Why is laser eye surgery performed?
Laser eye surgery is primarily performed on people who need glasses or contact lenses due to nearsightedness (myopia), farsightedness (hyperopia), astigmatism or presbyopia.
Depending on the type of vision problem, different treatment approaches are used. For example:
- In myopia (nearsightedness), the central area of the cornea must be flattened to reduce the myopia.
- In hyperopia (farsightedness), the central area of the cornea is made steeper by applying the laser at the edge of the cornea.
- In the case of astigmatism (curvature of the cornea), the laser is used to make the curvature of the cornea more uniform.
- In the case of presbyopia (age-related farsightedness), the Presbyond eye laser treatment creates a kind of mini-monovision.
People may consider laser eye surgery for the following reasons:
- You cannot wear contact lenses and would like to avoid wearing glasses for cosmetic reasons.
- You are pursuing a career or hobby that is not possible with glasses or contact lenses.
- You don’t want to have to deal with the inconvenience and care that comes with wearing contact lenses.
What types of laser eye treatment are there?
There are various methods of laser eye surgery, which can be confusing due to the multitude of terminology. For clarity, the methods can be divided into three main categories: LASIK, SMILE, and resurfacing laser treatments.
- First generation: Resurfacing laser treatments ( PRK , LASEK, EpiLASIK, and TransPRK) – In this treatment, the clear layer covering the cornea is removed to allow the laser to reshape the cornea. This layer then regenerates naturally.
- Second generation : LASIK – FemtoLASIK – This involves creating a very thin corneal flap, after which the cornea is reshaped with an excimer laser. The flap can be created either with a microkeratome (a blade) for classic or traditional LASIK or with a femtosecond laser for FemtoLASIK. The flap is then replaced without sutures.
- Third Generation: SMILE – The surgeon creates a lens-shaped piece of tissue in the cornea and removes it through a small, self-sealing hole to reshape the cornea. The method using the Visumax 500 femtosecond laser is called ReLEx SMILE , while the Visumax 800 (considered safer, more accurate, and more precise) is known as SMILE PRO .
Refractive surgical procedures have continuously evolved and been perfected over the last two decades.
- with the correct information
- detailed diagnostics before surgery
- in selecting the most suitable procedure for each individual
- Using the latest equipment and lasers ( at Lasik-Welt: Z eiss Visu max 800)
- as well as detailed advice and information for patients
can be a full alternative to glasses and contact lenses.
RELEX SMILE is currently the world’s most widely used and sophisticated laser eye treatment method for correcting refractive errors. The results achieved are demonstrably better than those achieved with other methods, while also causing fewer side effects .
Suitability for laser eye surgery – Who is laser eye surgery suitable for?
9 criteria for a suitable candidate for laser eye surgery
The success of laser eye surgery depends largely on whether you meet certain criteria and whether the procedure is suitable for you. Although the results of this type of surgery are generally positive, not everyone qualifies for laser vision correction. The following list provides guidance to help you assess whether laser eye surgery is an option for you.
1) Your eye health is crucial
If you have a condition that could affect your response to the procedure or your healing afterward, it is necessary to wait until your condition improves before having the surgery. These conditions include severe dry eye syndrome , conjunctivitis (“pink eye”), infection, or any type of eye injury.
If you suffer from a chronic form of dry eye, meaning insufficient tear production to keep your eyes moist and healthy, laser surgery could worsen this condition. Typical symptoms include burning or stinging, a gritty feeling in the eye, low tolerance to wind, temporary blurred vision, and sometimes excessive tearing. If you experience any of these symptoms, it’s important to discuss them with your ophthalmologist before surgery.
During a preliminary examination, your ophthalmologist can determine whether you suffer from dry eyes, which can usually be successfully treated, meaning you’re eligible for laser eye surgery. Possible treatments include artificial tears, tear duct plugs, medicated eye drops, flaxseed or fish oil supplements, or a combination of these methods.
In addition, people with cataracts that impair vision and those with uncontrolled glaucoma are generally not considered suitable candidates for laser eye surgery.
2) The thickness of your cornea is crucial
Most refractive procedures that improve visual acuity require reshaping the front surface of the eye, i.e., the cornea. Laser treatment of a cornea that is too thin or has a severely irregular and deformed surface, as is the case with keratoconus, for example, can negatively impact the surgical outcome and worsen vision.
Adequate corneal thickness is crucial because the surgery involves removing or reshaping corneal tissue. Specific requirements may vary, but generally, a minimum thickness of approximately 480-500 micrometers is considered necessary for safe treatment.
If you were previously told that laser eye surgery wasn’t suitable for you due to a thin cornea, recent developments may mean you are a suitable candidate for this type of vision correction. By using a femtosecond laser instead of a microkeratome, it’s possible to create a thinner corneal flap, preserving more corneal tissue for laser treatment. The latest generation of laser eye surgery, SMILE PRO, also opens up further options for people with thin corneas.
3) Your pupils should not be too large
Pupils that are too large can increase the risk of side effects such as halos, glare, and stargazing in low-light conditions, especially when driving at night.
4) Your visual acuity must be within certain limits
If your vision is very poor – whether due to nearsightedness, farsightedness or astigmatism – your ophthalmologist may advise against laser eye treatment.
The results of such surgery for severe refractive errors are often less predictable, and the associated costs and risks may not be justified.
Particularly in cases of severe myopia, too much corneal tissue may need to be removed, increasing the risk of vision problems.
In cases of significant refractive errors, alternative vision correction, such as phakic intraocular lenses (IOLs) or refractive lens exchange, may be a better choice.
The thresholds for suitability for laser eye surgery (LASIK, PRK, SMILE, etc.) can vary depending on the specific procedure and the individual patient’s condition. However, there are general guidelines that often serve as a guide:
Nearsightedness (Myopia): Most laser eye treatments can correct nearsightedness to some degree, typically up to -10.00 diopters, sometimes even up to -12.00 diopters, depending on the thickness and health of the cornea.
Farsightedness (hyperopia): The treatment limits for farsightedness are often somewhat narrower than for nearsightedness, typically up to +4.00 to +5.00 diopters. Some procedures offer possibilities up to +6.00 diopters.
Astigmatism: Astigmatism can usually be corrected up to 6.00 diopters, depending on the technique used and other factors such as corneal thickness.
It’s important to emphasize that these values are guidelines, and individual factors such as eye health, corneal shape and thickness, and the patient’s lifestyle must be considered when deciding whether laser eye surgery is feasible and which procedure is most appropriate. A comprehensive preliminary examination by a qualified laser eye surgeon is therefore essential to evaluate these factors and provide a tailored recommendation.
5) You must have reached the required minimum age
For certain laser eye procedures, you must be at least 18 years old, while for others, a minimum age of 21 is required. Under certain circumstances, patients younger than this age may still be treated with parental or legal guardian consent.
Although there is no set upper age limit for laser eye surgery, it is important to know that from the age of 40 onwards, reading glasses for near vision may be required due to a natural age-related change called presbyopia.
Depending on your individual case, your surgeon may also consider you a suitable candidate for presbyopia correction surgery, such as Presbyopia laser eye surgery, which can reduce or eliminate the need for reading or bifocal glasses.
6) Your eyesight should be stable
It’s not uncommon for adolescents and young adults to experience changes in their prescription for contact lenses and eyeglasses from year to year. Therefore, it’s crucial that your refractive error remains stable for at least one year before undergoing LASIK or any other form of refractive surgery.
It is often myopia that worsens over time, but other changes in vision are also possible.
Young people are only considered suitable candidates for this type of surgery once their vision has stabilized at a certain level. Your ophthalmologist will be able to assess whether your vision is stable enough for the procedure.
7) You must be in good general health
To be eligible for laser eye surgery, patients must not have uncontrolled degenerative or autoimmune diseases, such as Sjögren’s syndrome, rheumatoid arthritis, type 1 diabetes, or AIDS. However, people with HIV who have a stable and high immune cell count may be eligible for laser eye surgery.
In general, a compromised healing capacity of the body increases the risk of unsatisfactory results after LASIK surgery. LASIK surgeons’ assessments of which conditions preclude surgery or pose an acceptable risk under certain conditions can vary.
Furthermore, certain medications can increase the risks of laser eye surgery. Immunosuppressants can impair healing after surgery, and some medications can increase the risk or severity of dry eye.
8) If you are pregnant, you should postpone the operation
If you are pregnant or breastfeeding, laser eye surgery is not recommended. Hormonal fluctuations can affect the shape of the cornea and cause temporary vision changes.
It is recommended that you wait to have this surgery until your hormone levels and vision have stabilized after pregnancy, which may take several months.
Pregnant women often suffer from dry eyes, which may be another reason to postpone laser eye surgery until several months after pregnancy. In addition, certain medications commonly used before or after surgery to promote healing, such as antibiotics and steroids, may pose a risk to the unborn or breastfed child.
9) Your expectations should be realistic
Although most laser eye surgeries produce excellent results, it is important to be aware of the potential risks, side effects, and complications of LASIK treatment before making a decision.
An experienced laser eye surgeon will advise you comprehensively on whether you are a suitable candidate for laser eye surgery or whether another form of refractive surgery would be preferable.
It is crucial that you share all relevant information about your health and medical history with your surgeon to ensure the best possible treatment outcome.
The age limits for laser eye surgery / LASIK
When it comes to correcting vision problems, laser eye surgery is at the forefront of modern eye surgery. This popular method for correcting refractive errors such as nearsightedness, farsightedness, and astigmatism has helped many people around the world live without glasses or contact lenses. A frequently asked question surrounding this procedure concerns age limits: Who is a candidate for LASIK, and is there a “too young” or “too old” for this procedure?
Minimum age for laser eye surgery
The minimum age for laser eye surgery is generally 18. This guideline is primarily based on the importance of maintaining vision stability. During adolescence, the body, including the eyes, is still growing. During these years, vision can continue to change and fluctuate, making it less ideal to undergo laser eye surgery/LASIK surgery before this age. Performing the surgery too early, before the eyes have fully stabilized, could result in the need for additional corrections later, as vision could continue to change after surgery.
In most cases, ophthalmologists require that a patient’s vision has been stable for a certain period of time before considering them as a candidate for laser eye surgery/LASIK. This period of stability is typically at least one year, but can vary depending on the individual situation. Stability is crucial because laser eye surgery/LASIK is designed to correct the eyes’ current refractive error. If vision is still changing, the correction provided by laser eye surgery/LASIK could become outdated, resulting in suboptimal or temporary results.
Furthermore, waiting until age 18 allows the patient to be more involved in the decision-making process. At this age, most people are better able to understand the risks, benefits, and obligations associated with laser eye surgery/LASIK. They can make a more informed decision about whether this procedure is appropriate for them, taking into account both their current vision needs and their long-term expectations.
In some exceptional cases, laser eye surgery (LASIK) may be considered for patients under 18 years of age, but this is rare and is usually only performed under specific medical circumstances where the benefits clearly outweigh the risks. For most people, however, it’s best to wait until age 18 and ensure that vision has stabilized to achieve long-term, successful results from laser eye surgery.
Is there an upper age limit for laser eye surgery?
Laser eye surgery and age considerations
Although there is no officially established upper age limit for laser eye surgery such as LASIK, general health and eye condition play a crucial role in determining suitability for the procedure. With increasing age, various changes occur in the eyes that can affect the effectiveness and appropriateness of laser eye surgery.
Age-related eye problems become more common in older patients, typically starting around age 40. One of the most common conditions is presbyopia, an age-related form of farsightedness that usually begins around age 40. Presbyopia occurs when the eye’s natural lens loses its flexibility, making it difficult to focus on near objects. Traditional LASIK surgery, which aims to correct vision by reshaping the cornea, may not be completely effective in treating presbyopia. Therefore, alternative laser eye surgery techniques such as PRESBYOND may be more suitable. PRESBYOND laser eye surgery is specifically designed to treat presbyopia and offers a customized approach that expands the field of vision for patients with this condition.
Additionally, older patients are more likely to develop cataracts, a condition in which the lens of the eye becomes cloudy and impairs vision. The presence of cataracts can significantly influence the decision to undergo laser eye surgery. In such cases, the patient’s overall eye health must be carefully evaluated. In some cases, it may be more beneficial to treat the cataracts first, either with traditional cataract surgery or with lens replacement surgery, which can also correct refractive errors, potentially eliminating the need for laser eye surgery.
Ultimately, the decision to perform laser eye surgery on older adults should be made in consultation with an experienced ophthalmologist. A thorough eye examination and a discussion of the patient’s visual goals are crucial to determining the best treatment approach. While laser eye surgery can offer significant benefits at any age, it is especially important for older patients to consider the broader context of their ocular health and any age-related changes that may affect the outcomes of the procedure.
Laser eye surgery risks
Although laser eye surgery is considered safe and effective, like any surgical procedure, it carries certain risks.
The potential risks and side effects of laser eye surgery to enable an informed decision.
Short-term side effects
- Discomfort and mild pain: After the procedure, your eyes may feel slightly sore or uncomfortable for a few days. This discomfort is usually mild and can be relieved with pain medication prescribed by your doctor.
- Dry eyes: One of the most common side effects after LASIK surgery is dry eye syndrome. Patients may experience reduced tear production for several weeks or even months after surgery. This can usually be treated with artificial tears and improves over time.
- Temporary vision problems: Temporary vision problems such as blurred vision, halos around lights, sensitivity to glare, and difficulty seeing at night may occur immediately after the procedure. These effects usually subside within the first few weeks after surgery.
Long-term risks
- Flap complications: LASIK surgery involves creating a thin flap in the cornea, which is folded back to laser the underlying tissue. Complications with the flap, such as displacement or wrinkling, can impair vision and require further surgical intervention.
- Under- or over-correction: In some cases, the result of laser treatment may not correct vision exactly as intended. This may require re-correction to achieve the desired vision.
Is laser eye surgery painful?
You won’t feel any pain during LASIK or PRK, as your doctor will prescribe numbing eye drops beforehand. They will then prescribe pain medication if needed. For most LASIK patients, the pain is mild and lasts no more than a day after surgery. After PRK, most patients experience more pain because the treatment exposes deeper layers of the cornea. To achieve good vision after PRK, the protective cells on the surface must regrow. This process can take one to two weeks, sometimes longer.
Before, during and after laser eye treatment
Before treatment
- Consultation and preliminary examinations: The first step is a detailed consultation with a qualified ophthalmologist. Your visual acuity, corneal thickness, and overall eye health will be assessed. This information will determine your suitability for treatment and which procedure is best for you.
- Preparation: Before surgery, it is recommended that you stop wearing contact lenses – usually for one week for soft lenses and at least two to four weeks for hard lenses. This is to restore the cornea’s natural shape, as contact lenses can temporarily alter it.
During treatment
- The procedure: The actual laser eye surgery takes only about 10 to 15 minutes per eye. Numbing eye drops are used during the treatment to reduce pain. Many patients report a feeling of pressure, but no pain, during the procedure. Modern LASIK procedures offer a high level of precision and safety, minimizing the risk of complications.
After treatment
- Immediate recovery: Immediately after surgery, your eyes may burn, itch, or feel like there’s a foreign object in them. However, these symptoms should subside within a few hours. Many patients notice a significant improvement in their vision as early as the day after surgery.
- Follow-up care: After LASIK treatment, several follow-up visits are necessary to monitor the healing process and ensure your vision is improving as expected. It’s important to use the eye drops prescribed by your doctor as directed to prevent infection and inflammation.
Long-term results
Most patients are very satisfied with the results of their laser eye surgery . However, it’s important to understand that some people may require re-corrections over time, especially if they were very young or had very high prescriptions at the time of surgery.
Laser eye surgery offers many people the opportunity to live a life without glasses or contact lenses. With proper preparation, an experienced ophthalmologist, and appropriate aftercare, patients can create the best conditions for a successful outcome.
Long-term results
Most patients are very satisfied with the results of their laser eye surgery . However, it’s important to understand that some people may require re-corrections over time, especially if they were very young or had very high prescriptions at the time of surgery.
Laser eye surgery offers many people the opportunity to live a life without glasses or contact lenses. With proper preparation, an experienced ophthalmologist, and appropriate aftercare, patients can create the best conditions for a successful outcome.