Which Laser Eye Procedure Should I Have?
Dave Allamby | May 16, 2010 | Comments 22
This is a common question. Simply, there are two options available to you: LASIK or PRK (aka surface laser, LASEK). In my clinic around 95% of all treatments are LASIK. Surface laser is usually reserved for those cases where the cornea is too thin for the LASIK option.
LASIK offers a very fast recovery, with 20/20 vision typically within 1-2 hours (from our own clinic data). The procedure is virtually painless and post-op discomfort is limited to 3-4 hours of grittiness and often a warm sensation, easily relieved with anaesthetic drops if needed.
LASIK is now typically offered as a blade-free technique using an advanced laser, instead of an older mechanical device containing a blade (called a keratome or microkeratome) to cut a flap during the first part of the procedure. The newer, more advanced method is to use a special laser (known as a femtosecond laser) to create a flap without a blade, known as Z-LASIK or IntraLASIK or i-LASIK.These femtosecond lasers are very expensive (about a quarter of a millions pounds) so expect to pay more for this technology. Some clinics have not yet invested in femto lasers, possibly due to the high cost involved, and continue to use a blade.
The benefits of a laser flap over a blade flap are becoming clear: more accurate treatment, better healing of the flap, greater strength in the cornea post-op due to significantly thinner laser flaps and greater residual thickness. Blade flaps have been used for many years and have been proven safe to date, but thinner laser flaps have added better accuracy and strength. You will see a gradual phasing out of blade flaps over laser flaps over the coming few years.
Filed Under: LASIK
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I forgot to add my vision. It's -6.50 on both eyes. 
Hi Dr. Allamby,
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Hello Sir
My cornea thickness is 495micron after the Aberroscans.
She suggested me TO HAVE FEMTO LASIK instead of normal LASIK.
but i read post op risks are high or the discomfort in Femto is higher.
Should i follow my doc advice?
Which one is superior and preferrable?
Dear Neha. It is better to have femtosecond LASIK if your corneas are thinner than average. With the femto laser you can create a thin flap that is more precise than using a blade, helping ensure you keep the flap thickness within a tight range. Blade cut LASIK can produce some surprisingly thicker flaps, which is not a good idea in your case, so your doc’s advice is the correct one.
Best regards, Dave
Thank you so much Dr.Dave!
Hello Dave,
I am a 53 year old female.
I have had a cornea graft done about 7 years a go. I have astigmatism in both eyes, and my doc suggests that get the iVis laser treatment done, since it does not touch the eye.
Do you perform this surgery yourself? How much will it cost? How much time am I looking at to be away from work?
Thanks
Mimi
Hello Mimi, Laser vision correction post graft is quite possible, and can be done through LASIK, PRK or a transepithelial PRK approach. iVis is one brand of laser, but not so popular in its use. Mr Mearza at Focus is our corneal graft specialist, and would perform the procedure. The cost would be confirmed at consultation, but typically around £2,500 per eye.
With best regards, David
Hi Dave,
I had Lasik treatment on both eyes three months ago. I now need a recorrection. My surgeon told me that they will do Lasek this time because it is less risks for me. Can this be the real cause?
Thank in advance.
Freda
Hi Freda
Not sure why LASEK is being offered here. I do prefer LASEK enhancements for older LASIK cases when there is a longer period since the original surgery. We routinely lift the LASIK flap at 3 months post op, which is usually straightforward. There is an increased risk from a flap lift, from epithelial ingrowth, where the surface cells can grow under the edge of the flap. But if this occurs is usually minor and not troublesome.
You will have to ask your surgeon as to any other reasons why LASEK this time, rather than a flap lift. There are sometimes indications for opting for LASEK so it may be the correct choice, but I can’t add more without knowing the full story.
Regards. Dave
Hi Dave,
I got iLasik performed 4 weeks ago.
Since then I got 3 exams and they show I still got -2 and -1,75( was -4,75 both eyes before the op)I also got very high pressure in the eyes – like 34-40…The doctor said it’s normal – comes from the eye drops and will go away, got new drops now, but still can not see clear, still got miopia that I can not watch Tv or drive…is this normal?
I was told with Lasik the sight is improved right after the surgery, I still can see as far as my nose…What is next?
Thanks.
Hi Ellie
No not common at all in LASIK surgery, but it is possible. Under-correction of that degree is rare but it is feasible it could happen/ The high pressure afterwards could have led to some increased swelling in the cornea which would change the vision significantly. The pressure rise occasionally happens with steroid drops, and rapidly goes back to normal once stopped.
As for what is next? You should wait around 12 weeks to let the eyes and corneas settle and ensure all swelling has resolved. You may find the myopia decreases more. If not, then the flaps can be easily lifted and eyes re-treated around 3 months post. Keep in contact with your clinic and let time pass to see how it settles. It’s still pretty early at 4 weeks.
It’s normal for some patients to need an enhancement to finish off the result. Our own clinic rate is less than 1% for myopia, and it can vary between clinics – but we ALL perform enhancement procedures.
Certainly must be disappointing as most patients see 20/20 or better the following day, and yours is a pretty big under-correction. Hang on and I suspect your end result will be good.
Regards, Dave
Thank you very much for your answer, it really calmed me down a bit.
Best regards,
Eleonora
Mr. Allamby, do you still perform laser eye surgery at Focus Laser Vision Clinic ?
Dear Alan, Yes I do operate at Focus. Best regards, Dave
David,
Many thanks for a very informative site which has answered most of my questions. I hope you can also provide me with an answer for my situation:
My eyesight is:
L: -9.50
R: -9.00
A few years ago I went for an Ultralase consulation and they would not perform any eye surgery.
Is there any technology for this level of short-sightedness? Another option I am willing to consider is to reduce my number to a range of between -1 and -4.
Is this a possibility?
Thanks and appreciate your professional advice.
Regards,
Hi Gilbert, may well be possible to correct but will depend on your pupil size and corneal thickness primarily assuming no other problems. Our Wavelight laser removes less tissue compared to other systems so often helpful in these high prescription cases.
Did Ultralase say why they would not operate?
Leaving you at say -2.00 can be a very good option if corneal tissue is not adequate for a full treatment as this will allow you to read without glasses from age 45 plus when your friends are starting to wear reading correction.
Best regards Dave
Hi Dave,
Yes, the reason given by Ultralase was that my corneal tissue was not thick enough to restore 20-20 vision. We did not discuss any reduction in the short-sightedness.
I assume in any consultation with LASIK that all these options will be discussed?
Hi Gilbert
OK, so planned under-correction may be an option. However, with the WaveLight not being ’tissue hungry’ we may still be able to achieve a full correction. When you see one of my team for consultation they will cover that. If you want to see me personally for the consult, it would be £200 in addition. You can reach the clinic on 0845 5000 500.
Best regards, Dave
Dear Dave,
I am a boxer and I want to have a laser procedure on my eyes, but i have been told that having your eyes done can weaken the cornea so its best I have Trans-Epithelial Surface Treatment Lasik, Advantages given are that there is no flap (avoiding any possible flap complications) and no chemical or mechanical seperation of the epithelial layer as it’s done by laser.
But from looking at all the clnics online over the past 2 mouths only one clinic in the whole of the UK does this, My questions is if Trans-Epithelial Lasik is so good for sports people like myself why does only one clinic in the UK do it?
Also my pupils are larger then normail 7.5mm I have been told by a firend it is more then likely I would have night vision problems with halos etc
Hi Kay
Yes surface laser is a good idea if you are a boxer. Removing the surface epithelium is simply and safely achieved at clinics around the world using a dilute 18% alcohol solution for 20 seconds which loosens the thin skin layer which can then be brushed aside, prior to reshaping the corneal stroma (structural part) with the excimer laser. The surface layer heals in about 3 days. This alcohol method has been used since the 90s.
Pupil size of 7.5mm will not be a problem for night glare as long as the surgeon performs a wide enough ablation. Have never seen night vision problems with our WaveLight laser using its advanced prolate treatment profiles for correction of myopia.
Best regards
Dave
Hi Dave, I have a problem with my eyes called ”compound astigmatism”, since I was a little girl, it was hereditary I believe,and since then I have been wearing glasses. I have -1.25 both eyes with cyl and axis numbers i do not remeber well, i think -75 cyl and axis 90, but in my country Romania doctors have said to me that due to the astigmatism I am not suitable for a laser eye surgery.I would like to ask you if I am suitable and how much can it cost me and for which laser best suits me.Thank you very much
Hi Gabriella. Your prescription should be simple to correct from your numbers given. Astigmatism is routinely corrected these days so I am not sure why your doctor has said that, unless there is some other problem with your eyes I am not aware of. Costs vary between surgeons depending upon experience so you want someone who has treated many patients. You will want a femtosecond laser LASIK procedure (Z-Lasik, iLasik) and wavefront correction included. I personally use the WaveLight laser which gives excellent results, including astigmatism. In the UK expect to pay around £1500 per eye.
Best regards, Dave
Great resources and information i am sure your content will be helpful to many people out there. I am a writer within the Laser Eye Surgery industry. I am wondering whether i can send you some original professionally written posts for your website.
Look forward to hearing from you.
Kind regards
David
Hi David. Thanks but all the content comes from me so readers have a direct connection with a laser eye surgeon, which is the key benefit of this site over generic laser eye content on other sites.
Thanks anyway, Dave