Laser Eye Surgery

In the last two decades the number of people who have had laser treatment to correct their eyesight has risen sharply. Laser surgery involves reshaping the front surface of the eye, the cornea, with a specially equipped laser in order to improve vision. Treatment is available for long-sighted, short-sighted and astigmatic patients. However, there are limits to the degree of each condition that can be treated with the laser. If your prescription falls outside the “treatable” range for laser surgery alternative surgeries may be suitable.

What’s the difference between LASIK and LASEK?

In LASIK:  a thin layer of the cornea is lifted back after being cut with a machine called a microkeratome. Then, the laser is used to reshape the internal cornea. After the tissue has been reshaped, the flap is replaced in its original position and heals quickly.

In LASEK: a thin superficial layer of corneal cells is removed and the tissue beneath is treated with the laser. Unlike in LASIK, there is no “flap” created. After laser treatment, the cell layer is replaced and the eye covered with a bandage contact lens to allow it to heal. This method allows higher levels of myopia to be treated than LASIK. However, this treatment takes longer to heal and often provides more discomfort than LASIK.

If I have Laser Can I Throw Away My Glasses Forever?

The most likely answer to this question is No. If you are under 45 and have laser surgery to correct your vision to “20/20” or as close to perfect as possible in both eyes, you will need reading glasses from your mid 40’s or 50’s onwards. If you are over 40 and have already developed a reading prescription or remove your glasses to read, then having bilateral laser treatment may mean you will need a spectacle correction for either distance or near.

I’ve heard people talk about monovision, what is this?

From mid 40’s onwards people develop different distance and reading prescriptions – see Presbyopia. Correcting both eyes with laser treatment to make them “perfect” for distance means that reading glasses are necessary. Correcting both eyes so that they are “perfect” for reading means that distance glasses will probably be needed. In Monovision  - one eye is corrected for distance vision and the other for near vision. In some cases this is achieved by performing laser on one eye only and leaving the other eye in it’s natural state.

When this works, it means that reliance on glasses for both distances is done away with. However, having two eyes focussing together and corrected for the same distance is what gives us binocular vision and gives critical depth perception. 

Monovision does not work for everyone, some people will be aware of visual confusion as the eyes are focused at different distances and / or that judgement of depth is impaired. This is an important consideration for those people for whom critical depth perception is required in their occupation or hobbies. Often a trial with contact lenses to simulate monovision will be offered and patients can assess for themselves how comfortable they are.

Monovison may work better for early presbyopes with lower reading prescriptions, hence the success and comfort obtained in the first number of years after treatment may not be maintained over time.

Laser Surgery has brought freedom to many spectacle wearers, however, it is a surgical treatment and as such, carries risks. Many laser clinics have opened in Ireland over the past decade and anyone opting for the treatment should be confident and comfortable with the clinic they choose. As some clinics do not perform surgery on a daily basis, the surgeon may only attend once or twice a week and in some cases may fly in and out to carry out the scheduled surgeries.

Before you decide where to have laser treatment or indeed if the treatment is suitable for you ask the following questions.

  • Will I meet the surgeon before I am booked in for treatment?
  • Is the surgeon available 24/7 should there be any complications?
  • Am I likely to need glasses again and if so in how many years?
  • How long has this clinic been carrying out procedures and how many patients have been treated?  What percentage of them needed additional treatment?
  • If I need a “top-up” treatment, do I have to pay for it?
  • If I am comfortable with monovision now, is it a guarantee that I won’t need spectacles again?
  • I have dry eye, is this likely to cause me additional problems after surgery?