Guide to laser eye surgery

Most people are happy with the results of their laser eye surgery.
 
 
 
 
 
  • Updated:3 Apr 2007
 

01 .Choosing a clinic

Woman with blue eyes

In brief

  • There’s no guarantee you’ll end up glasses-free, but many people experience an extremely reduced dependence on them.
  • It’ll cost you around $2500 per eye, and neither Medicare nor most health funds will pay for it.


Please note: this information was current as of April 2007 but is still a useful guide today.


Most people happy with the results

Since it was first performed in Australia in the early 1990s, laser eye surgery to correct vision has become very popular, with many thousands each year choosing it to correct their long- or short-sightedness or astigmatism. Forty CHOICE readers told us about their experiences with laser eye surgery. The vast majority were very happy with the results and would recommend or repeat it:

  • "It’s amazing to look at a distant mountain range and actually see trees." Michelle, NSW.
  • "I feel younger and it’s so much easier running, exercising, swimming and generally enjoying life." Dee, Victoria.

No regulation

It's fortunate so many people are satisfied with the results of laser eye surgery, because essentially it's an unregulated industry. A surgeon needs no formal postgraduate training in laser eye surgery before setting up to do it, and you don't have to have a referral from any medical practitioner.

So how do you make sure you get an experienced surgeon and a good clinic?

  • Your GP, optometrist or ophthalmologist may be able to recommend a surgeon.
  • Check out more than one clinic, both to get a second opinion and compare the services offered. Be wary of clinics that guarantee you perfect vision — it’s not something that can be guaranteed.

Checklist for choosing a laser eye surgery clinic

Things to look out for when selecting a surgeon and clinic:

  • Holding an academic appointment indicates the surgeon is actively involved in research or teaching and exposed to peer review.
  • What’s the surgeon’s experience with correcting the type and degree of your refractive error? This is particularly important since they need no extra postgraduate training to do laser eye surgery.
  • What’s the degree of the surgeon’s involvement pre- and post-operatively? They shouldn’t see you just for the operation and leave the assessments and check-ups to assistants.
  • Ask for data on their surgery outcomes. How do they track them? How do the results compare with national benchmarks?
  • The clinic should inform you comprehensively about what’s going to happen on the day of the surgery and afterwards. Ask questions and read all the material you’re given.
  • If you wear contact lenses, ask for how long you shouldn’t wear them before the assessment.
  • Does the price include check-ups and, if necessary, enhancement procedures? (These are further operations that may be necessary if the first procedure leaves the eye over- or under-corrected.)
  • Accreditation to a quality standard such as ISO 9000 is an indicator that the clinic has written quality procedures in place.
  • Don't go by cost alone; the decision you make will affect you for the rest of your life. Or, as David from Victoria put it: "It was pricy but I was happy to pay it for a very experienced surgeon. My eyes are too important to penny-pinch."
 
 

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02.Expectations and costs

 

What to expect

Most people will see better after laser eye surgery, but there’s no guarantee you’ll no longer need glasses or contact lenses.

  • Slightly to moderately short-sighted people have the best chances of success, with more than 90% achieving 6/12 vision and many 6/6 vision or better. A person with 6/12 vision — the legal requirement for driving in many Australian states — can see at six metres what a person with normal vision can see at 12. The old term for normal vision was 20/20 vision, referring to feet instead of metres.
  • People with worse short- or long-sightedness can still benefit from the surgery, but might have to temper their expectations.
  • Although astigmatism can be treated as well, its type and severity will affect results.
    So keep your expectations realistic — no surgery can guarantee you can throw away your glasses. In fact, you’re very likely to need reading glasses anyway as you get older, as laser eye surgery won’t prevent the onset of the age-related vision problem presbyopia. (It won’t speed it up either, though it might become more noticeable after surgery.)

As Georgia’s story shows, her expectations seem to have been a key point in how happy she was with the results of her surgery. It didn’t leave her free of glasses but greatly reduced her dependence on them. So if you’re aware of the surgery’s limitations and the potential complications and risks it entails, and you’re still convinced it’ll improve your lifestyle, laser vision correction might well be worth the thousands of dollars it’ll cost you.

The costs

The cost of laser eye surgery varies, depending on the type of procedure and the technology used. The clinics we consulted — some of which offer interest-free loans — charge between $1500 to $3700 (on average $2500) per eye. This is in line with what you told us you paid for your surgery over the last few years, mostly without any contribution from a health fund.

"It’s the best money I’ve ever spent … Unfortunately, I was unable to claim a cent through my health fund [as] it’s considered cosmetic surgery. I’m unhappy about this as I won’t be claiming either glasses or contact lenses ever again." (Shelley, WA)

Health fund contributions

  • Five of the six major health funds we contacted confirmed they pay no benefit for laser eye surgery to correct vision (NIB, HBF, HCF, MEDIBANK PRIVATE, MBF); only one of the ones we contacted (HBA) covers it, with some conditions. (Smaller, industry-specific health funds such as Defence Health and Teachers’ Federation Health Fund may also give some rebates.)

Medicare benefits

  • Medicare pays no benefit for most laser eye surgery either — only if it’s required to treat certain eye diseases. Otherwise it’s seen as cosmetic, as it’s generally done to eliminate your need to wear glasses.
  • In something of a contradiction, however, the Australian Tax Office regards the surgery not purely as cosmetic, as it’s changing the eye’s function, not its appearance. It’s therefore still a claimable expense for the medical benefit tax offset (which pays for 20% of your net medical expenses above $1500).

03.Techniques and technologies

 

LASIK (laser-assisted in situ keratomileusis)

The procedure
  • The surgeon cuts a tiny flap in the outer layer of the cornea so a laser can reshape the tissue underneath, before the flap is placed back over the treated area.
  • The flap is either cut with a miniature scalpel or created ‘blade-free’ with a fast, computer-guided femtosecond laser, which is also called by its brandname, IntraLase.
Suitability
  • Currently the most popular procedure — your eyes should feel fairly comfortable the day after surgery, when you can probably resume normal activities.
  • The more effective option if you’re more severely short- or long-sighted.
On the downside
  • It has been linked to the rare condition ectasia, where the cornea bulges out because it’s been structurally weakened, resulting in poor-quality vision.
  • There’s a small but significant additional risk of surgical complications, mostly associated with the corneal flap — it can get lost or damaged, cut incompletely or completely cut off, to name a few. However, the developments in computer-guided femtosecond laser technology are designed to improve precision and make flap creation safer.

PRK (photorefractive keratectomy)

The procedure
  • A type of laser treatment to the surface of the eye that entails no flap creation. Instead the surgeon scrapes off a portion of the very top corneal layer — it’ll grow back naturally — before reshaping the surface with a laser.
Suitability
  • A simpler procedure than LASIK with a lower potential for complications — the most common technique before LASIK gained popularity during the last decade.
  • Particularly suitable for correcting lower degrees of short-sightedness and astigmatism.
  • May also be recommended if you have a very thin cornea.
On the downside
  • Compared with LASIK you’re likely to feel more discomfort.

LASEK (laser-assisted subepithelial keratomileusis) and EpiLASIK (using a finer tool)

The procedures
  • Modified and refined procedures based on PRK, where the top layer of the cornea is pushed aside during the surgery and replaced afterwards to preserve more corneal tissue. However, both procedures still involve laser surgery on the surface of the cornea, not inside the eye, as with LASIK.
Suitability
  • Developed as a treatment for people whose cornea is unsuitable for LASIK.

Wavefront-guided technology

  • The latest development in laser eye surgery that can be used with both types of procedure and has the potential to improve the quality of vision, especially when correcting larger refractive errors.
  • It involves taking a detailed scan of the eye that’ll reveal all its refractive errors and programming this information into the laser, which can then deliver a more tailored treatment.

04.Risks and complications

 

Laser eye surgery for vision correction can change your life for the better, but you need to be comfortable with taking a certain risk, as no medical procedure is totally risk-free and the results are irreversible.

Laser eye surgery has been performed for more than a decade now and over that time, the complication rate has proved to be generally low. Around 5% of patients report problems following it.

The most common problems occur during the first few weeks after surgery and include:
  • Over- or under-correction, or residual blurry vision, which requires another ‘fine-tuning’ enhancement after three months.
  • Dry eyes, or inability to produce enough tears to keep the eyes comfortable, especially after LASIK.
  • Visual symptoms, especially after PRK, affecting night-driving ability, such as corneal haze, glare and/or haloes, starbursts around lights, blurry double vision or light sensitivity.
  • Eye sensitivity after PRK or other surface treatments.
  • Other, less common problems include myopic regression (where eyesight changes back to the pre-surgery state), lower contrast sensitivity and less crisp vision, even with glasses or contact lenses.
  • Visually threatening complications are very rare. But as with any other surgery, there’s always a slight chance of infection, especially within the first two days after surgery. It’s rare and more common with PRK than with LASIK. Infections can lead to scarring and, in extreme cases, blindness.
  • As it’s a fairly recent procedure, the long-term effect of removing corneal tissue is unknown, but so far no studies have suggested that there’ll be complications in the long term. Most problems discovered so far occur in the first year after surgery.

Common vision problems

In the normal eye, light rays pass through the cornea at the front of the eye and the lens behind it focuses them as a sharp image onto the retina at the back. When the cornea or eye is misshapen, however, we see a distorted or blurred image (called a refractive error). The most common errors are:

  • Myopia (short-sightedness) - light rays are focused in front of the retina, leading to an inability to see far, or blurred distant vision.
  • Hyperopia (long-sightedness) - light rays aren’t yet in focus when they reach the retina, leading to blurred close-up vision.
  • Astigmatism - light is focused at different points because the cornea is uneven, leading to blurred or distorted vision at all distances.

Laser eye surgery

Laser eye surgery is an irreversible procedure that’ll permanently alter the curvature of your cornea. (There are other procedures, such as a lens implant, but this is the most common.) Varying degrees of myopia, hyperopia and astigmatism can be corrected with laser eye surgery, either singly or in combination.

  • An ophthalmologist (opthalmic surgeon) performs the operation, most commonly in a laser eye clinic, with a computer-controlled excimer laser that uses pulses of ultraviolet light to reshape the corneal surface — flattening it in short-sighted people, sculpting a steeper curve if you’re far-sighted and evening the curve out to correct astigmatism.
  • Ophthalmologists are registered medical doctors who assess eyes, diagnose diseases, prescribe corrective devices and carry out medical and surgical procedures. However, they need no formal training to do laser eye surgery.
  • For a description of the various laser eye surgery see Techniques and technologies.

Presbyopia — the age-related loss of our ability to focus on near objects — can’t be corrected with traditional laser surgery, but monovision or conductive keratoplasty may help. With monovision your eyes work independently — you use your dominant eye for distance and the other for near vision. This condition can occur naturally, or can be created with contact lenses or laser treatment. But not all people can tolerate it, so you may want to trial monovision first with contact lenses before you decide on surgery. Conductive keratoplasty (CK) is a radiofrequency heat treatment to the peripheral cornea that’s less invasive than laser surgery. It can be used to correct small degrees of long-sightedness or improve reading vision in one eye.

More information

Extremely happy, but not glasses-free

Georgia from Bega, NSW, had LASIK surgery a few years ago after early, unsuccessful PRK treatment, and is “extremely happy” with the results, although it hasn’t left her glasses-free.

“I can legally drive a car without glasses and only need my glasses occasionally,” she says. “Before the treatment I had a myopia of –7, which meant I had to leave my glasses beside my bed so when I awoke I could find them to read the time on the bedside clock. Being short-sighted controlled my life, now it doesn’t,” Georgia says.

She now chooses to wear glasses when she wants to see really clearly — such as for driving at night, or at the movies. Otherwise she doesn’t need them.

“It’s given me much greater freedom, even if it’s only perceived. I didn’t expect to get 20/20 vision after the operation, and I think that was the most important thing in the way I view the success of the treatment … I have no regrets.”

Unobscured view down the ski slope

Jim, of Echuca, Victoria, couldn’t tolerate contact lenses, so was stuck with glasses for 30 years and got pretty tired of wearing them all waking hours.

"The worst for me was when snow-skiing, which I loved. I’d get partway down a run and the glasses would fog up from the exertion, so I’d have to stop three or four times to wipe them. If I left the glasses off, I couldn’t see ruts and bumps and kept falling over," he says.

A few years ago Jim gave LASIK a go. Apart from a few days of gritty and dry eyes, he had no complications. With his dominant eye he now has better than normal vision. The other eye was deliberately left a little short-sighted so he can read fine print without glasses.

"I can see better than I ever could with spectacles,” he says, “and six years later it still gives me pleasure to be able to look at things without those pesky bits of optical plastic in the way. Pity I’m too old for skiing now …"