Is laser eye surgery right for you?

Laser eye surgery has come a long way. Get an update on the latest techniques to help you make an informed decision.

After years of wearing contact lenses, Dave Yasvinski had had enough of them. “My eyes were always getting irritated from having them in,” he says. “Glasses were just as annoying — always fogging up in the winter and getting wet in the rain.”

Like most people, Yasvinski had been jumpy about laser eye surgery. “Something about paying to have lasers shot into my eyes just did not seem like a smart move,” says the 38-year-old, Toronto-based sports editor, who undertook the procedure four years ago after extensive research.

He says that going to a place that’s reputable, even if it’s expensive, is worth it: “You see commercials that talk about eye surgery for the low, low price of $500 an eye or something. No thanks. Don’t go cheap on your eyesight — it’s not worth the risk.”

Yasvinski’s operation was a success. “There’s nothing like waking up in the middle of the night, and being able to clearly see the time on your clock; or to travel and not have to worry about glasses/contact solution, etc.,” he says. “The laser eye surgery was literally one of the best decisions of my life.”

Laser eye surgery has come a long way. Many of the new techniques are now bladeless, and involve careful mapping of the eye before surgery to maximize effectiveness.

New techniques include:

• LASIK (laser-assisted in situ keratomileusis). A surgeon uses a blade or laser to cut a flap in the cornea and uses a laser guided by a computer to reshape tissue underneath. Recovery time is typically a day or two, with vision improvement seen almost immediately.
• Wavefront-guided LASIK. A computer maps out the surface of the eye, which helps the surgeon reshape the eye with a bladeless laser to change the way the cornea reflects light.
• PRK (photorefractive keratectomy). The entire corneal layer is removed with a blade, so that a laser can remove epithelial tissue underneath (no flap is created). Often better suited for people with thin corneas, the recovery time is longer than for LASIK, lasting about a week. Vision usually improves after a week or two.
• LASEK (laser-assisted sub-epithelial keratomileusis). A variation of PRK, the epithelial layer isn’t removed — it’s cut with a blade, lifted up and the tissue beneath it reshaped with a laser. Recovery time is similar to PRK.

The most popular technique is LASIK, says Dr. Guillermo Rocha, president of the Canadian Cornea, External Disease and Refractive Surgery Society, who has been doing laser eye surgery since 1995. “The technique has evolved to a degree where it is very safe and effective in the right candidates,” he says, adding that there is less than a 1% chance of complications with LASIK, and a 1% chance of scarring with PRK.

But Rocha does caution that people considering the procedure take the following steps:

1. Don’t go cheap

Laser eye surgery for both eyes costs from $2,500 to $6,000. Centres that advertise discount procedures may not be using the most up-to-date technology. Prices may be higher than advertised if you are a less-than-optimal candidate. (The best candidates for laser eye surgery have low prescriptions of under six diopters, are older than 21, have had a stable eyeglasses prescription for at least a year, have normal corneas and minimal astigmatism.) In the end, the price may end up being similar to that of other providers.

2. Choose a qualified surgeon

Ask how many corneal procedures the surgeon has done — not just eye procedures in general.

3. Meet the surgeon before surgery

“A patient’s goals may be different than the doctor’s,” says Rocha, so select an eye centre where you can talk to the surgeon days before the procedure to make an informed decision.

4. Ask about expected results

If you are experiencing presbyopia (trouble seeing things that are close) — a condition that usually starts around age 40 — laser eye surgery may improve your ability to see things far away but worsen your ability to see things close up. Talk to an ophthalmologist/laser eye surgeon about what type of vision you can expect after the procedure.

5. Prepare for some side effects

These may include discomfort, sensitivity to light and blurry vision for a few days to two weeks after surgery, dry eyes, seeing halos or reduced night vision. But each case is unique. Blogger Maureen Wood, whose procedure was done in 2008, was surprised by what she felt. “The pain subsided by about 50% a few hours later but was still painful for a few days.”

Luckily, most patients come away with vastly improved vision, says Rocha. Wood was one of them. “I made the right call for me,” she says. “I had a really high prescription and the freedom I have now was definitely worth it.”

Thinking about laser eye surgery? Consider this:

1. How good a candidate are you? Have an examination by a qualified surgeon.
2. Ask about payment plans — many eye centres have them.
3. Check whether and for how much laser eye surgery is covered under your workplace health benefits, and whether you have to get prior authorization from your insurer.
4. Talk to people who’ve had the procedure done to get a sense of what to expect.