daughter had a large prescription. The higher the prescription, the higher the chance of enhancement to get the best results.
I would like to know.. is it the fact that an enhancement is needed that you are not happy with, or the fact that LASEK has been recommended instead of a flap lift LASIK approach?
Why would be enhance with LASEK? With large prescriptions there may not be enough corneal thickness remaining to safely retreat with another LASIK approach. It is usually safer in these cases to change to a surface procedure, LASEK, to keep the cornea strong.
Alternatively if it has been a long time since the LASIK flap was made, it may be better to do LASEK on the surface, rather than lifting an old flap.
Both these latter two points really depend on how the eyes are at the last check up.
If LASEK is the best way to go to enhance for your daughter, assuming no other issues, the results are usually very good. There is more downtime compared to LASIK as the eyes will take a few days to heal.
I would suggest talking with your surgeon again to help clarify the decision to retreat with LASEK. He or she can explain the reasons for that approach. Certainly, needing an enhancement wouldn’t be a reason to go through a complaints procedure.
Usually some one-on-one time with your doctor is the best approach in the first instance.
Hope that helps
David
After having customVue wavefront Lasik at Optical Express my daughter was left with a minus 1.25 perscription in both eyes down from minus 5.75, they now wish to correct this with Lasek which we are not happy about at all and will not proceed with. Is there a complaints proceedure or a governing body. Any advice would be gratefully accepted.
hi Lin
Yes we can treat both long sight up to +6.00 dioptres and astigmatism up to 6 dioptres.
The choice of laser is very important when considering laser eye surgery for long sight, as some lasers are better than others in this area. We chose the WaveLight laser partly for its superb handling of these kinds of prescriptions.
Best regards
Dave
there is no mention of astigma’s – is treatment still possible for those and long sight?