Laser eye surgery and lens surgery

Surgery to improve your sight is known as refractive surgery or vision correction. There are 2 different types: laser eye surgery and lens surgery.

Both types of surgery can make you less dependent on glasses or contact lenses. Research shows that both are safe and effective.

The type of refractive surgery that will be best for you depends on many factors, including your eyesight, eye health, age, budget, and lifestyle.

Your surgeon will examine your eyes, assess your needs, and help you choose the best option for you.

When weighing the risks and benefits of refractive surgery, keep in mind that wearing contact lenses also carries risks to your eye health.

Refractive surgery is not available on the NHS for people who simply want to improve their sight.

Most people do it in a private clinic. Costs vary depending on the type of surgery you are having.

Laser eye surgery

What is that?

Laser eye surgery, or laser vision correction, involves using lasers to reshape the front surface (cornea) of your eyes so you can focus better. It can correct myopia, hyperopia and astigmatism.

Who is it suitable for?

Laser eye surgery is suitable for most people over the age of 18. Ideally, your eye prescription will have remained more or less the same for about 2 years. Lens surgery may be more appropriate if you have a high eyeglass prescription or later in life.

What does this imply?

There are 3 main types of laser eye surgery: LASIK, SMILE and surface laser treatments.

  • LASIK – this is done with 2 lasers, one to open a thin flap on the surface of the cornea, and another to reshape the cornea underneath. The protective flap is then smoothed out and stays in place without stitches.
  • SMILE – the surgeon reshapes your cornea through a small self-sealing hole.
  • Surface laser treatments (PRK, LASEK and TransPRK) – the clear skin covering the cornea is removed so that the surgeon can reshape your cornea with a laser. The skin then grows back naturally.

The 3 types of laser eye surgery have similar results. Your surgeon will discuss your options with you and help you decide which is best for you.

Are there any risks?

About 1 in 10 people who have laser eye surgery need more surgery to get the best possible results. There is usually no additional cost for this.

Common side effects include:

  • Mild, gritty discomfort – artificial tears can help with this and your eyes will usually feel comfortable again in about 3-6 months
  • Visual disturbances (such as glare from oncoming headlights when driving at night) – this usually resolves or can be successfully treated
  • Red marks on the whites of your eyes – these always disappear after about a month

Severe vision loss is very rare.

Lens surgery

There are 2 main types of lens surgery: phakic intraocular lens surgery (PIOL) and refractive lens exchange (RLE).

Implantation of phakic intraocular lenses (PIOL)

With PIOL, artificial lenses are placed in your eyes without removing your own natural lenses. It’s like putting contact lenses in your eyes.

Because the lens is inside your eye, you can do things you couldn’t normally do with contact lenses, like swimming or water sports.

Who is it suitable for?

PIOL may be a good option for young people who cannot have laser eye surgery, perhaps because they have a high eye prescription or a high degree of astigmatism. Later in life, RLE may be a better alternative.

What is PIOL?

The surgeon makes a small incision in the surface of your eye and slips the new lens into it. No stitches are needed.

Are there any risks?

Your surgeon will discuss side effects and risks with you before you have surgery.

It is normal for your vision to be disturbed after PIOL, but this should gradually subside. Glare from oncoming headlights while driving at night is common to begin with.

The surface of your eye may feel uncomfortable for a while. You may also have red spots on the white of your eye for a few weeks.

Serious complications are rare, and if you have any problems after surgery, they can usually be corrected. Cataracts (when the lenses of the eyes become cloudy) may develop earlier in life after PIOL.

Refractive Lens Exchange (RLE)

RLE is basically the same as cataract surgery. The natural lens in your eye is removed and replaced with a new artificial lens.

Who is it suitable for?

RLE may be a good option if you are older and not suitable for laser eye surgery, perhaps because you have a high eye prescription or have early cataracts.

What does RLE entail?

There are 2 different types of artificial lenses used for RLE: monofocal and multifocal.

  • Monofocal – these improve your distance vision but you will still need to wear glasses for near work.
  • Multifocal – these provide clear distance, medium and near vision, but about 1% of people find that they cannot get used to them and opt for another lens exchange operation.

Are there any risks?

Most people have visual side effects and discomfort in the weeks or months after surgery, but these should gradually subside.

Serious complications are more common after RLE than after laser eye surgery or PIOL surgery. About 1 in 500 people have significant vision loss after RLE.

Your surgeon can tell you more about the risks before proceeding with the surgery.

See more information from the Royal College of Ophthalmologists at laser eye surgery.

Page last revised: April 21, 2020
Next review date: April 21, 2023

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