Types of Laser Eye Surgery: Understanding Your Options

Laser eye surgery involves using a laser to correct a visual problem, most often a refractive error like nearsightedness, farsightedness, or astigmatism.

Some surgeries remove scar tissue or improve vision in other ways, but LASIK is the most popular form of laser eye surgery, and it is considered a cosmetic procedure. Using lasers improves patient outcomes and healing times, as well as the surgeon’s ability to make less invasive motions.

The Growing Popularity of Laser Eye Surgery

Laser eye surgery is most associated with trendy LASIK, but there are several types of laser or laser-assisted surgical procedures that not only correct refractive errors like nearsightedness or astigmatism, but also reduce the risk of blindness, improve post-surgical healing time, and lower surgical costs. As more surgeons are trained in laser eye surgeries, these options are becoming more accessible, so more people choose the faster, safer laser procedure over more invasive traditional surgeries.

People may consider laser eye surgery if:

• They cannot comfortably wear contact lenses.
• They dislike glasses or contacts.
• They have a job or hobby that is safer without glasses or contact lenses.

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Laser Eye Surgery Options

Most forms of laser eye surgery involve reshaping the surface of the eye or the inner part of the cornea to improve how light is refracted to the retina, so vision is clearer.

Overall, LASIK is the most popular type of laser eye surgery, but if you are not a good candidate for LASIK or are interested in a different procedure, there are other forms of laser eye surgery available. Here are some of the most common.

LASIK

This acronym stands for laser-assisted in situ keratectomy, which describes what occurs during the operation. A laser, guided by a pre-programed computer, will remove some of the tissue from parts of your cornea to reshape it, so that it more clearly refracts light to your retina.

The U.S. Food and Drug Administration (FDA) approved LASIK as a consumer procedure in 1999. Since then, more than 90 percent of the millions of people who have undergone this operation report great satisfaction with their clearer vision, even in the rare cases where LASIK did not achieve 20/20 sight.

Almost everyone is a great candidate for LASIK, but there are some caveats. Here are considerations that would mean you are not a good LASIK candidate:

• You are younger than 18 years old.
• Your refractive error is still changing.
• You have presbyopia, or age-related farsightedness.
• You have other eye conditions like severe dry eye, keratoconus, cataracts, or glaucoma.
• You have a history of some eye infections.
• You have underlying health problems like diabetes or high blood pressure.
• You have very thin corneas.
• You have an aversion to surgery.
  

Overall, most people between the ages of 18 and 60 are great LASIK candidates and benefit from improved visual acuity.

Photorefractive keratectomy (PRK)

This is a less well-known form of refractive surgery, similar to LASIK and often recommended for people who are not good LASIK candidates but still want to improve their visual clarity. Like LASIK, PRK involves a laser changing the shape of your cornea.

People who have thinner corneas or chronic dry eye are often better candidates for PRK than for LASIK. As with LASIK, being younger than 18 years old, having a consistently changing refractive error, or having a history of certain eye or health conditions means you are not a good candidate for PRK.

Small incision lenticule extraction (SMILE)

This is a newer approach to laser refractive eye surgery that not only treats myopia, hyperopia, and astigmatism, but also presbyopia, which is an age-related change in visual acuity leading to farsightedness. Rather than using a femtosecond laser to reshape the cornea in several slices, the laser is used to make a lenticule, or “bubble,” in the cornea, which is extracted through the smallest possible incision. This improves healing time since there is less invasion of the eye.

LASEK

Short for laser epithelial keratomileusis, this form of laser-assisted refractive surgery allegedly combines the benefits of LASIK and PRK, with fewer complications. The procedure was developed in 1996. Although it is not as popular as LASIK and PRK, it is a good option for people who might be poor candidates for LASIK.

Rather than using a femtosecond laser to create an incision in the epithelium, the laser of cells at the top of the cornea, LASEK uses an alcohol solution of 18 to 20 percent on the top of the cornea to detach this thin layer. This should produce a thinner opening through which to reshape the cornea, making this a great option for people with high refractive errors or thin corneas.

EPI-LASIK

This form of LASIK uses a small suction device and an epikeratome blade to create a very thin flap in the epithelial layers of the cornea. This creates a thinner flap than many earlier lasers or the microkeratome used in early types of LASIK, but modern epi-LASIK is similar in effectiveness to standard LASIK procedures.

Laser-assisted surgery for cataracts

This procedure enhances traditional cataract surgery with the addition of a guided laser, which can create a thinner incision in the cornea that should heal a little faster than scalpel-created incisions. The laser can also be used to reshape the cornea after the natural lens has been removed and replaced, which can greatly improve visual acuity overall.

Laser cataract surgery is most often recommended for people who have astigmatism, which causes the eye to become an oval or oblong shape rather than circular.

Posterior capsulotomy (YAG)

This operation is performed after cataract surgery if the membrane behind the new artificial lens becomes cloudy due to scar tissue. This can create the sensation of having another cataract, but the scar tissue develops in a different part of the eye. The artificial lens cannot develop a cataract.

This simple laser procedure takes about five minutes per eye. Your surgeon will numb your eyes with drops, point a laser toward the back of your eye, make a small incision, and guide the laser to remove the scar tissue. You might need someone to drive you home after the operation, but you can return to normal activities once your vision clears, which should be within a few hours.

Laser treatment for glaucoma

While there is no cure for glaucoma, there are several approaches to managing the condition to reduce eye pressure and keep your vision for as long as possible. Most glaucoma treatments involve eye drops that reduce inner eye pressure, but sometimes, your eye needs additional help regulating how much aqueous humor moves in and out. Lasers are now used on various parts of the eye to create small, temporary drains so internal eye pressure lowers.

Is Laser Eye Surgery Safe?

Different types of laser eye surgery have different recovery times, but most people have good visual acuity restored in about two weeks, typically less. These procedures are some of the safest and most effective eye operations available, although many are not covered by health insurance since they are not considered medically necessary.

References

1. Eyes – Laser Eye Surgery. (October 2020). Better Health Channel, Victoria.

2. LASIK. (March 2018). US Food and Drug Administration (FDA).

3. What Is Photorefractive Keratectomy (PRK)?? (September 2017). American Academy of Ophthalmology (AAO).

4. Small Incision Lenticule Extraction (SMILE). (October 2021). EyeWiki, American Academy of Ophthalmology (AAO).

5. LASEK. (September 2021). EyeWiki, American Academy of Ophthalmology (AAO).

6. Experts Revisit Epi-LASIK. (April 2006). EyeNet Magazine, American Academy of Ophthalmology (AAO).

7. Traditional Cataract Surgery vs. Laser-Assisted Cataract Surgery. (April 2021). American Academy of Ophthalmology (AAO).

8. What Is a Posterior Capsulotomy? (November 2021). American Academy of Ophthalmology (AAO).

9. Laser Treatment for Glaucoma. (July 2021). National Eye Institute (NEI).