When people have eye-focusing problems — usually either long-sightedness, short-sightedness or astigmatism (uneven focusing) — they’ve traditionally turned to spectacles or contact lenses. Laser refractive surgery (more commonly known just as laser surgery) provides another option. It reshapes the cornea, the clear surface of the eye, which focuses light on to the lens in the eye.
In the longest-tested type of laser surgery, photorefractive keratectomy (PRK), the surface cells of the cornea are removed and then a laser beam is applied directly to the surface of the cornea. The energy from the laser removes microscopic portions of tissue from the cornea, altering its shape. The pattern of tissue removal varies according to problem — short-sightedness is treated by flattening the surface of the cornea, while long-sightedness is treated by making the cornea more pointed.
A variant of this procedure, called laser-assisted in situ keratomileusis (Lasik), has become hugely popular in the past decade. Known as “flap and zap”, it involves slicing a tiny hinged flap in the cornea and burning away the corneal tissue below with a laser. Because there is no need to scrape off the cornea’s surface cells, there is less pain after the procedure than with PRK, and full vision returns within days, rather than weeks. The latest version of Lasik is called Wavefront Lasik, which uses sensors to map the contours of the eye before surgery. The eye is anaesthetised with drops in both procedures.
Possible complications of Lasik
In rare cases, excessive thinning of the eye wall can cause the shape of the eye to change. Some patients requires corneal surgery or hard contact lenses to restore vision. KEY QUESTIONS
What type of laser surgery is best for me? There are several types of laser surgery, which change the way light is refracted through the eye and on to the retina. Conventional Lasik can correct 95 per cent of refractive errors, covering short sight, long sight and astigmatism. Wavefront Lasik tackles the remaining 5 per cent of defects and many consider that it offers better results. PRK is sometimes recommended as safer if you have low to moderate myopia or if the cornea is relatively thin but the recovery period is longer than for Lasik.
How much will it cost? Laser refractive surgery is generally considered non-essential and is therefore not usually available on the NHS. However, it is available privately at some NHS hospitals. Most commonly, it is available at private clinics and high street chains. It usually costs £1,000 to £1,500 per eye. Clear lens extraction (see below) is usually twice the price. Make sure you get full details of exactly of what is, and what isn ’t, included in the quoted fees.
What qualifications does the surgeon have? You’ll want to try and gauge the skill of the surgeons who might be treating you. One way is to find out how well qualified they are.
Guidelines from the Royal College of Ophthalmologists say that only registered surgeons with specialist training should carry out laser surgery. You can find out whether someone is qualified as a surgeon by checking the General Medical Council’s register. Visit www.gmc-uk.org or phone 08453 573456. Ideally, surgeons should belong to a relevant professional organisation such as the Royal College of Ophthalmologists (020-7935 0702; www.rcophth.ac.uk) and the British Society for Refractive Surgery (www.bsrs2000.fsnet.co.uk).
What experience has the surgeon had? Another way to gauge the skill of the surgeon is to find out how many times they have performed an operation. Generally, the more operations, the higher the success rate.
What is the procedure’s success rate? After laser surgery, some people find that their sight is not as good as with glasses before the operation. The Royal College of Ophthalmologists (RCO) says a significant reduction in visual acuity may occur in less than 4 per cent of patients with low to moderate myopia and 10 per cent of patients with high or extreme myopia. Ask the surgeon how many patients have had to come back for further treatment after the initial surgery.
What is the surgeon’s complication rate? Because laser surgery is relatively new, reliable information on complication rates is scarce. One study put the rate at 5 per cent but the RCO says that it may be as high as 40 per cent at some clinics.
Can both eyes be done on the same day? It is possible to have treatment on both eyes on the same day but the consultant should outline the risks.
Would a clear lens extraction be suitable? If you are older, specialists sometimes prefer clear lens extraction (CLE). This removes the natural lens and replaces it with an artificial one. CLE is better suited to people with high levels of prescription. However, the procedure is twice as expensive as Lasik.
CONSULTANTS
The details of eye surgeons compiled by Dr Foster are available to Times readers here. The consultant listings tell you which consultants specialise in particular conditions or procedures. You can search by operation or diagnosis for doctors in your area. Against each consultant we also tell you the current predicted waiting time for an appointment with that doctor on the NHS. The listings do not include all the eye surgeons who will conduct procedures privately, such as Lasik. But, since all the surgeons listed work in the NHS, an inclusion does indicate that they are well qualified.
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