LASIK eye surgery: What to know before you decide

What is LASIK eye surgery?

Thinking about LASIK? This elective eye surgery can eliminate the need for glasses or contact lenses by using a laser to reshape the cornea, the clear front part of the eye. The best way to know if LASIK is right for you is to learn more about it and have a comprehensive eye evaluation.

LASIK stands for laser-assisted in situ keratomileusis. During LASIK eye surgery, a thin flap is created in the outer layer of the cornea with a laser or mechanical microkeratome (blade) to access the middle layer of the cornea. An excimer laser is used to remove small amounts of the tissue beneath the flap. After the cornea is reshaped, the flap is gently repositioned and heals naturally without stitches. 

The entire procedure typically takes less than 30 minutes for both eyes, with the actual laser treatment lasting a very short time. LASIK typically improves vision within a day, and you can go back to your daily life within a few days. People choose this surgery for many reasons:

• It is a quick laser procedure.
• It can be performed in an office or an outpatient surgery center.
• It causes minimal discomfort.
• It has a fast recovery. 
• Vision improvement occurs quickly after the surgery.

What vision problems can it correct?

LASIK surgery is performed on people who use corrective lenses because of refractive errors. These include:

• Nearsightedness (myopia) – This causes distant objects to look blurry. 
• Farsightedness (hyperopia) – This typically causes close objects to appear blurry. 
• Astigmatism – This is an irregularly curved cornea or lens that causes distorted vision.

It is important to carefully consider the risks and benefits of LASIK. The pros and cons of laser vision correction vary from person to person. If you decide you would like to get LASIK, you will need an initial consultation to ensure you are a suitable candidate for the procedure. 

Who might be a good candidate for LASIK?

Specific health, age and prescription criteria must be met in order to be a good candidate for LASIK eye surgery:

• You must be 18 years of age or older, although it is better to be in your 20s.
• Your prescription should be stable, meaning it has not changed significantly for at least one year (note that pregnancy and breastfeeding can temporarily cause changes).
• Your prescription should be within the treatment parameters approved by the FDA.
• You must have generally good eyesight and overall health.
• Your corneas must be sufficiently thick and healthy for the procedure to be performed safely.

The FDA requires that your prescription fall within the following parameters:

• A maximum of +6.00 diopters of hyperopia
• A maximum of 6 diopters of cylinder/astigmatism
• A maximum of -12.00 diopters of nearsightedness

Should I stop wearing contact lenses before my initial consultation?

Yes, you should stop wearing contact lenses several weeks before your appointment. 

Contact lenses can temporarily alter the cornea’s shape. To ensure the most accurate measurements during the evaluation, stop wearing contact lenses for several weeks before your appointment.

• Soft contact lenses – Stop wearing lenses two weeks before.
• Toric soft lenses – Stop wearing lenses three weeks before.
• Rigid gas permeable lenses (hard lenses) – Stop wearing lenses three to four weeks before.

What happens at an initial consultation?

A comprehensive initial consultation will allow the LASIK surgeon to obtain the necessary information to determine whether you are a good candidate. It will also give you the opportunity to ask any questions you may have.

To ensure you are a good candidate for LASIK, your eye doctor will perform a comprehensive exam that includes:

• A complete medical and eye history
• A vision check and review of your previous eye prescription records
• An eye examination, which includes testing for glaucoma, checking the retina and taking precise measurements of the shape and thickness of the cornea
• A review of your complete list of medications, including over-the-counter drugs and herbal remedies, as some can interfere with healing

Will I be asked to sign a consent form?

Yes, you will be asked to read and sign a consent form that outlines the procedure’s risks, benefits, alternatives and potential complications. Your eye doctor can discuss expectations and answer your questions.

What happens once the procedure is scheduled?

After your surgery date is scheduled, you will receive specific instructions to prepare for the day of the procedure. It is important that you follow these instructions carefully and reach out to the office if you have any questions or concerns. Additionally:

• Arrange for someone to drive you home after the surgery, as you may experience temporary blurry vision.
• Avoid using cosmetics, creams or perfumes for a couple of days before surgery.
• You may be provided with eyelid scrubs to help reduce the risk of infection.

Who isn’t a candidate for LASIK?

LASIK surgery may not be safe or effective for everyone, and certain preexisting health or eye problems can increase the risk of complications. These include:

• Keratoconus 
• Ocular herpes
• Corneal infection
• Severe dry eye
• Cataracts
• Glaucoma

People with large pupils may not be suitable candidates. Additionally, certain health conditions, such as diabetes or autoimmune diseases, can also make someone a poor candidate. Individuals who are taking medications like steroids should consult their doctor. These health conditions and medications can interfere with proper healing.

What happens during LASIK surgery?

On the day of surgery, it is important to follow your doctor’s instructions. Remember to avoid cosmetics, creams and perfumes. Ensure you have someone to bring you home after the surgery.

Before LASIK

Before the procedure, you will have a pre-surgery evaluation. You may also be given medication that will help you stay relaxed during the procedure. 

During LASIK

The procedure typically takes 10 to 15 minutes for each eye. You will be awake during the surgery, but you should feel minimal discomfort. In general, the procedure will follow these steps:

1. Instillation of numbing eye drops – These drops prevent discomfort.
2. Placement of eyelid speculum – This holder keeps you from blinking during the procedure.
3. Placement of the suction ring – This ring helps keep the eye still. It may cause a feeling of pressure and a temporary darkening of vision.
4. Creation of the corneal flap – A very thin flap will be created with a microkeratome (blade) or femtosecond laser. This flap will be folded back to expose the layer beneath.
5. Focusing on a target light – You will be asked to look at a light for about 30 seconds to keep your eye steady (excessive eye movement will cause the laser to stop).
6. Reshaping of the cornea – The cornea will be reshaped using an excimer laser based on your eye measurements.
7. Corneal flap returned to position – The flap will be folded back and will reattach within minutes and heal naturally.

While the laser is working, you will hear a clicking sound. Some people notice a smell similar to burning hair, which is completely normal. 

After LASIK

Immediately after the procedure, you will notice your vision is somewhat clear, but it may not be perfectly sharp right away. It will clear up within a few days. It may take up to three to six months for your vision to fully stabilize.

You may feel slight discomfort

For the first few days, you may feel some discomfort, such as an itchy, dry or scratchy feeling. You can take an over-the-counter pain reliever. Lubricating eye drops can also relieve dry eyes.

You should protect your eyes

It is important not to rub your eye for one week, as this could displace the flap. Also, avoid getting tap water or makeup in your eyes during this period. To protect the healing corneal flap, your doctor may give you a clear shield to wear over the eye, especially while sleeping, for the first few nights.

Your doctor will prescribe eye drops, typically containing a steroid and an antibiotic, to prevent infection and aid healing. Your initial follow-up appointment will likely be scheduled for the next day so the doctor can check your healing progress.

Restrictions after LASIK

To allow your eyes to completely heal after LASIK, it is recommended that you follow these guidelines:

• No contact sports for a month. 
• Avoid or limit exercise for three days.
• No products or cosmetics around the eyes for two weeks.
• Avoid pools and jacuzzis for one to two months.

Follow-up appointment

You'll typically come back to see your eye doctor the day after your surgery. During this appointment, your doctor will:

• Check how well your eye is healing and if you have any eye pain 
• Test your vision
• Give you antibiotic drops if needed and artificial tears for comfort
• Let you know when it’s okay to go back to your normal activities, such as driving

The timing for playing sports, applying eye makeup or using a jacuzzi varies for each person, depending on how quickly their eyes heal.

For about four weeks, you’ll need to wear an eye shield while you sleep to protect your eyes. Your doctor might schedule a few more eye exams over the next six months to make sure everything is progressing as expected.

What are the risks and side effects?

Research shows that nearly all patients — about 98 out of 100 — can see 20/40 or better after LASIK eye surgery, which is good enough for most daily activities, like driving. More than eight out of 10 patients achieve 20/20 vision or better, meaning they see clearly without glasses or contacts. In recent studies, over 95% of participants have reported satisfaction with their vision after LASIK.

Common side effects

There are some common side effects, although they are usually temporary. A study, called the LASIK Quality of Life Collaboration Project (LQOLCP), analyzed symptoms before and after LASIK. Nearly half of the study participants reported at least one new visual symptom three months after their procedure. These included:

Dry eye

A common reported side effect of LASIK surgery was temporary dry eye. About three out of 10 participants in the study reported new dry eye symptoms. This finding aligns with other research. Dry eye can develop because the procedure temporarily affects the nerves on the outer surface of the eye, leading them to signal less tear production. Studies have shown that dry eye symptoms usually lessen or resolve within the first year.

Halos

Another common issue people noticed was the development of halos — a halo-like glow or ring of light around bright objects. Up to four out of 10 patients who didn’t see halos before surgery reported experiencing them three months afterward.

Overall visual symptoms

Fewer than one in 100 participants reported significant difficulty performing everyday activities, such as working or driving, because of visual symptoms, like starbursts, ghosting, halos or glare.

Risks and possible complications

As with all surgeries, there are risks and possible complications with LASIK. In very rare cases, issues can arise during the procedure, such as malfunctioning equipment. But the overall risk of a serious sight-threatening complication, such as an infection or corneal damage, is very low. Studies report that this happens in only .07% of cases.

Uncommon LASIK complications include:

• Eye infection
• Significant inflammation 
• Severe, ongoing dry eye 
• Difficulty seeing in low-light conditions 
• Difficulty driving at night due to halos, double vision or glare
• Challenges with corneal flap healing
• Ectasia (where the cornea becomes thinner and more distorted over time)

How much does LASIK cost, and is it worth it?

LASIK eye surgery is considered an elective procedure, so it is not usually covered by health insurance plans. Typically, the cost for laser vision correction ranges from about $1,850 to $2,250 per eye at high-volume centers. This price often includes the surgery itself and any necessary follow-up visits. Keep in mind that you’ll usually need to pay for the initial consultation separately.

Deciding if LASIK is worth the investment is a personal choice. It involves weighing the cost of LASIK against its common and rare side effects, as well as its potential benefits.

How to find a trusted LASIK surgeon

A first step to finding a trusted LASIK surgeon is to ask your regular eye doctor or primary care provider. They may be able to recommend a board-certified LASIK surgeon. It’s important to choose a physician who performs a thorough screening during the initial consultation to determine if you are a good candidate.

Researching the ophthalmologist’s experience with LASIK is also a good idea. It’s helpful to learn how long they’ve been performing the surgery and how many procedures they’ve performed. When you meet with them, you can ask about their outcomes — specifically, how many patients achieved 20/20, 20/40 or better vision after surgery. 

Frequently asked questions about LASIK

What happens if you blink or move during the LASIK procedure?

During the procedure, your eyelids will be gently held open with a small speculum, so you won’t be able to blink. To help you stay still, the laser bed has a special headrest that supports your head and keeps it stable. The laser typically also has a tracking system that follows your eye movements. If your eye moves slightly, the laser will automatically adjust.

Can LASIK fix age-related vision changes?

With age, the lens inside the eye becomes less flexible, which can make it harder to see things up close, such as books, menus and phones. While LASIK is a popular option for reshaping the cornea and improving distance vision, it doesn’t address this common age-related issue called presbyopia. However, a technique called monovision can correct one eye for distant vision and the other for close-up vision. 

Do LASIK results last forever?

The change in corneal shape is permanent, but visual acuity can change slightly over the years due to natural changes in the eye. Most people continue to have stable, clear vision 10 to 20 years after LASIK surgery. If your vision changes significantly over time, your doctor may be able to perform a LASIK enhancement or touch-up procedure to restore clarity.