Laser Eye Surgery

Laser Eye Surgery

Laser eye surgery is one of the grandest miracles of modern medicine.  I have had laser eye surgery on my own eyes.

Why Laser Eye Surgery?

Great vision enhances every aspect of life. This is why such a large life change can be created by such a minor modification to your cornea through corrective eye surgery. The cornea is the outer layer of the eye that bends light rays to create perfect focus and clear vision. Eyes that are nearsighted, farsighted, or with astigmatism have a cornea that can’t bend the light rays enough or bends them so much that your vision is out of focus. Laser eye surgery uses an excimer laser to restore balance by gently reshaping cornea so it naturally focuses light rays to a clear focus.

Am I a Candidate for Laser Eye Surgery?

Prior to laser eye surgery, preoperative testing is crucial to determine if you are a good candidate for laser. One of the most important tests is topography which measures the shape of your eye. Some centers use a topographer that only measures the outer shape of the cornea.

However, I recommend the machines that measure both the outer AND the inner shape of the cornea as the additional information allows for a more complete analysis of the strength of your eye and the safety of your procedure. The pentacam is an example of one of these later generation topographers.

Excimer Laser

If you are a good candidate, you will want the best laser available for your eyes. There are several different excimer lasers that are F.D.A. approved. Most of them track the position of the eye and make automatic adjustments to ensure the laser is applied to the correct location even if the eye is moving. Newer generation lasers, like the Allegretto, monitor the eye’s position 400 times per second during your laser eye surgery.


The various Excimer lasers differ in the treatment patterns used for corrective eye surgery. These vary from the older patterns called “traditional,” to the improved modern patterns like “wavefront optimized,” “wavefront guided,” and “topo guided.” You will need to consult an experienced LASIK surgeon to determine the pattern that best matches your unique focusing problems. If you choose a center with multiple excimer lasers and multiple laser patterns, your options will not be limited by their technology for your laser eye surgery.

PRK vs Lasik

There are two types of laser eye surgery–Lasik and PRK. Both use the excimer laser and the visual outcomes are similar. LASIK reshapes the middle layers of the cornea, and PRK reshapes the superficial layers. Lasik eye surgery is appreciated for its faster visual recovery with less discomfort while PRK appeals to those involved in contact sports, as well as those whose corneas are not strong enough or thick enough for Lasik. Two out of every three of my laser eye surgery patients choose Lasik while around a third prefer PRK. Your eye surgeon will recommend the procedure that is ideal for you.

Lasik Eye Surgery

In Lasik, a thin flap is created on the cornea. This flap is elevated to expose the middle part of the cornea. The excimer laser pattern is applied and the flap is laid back down and allowed to strengthen in its original position. The discomfort tends to be minimal and last only for an hour or so.

There are two different ways to create the flap. The first method uses a mechanical oscillating blade called a “microkeratome” to make the incision. Originally, this is how all surgeons made the flap. As Lasik improved, engineers developed a more precise method using a femtosecond laser that makes a smoother treatment bed and leaves the flap edges stronger. In most quality oriented practices, the femtosecond laser has replaced the microkeratome making laser eye surgery “bladeless.”

PRK Surgery

In PRK surgery, the excimer laser pattern is applied at the surface so the resulting cornea is stronger. It takes about four days for the surface to heal and eyes tend to have some discomfort, light sensitivity, and visual blur during this healing phase.  Medications for comfort are made available if needed for your PRK laser eye surgery.

SMILE Procedure

The SMILE Procedure uses the femtosecond laser to create a small lenticule of tissue in the mid layer of the cornea. This small lenticule is removed, creating a gentle flattening of the cornea that treats Myopia and Astigmatism. The SMILE ReLEX procedure tends to leave the eye stronger than after LASIK and with less dry eye.

Eye Laser Surgery Risks

Millions have had successful laser eye surgery and many studies show that it delivers one of the highest levels of patient satisfaction ever recorded. Having said that, complications can occur ranging from the need to fine-tune your vision, up to sight threatening complications like infection. Your surgeon will review your specific risk profile for Lasik or PRK to aid you in making your decision. Laser correction outcomes and safety have improved dramatically over the last 15 years. For the best results, it is recommended that you choose a surgeon that has embraced these improvements in technology, testing, and technique.

Laser Eye Surgery Cost

Laser Vision Correction pricing is affected by the quality of the equipment used and the amount of time you spend with your surgeon. Older equipment costs less to use. Quality will cost more but deliver greater value, and the added safety and precision are priceless. Be sure to get a fair price, but don’t compromise with your eyes. Good enough applies to haircuts and lunch appointments, but not so much for eye surgery.

Questions to ask a Laser Eye Surgeon

  1. How many eye surgeries have you done?
  2. Will you use the femtosecond laser or the blade to create my flap?
  3. Do you measure the front AND the back of my cornea?
  4. Which laser patterns do you use and which are you recommending for me?
  5. What are the risks of laser eye surgery for my eyes?

As a surgeon, I have helped thousands with their laser eye surgery experience, and as a patient, I have personally had Lasik.  I have written this from both of those perspectives to help you in your quest for better vision. Feel free to contact me if you have any other questions.


Gary J.L. Foster, MD