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General information about Laser Refractive Surgery

Laser vision correction surgery reshapes the cornea - the clear layer at the front of the eye — so that light is focused more precisely on the retina. The surgery is designed to correct nearsightedness, farsightedness and astigmatism (cylinder), and to reduce dependence on glasses and contact lenses.

The three main methods of laser vision correction

Surface laser (PRK) — the thin top layer of the cornea is removed, and the cornea is then reshaped with a laser. A contact lens protects the eye during healing. This is the method with the slowest recovery, and the pain usually lasts two to three days.

LASIK — LASIK surgery is a short procedure in which the shape of the cornea is changed with a laser to correct nearsightedness, farsightedness or astigmatism. During the surgery, a thin layer is created in the cornea, the correction is performed with a laser, and the layer is put back in place. The procedure usually takes a few minutes per eye, and recovery is relatively fast. Many patients experience a significant improvement in vision within the first few days, but vision may continue to stabilize over the weeks following surgery.

SMILE — the laser creates a tiny piece of tissue (lenticule) inside the cornea, which is removed through a very small incision. Unlike LASIK, there is no need to create a corneal flap. The procedure usually takes a few minutes, and recovery is usually fast. Vision improves within the first few days, but may continue to sharpen and stabilize over the weeks following surgery.

There is no single method that suits everyone. The choice depends on the structure of the cornea, the glasses prescription and lifestyle, and is made together with the surgeon after a candidacy evaluation.

The candidacy evaluation for laser vision correction

Not everyone who wears glasses is a candidate for surgery. The candidacy evaluation examines, among other things, the thickness and shape of the cornea, the stability of the prescription over time, the size of the pupils in dim light and the moisture level of the eye. Certain conditions — such as a thin cornea, significant dry eye, a prescription that is still changing or eyelid inflammation — may make the surgery unsuitable, or lead to a different method.

Anyone who undergoes surgery expecting perfect vision without glasses may be disappointed. Even after successful surgery, glasses may be needed for certain activities, such as reading or driving at night. And for those who feel comfortable with glasses or contact lenses — the surgery may simply not be necessary.

For those who are not candidates for laser surgery, for example because of a very high prescription or a thin cornea, there are alternatives such as lens implantation, phakic lens implantation, Collamer lens implantation and more.

Frequently asked questions about Laser Refractive Surgery

Who can have laser surgery to get rid of glasses?

Suitability is determined in a preliminary examination, but there are several situations in which it is worth knowing in advance that the surgery may not be suitable. According to the U.S. Food and Drug Administration (FDA), this is the case when the prescription is still changing, when there is a disease or drug treatment that may impair healing, and when there is dry eye, eyelid inflammation, a thin cornea or especially large pupils in dim light. Large pupils may cause glare and halos around light sources after surgery. Age is also a consideration: there is currently no laser device approved for LASIK surgery under the age of 18. Surgery is not recommended during pregnancy and breastfeeding, as these conditions may affect eye measurements.

After laser surgery to get rid of glasses, will I no longer need reading glasses?

Not necessarily. Laser surgery does not correct the age-related decline in near vision (presbyopia). [According to the American Academy of Ophthalmology](https://www.aao.org/eye-health/ask-ophthalmologist-q/why-has-my-near-vision-gotten-worse-after-lasik), almost everyone who sees well at a distance will need reading glasses around age 40, with or without surgery. Some patients choose a solution called “monovision”: one eye is corrected for distance vision, and the other is left slightly nearsighted to allow near vision. This solution is not suitable for everyone, so it is recommended to try it first with contact lenses before deciding on surgery.

Why do I need to stop wearing contact lenses before the suitability exam?

Contact lenses temporarily change the shape of the cornea. For the measurements — which determine how much tissue will be removed during surgery — to be accurate, the cornea needs to return to its natural shape. According to the FDA, it is recommended to stop wearing contact lenses before the suitability exam and switch fully to glasses, since cutting this break short may adversely affect the outcome. The required length of the break depends on the type of lenses, and your doctor will give you exact instructions.

Does my health fund's supplementary insurance cover part of the cost of the surgery?

The health funds' supplementary insurance plans offer laser surgery to get rid of glasses at a partial subsidy, in exchange for a co-payment. Eligibility conditions, the amount of the co-payment and the list of participating centers vary between health funds and insurance tiers, so it is worth checking them directly with your health fund before booking an appointment. Private health insurance policies may also include reimbursement.

Why should I keep my eye data from before the surgery?

Laser surgery changes the shape of the cornea, so it affects the calculations for future eye surgeries — mainly cataract surgery, in which the power of the implanted lens must be calculated. The American Academy of Ophthalmology recommends keeping a record of your eye data from before and after the surgery, so that your ophthalmologist can use it if another surgery is needed in the future.