Written by Vasileios Skouteris MD, FEBO, Ophthalmic Surgeon
Page contents
- What is laser refractive surgery?
- Which refractive errors does it correct?
- LASIK, PRK and TransPRK: what is the difference?
- Who is suitable for laser eye surgery?
- Pre-operative assessment
- Recovery after surgery
- Risks and possible side effects
- Laser eye surgery: what does the cost depend on?
- When to contact your ophthalmologist after laser
- The day of surgery step by step
- Stopping contact lenses before the assessment
- Laser eye surgery and dry eye
- If you are not suitable for laser: the alternatives
- Laser after 40: what about presbyopia?
- Sport, swimming and daily life after laser
- Laser eye surgery, pregnancy and breastfeeding
- Myths about laser eye surgery
- Other uses of laser in ophthalmology
- Questions worth asking before you decide
- How to know it is the right time
- Follow-up after laser
- Frequently Asked Questions about Laser Eye Surgery
Laser eye surgery, also known as excimer laser refractive surgery, precisely reshapes the curvature of the cornea so that light is focused correctly on the retina. It corrects myopia, hyperopia and astigmatism and can greatly reduce your dependence on glasses. The main techniques are LASIK, PRK and TransPRK.
What is laser refractive surgery?
The cornea is the clear “dome” at the front of the eye and provides most of the eye’s focusing power. When its shape does not match the length of the eye, the image forms in front of or behind the retina and vision becomes blurred. The excimer laser removes microscopic amounts of tissue, just a few microns deep, and “sculpts” the cornea according to measurements taken for that specific eye.
The treatment is planned separately for each eye. The procedures are performed under local anaesthesia with eye drops, take a few minutes per eye, and the patient goes home the same day.
Which refractive errors does it correct?
- Myopia: the laser flattens the centre of the cornea. If you have myopia (short-sightedness), suitability depends mainly on your prescription and corneal thickness.
- Astigmatism: the uneven curvature of the cornea is smoothed out. Astigmatism is usually corrected at the same time as myopia or hyperopia.
- Hyperopia: the laser increases the curvature of the centre. In hyperopia (long-sightedness) the range of correction is smaller than in myopia.
Laser does not stop the natural ageing of the lens. After the age of 40-45, presbyopia develops, meaning difficulty with near vision, even in people who have had a successful correction. At this age alternatives are discussed, such as monovision, where one eye is set for distance and the other for near, or solutions involving the lens of the eye.
LASIK, PRK and TransPRK: what is the difference?
All three techniques use an excimer laser to reshape the cornea. They differ in how the laser reaches the treatment area.
LASIK
A femtosecond laser creates a very thin flap on the surface of the cornea, which is lifted. The excimer laser is applied to the underlying layer and the flap is put back in place without stitches. Recovery is fast and discomfort is minimal.
PRK
The epithelium, the very thin surface layer of the cornea, is removed and the laser is applied directly to the surface. No flap is created. The epithelium regenerates within a few days under a bandage contact lens.
TransPRK
This is a surface technique like PRK, except that the excimer laser itself removes the epithelium and corrects the cornea in a single step, with no instrument touching the eye.
| Feature | LASIK | PRK | TransPRK |
|---|---|---|---|
| Corneal flap | Yes | No | No |
| Epithelium removal | No | With an instrument or solution | By the laser, no contact |
| Discomfort in the first days | Mild, for a few hours | Moderate, for 2-4 days | Moderate, for 2-4 days |
| Functional vision | Usually from the next day | In about one week | In about one week |
| Vision stabilisation | A few weeks | 1-3 months | 1-3 months |
| Suitable for thin corneas | Less so | Yes | Yes |
| Suitable for contact sports | Less so, because of the flap | Yes | Yes |
No technique is “better” for everyone. The choice is based on corneal measurements, prescription, occupation and lifestyle.
Who is suitable for laser eye surgery?
In general, candidates are people who:
- are at least 18 years old,
- have had a stable prescription for at least one year,
- have sufficient corneal thickness and a normal corneal shape,
- have no active inflammation or serious eye condition,
- have realistic expectations of the result.
Surgery is postponed or not recommended during pregnancy and breastfeeding, in severe uncontrolled dry eye, in certain autoimmune diseases and in cataract. An important contraindication is keratoconus, a condition in which the cornea progressively thins and changes shape. Laser would weaken it further, which is why the pre-operative assessment looks for even the very earliest forms.
Pre-operative assessment
The assessment before laser is the most critical step, because it determines whether surgery is safe and which technique is suitable. It includes:
- Corneal topography and tomography: mapping the curvature and shape of both surfaces of the cornea.
- Pachymetry: measuring corneal thickness at many points.
- Refraction with and without cycloplegia: accurate measurement of your prescription after the eye’s focusing is relaxed with drops.
- Pupil measurement in low-light conditions.
- Tear film assessment for dry eye.
- Full examination with tonometry and dilated fundoscopy.
Contact lens wearers need to stop wearing them for some days before the measurements, because lenses temporarily change the shape of the cornea. The exact period depends on the type of lens.
Recovery after surgery
After LASIK the eye may sting or water for a few hours and vision is usually functional from the next day. After PRK or TransPRK, discomfort, light sensitivity and watering last 2-4 days, until the epithelium heals and the bandage contact lens is removed.
In the first weeks you will need eye drops as instructed by the surgeon, protection from rubbing, no swimming and protection from the sun. You can return to work and driving when your vision allows, which is confirmed at the post-operative check-ups.
Risks and possible side effects
Refractive surgery is considered safe when patients are selected correctly, but like any procedure it has possible side effects:
- dry eye, usually temporary, which may last a few months,
- halos and glare around lights at night, which usually decrease over time,
- under-correction or over-correction, which may need an enhancement treatment,
- haze on the corneal surface after surface techniques,
- flap problems after LASIK,
- rarely, infection or progressive thinning of the cornea.
Laser eye surgery: what does the cost depend on?
The cost depends on the technique chosen, whether one or both eyes are treated, the pre-operative assessment and the schedule of post-operative visits. You will receive full details after the pre-operative assessment, once it is clear whether you are suitable and which method fits your eyes.
When to contact your ophthalmologist after laser
Contact us immediately if after surgery you notice:
- pain that is increasing instead of easing,
- a sudden drop in vision,
- marked redness or a pus-like discharge,
- a blow to the eye.
For a pre-operative suitability assessment at the practice in Neo Psychiko, Athens, book an appointment.
The day of surgery step by step
Many people worry more about the unknown than about the procedure itself. In reality, the process is short and well organised.
- Preparation: Come without make-up, face creams or perfume. Bring someone with you, because you will not be driving afterwards.
- Anaesthesia: Anaesthetic drops are put in. No injection or general anaesthetic is needed.
- The laser: A special instrument holds the eyelids open, so you do not need to worry about blinking. You look at a small light and the laser is applied for a few seconds per eye. Modern systems track the tiny movements of the eye and adjust automatically.
- Duration: For both eyes, the time in the operating theatre is usually 15 to 20 minutes.
- Going home: With drops, protective glasses and instructions. You spend the rest of the day resting with your eyes closed.
Stopping contact lenses before the assessment
Contact lenses temporarily change the shape of the cornea. If you wear them up to the day before the pre-operative assessment, the measurements will not be reliable and the correction may be calculated incorrectly. It is usually recommended to stop soft lenses for about one week and hard or rigid gas permeable lenses for considerably longer. You will be given the exact time when you contact the practice.
Laser eye surgery and dry eye
Dryness is the most common symptom in the first months after laser, because the procedure temporarily affects the corneal nerves that regulate tear production. In most people it gradually settles within 3 to 6 months with the help of artificial tears. People who already have dry eye need to have it treated before surgery. For them, surface techniques such as PRK and TransPRK are often preferable to LASIK.
If you are not suitable for laser: the alternatives
Not everyone is suitable for laser, and that does not mean there is no solution. When the cornea is very thin, when myopia is very high or when there is keratoconus, there are other options:
- ICL implantable lenses: A thin, biocompatible lens is placed inside the eye, in front of the natural lens, without removing any tissue from the cornea. It is suitable for high myopia and can be removed if needed.
- Refractive lens exchange: In people over about 50, especially with hyperopia or early cataract, the natural lens is replaced with an intraocular lens that corrects the prescription.
- Corneal cross-linking: In keratoconus, it stabilises the cornea so that the condition does not get worse.
Want to be free from glasses?
The pre-operative assessment will show whether you are suitable for laser or which alternative suits you. Book an appointment with Dr. Skouteris.
Laser after 40: what about presbyopia?
Laser corrects myopia, hyperopia and astigmatism, but it does not stop presbyopia, the natural difficulty with near vision that appears after 40. A 45-year-old with myopia who has laser will see clearly at a distance but may need glasses for their phone and for reading.
For suitable patients, one solution is monovision: one eye is set for distance and the other for near. The brain adapts and most people manage comfortably without glasses. Because it does not suit everyone, it is usually tried first with contact lenses. Discussing presbyopia is an essential part of the assessment for every patient over 40.
Sport, swimming and daily life after laser
- Screens and reading: Allowed from the next day, with frequent breaks and artificial tears.
- Eye make-up: Avoid for about one week.
- Gym and running: Usually after one week, taking care that sweat does not get into the eyes.
- Swimming pool and sea: After 2 to 4 weeks, depending on the technique, and with swimming goggles at first.
- Contact sports: After one month and ideally with protective eyewear. PRK and TransPRK are preferable for people who do martial arts or sports with frequent blows.
- Sun: Sunglasses with a UV filter for several months, especially after surface techniques.
Laser eye surgery, pregnancy and breastfeeding
During pregnancy and breastfeeding, hormonal changes can temporarily alter the prescription and the hydration of the eye. That is why laser is not performed during this period. It is usually recommended to wait a few months after breastfeeding ends, so that the prescription stabilises, before having the pre-operative assessment.
Myths about laser eye surgery
- “Laser causes blindness.” Refractive surgery is considered one of the safest procedures in medicine when the patient is selected correctly. Serious complications are extremely rare.
- “The prescription always comes back.” When the prescription is stable before surgery, the result is permanent for the vast majority. A small regression is more likely with very high prescriptions.
- “If I have laser, I won’t be able to have cataract surgery.” You can, as normal. It is simply important to keep your measurements from before the laser, for the most accurate calculation of the intraocular lens.
- “After laser I don’t need an ophthalmologist.” Laser corrects your prescription; it does not prevent glaucoma or retinal conditions. Regular check-ups continue.
Other uses of laser in ophthalmology
The word “laser” in eye care does not only mean freedom from glasses. Laser is used to treat glaucoma, for photocoagulation of retinal tears and in diabetic retinopathy, and also to treat posterior capsule opacification, which sometimes develops after cataract surgery. These treatments are usually done at the practice in a few minutes.
Questions worth asking before you decide
Ask which technique is recommended for your eyes and why, what your corneal thickness is, what result you can realistically expect, how many days you will need off work and what happens if an enhancement is needed. A good pre-operative assessment is not a routine formality; it is the foundation for a safe and stable result.
How to know it is the right time
The decision to have laser should not be made in a hurry or on the basis of a special offer. The right time is when your prescription has been stable for at least one year, when there are no active problems on the surface of the eye and when you have a few quiet days for recovery. If you are planning a pregnancy soon, if you are going through a period of high stress and little sleep, or if you have demanding exams ahead, it may be better to wait a few months.
Think also about what bothers you most in daily life: waking up in the morning unable to see, swimming, sport, contact lenses that dry your eyes at the office. The more clearly you know what you want to gain, the easier it will be for us to discuss together which technique suits you best. At the assessment you will receive all your measurements in writing, so you have them for the future.
Follow-up after laser
Check-ups are usually carried out the next day, at one week, at one month and at three months. With PRK and TransPRK, the bandage contact lens is removed at the practice once the epithelium has healed, usually in 4 to 5 days. At each visit we measure your vision, check healing and the hydration of the eye, and adjust your drops. After the first year, an annual eye examination is enough, as for any adult.
If in the meantime you notice anything that worries you, such as increasing pain, redness with discharge or a drop in vision, do not wait for your next scheduled appointment. Contact the practice immediately so we can see you the same day. Prompt treatment of any small problem is the key to an excellent final result.
To book a pre-operative assessment, call +30 210 677 0007.
Frequently Asked Questions about Laser Eye Surgery
Does laser eye surgery hurt?
During the procedure the eye is numbed with drops, so most patients feel only pressure or mild discomfort. After LASIK there may be stinging for a few hours. After PRK or TransPRK, discomfort is stronger for 2-4 days and is managed with the instructions and medication given by the surgeon.
Are the results of laser eye surgery permanent?
The change in the shape of the cornea is permanent. However, a small regression of the prescription may occur over the years, mainly with high corrections, or vision may change for other reasons, such as presbyopia after 40 and cataract later in life. That is why a stable prescription before surgery is so important.
How many days after surgery can I drive?
After LASIK many patients have adequate vision for driving within a few days, while after PRK or TransPRK it usually takes about one week or a little longer. Driving is allowed only when the ophthalmologist confirms at the post-operative check-up that your vision meets the legal standard, and with care when driving at night.
Can I have laser if my cornea is very thin?
A thin cornea does not always rule out correction, but it limits the options. A surface technique such as PRK or TransPRK is often preferred, as it takes less from the overall strength of the cornea. If the measurements show that laser is not safe, alternatives such as implantable lenses are discussed.
What is the minimum and maximum age for laser eye surgery?
Surgery is usually performed after 18, once the prescription has been stable for at least one year. There is no strict upper limit, but after about 45, presbyopia and the condition of the lens need to be taken into account. At this age a lens-based solution may be more suitable than laser.
Medically reviewed by: Dr. Vasileios Skouteris MD, FEBO