OK, that may sound scary but in fact laser eye surgery offers (in most cases) a quick, effective and fairly pain-free solution to vision problems such as short- and long-sightedness and astigmatism. For many people with these conditions, laser eye surgery can completely remove the need to wear glasses or contact lenses.
On the downside, there's no guarantee you'll end up completely spectacle-free, and it'll cost you around $2500 per eye. You can't claim a Medicare benefit for it and private health funds generally either don't cover it, or offer only limited rebates for members with top hospital/extras cover.
In this article we take a look at:
Choosing a clinic
Since it was first performed in Australia in the early 1990s, laser eye surgery to correct vision has become very popular, with many thousands of people each year choosing it to correct their long- or short-sightedness or astigmatism. Forty of our members told us about their experiences with laser eye surgery. Most were very happy with the results and would gladly recommend it.
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 need 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. You should check out more than one clinic though, both to get a second opinion and to 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
- Holding an academic appointment indicates the surgeon is actively involved in research or teaching, and is 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 should avoid wearing 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 assurance procedures in place.
- Don't go by cost alone; remember that the decision you make will affect you for the rest of your life.
Expectations and costs
Most people will see better after laser eye surgery, but there's no guarantee you'll no longer need glasses or contact lenses. 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 problems. (It won't speed it up either, though it might become more noticeable after surgery.)
If you're aware of the surgery's limitations, as well as 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 expense.
Best chance of success – more than 90% of lightly to moderately short-sighted people achieve 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, which referred to feet instead of metres.)
May find surgery beneficial – people with worse short- or long-sightedness can still benefit from the surgery, but might have to temper their expectations. And although astigmatism can also be treated, its type and severity will affect results.
The cost of laser eye surgery varies, depending on the type of procedure and the technology used. Typical costs are between $1500 to $3700 (on average $2500) per eye.
Health fund contributions
Don't expect much, if any, in the way of rebates from your private health insurer. While many funds do cover laser eye surgery, the cover may only apply for their top hospital or extras policies, and will usually only cover a small portion of the total cost. Check with your health insurance provider.
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.
Techniques and technologies
LASIK (laser-assisted in situ keratomileusis)
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 known by its brand name, IntraLase.
Suitability: This is currently the most popular procedure – your eyes should feel fairly comfortable the day after surgery, when you can probably resume normal activities. It's the more effective option if you're more severely short- or long-sighted.
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)
Procedure: This is 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, PRK also has less potential for complications and was the most common technique before LASIK gained popularity during the last decade. It's particularly suitable for correcting lower degrees of short-sightedness and astigmatism, and may also be recommended if you have a very thin cornea.
Downside: Compared with LASIK you're likely to feel more discomfort.
LASEK (laser-assisted subepithelial keratomileusis) and Epi-LASIK (using a finer tool)
Procedure: Modified and refined procedures based on PRK created LASEK, 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: LASEK was developed as a treatment for people whose cornea is unsuitable for LASIK.
A more recent development in laser eye surgery, this 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 will reveal all its refractive errors and programming this information into the laser, which can then deliver a more tailored treatment.
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 amount of 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 proven 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 an 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.
Complications that threaten your vision 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, but 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.
What happens during laser eye 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 to 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 in one eye only or in both.
An ophthalmologist (ophthalmic 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 specific to laser eye surgery.
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.
CHOICE member experiences with laser eye surgery
In 2007 we spoke to 40 CHOICE members who'd had laser eye surgery. Here are some of their experiences and comments.
- "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)
- "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)
- "It was pricey but I was happy to pay it for a very experienced surgeon. My eyes are too important to penny-pinch." (David, Victoria)
Extremely happy, but not glasses-free
Georgia, from Bega in NSW, had LASIK surgery after early, unsuccessful PRK treatment, and was extremely happy with the results, although it didn't leave her glasses-free.
"I can legally drive a car without glasses and only need my glasses occasionally," she said. "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."
She still wears 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."
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.
Then 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 said, "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…"
Eye Surgery Education Council (US-based non-profit organisation)
Royal Australian and New Zealand College of Ophthalmologists
Royal College of Ophthalmologists of London
US Food and Drug Administration – information on LASIK
Vision Surgery Rehab Network (formerly Surgical Eyes) for vision surgery casualties: comments from people who had negative outcomes from vision surgery.